Friday, February 19, 2010

Haiti is not Hell

Yesterday I went to a meeting with Senator Johanns and two other groups who had also been in Haiti.  During the meeting one of the attendees made the comment that where they were on the Dominican side of the border between Haiti and the Dominican Republic was Hell.  I remember thinking to myself that not once did I think of describing Haiti that way.  Despite the fact that downtown Port-au-Prince looked as if a bomb had exploded, despite all the dead and wounded amputees, and despite all the chaos, I never thought to myself, "I'm in Hell."  I have seen nothing worse in my life than the sites I encountered in Haiti, and I still wouldn't qualify Haiti as "Hell on earth" because to me, Hell is a place devoid of all hope. And Haiti, albeit crippled, is a place full of hope, full of promise, full of gratitude for the help received thus far, and full of beautiful people.
But the needy will not always be forgotten, nor the hope of the afflicted ever perish. Psa 9:18

Saturday, February 13, 2010

30 days since the quake marked by 3 days of national mourning

It's been 30 days, and my thoughts are with the patients who left indelible marks upon my heart and the millions who have been affected by the quake and the resulting situation. The little girl I so wanted to bring back to the States with me. The older girl, only 15, who really did think I was her mother every time I gave her ketamine to change her dressings. She would want me to rub her face and hold her hand. So I did. Just like the mother she lost would have. For the girls who no longer have mothers, I cry. For the boys who lost their fathers, I pray. And for the nation that lost so much, I hope.

Wednesday, February 10, 2010

Pushups for Haiti on Friday

Please sponsor one of several awesome UNMC employees who will be doing pushups in the DOC on Friday to raise funds for the Haiti relief fund (

Saturday, February 6, 2010

The irony of donations

For each and every donation we were thankful. It was amazing to me what people thought to donate. For example I would never have thought about adult diapers or pop tarts. We had every kind of item one would need to take care of infants from diapers to formula to scalp IV sets. And we had all sorts of pain medications from morphine to percocet to demerol to dilaudid, for which I was extremely thankful to be able to dispense. And in the OR we had our choice of isofluorane or halothane for those few cases where we intubated and used an inhalation anesthetic. But what struck me most was the abundance of propofol in the midst of a national shortage in the United States. I was sure we had more propofol in our hospital than the supply that existed in the entire city of Omaha. And the irony of that fact is that we used very little of it due to the lack of a supply of oxygen.

Thursday, February 4, 2010

Pedal to support Haiti on Feb. 12

Pedal to support Haiti on Feb. 12


On Feb. 12, Prairie Life Fitness Center at Midtown Crossing will host "Strength for Haiti," an indoor cycling challenge that will raise money for the UNMC Haitian Relief and Outreach Fund.

Wednesday, February 3, 2010

Volunteer: Haiti needs supplies and continued support

Bryan Bader, a trauma nurse from The Nebraska Medical Center, was among 13 members of UNMC's first volunteer deployment to Haiti.

Tuesday, February 2, 2010

My 1st day in the OR

My first day in the OR was actually Wednesday, 27th January,my absolutely most stressful day of work in Haiti. The call for help in OR came around 1040 am. Although not unexpected, it couldn't have come at a worse time. At 1100 am, Joe Lupo, the other anesthesiologist on the wound care team, was due to go outside to help the French with their wound care rounds in the makeshift stepdown unit they were running in tents outside the hospital.

Patients ended up in the OR through many different channels. Either by triage because they were trauma, by the wound care team for I&D or stump/wound revision, or directly by surgeons upon review of their radiographs. Whatever the route, they all end up with a piece of tape on their heads like the patient pictured, who had 6 fractures in both arms that needed to be repaired (pictured). She was made nothing by mouth the night before surgery and scheduled for open reduction and internal fixation (ORIF) on the 27th. I had actually met her on wound care rounds on Monday, but the first opening on the schedule was Wednesday.
So I show up outside the ORs to meet my team: two surgeons who literally arrived at the hospital an hour prior to our meeting, and two nursing students who were to be our scrub tech and circulator who had never been inside an OR before or learned about sterile technique. I could tell this was going to be a long, long, day, because little did the surgeons know this was literally a find it yourself, sterilize it yourself, light it yourself, and do it yourself operation we were running. It was going to take them forever to find all their instruments and supplies, and I knew it was going to be a really long day when they asked for suction and overhead lights.

In effect, I became part scrub tech and circulator in addition to anesthesiologist at the start of this case. The suctuion I couldn't help them with since the only working suction we had was being used in another OR. It would have been nice to have though because her surgery did become a bloody mess. Our nursing students probably thought they had drawn the really short straw, as they became our light holders on top of a folding chair.

For my part I had an anesthesia machine I had no idea how to use (pictured). I tried hooking the oxygen tank up to the back of it since I did have a circuit and a mask I could use if her sats dropped but never did figure out how to get the oxygen to run through the machine. So in effect, I was left with a portable sat monitor (pictured) which only worked half the time since it was precariously perched on her ear (both hands not available to me), and a blood pressure machine.

Since I was doing a ketamine/versed general I was comfortable enough with what I had, but when I lost my sats and could no longer get pressures frm her right leg I had to resort to my hand over her mouth with my fingers on her carotid and my eyes on my watch while counting her pulse and respirations. Definitely not my most comfortable moments since I wasn't sure if loss of sats and pressure meant her pressure was dangerously low or she was cold and the cuff just wasn't working well.

Overall the case went well. I didn't really find anything all that shocking. However, I was rather alarmed by my options for sharps disposal. If you look closely in the picture of stuff on th floor, you will see there are three sharps containers--one big red one that most would properly identify, one small red one with no top full of all kinds of bloody needles and glass ripe for someone to fall on top of, and finally, one old clorox jug that was not marked sharps in English, French, or Creole. Besides the obvious regarding the open sharps box, I did ponder how all the sharps containers were being disposed of.

We dropped the woman off in PACU, and off I went to help Kurt, the nurse anesthetist, with a spinal for the c-section. And we all already know how the night went from there...

Danielle Dohrmann reflects on her Haiti experience

Volunteers return from Haiti

Monday, February 1, 2010

The work continues...and so does this blog

Please keep visiting this blog for daily updates, including guest spots, particularly from Nick Hall, a nurse at UNMC, who is still in Haiti for the next two weeks working in the Medishare tent. Also planned are updates from other doctors and nurses who are also still there as well as viewpoints from team members who returned this weekend.

I also have many entries from last thurs thru sat that have yet to be posted. So stay tuned, and spread the word so that our work in Haiti continues to be supported.

Finally, thank you for your support and prayers for our team and the people of Haiti.

UNMC Doctor Returns From Haiti

This is the clip in which I gave wrong information. There are more amputees in Haiti due to the earthquake than there were American amputees in WWI (approx 2600), not WWII (approx 15,000).

Med Center Doctors Return From Haiti

Action 3 news story: Omaha doctors return from Haiti

Interview with Action 3 news.

Correction: I think I told reporters that there are more amputees due to this tragedy than there were in World War II. That is incorrect. More amputations have been performed in Haiti in the last two and a half weeks than were performed on American soldiers in World War I (approx. 2650).

Thursday, January 28, 2010

Hats off to the 82nd Airborne

We heard the 82nd Airborne finally had good intel that the hospital had survived the quake and that a lot of American citizens were staffing it. So they decided to start patrolling the area. Now we finally had proof. It was great of them to stop in everyday. They were staying at the country club in Petion Ville, and hanging out with Sean Penn, hence the big smiles on their faces. They were good guys though, and I was proud of their service to the mission.

The Jamaicans are here!

On my next disaster relief mission I want to have my own calvary to escort me to and from work every day. Five soldiers from the Jamaican army escorted a Jamaican general surgeon to Hopital Communaute every day. And every evening when he was done they would whisk him away to wherever he was staying. They were some of the tallest soldiers I have ever seen carrying the biggest guns I have ever seen! They fast made friends with their easy going energy and their jokes in their Jamaican lilt, and the sense of security their presence provided was reassuring.

Wednesday, January 27, 2010

The circle of life.

As one life began around 1915 today in OR 3, another life in the very next room was ending. A woman I spoke to last night about her extensive wound to her left leg died today. Her death was especially hard because today she finally agreed to the surgery after refusing to have her leg amputated for several days.

Today was actually my first day in the operating room due to the departure on a pedi anesthesiologist and a nurse anesthetist. Most of our general cases are done with ketamine & versed because oxygen is in very short supply, and the only working anesthesia machine is in OR one, which also happens to have an EKG monitor. So in OR's two, three, and four our only monitors are a blood pressure machine and a portable sat monitor, which are difficult to use because patients are often cold or we are amputing the one extremity where we can pick up a sat (no ear probes available).

According to the anesthesiologist doing her case, they had just ligated the sciatic nerve when he got a low blood pressure reading. A short time later he lost her sat reading. He checked a carotid pulse and found she had none. At this point they started chest compressions and began to bag mask her with room air.

I was next door and had just finished helping the nurse anesthetist put in a spinal on a woman having a caesarian section, when Dr. Garcia bursts through the door in search of oxygen. Thinking our 19 year old in the ICU was decompensating again I was surprised when he said the patient next door was "in trouble."

I rushed next door find the orthopedic surgeon on a stool performing chest compressions and began administering cardiac resuscitative drugs. Epinephrine and atropine were in no short supply. We even had amps of calcium and plenty of lidocaine. Chest compressions to circulate the epi were sufficient enough to generate systolic pressures in the 70's and diastolic pressures in the 40's at one point, but to no avail. We had to call it. Time of death: 19:35.

There was no sustained drone of a flatline like on tv, for we had no EKG monitor in this room. There was only the deafening silence of our profound sense of sadness that not everyone we lay on our operating table will rise again. Given the acute demise of our patient I suspected she suffered a massive pulmonary embolism due to a blood clot that very likely would have developed in her badly fractured leg. As we began the work of sewing her leg back together and cleaning her up for her family, we each went to that objective place we all go that allows to cope with the extent of the loss of life and limb. But for one of us, a general surgical intern who was first assist in the case and one of the wound care team members who encouraged her to have the amputation, the day's stresses proved to be too overwhelming, and the woman's death took him to his emotional breaking point. We allowed him to shed tears for all of us, as this particular death--the first intraoperative death at our hospital--is undoubtedly poignantly and indelibly etched on the tableau of our experience here in Haiti.

Critically ill patients unable to get needed medical care in US

1530. "We need anesthesia to come intubate. Stat!" In the middle of our administrative meeting came the alarming call for a rapid response team that did not yet exist. In all of our attempts to get the hospital organized we had not formed a designated code team. Luckily we did have a code box, complete with endotracheal tubes, laryngoscope, ambu bag & code drugs. Two of four anesthesiologists available led the wound care team. And because of the need to be in communication with each other and other deptments we initially had 3 of about 7 or 8 walkie-talkies, which enabled us to respond immeidately.

We arrived to find a 19 year old, who looked to be about 13, in obvious respiratory distress, tachypneic with respiratory rate in the 40's, tachycardic with a heart rate in the 180's, and hypoxic with sats in the 60's. He was the same boy who had some sort of respiratory infection who had been making steady improvements since we arrived. We managed to get his sats from the 70's on 12 liters nonrebreather up to sats of 89 on 7 liters with daily nebulizer treatments, aggresive chest physiotherapy, and antibiotics. At 6am the pulmonologist performed a thoracentesis (lung tap) in an attempt to drain a suspected empyema. It is not clear to me whether fluid was even obtained. But by that afternoon he had decompensated severely, likely because of a collapsed lung. In hindsight perhaps this was a case where the enemy of good was better.

Perhaps he was going to decompensate anyway, but the question loomed whether tapping him was appropriate given his steady improvement. Whether to intervene using invasive measures, particularly when that intervention carries enough risk turn a stable patient into an unstable patient or set in motion a series of events that significantly decreases a patient's quality of life, is a decision we physicians face on a daily basis. Should we really be spending $150,000 or more replacing an aortic valve (major open heart surgery) on a 95 year old woman with boderline kidney function and underlying dementia who then goes on suffer another insult to her brain and ends up on dialysis? Clearly we decreased the quality of her remaining years, and utilized resources she likely would not have used had we decided such a major operation was likely to kill her sooner rather than later (actual case with which I was involved). The decision to intervene becomes even more critical in a resource poor situation such as the one we faced at Hopital Communaute.

In this case the resources in short supply were oxygen and ventilators. The one ventilator in the hospital was broken, and oxygen tanks were few. So the dilemma we faced was whether to intubate or not. As his need for oxygen became greater he was using more energy to breath, the weaker he was becoming, and the less he was able to keep up. He was fast tiring out, making intubation more iminent. But if we intubated our patient, we would be committing him to a nonexistent ventilator that used almost nonexistent oxygen. Even if there were enough oxygen, someone would have to hand ventilate him for the duration of his stay in the intensive care unit (ICU). So the decision was made to delay intubation, transfer to the ICU, and put in a chest tube.

Once the chest tube was placed his vital signs actually improved. His oxygen sats came up, and he became less tachypneic, but his heart rate was still in the 160's. So he remained on a nonrebreather as many many people began to work on trasferring him to a hospital with a ventilator. The only other hospital with a vent couldn't accept him, and the Comfort (floating US military hospital) said they were full to capacity. Finally someone was able to convince the Children's hospital at the Univ of Michigan to accept him. They found a medivac plane, complete with a critical care team, that would transfer him. And then everything fell apart.

Somehow funding became a problem, and there was no longer enough aid to cover a critical care team to fly to Michigan. So I was asked if I would be willing to help transport (and be one of a few who would help hand ventilate the boy for the duration of the journey). I deferred to another anesthesiologist who was stranded in Haiti and looking for any way he could get back to New Hampshire. At that point it looked like we had everything buttoned up and ready to go.

However, during the time it took to secure alternate funding and assemble our own transport team, the flight from Michigan lost its departure window. And to add insult to injury, we received word that the govenor of Florida was no longer willing to accept critical patients to Florida hospitals, citing the lack of federal funding and the apathy of surrounding states in sharing the load. In effect all Humanitarian visas as well as military evacuations to the US were cancelled, leaving nowhere for us to get our patient the care he desperately needed. We were all devastated, as all we could do was watch the boy slowly slip away. There were no less than half the medical staff and administration, all tied to the Hippocratic oath and intimately vested in saving each life, frantically making calls over several hours to give this boy the chance of survival he deserved. And it seemed all our efforts were for naught since effectively the message in the bottle was "we don't want you here."

Save, Secure & Support. Shouldn't that be our mission? With the overwhelming amount of devastation that occured in just 35 seconds, 150,000 dead and more amputees than there were American amputations in WWI (about 2600), there is only so muc we can do on the ground here in Haiti and aboard the Comfort. We have the means to do more, and we should do more because it's the right thing to do. So we send out the rallying call and implore other states to step up to the plate. And we petition the federal government to fully support the mission. Rather then closing our borders to the critically injured we should be leading the effort to extend a lifeline of hope to those who would otherwise die without it.

Technical difficulties

Been having trouble posting since this past tues. Will update asap.

Tuesday, January 26, 2010

Two weeks ago today...

What were you doing when the earthquake hit? Some of my Haitian friends thought I was joking when I called to ask if their relatives were okay. They found the idea of an earthquake of this magnitude completely unfathomable.

Slowly getting back to normal

Market hustle & bustle


A bit like a big semi rolling by.

Christiane Amanpour

CNN was here at Hopital Dela Communaute Hatienne today. The 82nd Airborne thought this hospital was destroyed. A few days ago they began patrolling the area. Apparently word has gotten around about the care we are provinding here. I have no idea how many hundreds of patients are here,but yesterday our wound care team saw upwards of 70 patients, both in the morning and again in the evening.  We are mainly still dealing with amputees, but have seen a few gunshot victims, women who have been protracted labour. There are teams from Sweden, France, South Korea, Jamaica, and several other countries, all of whom have committed to being here for the next 6 mo or more. I hope the response continues to be as strong, as this country mends itself.

Omaha World Herald article

Rested and ready to go

Waking up to a view like this is the perfect way to start the day.


2300. Finally back at the house in Boutelliers. Our hosts, Linda & Ben & their daughter, Terry Boucard, have been absolutely awesome. They have opened their home & their hearts & availed themselves of their time & talents. A turkey dinner was much appreciated after being on our feet (or on our knees as in my case, as I was often giving anesthesia on the floor) all day and half the night. I would estimate our wound team treated 60 patients today. Off to bed to do it all again in the morning...luckily we're all exhausted enough to sleep through whatever aftershocks occur in the night (yes there have been two since we got here).

Monday, January 25, 2010

Off to work

Up early this am. Arrived at Hopital Dela Communaute Hatienne this morning. Operating rooms are well equipped so most patients having amputations under general anesthesia. Things are finally getting organized but finding have found situations whereby we have surgeons amuptating and no one doing wound care. Lots and lots of wound care to be done...I come bearing all the good stuff: ketamine, morphine, percocet, tylenol #3...acute pain service at it's finest!

It's been years since I've used ketamine without versed so the hallucinations my patients are having are something else. I've been maman to every other patient, the last in particular was quite upset when I went to the next patient after she told me to stay by her side until she finished flying in outer space.

Working with a great team of PA's from New Hamshire via St. Thomas. Tommy, Amanda, & Tiffany.

Sunday, January 24, 2010

En Ayiti

There are very few words to describe the devastation, but I'm already encouraged by the lives that have been saved and how those who were spared are volunteering to help their fellow man.

The first pic is a view of the propellers as we were landing in Port-au-Prince.

The second pic is a shot of the missions airport exit, which is currently being controlled by the Marines and the United Nations peace keeping forces.

The 3rd, 4th, & 5th pic show the way various houses feel, like pancakes, to the ground during the 35 seconds of pure terror the Haitian people experienced that fateful day.

The last pic is of the first hospital we visited--Hope Hospital. Many patients are outside, some out of fear of the aftershocks (which I'm told have not occurred for 24 hours), but most out of lack of space inside.

To Haiti we finally go

We have been very blessed by Joe Gibbs Racing of NASCAR, who we found out this morning donated this plane for our trip. In about 2 hours we should be in Port-au-Prince.
Yemisi Odugbesan

Supplies waiting to be shipped to Haiti

Per the wonderful people working here at Missionary Flights International, the outpouring support for Haiti has been phenomenal!

De plane!

Off to catch our charter flight in Ft. Pierce

After two hours of sleep, we are making the one hour journey to Ft. Pierce.  With the strict weight instructions imposed on us I'm guessing the plane is going to be of the size & type where a xanax (or several) would be helpful. Having nothing of the sort in my luggage I'm going to rely on extreme sleep deprivation as my anxiolytic.