Inferno

Inferno

Kimberly H Kim, MD

Winter 2011 - Volume 15 Number 1

Another day dawned in Haiti. The sun blazed over Port-au-Prince, streaming into our field hospital through the openings in the tent, warming the moist air that reeked of urine and feces. I inhaled the thick atmosphere and felt exhausted, unable to eat, drink, or sleep.

I felt nauseated whether I sat, stood, or ate. I paced in a vain attempt to flee the churning of my stomach. All morning long I took care of those in need, feeling slightly disassociated from the events around me. About 1:00 pm, a young woman in her early 20s walked uncomfortably into the emergency tent. Ms M had been "healthy" all her life. But now she had not eaten or taken liquids for several days, while exposed to the oppressive heat. Her heart rhythm raced in a supraventricular tachycardia. After several doses of adenosine (which I suspected was expired) and a beta-blocker her rhythm slowed. I was grateful for the cardiac monitor on the crash cart. There were no labs, no x-rays, and no EKG available. I hoped she would respond to intravenous fluids. I admitted her to the "med/surg" tent, among the hundreds of patients and their families who had been living there since the January earthquake.
The emergency tent was packed and crazy; as it had been since the day I had arrived. I had no time to count the number of critically ill patients I treated that afternoon. I had multiple "codes." This was a new definition of hell. I had found a place where people in dire need of care, care that I knew how to deliver, could not get the medical care that they needed. I was simply the person from whom help was vainly beseeched. I continued to work as best I could until 1:00 am. At that point I lay down, more tired than I could ever remember.

A nurse woke me an hour later. Ms M was now having trouble breathing. I ran to the tent and found her in the corner in severe respiratory distress. Her oxygen saturation had already dropped to 60%, on a 100% nonrebreather mask. She had put out less than 30 cc’s of urine over the last 12 hours, after receiving 6 or 7 liters of normal saline. Her heart rate continued at 150-160. Systolic blood pressure had fallen to the 70s. Ms M was in acute pulmonary edema and shock. Her young face contorted in fear as she focused her concentration solely on trying to get enough air. We intubated her.

At 4:00 am her labs (on a jury-rigged version of an i-stat) returned showing a creatinine of 7 and a potassium of 8. She needed emergent hemodialysis. That night, as on all the other nights that I was there, no dialysis was available in Port-au-Prince. We tried everything we had available, but by the time the morning sun rose to roil the fetid air, she was dead.

I cried from exhaustion. I wept for her loss. I felt I had failed her—and failed others that day. The nurse consoled me. She offered that I had done everything that I could with what we had. The medical care Ms M received from me in those 24 hours was more care than nearly anyone in Haiti receives in an entire life.

I could cry for only a short time. Another code blue was called. This time, I cared for a young man. He died also, suffering an acute myocardial infarction and cardiogenic shock. I had no cardiac drugs and no echocardiogram. Where were our cath labs and our balloon pumps?

I vomited over and over again for a period of hours. At one point, I felt as if the sickness was not so much inside me as it was all around me. I believe I must have slept.

After I recovered a bit, and when I could, I sat next to the body of Ms M and recited the Lord’s Prayer. In the distance the sun was setting, slowly and beautifully, into the western sea.

Yours truly,

Dr Aloha from Port-Au-Prince in Haiti.

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