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.

The Permanente Press

The Permanente Journal (ISSN 1552-5767) is a peer-reviewed journal of medical science, social science in medicine, and medical humanities published quarterly by The Permanente Press.

Circulation

27,000 print readers per quarter, 9725 eTOC readers, and in 2016, 1.4 million page views on TPJ articles in PubMed from a broad international readership.

Bookstore

The Permanente Press publishes books related to Kaiser Permanente and health care to advance knowledge in scientific research, clinical medicine, and innovative health care delivery.


ISSN 1552-5775 Copyright © 2018 thepermanentejournal.org.

The Permanente Press. All Rights Reserved.