A Day. A gasp. Day number three of gasps.
I found myself no longer counting the respiratory rate. It was rapid.
The pulse oximeter remained 72% on a 100% nonrebreather. No worse but certainly no better.
His wide-open eyes conveyed fear while also demonstrating the strength of the human spirit to survive. No translation was necessary to decipher any spoken Creole words.
There were no ventilators available in the entire city of Port-au-Prince and I had the misfortune of watching an otherwise healthy 18 year-old boy slowly deteriorate before my eyes. Coincidentally and due to poor luck, he had somehow managed to develop trilobar pneumonia around the time of the devastating earthquake in Haiti.
Four emergency medicine residents and myself arrived at a busy hospital overwhelmed with victims of the recent earthquake. Our trip was funded through a local professional football player’s foundation. I admit I had never heard of him prior to this trip. Now I will never forget his name or his efforts even though I have yet to meet him.
Although we had no reservation, we were greeted at the hospital door by a remarkable nursing supervisor clearly open to any help offered.
“Where are you all from?” she asked with a slight twang in her weary, exhausted voice.
“We are emergency physicians from Detroit,” I answered.
“That’s great. Would you be able to staff the Intensive Care Unit tonight?”
And that’s how the greatest humanitarian crisis in the Western Hemisphere entered into my life.
The teenage boy started off in a general medical area with difficulty breathing. His mattress on the floor was a luxury compared to many patients using blankets only on the hard concrete floors. His care was a coordinated effort by many health care professionals that crossed continents. “Team Sweden” provided excellent care given the austere conditions. The pneumonia, however, was rapidly progressing along with its counterpart, a large pleural effusion. I found myself supervising a thoracentesis performed on this mattress while the father lovingly wrapped his arm around his son. Over 700cc of fluid was removed, improving his work of breathing though the pulse oximeter remained poor. He was transferred to the ICU.
The ICU was a simple room of critically-ill patients and those who had undergone multiple, major orthopedic procedures. Overall, it was not unlike the remainder of the hospital though it did have a physician designated to that area only. The absence of any monitors beeping, nurses talking or ventilator machines breathing made his gasping only that much more unavoidable to hear. And then there were those eyes.
This patient wasn’t a challenging case. Any emergency physician would know that he needed to be placed onto a ventilator with aggressive pulmonary care. He was already receiving multiple antibiotics and some TLC but needed so much more that would be readily available in the United States. We had arranged transfer to a hospital in the United States but funding for the private jet fell through at the same time that the US government halted humanitarian visas. He was stuck at our hospital, as all other facilities were full with no additional resources to spare. I faced the problem of patient boarding on a worldwide scale. Patients needed to be transferred off the Navy ships to allow hospitals in the city to offload their patients and make room for more injured or ill people.
During the final night of our stay, the hospital was down to only one oxygen tank that was designated for this patient. There were no other tanks for the entire facility with the next shipment due in over 12 hours. It was at this point, the thought of this boy suffocating, that I hit bottom. Tears flowed briskly. His father could see that our transfer wasn’t going as planned. “Ma vie,” he said softly. My life.
We had met several Army personnel during our stay who were aware of our predicament. In fact, the entire hospital staff, volunteers, and other patients and their families were aware. It was about 5 hours into our 8-hour supply of oxygen that an Army team returned saying they had a ventilator. The sense of relief when the medical team entered the ICU cannot be conveyed in words. They only had a cot, however, and the ventilator was at their disaster base and not accompanying the team. We had no choice.
Loaded into a chair along with a bed sheet, the patient was placed in the back of a HumVee and driven away into the night. Dogs barking replaced the sounds of the gasping to which we had grown accustomed.
Back home in the United States, efforts continued to transfer the patient to a more definitive place of care, specifically the USNS Comfort. The next day, I received a phone call from a medical commander stating that the patient could not be located but a spot was available for him on the ship. The US government as well as our charity organization had been searching for him all day. I repeated the location and provided them with the father’s phone number to no avail. This had quickly turned into our version of “Saving Private Ryan.” More than 16 hours passed and he was nowhere to be found.
Finally, a charity staff member reached his family who was aware that “the United States government was looking for them.” Likely the context was lost in translation somewhere. We were able to gather specific information as to the location of the patient within the disaster unit. To date, he is graciously and skillfully being cared for by medical personnel aboard the Comfort.
The gasping has stopped.
A radio talk-show host asked me today if we needed some “downtime” upon returning home.
“We’re emergency physicians. We are trained to keep going. We have patients here in Detroit who need us just as much as the Haitian people. Fortunately, we have the necessary resources here to get the job done.”