Thursday, January 26, 2012

The Work

The pace of our days has been changing a lot since the last time I wrote.  Last week there was a large team staying here from Mayo, many of them Don’s friends and colleagues from the ER.  Doctors, nurses, EMTs and two Physical Therapists all working at St. Luc’s and St. Damien’s.  In the early days of Mayo’s involvement with St. Damien’s most of the teams were doing exclusively clinical work.  When Don came down as a team leader this past March he and his team did a three shift rotation in the cholera ward, which was still being constructed.  Don touched down in Haiti and was working at the hospital that night, pushing all of the patient’s beds and all of the expensive newly donated equipment to the middle of the platform under the tin roof so that everything didn’t get soaked by the rain blowing in through the still unfinished walls.

The game has changed now, in many respects.  The cholera building, St. Philomena’s, and the adult ward, St. Luc’s, are finished.  The flow of cholera patients has ebbed during this dry season, and while it is expected to peak again when the rains start, it will hopefully never again be as bad as that first huge wave.  And the Mayo teams have transitioned from exclusively clinical work to mostly teaching, moving into a new phase of their partnership with St. Damien’s. 

However, Don is down here on an elective rotation, not as part of an official Mayo team, so his responsibilities have been varied.  The first week he was doing a lot of clinical work in the Emergency room at St. Luc’s.  He has a special set of skills that makes him very valuable, since he doesn’t usually need a translator to work with patients.  While the Mayo team was down here doing their own teaching, especially with Venk, the ultrasound expert, Don has been able to cover the ER so the Haitian doctors can attend lectures. 

He was also working with the Mayo docs and the hospital staff to get their new ICU ready to open, work which continued after the Mayo team left last weekend.  I have been able to help a small part in this venture, typing up different charts and forms for patient transfers, checklists for various carts (IV carts, medicine carts, etc) and other charting forms which are then translated into French or Kreyol for use in the ICU.  They are aspiring to a new level of record keeping and accountability with this new ward, and so all of the forms for documentation must be in place!  Of course, Mayo is an excellent resource for documentation!

This week he has been working in the ER and the ICU, helping the staff transfer patients, manage patients, and doing some teaching on documentation.  His work is heartbreaking, impossible, necessary, insufficient, life saving, miraculous, and almost indescribable.  Everyday that he comes home here, I am reminded of why I married him – Don is simply the best human, man or woman, I have ever known.

There are so many opportunities for disillusionment and despair here in Haiti.  Sometimes Haiti itself seems like an opportunity for despair, like a rent I the earth venting hopelessness and pain into the world.  It is easy for people to come down here, for any length of time, and feel as if they have had the hope and light sucked out of them.  Just used up.  I feel that way here sometimes, and, to be frank, I’m not even doing anything here!  I rarely leave the house expect to go to mass in the morning or walk three blocks to the Lotzs, and sometimes what I see in those short walks or drives in enough to drive me into my own dark.  And what Don works in every day is…well, it’s this.

To help manage the ICUs resources and make sure it is sustainable, they developed several exclusion criteria, very basic and used as guidelines.  Of the first four patients admitted to the ICU in their first days open, all of them ended up either meeting exclusion criteria or not meeting inclusion criteria.  Two of the patients had active TB – the ICU isn’t ventilated appropriately to manage TB patients, but the X-Ray developer is currently down so they couldn’t get a chest X-ray to confirm TB.  One of the patients was dying, her feet eaten away by a flesh eating bacteria from unmanaged diabetes.  A dangerous misuse of ICU resources in a patient that could not be saved.  The fourth patient was panicked and having a respiratory attack because she is smoking during her pregnancy to reduce the baby’s weight, even though she has asthma.  She left AMA later that night because her breathing had returned to normal.  She’ll probably be back in a week.

He comes home and hugs our chubby, healthy, wriggling little girl thinking of the emaciated four month old baby he just saw with the arm dripping infection from an IV line.  Happy to cater to her bossy, cranky whims and she tries to order us around the house and yells at him to get off the bed where he has crashed for a few minutes of rest.

He comes home and is sad, is upset, but he does not despair.

Yesterday morning Don went with Pere Frechette, Wynn, Bryn, David, Raphael, his brother Robert and several other people to the Port-au-Prince city morgue to bury the unclaimed dead.  This is a ministry that they provide every week, taking the bodies up to Titanyen where the mass graves are and burying every person in an individual grave.  The movie Sun City Picture House, Bryn and David’s project depicts this process with a sensitivity and exactness that I won’t be able to convey.  I have wanted to go, but there is no one to leave Lucy with during the day, and there is no way to drive her safely or keep her clean in this process.

It is the procedure of the city morgue to leave bodies for three weeks before releasing them to Pere Frechette for burial, to ensure that they are indeed unclaimed.  Three weeks, lying in an unrefrigerated room in Haiti.  The bodies come from everywhere – from the streets, from the General hospital, from the slums.  They are women, men and children of all ages.  A shelf of unclaimed babies for just one week.  And they have not been embalmed or treated in any way. 

They are in their third week of rotting, their bodies in such a state of decomposition and indignity that they literally fall apart as they are finally put into body bags.  Body bags, because it takes two to contain them in this state.  I find it impossible to imagine this scene as Don has described it to me, and not picture a parent coming to identify their child in this hell.  Not be thankful once again for the blessing of being able to say goodbye to our brother, Riley, in a space of dignity and peace.

These trips to the morgue, far from being the time of despair and incredible sadness that one might believe, are turned into times of celebration by the men and women who administer this last sacrament.  Cigars and cigarettes are passed to cover the unholy stench.  Bottles of rum are passed in celebration of the lives they were not privileged to know or share.  Hymns are raised up to sing the bodies of these forgotten men, women and children back into dignity and glory.

We met Don back at Relax that afternoon, after he had spent all morning at the hospital, the morgue, and burying the dead and I had spent the morning playing, writing and playing some more at the Lotz’s.  Instead of pleading exhaustion, being overwhelmed and just shutting down, which he had every cause to do, he jumped into our current crisis which involved Lucy wanting more cookies for a snack and me refusing her, thus leading to a howling tantrum.  Don takes Lucy in his arms, hugs her tightly while she tries to kick her way to the cookie cupboard, and distracts her back into calmness by taking her outside to swing on his crossfit rings.  Later on he tells me all about his day, apologizing to me because I missed the opportunity to go and trying to help me figure out how to get out of the house more.

My husband is the reason I try harder every day to be a good mother, a good writer, a good human being.  On a dark day, he is the reason I try at all.  His work is incredibly difficult, technically and psychologically.  He comes home sad, literally covered in the feces of the dead, but he does not despair.  He jumps into whatever awaits him, with the faith that we will have what it takes to carry us through.

Children's cholera ward on the left, adults cholera ward on the right.

Emergency Room on the left, front gate in the middle, triage and waiting area on the right.

The new ICU!

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