There is really too much on my mind and I'm way too tired to be trying to write...but there are at least a few things I want to write out before I forget.
We saw many, many severely injured patients today...patients who "required" orthopedic surgery 6 days ago, patients who undoubtedly narrowly missed dying in the quake, patients who perhaps by all conventional wisdom should be dead from their injuries, but aren't.
Let's be real--This is all completely unjust. In a world as rich as ours, with as many resources available as ours, NO ONE with an open fracture (or any fracture) should suffer without medical care for 6 days. Or even 1 day. Especially while laying in a makeshift refugee camp (which are popping up all over Port au Prince), or beside a flattened home, or somewhere else equally uncomfortable.
Read Troy's account here of finding a pregnant woman with a pelvis fracture. We're not doing a lot for her, per se (emptying her foley bag, feeding her, providing her a place to sleep--until we can find a surgeon to fix her pelvis and deliver her baby), but I know she feels cared for, and loved. And that matters.
Most of these people had only simple bandages in place, and had received no pain meds at all before arriving. Taking off the bandages, we never really knew what would be underneath, but much of it was pretty severe.
The upfront truth is this--our little makeshift clinic has me, an anesthesiologist, a family practice doctor, and an emergency medicine doctor, plus many wonderful nurses, EMTs, and other support people. Are we "qualified" to be doing the things we're doing? Of course not...but you have to understand that there are NO other options, right now, for most of these people. Literally none. We tried to get several of them into an Israeli field hospital (currently set up in a soccer field) that is handing orthopedic surgical cases. We got one person in late morning, then went back with 5 others in the late afternoon, but had no luck that time--they were full. So all 5 came back to us, and we provided the absolute best care we could. Having an anesthesiologist here is wonderful--we have been able to do extremely painful procedures on people with only minimal pain.
Fairly early on we saw a young man who is a drummer at his church. He had very severe, VERY deep lacerations on his right hand that someone had tried to stitch together several days ago. A couple of his fingers were close to falling off. His left arm was even worse. He had an open radius/ulna fracture and fairly severe swelling of the whole lower arm. He's one of the patients we tried to get in at the Israeli hospital in the afternoon. He came back to us after dark, and we decided to do a couple things--we cut open his arm (beyond the part that was already open) because it was already very infected. We then reduced his fracture as best we could. We got the radius back in place, but no matter what we did, couldn't get the ulna back in place. We put a makeshift drain in place (cut off one of the fingers on a sterile glove) and sewed around it, then splinted the whole thing. The hand ended up needing the pinky finger amputated, but for now the rest are in place. He might need one more finger amputated later. He'll stay with us for awhile.
Yeah about that...we soon realized that there was no way some of these patients could go home. We turned one room of the house into an inpatient ward and made up charts and organized a schedule of the nurses/paramedics who are here to keep the placed staffed 24/7. A reporter from South Africa showed up at one point during the day and asked "So were you guys planning to have a little inpatient hospital like this? My answer, "Doesn't matter, we are now."
We reduced another open fracture as well, on a very funny and brave 13 year old boy. A concrete block fell on his leg, leaving him with a bad and very unstable tibia fracture. He had a little piece of gauze and tape over it. I asked if he'd gone to the hospital and he said yes, a few times--but as far as I can tell it was just to change the gauze. This poor kid's bone was sticking out of his shin. I told him we were going to put him to sleep so we could fix his leg, and he got very panicked and asked, "You're not going to cut it off are you?" I think people here are very aware that MANY people in this city are ending up with amputated limbs (a 9 year old girl here with a simple fracture asked the same thing with a very panicked look in her eyes; her relief was immediate when she heard the answer was no).
We deeply sedated him, then somehow, after a long time and a lot of work (including having to cut his laceration bigger so we could get at the fracture sites), managed to put the 2 ends of the bone back together (after a bone breaks, the muscles contract, pulling the 2 ends of the bones over each other, so it is hard to pull them apart enough to get the ends realigned). We put a drain in the big laceration (where the bone was sticking out) and sutured around it. We put him in a sort of makeshift traction (that was a project for the guys, and they rigged something up within about 15 minutes). He could very easily still lose his leg...but at least there is a chance that he won't. We will keep trying to get him to a surgeon, but for now it's traction, immobilization, and antibiotics.
There was a women who had a huge facial laceration from her scalp onto her forehead and then her eyelid, probably about 15-20 centimers long. It hadn't been attended to at all. Left that way, she would have had a horrible disfiguring scar for the rest of her life. Lori, an awesome nurse from Real Hope for Haiti had come down from her clinic in Cazale to work with us for the day. She debrided the wound, creating new wound edges with good tissue, then sutured it closed with a drain in place (again due to infection risk). She will still have more of a scar than she would have had if it had been sutured immediately, but Lori did an amazing job, and it's going to heal up amazing well given how bad it looked when she came in.
At one point they brought in a 3 week old baby with a big abscess that I drained. Definitely fun to take care of a baby with a non-ortho problem...
We're about to lose power--going to post now and add more later.