update on Amanda

I have been waiting almost 4 months to write these words: Amanda has been accepted for comprehensive charity care at a hospital in the U.S.!!! Words cannot adequately express how grateful I am, but I want to say a huge THANK YOU to her accepting hospital, Dr. B at the accepting hospital, the charity care committee at the accepting hospital, Rachel with Medical Advocacy Team, Marilyn (executive director of an organization that helped with letters), Monique the lawyer from D.C., all of the EMTs, medics, nurses, physical therapists, physician assistants, and physicians who've cared for Amanda at Heartline since early March, all of the medical personnel in the Dominican Republic and at MERLIN who cared for Amanda prior to early March, and everyone who has prayed, e-mailed with offers of help, and spoken encouraging words to all of us throughout this process.

walking unassisted, June 2010

You can read more about Amanda's story here and here (see the June 23rd post "Fallen Houses Broken Bodies").

the rubble of the house Amanda was in (just beyond the standing wall) on January 12th, picture taken June 30th

When I received the official news of Amanda's acceptance earlier this week, I was sitting on my couch. After reading the short acceptance e-mail several times, and convincing myself that it really was saying what I thought it was saying, I laid my head back, closed my eyes, and exhaled....for a long time. It felt like I was releasing almost 4 months of stress, tension, uncertainty, and fear. Fear that we had lost 4 months of valuable time. Fear that Amanda would live the rest of her life with a non-functioning left arm.

I very clearly remember picking up Amanda at MERLIN Field Hospital back in early March. I'd actually heard about her several days prior, and she was supposed to transfer to Heartline Field Hospital the day prior to when she actually did. The MERLIN staff described a young woman who'd been crushed all along her left side when the house she was in collapsed on her. She had a severe femur fracture with an external fixator in place, a humerus fracture that had become infected, a foot wound that had been skin grafted, and a brachial plexus injury that left her with a severely painful and completely paralyzed arm.

I was at MERLIN the day before Amanda came to us, and was ready to pick her up along with another patient. However, the staff at MERLIN told me that Amanda was hesitant to come to Heartline--she'd heard through the grapevine (a LOT of our patients spent time at MERLIN, and they talk!) that "le lapli tonbe, tap yo koule e tout moun vin mouye"--when it rains, the tarps leak and everyone gets wet. Now, that was not completely true, but it is true that right around that time we were having some serious issues with our intricate tarp system (and the rains, which held off until mid-February, were coming frequently). We also happened to be fixing the tarp system that day--and the hospital grounds were a mess. So it wasn't the best day to bring her back.

constructing the new tarp/tent, March 2010 (photo by Morgan McHoul)

new tarp/tent from outside the gate, March 2010

We went the next day instead. I walked into one of MERLIN's makeshift hospital tents, located on what used to be several tennis courts in the Delmas neighborhood of Port au Prince. I walked over to Amanda's bed, and she gave me a small smile. She sat up straight and looked me in the eye as I introduced myself and explained that the MERLIN doctors wanted her to come to Heartline, because we could provide some care that they weren't able to. She needed around-the-clock IV antibiotics for at least 2 weeks, and while MERLIN could do an amazing variety of operative interventions that we (obviously) couldn't do, they were less able to provide 24/7 IV medications. That's part of the reason our 2 hospitals worked so well together--our strengths and weaknesses complemented each other perfectly, and MERLIN continued to assist with Amanda's care after she was transferred to us.

Amanda listened to everything I had to say, including the fact that we had just put up a giant, new, half-dome tent structure. I promised her that she wouldn't get wet when it rained, a promise that has (mostly) been true. I then asked her if she was okay with coming to our hospital. She paused for a brief second, nodded, and said "wi". She asked a couple other brief questions, and then we were on our way.

Everything about the trip from MERLIN to Heartline--moving her from her bed to the back of the pickup truck, driving the 3 miles between the hospitals, moving her from the pickup to her new hospital bed--was painful for her. Every bump in the road (so basically the entire drive) caused her femur external fixator to move, and even small movements were nearly unbearable. We drove as slowly and carefully as we could...but you know how it is.

typical road here...one of the more decent ones

That first month at Heartline was one of excruciating pain for her. Any movement caused severe pain in her unhealed femur. And the lack of movement (i.e. the brachial plexus injury) caused severe, constant, incapacitating, burning nerve pain in her entire left arm. Everything about her day-to-day life was difficult. She cried frequently. We provided strong narcotic pain meds (both oral and IV), but it is well-known that even narcotics can't do much to relieve "nerve" pain. And while her other injuries slowly healed, we felt helpless when it came to her brachial plexus injury. Some suggested amputation, but others pointed out that even with amputation, the nerve pain would likely continue as phantom limb pain. Can you even imagine? I know I can't.

In April we put out the word that we were looking for a neurosurgeon to help Amanda. We knew she needed operative interventions for her arm that were far more complicated than what could be done in Haiti. We received many helpful suggestions and offers--thank you so much to everyone who contacted us! We started working on her case at the U.S. hospital at which she was ultimately accepted, a process that we originally thought would take several weeks, but ended up taking several months. In mid April, Barbie made contact with an Air Force anesthesiologist, who placed an intraneural catheter into her brachial plexus, allowing us to infuse a long-acting anesthetic. This gave her about 3 weeks of relief from the arm/nerve pain. Interestingly (and thankfully), towards the end of April, her nerve pain started to improve with a new combination of medications even after the catheter was removed.

In late April, her femur external fixator was removed, but she unfortunately continued to have a lot of pain and difficulty with any movement. In early May, a visiting orthopedic physician assistant made a beautiful, intricate, specialized "hinge cast" for her leg, allowing her to much more easily transfer from her wheelchair to her bed (thanks Cliff!). I've been told that making a good hinge cast is becoming a lost art these days, and that very few people can actually do it right. But Cliff is a cast artist!

with Cliff, mid-May 2010

On one of my last days in Haiti earlier this month, Amanda asked me for a new sling. I wasn't sure that we had any, but I did find one. I gave it to her, but instead of putting it on, she carefully hid it amongst her belongings, and told me, "M'ap sere li jistan w tounen pou mennem'm ale zetazini"--(I'm paraphrasing...hoping the Kreyol is correct...it was something along those lines)--basically, I'm putting it away, or saving it, until you come back to bring me to the United States.

Theresa, April 2010

Amanda will be staying with Theresa, a nurse who spent a couple weeks with us in late January and early February, and another week in April, and her husband. I can't think of a better host family for her--thanks so much Theresa and Matt!

July, 2010

On July 13th, I passed through immigration at the Miami airport like I've done dozens of times before. My one prevailing thought as I passed through there was "I really, really hope that the next time I do this, I'm with Amanda." And that is very likely going to happen. Soon. I can't wait.

Amanda has a visa appointment at the U.S. Embassy in Port au Prince next week. Please pray that she receives the specific type of visa that we're requesting so that she can travel as soon as possible.

walking without crutches for the first time, July 2010, exactly 6 months after the quake

entertaining the hospital, April 2010

(videos, pictures, and information posted with Amanda's permission)