Haiti - Day Two

The following has been re-posted to HCPLive.com with permission from Dr. Jan Gurley. You can visit her blog, Doc Gurley, at www.docgurley.com.

After six hours of unaccustomed sleep, I awoke like a mad pirate, with one red eye, hair askew, lurching and croaking. While fearful in aspect to my teammates, my somewhat altered appearance had simple explanations. Despite my wearing glasses, concrete grit fell in my eye when I tried, unsuccessfully, to hammer a mosquito-net hook into the ceiling above my head, using the handle of a screwdriver as the hammer. And my exploded-dandelion-puff hair?…well, that is it’s usual morning state, worsened somewhat by a cold gurgling shower right before sleep (a shower where I tried very hard to keep my mouth closed and my lips rolled in, the water being of uncertain vintage). My croaking voice was the natural result of being in a country where the air quality is so poor, you awake in the morning with an urge to blow your nose and find pure lumps of condensed soot in the tissue. I realize, looking at the tissue, that I somehow failed, this past Valentine’s, to express my deep love to the EPA. And my drunken staggering gait is the normal result of muscles that protest like rioting inmates over how they’d been treated the last 72 hours, only 6 or so of which were broken sleep.

The house still hummed with subdued activity when I crawled under my mosquito net at 1 a.m. last night, but it was vibrating with movement when my eyes (one red) popped open at 6:30 a.m.

I was grateful to be awake, having dreamed the kind of dreams you are happy to see depart. I dreamed I was back at the hospital in Africa, where I’d worked 20 years ago, frantically busy — only I left my job suddenly, in mid-sentence – teleporting to the States to hover, invisible, watching my daughters as they went to classes. My haunting of them was greedy as an incubus, watching the way a head tilted, a hand gestured. But intruding dream-thoughts alarmed that I should get back, NOW. And always, as dreams shifted, I fretted and picked at the French language, over and over: What is the word for “like”? “Comme”? It couldn’t be comme. Could it? That sounded wrong.

Like those moments when you realize you can’t say a familiar phone number because you’re thinking about it too hard, basic words became suspect and, frankly, traitorous.

I am writing this before the sun comes up. And, I have to say, frankly, that when it comes to all this typing with the thumbs, Steve Jobs, your product’s a bit of a disappointment, ergonomically speaking. As my thumbs hunt and peck, hen-like, thousands of roosters crow in the distance, a vague avian stadium-cheer. The opened-doored, breezy house already rumbles with activity. We send people out to stores to see what we can buy (more penicillin?) and everything must be packed and repacked, morning and night. Like a mini reflection of the huge backdrop of Haiti relief, we are hampered by issues of transport and goods. Who knew that in the end of days, the most valuable human on earth would be a supply sargeant? Give me a team of decent soccer moms who effortlessly coordinate impossible schedules and complex deliveries on a minute-by-minute basis, and lives could be saved.

And all I can think about is the wee toddler girl from last night. In the States, she would have spent the night in the ICU. Here — lying on the dirt and rubble with, hopefully, a sheet haphazardly suspended overhead for when the rain misted down last night, and having as her medical care only the pills and oral rehydration fluid we’d seen her take as the sun was going down. Would she still be alive? It was a question that haunted me like I’d dream-haunted my daughters all night. Was there something different that should have, could have, been said, or done? But the conversation about going to the hospital had that awful sameness, similar to the kind I am forced to have so often in clinic back home – telling uninsured people you must get care, you must go to the hospital, that this is a condition that can kill you. And in return, as a doctor, you get silence and a look that seems to convey a blended pity, even a bit of contempt for your foolish ignorance of how the world works, of the impossibility of all that you so earnestly demand. Only here there is a more ominous, flat resignation, a chilling silence, as though nothing more, truly nothing more, can can be tolerated.

I try to comfort myself with the thought that she was better — not so near death – when I last saw her. That she roused enough to gasp and even scream when we poked needle after needle into her. That she was, thank God, now able to drink – even if her eyes still had that scary glassy, unfocused stare that only those near death, or newborn, seem to have.

More people have amassed today. There is an oppressive feel of a potential mob, bodies pressing against the oven-warm metals of our bus, shouts and shoving. Our organizer wisely parked our bus at an angle, blocking the cornered area where we see patients under tents, forcing people to funnel in, a simple rope across the gap regulating the flow. I am once again Queen of Pelvics. The need is so great that groups of women find a way in through the back, women pushing forward, worried that won’t be seen until bodies are pressing against the airless tiny curtained-space where I am examining women. Between every patient, for the first few patients, I ask, with a smile, for them to step back (another step please, and another), that everyone deserves some privacy to talk to me. Sheepish, the women quickly learn, and before long they are keeping order themselves, instructing newcomers with the passion of the converted.

Everyone, everyone, has a vaginal discharge. It is code for every type of female problem. Often enough, based purely on history and exam, it does indeed seem to be miserably untreated infections, sometimes for days, more often for weeks. But I also diagnose 3-4 unknown early pregnancies, an incomplete miscarriage, a new diabetic, a few probable “fibromas” (fibroids) and women who, almost as an afterthought, probably have tuberculosis, or bring dehydrated and malnourished children with them, or profound grief reaction from seeing their infant literally crushed only weeks ago.

Some of these women are law students, some store owners, two of them women who’d never, never, seen a doctor of any kind, ever, despite having 1 or 2 kids. Explaining the act, and concept, of a pelvic exam to them with my fabulous Creole-translator’s assistance (she is an MBA student whose school is gone, and she waves away both thanks and praise for an unbelievable, brutal job “I have nothing to do, not since The Day. I have no job, no school, no home. Of course I help”), our three-woman discussion provokes the kind of giggles women share the world over when discussing the ridiculous requirements of our reproductive organs. There are hushed stories of women across the dense urban area, in the days after The Day, who screamed as they were raped through the night. I don’t ask, and it aches my heart to not, but the press of bodies is too great, and while there is a greedy eying and hiding of the condoms that I offer, there is not a single newly diagnosed, 8-9 week pregnancy that is not greeted with joy.

We stagger onto our bus — she spent the day as our “Pharmacie,” plastic tubs of drugs and supplies on bench seats, baggies of meds handed out open windows to up-raised arms. Everyone on the team is coated with a visible combo paste of sunscreen, DEET, and dust, a darker bracelet of the grime at our wrists, just above the hand-sanitizer line. Our highly-skilled, phenomenal vascular surgeon spent her day as a triage nurse. For our meticulous, cutting-edge texhnology Stanford ICU nurse, it would be hard to imagine that there could be a day more dramatically different from her usual work. Everyone just did what needed doing.

And I see, for the very first time, on the bouncing, grinding ride home, as the multitude of faces flash by — a smile. One. But it is a first. An only. And when we get out to lighten our bus’s load so she can make it, grumbling and complaining, loaded as she is, up the steep incline – as we pick our way up the rubble-coated hill – I am told that “our” toddler not only survived the night, she came back, looking nearly normal, staring at people and irritable as a child should be. With just that bit of help, at the right time, she is Haiti, coming, bit by bit, back to life.