I'm not a doctor!

Author: Joey Leary ’09

What follows is a part II of Joey Leary’s report from Haiti. Part 1, An angry mob and an earthquake covered the day of the earthquake and its immediate aftermath.

I seriously doubt that “the morning after” or any of the details of the entire day of Jan 13 will ever fade from my memory. I stood up and I walked out into the street. It was my first daylight view of the destruction in Leogane. Reports now are saying 80 to 90 percent of the buildings were destroyed.

I looked out at “Masaje,” the bar across the street from the hospital that was the center of nightlife in the town. I realized I might never see Dominic, Lady, Mckenzie, Ti Frere, or any of the “regulars” there again. I headed for my home (the Notre Dame compound) known to the locals as the CDC and foreigners as The Residence Filarose, on the same route, between the hospital and the Residence Filarose, that I had taken 500 times before.

Today I had to climb over rubble that had poured into the streets. There were no friendly smiles that morning. Everyone was going somewhere. The streets were swarming. I was almost running toward the Residence Filarose. We had heard from Jean Marc the night before that it had not collapsed, so I wasn’t expecting to find any destruction. I walked past my buddies in the Zoe Club standing listlessly in the street. I gave some of the guys hugs but had to keep walking. By this point I had seen many terrible scenes of people stuck in collapsed buildings, so my eyes focused straight ahead. I didn’t want to see any more. The faces in Port-au-Prince were strange faces. The men and women suffering in Leogane were familiar strangers; girls I had danced with at Eve Andre’s house, guys I had played basketball with at Suren School, English club, Saturday morning soccer, Saturday nights at Praktik, the nursing school, etc.

I arrived at Belval Plaza and entered the gate. Nearly 200 people had already congregated in the open field surrounding the FISL Nursing School Compound. I saw some of the nursing students I knew sitting around the entrance to their school. Men and women were starting to be be laid out on the ground in front of the front gate. I was amazed to see that the Residence Filarose didn’t have any visible damage, although parts of the cement walls around the compound had fallen. I remembered Father Tom telling me that Residence Filarose was designed to withstand earthquakes. I ran inside to collect my most important things. I was factoring in looters, food provision, possible evacuation, and the immediate need for my first aid kit and scissors.

I put together a small bag with the essentials, including my wallet, passport, contact information, my U.S. phone and charger, my Haitian phone and charger, two flashlights, my canteen and some power bars. I was hurrying frantically because I knew there could be another tremor and I didn’t want to be inside and because I needed to bring medicines from Hospital St Croix to the nursing school, where all the seriously injured were congregating.

I set out on my bike, and as I rode past all of the refugees I knew they believed I was abandoning them. This was tough, but compelled me to ride even faster to the hospital for supplies.

When I arrived back at the hospital courtyard, 15 minutes later, John and Suzie Parker had a group pulling medicines out of the collapsed mini-pharmacy. The building could have collapsed at anytime, but the need for those medications was too great not to take the risk. Dr. Desir, the Notre Dame Haiti Program medical director, showed up with a truck shortly after to help transport even more of the medications to the two improvised field clinics/refugee camps that were forming rapidly in town. I helped him sort supplies but was distracted by the horrendous wounds that were coming in.

The wounded

The Cuban doctor from Hospital St. Croix was holding six inches of a screaming boy’s scalp away from his skull so he could scrub the bone with butadiene. I recognized one of the best basketball players from Suren school sitting on a bench waiting for attention. He was insanely good at basketball. A woman came over to me and tugged on my arm and said, “Doctor please help him.” I told her I was not a doctor, but she was almost screaming at me and I remembered him from basketball. He looked fine from my vantage point, so I was expecting to just see some cuts or bruises. The look on his face was one of fear, confusion and utter helplessness.

When I asked the young man what was wrong with him, he turned his head and exposed a piece of his scalp and skull hanging away from his head, exposing a large chunk of brain that was leaking cerebral fluid down his neck. I wanted to cry, vomit and scream for help all at the same time. I kept my composure and interrupted the Cuban doctor, now suturing the boy’s entire scalp back over his freshly scrubbed cranium, to tell him we had an awful head injury waiting. He shrugged. I left to continue my job organizing meds to transport back to the nursing school, but walked past a little boy with two sharp gashes in his head that penetrated his skull and allowed for a glimpse of his brain, and several others with broken bones, some compound fractures, lying on the ground.

I headed back to the nursing school on a bike, which is faster than a car in Leogane. When I made it back to the nursing school, the number of refugees and injured seemed to have doubled. The gate leading to the inside of the nursing school was swarming with all sorts of urgent and terrible injuries. Several students were manning the gates to keep people from forcing themselves inside. A group with a stretcher was going around and identifying the worst and most urgent to be let through the gate where Michelle, a visiting U.S. nurse practitioner, was waiting along with 15 to 30 nursing students to do whatever they could to help.

With the arrival of my supplies and Dr. Desir’s truck, the makeshift clinic came alive with activity. I decided to stock up a supply of water for the makeshift hospital. I grabbed two 5-gallon, buckets and went in search of clean water. I was optimistic about this because I knew that Leogane has had quite a few wells drilled around its community over the recent years. I was happy to find some running water only 200 yards down the road from the Belval Compound. What types of bacteria and parasites were in the water I’m not sure of.

On my way back from outside struggling with two 50-pound, buckets of water I saw Marah! I still don’t know how she got back to Leogane from Port-au-Prince, but I gave her a hug. She was my best friend at the nursing school, but she had a stoic look on her face and didn’t hug back with much enthusiasm. She said her family was okay. I didn’t ask about her aunt and cousins Fera and Rachel, who she passes the weekends with in Port-au-Prince because I had seen their home and knew that it didn’t stand a good chance.

After we parted ways, I had to fight my way through the nearly rioting mob of horribly injured and maimed people in order to get my water in the gate. I was exhausted. I spent the next hour giving water to the most seriously injured folks inside the compound. By 8 a.m. there were probably 40 people lying inside the nursing school gates. I found a bottle of ibuprofen in the mound of medical supplies in the center of the lawn, and made one complete sweep of all the patients, giving all those who needed it water and some mild pain-reliever. It probably made people feel better regardless, like a placebo might.

By 10 a.m. things were getting out of control. Word apparently had traveled all over town that patients were being treated here and we had medications. The number of people at the gate yelling to get in doubled and the number inside probably went up to 60. Only about 10 at any one time were receiving attention from one of the nursing students. At this point I felt I could no longer spend my time distributing water and ibuprofen. People had urgent needs that I could tend to: bones to be splinted, splints to be made, wounds to be scrubbed, bandages to be changed.

Unskilled surgery

I began by working at Michele’s side doing whatever she instructed me to do. The next thing I knew I was prescribing amoxicillin (by this I mean digging through a big cardboard box of miscellaneous meds we had dug out of the makeshift pharmacy in the collapsed part of the hospital until I found something useful to hand out) and cutting off the mangled remains of an old woman’s pinky finger while she looked away. Instead of letting it be ravaged by maggots and cause gangrene of her hand, I got the nod from Michele to cut it off. I tried to wash the wound with betadine before I did anything. A piece of string had gotten stuck in the wound and I knew it had to be moved to prevent infection, so I reached into the flayed finger and pulled the string. It wouldn’t come out so I yanked harder. I got it out but it splattered bits of blood all over my face.

In the meantime the woman wasn’t even moaning. She had a foot swollen three times the size of her other one, but it wasn’t broken when I checked. I tested the scissors on some cloth nearby because they didn’t seem very sharp, and if I was going to do this I wanted to do it fast. Her finger obviously needed to come off, but in good conscience I could not cut someone’s finger off without explaining the situation and asking permission. After all, many Haitians don’t believe in Western medicine, let alone something as invasive as this. I asked permission in Kreyol and she nodded and tried to look away.

I removed the drawstring from a little bag laying around with my pocket knife. I tied it around the nub even though there was almost no bleeding at this point despite the wound. I was committed now. Other nursing students, some in shock, some helping, paused in amazement or horror at what it seemed I was about to do. Family members of other patients who were screaming at me to help their mother or brother even for just one moment, realized that I WAS F——- BUSY and couldn’t help them right now! I was committed. Even Michele looked over from the bone she was scrubbing. Snip… tendon, snip… flap of skin. It hit the grass. I poured some more betadine on the wound and went looking for antibiotic ointment. One of the nursing students gave me a little container which I squeezed onto a piece of gauze. I later found out that the cream the nurse gave me was antifungal cream and not antibacterial cream, and that we actually had sutures on the other side of the nursing school. I did the best that I could, and this one was very lucky to get a five-day course of amoxicillin.

As soon as I stood up I was hit with the angry man who spoke broken English. His wife had a broken leg that had not yet been splinted. There was no bleeding, which put her almost at the bottom of the list of urgent patients. I thought he was going to hit me. He was right in my face yelling, “What you gonna do for my wife? You walk by and never see her! You help everyone but me! You can’t do that man!” I tried to ignore him but he was a big guy at his wit’s end. I don’t remember why he stopped hassling me, but someone must have gone to check on his wife.

The sequence of events of this day is blurry. There wasn’t anything I could say to people to convince them that I wasn’t a doctor. They didn’t care. They saw me cut off that woman’s finger and wrap it up. During this interim period I saw four compound fractures where the tip of the tibia and fibia both tear through the skin of the ankle where it should meet the foot. In all four cases the foot was at an awful 90-degree angle bent inward. Michele explained that all that we could do was scrub the bone, keep it moist, and try to wrap the foot and ankle. She said we would need a doctor or orthopedic surgeon to put the bone back inside the skin.

It was so awful seeing these patients and knowing immediately that what they needed was so far from being available. Michele tried to teach me how to recognize a pulmonary embolism on a man whose chest and stomach had been crushed. There was nothing we could do for him. I had to tell him in Kreyol for Michele. I watched a girl with the side of her face swollen to four times its normal size seize on the ground. Ironically not far away an unharmed Haitian women was screaming at the sky and shaking her body as if seizing.

A Red Cross transport plane flew overhead in the distance, which was the first sign of help any of us had seen or heard of. We didn’t know where it was headed.

Next I was interrupted by a man who had goo oozing from his left swollen eye. I think something may have penetrated it. He spoke perfect English, as some Haitians who have immigrated to the U.S. and returned do. He seemed so resigned, but asked me if he could have some ibuprofen. I gave it to him.

Michele and I began assessing a screaming 6-year-old girl with a broken femur and a tibia-fibula fracture of the same leg. Her father spoke English and was remarkably calm and appreciative of our attention. Together Michele and I splinted both parts. Michele explained that in order for the femur fractures we were seeing to heal properly the patients needed to be in traction. Since the father spoke English she was able to tell him that because there was no traction available, his daughter would be crippled for the rest of her life. I believe that is exactly how she said it. He just nodded and started to look for a place to move her out of harm’s way.

I need a doctor!

I think it was about this time that I bumped into the patient who I really connected with/felt the sorriest for. It was sometime in the afternoon now and I was feeling fatigued and disoriented. As I stood wiping my head and thinking “oh my God,” I got my next call. A frantic young man came over. I went to see and my mouth dropped. In actuality this girl was better off than those bleeding internally or with compound fractures. She had just been pulled from the rubble (approximately 20 hours trapped). She had what I can only compare to a shark bite on her right calf. It was a gaping 1½ foot slash. Part of her muscle was flayed and the entirety of her calf was exposed. Her hands were crushed and horrendously cut. The muscle in her right hand was hanging out of the laceration.

None of her cuts were bleeding at the moment, whether it be dehydration, clotting or the nature of the injury. I was surprised to note that her left hand had been stitched up. This puzzled me. Who had stitched up one hand but left the other two worse wounds gaping open? (It turns out that my friend would soon recognize her as the girl who they had to turn away from the hospital because there wasn’t anything more they could do for her there.) She was moaning but conscious. She was obviously dehydrated, which was the first thing I told her friend to handle. She also was starving. Her friend gave her some rabbit meat that he had bought from a vendor.

I was unprepared to handle any of these problems. I searched for someone to help me. Michele was occupied with an internal stomach bleed. The chief 4th-year nursing student said he would be right there but never showed up. I realized that if anything was to be done for this beautiful girl that I might have to do it. I started by rolling her onto her stomach, which was difficult with the state of both hands. I poured water and betadine onto her leg wound, which was starting to dry out. Then, as I began to get desperate for what to do next, a REAL DOCTOR showed up out of nowhere. He said he would be back. He had sutures, gloves, lidocaine, and disinfectant. I have no idea where that stuff came from.

The doctor used his gloved hand to reach down inside her leg and pull out dried chunks of blood. He snipped away dead pieces of muscle that were starting to get black. He used a damp piece of gauze to rub up and down on the exposed calf muscle. The girl was in agonizing pain. He cut away dead tissue and picked debris out of the inside of her leg. During this time I was holding her down and giving him whatever he asked for. Next he used oversized needles to inject lidocaine into some of the skin around the wounds — probably a little late to do any good — and began to sew up some of the muscle which had torn and recoiled down to her ankle.

He did a beautiful job. One continuous stitch that connected to the muscle in a number of locations all pulled together to reconnect the muscle. Then he cut the finger off of a rubber glove, opened both ends and put that into the wound to create a drainage opening. He began to sew the skin back around the gastroc. He worked rapidly, starting at the ankle, and working his way up to the center of the calf. Unfortunately three sutures in a row broke and he said he couldn’t close the leg up without steel wire sutures. He had me grip the bare muscle (I had just found my first pair of rubber gloves of the day) and try to force it down under the skin. The suture broke anyway. He started again at the top and worked his way down from the other direction until the sutures started breaking again. Then he stopped and said that was all he could do and disappeared. I began re-sterilizing and wrapping the still-exposed small envelope sized area where the skin was unable to meet over the muscle. I got it covered to the best of my ability and turned my focus to the unsutured hand.

The doctor had looked at the hand and concluded that the tendons in her wrist had torn and that she would need microscopic surgery to reattach the tendons. I was about to attempt to sew the hand wound up based on all of the times I had watched it done, when a nursing student came over and said that she had learned how to suture. (It was about this time that I looked up and saw my two best friends from the Childrens Nutrition Program! Kara and Courtney, standing there behind me alive! We all had a two-second teary moment, and then it was back to work. They told me to come to the hospital tonight and left.) The nursing student was able to close up the wound while I used some forceps to push the hand muscle back down while she closed the skin over them. The sutures took an hour and the girl was moaning that she just wanted us to stop. It was as if she didn’t care anymore.

When we were done I remembered the nondescript bag in the mountain of meds, both useful and not, where I had found the amoxicillin for the woman whose finger I had cut off. Sure enough there was some left. I selfishly grabbed three bags, which equated to about two weeks of antibiotics, and gave it to her friend with strict instructions. That was the last I saw from her.

It was getting dark now and the guards had stopped letting people into the FISL nursing school compound. I helped move the girl with a broken femur and tibia/fibula from earlier outside into the tent village with her father. After that I decided I was done for the day and walked the 100 yards to the Notre Dame building while fighting off tears.

Joey Leary and many of his friends eventually were evacuated from Haiti. For the full story, see his blog.