9 March 2010

Another day in the ICU. It was better today in that I actually felt like I sort of knew what was going on – at least I knew what to expect and how to organize the beginning of my day. It was also really warm today. The tents were baking. I knew before a half hour into my shift that I was going to need to push the fluids today and, in fact, I drank a whole liter of Gatorade at the end of the day to be sure to rehydrate and replace some electrolytes.

My sickest patient died today. He was transferred to us in the AM with a diagnosis of cerebral Malaria (rule out Typhoid). The big question of the day was if the versed dose he received ultimately did the job? Earlier, the Haitian American nurse who was working in the ICU saw that he was agitated and had pulled out his IV. There was no doctor around, so she decided to give him some versed (who knows how much), but he wasn’t quite the same after that. He had very extreme work of breathing with a respiratory rate in the high 30s to low 40s. He was diaphoretic and pale and jaundiced. He was breathing with his abdomen for most of the day. We had drawn labs on him early in the day, but didn’t realize the correct way of the lab and found out that none of our labs actually were run. So, we had no results. We drew blood to test his blood type and got 2 units of blood. His BP was low (98/60) when I hung the first bag, but his other vitals were fine. After about 20 minutes we rechecked his vitals (not something that Haitians usually do) and his BP had dropped to 78/50 then 62/30… Meanwhile, his respirations changed dramatically and they started to decrease to the point where he stopped breathing, but he still had a pulse. We started to bag him and bagged until there was no pulse. All of this happened in about 5 minutes. His wife was there and during the bagging Ragen (our wonderful doctor) explained with a translator that the situation was bad. We prepared the body and waited for the rest of the family to arrive before taking the body to the morgue.

What killed me was the picture that Corey painted of the morgue earlier when she had visited it and how I couldn’t wish for my patient to be thrown in there with the rest of the bodies. It seems so inhumane! (I can’t begin to describe what she described to me…)

My heart broke today. As I watched my patient die I felt so helpless. I felt inadequate. I felt despair. My heart broke for his wife – she looked so shocked. My heart broke for this country – how many more 50 somethings, or any age for that matter, are going to die just like Paul Lazar?

All of this happened at 1630 and our bus leaves at 1700, so the end was a whirlwind and not much closure. I think tomorrow we will stay until 1800 (there is another bus) just to be sure that the tent is staffed because there is usually a pretty big lag period between when we leave and when the next volunteers come. At least then we can provide some coverage.

Tonight at our meeting a psychiatrist talked with us all about dealing with stress and being sure to take care of ourselves. I think there are some rather stressed out people in the crew that arrived while we were at Petit Goave and tempers have been flying high. I actually thought he did a really great job – fielded all the questions really well and focused on a lot of the really important points. The rest of the evening was spent eating and great stimulating conversation, which helped to normalize the day and our work here. I still have a lot of think about with what happened today. It will be on my mind.

Lord, thank you for life. Thank you for death. Thank you for grace when it feels like nothing will do. Thank you for this day no matter how hard it was. Thank you for all that I am learning. Be with Paul’s family tonight as they grieve. Be with them throughout the days and weeks ahead. Show yourself to them. Make it evident to them that you are alive and able to comfort them. As my pen strikes this page, send them peace. May they rest well tonight. Protect them. Support them as they need it. Send them rest. Allow them to grieve adequately. Save them from the sight of the morgue. Amen.