10 March 2010
Last day working in the ICU and the hospital as well. It seems weird that the time is almost up. The first couple of days I felt like the time had been slow and long and tiring, but now it feels like the time has flown by – I would love to spend more time here. It would be hard and exhausting (and perhaps I would feel different if I were staying longer), but I will definitely miss it, especially after working with such incredible doctors and nurses!

The ICU tent was pretty crazy today. We were extremely overstaffed (for once!) and many people were under-experienced (under-oriented may be a better word). It took a bit longer than normal to explain how things worked. We tried to pair the “American” RNs with Haitian RNs in order to start the process of turning responsibility back to the Haitians. It’s frustrating because the nurses don’t practice like we do and, in fact, I’m not sure they are trained like American nurses, so stuff that we were doing naturally we had to teach them because they had never done it before. They said only doctors did that – like assessments and hourly rounds.

It’s mind blowing to think that when IMC and all the other NGOs pull out that the health care system will probably return to its awful state. This makes me so sad. Some people here seem to think that there will be a small change, but it seems so futile and I can understand why IMC is having trouble getting funding from huge companies based on the, “It’s not sustainable” argument. Even though it’s not sustainable, it doesn’t mean that we shouldn’t try. For example, there is a tent where no patients have been seen by a doctor since February. How can this type of neglect occur? This is something that would never be allowed in the states, but it happens here on a regular basis. People will once again come to the hospital to die. Death is natural, but it sure shouldn’t be expected with a hospital stay. All I can say is that there is so much more work that needs to be done. More training is required before the University Hospital can be returned to the Haitians.

The main thing today that happened was that our vented patient died. He was 18 and involved in a head-on collision on a motorcycle. He wasn’t wearing a helmet. He had been kept alive on the ventilator for 2 days, first in the ED, then with us all day yesterday and most of today. At one point today he stopped breathing on his own and the machine was working for him (up until this point he was triggering his own breathing). After this period of apnea, we decided that it was important to get the family and doctors on the same page. Finally at about 1700 the family agreed to take him off the ventilator and let him die. He was able to sustain life on his own. Interestingly, I only saw one family member sobbing. The others were standing around watching, like it was a show – there wasn’t even much saying Goodbye. One person was even taking pictures of the whole ordeal during his last minutes and afterward as well. It was tragic and extremely sad.

One of the translators came up to me with teary eyes and said, “I don’t know how you can do this.” And I didn’t have much of an answer. You just keep going. There are so many people that need help. If you can only help one or two that’s great, but many are going to be lost along the way. That’s why discharging that patient yesterday was such a huge miracle. His treatment worked and hopefully he won’t be back. Small steps…

We stayed until 1800 tonight (Corey, Trish, and I – in order to cover until the next shift arrived) then proceeded to miss our bus, so we had to wait until 1900. Meanwhile, we headed over to the ED tent where a patient with a gunshot wound had just arrived. I’ve never seen a gunshot wound before. It was intense. I had forgotten the pace of the ED and had I not felt like my intestines were going to explode, I would have been invigorated by it all. While we were helping as we could, there was a code in the maternity tent. People in the ED tent wanted updates, so they handed me a walkie-talkie and sent me over there. It was also intense and the woman didn’t make it. I am still unclear if she was pregnant or postpartum. It was brutal for me to watch the end of the code and heartbreaking to not see any family present.

We ended up getting back to the hotel just in time for dinner, which was great because we hadn’t eaten anything all day. I am very tired tonight and I am sure I will sleep well.

Jesus, thank you for this opportunity and for opening my eyes to what you have cried over. Thank you for the moments complete with utter brokenness. Thank you for times of blissful joy. Be glorified through it all. Amen.

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