Update from Haiti: "Today was more hopeful." #HaitiDrDispatch continues


 

I received the following as a series of 30 text messages from Anil. I've made minor spelling and grammar corrections and have tried my best to fill in missing words using brackets and add some light styling for readability. I've also added a few links to the medical terms and locations. 

After yesterday's heart-wrenching update many of you asked what could be done. I passed that question on to Anil, and he answers as best he can in his first text back.

 

 

Anil Menon

(7:24pm)

I think people in the U.S. can help by keeping this on their conscience beyond the immediate suffering. Imagine the post earthquake devastation?

(10:31pm)

There is a beautiful luxury hotel called the Villa Creole where the likes of Sanjay Gupta and Anderson Cooper and their respective entourages are staying. The owner took pity on us and provided a floor of her conference hall for some of our group to stay in. The other half is staying on the floor of an abandoned building, in tents. The end outcome of this is that I got to see the huge machine of 100s of people that bring us live feeds from the epicenter, and I wondered what I can add other than write texts as self-therapy. They serve a valuable role of generating help and awareness but also have a specific bias. I feel guilty even camping in this place, but I'm glad for the opportunity to take a deep breath before going at it the next day. 

Today was more hopeful because more help came and more people were helped but also brought with it more complications. Our ER was supplemented by a few additional doctors. Tracy was exceptional. She started reducing fractures from the moment she hit the door, and together we couldn't get a line but put ketamine directly into [the patient's] femoral vein and quickly reduced her hip dislocation. The scary thing is that when our pain medications ran low we had to continue to change wounds and reduce fractures to provide care, and it wasn't easy to induce more pain. More pain meds are on the way. 

The vast majority of injuries are delayed treatment of huge lacerations and fractures. Lacerations can't be closed after this time period because they will trap infections and become worse, so you leave them open, keep them clean, cut away dead tissue, and bandage then up. One cute 8 year old who still had barrettes smacked me when when I began changing her bandages. She was seriously upset. It was funny at first, then tough as I saw the big lime sized chunks of tissue missing on both legs. Luckily, unlike many others, they were not infected, so I cleaned them with betadine, and packed them and bandaged them up. I can't say she smiled afterwards, but she didn't cry, and she looked at me quietly, and for a moment things were okay. 

When a femur or tibia fracture comes in, we check to see if it is open and has penetrated the skin or is closed. The open ones go to the [operating room], they are usually infected, and usually lead to amputations. That means [people] who would have just broken their legs and be back on track in a few months, are losing their legs. The closed fractures, no matter how bad don't have priority for the OR and can't be x-rayed, so I put them into place as best as I can estimate, make a splint and give them Tylenol and send them home. I know home doesn't exist so i feel bad, but there are so many people to see and very limited post operative space. That said, new buildings open up.

Bill Clinton stopped by (but our [Emergency Dept.] director Bob Norris was too busy to look up. I also have a feeling he voted for Bush). A crew of 30 Haitian doctors from New York showed up, and a few Swiss pediatricians. The army also offered to helicopter out a few complicated patients. It seemed like things were happening, but at the same time with more doctors, more bodies, and no authority, the early organization of [the International Medical Corps] has been difficult to maintain. One ER physician was working with us and then told me he didn't know how to do a splint which made me wonder if he was a physician. Most everyone is very good, and even this guy was very nice. 

Where do they go? What space do they work in? How do we communicate? How do we play nice? Hopefully these questions will be continually solved as it grows bigger. If we keep the big picture in mind, remove any ego, and keep maximizing care it should improve.

 

(10:47pm)

I saw Chelsea Clinton today and said, "Yo chelsea, we got the Stanford crew here." Bill somehow could get. A few people to the carrier. Not sure if it was a photo op or something.

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag