I am still a ninja. A body fluid ninja. I thought that I might’ve lost my skills after so much inactivity, but cholera outbreak #3 (occurring exactly 9 months after the original outbreak, for those of you that also find dates interesting) confirmed that I’ve still got it.
A week and a half ago, I was looking forward to sleeping in after a few days of mobile clinics. Jon and I were sitting at the table after everyone had left for the day when my phone rang. On the other end was a semi-frantic sounding Fabienne (medical director for MTI), talking a mile a minute. “Oh good. Does the new guy have Mark’s phone? I think he’s ignoring my calls. I’ve been trying to get you since 2am. Cholera has exploded in Port-de-Paix. Wednesday night they had 50 patients, by last night it was up to 100, and as of this morning they have 250 patients. They’ve overflowed the hospital rooms into the hallway and they’re spilling out into the yard and the walkways…” She continued to fill me in, said she was going up that afternoon with some logistics people from GRU, then said, “Can you come with me?”
After some discussion with Jon about how the week would work (including how we were getting a 16-year-old paraplegic girl to Minnesota
It turned into a Haitian operation. I got to MTI at 2 and waited around for a while. At 3pm, I thought, “Oh, we’ll probably be in the air in an hour,” so I took my dramamine. For some reason, I was under the impression that we were flying up and working the nightshift, since Evangel (MTI’s long term head nurse) and Nick (their volunteer) were there alone. At 4pm, we left MTI and drove to GRU. Where we continued to wait around. When we left there at 5pm, got gas, and then had a brief prayer session, I realized that we were, in fact, driving the whole way to Port-de-Paix. A six hour drive. On second thought, yes, I will eat that bag of Fritos, thanks.
The highlight of the trip was definitely reaching Saint Marc before sunset and being able to see my old house from the street. That wasn’t too long before I got really drowsy and we turned onto a dirt/gravel road. I kept thinking, “Okay, we’ll soon be off this road, then I can put my head against the window while I fall into a coma.” But the road never ended. Shortly before we reached MTI’s apartment around 11pm, I regained consciousness long enough to see the lights from the island of Tortuga
Luckily, I had assumed incorrectly once again, and we weren’t actually going to work the nightshift. So Saturday morning, bright and early, we headed down the street to Centre Medical Beraca. I stepped through the gate and was actually overwhelmed for around 6 seconds. I think I actually said “holy cow” out loud. By that morning, the number of patients had risen to 330, and they were laying absolutely everywhere. It all hit me at once, the sheer number of people (because every patient had family members with them), the smell, and that feeling that I can’t explain. What was different was the noise. It seemed so loud. Maybe it’s because I’ve always worked cholera at night. Whatever it was, after those first few seconds, I snapped out of it and went to work.
We worked into the early afternoon, then it was decided that Evangel and I would go back to the apartment, sleep for a few hours, and return to work the nightshift. I was happy with that – I had actually volunteered myself and kept pushing to have some of us on nights because that’s when things were bound to get crazy. It felt weird doing cholera without any marines, and I was hoping the familiarity of the darkness would make it seem more normal.
The only things I clearly remember from that first night are the absolute frustration Evangel and I felt with the Haitian staff, the stress of all the patients and family members (we peaked at 400) calling us and tapping us every three minutes all night long, and thinking I was going to be sick. At one point, I thought I was going to pass out and asked Evangel to take my blood pressure – 85/50. She’s like, “Why don’t you just sit here and drink your water?” For those of you who have lots of experience with passing out, you know that it makes you feel a little nauseous. Not something you want to feel while working cholera. All I could think of was how embarrassing it would be to get cholera, especially since I’ve said so many times that you have to try really hard to get it. As the week progressed, we discovered that I really only had strep throat…which then moved into my chest. The cough I still have is a souvenir from the week.
I decided I should try to write some things down during the week if I had a chance. From Sunday morning, after our first nightshift:
“One of the 3000 times I was frustrated with a patient and/or family member last night, I said, ‘Why can’t you just trust me?! I’m not going to let you die!’ When I’m not stepping over bodies or watching someone puke rice water on my boots, I feel a little bit of weight from that. Especially since I watched the woman I thought was dying while I held used tape over someone else’s pulled IV site…Should sleep. It’s a trade off – there aren’t dead bodies in the break room here, but I’ve gotta sleep on IV tubing instead of water bags.”
Tuesday
“Scratch that. Evangel and I found the best sleeping spot ever. Absolutely gigantic water bladders full of potable water. Didn’t I just say a month ago that I wanted a water bed? Right outside the gate by the new tents but close enough that we can still hear who’s puking (and a Haitian nurse come change the bag, conveniently enough).
Last night was by far the best (of this outbreak). The staff has gotten into a routine and they evaluate people a little better now instead of just jabbing every person that sits in front of them, so its relatively calm until like 4am. I’m not sure if everyone wakes up to discover they’ve got cholera, or if the nurses get sick of individualized treatment, or just feel like they haven’t gotten to practice their skills enough during the night, but we run a lot more lines in the morning/around change of shift. But Ev and I took over triage this morning. The Haitian nurse moved into the walkway to put a line in a kid Evangel asked for help with because we were both starting IVs in active pukers. So then people that didn’t like that I said they just needed to drink went to her and she stuck them! We’re like, ‘Mm, no no.’ We’re getting good at being mean. Or, Evangel and Nick are; I was already jaded. But she told people that if someone really sick comes in we won’t have fluid to give them and they’ll die because someone who didn’t need LR got it.
Moved mystery worm kid to Urgence. Really humbling when I was first evaluating him this morning – he’s still sunken and floppy but hasn’t been puking for a day and he drinks. Still has weird yellow diarrhea. I was leaving the room to see if there was a place in the tent, still talking to mom. Some woman laying on the table was saying, ‘Nis
Patient count yesterday afternoon was 328, so going down. 122 discharges, 104 admits. The second night was when I discovered I still hadn’t been in the actual hospital. Ha.
Officially have red bumps on my big tonsils and the back of my throat but I don’t feel like crap anymore. The perks of having a fever in Haiti
My last night working was quite eventful. Evangel had gone into town to get supplies earlier in the day, so she planned to sleep for awhile and go in late. I wasn’t wild about walking to the hospital by myself in the dark in an area I wasn’t familiar with. But eventually I figured I had no choice. I went over thinking to myself, “Okay, situational awareness, situational awareness.” So knowing what was beside me caused me to miss what was in front of me. I tripped over some concrete, nearly falling into dogs that were circling a street fire.
When I got there, I found the entrance and back hallways had been cleared out. The census was down to 240. I actually thought it was creepier with all the people gone.
Ten minutes after I got there, I was rounding on the patients in the Urgent Tent and a nurse came running over for me because a kid in triage was seizing. There was not a thermometer in the whole place. He seized again 80 minutes later, for 45 seconds. I got the ambu bag for that one. Not sure what I intended to do with it. Evangel got there soon after with valium. The seizures weren’t cholera related, so my initial assessment had been correct, which was encouraging. He did fine throughout the rest of the night, and we had the doctor see him in the morning.
Around 3am, we heard an ambulance pulling up. Confused, we went to investigate. There was a woman, she looked around my age, very pregnant and in labor. We took her into the actual hospital and stayed with her for about an hour and a half. She’d had two C-sections before and they decided to do another one for this baby. I was trying really hard not to laugh. I’d only been able to sleep for two hours that afternoon because people woke me up to ask questions and Jon had been calling me from Port-au-Prince Nis
Around change of shift, Evangel and I found a guy laying by himself on a bed out in the grass between the Urgent tent and the building. He was unresponsive. He had a line, but it was little and wasn’t running that well. I looked at his hands and said, “Heyyy, a molasses man.” Evangel gave me a really confused look, and I tried to explain while we were both sticking 18gauge needles in his arms. “This is how most people looked in Saint Marc. Because nobody knew what was going on, they were all super sick.” This particular guy was so dehydrated, his veins so fragile, Evangel and I both blew our lines. So we ended up putting a bp cuff around his current bag and inflating it as far as we could to run it in really fast.
After two bags he started perking up, getting a little confused. At one point we had to go catch him so he didn’t fall out of bed. Evangel was talking to two guys who wanted jobs as a translator and I was being the one-on-one for the climber, when a Haitian nurse comes up to me saying, “Problem!” I was like, “Uhh…okay. You stay with this guy, don’t let him fall. Where’s the problem?” In the Urgent tent. I had been there half an hour before, and everyone seemed to be doing well. We were actually taking out some lines and sending some people home. One old lady (the woman I thought I watched die the first night), had been sitting up eating when I was in there before, so she was about ready to go home.
But when I walked into the tent, there she lay on the ground. The huge flies that had been attacking us every morning when the sun came up were buzzing all around her. I checked for heart sounds as a formality, then closed her eyes. Evangel came into the tent then and we both stood looking at her for a few moments. Just a few hours before, the two of us had been talking and she asked if there was something wrong with her because she didn’t necessarily have a lot of emotions regarding all the patients. I told her that there might be something wrong, but I felt the same way, so we were at least in the same place. But we both felt something while we stood with the patient’s husband.
Before we went back to the apartment that morning, we checked in on our new mom. The baby was a girl. Mom was happy to see us. She was really smiling, but she was also shaking. We told the doctor that we thought she might have an infection and he went to examine her. We went to sleep. A few hours later, I was awakened by a phone call from Jon that started out, “Sarah…don’t freak out…” He’d been in a moto accident and ended up missing his flight to the States. He was also having a mild panic attack about getting the medevac patient onto the tarmac. I tried to be very calm. After I got off the phone, I sent my own panicky email to Mark. While I lay there unable to sleep, the doctor and some of the MTI staff came back to lunch. I overheard them talking about the C-section patient. She had died.
Just a few hours earlier, I had been talking Nick through the death of the older lady. He kept talking about what he should’ve done differently – how he should’ve checked on her more or been more diligent with taking blood pressures. I tried to reassure him that he did all he could. This was, in fact, exactly what had happened to my first patient that died – the lady in the blue dress. She had recovered from the actual disease, the cholera wasn’t in her body anymore. But the stress on her heart from the electrolyte imbalance was just too much. That all makes sense enough that I could let it go. But my pregnant lady…that one actually woke me up the next night and I sent one of my friends a “what the heck?!” email.
By Thursday, the census was down below 100, and I needed to get back home for an incoming volunteer. After we’d driven for about three hours, I decided I’d be audacious enough to ask if we could make a five minute stop in Saint Marc. The country director of MTI said he’d do me one better and we’d stop and have lunch there. We stopped at the Deli Mart, the last place I’d eaten out there (interestingly enough, it had been on Thursday October 28, nine months to the day – thanks overactive memory). I was too excited to sit still or eat anything.
When I finally directed Ted down our street (a few minutes prior he’d said to me, “When you’re done being lost, let me know”), it looked like a ghost town. There were no kids on the basketball court. The market was gone. In its place was a fenced in concrete…area. There were still those few moto drivers by the fence harassing me, though, as I walked up to my gate. At the same time, Merites rode up on his bicycle. I called his name and ran up to hug him. “Ou sonje mwen [Do you remember me]?!” I asked. “Wi, Miss Sarah!” he hugged me again. I went through some formalities, then asked after the small child. “Is he here?” “No.” My face fell. But then he started talking again, and I caught enough of the words to realize he was asking if I wanted someone to find him. I said yes, and then he asked if I wanted to come in.
I sat in the courtyard on a kid’s school chair that Merites cleaned off for me. There was a new painting on the wall and two more basketball hoops. (Interestingly enough they were positioned on different walls than before – does this have something to do with me popping the one soccer ball when I threw it over the hoop and into the barbed wire? We’ll call that part of my legacy…) After about ten minutes, I was starting to get anxious. I didn’t know when they were going to find Licson, and I felt bad for the people in the car who were gracious enough to make this “five minute” stop. Then his dad came running through the gate, followed by the small child with a huge smile on his face. I ran up to him and gave him a huge hug. I feel like he’s grown up since I left – he’s definitely taller. We talked for a few brief minutes. Then I said that I needed to go but that I would come back again – I don’t know when, but I will come back. I hugged everyone again and walked back to the truck. Even though I’d said goodbye to all of them in November, I feel like I got a little bit of closure from that visit. Definitely better than screaming goodbye to people across the street while I’m taken away in the back of a truck.
And now here I sit in Port-au-Prince
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