What a day!!!

Monday morning: Well we should be careful what we ask for. Literally minutes after writing that last sentence a batter white pick up pulled up out front the guest house. The drivers side window was broken with a large indent on the drivers side frame. A young woman sat in the drivers seat complaining about her arm. In the back laid 2 young men about 20, victims of a motorcycle accident. Both were awake and moving but one had an obvious head injury and ankle fracture dislocation and the other had obvious femur fractures, one open, an open foot injury, and open knee and an arm fracture. Chaos reigned as people climbed in and out of the truck, flashlites and head lites like lightening bugs flitting around. The truck was backed up the drive way and across the street. We crossed carefully looking left and right several times. The 2 stretchers available were retrieved from the back and with multiple chiefs and a lot of indians, the men were moved to the stretchers and wheeled to the OR, the one air conditioned room with good lights at this time at night. Blood dripped off one stretcher and the team divided. The ankle dislocation was closed reduced and splinted and the head injury assessed. Immediately, we realized that he needed transportation to a larger hospital. Tim began working the phones. University of Miami hospital agreed to take him IF he lived until the morning. LeeAnn and Susan, working in tandem with Majid monitored him through the night and with help of medications, he was still alive and breathing on his own this morning when a van arrived from the hospital to transport him to Port Au Prince, about 2 hours. No portable O2 tanks were left, so he will need to breathe on his own. Our fingers are crossed. As we were working frantically in the OR, a large bang was hurt from the supply room. We thought something had fallen over but NO…the autoclave door had exploded as the pressure went up. We have a small autoclave but it will not do the larger rods we need for an external fixator. Kathy devises a plan to get our equipment ready. The other young man underwent emergency surgery and with Ruth, Naomi and Sathe as surgeons, Carlos as the outstanding ortho tech, and Jessica, anesthesia, his humeral fracture was splinted, traction pin placed in his right tibia and traction hung over an IV pole with an xray gown folded and laid on the base to keep it from tipping. His left leg was prepped. Debridement began and we pulled pieces of paint, metal, gravel, dirt from all wounds. Irrigation was done and after several hours, his wounds loosely closed and a traction pin placed. A long splint was placed to stabilize the foot and knee as well. Then the long nite waiting continued. Susan and Jessica monitored him until morning. In the morning, a group discussion was held. Both are critical. Only one can go to Univ of Miami hospital. After discussion, the young man with the head injury was loaded into the van along with Leeann and Majid, anesthesia. They will likely stay at the UofM hospital til tomorrow and assist with their anesthesia needs. As they left, the other young man, took a turn for the worse. He desperately needs blood. We have used all the volume expanders. A hospital 30 minutes away has some blood but will not release it without knowing his blood type. No one knows. After more phone calls, a place was found to do a blood type. Blood is drawn and we are waiting for the technician to arrive. We are all sleep deprived but glad that both patients have survived.

Clinic is about to start. A borrowed autoclave has been arranged. The trade off is we will take a patient from that hospital who needs some dressing changes. The blood that is available if the blood type is right is in the oppositie direction. The team is assigned: 3 to do ward rounds and dressing changes, 2 to stay in the OR monitoring the patient and the rest for clinic. I’m posting this now for Ruth…more later. Naomi