“Take his leg? Just kill my family! You can’t take his leg!”
Angelo Caery was a tough young man, a laborer in Port au Prince, with a pretty wife and a couple of kids about four and five. When the building fell on his leg, he was trapped for a few hours, and when the remainder looked like it would pancake him entirely, he yanked his leg for all he was worth. He “degloved” it — a medical nicety for stripping all the skin and tissues from above the knee to the tips of his toes.
He got loose alright, and with the hospital in Port au Prince crushed and overrun, squeezed onto a motorcycle between the driver and his wife and rode the five hours of lousy highway out to family in Les Cayes, on the south peninsula, and thus to us at hospital Cite Lumiere.
We’d been debriding his leg — a medical nicety for scraping away dead flesh — for five days now, the narcotics long gone, his screams echoing off the cinderblock walls, and it was time for a decision.
We took it.
I flew medical supplies for Bahamas Habitat. I used a single-engine piston, a Cirrus SR 22, out of Birmingham to Ft. Lauderdale, staged in Nassau, and then all over Haiti. The 22 has a whole-frame parachute…but we’ll get to that.
It was a great flying adventure, but it eventually came down to caring for smashed and neglected people, and later, cholera. I met some heroes, got hooked, and I’ve been flying down ever since.
I mostly worked the night shift, and I took notes.
Declared another dead last night, and this one hurt.
A battler, she came in just as I started the first night, with bad asthma and advanced lung disease, in her 70s. Sweet, needed a lot, and wasn’t afraid to ask for it, but so grateful for everything. She offered up a piercing half-tooth smile.
Then last night it was harder. She was clammy, working her ass off, like my Mom in her last days. I gave her morphine, bronchodilators and Lasix, held her hand awhile, made some dumb joke and kissed her like a politician. She was unconvinced, but knew we were out of wriggle room. She just nodded, wheezed mesi.
Later, her O2 sats dropped. When I increased the O2, she retained CO2. Steroids and bronchodilators failed. No BIPAP or ventilator in Port au Prince, and I was out of outs. That’s lonely.
I’m spring loaded to treat cholera here, but asthma management — well, that’s lost in the recesses of residency some decades ago. I needed William Hays. He’d have thought of something…
Later I fell asleep. They woke me to her gasping, so I listened as her struggle diminished, then quit, and then two minutes longer, until her heart stopped its ragged rhythm altogether. Without the rasping breathing I could hear aortic stenosis. Shoot, I didn’t hear that before! Is that just agonal? Maybe Lasix was the wrong call. Well, she’s apneic now, we’re below minimums, there’s no missed approach from here.
At home, they call me to pronounce patients occasionally, listen to a silent chest a minute, nod to the nurse, record the time of death like an umpire. They ain’t balls or strikes until I say so.
But it’s rare to listen to life as it ebbs away, whisper a goodbye and godspeed as it all runs down.
The nurse blurted she’s dead, she’s dead, but I said wait, wait. Her daughter was at the foot of the bed. They never know, it seems obvious, but they never know. And sure enough, just like my Pop, she took another rattling breath, a second, a third, Then, muscle’s long memory lost at last, she finally went still.
Then I told her daughter she was dead.
And all hell did break loose.
The hospital grew in my absence, always another ward or two, and with the rain, this time they were all packed to the rafters. There were 85 cholera beds filled last month, now there were 210. The emergency room doubled to 24. With the GI lab to deal with, I planned on day work, but the only doctor on hand is Matt Cohen, a family practice resident from Ohio, overworked. I took pity. He knew some French, so he took ER, where they might say anything, and I worked the cholera ward, where weak Kreyol was enough. Saturday night went well enough, crazy fast, but not chaotic. People nodded in chairs along the walls, waiting for a bed.
At midnight we admitted a 25-year-old woman in a coma with a fever of 40.5*C, quietly exuding something from every orifice. Her lower belly was hard. She was plenty big everywhere, but bigger there. She felt pregnant, but I couldn’t hear fetal heart tones there in Grand Central.
Tried that portable sonography unit.
Sure enough, it was a boy, all four heart chambers squeezing along at 148, which seemed about right. Impressive. That temperature usually kills a fetus pretty quickly. Junior sucked his thumb, greedy for life. It’s a terrific machine.
Live, Junior! Bide your time, get out of that hot oven and kick ass.
But the mother wouldn’t cool off, and she wouldn’t wake up. Before the night was done, I chilled her IV fluids and treated her for cerebral malaria, meningitis and urosepsis. She didn’t die, but the morning feels like ten rounds, no decision. Time for bed.
Back Sunday night, and there again was Simone Galsfar, hanging on, her temp 40.2, and the boy’s heart rate 148, tick, tick tock. Repeated the same. Malaria should be a little better by now, the cholera was a little slower, but she still foamed at the mouth, responded only to pain, and only a little. I catheterized her to see the urine. It looked OK, but I needed a microscope, needed a lot of stuff. Just a month ago, I bragged to my partners about all the progress I can make with just a history and physical and intuition, but I cursed that process now.
Admit it. We’re great seat-of-the-pants flyers only because we have attitude indicators.
So I sat thinking of William Carlos Williams’ haiku about the red wheelbarrow, written in the kitchen of the girl he was caring for, waiting to see would she live or would she die.
But Williams didn’t have cholera banging at the front door and the back…
So I transferred her to Med sans Frontiers’ high-risk OB hospital, freed up the bed, and now I’ll never know.
Just like Taicha Inocent, the bravest of the five-year-olds we cared for, and fell for, in November, in that desperate slum clinic at Warf Jeremie, near Cite Soliel — we’ll never know. We cleaned her up and IV’d and NG’d and spoon fed her, and cleaned her up again, and again, watched over by her nine- year-old stoic brother in his overwhelmed parents’ absence. No charts that frantic night. No dossier attests to her fate.
Taicha made it through the night, still touch and go, but we transferred her to St. Damien’s, and no amount of call backs or revisits could turn her up.
Either we lost her altogether, or she disappeared into tent life — that addressless, unnoted existence, just another vapor in the miasma that brewed her. But which was it?
So I reckon we’ll lose track of Simone Galsfar, or just lose her outright.
Junior’s story may or may not unfold, may or may not be told.
But I say LIVE, damn it!
A) Benezet was brought in by wheelbarrow. I guess it took awhile.
The Istat is a handheld device that measures electrolytes. It is notoriously finicky. It needs to be refrigerated, but not too cold, or it jams up, and humidity is also a problem. Well, today it worked, and his sodium was 165, about as high as I’ve seen.
He looked dead from the get go, and then he was, before we got an IV going, or an NG, or even a first name. Amazingly, my first cholera fatality down here. I wish he gave me a better shot, but it was inevitable.
After the sweaty shift, there’s a mass at 7 p.m., and I go, mostly to hear the cacaphony of language. They’ll sing in Latin, English, Kreyol, French and Spanish, and it always begins just as the U.N. camp across the way — they’re from Bangladesh — calls muezzin. That’s pretty discordant, and I’m not sure if we infidels can count Arabic.
But there is Benezet on the floor of the chapel, an embroidered shroud over his body bag. There’s a dead lady adjacent. I know her story, but she wasn’t my patient — an OB complication, now looking diminished, a young father tonight trying to cobble something together, his gratitude over the new baby tempered by reality’s grim bite.
Night falls fast nearer the equator, and the chapel is dark, candles guttering in the still brisk wind. There’s a little incense, and Benezet’s shroud shudders some in the breeze. The candle at his feet magnifies the movement in swirling shadow.
Rick Freschette, the carpenter pediatrician, wears a white cassock, a priest tonight, the 15th Sunday in Ordinary time, and he sends them off praying for dignity and comfort in their new estate. The six living — we kneel, we all touch them, say Kaddish, the ancient Jewish prayer transplanted whole.
He doesn’t dress it up much. This comes up a lot. He mentions the laying aside of life’s burdens, shaking off this mortal coil. It sounds peaceful.
The shadows do their part, and Wynn Wylant breaks into a Protestant hymn, set to the triumphal chorus from Beethoven’s 9th, but he sings it like a plaintive West Virginian mountain crooner. You’d hardly recognize it if you didn’t know it already, and instead of the joyful finale, the tune drifts away, fades down to nothing.
Things are closer to the heart here. You lose them, say a prayer, and bury them that day, but you don’t lose sight of them.
We could be Orthodox Jews.
Simone Galsfar made it, and Junior too. Benezet’s minion.
Hectaire. His first name is Hectaire. Or was.
He was 55, not young, not quite ancient, and apparently had a full schedule for the day he died, so the diarrhea was just an impediment, another obstacle to work around.
Certainly he’d had others, in a life as full as any, and no reason yet to think this was more than the typical nuisance he’d managed before, among various nuisances. But it didn’t stop. It got worse, and soon he was thirsty, lightheaded. A man in full, though, not one to let the incommodious hold up the necessary.
He worked on a bit. His stomach cramped. He vomited once, then again, realized he might really be sick. Time to get off this mountain, better see about this.
So the slow trek over uneven ground commenced, off his own played-out share, and on to others’ stony soil, punctuated pretty often with uncontrollable diarrhea, smeared, wishing for water despite the cramps. By now he knew his fate.
Down the mountain he passed others, with their knowing looks, and they turned away. Nobody healthy walks off the mountain. A couple of tap taps slowed, then sped up, the passengers shouldering up in the back, trying to sit bigger.
Finally, his skin etched across his face, eyes sunk, he collapsed near a shop wallah, bad for business.
The shopkeeper hired a boy to carry the man in his wheelbarrow, and in another hour or so, he reached St Luc’s, the boy sweaty and scared. Wheeled straight through the gate and past triage, where they transferred him to a handheld stretcher, poured him in, really, as the boy scoured the wheelbarrow with clorox. There we met him, or saw him anyway, clamped down, past pressures, past caring, slimed and clammy, pulseless, eyes clouded, but breathing. The Istat was not useful, but it was handy, and I couldn’t stick him — just nothing. Hustling now, hunting for an intraosseous line, gathering the NG tube and goop, but he was dead, just like that. The fever of life was cooling already, the bustle of the day laid aside, now and subsequently. There was no family near, no inconvenient mourners smashing themselves about, bellowing. Lucky us.
There was a funeral mass sufficient to the day, and he went into the fridge with only the last name.
So in the grand tradition, “I stand on the ground he stood, and take up his load,” or at least tell his story.
Three days in the fridge — was it Lazarus? — but no redemption here. His two sons came to pick him up; the wife stayed home.
He was a farmer, grew mamba and some coffee up in the hills near Kenskoff, but not all that much of either, from the look of him and his.
With flatter affects than I expected, they took him home in a tap tap, apparently a lesser threat dead than alive, and that was that.
Hectaire, they said, and not much more.
It’s raining hard again, so a light week will end rough, the reeking roadside gutters frothing foul and brown.
Fixer upper, bay views
No need to mince words.
Cite Soleil is a dump. A pigsty. Footing is rancid muck at low tide, and the scrabbled shacks so leaky you have to sleep upright in the rainy season. The stench will do for your appetite.
Pigs thrive, but people look transient, the kids in tattered shirts, with excoriated skin eruptions. Open cook fires result in horrific burns, which fester untreated.
The ramshackle structures had one advantage. Nothing much was lost in the earthhquake.
It’s a notoriously lawless place, violent, run by various thug outfits. There’s disproportionate mayhem, and the police don’t care to go in after dark. Women are at risk.
The hind end of it, on the bay, under the middle marker for the ILS for runway 10 (what the hell; add jet noise to the mix), is called derriere chabon, behind the charcoal.
The place is just chaos, entropy’s bitter end.
In Rick Freschette’s words, a fixer-upper.
He doesn’t seem to think like the rest of us.
Lives in hand, we took a mototaxi to see what he’s doing down there.
He went down to confer with the gangsters he hired at shop rates to build his primary care clinic and hospital. The plan is to treat basic problems here and refer the sickest ones to St Luc’s. A standard hub and spoke system that works better for medical care than air travel.
He opened an internet cafe there, too, but it’s been slow going. The net company stiffed him, or at least didn’t fulfill the terms of the contract.
Just advancing the concept surprised me — no water, no electricity, no solid structures:
“Rick, what the hell are you doing setting up an internet cafe?
“Well, how are they going to participate in the modern world, look at Craigslist, submit a resume, get a job without net access?”
“Rick, they don’t even have pants.”
“Right, they’ll need to get those, too. Make a list.”
A tough guy to argue with.
First, he got it off the ground. Literally. All that rubble in downtown Port? Just scooped it up, lay it in Cite Soliel and built on it. Dry feet.
The hospital will be pretty nice: open wards with enclosed bathrooms in the back, a throughway in the front, like the cholera hospital layout.
He used the gangsters to build the hospital and the adjacent residences. They’re not bad as builders, and the result compares well to the surround.
They seem proud of it.
He visits them daily, talks things over (and counts the silverware, I suspect). It’s a vigorous discussion.
They come to some agreement, everybody representing. They connect with him.
Later, he wants to power it with solar panels (possible), truck in water (expensive) or build a water tower (very expensive), and lay out septic lines (Nah. This place couldn’t pass a perc test at gunpoint) or collect the honey pots with a very expensive truck.
Honey pots? What, they called in George Orwell to head up the department of obfuscatory monikers?
But you get the idea.
Start with a completely naive assumption.
Everybody everywhere deserves a little dignity, something clean and decent in their lives regardless of the setting.
Then pretend everything is normal and try to make it so.
In just a short time, this leads to surprising ideas.
I spent most of my time looking down, at the pigs and the filthy kids, at the amazing cluster of garbage and detritus at the water’s edge. That’s a doctor’s view, I think. Feet of clay.
While I looked down and asked why, Rick looked up at the bay, blue in the distance, and the mountains circling it — so Santa Barbara, so Santa Cruz. He looked at the top half and asked why not?
That’s what faith will do for you.
But when I looked up and squinted a bit — a process made easier by my lack of wraparound shades, which would have kept perilous quantities of grit and road dust out of my conjunctivae — when I looked up and squinted…
I could sort of see what he was talking about.
January 7, 2012
Not all the flights worked out.
Flying a small plane over long stretches of water has associated risks, and you pay with those anxieties for cruising through customs. We carry a raft, lifejackets and a GPS phone, just in case, God forbid, we go into the water.
An annual inspection and some maintenance is required. Work was done in Tamiami over Christmas. The mechanic flew it, then I flew it, then we took off the cowling and looked it over. It looked good, so I took off for Port au Prince with my daughter Elaine. About an hour out, the oil pressure fell to zero and the engine seized, the propeller upright like a snaggled tooth. We set for best glide speed and looked for the nearest airport, 62 miles north to Bimini, all open water, 65 west to Andros, but 20 of that is over land. We turned west, made it 43 miles but, a couple of miles offshore, it’s clear we’re going into the water, time to pull the parachute, and we slam stopped, then glided into the water at 17 knots. It beats ditching. Out onto the wing, inflate the raft, hop in, and it’s just another beautiful day in the Bahamas, turquoise bleeds to indigo, and here comes the Coast Guard helicopter. Let’s airlift to Nassau, where instead of “yield” the signs say “give way.” We did.