Haiti - Day 9

I'm coming down the home stretch!

It was another busy day (this is a reoccurring theme). It was actually one of my busiest days yet, as I had 7 little nursing students following me around until noon. I tried to keep them busy, stimulated and interested, and I think they had a good time. I used as much French as I could (most educated Haitians can speak French in addition to their native language of Creole) but had to resort many times to my excellent hand gestures. They actually taught me a thing or two - yikes! it has been a long time since I have done bread and butter nursing, which is what we were doing today. it was mostly a morning of teaching, and then when the students left at noon, I switched back to the ER.

It was a very sad afternoon in the ICU yesterday, while I was having my afternoon off. We have had this young kid, just 15 years old, who developed a severe, acute renal disease (Acute tubular necrosis) several weeks ago. He was already in the ICU when we arrived last week. This serious disease requires patients to have dialysis, as their kidneys have failed. Dialysis is vital to their survival. If patient's miss a day of dialysis, then they can develop horrible systemic problems that involve every vital organ. He got dialized a few times last week, and was doing relatively well...

In fact, Dr. Ansell, an MD from Rush Medical Center in Chicago who is on our team now, had arranged through his clout and heart and passion for this kid to fly to Chicago and receive a kidney transplant from his brother. His family just had to get to Miami, and they would take care of the rest. All he needed was a few more dialysis treatments, and he was all set for his life saving surgery.

And then last weekend came.

He was to have his dialysis on Saturday afternoon. We waiting all morning for someone from the dialysis "clinic" to come get him. No one came. We waited all afternoon. No one came. We made calls. We had our director work on it. We had family check into it. Night time came, but no one from dialysis did. Sunday morning rolled around, and he began to have some mental status changes. The lack of any organ or machine filtering his blood of waste and toxins was building up to lethal levels, and was now affecting his brain. He became encephalopathic, and the need for dialysis was now greater than ever. All day Sunday came and past, and the kid never got dialized. Monday he was critically ill and had at this point suffered brain damage.

Finally, the dialysis folks came to get him on Monday afternoon, but it was too late. He had suffered a severe stroke, and by Monday evening, he was nearly dead. He required intubation, and remained on a ventilator overnight.

Yesterday afternoon, while I was floating in the pool, the decision was made to unplug the ventilator and to let the family take their son home to die, instead of passing in this catacomb of a hospital. You see, if someone dies at the actual hospital, they are taken directly to the morgue where the family has to come by the next day and pay $25 to take the body home. ($25 is a ton of money here). Instead, we let the family take him home to die in peace.

We discovered today that the dialysis team just decided to not work this weekend. Just didn't show up. Maybe they weren't getting paid...who knows. The point is - how can one ignore the complete irony of the family having to pay the ones responsible for killing their son?

This story makes me sad, and angry. This is just one example of many that reflects how messed up the system is here. We wait and wait and just watch people die. It is a horrible thing to know that at some times, our hands are tied, despite our passion and best efforts. This was a life that we were going to save, and for many reasons that are hard to explain or accept, we didn't.