Thursday, April 26, 2012

A Sign in Haiti

Claudia in St. Catherine's Emergency Room, Cite Soleil--April 26, 2012 (Photo by John Carroll)


We lost our beautiful mother two years ago today. The last two years I have lived with a deep ache in my chest.

My mom meant everything to me.

As I prepared for pediatric clinic in Cite Soleil today, I asked my mom to send me a good strong sign that she is ok.

And for some reason before I left for clinic today, I threw one sterile Vidacare intraosseous needle (IO) into my beat-up doctor bag. Vidacare Corporation generously donated many intraosseous needles for me to use to treat cholera patients.  IO needles are put directly into the marrow space in the bone for people who are in shock and have collapsed veins. The marrow contains a great plexus of venous channels that will accept iv fluid very quickly.

On this trip I have never packed an IO needle because we are not seeing much cholera in Soleil, and the Haitian nurses I work with are excellent at starting IV’s in the usual fashion. But today I packed the needle... 

Pediatric clinic went well this morning considering this is the rainy season and mud and water are almost everywhere in Port-au-Prince and in Cite Soleil. Hundreds of babies showed up for for clinic with their mothers even though many of their shacks and tents are flooded inside.

After pediatric clinic was over, I walked across the street to St. Catherine’s Hospital and worked the ER this afternoon. 

It is a tiny ER with three stretchers and one MSPP (Haitian Public Health) doctor. This serves as the only ER for hundreds of thousands of people in the slum.

We had the usual slum sort of ER medical problems today. But when I poked my head out the ER door early this afternoon, I noticed a lady holding her tiny baby sitting on a bench a few feet from me.

The baby appeared parched and gaunt and her little eyes were sunk in her head. And she wasn’t moving.  
As I quickly gazed at the baby, her mother began crying. She said her three month old baby had diarrhea and she had come to Soleil from Croix-du-Boquets to try and save her baby.

I rushed her in the ER door and had the mom put her tiny baby on the first stretcher. The baby’s name is Claudia. And I "guestimated" her weight to be about ten pounds. 

Claudia’s hands and feet were cold and she was breathing quickly. I could not feel her femoral pulse. She was clamped down. Babies like this die sometimes within minutes after arriving at a health center. 

She needed a line right away. But she had "no veins", as we like to say.

The Haitian doctor slapped a way-too-large oxygen mask on Claudia’s face and turned on the oxygen to six liters. We used an adult pulse oximeter and taped it to three tiny fingers on her right hand. Claudia's heart rate was about 200. 

It occurred to me that I had my IO needle in my bag a few feet away. I opened the bag and opened the sterile needle.

I thought of my mom watching and urging me on. She urged everyone on her entire life. 

I quickly prepped Claudia’s little shin bone on the right and felt for the flat spot below the knee cap. This was going to have to be it.

I pushed the thick needle through her skin and skewered the cortex and drove the needle into the center of the bone. Claudia moved a little and made a weak little pathetic cry. I aspirated blood from the inside of the bone and we attached the IV solution. 

But the iv didn't drip well. It just didn’t seem right.

So I removed the IO needle and felt for the landmarks on her tiny shin again. I stuck her again. The needle seemed like it entered the bone and I had good blood return on aspiration again. 

We hooked up the IV again and it happily dripped microdrops of fluid back into Claudia's bloodstream.
I gave her about 150 cc’s of fluid through the IO needle and a pediatric nurse came down in an hour and after a few sticks was able to obtain a 24 gauge IV angiocath in Claudia’s left forearm. And it worked too.

Claudia quickly warmed up and began to breathe hard and fast. She had a reflex sort of breathing as she was breathing off her volatile acid to compensate for her non volatile lactic acid that had built up.

I held Claudia’s right shin to secure the IO needle. I kept thinking of my mom.

Claudia opened her eyes and stared, but she did not track. Her pulse came down to 160, then to 150, then to 140 and her breathing slowed to a normal rate. Her little body liked the IV fluid.

As time went by, she began to kick her legs some and developed a stronger cry on stimulation.

We gave her a strong antibiotic in her iv to cover her for sepsis.

We drew labs. Claudia's hemoglobin was 7.9 and her white blood cell count was 21,000. And her glucose was 173.

So what now? Time to admit? What would my mom do?

I went and got a Haitian pediatrician friend of mine who works during the afternoons in the pediatric ward at St. Catherine's.  She came to the ER and “eyeballed” Claudia. The pediatrician said to send her away because the hospital closes after 4 PM and Claudia would be on her own on the pediatric ward.

Right after this discussion,  my mom gave us another miracle. My driver Jean-Claude miraculously showed up in front of the hospital with his beat up truck.  I ran to Jean-Claude and told him that we needed to take a very sick baby to a children's hospital several miles away called Petit Freres et Soeurs. He agreed right away.

So I ran back to the ER, took the baby’s oxygen off, disconnected the pulse oximeter, and carefully carried her across St. Catherine’s courtyard with people holding the IV bags up in the air. 

I carried Claudia carefully attempting not to fall in the street in the commotion. Jean-Claude was parked too close to a canal of green stagnant water and so I motioned for him to pull up so I could get in the front passenger door with the baby.

I pushed my way into the front seat protecting Claudia's head and her IV sites which were keeping her alive.  The IV tubing went out the window and up to the IV bags that we hung from scaffolding hanging off the bed of the truck.

Claudia’s mother shoved in besides me. 

Jean-Claude took off. And when he would hit about 20 mph the truck would start to wobble. 

As we wound through the streets of PAP, things did not go well. The streets were packed with huge water filled potholes, car breakdowns, and chaos. Jean-Claude is a skilled driver and actually drove into oncoming traffic many times blaring his horn for drivers to give us room.

And whenever we slowed or stopped in traffic, which was often, people would stick their heads in the cab and gaze at Claudia. 

However, when we reached the airport area we were almost out of gas. So Jean-Claude pulled over in a gas station and screamed how much he wanted to the attendant. We got a little gas and threw the money out the window.

We left the gas station and Jean-Claude was shifting hard. And each time his hand came back off the stickshift, his right hand hit my left hand which was cradling Claudia's beautiful little curly head.

During the trip Claudia looked at me quite a bit like babies do.  She was tracking very well. And at one point I thought she gave a little baby smile. 

I couldn’t quit thinking of my mom making this happen and guiding all of this from Heaven. I knew Claudia would make it.

We entered Tabarre which is the section of Port-au-Prince where Petit Frere et Soeurs Hospital is located. But we had to go down a dirt road with deep water. I was mentally preparing a plan to get out and carry Claudia the rest of the way through the water because I could see the hospital about one quarter mile away. 

But Jean-Claude is unflappable and handled this impossible last road and water barrier with his normal acumen. As we wheeled up to the hospital gate, the guard saw the baby in my arms and told us to go “fast” to the ER.

I carried Claudia into the ER and her mom followed. 

The ER was filled with 20 babies in all sorts of distress. And there was one very hard working Haitian doctor in charge.

I gave Claudia another bolus of fluid in the ER because I think we fell behind on her hydration during the horrible trip through the streets.

The Haitian doctor seemed competent and polite considering the circumstances. She was writing orders and Claudia’s mom was calmly holding her when we left. And Claudia was asleep and peaceful.

Mom, you sent me a definite sign today. I am a weak person and needed a sign from you. I know you are fine. I miss you so much I hurt. Thanks for giving all of us a great life. Help us live our lives like you lived yours. And thanks for intervening for Claudia today. 

Say "hi" to dad and to everyone up there...

See you Mom.

Love,

John 
www.haitianhearts.org


2 comments:

Karol said...

I love this post, John. Wish I could be there to help with little Claudia. I too miss Laynee with every single beat of my heart. Mary, hold my baby close and give her lots of kisses for me.

David Volk said...

This was meaningful, John. I recall encouragement your mom gave us, frequently. Thank you. God bless.