I received the following as a series of 17 text messages from Anil. I’ve made minor spelling and grammar corrections and have tried my best to fill in missing words using brackets and add some light styling for readability. I’ve also added a few links to the medical terms and any news events referenced. 

Anil Menon (10:25pm)

Ohh you got me started, today was a blur because we were pushing so hard. There was a 70 year old woman, pulled out of the rubble today. She was thin, talking to us but quite stoic like everyone else with a tibia and fibula fracture. 

There was also a 14 year old girl pulled out yesterday. The family was sitting for dinner–mom dad and three children–when the ceiling caved in, and they spent all this time finding this girl (the other two died). The dad brought her in because she had pain in her right leg and now couldn’t move it. 

The leg was tense, swollen, painful, and appeared to be a fracture which transformed into a compartment syndrome. Heather, our nurse, and I attempted an IV and couldn’t get one because she had no water in her system. There was one vein in her neck I could see but her skin was so tough for a young girl, because of dehydration, that I thought I would fail, but with a little luck, I saw a flash of blood and we started giving her fluids. Given the OR precedence for infected, open fractures, I didn’t expect her to get an operation and feared we might lose her leg. 

A Belgian group of nephrologists brought some dialysis machines. Soft spoken and concerned, they offered their service today, and they had the ability to check blood levels of electrolytes with an i-Stat machine. I wasn’t sure about the utility in our acute ward with the complexity of doing dialysis. 

We started with this girl and to our surprise her creatinine was 9 and potassium was 7 [baratunde note: i’m not a doctor, but some quick web research reveals these numbers are astoundingly high] and the nephrologist got a little nervous. He wanted to take her, so I started a central line in her right groin for dialysis, her father watched with hopefulness and trust that I couldn’t believe because my interpreter, who was helping out, couldn’t explain things perfectly. I save my morphine supply for the little girls so I think she was okay (if I didn’t have that morphine it would be too painful for me). They took her to dialysis, and she came back looking a lot better. A lot better. 

It is worth saying that the next 3 creatinines we checked were 14, 9, and 11. The nephrologists were overwhelmed and didn’t even want to check them in that older woman that was rescued because they were full. 

A woman told me that “no matter what you Americans did in the past, you were here when we needed you, and I love you”. It was good to hear that. The 82nd airborne arrived today and have made it a lot easier for the hospital to function. I also think we’ll have food and water for patients. Thanks for all of that.

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he’s part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

Posted via web from baratunde’s internet scratch pad

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