Which way out.

"Please... Please let me in."
Don't shut me out I won't let you down.
Alway here, never left. Never left you
You never left me.
Finding what's right, what's still left to say
Trying to believe in the best of intentions
But still wondering if, deep under the water
If I had something to do with it.
If it had something to do with us.
Fixing by adding, one-plus-one-plus
Keep piling on until one day we turned around and found nothing left.
Two wrongs. Trying to make it right.
Trying. That's all I can ever promise.
Taking on another project- who's collecting broken wings now?
Who's the one with the mangled menagerie?
Darting, cagey, but holding my cards out for all to see.
Jumping- was that the word?
Shall- ten extra points?
Wet- aren't we?
Deep under water, yes. There's a dim silence in the night, between the swaying trees and creaking rafters.
There's a quiet longing.
A jeweled threat.
A standing offer.
Whether right or wrong the "only thing left to do is jump..."
I'm excited about possibilities. I have faith in the right opportunity. I am keeping my head out of the drink. Treading water well.
But it's still just under my chin.
And I'm not sure I would like it any other way.

Home.

Back home now. There was some confusion in the morning Thursday that had us waiting for our pilot for 4 hours at the Les Cayes Airport. It's the same in many tropical places - island time! Our trusty old jalopy of a Cessna carried us through the green mountains north of Les Cayes and out over the Caribbean. I was so sad to leave so much suffering behind. Sad I couldn't do more, sad to leave the few friends I had made. There's so much to do there, so much. I felt selfish about wanting some vietnamese soup, a bigger seat on the airplane, and a long, long, long shower. Guilt creeps in a little around the corners - but I have to remember the standard is so different in the US. We all do what we can. I paid what I am sure is a year's salary in Haiti for a sooner ride home. Got home at noon on Friday - tired, but running on adrenaline and the excitement of being home.

Everyone asks me "How was Haiti?" At first, I said "Great!" and kept a positive attitude about things. As Friday wore on, I started feeling a little worse, a little overwhelmed and got more honest about it.

"Interesting."

"Nuts."

"Intense."

I tell the stories about the things I saw- the maggot-infested leg, the amputations, the lack of care, medicine, supplies, organization. The people I met - the thankful teenagers, the singing man, the surgeons both Haitian and foreign doing all they could. The frustrations we all had.

I don't tell enough, though the things I learned. I learned some about myself and I strengthened my faith in the inherent goodness of the human spirit. Most of all though, I was reminded that the only thing that matters in life is relationships. I am convinced that if there ever is a Judgement Day, we will not be judged on the merit of our actions, the purity of our intentions, or certainly not the size of our cars or houses. In the end, the only thing that really matters is love. I believe that if there is ever a judgement to be made, it will be based on the love that we give and the love we receive.

Each of us exists tenuously. Some of us are lulled more than others into a mistaken sense of invincibility or immortality and this breeds irresponsibility. Everything you have could be taken from you in a moment by a car wreck, a gunshot, an earthquake, a hurricane... And what will you have left? What do you have that cannot be taken from you but the love of your family and friends? What thing in your house, what shiny possession or green dollar bill or job achievement will carry you through the darkest, loneliest times in your life? The people I met in Haiti have nothing but the clothes on their backs, but they smile and sing anyway because they still have love. They have eachother.

There is so much that drives us apart - our cell phones, computers (the one I'm typing on...) transactions, closed-up cars and fences that get in the way of real human interaction. One of the 10 principles of Burningman is decommodification - "resisting the substitution of consumption for participatory experience." (www.burningman.com)

/soapbox

I could preach forever, but I'm not here to criticize or give some sermon on how we need to change the world and tell you the American way of life is bad and all that.

It's just that I got a big reminder to keep the people in my life close to my heart, and let them know how much I love them because at the end of the day, they are all I have ever had, or ever will have.

Day 5 - Wednesday

Wound care again today with people I know. One woman sang hymns to cope with the pain of her dressing change. These are incredibly stoic people. The 4-year-old near the nurses station was hit by a car recently and thankfully had no other injuries besides extensive abrasions on her face. I was asked to put some neosporin on her scabs. She eyed me suspiciously when I sidled up to her, so I blew up a glove as a balloon and handed it to her. The international sign for "It's gonna be ok." Her little face lit right up. She bounced her new toy off my arm and turned her head to the side patiently while I applied goop. She grinned and waved when I moved on. I stopped to play peek-a-boo with her later, and she waved every time she saw me the rest of the day.

The little things.

There was a kitten in the back room where I was organizing. It was shy, but every time I went back to work it would come out from behind the boxes and meow loudly. Whether it was mewing for its mother, some food, or just to be heard, I'll never know. I don't speak enough Creole.

As I walked back to the guest house for lunch, I took a left turn off the road and got about 50 yards down when a boy on a 10-speed rode up next to me. He introduced himself and asked where I was going. I was a little wary but told him I was staying at the guest house. He said "it's not this way." I had taken the wrong turn. He rode back up the road with me and we chatted until I got to my gate. He said goodbye and rode on. These people are kind-hearted. I am a little ashamed of my mistrust.

My EMT friend and I talked more about the difficulties of the situation. There's no heroism here. You can't expect to come in and do a lot of good in a short period of time. Establishing relationships is required to make long-term, lasting changes. I am ashamed of my unwillingness to spend more than a week here.

These people love to sing. They sing their prayers to God - singing hymns of sorrow, praise, humility and thanks. Families, friends and strangers gather around one bed and then the next and all who can join in the melody. One man sang all day from his bed. All. Day. I stopped for a moment to smile, breathe and just listen. I will remember that.

I have all these little memories. The kitten in the storeroom, the boy on the bike, the man in the corner... All these snapshots, moments of connections that I have made. Everything helps. Every smile, every "Bonjour" and "Bonsoir", every touch, every bandage, every pill, ointment, dollar, prayer, everything helps because the need is so great. These people have nothing.

We leave at 7am tomorrow. I am changed a little, in ways I didn't expect. In ways I won't begin to realize for months to come. "Was it worth it?" my husband asked me last night. Yes. Would I do it again? Absolutely. With fewer expectations, and more forgiveness for myself. Will I come back? Maybe. Maybe yes, maybe no. Certainly not for a while, I'm going to need some time to recover.

The right opportunity always presents itself.

Day 4- Tuesday

Today's challenge is in organization- finding a way to get things to the people who need them involves identifying their needs in the first place. What this place could use more than anything is a big, fat needs assessment.
I finally found a rhythm of sorts doing wound care rounds, but I left it too soon, to my regret, again hoping I would be needed more elsewhere. I was wrong, and spent the rest of the short day doing nothing but following people around, trying and failing at being useful. I am dissatisfied with everything- with myself, with the situation, with my inability to function autonomously here and commit to something. I guess I really just do better with structure, but I think it would be hard for anyone to come into a short-term, chaotic situation without a well-defined role. This is not teaching me what I thought it would. It is unfulfilling. I am ineffective. I am a little overwhelmed today, and probably dehydrated but at least I am not sick!
The novelty has worn off, the adrenaline rush is gone, reality is glaring in my face. Heh, it's the 4th day, playa bends set in at burningman about this time... This isn't easy, glamour or glory. Nursing is rarely glorified work, but what did I expect? To those people coming in behind me: have a plan. Have a role you are stepping into, otherwise you'll be totally lost. Know where you're going and what you're doing. Expect all of your plans to change. You are not the expert. There was a routine to things before you got here, and it will continue after you leave, so don't try and shake things up too much. There are lots of problems here- don't become another one. Remember that EVERYTHING you do helps. Every smile, every kind word, everything.
Made some new friends on the ward during wound care rounds. The man in the corner likes his name written on the bandage on his knee. The young woman across the way is one of 3 survivors from her nursing class of 85. The other two survivors are downstairs. She is missing a 6"x3"x4" hunk of flesh from her right butt. Her wound gets packed with wet gauze twice a day - in the US, we would administer heavy doses of morphine for such a large wound. Here she gets a couple of tylenol. She spends most of her day lying on her belly. She likes us to use some alcohol to remove the tape from her 5 or so other bandages so the tape doesn't hurt as much. I kept rounding with an advanced EMT from the US who will be there another 3 weeks. She shared with me some of her frustrations about the constant chaos and well-intentioned volunteers. Some people make promises to help, to send money, to bring kids to the States and then disappear. The Haitians wait for that. They look toward the door every hour to see if their new friend has come back with the food, soccer ball, or other thing that was promised. The Haitians remember. "Relationships are about saying goodbye" she told me. I'll remember that.

We discovered today that the supplies being donated to Les Cayes General - the "county hospital" type facility we started out at - are being sold back to the patients. We had to wait 20 minutes for a man's family member to go to the pharmacy and buy the valium we wanted to administer to him before trying to reset his dislocated shoulder. We were unsuccessful, and scheduled him for surgery. He thanked us when we left. For what, I'm not sure. Now our Ortho surgeon has a fever. We're going home Thursday. I am done.

Day 2-Sunday part 2

I spent Sunday doing what I could as an OR nurse. Without an anesthesia machine, endotracheal tubes, pulse oximetry, cardiac monitoring, oxygen, suction, or even a proper BP cuff, there wasn't much for me to do but take inaccurate manual BPs and a radial pulse. The anesthetist did what he could with spinal anesthesia and ketamine. The Supernatural Anesthetist. He did well, much of the time. Our Ortho surgeon fixed femurs, tibias and a humerus or two. I started an IV in the ER in a man with a large, bloody bandage around his head. I left later after I realized he was in agonal respirations and no-one was going to do anything. I kept looking at him and thinking "he's really sick." "He's REALLY sick. He needs help." "Can't one of our docs see what's under that bandage and do something?"
Oh yeah. There isn't anything to do. If he's bleeding that badly from that much of his head... There's no ICP monitoring, no pressors. If they cut a window in his skull to relieve the pressure, the flies will take up residence there, too. The feeling of helplessness is still with me.
Failure to prevent the inevitable. No attempt at clearly futile heroics. Powerlessness. Humility. Faith. Grounding.
I'll get over it, but I know his stridor will echo in my ears for a little while.

Day 3- Monday

Today we drive around looking for more trouble. At General, there are 2 American teams- one from Maine with 2 Ortho surgeons, an advanced practice nurse first assist, an anesthetist, a PACU nurse and a nephrologist who has spent a lot of time here and serves mostly as an interpreter. We are a ragtag group consisting of a cardiac nurse from NYC an Ortho surgeon from Atlanta, a retired Ortho surgeon from Eugene and me, the labor and delivery nurse. We are a team only because we are sharing housing and a driver, but are seeming to work better together than the Maine crew. There's some friction between the two groups- (Survivor-Les Cayes General...) add that to the chaos of the situation and communication difficulties between all of us Americans and the 2 Haitian surgeons and... Well, we thought we'd see if we could be helpful elsewhere.
Cité Med was crowded and had tiny private rooms. It seemed more a clinic and less a hospital, but there were two cute sisters on the 2nd floor recovering from similar leg fractures who grinned and giggled at us.
Hopiteaux Brenda is usually an ear-nose-throat clinic, but now has big UN tents outside and is seeing all patients. Some American, Canadian, Brazilian and Uruguayan medical staff seemed to have things under control. A nurse that we spoke briefly with told us that without interpreters to help us give care we would be in the way and we could help organize the stock room but that was it. I considered staying to do whatever I could, I could call our driver to fetch me at any time... I should have stayed. I am finding I do better with some structure, and have not had much success at finding my own opportunities or my own way. I have found some security with my new friends and am clinging to them. I hope they don't mind.
I want to be self-sufficient but fear a little for my safety and am not as confident as I want to be. Need my H here, or something. What did I think I was going to do? Start IVs, change dressings, organize paperwork... The nurses here sit behind a desk and chart. I have yet to see one change an IV bottle or give a medication. Not all that different from home I guess- who am I to judge? Language barrier makes it difficult to give instructions or explain a procedure, but I have to remember that love, caring and comfort are universal. And every little thing we can do helps.

Day 2- Sunday

Frustrated by finding a different opportunity than we imagined. Chaos, somewhat. Inefficiency somewhat. No lack of patients, that's for sure but we don't feel like we are doing disaster medicine per say. There are lots of fractures that need fixing, on top of the usual chronic human diseases complicated by scarcity of resources, trained personnel, and wellness knowledge. What these people have in plenty, though, is family, quality relationships and a faith in god. They have more prayer than anything. I am not sure it's helping. Everyone is dressed in their Sunday best- frills and ribbons, tucks and pleats. Another of many ironies here- little girls in fluffy dresses picking their way across filthy, cracked streets, through trash and poisoned water, motorcycle exhaust and skinny dogs to school or church. Chaos, yes they have in plenty.
Maggots. Maggots keep the wound clean, at least. This is a 92 year old gentleman with peripheral vascular disease. His poor circulation has caused what I am sure was a scratch at one point to brew into a large hole in his shin with tunnels that host little friends. They squirm away from the light when we remove his filthy yellow bandage. I am not as squicked out as I would be normally. I am not sure why. The little worms keep the wound a little cleaner, at least. Giving the pseudomonas and staph and whatever else less dead material to grow in and infect the rest of him.
How do they get there? Do flies lay their eggs there? Do all maggots look the same? I wonder about the fly's lifecycle. I wonder about my lifecycle.
Too many doctors, not enough nurses. Doctors fight over cases, try to organize themselves into an effective OR, but without anyone to structure things, they flail a little.
We all do.
Haitians are stoic in the face of pain and laugh, joke and tease their way through daily life. They shout, sing and stomp their prayers, but intense pain is met with a quiet "Oh-oh-oh..." I wonder if we subject them to more pain than is necessary because they do not complain about it. There is no 5th vital sign, here. I saw morphine on one man's chart but haven't seen any evidence of it being used. "Beaucoup doule?" I have learned to ask, despite having nothing but a smile and a pat to help when sometimes the answer is "Oui, oui."