Differences

After almost 2 weeks I’ve gotten past the shock of the conditions here, and I think I can try to describe to all of you who are familiar with US emergency departments the difference between here and there.

The way I see it, there are 4 main differences between this ED and any I've seen in the States. The first is obvious. The supplies and access to medications/tests/consultants are always inadequate and ever changing.

The second is the utter lack of privacy. Physical exams, procedures, resuscitations, births and deaths happen right in front of everyone else. Patients often have to share bedpans.

The third difference is one that took me a while to notice. With the chaos that is the Haitian ED constantly coming at me, it took me a good 4 or 5 days to realize that there's essentially no service other than physical medicine that's provided. What I mean by that is that there is no social worker, there's no psychiatrist, there's no patient meals, no one helps grieving families. The mother that comes with her dying child may well leave with her dead child. The patient who hasn't eaten in 2 days won't eat during his stay in the ED (sometimes 3-4 days) unless a family member brings food from home or one of us gives him a Powerbar or some beef jerky. I don’t know if these services were around before the quake, but hopefully the organizations that are here helping out will make sure that they are in place before we all leave.

The last difference is the acuity of the patients. So many patients are seen, treated and discharged from triage that the ones who make it into the ED are all amazingly sick. We’re averaging 4-6 deaths per day in the ED, with another one or two per day who are beyond help by the time the even reach triage.

An example of how acutely ill everyone is: last week we delivered a baby first thing in the morning on a day shift (as I described in an earlier post). Back home if I delivered a baby in the ED I would be thinking about it and talking about it for weeks (if not months). But here, I completely forgot it happened at all until the next day. When someone asked me if I had seen anything interesting at the end of my shift that day, delivering a baby didn’t even make the short list.

Don’t get me wrong--I very much enjoy taking care of critically ill people (it’s one of the main reasons I work in emergency medicine), but working essentially every day seeing only the sickest of sick in this environment is one of the most challenging things I’ve ever had to do. That being said, at the end of almost every shift I’ve worked here, I can objectively look back on the patients and families that I took care of and feel absolutely certain that had we not been here, most of these people would not be around to see the end of the day. And while that certainly doesn’t make up for the patients we couldn’t help, it does give me a reason to come back tomorrow.