Stories from Haiti 2010/Genie Lindsey

Waves of heat and lime dust blew over the white post op tents leaving everything and everyone covered with a fine layer of sweat and fine lime residue. The morning patie rounds were over adn this was our last few days at the Love a Child disaster relief acute field hosptial in FOnd Parisien Haiti. The patients three or four to a tent that the Eddie Bauer Company donated had alll forms of wounds and infections. But within the week since our team arrived amny of those who were literally dying lying on cots and mattress pads were actually moving and talking and somehow life had crept back into what was a cloud os death.
The tents were in rows and we , the nurses and doctors tending to the rows were assigned where to go on a weekly basis. A few days prior to leaving someone had asked me to go to a tent I had not visited and look at a ptient there who had a oleg wound that appeared infected..
Tent 9-8 held two women patients with heling fractures and failed skin grafts. I was told that the patient I had was particularly anxious ( medical people are famous for that term) and would not let anyone touch a large wound on the back of her knee.
I found my favorite creole translator John and headed down to look at her leg. Madame Renee was 33 years old. She appeared somewhat older , her eyes were dark and sunken, but she looked straight into mine as I spoke in english and broken creole to explain the reason for
my visit. I introduced myself and asked her permission to look at her l. She shook my hand and smiled and said yes I could evaluate her leg. Her smile was so kind, it was as though she looked inside of me and trusted me. I assured her that I was only going to look at it to figure out what we could do to help her pain and treat any infection in her wound.
As she turned to her side she began shaking and crying. The wound was a large peice of flesh that had been sewn back onto the back of her knee with the thickest suturing material I have ever seen, it looked like hemp or horse hair. Whatever it was the skin around the suture area had grown arotund the material and from the areas broken apart from the swelling around the wound the familar smell of infection and pus flowed around the site. She rooled back over and I explained that I had to find the doctor our surgeon David to return with me to look at her leg. She hugged me and said "Merci" as I left the tent to find him to perhaps set up a time in the operating room to debride, take down the dead material from her leg and clean the area which I was sure extended dwon into her tendons and perhaps bone.
David was one of the most compasionate physicians I have ever met. A plastic surgeon from Maine he still takes call and performs trauma surgery. He has kept true to his comittment to healing when many others as experienced as he would have opted out to the more lucrative world of face lifts and liposuction. But he has chosen to remain a real physician. a healer and never lost hope amongst the most hopeless of cases presented to us. He hiked down the rows in the midday heat and looked at her leg. As we left the tent he simply said," Genie you are going to have to take that down, we have no operating room time left before we leave." He continued "Give her pain medication ,( we were one of the few field hospitals that had a complete pharmacy) remove the sutures, clean it well, and we can provide some antibiotic treatment. The team coming in tomorrow will take over the case. You know what to do."

That night I gathered up all of the supplies and stuffed them into a wound care bag I had made up out of a packback someone left from another team. I put everything I could think of in it then went to the pharmacy to pick up the medications he ordered. My translator was nowhere to be found but I thought I could get with the little creole I had picked up until someone could meet me there to translate. I took a headlamp with me because darkness fell as soon as the sun went down usually around 7 PM.
As I entered her tent I showed her my wound bag and pointed to her wound. I said I was going to clean it. I gave her one percocett which had become our limit for most paitients as some being narcotic naive had become overmedicated on two pills. I also gave her a granola bar and antibiotics as I didn't want her take medications on an empty stomach as the dinner plate of rice and or cream of wheat had not arrived.
Her nephew arrived and he also helped with some translation as he spoke a little English and Spanish. I tried to talk and let the pain medication take effect before I began removing te sutures that had grown into her skin. As she rolled over her nephew held her hand. I began very slowly to cut into the coarse thread sewn around ina circle holding a very thick piece of skin onto the back of her leg. she began to tremble and cry out. "Madame! "she cried. And them yelled out in creolet . I did not understand and I yelled down the row for one of the translators to come and help me.
She held my hand and cried saying the same thing over and over again. "What is she saying I asked ." The translator with tears in his eyes answered, " Madame Genie, she is begging you to save her, She says she has lost everything, her house, her husband and her only baby. she begs you now to help her not to lose her leg..." I began to cry. ' Pthlease explain that I have to do this to help save her leg." I told the translator. " I do not want to hurt her or cause pain but I have to take this skin off it is dead and infected. I have two sons and I do not know what I would
do if they died as her baby died. My heart would be broken."
"Yes, she sobbed, my heart is broken. I feel dead, but do not want to die." I held her and we cried together but then I asked her to turn so I could continue the work at hand. As I opened up more of the wound it was clear that the space underneath the sewn in flesh was full of blood and exudate. I did not want to alarm her as she was so very upset. It was also very dark and difficult to see in the tent partly from limited light from the headlight and my inability to stop crying. So I packed the wound with materials to soak up the blood and used lots of packing and gauze to protect the site as she slept overnight.
I walked to her tent from our campsite in the middle of the night to make sure she was not covered in blood and exudate fromt he wound. When I looked in everything still was dry and her nephew said that she had been sleeping well after the second percocett.
I woke up earlier than usual, amidst the roosters, donkeys and dogs and set out to her tent to finish the debridement. I brought her granola bars and juice to take with her pain medicine and we began the work we had started the night before. Only this time it was very differentl. She held my hand and said that I was like her family now. She was calm as I removed the sutures, even those covered in skin. I removed the packing from the night before and inside the wound was clear and areas that were pink and well granulated. She held the dressings for me and we worked together for an hour as I removed every piece of dead tissue. The wound site looked beautiful and clean as we dressed it together and wrapped it with gauze and an ace bandage to secure it.
She hugged me and said I was truly part of her family. "Bless you and bless your sons" she sais as we exchanged goodbyes. I walked down one more time before our team left the camp to return to the US that afternoon.