3AM

I am on call at the hospital tonight, lying under the mosquito net on the lower bunk of the on-call bunk bed. When I lie down, my headlamp illuminates the handwritten message taped to the bed above. "Don't let the bedbugs bite," it advises cynically, with an an inky illustration of a small swarm of insects surrounding the words. My legs begin to itch. This is a fascinating world of insects, tropical medicine and infectious disease...as long as the patient is someone other than myself. I just awoke to deal with a patient retching with vomiting and diarrhea. The next stage of this Haitian crisis -- people now malnourished and immunocompromised from stress -- will be infectious disease. And an outbreak of diarrheal illness in our hospital -- with one patient bathroom -- is something I would prefer to not imagine.

I would rather awaken to a patient's illness than the earthquake aftershocks that hit us the two previous nights. Like a scene from the exorcist, three times I have been stunned awake by my bed shaking beneath me. These 4.7 level aftershocks lasted 15 seconds or so and were accompanied by a deep groaning rumble from underground, like a moaning demon crawling below the house. These sounds and sensations make hair stand on end and are the things from which nightmares are born. Each time coming awake, I found my heart racing, like my adrenal glands instinctively dumped adrenaline in preparation for flight...even before I awakened. According to our night nurses, the clinic dogs were able to anticipate the quakes and barked excitedly several minutes before the actual aftershocks hit. Images of leaning buildings and our crushed patients spiraled through my mind as the ground trembles.

How do these psychologically and physically battered patients tolerate this frightening rumbling? I think of one, trapped for 12 days in the rubble, pregnant and crushed with multiple lower extremity fractures. What went through her mind as the earth repeatedly rumbled like a demon below her? Absolutely terrorizing. In the first 10 days she was trapped, more than 50 aftershocks shook the city. The aftershocks are more horrifying for the small children, unable to intellectualize. Like a child myself, I found myself pulling my sheet up closely under my chin, despite the tropical heat, calling on the protection it used to provide me from monsters and vampires and the thing that lives under the bed. This monster under the bed this week is a bit too active for my taste.

The unpredictability of the aftershocks frays already raw patient nerves. After the second aftershock last night, our inpatients began screaming and crying out. Those housed under the concrete overhang of our courtyard -- 15 patients with severe ortho injuries -- instinctively began to run or pull themselves to the outside lawn, screaming and crying. Many Haitians will now not live inside...for many, a wise choice. Out clinic is structurally sound, per the review of a privately paid structural engineer. What do we do with a country of terrorized patients with PTSD, I asked myself, as I myself stood outside in the courtyard in my bare feet at 2:00am after the second aftershock... emotionally shaken.

But tonight, so far, the only threat is bedbugs. And diarrheal illness. And the annoyance of chickens crowing in the dark in reaction to the inadvertant shine of my headlamp into their nests as I gaze out the window. Sorry chickens. It's not morning yet. Go back to sleep. And so will I. Don't let the bedbugs bite.