Friday, March 26, 2010

Faux Pie

How can this be?

It is ten weeks from the earthquake, and today, as we performed wound care on our truck in the slum of Pele, two men walked towards us up the street carrying a middle aged woman on a folding metal chair. I did not recognize her. Neither did Alex. Her right leg was wrapped in a makeshift splint, now dirty from weeks of wear. Her left leg was missing below the knee. I climbed out of the truck to greet them.

"Hello," I said. "How are you?"

"Please help us," implored the older man as he set the woman down on the street beside the truck. He identified himself as her husband.

"Of course," I replied. "Tell me about your injuries..."

"She received care in a hospital in the Dominican Republic in the days after the earthquake," he replied. "They cut off her leg, and put the other in a splint."

"Where is your leg broken?" I asked, pointing to the mass of gauze and plaster. Followed by our commonly asked, but clinically unusual question: "Did you have an x-ray?"

"I don't know where it's broken," she replied to the first question. "No," to the second question. "No x-ray."

We have seen this situation repeatedly. A patient in a splint for a non-specific, unidentified fracture. In the chaos of the post earthquake situation, probable fractures were splinted based on symptoms -- appropriately so in the critical triage environment. We found one poor elderly gentleman placed for eight weeks in an uncomfortable long leg cast -- only to x-ray him to discover he'd never broken his leg to begin with. So, once again, another patient with an unknown fracture. But, ten weeks out, one would expect the bones to be healed.

I cut off the splint and took her leg into my hands. With a torquing twist to the lower leg, I felt the bones grind harshly against each other -- a malunion (unhealed fracture), so unexpected this long from the injury.

"You've been unable to walk on this, because of pain, I'll bet," I said.

"Walk?" she asked incredulously, almost accusingly. As if to say, "How do you think I will every walk again."

"Do you have crutches?" I continued.

"No," her husband replied. "We just carry her around in this chair." He pointed to a folding, slightly rusted metal office chair.

I squatted down beside her to meet her eye. Her situation was becoming clear. A woman with an aggressive post-earthquake amputation and a shattered surviving leg. Sent back to the streets -- to a tarp shelter? -- just days after her surgery. Unable to walk. Given no instructions. No rehabilitation. Provided no crutches. Nor a plan of follow-up. Now assuming she will be non-amblatory for the remainder of her life -- crippled. And a constant burden on her family.

"You know," I told her, resting my hand on the leg above her splint. "We have a patient just like you in our hospital. She had both of her legs crushed under a wall. She had one leg amputated and the other severely broken. Just like you."

The woman nodded.

"She took her first steps this week, at our hospital, using crutches," I told her with a smile. "Would you like to walk again, too?"

The woman and her husband both looked at me with astonishment. As if they had never imagined this could be an option. Her son, who had carried the other side of her chair, grabbed my arm.

"Please," he asked with urgency. "We want to fix her legs. Please...can you fix her legs?"

"How about this," I said. "Get on our truck with us, and come back to our hospital. You can stay with us for a while. We'll get an x-ray of your leg, to know how it's healing. We'll give you physical therapy to help you get stronger. And we'll give you crutches, so that we can teach you how to walk again. And I will connect you with a we can find you a new leg."

"A faux pie?" her son asked with excitement. A fake leg?

"Yes," I said. "A faux pie. Will you come with us?"

The woman nodded quietly, a look of hope in her eyes. Her husband's eyes filled with tears. They gripped each others' hands.

Where had these people come from, ten weeks after the earthquake. From which make-shift shelter down which little alley in this labarynth of cinderblock shelters and tarps? Where had they been these past 10 weeks? How had they found out about our truck? And why had we not met them sooner? How many other patients are lying in the slums of Port au Prince, hopeless, helpless, crippled...completely unable to access care? Being tended to on the floors of their homes, or carried around by their families? How many more are out there

We carried the woman in her chair into the back of the truck. Inside, I asked her her story. With the typical flat, matter of fact affect that is so common amongst our patients -- a protective mechanism, I assume, to limit the power of the torturous memory -- she described that she was a restaurant owner, and the wall of her business collapsed upon her during the earthquake, pinning her for five days under the rubble. Five days of agony, leading ultimately to amputation and severe disability.

We drove this woman, along with two other patients with poorly healing fractures, to a volunteer medical organization called Merlin late in the afternoon. Merlin arrived in Port au Prince within the first weeks of the earthquake, providing volunteer orthopedists and plastic surgeons. They operate out of green canvas tents set up on an old tennis court in the center of the city. There, I met with Mister Andrew, a retired orthopedic surgeon from England. "Mister", he had educated me, is the title for surgeons in England, not "Doctor". He is, like so many here, something of a character; a gangly old chap with thinning grey hair, glasses falling down to the tip of his nose, a giant floppy safari hat to protect his pale British skin from the blazing Haitian heat, and occasionally seen wandering through the tents with a fragile china tea cup with a saucer. A brilliant mind, with a golden heart. The days of long hours wear on his face.

I shook his hand and sheepishly began, "I know it's late, Mister Andrew, but we've found three patients on the street today who need x-rays." The doctors at Merlin have a curfew, and are forced to be out of their tents and back to secure housing by sundown due to safety concerns; at night, the tents and patients are watched over by local Haitian staff and security guards. As I spoke, the sky was turning a pale orange, as the sun threatened to drop below the horizon.

"Bring them in," he said, without a blink of an eye.

I described each patient's scenario. Under the fluoroscopy of his mobile C-arm x-ray, each fracture revealed itself to be a shattered mess, non-healing despite 10 weeks in splints.

"I'm leaving in three days," he said, "and we have no plan for replacing me as an orthopedist."

My heart sank. What will we do, without an orthopod in the coming weeks?

"All of these patients need surgery," he continued.

"Okay," I said hesitantly, "What shall we do?"

"Well, you'll leave them all with me, and I'll fix them all before I go."

Perhaps you don't know how generous and selfless this man's offer was. A man old enough, and currently appearing tired enough, to be your grandpa. Operating in a stuffy canvas tent under the blazing Haitian sun. With years of practical experience, doing orthopedics long before the fancy modern technologies we now enjoy. An offer beyond generosity.

"It won't be easy, though. Ten weeks from the injury...with some calcification setting won't be easy," he said, shaking is head.

"Wow, thanks," I said. "I'm so grateful. We'll take them back from you right after surgery." Then, "If we didn't do the surgery," I asked, as I looked at his tired face. "What would happen?"

He laughed, shaking his head, "Well," he pondered. "I imagine nobody knows. I've never left fractures like this to heal on their own. You just don't do it. This is unprecedented. I wouldn't be the one doing a clinical trial, leaving these people without surgery to see how they fare. It's just unprescendented."

So, we left our patients, including our lady and her metal chair, with Mister Andrew, the grandfatherly safari-bound orthopod from Britain. She couldn't be in better, caring, experienced hands.

And when he is finished, we will take her back to our hospital, tend to her incisions, give her crutches, and teach her to walk again. And find her her a cherished "faux pie". So that she can reenter society, standing tall like the woman she once was.

How many more of these patients are out there in the city, unhealed after ten weeks of suffering?

What will we do when the orthopedists go away?

This crisis is no where near resolved.

Thank you, Mister Andrew, for your amazing generosity of time, knowledge and compassion.

Did I mention that, with each patient, he pulls out a colorful hand made spiral "lolly" from a candystore back from his home town in England, that he carried to Haiti on his back with his medical tools? "Who was a good girl today," he smiles as he leans over and hands one to our woman.

She takes it hesitantly, and her guarded eyes open, and she smiles at his grandfatherly form.

"Well, allrighty," he says, then turns and shakes my hand. He meets my eyes over the glasses that fall to the tip of his nose. "Thank you for what you do," he says with great seriousness.

"Are you kidding?" I reply. "No, Mr. Andrew. Thank YOU."


  1. Wow. I am speechless. Thank you for sharing these types of incredible stories--the daily reality of life on the ground in Haiti.

    I'm filled with admiration for what you do--and questions, like how you support yourself when you go to places like Haiti and do this vital work. And how long do you plan to stay there? Anyway, I am incredibly grateful that you choose to do what you do, however you do it. I'm thinking I should head to nursing school or something (my English degree I'm sure means squat when it comes to disaster response) so I could be more useful in developing countries. Prayers for you, everyone at Heartline, and especially the patients. Terri Urban

  2. Your first hand accounts are amazing and have been very helpful to my Industrial Design Studio class at the Savannah College of Art and Design this quarter. We are in the process of designing crutches that will be manufactured and sent over for Haitian amputees. Your first hand experience and empathy are invaluable since we are unable to visit Haiti ourselves (though we did try to convince the school to send us over). I was wondering if you might be willing to do an interview via email?
    Tessa G. my email -

  3. If you are not already acquainted, you will love to meet our NGO, Healing Hands for Haiti- we provide long term rehabilitation and prosthetics with and for the people of Haiti.

  4. Hi Barbie,

    You probably don't remember me. I brought in Daphne, a 4 year old from our orphanage. She had a femur fracture and ended up with the fractured leg 1 1/4 inches shorter than the other. Recent xrays show its healing nicely and multiple stateside docs have looked at it and said her leg will lengthen to equal (or close to it) the length of the other. Anyways, wanted to let you know I thoroughly enjoy your blog! You are a wonderful writer and really bring to life the Haitian people and the work going on there. Thank you!