Healing

This week will mark 2 months from the earthquake. And what I am seeing is remarkable.

How often does a medical person encounter such an enormous disaster -- 250,000+ dead and injured, all on the exact same day? I have trained in disaster response, when a car with four victims is overwhelming, an overturned bus of 20 patients a nightmare, and an airliner crash with 200 victims -- impossible. So, now, imagine twelve hundred airliners screaming out of the sky and crashing simultaneously down to earth...and into the poorest, most underdeveloped country in the Western Hemisphere. That was Haiti on 12 January. The airliners crashed and scattered the bodies. 250,000. Most dead. But many not.

Imagine laying in your slum, under a concrete wall, pregnant with both of your legs crushed. One of our patients did... for 3 days. Imagine laying on the ground outside of your home for 12 days with a pelvic fracture...bleeding internally and unable to move. In a city with no ambulance service...and now no hospitals. With no one to save you. Really. Stop and think. 12 days. That's longer than Christmas vacation...longer than your week at the beach. Imagine sitting on your livingroom couch for 12 days straight, immobile, without food. Impossible? Now, imagine doing it on the concrete ground of a dirty slum, your body shattered, sweltering day into smoky cool night, then repeat, ants crawling across your body, malaria filled mosquitos feeding on your dying form. One of our patients did.

Imagine wandering the streets with your injured 11 year old child, his face and eye orbit crushed with open fractures, seeking someone...anyone... to help you...and failing. This child -- now our patient -- finally found help four weeks after the earthquake, a massive orbital infection around his crushed eye. His face was so injured, and so exposed, for so long that when he was finally examined on the USS Comfort -- four weeks after the quake -- they found multiple bot fly larvae growing in the infected tissue around and behind his eye. Imagine four weeks of agony, without care. Wriggling larva burrowing into your open wounds to feed. Imagine if that agony were suffered by your child...and you were helpless to intervene.

Thank God for the first responders who went into the streets. The first volunteers from our field hospital -- who took our truck into the the depths of the slums -- and dragged back devastating injury after injury. Open fracture reductions by headlamp. Kitchen table top amputations. Desperate, life saving, life altering, interventions.

I was not here in the week after the quake. I did not see the initial devastation. But this week, I see objective evidence of their suffering. This week, we brought eight of our patients to another volunteer medical facility hosting volunteer orthopedists. With their imported c-arm x-ray, we were able -- for the first time -- to visualize these patients' shattered bones. In the weeks initially after the earthquake, many victims were splinted and casted for presumed injuries, based on the external appearance of their bony deformities. Xrays were an unavailable luxury. So, this week, for the first time, many of the injuries were defined.

I suppose you don't want to be the patient that causes the orthopedist to suck in his breath and whisper, "My God...look at that." Nor the one that makes him comment, "Unbelievable..." Nor, "No wonder she wouldn't weight bear..." as the c-arm xray scrolls up the leg and reveals a healing but angulated femur fracture. In my 12 year emergency medicine career, I have never seen so many dramatic, devastaing x-rays.

But the magic is, many were healed. Surrounding the matrix of shattered bones, hinting at a pain filled past, cocoons of tough white callous were visible.

"I know it looks awful," said Dr. Steve, the orthopedist, as he glanced at one particularly macerated tibia "but, believe it or not, it's sufficiently healed. Let her walk."

And so, through a translator, patients were told, throw down your crutches.

Walk.

You are healed.

After weeks of immobility, deep aching pain, disability, fear, hopelessness... sweltering long leg casts dragging in the tropical sun... the crippled were set free. And the announcement brought uncertainty and hesitation.

"My crutches..."

"You can walk without them, whenever you feel ready."

Hesitantly, castless feet touch down, lightly feeling cool ground again under now naked toes.

How amazing, yet perhaps not surprising, that when all injuries occur on the exact same day, that healing also completes, for many, on the exact same day.

The same is true for crush wounds. Skin grafts and massive open wounds have started to close. In the truck this week, I removed multiple dressings to find wounds finally healed. After 8 weeks of painful surgeries, debridements, grafts, and every other day dressing changes...many of the wounds were closed.

"Congratulations," I declare, time and again, grabbing a patient's hesitant hand, meeting eyes with a gentle smile . "We're done. You're healed."

Uncertain glances. Tears well in eyes. Hands hesitantly touch thick new scars...getting reaquainted with self, so long hidden under dressings and ace wraps. Tentative...

We, the truck crew, stand. And honor each individual.

"Bravo," we call. Then gentle applause. A pat on a shoulder. Sudden, dawning realization in a patient's eyes. A beaming smile.

"Merci...merci....." they say, repeatedly, as they rise to exit the truck. "Thank God...merci....thank God..."

And so they walk away.... from us, from our hospital, from our truck, from that day... back into their urban labarynth, to start their lives again.

Healing...