Posts
Thursday, August 18, 2011
The night before
I'm finally ready and packed. I'm kinda panicked to leave to MIA tomorrow (almost today)... I have to be at the airport in 4.5 hrs!!!!!
Wednesday, August 17, 2011
Second trip to Haiti in three days
Its unbelievable that its been already so long since the earthquake, but the field hospital is still the only operating critical care facility. I'm so interested to see how much have changed since I was there 1.5 years later -)
Thursday, April 15, 2010
Why does Haiti needs nurses? Posted on http://news.nurse.com/article/20100308/NATIONAL02/103080064/-1/frontpage
Scott Plantz, MD, FAAEM, is a member of Gannett Healthcare Group, parent company of Nurse.com. He is senior vice president of continuing education for GHG’s nursing certification preparation company, Pearls Review. Plantz volunteered at a hospital in Haiti Feb. 19-23.
After 20 years working in inner-city EDs, I thought I had seen it all — until I arrived in Haiti. Late last month I traveled to the earthquake-ravaged country as a volunteer physician with a team of nurses and other healthcare professionals. We worked through the relief organization Project Medishare at the Global Institute hospital established by the University of Miami just 200 yards from the Port-au-Prince airport runway.
I felt I had arrived in some version of hell. The med/surg ward, housed in a tent, took my breath away with row after row of patients in cots set 12 inches from the floor. I teamed up with Max Varona, RN, an emergency nurse from Bert Fish Medical Center in New Smyrna Beach, Fla., in a 10-bed ED with dirt floors, no privacy curtains and just one trauma bay. And this is the best organized, best manned and best stocked hospital in Haiti.
I saw end-stage clinical findings rarely seen in the U.S. Malaria, tuberculosis, typhoid and parasitic diseases were common. I also witnessed my share of heartbreak: the father who walked 20 miles to reach the ED with his brain-injured child on his back, for example, or the man, paralyzed from the chest down, who arrived with both of his legs rotting. You can read nurses’ moving firsthand accounts of their care of Haitian patients like these at Nurse.com/Haiti.
Because the U.S. doctors and nurses arriving in Haiti since the earthquake are all volunteers, the staffing mix at a hospital like the Global Institute’s is patchy at best. On any given day, one nursing specialty might be oversupplied, while on another there could be pockets of missing expertise .
Yes, nurses are needed in Haiti to respond to continuing post-quake healthcare concerns, but as the country begins a long, slow healing process, the need for patient education — and the RNs to provide it — will grow. A large percentage of the population is under the age of 18, and many young parents have limited understanding of how to care for their injured children. Limited, as well, is the population’s knowledge of the importance of clean water, sterile technique and proper wound care. Nursing expertise, particularly in patient teaching, could play a crucial role in the survival of the Haitian people.
In Haiti, I was fortunate to have worked with some of the most dedicated nursing professionals I have ever known. I plan to return there soon and hope to once again have that privilege.
After 20 years working in inner-city EDs, I thought I had seen it all — until I arrived in Haiti. Late last month I traveled to the earthquake-ravaged country as a volunteer physician with a team of nurses and other healthcare professionals. We worked through the relief organization Project Medishare at the Global Institute hospital established by the University of Miami just 200 yards from the Port-au-Prince airport runway.
I felt I had arrived in some version of hell. The med/surg ward, housed in a tent, took my breath away with row after row of patients in cots set 12 inches from the floor. I teamed up with Max Varona, RN, an emergency nurse from Bert Fish Medical Center in New Smyrna Beach, Fla., in a 10-bed ED with dirt floors, no privacy curtains and just one trauma bay. And this is the best organized, best manned and best stocked hospital in Haiti.
I saw end-stage clinical findings rarely seen in the U.S. Malaria, tuberculosis, typhoid and parasitic diseases were common. I also witnessed my share of heartbreak: the father who walked 20 miles to reach the ED with his brain-injured child on his back, for example, or the man, paralyzed from the chest down, who arrived with both of his legs rotting. You can read nurses’ moving firsthand accounts of their care of Haitian patients like these at Nurse.com/Haiti.
Because the U.S. doctors and nurses arriving in Haiti since the earthquake are all volunteers, the staffing mix at a hospital like the Global Institute’s is patchy at best. On any given day, one nursing specialty might be oversupplied, while on another there could be pockets of missing expertise .
Yes, nurses are needed in Haiti to respond to continuing post-quake healthcare concerns, but as the country begins a long, slow healing process, the need for patient education — and the RNs to provide it — will grow. A large percentage of the population is under the age of 18, and many young parents have limited understanding of how to care for their injured children. Limited, as well, is the population’s knowledge of the importance of clean water, sterile technique and proper wound care. Nursing expertise, particularly in patient teaching, could play a crucial role in the survival of the Haitian people.
In Haiti, I was fortunate to have worked with some of the most dedicated nursing professionals I have ever known. I plan to return there soon and hope to once again have that privilege.
Wednesday, March 31, 2010
Living and working conditions
All of us worked every single day. We had food provided us ones per day. This food included beans and rice with mystery eat and something that supposed to resemble a vegetable. Personally, I wasn’t interested in eating the high carb foods, so I ended up eating the power bars I got with me. I could not sleep during the day because of the noise and the heat in the tent. I also worked anywhere between 10-16 hrs per 24 hrs period while sleeping anywhere between 0-4 hrs per 24 hrs. Very little food. I was able to take shower every day though, this was the highlight of the day
Half way through the week, my physical needs shut down. I’ve never experienced anything like this before. I wasn’t interested in food or sleep. I was deprived of both, but didn’t care to get it. It was all about work and things that needed to get done. Also, the sense of fear was gone, the fear for safety or tiredness. It was very refreshing.
Half way through the week, my physical needs shut down. I’ve never experienced anything like this before. I wasn’t interested in food or sleep. I was deprived of both, but didn’t care to get it. It was all about work and things that needed to get done. Also, the sense of fear was gone, the fear for safety or tiredness. It was very refreshing.
Monday, March 29, 2010
Braden Hexom's memory of the first day in Haiti
"Airport is busy today. Every few minutes we are deafened by the takeoff and landing of commuter and military aircraft. American Airlines, Air France, C-130 USAF Cargo, UN Sikorsky helicopters. There is a lot of traffic going both ways in Port au Prince. Each plane is undoubtedly loaded with supplies coming in, relief workers going out. Many are leaving, there are few left now. Our team is drawing down. We have 160 personnel on the ground now; there will be 30 after I leave on Saturday. We have been told to close the ER. I have had my first fight of the day with the CMO. I came here to help, but I am hamstrung by the need to limit our census. No more admits. They are turning patients away at the gate. If you can bribe the guard or if you know someone you get in. “Send them away,” I am told. I tell my people to see them anyway. The CMO means well, and wants to help, but 30 people can’t take care of a 150 bed hospital on their own. We need to discharge the whole ward so they can move the unit to a permanent structure before the rains come.
Our field hospital is four tents set up right on the airport grounds only a few hours after the earthquake. I have travelled a total distance of 1000 yards from the airplane since I got here. I can see the terminal from here. Two hours upon getting in country and I have found myself appointed as the Emergency Room chief of service. We have 5 ER docs. We had four or five ER nurses, but most have been pulled to cover the inpatient wards. I only have two nurses left. But they are UCSF nurses, and don’t take any shit – they are incredible and get to triaging right away. The gate is blocked and the word is ER is closed, but there are still more than 100 who have made it through and are waiting to be seen. The UCSF nurses start combing the benches, looking for the dehydrated babies and sick adults. We turn away the walking well. 50 get seen in the ER that afternoon, the rest get some Tylenol and go home.
Home – what a terrible word to use here. Home is wherever they are staying. Home is most likely to be a tent or a tarp. There are parking lots jammed full with tents. Whole tent cities within the city. Tents in the streets. They are everywhere. The doctors at General Hospital are living in tents on the roof of a pancaked bulding, sleeping at 30 degree angles as the sloping roof that once stood four stories up now lies just above ground level. Rubble and rebar lie about in piles. People mill about, aimless, lethargic.
Our emergency room is two tarps and an overhead tent. Like ERs everywhere we feel a bit shafted. The other units are in the hard-walled infrastructure tents. With AC. We sweat in the heat, but at least we have shade. Six cots – three medical/trauma, three pediatric. We have a corner where we have lashed tarps together to create a semi-private OB/GYN room. We deliver the babies there. The obstetrician left today, so us ER guys have also now become maternity docs. No one else wants to do it, or don’t know how. I cross my fingers that no one needs a C-section. The closest maternity hospital is across town, on the other side of Port au Prince. It is run by MSF-Holland. Their structure was spared, so it is one of the only hospitals that is still in a building and not tents. I think they do C-Sections there but I’m not sure. Anyway, it’s an hour drive if there’s traffic, so they’re no help anyway if there’s a complicated delivery. I pray we don’t have one tonight.
We divide up, 8 hour shifts are scheduled. Three rotations. It rarely works out that way. I slept 4 hours the first night. I want to make sure that my team gets some sleep. I haven’t slept well since I got here. The staff tent is noisy, hot, stuffy, and I got the worst cot possible. It is one of the old ones. It’s ripped down the side so my butt sags near to the dirt ground. The night workers are packed in a corner near the AC. Clothesline crisscrosses the walkways and you have to walk hunched over in the dark so you don’t get garroted by the wires. I am stuck by the entrance so I hear all the chatter. I can’t sleep. I roll over and slip on my flip flops and head back to the ER to see what is going on.
There are a few kids sucking on nebulizers, an old woman with belly pain, and a head injury. The two on-call ER docs are busy assessing him. He looks bad. Depressed skull fracture. Blood everywhere. Breathing labored. Everyone is sweating – it just pours off of them. It is midnight but still more than 90 degrees and very humid. The referral hospital had a staple gun and had tried closing his head with it. There are staples all over his scalp, in no real order and although the bleeding has stopped, his head is still misshapen and I start considering whether or not we should continue with the resuscitation. It is our first major trauma since our arrival this afternoon, and my team is being tested. One doc is establishing IV access. Malini from UCSF grabs the ultrasound machine. It doesn’t work. We have a backup and she switches it out. The screen flickers and dies every 5 seconds, so we don’t get good looks, but we think the FAST is negative – no blood in the belly. No pneumothorax. Someone suggests we intubate him. Do we even have ventilators, I think? Do they work? Is it even worth it with for a guy with this level of injury?
We do have a ventilator. It works. We even have a neurosurgeon. He arrived today on the flight. We have all the tools we need. It all starts clicking into place. We may actually be able to do something here. Okay, lets intubate. Lidocaine, etomidate, sux. No monitor working but we have a handheld pulse ox. He is in C-spine precautions and we don’t have a bougie. It is a difficult tube but she gets it without any desats. We send someone running into the tent to find the neurosurgeon and the anesthesiologist so they can get the OR up and running. The tent has 150 snoozing staff members, is hot and dark and muffled. They run up and down the rows with headlamps, whispering for the OR staff, trying not to wake the others who have all put in 16 hour days this weekend. Meanwhile the Haitian transporters have carried our patient into the xray booth – a few wood barriers and a portable digital xray machine attached to a laptop viewbox. I don a lead apron and bag him from the portable oxygen tank while they shoot the trauma series. The neurosurgeon arrives sleepy, disheveled, but ready to operate. Our patient is carried straight from the xray table into the sterile OR (how anything can be sterile in this heat and dust, I have no idea, but it works). He is on the operating table and the ER is quiet again.
My hands are dirty. I lather another layer of Purell onto them. There is no running water in the ER. We are all tired but the adrenaline is still up. We start debriefing. We have never worked together before, each of us are from institutions all over the country. But we know our jobs, know what to do, and realize it will be a good week. I head into the OR to check on our patient’s progress."
Branden Hexom is an Emergency Medicine Physician at Mount Sinai Medical Center
Our field hospital is four tents set up right on the airport grounds only a few hours after the earthquake. I have travelled a total distance of 1000 yards from the airplane since I got here. I can see the terminal from here. Two hours upon getting in country and I have found myself appointed as the Emergency Room chief of service. We have 5 ER docs. We had four or five ER nurses, but most have been pulled to cover the inpatient wards. I only have two nurses left. But they are UCSF nurses, and don’t take any shit – they are incredible and get to triaging right away. The gate is blocked and the word is ER is closed, but there are still more than 100 who have made it through and are waiting to be seen. The UCSF nurses start combing the benches, looking for the dehydrated babies and sick adults. We turn away the walking well. 50 get seen in the ER that afternoon, the rest get some Tylenol and go home.
Home – what a terrible word to use here. Home is wherever they are staying. Home is most likely to be a tent or a tarp. There are parking lots jammed full with tents. Whole tent cities within the city. Tents in the streets. They are everywhere. The doctors at General Hospital are living in tents on the roof of a pancaked bulding, sleeping at 30 degree angles as the sloping roof that once stood four stories up now lies just above ground level. Rubble and rebar lie about in piles. People mill about, aimless, lethargic.
Our emergency room is two tarps and an overhead tent. Like ERs everywhere we feel a bit shafted. The other units are in the hard-walled infrastructure tents. With AC. We sweat in the heat, but at least we have shade. Six cots – three medical/trauma, three pediatric. We have a corner where we have lashed tarps together to create a semi-private OB/GYN room. We deliver the babies there. The obstetrician left today, so us ER guys have also now become maternity docs. No one else wants to do it, or don’t know how. I cross my fingers that no one needs a C-section. The closest maternity hospital is across town, on the other side of Port au Prince. It is run by MSF-Holland. Their structure was spared, so it is one of the only hospitals that is still in a building and not tents. I think they do C-Sections there but I’m not sure. Anyway, it’s an hour drive if there’s traffic, so they’re no help anyway if there’s a complicated delivery. I pray we don’t have one tonight.
We divide up, 8 hour shifts are scheduled. Three rotations. It rarely works out that way. I slept 4 hours the first night. I want to make sure that my team gets some sleep. I haven’t slept well since I got here. The staff tent is noisy, hot, stuffy, and I got the worst cot possible. It is one of the old ones. It’s ripped down the side so my butt sags near to the dirt ground. The night workers are packed in a corner near the AC. Clothesline crisscrosses the walkways and you have to walk hunched over in the dark so you don’t get garroted by the wires. I am stuck by the entrance so I hear all the chatter. I can’t sleep. I roll over and slip on my flip flops and head back to the ER to see what is going on.
There are a few kids sucking on nebulizers, an old woman with belly pain, and a head injury. The two on-call ER docs are busy assessing him. He looks bad. Depressed skull fracture. Blood everywhere. Breathing labored. Everyone is sweating – it just pours off of them. It is midnight but still more than 90 degrees and very humid. The referral hospital had a staple gun and had tried closing his head with it. There are staples all over his scalp, in no real order and although the bleeding has stopped, his head is still misshapen and I start considering whether or not we should continue with the resuscitation. It is our first major trauma since our arrival this afternoon, and my team is being tested. One doc is establishing IV access. Malini from UCSF grabs the ultrasound machine. It doesn’t work. We have a backup and she switches it out. The screen flickers and dies every 5 seconds, so we don’t get good looks, but we think the FAST is negative – no blood in the belly. No pneumothorax. Someone suggests we intubate him. Do we even have ventilators, I think? Do they work? Is it even worth it with for a guy with this level of injury?
We do have a ventilator. It works. We even have a neurosurgeon. He arrived today on the flight. We have all the tools we need. It all starts clicking into place. We may actually be able to do something here. Okay, lets intubate. Lidocaine, etomidate, sux. No monitor working but we have a handheld pulse ox. He is in C-spine precautions and we don’t have a bougie. It is a difficult tube but she gets it without any desats. We send someone running into the tent to find the neurosurgeon and the anesthesiologist so they can get the OR up and running. The tent has 150 snoozing staff members, is hot and dark and muffled. They run up and down the rows with headlamps, whispering for the OR staff, trying not to wake the others who have all put in 16 hour days this weekend. Meanwhile the Haitian transporters have carried our patient into the xray booth – a few wood barriers and a portable digital xray machine attached to a laptop viewbox. I don a lead apron and bag him from the portable oxygen tank while they shoot the trauma series. The neurosurgeon arrives sleepy, disheveled, but ready to operate. Our patient is carried straight from the xray table into the sterile OR (how anything can be sterile in this heat and dust, I have no idea, but it works). He is on the operating table and the ER is quiet again.
My hands are dirty. I lather another layer of Purell onto them. There is no running water in the ER. We are all tired but the adrenaline is still up. We start debriefing. We have never worked together before, each of us are from institutions all over the country. But we know our jobs, know what to do, and realize it will be a good week. I head into the OR to check on our patient’s progress."
Branden Hexom is an Emergency Medicine Physician at Mount Sinai Medical Center
Sunday, March 28, 2010
ED
Three beds on the right and three beds on the left. Usually the majority of the pts are on the beds to the right. If there are no beds left we would put them on the left side.
There is gravel on the ground. Sharps containers present (imagine that). No isolation of any sort and no privacy existed in the ED. Patients changed infront of everyone and went to the bathroom while others were walking by.
Normally, night shift in the ED is 7-10 pm, unless there are patients still treated in the ER after 10. If there are no patients, starting 10 ED staff is on call. On call meaning, our names and cod number is listed in the "Logistics office" and someone has to wake up the staff on call.
On average our "on-call" time would start anywhere between 10 to 2 am.
The staff in the ED at night would consist of one to two nurses (I would be one of them) and one to two doctors. I actually found myself one time as the only nurse with four doctors. Imagine that in US... lol. During the "on-call" time there would be one nurse and one doctor.
I couldn't sleep, which I normally have trouble with anyways, thus I would start being a "resource" nurse during the "on-call" time. So I worked the whole night every night :)
There is gravel on the ground. Sharps containers present (imagine that). No isolation of any sort and no privacy existed in the ED. Patients changed infront of everyone and went to the bathroom while others were walking by.
Normally, night shift in the ED is 7-10 pm, unless there are patients still treated in the ER after 10. If there are no patients, starting 10 ED staff is on call. On call meaning, our names and cod number is listed in the "Logistics office" and someone has to wake up the staff on call.
On average our "on-call" time would start anywhere between 10 to 2 am.
The staff in the ED at night would consist of one to two nurses (I would be one of them) and one to two doctors. I actually found myself one time as the only nurse with four doctors. Imagine that in US... lol. During the "on-call" time there would be one nurse and one doctor.
I couldn't sleep, which I normally have trouble with anyways, thus I would start being a "resource" nurse during the "on-call" time. So I worked the whole night every night :)
The patients that were treated in our hospital
These were few patients that we’ve seen in the Project Medishare for Haiti – Field Hospital:
1 yrs old with battery acid ingestion. He drank a cup of clear fluid that looked like water, that apparently was a car battery acid. He was transferred from another hospital. As the ambulance brought him in, he was pretty lethargic and was not crying anymore. The doctor who took the patient in didn’t know what to do with him. This is not exactly something you deal with on a regular basis back in the States. He ended up calling the California Poison Control stating to the counsler on the other side “I’m going to be the phone call of your day… I am calling you from Haiti”. After receiving all the pertaining information the Poison Control counsler adviced us to leave the kid alone and see how he does. The child started sitting down comfortably half an hour later and a little later was behaving like nothing happen. Go figure
During the time that a lung cancer hospice patient was dying in my ED, a car pulled over stating that a patient having chest pain. The woman who was the patient was sitting comfortably, did not show any signs of respiratory distress, wasn’t grimacing or guarding, and was not profusely sweating. I had to wipe my tears, get my shit together and treat her. Surprisingly, when I took her blood pressure it showed 240/180. I was shocked. Never seen blood pressure that high. We ended up getting aggressive medication treatment for her over four hours without any results. We kept giving her different medications and nothing was affecting the blood pressure. It was still up. At some point during these four hours she fell asleep and was snoring. Me and the doc, who worked with me, joked that she is sleeping better than we do. Eventually, one medication worked and we admitted her to Med Surg unit for observation.
An ambulance transferred a premature baby, who was 2 days old and didn’t eat since he was born. He was dehydrated and starving and didn’t really look human.
During a day shift, right before I was supposed to start working, one of the docs came up to me and asked if I wanted to see a gunshot wound. I replied “Of course”. As I approached the ED, he said that the guy came in after an assassination attempt with two gunshot wounds, one to the head and the other to the abdomen. The doc pointed to a curtain and said “Go!”. I remember thinking to myself, how come I can’t see anybody around the patient. Oh well… I pulled the curtain open. There was a guy lying on a gurney. Surprisingly, he was not moving. I looked at his face and realized that his eyes were rolled back. It finally figured out… “ha… he is dead”. Apparently, earlier when he was brought in, he dropped out of the car already pulseless. Our medical professionals didn’t even initiate CPR. I just wish that I was told prior to entering to see the patient that he was dead.
Trauma patient came in after motor vehicle accident. It was bus versus bicycle. Guess what he was on? His skull was open and you could see the brain. Also, doctors figured that he had a massive stomach bleed. They decided to rush him into an emergency surgery. When they opened him up they realized that his liver was ruptured in two places. He was packed with gauze and closed up temporarily to hopefully stop the bleeding and figure out what to do later.
Woman came in with a infection on her foot all the way up to her knee. She stated that she never injured the leg and this swelling and pus developed over the last three days. She was diagnosed with necrotizing fasciitis and taken into emergency surgery to remove the leg. She died 30 minutes after the surgery.
6 years old kid was brought in for head injury after fall. He had a 2 in laceration on the forehead and was vomiting. We didn’t have CT, so head bleed could not be ruled out. Due to that, he was kept in for observation in the pediatric unit for 24 hrs. When I came back the day after I realized that his mother left him in the hospital and wasn’t going to come back.
The cool thing about working in the ED in Haiti is that if a pt comes in for something simple like a headache without neurological deficit or constipation, or something that we in the ED consider a non-emergency. We would just give do a quick assessment, come to realization that’s it’s not an emergency and send them off right away with Tylenol or just tell them to go to a clinic. No admission papers, no discharge teaching, no waste of time. It was really nice. In Haiti we did what we really want to do in the US sometimes.
1 yrs old with battery acid ingestion. He drank a cup of clear fluid that looked like water, that apparently was a car battery acid. He was transferred from another hospital. As the ambulance brought him in, he was pretty lethargic and was not crying anymore. The doctor who took the patient in didn’t know what to do with him. This is not exactly something you deal with on a regular basis back in the States. He ended up calling the California Poison Control stating to the counsler on the other side “I’m going to be the phone call of your day… I am calling you from Haiti”. After receiving all the pertaining information the Poison Control counsler adviced us to leave the kid alone and see how he does. The child started sitting down comfortably half an hour later and a little later was behaving like nothing happen. Go figure
During the time that a lung cancer hospice patient was dying in my ED, a car pulled over stating that a patient having chest pain. The woman who was the patient was sitting comfortably, did not show any signs of respiratory distress, wasn’t grimacing or guarding, and was not profusely sweating. I had to wipe my tears, get my shit together and treat her. Surprisingly, when I took her blood pressure it showed 240/180. I was shocked. Never seen blood pressure that high. We ended up getting aggressive medication treatment for her over four hours without any results. We kept giving her different medications and nothing was affecting the blood pressure. It was still up. At some point during these four hours she fell asleep and was snoring. Me and the doc, who worked with me, joked that she is sleeping better than we do. Eventually, one medication worked and we admitted her to Med Surg unit for observation.
An ambulance transferred a premature baby, who was 2 days old and didn’t eat since he was born. He was dehydrated and starving and didn’t really look human.
During a day shift, right before I was supposed to start working, one of the docs came up to me and asked if I wanted to see a gunshot wound. I replied “Of course”. As I approached the ED, he said that the guy came in after an assassination attempt with two gunshot wounds, one to the head and the other to the abdomen. The doc pointed to a curtain and said “Go!”. I remember thinking to myself, how come I can’t see anybody around the patient. Oh well… I pulled the curtain open. There was a guy lying on a gurney. Surprisingly, he was not moving. I looked at his face and realized that his eyes were rolled back. It finally figured out… “ha… he is dead”. Apparently, earlier when he was brought in, he dropped out of the car already pulseless. Our medical professionals didn’t even initiate CPR. I just wish that I was told prior to entering to see the patient that he was dead.
Trauma patient came in after motor vehicle accident. It was bus versus bicycle. Guess what he was on? His skull was open and you could see the brain. Also, doctors figured that he had a massive stomach bleed. They decided to rush him into an emergency surgery. When they opened him up they realized that his liver was ruptured in two places. He was packed with gauze and closed up temporarily to hopefully stop the bleeding and figure out what to do later.
Woman came in with a infection on her foot all the way up to her knee. She stated that she never injured the leg and this swelling and pus developed over the last three days. She was diagnosed with necrotizing fasciitis and taken into emergency surgery to remove the leg. She died 30 minutes after the surgery.
6 years old kid was brought in for head injury after fall. He had a 2 in laceration on the forehead and was vomiting. We didn’t have CT, so head bleed could not be ruled out. Due to that, he was kept in for observation in the pediatric unit for 24 hrs. When I came back the day after I realized that his mother left him in the hospital and wasn’t going to come back.
The cool thing about working in the ED in Haiti is that if a pt comes in for something simple like a headache without neurological deficit or constipation, or something that we in the ED consider a non-emergency. We would just give do a quick assessment, come to realization that’s it’s not an emergency and send them off right away with Tylenol or just tell them to go to a clinic. No admission papers, no discharge teaching, no waste of time. It was really nice. In Haiti we did what we really want to do in the US sometimes.
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