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Disaster response B #5

            It sounded so nice.  A patient is in the hospital and almost always has family around them.  This evening many were gathered around and singing hymns to the patient.  They sang beautifully and loud.  Other patients families joined and as well as some of the staff.  This evening was a loud evening.  Claps of thunder, music blaring from a loudspeaker somewhere with hymns on it, and the singing in the hospital.  Earlier in the evening I rounded with the surgeon that came over to round with me.   

            The day also started with rounds with one of the local surgeons.  Then I went to the OR to see one of the orthopedist dressing changes.  He has very different method of wound management than I’ve never seen before.  So I wanted to see how his dressings worked and his methods.  This patient had had an infection in their foot after the hurricane.  The infection was in a number of compartments of the foot.  He had taken the patient to the operating room and opened about 5 different compartments in the foot and ankle area.  Then he placed a plaster cast with a lot of padding.  He told the patient to walk on it.  He says the cast causes a hydraulic force in the foot to squeeze fluid out and push it up the leg.  The padding and cast absorb the fluid, then he leaves it in place for 4-5 days.  The dressing was saturated but the skin and wound looked well, and healing granulation was starting.

            Next was a guy with an anal fissure.  He had tried a variety of topical treatments and no change for about 4-6 months.  He wanted it fixed as there was burning sensation with it.  We took him to the OR.  In the OR I found the area of the fissure and went laterally on the anus and made a small incision.   Finding the 2 muscles that in-circle the anus, I cut the inner one.  The inner one spasms, and keeps the fissure from healing.  The outer muscle is the one that maintains continence.  I injected a bunch of local anesthetic and then finished the operation,

            Another patient had a small hole in her leg.  She described being with her family in their villa when the storm hit.  They were up on a hill, so they didn’t get flooding, but did get wind and rain.  The windows broke and the roof started to leak.  They huddled in the bathroom in the center of the house.  Pieces of roof were crashing all around them and they were running to get out of the house when something hit her let.  She didn’t think much of it when they were running for their lives.  Later when she took off her pants she realized there was blood running down her leg.  It seems to be hurting more so she came in to be seen.  I looked at the wound and it appeared like a small ulcer.  After numbing her up, I took off the dead stuff and found a hole that went nearly down to the bone in her leg, about an inch deep.  I cleaned it out and packed it. 

I go by the ER frequently to see if there is something I can help with as our Er docs are getting 2-3 hours of sleep a night and are going the entire rest of the day.  They said I could see a boy for them.  There was a 14 year old boy who came in.  He was chasing a friend and stepped in a puddle of water and slid and fell and split open his chin.  He told me he was afraid of needles and had passed out before.  He asked if he could be put to sleep so that it could be closed.  I said no, but if he passed out, he would be asleep for it anyway!  I sprayed lidocaine in the wound and waited while I prepared everything.  After that I was in the process of injecting lidocaine, when the ER doc brought up a light on a stand to help me see.  He lifted it up and aimed it down at the boys chin.  Just then the light slowly slumped and went down.  I looked at the doc and joked that it needed Viagra.  Both the boy and his mom just busted up laughing.  The boy did great with the injection and I was able to close it up without problems.

Disaster Response B #4           

 I was talking to one of my male patients today about his experience during and after the hurricane.  He said that leading up to the hurricane they had no idea that the storm would turn out the way it did.   He’s an electrician by trade, and worked up till the storm hit.  They’d been through many storms and were not concerned.  This storm had high winds, sustained at 180mph with gusts to 200mph.  it went over the island at about 1 mph.  so essentially lingered for 2 days.  And the storm hit at the time of a king tide and the storm surge across the island was devastating.   He was at home when the storm hit.  And after a few hours he discovered there was water flowing in under the door.  The water slowly rose, and he realized that the water was flowing brown with septic system contents.  He decided to drive his family to higher ground.  On the way there the water got to deep and killed the engine of the car.  He took his child and niece in his arms and waded to a near by house.  He said the water was flowing constantly from East to West.  The family let him in their house and he said the water was getting higher and higher and was up to his waist.  He put the three children on top of the refrigerator to keep them out of the water.  He said on his way to the house he stumbled over something hitting his lower leg and hurting his toe.  He estimates he stood in water for about 16 hours.  His house is still standing but everything in it is ruined.  He had a cut and dead area on his toe that I debreeded and found a piece of glass in it. 

People are very traumatized after the storm.  They’ve lost everything in 2 days.  A team went out to help with tarps and water to the other end of the island and the damage was as if a “bomb had gone off.”  

A woman said she came back after the storm and this is what she found- it was a cement pad of her home.  No walls, no roof, no stuff laying around or near by, NOTHING- just a cement pad.  

Another man described the water coming in his house and he was hanging on to the AC unit in the wall when the water broke through his front door and swept him to the back door and nearly through it.  He said he hung on to the doors of the fridge for about 12 hours as the water swept though his house, and he struggled to not let go and get swept out.

In another small village a grandma described that she lived on a “high” spot on the island and her daughter brought her niece to be with her and then went back to the village to get other people.  They begged her to stay but she left, and was never seen again.  Of the 25 people in that little village the niece is the only one who anyone has seen.  The village is gone, and they were likely swept out to sea with the current flowing across the island.  

Another family describes, how they were in the house when the water started coming in, and they got up on chairs.  They have a disabled teenage daughter.  As the water rose the family of 4 got up on higher furniture and eventually climbed up in the rafters.  The water in their house was 10 feet deep and they only survived by being in the rafters for >10 hours, before being rescued.

            A number of churches at that end were even concrete and were destroyed.  A few houses remained standing but their roofs were heavily damaged or gone.  Businesses were flattened.  Cars swept out to the ocean.  Boats turned upside down on top of trees.  Containers on their sides, or swept away.  Rows of houses- are now rows of barren cement pads with very little debris around them.  

            Lord God, help us to show your love to these hurting people.  Help me to see each one as a person who not only needs physical help, but also emotional and spiritual help.  Give me your words for each that I see tomorrow and every day there after!