A Longer Story

Roselin traveled 80 km to reach us, in the back of a furniture truck. A connection at a hospital in Pierre Payan asked to refer her and another patient to our hospital, saying the patients needed surgical and wound care they could not offer. I accepted.

Several men had to carry Roselin inside on an improvised plank stretcher. We learned this 30-year-old woman had been crushed in the earthquake, and paralyzed from mid-back. At some point in the horrible aftermath, she had lain for a long period without being turned, and so developed a very large sacral decubitus ulcer. Just before the transfer, her previous hospital had attempted to surgically repair her raw sore with a skin flap.

But upon first examination, our two lead surgeons found that solution hadn’t worked. Her flap was highly infected, necrotizing. So they took her straight to the OR, removed the flap, de-brided the sore. And with great creativity, they jimmy-rigged a “wound vac” using tegaderm and a suction canister. The negative pressure would keep her wound clean & drained, and potentially encourage some natural shrinkage until they could attempt another closure. An absolute best effort in a complicated situation. Still, her first days with us were precarious as she battled fever and confusion, teetering on the edge of sepsis, possibly death. “She would have died if we hadn’t gotten to her when we did,” one of the surgeons remarked.

Roselin pulled through. Her mother stayed with her most of the time, “nou pa gen lakay.” We don’t have a home. Roselin’s brother, Fezen, was also often present—clearly devoted to his ailing sibling.

And so, for more than two weeks, our nurses turned her every four hours. Cleaned around her bandaging when the vacuum seal became soiled and started to break. Propped as many pillows and blankets as we had to offer comfort. Sat with her family. Easily our most challenging patient to care for, literally back-breaking sometimes. “But she’s been my favorite patient. I love her,” one nurse said. Roselin felt the care, came to know all the nurses by name, and often tried to communicate even without an interpreter. She knew me, and I usually couldn’t pass her bed without catching her eye’s subtle beckon—must stop to talk.

But things were becoming difficult. The ulcer was getting bigger, not better: 2-cubic feet across and through her back—gaping, raw. We couldn’t offer what she needed, lifetime 24/7 care. I started making calls to all referral contacts I could find: Handicap International, Hopital Paix, Adventiste. One became promising, requesting details on her case, saying “we just need to line some things up, give you a definitive answer tomorrow.” This hospital, in Port-au-Prince, was offering to take her for wound care, and then send her all the way north to Sacra Couer in Milot, where there supposedly exists a long-term rehab program.

Several tomorrow’s past, and I gave a quick pestering call on each. Until finally a tomorrow that said “we got hit hard with urgent care last night; we just can’t take her…”

Of course, we were facing the same: more acutely ill and injured people, constantly. Perhaps the anticipated infectious disease boom has arrived, from a homeless country living in squalid camps? Perhaps we’re simply now treating the baseline injuries, burns, and ailments—things that in pre-January Haiti would likely have gone ignored? I believe it’s all still disaster relief: acute insult reveals chronic suffering.

The staff doctors conferred: Roselin’s prognosis was terminal. Even in the States, her wound might beat our best-in-the-world care. And here in Haiti, even if she survived this acute insult, what is the chronic? More bedsores, surely. More infection and suffering. No rehabilitation.

Following clinical consensus, we sat with Roeslin, mother Julienne, and brother Fezen. We explained, slowly. To the questions of what could be done, we answered that even in the “Ozetazini,” long life was probably not possible. Stopping antibiotics and aggressive treatment would be most comfortable. All pain medicine she needed. All comfort possible. I offered two options, “We can keep you here, and care for you until the end, or we can send you home.”

It was a hard moment… probably don’t need to describe.

Fezen spoke on behalf of family, needing to think and talk to each other. Of course, all the time you need. “We don’t have a home,” he reminded. I told him that if he wanted to go, we’d make them a home.

Left them over the next couple days. Roselin was quiet, sometimes murmuring to herself. Fezen stood in the entrance corridor, reading a small Bible. He then came to me: home, as soon as possible.

Found 2 tents, gave them to him the night before departure, showing how to pitch them. And called Maltesser, an NGO that has an ambulance, pleaded for its use to drive the 2 - 3 hours it’d likely take to reach Tabarre in traffic. Found a cot, pillows, sheets, kerlex and dressing coverage, pain medicine. Sent them off. In the last moment of eye contact before I stepped out of the ambulance, Roselin looked calm, but also blank.

Nothing is predictable here, and this day no different. When the Maltesser ambulance driver returned, he said “the brother told me to take her to a hospital, so I did.”

Were they trying for a hospital closer to home for her comfort care, for her dying? Perhaps. More likely the decision was hope for better treatment. And now, what? Is she being turned every four hours, and kept clean? Is she comfortable? Or is she just receiving antibiotics to keep sepsis at bay? What now?

What should have been done for her? The docs & nurses did their job, offered their very best care. So then, what should I have done?

That was a week ago. I intended to write this story on Good Friday. Now it’s a day after Easter, and I don’t see Roselin’s resurrection. I guess I just hope she somehow finds it.