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My computer battery is currently at 32%. I think my personal battery is much lower. Yesterday was a long, tiring, busy day. The disaster relief effort is past the battlefield medicine of the initial weeks after the quake, but we are in the midst of our own battle at HAH. Everyday, the clinic lines are long, the operating room schedule is beyond capacity, and people are transferred and flown in from field hospitals and local hospitals needed "definitive" orthopedic care. Definitive meaning more than just a temporary solution until the patient can get to someplace more sophisticated. We are that more sophisticated place. We have the honor of having the best Orthopedic care in the country and being a tertiary referral center for the county. We are the end point. If we can't take care of them, no one can. We don't turn people away and we do all we can for them.

Yesterday started out with the news of an emergency C-section for a baby who did not survive. Sometime mid-day, there was a C-section done for a beautiful baby girl who was crying and moving and giving "the eye" all of us oolgers with cameras. I marveled at life and death and the spectrum we see. The day yesterday was full of Ortho cases. We did at least 11 surgeries, and a Plastic surgery team who came to HAH for the day did 4 cases that were on our schedule as well. About 7 last night, as we were plowing through our last 5 cases, we got a call that an American relief worker had had an injury to her left arm with a possible severed artery. They were 20 minutes away and wanted to come into the OR we were in. Scrub technicians (the people who really know the instruments and are responsible for handing instruments, setting up and taking down cases, well, we really don't have any. We have a two nurses who used to scrub cases years ago, and well, that's about it. So, I was acting as scrub tech and 1st assist for our Ortho case last night when this woman came in. The general surgeon asked who he had to tech and I said, well, I'm an Ortho PA with no vascular tech experience, but I can try. When he asked who we had just had as our tech, I said, "Me!" I was very thankfully that one of our nurses/previous scrub nurse was able to step in and take over and I was relegated to running and finding supplies for them. THankfully, the artery was not damaged but it was a large vein that bled badly. The people in the field had put on a tourniquet so tightly there was no pulse in the wrist and her hand was blue. It ended up being a simple procedure and over quickly, and she was on her way. The remarkable thing was seeing everyone come together for an emergency, make the most of the situation and the supplies we have, and get something accomplished. The whole night was like that, though less emergent. We worked till past 1 am this morning. I got to bed about 1:30 after a much overdue albeit quick shower and slept soundly till 6 when rounds started. It was even cool enough to need to pull on the sheet last night.

We did wash out a TON of pus yesterday, and will have more today, and more tomorrow, and more the next day. The major things we are dealing with post earthquake are all the infections. Imagine having your family killed in the quake, living in a tent in a field with no clean water, and having a wound from surgery. Even some of the "clean wounds" have been infected. Also, initial treatments for some open fractures (bones that protrude through skin) was to fix the break with metal hardware. One principle of Ortho is to NEVER implant metal in an open fracture. It 99.9% of the time gets infected, but people here don't know that. So, we are still cleaning out wounds of people with horrible infections. Last night, at midnight, we were debriding the stump of a 40 year old woman whose stump form her above knee amputation was infected. She was sent from another hospital because they didn't feel they could care for her. We did extensive debridements for necrotizing fasciitis, or flesh eating bacteria. It was ugly with lots of dead tissue. She could potentially die from this infection if we don't keep it under control. She could certainly lose the rest of her leg which is highly likely. We will take her back to the OR today for another cleanout surgery.

Well, I know there is more to tell, but no time or brainpower to tell it right now. I'm going to check my email with my feet up for a few more minutes and then get down to clinic. Terry was gracious and suggested I take a break while he gets things rolling downstairs. He thrives on this kind of medicine and schedule and can operate, literally and figuratively, on 4 hours of sleep night after night. I do not. Also, our medical student leaves this Friday morning, and Jeannie and I will be trying to take the job of three people. Also, our wound care nurses will leave on Friday as well, taking most of our team. You can pray that some people come who could join our team and really help shoulder the load. We do have some nice size teams coming from CURE this week, so we can hope and pray for some more hands. Also, our amazing Scott leaves this weekend for some much needed respite time in the US with his family, leaving Terry as the head of Ortho. We will be getting another Ortho surgeon as well, so we'll have his help, too. Terry has a wealth of knowledge and experience in this kind of medicine, but we are still figuring out the logistics around the hospital and with teams coming and going constantly, Scott does a lot to coordinate the entire effort. We will need to all work hard at communication and working as teams to care for these people. We are all tired and all working on little sleep, and what we do get is restless from heat and humidity and from having 40 people stuffed into one area and another 20 down the hall. It is noisy and cramped and crowded, but we are making a difference for people one at a time.