A Tampa General surgeon learns from his Haitian patients

Fritzcar Pierre, 18 months, walks around her room at Tampa General. Among the injured evacuated from Haiti, 70-80 were brought to Tampa. Fritzcar is recovering from severe injuries when her home collapsed, including losing skin from her head and her right eye.

DANIEL WALLACE | Times

Fritzcar Pierre, 18 months, walks around her room at Tampa General. Among the injured evacuated from Haiti, 70-80 were brought to Tampa. Fritzcar is recovering from severe injuries when her home collapsed, including losing skin from her head and her right eye.

On a Monday morning in January, I walked into an operating room at Tampa General Hospital, ready to get back to work after vacation.

The patient who awaited me was my introduction to an experience that will forever affect how I practice medicine.

During morning rounds, my colleagues told me about a number of Haitian earthquake victims who arrived with injuries so stunning that they were unique even to a major trauma center. The gash in my patient's head, spanning most of her scalp, went down to the bone. At first glance, it looked fairly clean. But as I washed out the wound with saline, I saw that it was filled with dirt and glass — and had been for weeks. As I cleaned and stitched the multiple layers of damaged tissue, I realized that without this surgery, the wound never would have healed.

I am a plastic surgery resident at the University of South Florida, in my fourth year of a six-year training program. The life of a resident is nothing like what is portrayed on Grey's Anatomy or Scrubs. Our work hours are long and we often are underappreciated, but I love what I do and learn something new on a daily basis. Each patient we see — whether they've been badly burned, need reconstruction after cancer treatment, or want a facelift — offers a new perspective on plastic surgery. But the Haitian patients — with their distinctive injuries, language and cultural barriers, and phenomenal stoicism — were in a class by themselves.

Over a three-week span, 36 Haitians were brought to TGH, the most of any area hospital. Dr. Jose Lezama, chief of medicine at the James A. Haley VA Medical Center, received a list of patients and their injuries only hours before their arrival at Tampa International Airport, and had to decide where to send them for care. I knew Dr. Lezama from my days in medical school at USF, so I became the liaison between him and Dr. David Smith at TGH. Even after four years of medical school and four years of plastic surgery training, my work is closely supervised by attending physicians. But this sudden onslaught of new patients meant more responsibility for everyone. For the first time in my surgical training, I felt like I was more independently making important decisions to ensure patients got the proper care.

The injuries we saw — burns requiring skin grafts, legs with badly broken bones needing to be stabilized and holes needing coverage with muscle — told the story of what our patients endured. Around them and on top of them, walls fell, homes crumbled, boiling water spilled. Many of them watched neighbors die while they themselves were being crushed by rubble. These were physical and emotional wounds that I had never before seen, and likely never will see again.

These injuries were so complex, we had to coordinate among the plastic surgery, trauma, neurosurgery and orthopedic surgery services. Under normal circumstances, this would be logistical challenge at best. Yet all these busy services came together seamlessly, no passive aggression, no egos, just everyone working together to fix problems.

• • •

For all the surgical challenges, our learning curve was at its steepest when it came to crossing the cultural and language barriers. None of my colleagues spoke French-Creole. At first, we phoned professional translators, who were always available. But that soon became tedious and time-consuming. Nor did it help us make the personal connections we needed to care properly for our patients.

So the residents pooled their money to hire a translator to come along on morning rounds. Issues that were lost in translation before became clear and simpler to remedy.

While plenty of patients dislike hospital food, the choices for most are at least recognizable. However, the menu was so strange to the Haitian palate, our patients weren't eating. Without good nutrition, we knew they couldn't heal properly, and would face more complications.

Tube feeding through the nose seemed a good option. But the very first patient on whom it was tried became hysterical, screaming until the tube was removed. None of us knew that many Haitians regard any tube placement in the body as a sign of impending death.

On to the better, lower-tech solution: A special menu with foods and spices our patients would accept.

• • •

A cynic might think our patients would use their injuries as a ticket to stay in the U.S. But this was far from the truth. In fact, the most common question asked was when they could go home — even if they had little idea what or who might still be there.

Unlike their hospital roommates, they didn't have visitors, greeting cards, family photos and familiar books and games to pass the time. There was no way to contact their family and friends. Other than a beautiful view of Tampa from their hospital window, all they had was prayer and hope. They were stuck in an unfamiliar place with people speaking a foreign language. We were so grateful for the Haitian-Americans in the Tampa area who visited patients daily, bringing familiar food and good company. Those visits had to contribute to the positive attitude we saw in our patients.

Of the 36 patients who were admitted to TGH in January, only nine remain in the hospital. The other 27 have been discharged to a local facility for continued wound care and physical therapy, with hopes of returning home soon.

These children and adults appreciated everything their doctors, nurses, and technicians did for them. They never complained as we stumbled as best we could through the communication and culture barriers. They were in essence, the perfect patients.

I know that our government's decision to treat these patients has been controversial to some who point out that many Americans can't afford health care. But I am thankful both professionally and personally to have been a part of a team devoted to caring for people who endured a horrific disaster.

I'll always cherish getting to know our Haitian patients, and what they taught me about caring for the entire person, not solely their injuries. And the surgical training their care offered will undoubtedly make me a better physician. Experiences like these are why we become doctors.

Michael A. Harrington, 33 is a resident physician in plastic and reconstructive surgery at USF. He is from Ormond Beach and holds his M.D. and master's in public health from USF. He is now on the plastic surgery service at Moffitt Cancer Center.

A Tampa General surgeon learns from his Haitian patients 03/28/10 [Last modified: Sunday, March 28, 2010 7:48pm]

    

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