Saturday, January 30, 2010

Day uh, I don't have a clue. Maybe Saturday?

The picture below was drawn by one of our patients in the Intensive Care Unit onboard COMFORT. This is the first of several drawings he has made showing some of the destruction that is so common in this city. And while the COMFORT may look like a cruise liner in this picture, it's only because he probably has never seen the ship.

Another full day! Our patient census continues to rise, but we have essentially hit the limit of what we can take without discharging more patients. So far we've treated over 700 patients and we have 500 or so aboard now. We have a pretty good number that is ready to go home and tomorrow's emphasis is on making that happen.

We have been having increased success in finding available beds in the hospitals outlying the city of Port-au-Prince. They can take some of our patients for ongoing care and recovery. That's a good thing because we need to lower our census if we are to continue to receive patients and attain a sustainable level of effort. It's been 15 days since we left Baltimore. It seems more like 15 weeks and we haven't had any time to pause other than the serindipitous breaks that come from helicopter delays or retaskings.

We had a young child die unexpectadly today and it's been tough on the Pediatric ward staff. He had a broken leg but was healing well. We planned on discharging him today. As his nurse approached him to give him some oral medication early this morning she saw that he was gasping for breath. She started resucitation procedures and called away a "Code Blue" but the child was not able to be resucitated. It's hard whenever we lose a patient, particularly a child, but it's extra hard when you think, "Here's one we've saved!" and then we didn't.

We had a memorial service tonight for a 12 year old girl who died several days ago. She and her mother were from some distance away and we were having trouble arranging to get her back home with her daughter's remains. The way it works here is that if a family wants to bury their loved one, they have to make all of the arrangements and pay for the funeral. If not, the Government will take the remains and bury them in mass graves with the nearly 200,000 others who were killed in a matter of minutes two weeks ago; or died of their wounds in the days to follow. This mother wanted to take her daughter home, but she didn't have any resources to do it. The closest landing zone that we had to her house was about seven kilometers away (about four miles). With no transportation or ability to get transportation, or money to pay for a funeral, she came to the point today where she asked if we would have a funeral service on the ship, then she would allow her daughter to be buried by the Government.

I meant to go. I wanted to be sure that someone other than her and the Chaplain would be there to morn the loss of her child. But I got tied up in one meeting after another and before I knew it, the time for the service had passed. We had decided that we wouldn't announce the service on our overhead speaker system because we didn't know what the reaction would be amoung the other patients onboard. So I was afraid it would be an empty room with no one but a grieving mother and an over-worked chaplain.

I was wrong. I ran into Chaplain Oravec about an hour after the service and he told me that it was a powerful, cathartic time of sorrow and remembrance. There were about 70 people in attendance: Medical staff, translators, and patients.

Tomorrow the two will leave the ship. One going home to a life of uncertainty. One going to an unmarked grave. This is a very sad place today.

I'm going to bed.

Wednesday, January 27, 2010

Day 8: Meet Baby Isabel Rose!

If you refer back to my Day 2 post, I mentioned at the end that our first baby born on COMFORT was born that day. Well, here she is!

Her name is Isabel Rose. Now this is something that her mother doesn't know, but before the COMFORT was the COMFORT, she was an oil tanker named "Rose City." So Isabel Rose, welcome to Rose City!

Another busy day today! At about 4:00pm this evening I stopped by Casualty Receiving and we had already received 53 new patients. I don't know what the day totals were but after that, I was outside for a breath or air (it's really not very fresh here!) and helicopters were landing as quickly as one could get out of the way!

We have 75 Red Cross volunteers onboard helping us with translation. And today, a group of Project Hope nurses and doctors arrived to augment our nursing and pediatric care ability.

Well, it's after 11:00pm and I'm tired! If I get to bed now, I'll get six hours of sleep!

Tuesday, January 26, 2010

Day 7: It's Only Been a Week?

It's hard to believe on one hand that we have only been here a week, and on the other hand that we've already been here a week. I have never been involved in anything where the days have blended together like this mission.

As of today we now have over 400 patients aboard, 35 of them in Intensive Care, with 14 of them on ventilators. The patients on the ward are all what we call "high acuity" patients. Our nurses are stretched to the limit and are doing amazing things to help their patients.

One of the issues for this ship is that half of our 850 ward beds are upper bunks, designed to provide space for slightly wounded or injured patients who can climb up a ladder to reach the rack. Well, anyone who is well enough to climb up to the top bunk doesn't belong on COMFORT, so using those beds has been difficult.

But, the nursing staff is not about to be overcome by such trivial challenges! Most people wouldn't consider a pelvic fracture patient as a suitable candidate for an upper bunk. But, if you pick them up with a scoop stretcher, lift them up to the top rack and place them in the bed, well there you go! One more lower bed for patients who need it.

We have brought patients onboard faster than we can take them to surgery, so we have quite a few patients still waiting to go to the operating room. The last estimate I heard was that we could operate non-stop for three weeks to take care of just the patients we have onboard now. But instead of that, we're working to get more surgeons and nurses and Hospital Corpsmen here so that we can expand our Orthopedic surgery capability and take care of as many as possible.

We've started discharging some of our patients now. At least 50 or so have been able to go home, and we expect more each day. We are working on identifying places where our patients who are recovering, but aren't ready to go home yet, can go so that we can free up more capacity for those who haven't yet been able to get care.

It has been great to be on the receiving end of all the help that has been coming our way from back home. We have had people jumping through some amazing hoops to get us the blood, medical supplies, and equipment we need to keep going. A lot of people have asked if they can send things to the ship for our patients, and I would ask that people not do that. First of all, we have lots of bears and toys that we brought with us when we came, plus we haven't even started to receive mail yet, so I have no idea how long it would take for any packages to arrive. I'm sure that there are organizations in the States who could work with people wanting to donate to the people of Haiti to distribute those kinds of things after the initial emergency is over.

Well, that's all I have time for today. It has been such an honor to be involved with the people who are working so hard to do so much for so many. It hasn't been easy and the toll on our people is substantial. It's very hard to put so much of yourself into this effort and realize that it is just a drop in the bucket compared to the need. It reminds me of the story of the old man and his grandson who were walking down a beach that was littered with starfish left exposed by the retreating tide. As the boy picked up a starfish and threw it back into the sea, his Grandfater said, "There are so many! You can't possibly makd a difference!" The boy looked at his Grandfather and said, "I made a difference for that one!" Well, we can't make a difference for everyone in Haiti, but we are making a difference for some.

Got to run.

Friday, January 22, 2010

Day 3: Aftershocks!

I haven't heard how big is was, but at about 7:45am this morning, the ship was shook by the strongest aftershock we've felt so far. Thirty minutes later, another aftershock hit. Not as strong as the first, but certainly able to be felt throughout the ship. We're not in any danger on the ship from these aftershocks, but they certainly present a danger to those who are ashore. The good news for those of you who would worry about a loved one here on the ship is that even when ashore, we are using tents for shelter, we're not inside any buildings, so I'm comfortable that all of our people are safe.

Geraldo Rivera was onboard COMFORT this morning. I know that he was impressed with the work our people are doing here. He is a bit of a celebrity and lots of people wanted to get their picture taken with him!

We were up on the bridge wing for awhile as his crew was getting set up and while we were there it was one helicopter after another bringing in more patients. One helicopter would barely be off the deck before the next helicopter was approaching to land. We are the busiest trauma hospital in the world today. Our surgeons and CASREC staff are working 19 hours a day and they are truly saving hundreds of lives. But now we're starting to see people who are coming aboard with massive infections that are too far advanced for us to do anything but make them comfortable until their inevitable passing. That takes a tremendous emotional toll on our people. Especially when some of these people look healthy and vigorous, but in a matter of hours become overwhelmed by the infection.

We have three Chaplains onboard who pray with the dying, and pray for and councel the living. Our lead Chaplain is Chaplain Oravec. He has been in the Reserves for years, but just before our CONTINUING PROMISE deployment, he came on active duty and sailed with us for nearly five months back in early 2009. He was a blessing to the crew then and to the people of Latin America. He's a blessing to the people of Haiti and to our crew now. It has been so good to have so many of the people we sailed with in 2009 back with us now when the stresses of this mission are so much larger.

Well, I have to run. Remember us and the people of Haiti in your prayers.

P.S. We got the A/C back on the ICUs! It's actually comfortable in there today. Today we started putting patients in our third ICU.

Thursday, January 21, 2010

Day 2: Heroes on the Loose!

I've titled today's blog entry as "Heroes on the Loose!" because that is exactly what is happening on USNS COMFORT. Yesterday started before 5:00am for most of the crew. By 6:00am, when reveille sounded, the galley had been serving breakfast for more than 45 minutes, the Casualty Receiving (CASREC) department was fully staffed and ready to receive patients, flight quarters was set, and COMFORT was ready to provide comfort to the injured thousands of Haiti.

It didn't take long for them to get busy. By the time most of our friends back home were climbing out of bed, we had received our first casualties and were taking patients to the OR.

13 hours later, patients were still being processed in CASREC, and as we were being briefed on the plan for today, I took these pictures of the people present to hear the brief. They had been working almost non-stop for 13 hours, and many of them left the brief and returned to spend many more hours continuing the fight. When I gave up and went to bed, there were still seven surgeries that needed to happen to clear the decks for today's arrivals.

This is Dr. Tim Donahue, our Director of Surgical Services. He's a Hero. As I was turning in for the night, he was taking a patient to the OR. I don't know what time he got to bed, or even if he did, but today he was right back at it, prioritizing patients for the OR, coordinating with all of the surgeons, and trying to manage the flow of patients to the ship in a manner that would allow the best use of our resources to save lives.

But Surgeons aren't the only heroes onboard COMFORT. This is a picture of a midnight engineering marvel rigged by some of our Civilian Mariners (CIVMARS) in the middle of the night in an attempt to bring down the temperature in our ICU. The electric motor that powers the air handler that provides cooling air for the ICU burned up. A new one is on order, but it hasn't arrived yet. Last night, the temperature was 104 degrees in the ICU. We had been running portable Air Conditioning units all day in an attempt to cool the space, but this space also contains our negative pressure isolation ward which was drawing hot air into the space faster than the air conditioner could pump it out. So, in the middle of the night, they connected flexible ducting to the discharge of the air conditioning units and ran it up the stairwell and off the ship. It got the temp down to the mid 80's by the morning.

And as the morning broke around us, the patients started coming again. Helicopter after helicopter after helicopter, each bringing three patients at a time. And as they arrived, they were brought down to CASREC by a hard-working team of stretcher bearers where doctors, nurses, and Corpsmen evaluated each one, started IVs, ran lab tests, took X-rays, stabilized them, and made decisions on where they needed to go from there. I heard some of our Corpsmen say that they learned more in one day than they did in months of working at hospitals back in the States.

And still they come. As I write this blog, it is now just before 5:00pm on day two. I'm in my stateroom typing this entry and out the window I see helicopters still bringing more. They will fly until dark, and the CASREC and OR will work till past midnight. The ICU's and Wards will work all night, and tomorrow will come.

I would be remiss as a Medical Service Corps Officer if I didn't highlight the nerve center of CASREC. The Patient Admin Cell who tracks every single patient and escort who comes aboard the ship. They collect identifying information, register them in our computer system, print out addressograph cards, follow them throughout their stay here and will ultimately discharge them and process them off the ship.

Today was a day of firsts: Our first baby was born: Life coming amidst the death that is everywhere in Haiti today. And we had our first death: a young man who was crushed in a building collapse during the earthquake. I would like to think that it is our last, but I know better. Pray for the people of Haiti. Pray for us.

Wednesday, January 20, 2010

Anchored off Port-au-Prince

At first light this morning we were approaching our anchorage off the city of Port-au-Prince, Haiti. We already had patients aboard from last night, and it didn't take long for more to start coming.

First we received patients that were transferred to us from the USS CARL VINSON and the USS BATON. Some of these men and women had horrible injuries and in short order were on their way to the operating room where our impressive team of surgeons went to work. As the morning progressed, more and more patients came and an awesome team of professionals took great care of them. It takes more than a doctor to care for these patients and our teams of Hospital Corpsmen, Nurses, and Patient Admin personnel combined with our patient transporters, security personnel, air crews and flight deck personnel did a great job.

Well, I have to run to our 1400 planning meeting.

Operation Unified Response, Haiti

Wow! What a difference a week makes! One week ago, my wife and I were still enjoying our RV trip to Florida to visit our Son, Daughter-in-Law, and Grandson. Last Tuesday, we got home from our trip about one hour after the earthquake struck in Haiti. As the first reports started to come in, it quickly became apparent that this was a disaster of epic proportions and that there was no one more capable and ready to respond than the crew of the Mighty USNS COMFORT!!

If you're new to this blog, I encourage you to take a few minutes and look back at the posts that were made during our recent deployment to Haiti and six other Central and South American countries from March to August 2009. We visited Haiti in April.

Three and a half days after the earthquake, two and a half days after our activation, COMFORT was underway enroute to help in the relief effort.

I wish that I had the energy to relate all that took place to make that happen. But quite frankly, I'm too tired, and it was too much to possibly give all the credit to where it was due. The day of the earthquake, our ship was not only in it's reduced operating status (normally ready to deploy in five days), but we had construction going on on the ship with major renovations to our sanitation systems and electrical systems still under way. We had a new CT scanner that had just been installed and an Angio suite that is half installed. Several of our key crew members were on leave and due to the construction, all of our blood had been transferred to Bethesda.

Two and a half days after activation, the ship put to sea with a medical staff of over 500 people, a security detachment, an air detachment, 84 civilian mariners, a Public Affairs shop, imbedded media, representatives from USAID, a logistics specialist, and I can't even think of the rest!

During the three days of our transit to Haiti we have not only pulled together our team, but have developed plans that include the expansion of the Hospital to levels that have never been done before. With an influx of over 450 additional medical and translator persoonel, we will be ready to fill every patient bed on the ship, run every available operating room, fill every one of our 80 intensive care beds, and do everything within our power to ease the suffering of the people of Haiti.

Tonight was our last night to get a good night's sleep before the crush begins. At our 1900 confirmation brief (7:00pm) we told everyone to get to bed early and get a good night's sleep in preparation for our arriving at anchorage off of Port-au-Prince tomorrow morning.

Then the phone rang. It was the aircraft carrier USS CARL VINSON (CVN 70). And at 9:00pm we got word that our first patients were on the way: Two children, one with a head injury and one with a pelvic injury, both needing immediate surgery.

So as I write this first entry, we are waiting for the helicopter to arrive with these first of what will no doubt be thousands of patients. Our team is ready. Our ship is ready. May God grant us the strength to do what needs to be done.