EMERGENCY MEDICINE

Tonja
Stothart (QCH)

My week:

I was in the ED every day but they are really well staffed so my focus for them was education of students, residents, staff, nurses and anyone who was interested. Basic trauma (TEAM/ATLS) and principles of fracture management as well as bedside ultrasound. US is truly a groundbreaker for medicine in resource-poor situations where we can quickly, and while doing no harm, determine pertinent positives and negatives. Similarly, in the pediatric ED there is a great local team of residents, students and a staff pediatrician who run this service. There’s also a fantastic wound care nurse who takes care of all of the complex dressings in the hospital. He is ubiquitous and can be found anywhere around the hospital as well as across the street at their wound care clinic setting. I managed to do some teaching and consultation with him along with some of the nurses on some basic principles.

On the first day our sentinel patient was a young mother who was 3 weeks postpartum with a presumptive dx of tetanus. She didn’t have a “source” so we needed to do an internal exam. She was so rigid that was impossible and movement was excruciatingly painful, so we used the bedside US to confirm no retained products of conception or other pelvic pathology. She was someone we saw every day and were involved with advocating for palliation as well as hands on repositioning and some healing touch. Since being home I have heard from our new friend Trish who says this patient is recovering splendidly and is now able to be up in a wheelchair and interacting with family and staff. This is not at all what I expected.

In the ICU the HBM staff were very good and there was a Project Medishare volunteer (Internal Medicine) named Thomas who ran a great unit while we were there. The experience in the ICU was similar to what we would see at home from a patient perspective but a huge challenge from a resource point of view. The tools we have readily available in our hospitals are just not right at our fingertips to take off the shelf. Medications may not be available in a quantity that would support infusions. There may be only a couple doses of the specific antibiotic, inotrope or sedative available in the hospital. There was a constant tightrope walk between efficacy and accessible resources. Sometimes, there was no more left or maybe none to even begin the treatment of choice. Sometimes that was the difference between a chance at survival and none. The code blue arrests called in the ICU, Emergency Department, and inpatient wards were reminiscent of those run at my hospital, if a little less sophisticated and fewer resources like vials of meds instead of pre-filled syringes. The compressions were the same. The teamwork and common goal were evident. The hope and tenacity were consistent. There were deaths almost everyday in the ICU. This is commonplace for them and even at home in Canada. This is a universal truth we witness in healthcare and heart wrenching every time, despite our lack of innocence.

Ashmi was one of the many gems from trips past and present. She is a beautiful girl with a congenital below knee amputation who we met in our 1st TBE mission in 2015 at the orphanage. When we visited in 2017, Mark Steeves and MJ Duncan did a stump revision surgery so that she may be fitted with a prosthetic limb and walk or run like her friends. Wilfred Macena is the Haitian prosthetist who lost his leg in the January 2010 earthquake. He has been working with Ashmi and following her development and progress since our mission in February 2017. It was a complete joy to see her and to connect with Wilfred again. They will be working together to make Ashmi her new articulated prosthetic in the next few weeks and will enjoy an ongoing relationship as Ashmi grows and needs further prosthetic support.

While working with Beth in the paediatric ward, I had the opportunity to meet Jedediah. He is a beautiful and well loved 2 year old child who has microcephaly. He lives in an orphanage over 2 hours from Bernard Mevs. Beth discovered his own fingernails were cutting his palm because of contractures. We managed to make him a tiny splint to support his fingers and keep them off of his palm. We asked permission to do this and hope we might be helping to make his life more comfortable. He was cared for in the hospital by his incredible Mommas who also care for him at home. They created a nest of beautiful warmth and caring, surrounding Jedediah with so much love. I was in awe and very much humbled by Jedediah and his amazing Mommas.

At other times during the week, I managed to see some post op orthopedic, urologic, plastics, and general surgery patients from previous teams, help with some outpatient urology consultations, make a few splints, scrub in the OR, do a couple fracture reductions and small outpatient procedures and support the team wherever I saw an opportunity.

I’ve spent the last 3 days at the hospital, rinks, churches (my daughter’s confirmation), gymnasiums and on the snowy roads. I’ve never been so happy to be driving a car in a snow squall as I was yesterday. The feelings of thankfulness are magical after every mission. The comradeship, collaboration, humanity and love we have had the honour and privilege to witness are hardly short of miraculous. I consider myself lucky to be a part of this team. I have loved watching the building of relationships amongst the veterans and the newcomers as eyes and hearts open with the vision and knowledge of all we have to give and to receive. I am not a religious person but my cup runneth over!

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