this is for Shelby and nurses in general.

So Sunday evening, amidst the chaos of having a brilliant new team here trying to get organized and do operations on what is supposed to be the slow day, the German Red Cross decided to transfer me a orthopedic trauma patient.

This might have been due to the fact that not 24 hours earlier Brooke and I drove to the German Red Cross’s hospital to get their correct info as they are a General Surgeon resource and it’s nice to see where you are shipping people off to.

We had good conversation with them and told them we’d be happy to take orthopedic transfers. We gave them our contact info.

So Sunday evening, one of the Radiology techs who thinks he runs the hospital walked up to me waiving papers in my already overwhelmed face telling me in Crenglish that there was an ambulance out front.

I read a few words of the report before handing the French words (or maybe they were German…) to a translator and going to see the patient.

He was in his 50’s. He had an open femur fracture. Closed tibia fracture and humorous fracture (these were determined later as the GRC hadn’t done xrays). He was bleeding from the goose egg on his head. He reeked of alcohol. He had been hit by a car. The Germans clearly didn’t want to deal with him.

The patient was taken to the ER where I went and found the one short-term volunteer ER nurse because I was in the middle of about five other jobs at the time and I at least needed a BP on this patient.

The BP was 60/?. The hemoglobin was 6.0 (definitely a surgery candidate with no blood in this country).

I wish I knew how to cuss in German.

We dumped fluid in him. Got his blood pressure up. We drew his labs and sent his wife with the blood samples and script for blood to the Red Cross at General Hospital (this is the system…the family goes, sits in line for hours or days, donates, and maybe gets blood for their loved one). I spoke to the Haitian nurse telling her the situation and asking her to watch over him closely. We weren’t sure he would make it.

He lived through Sunday night.

The next morning I learned that the patient hadn’t gotten pain medicine all night and his blood pressure had been taken maybe one time.

I transferred him to Pre-op where I knew he’d be watched more diligently.

He lived through Monday (hemoglobin 4.8) with a promise of blood at 4pm.

He lived until Tuesday with a promise of blood at 8am.

At about 2pm the family member came back and told me the Red Cross said there was no blood.

We called our other contacts with no results.

I walked past Meghan in the hall. A girl from a clinic way out who’d brought some patients in for Ortho clinic. “Do you have any blood contacts I should know about?”

“Well you can always call Big Paul.”

I’ve heard a lot about Big Paul but hadn’t met him. Apparently he’s some crazy American, been here since 10 days after with no medical background but simply “gets shit done.”

He provided us with the hundreds of cases of Pedialite last week.

I called him. He doesn’t know me from Adam. But told me to give him the patient name and he’d take care of it.

He texted me about 30 minutes later and said to be at General at 7pm. I would have two units.

I walked into General at 6:50pm. Brooke dropped me to go by the TB clinic. I walked past about 20 people waiting in line with their coolers.

Holy crap, I forgot the cooler.

I spoke about 5 words of Creole. He spoke about 5 words of English.

I gave the blood tech the patient’s name. I think she said it was almost ready.

I waited.

I lied and said the cooler was in the car. He believed me. Brooke came in without the cooler. She lied and said the cooler was in the car. He told us to go get it. We lied and said the driver was coming.

He knew we were lying. Brooke left to go see if Big Paul had a cooler.

I waited some more. I noticed a girl with a goiter about twice the size of her neck waiting in line I’m sure for blood that would enable her to have surgery.
I suddenly felt sick that my blood was going to a drunkard who walked in front of a car.

I am white. I had connections. I had walked to the front of the line.

I waited some more. The lab tech brought me a cooler. (Guess I should have told him I forgot it to begin with).

Big Paul walked in with no cooler. It didn’t matter. I had the blood.

I walked past the girl with the goiter and the other patients waiting for hours…or days.

We only got one unit of blood. That’s okay. I hope the girl with the goiter gets the other one.

I gave the blood to our patient’s nurse back at Adventiste. She hadn’t hung it when I came back 30 minutes later. I asked her why and she said the patient had a temperature and she couldn’t hang it when the patient has a temperature. I didn’t understand. I told her the blood would expire in four hours and it had to be hung now. I explained the importance of watching the temperature baseline to make sure he isn’t having a reaction, and that didn’t matter that he had a temperature. She wouldn’t do it. I asked Brooke what to do. She said….yeah, it’s that cultural hot body, cold blood thing. Trying to respect her education Brooke and I explained that the patient was going to die without the blood and that the risk of hanging it while he had a temperature outweighed the fact that not hanging it meant certain death. She wouldn’t do it. Brooke and I asked if we could hang it ourselves. Then decided to compromise.

We gave Tylenol immediately and left for half an hour. We would now have about 2.5 hours until the blood expired.

30 minutes later the plan had worked. Brooke said he was afebrile and the nurse was hanging the blood.

He’s getting it now. Dr. Scott says if his hemoglobin is above six he’ll take him to the OR.

Maybe he’ll go in the morning.

For now we’re just waiting.