The Surrogate Child

On January 20, a 13-member team of physicians and medical experts led by TUSM's Dr. Mark Pearlmutter, chair and Vice-President for Network Emergency Services (Caritas), left for Haiti to provide medical care where it is needed most. The medical team is a group of physicians, nurses and techs from the six Caritas Christi Health Care Hospitals, which include St. Elizabeth's Medical Center (Brighton), Norwood Hospital, Good Samaritan Medical Center (Brockton), Saint Anne's (Fall River) and Carney Hospital (Dorchester). Dr. Pearlmutter and his team have been working around the clock to tend the wounded. This is his first-hand account of the team's experience:

"It's amazing how beautiful Haiti is from the air. Mountainous terrain with sharply angulated peaks and lush valleys stretch as far as the eye can see. The contrast to the scene on the ground is almost surreal. Escaping the tragic day to day deluge of displaced severely injured patients seems to happen instantaneously in a chopper.

Helicopter transport to and from the site

Today, I awoke to the news that our four-year-old patient, who was diagnosed by Dr. Arcuri with tetanus, had decompensated during the night. She was without family, which perhaps explained her sad penetrating eyes. On the day of her arrival, she presented to us with a crush injury to both of her legs. She required extensive surgical debridement, a procedure that extensively cleans a wound.

Send donations to: Caritas Christi Haiti Relief Fund Attn: Sr. Marie Puleo Senior VP for Mission 77 Warren St., 5th fl. Brighton, MA 02135

The following day she developed a fever and generalized spasm of her muscles, especially her jaw. Her body would arch back in that typical way I've seen only in text books.

She was immediately given antibiotics antispasmodics and returned to the OR to further clean her wounds, hoping to reduce the bacterial tetanus load. The timing of this event couldn't have been better, as our new Philips ventilator had just arrived that day.

However, the following night, her IV accidentally fell out, and unfortunately wasn't noticed until the effect of the medications wore off. By this time she was in severe respiratory distress. The best decision was to transfer the patient to a higher level of care, the US Navy hospital US Comfort, Project Hope's ship located in Port-Au-Prince harbor.

Doctors provide triage

At the bedside of such a sick child, it's always hard to rationally think through the difficulty of focusing on one child at the risk of not being available for multiple other patient victims. As I ran the non-breathing child across our soccer field converted Helipad, my singular thought was that this young girl could survive and possibly lead an entirely normal life.

Her limp warm body on my lap contrasted with the cool hard steel floor that I sat on. I was reminded of the frailty of life, and how dependent this adorable girl's life was on the proper cadence of my delivery of ventilations with an antique ambu bag. As we swept across the country side on the chopper I had the time to reflect on the past few days. Up to this point there really hadn't been any time to think about the intense and indescribable situation that both the Haitian people and our medical team had experienced.

Outdoor orthopedic ward

We arrived on the US Comfort approximately 25 minutes later There we were directed down the elevator into the pediatric ICU where a team of 10 were awaiting us. We provided a brief report to the medical officer in charge and were ushered back to a holding area waiting for the next Navy chopper to take us back home. The return trip was much more relaxing and provided a respite from the stark reality on the ground.

It amazed me that although we had 250 patients in our hospital compound, the entire team was emotionally connected to the fate of this child. Part of this was because not one of us had diagnosed, seen or treated a case of tetanus. But I'm convinced it was more to do with the dependent fragility of a sick child who was alone without her parents. We all assumed a surrogate parental role that went beyond simply being medical caregivers. Now all we could was hope and pray that the exceptional care being provided on the US Comfort would make a difference.

A child receives an operation

The next day we got word that the parents arrived on our compound by bus (a 36-hour ordeal) from Port au Prince. Our hearts went out to the parents as we told them about their child. We showed them pictures of their child, initially intended for didactic purposes. Who would have known that these pictures would be the last they would see of their child. Their daughter, our surrogate child, had succumbed to the effects of overwhelming tetanus infection. Although we all mourned the loss of this child, we took solace and were even somewhat uplifted when the parents thanked us for all that we had done.

As I watched them leave our compound, I couldn't help but feel that the entire country of Haiti had become our surrogate child."