A Death in Haiti

It was my first full day in Haiti. I had arrived the day before, both excited and nervous to begin my summer volunteer experience as an EMT-Basic at Hospital Bernard Mevs in Port-au-Prince, the only trauma hospital in the entire country, and to learn more about healthcare delivery in a developing country. I was assigned to help out between the triage area and the Emergency Department (ED). The triage area consisted of two cots, along with several chairs for patients, and the ED had two beds. I do not remember exactly what this patient’s complaint was when she came in, but I remember listening to her lungs and being excited about hearing crackles for the first time. I remember her son was very friendly, was wearing a bright purple shirt, and asked me numerous times if his mother was going to be okay. I said, numerous times, that I was not sure. He asked me what I thought was wrong with her, and I remember one of the Haitian doctors saying that maybe she had pneumonia and I passed along this information to him. He asked again if she was going to be okay, and without thinking and since he had asked me so many times before, I replied, “Yes, I think so”.

I do not recall why (probably suspected dehydration), but she was given a liter of fluid and oxygen in triage, and proceeded to sit there for several hours, as most patients in triage did. At some point, she was transferred to the ED. She began to look much sicker, and it was decided that she would be admitted to the Med/Surg unit, which had 8 beds and was in the room right next to the ED. This was a huge step up from the ED as it had a fan, which was manually rotated around to each patient bed. The ED was a room open to air and had a broken air conditioning unit that sat there teasing us all. The running joke was that the A/C unit would be fixed if someone could only close the door; alas, the ED had no door. I was instructed by one of the oxygen techs to briefly take off her oxygen while she was wheeled maybe 100 feet into her newly assigned bed. I did so, and en route, she coded. One of the volunteer American doctors, who was in her last year of family medicine residency, called the code and CPR and ventilation was started. I was complimented by one of the full-time doctors at the hospital on my compressions, and this surprised me, as it was the first time that I had actually done them on a real person. Unfortunately, the woman passed. I remember her son throwing himself on his mother after hearing the news, and I recall saying, “I’m so sorry”.

This was the first of many similar experiences of death in Haiti during my three weeks there. What makes this experience different from the others is that, although I know it was not “my fault” as it is something that I was asked to do, I removed this patient’s oxygen right before she coded. I told her son several hours before his mother died that I thought she was going to be okay. I have no idea why I would say something like that to any patient or patient’s family member, but I did. In talking with the volunteer physicians present after the code, they were not exactly sure the cause of death, but they suspected that the patient had pulmonary edema from CHF which was acutely worsened with the IV fluids that she was given in triage earlier that day. At first, I was greatly frustrated with myself. I thought that maybe, if I had more medical knowledge and experience under my belt, I would have recognized the signs of CHF if she had them (JVD, pitting edema, etc.) and known that it was wrong to give her fluids and remove her oxygen, even for a short trip across the room. Or maybe, if I had known more Creole, I would have been able to speak with her and get a more accurate description of her symptoms. Instead, I had taken at face value what I was told about the patient and followed instructions from those who didn’t really know what was going on either.

After speaking with others mentioned about this, I was told (and realized) that it was futile to blame myself for her death, which, as terrible as it sounds, was more the result of being born in Haiti and not in a developed country with resources and access to good healthcare throughout her lifetime. My time in Haiti was a time of mixed emotions—frustration, anger, sadness, wonder, excitement, and happiness. I learned many lessons while there, but this one will definitely stick with me– I can guarantee that I will never again tell a patient’s family what they so desperately want to hear—that their family member is going to be okay, when in reality, I have no idea if they will be. It was one of those things that if someone had asked me beforehand, I would have never thought that I would do, but when the time came, it just slipped out. It is an important lesson to take into practice with me as I begin third year.

Rachel Heidt

I am originally from Beaufort, South Carolina, and graduated from New York University with my B.A. in Psychology in 2009. Unsure of exactly what I wanted to do with my life, I was fortunate to have the opportunity to work, travel, and volunteer for two years while discovering my desire to become a physician. I lived in Alaska, Belgium, Australia, and Thailand before beginning a one-year post-baccalaureate pre-medical program at Bryn Mawr College in 2011. I spent the past year in Berkeley, California, working for the University of California San Francisco as the analyst for the Division of Hospital Medicine at San Francisco General Hospital, the safety-net hospital for the city of San Francisco. My interests include integrative medicine, global and community health, narrative medicine, and working with underserved populations. Other interests include hiking, yoga, and exploring Greenville and the surrounding areas with my husband. I’m thrilled to be back in my home state and to become a member of the second class at USC School of Medicine Greenville. I look forward to sharing my journey into medical school with you!