January 21, 2010
PORT-AU-PRINCE, Haiti - The faces of the Haitian disaster arrived Wednesday aboard the Navy hospital ship Comfort as a procession of earthquake victims, looking lost and scared, staggered off helicopters or strained to look up from their stretchers while corpsmen carried them below deck.
There was a 20-year-old man with a shattered right leg wincing; a 47-year-old woman with her arm in a splint crying; a school bus driver, burned from the tips of his fingers to the top of his head, smiling. They came from clinics and triage centers across Haiti, beginning just after sunrise and ending at dusk, shattering the ship's military and clinical sterility with the cries and smells and blank stares of human anguish.
More than 70 were aboard when the helicopters stopped flying, the first ripple of what is expected to be a torrent of patients over the next few days.
"I saw more patients in six hours today than I would normally see in 24 hours back home," said Lt. Cmdr. Dan D'Aurora, director of the Baltimore-based ship's receiving ward and division officer of the emergency department at the National Naval Medical Center in Bethesda.
"This is what we train for. This is what it's all about for us."
The patients were flown in by the Navy, Coast Guard or Air Force in one of the 30 helicopters available within the ship's range. Plans for a boat-based shuttle were foiled by an earthquake aftershock that flattened the pier the Comfort had expected to use and that jolted the ship as if it had hit ground. Ship officials identified an alternate boat-landing site by midafternoon.
Operations were also hindered Wednesday by the slow arrival of more than 350 crew members who are expected to bring the vessel up to its full 1,000-bed, 12 operating room capacity. Most of those crew members, expected to join the ship during the next two to three days, will arrive by boat.
But even with the slowed startup, the ship's main treatment and assessment rooms seemed on the verge of being overwhelmed. As one helicopter touched down on the Comfort's flight deck, three or more could sometimes be seen circling over Port-au-Prince harbor.
At the ship's medical receiving area, the first stop of any patient aboard, the same scene was repeated throughout the day: Elevator doors rumbled open to reveal a bewildered collection of men or women, some on stretchers, some in wheelchairs, all gaping at the mad frenzy and bright lights of the Navy's flagship of disaster response.
They wore bloody bandages and wounds wrapped in old sheets or clothing. Some had tape or stickers affixed to their shirts, bearing messages from the triage team such as "chronic renal failure" or "left leg."
By 11:40 a.m. the operating suite was already preparing for four surgeries. By noon, another two had been written on the scheduling board and more than 20 were scheduled by the end of the day. A broken ankle to reset, burns to clean, a procedure labeled simply "crani."
By early afternoon, some surgeons were calling for more operating rooms to open, a challenge before the rest of the crew arrives. The idea was resisted by others, however, because it could tie up all of the surgical teams and leave them vulnerable if an emergency patient arrived.
There was little time for arguing though, as the elevator doors kept opening.
A helicopter from the U.S. Embassy arrived to deliver a 27-year-old Frenchwoman who had been stuck in a collapsed building for days, trapped by her two crushed arms.
Then a boy in pajamas with cuts on his face; an older boy with an IV bag; a woman with a bloody bandage on her left foot; a man with a tube in his chest and failing kidneys.
"It's a 180-degree turnaround from the last mission - the sense of urgency, the desperation you sense in the patients," said Jeff Brown, a Navy corpsman from Columbia. He has been assigned to the Comfort for 2 1/2 years and served in two humanitarian missions to Haiti before this assignment.
"Last time, people wanted to come because they could cruise through the Caribbean and have fun," Brown said. "Now we're here to take care of people and make a difference, and everyone is very motivated by that."
The ship had been preparing for this day since it left Baltimore on Friday, testing equipment, unpacking supplies and holding trauma drills.
But the human reality of what the crew will face - and what Haitians have struggled with for a week - became evident on one of Wednesday's first flights.
He was a young Haitian whose crusting burns covered his head, concealing most of his features. The man told doctors and nurses that he was a school bus driver and was pumping gas when the earthquake hit - and the pump exploded. For six days his wife treated him at home by drizzling cold water over his burns, which showed signs of infection by the time he reached the Comfort.
In the ship's operating room, doctors had to make a decision. To save one of his hands, they would need to set him on a long-term course of treatment, including skin grafts, multiple surgeries and therapy. Since he almost certainly could not get that kind of care in Haiti, the alternative was amputation.
The Comfort's crew arranged an emergency medical flight that will take him to a burn center, perhaps the one at Brooke Army Medical Center in San Antonio, which treats combat injuries,
The man, who was anesthetized to clean his wounds and could not consent to having his name used, was a conspicuous example of Haiti's suffering, but hardly the only example.
As he was being wheeled into surgery, the elevators opened to reveal a man with amputated fingers and a woman who seemed to have miscarried. They were wheeled into the ship, past the seemingly lifeless baby, into spaces vacated by the old man with a neck collar and the young woman who never seemed to move.
"A number of them have been injured in the last few days by walls falling on them in structures where they were trying to sleep," said Cmdr. Tim Donahue, head of surgery on the Comfort. "It shows how dangerous Haiti still is, and how much work we have to do."