Tuesday, February 2, 2010

"He died two hours later."

Tom Kirsch, M.D.
Johns Hopkins emergency physician and Go Team leader

We work out of big, cream-colored tents, maybe 30 feet long and 15 feet wide. There are tents scattered all over the compound, from many different countries, but all with slight variations on the same design and a color range of white to tan. I guess they are the international standard disaster tent.

We have three tents for our ‘Triage Emergency Department’. Two tents stand out: the ‘Jiffy Pop’ (look that up those of you born into the microwave era), and the Blue Tent.

The Blue Tent is the infectious disease tent with six places for the emaciated people coughing blood that we think have advanced TB. There is an exceptionally brave and unassuming Infectious Disease fellow from California who works there, pretty much alone it seems. She is quiet and unassuming with dark hair and a serious look about her. And she risks her health and maybe even life every time she steps in there.

She works 10-11 hour shifts. At night the patients are alone to cough and gasp for breath, The patient I sent there yesterday was a 19-year old with what appeared to be advanced AIDS. He looked like one of those classic ‘refugees’ in a starvation area with racks of ribs cascading down his chest, sunken eyes and limp, lean arms and legs. By the time he got to us he was already breathing so hard that he had to sit upright and could only gasp out one or two word sentences. He was sweating and you could see every muscle in his torso working to drag in each breath.

We poured antibiotics, anti-malarials and fluids into him immediately, but because he reported coughing blood we moved him to our ‘isolation area’- the open space between our two tents under the shade of some trees. I moved his to the Blue Tent in the late afternoon knowing there was not much to do, but hoping the California doc could work some miracle.

The next morning I went by and was somewhat surprised to see him from under the tent flap still sitting in his bed. After donning an N-95 mask I went into to the dark cramped tent among the shrunken, slightly stirring bodies to get a better look. He sat exhausted and glassy-eyed, sweat streaming off of him and making small grunts with each breath. It took him all his remaining strength to keep himself breathing thru the night and now he had no reserves left. I just tuned and left.

He died two hours later.

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