I'm going to try really hard today to only report good things. Or at least good things that we did for unfortunate patients we encountered.

Today, "Dr." Nick Peairs performed his first surgery and actually got to perform a manipulation on the patient Susanne identified in clinic. Crunch, crunch, pop, snap, crackle, crunch. He was overjoyed. He spent much of the day observing in surgery and helping out at triage.

I started my day looking for Jerry. He wasn't where we put him to sleep last night and it took me a while to locate him. He was happy to see me and I was able to sneak him a breakfast.

Things have calmed down in pediatrics today thankfully. There is an American family who came down here two years ago and opened up an orphanage. One of their babies came into the hospital yesterday with a fever of 105°. Today she is doing much better and I had time to talk with the mom who runs the program. I told her about Jerry and she was going to look into what the hospital is planning on doing with him. Ok, I know I said I would keep today light but I have to explain that the staff here have asked us to stop giving Jerry food, which is provided for the volunteers, and to not allow him in the staff eating room. This is a little hard for us to adhere to as all of the patients here are dependent upon a family member to provide food, bathing and linens. So given Jerry has been sleeping in abandoned cars, we are not seeing anyone else stepping up to take care of him. Given this scenario, we continue to break rules and keep him clean, fed, hydrated and loved. We now get regular smiles and are starting to see that this boy has some real soccer talent. Susanne and I have decided that we are going to ask this American family to have Jerry meet them outside the hospital gate and take him to their home. This will be at the top of my agenda tomorrow, our last full day. It will be too difficult to leave on Saturday if Jerry's future is not a little more secure and unfortunately, he is too big to fit into our suitcases. Plus the Haitian security at the airport is worse than getting through the White House during a terrorist attack.

Susanne's had special moments today which we will share. She evaluated a stroke patient in clinic. She saw great potential but felt he wasn't doing all he could for himself so she gave him some tough love, taught him a few good exercises and told him if he didn't come to clinic knowing how to do these exercises next week, he couldn't come back. She thinks he will now be on board.

Her tender moment of the day was working with the one of the gunshot cervical spinal cord injured patients. He is essentially paralyzed below his neck but has full knowledge of his condition. Haiti handles these things differently from the US. For example, there has been no social service or pysch intervention to help this man face his inevitable death. Susanne took it upon herself to introduce herself and start range of motion with him. With each thing she did, she got his OK. She got the interpreter to tell him that she was so sorry this happened to him and their souls connected in that moment and Susanne fell apart with him and shared some humanity and loving kindness to which he was so grateful. Yes, this place can tear your heart apart several times a day.

I was in the clinic while this was going on treating a seven-week old little girl named Sarah who had "abnormal tone". I was taught when doing infant care to always undress the child so you can fully observe the tone and movement of the baby. So I have the mom undress the child and for a minute I get really confused and think this is a boy I am treating dressed in a dress with a girl's name (I have to digress a moment and explain that it is not unusual to see a boy baby dressed with pink clothes because if that is all that is available, that is what mom dresses the baby in). Ok, so the reason I get confused is because as the baby is being undressed, I see what appears to be a very (and I mean very) large penis. However, on closer inspection what I am seeing is the largest umbilical hernia I have ever seen. Even though we have been told we cannot take pictures of our patients, this is a sight that must be recorded for a number of reasons. I excuse myself from the clinic with the baby in my arms, go over to the pediatrics ward and ask a pediatrician what is the story with this child. She tells me to tell the mom to come back tomorrow for surgery clinic. But I have a better idea. I take the photo to the OR and show the ortho surgeon (who is here with a general surgeon who happens not to be here today), if he thinks that the general surgeon will operate on her and the decision gets made that she will be the first case for Friday. So here is another example where some rules are made to be broken.

Shortly after getting this issue resolved, things go crazy at triage and we are suddenly inundated with five gunshot wound patients. Triage, ER, ICU and Med/Surg are full, the X-ray machine is temporarily broken and it is time to go back into "medic mode". All three of us have been eyeing this one young woman who has been face down on a bench, with a foley catheter in her, in the baking sun and three to four hours have gone by. Each time, she gets closer to the front of the triage line, more trauma comes through and "changing a foley" becomes low priority again. So, I do some quick thinking and the three of us run around gathering up foley catheter equipment (about which we know nothing), and we persuade a pediatric nurse to come to ortho clinic to change her catheter.

We get her a wheelchair only to discover she is a max. dependent transfer. Evidently while pregnant, she suffered a stroke and has been a total care patient ever since. Except - she too knows what is going on and as it turns out, used to be a journalist who speaks decent English. Her sister-in-law has been there waiting all day with her and they have a lovely connection. So we lift her in to the wheelchair, collect all of the needed supplies and help this nurse change an infected foley catheter. The highlight was that a new batch of wheelchairs have just arrived, and we treated her to a new wheelchair, a soft seat cushion, a sundress I brought down with me and Clif bars to take home. She was so grateful, as was her sister-in-law. When the husband came to pick them up and saw that we had all of this new equipment, the smiles exchanged among all of us made every miserable moment experienced that day vanish!!!

I finished my day with Jean Eddy, my incomplete T12L1 spinal cord patient. It is amazing how much he has improved since we started working together. He works so hard and never gives up and it is starting to pay off. I told him that tomorrow I expect him to do all his transfers by himself. It is time to get this young man independent and he is ready and excited. I get nothing but huge smiles from him and much appreciation. He is a delight.

Tonight, we head back to the UN for dinner. We are all hungry, cranky, and dying for a cold beverage. We notice on the far side of the UN, there is a group dancing and living it up. Well, you know me, if there is dancing happening, I just have to go over and investigate. I look at Susanne and tell her you only get to dance with strangers at the UN so many times in a lifetime, so let's go! It turns out they are from Argentina and celebrating this woman's birthday. They re so eager to have us join them and soon we each have a dance partner and are having fun laughing and dancing it up with Hospital Argentina staff.

Back to Bernard Mevs Hospital with dinner for Jerry. Nick puts him to sleep. Now it is bedtime for us.

Jen