Never a dull minute in Bernard Mevs Hospital. Not a very good night's sleep as Kenny, who is sleeping in our bunk, was called out to the pediatric ICU to help intubate a baby who was not doing well. Each morning our bunk empties out by 6:00 am because the nurses start their shift then. We PT's have it made with "casual work hours", so we get dressed, heat up water for our prized Starbucks via instant coffee (never thought instant coffee could taste so good), and enjoy a protein bar. It is our moment of pure heaven. As soon as we venture out our door, the day gets started...

My new little friend Jerry is waiting outside our bunk. He slept in the bunk next door, not sure how long he has been up wandering around the hospital. We have adopted Jerry for the time being and now in addition to his new sneakers, he has soccer shoes, a sheet, a blanket, towel and an abandoned suitcase I found in the back of one of the bunks. Nick took him to the bathroom, (it may have been the first time he used a toilet) and he now knows how to brush teeth and wash up.

Jennifer and Jerry

For much of the day, Jerry was my shadow. I got him situated in the back of Med/Surg area, three hole punching the progress notes used in medical records. Talk about inefficient systems. The forms are put in folders and each time one is needed, you have to hunt down the three hole punch which is never in the same place twice.

We saw a few patients in the clinic and Susanne identified a patient in dire need of a knee manipulation. He had a non-union of a femur fracture which occurred in late 2011. In February 2012, he had surgery to internally fixate the unstable fracture. This occurred above the knee. But, as he admitted, he didn't know that he should move his knee so low and behold, we have the secondary ortho problems that run rampant in Haiti. For some reason, when people have an illness or injury here, they take to their beds and don't move. In clinic today, he had a total of 35° of knee flexion. This is lacking at least 90° of movement – not very functional for any activity.

The ortho doc was in surgery so they had me gown up and discuss the case with him. He will return to Bernard Mevs tomorrow for a manipulation under anesthesia and our beloved Dr. Nick Peairs will be doing the manipulation with guidance from Kevin, the MD.

Susanne and Nick actually went into the OR today to observe an amputation. This woman was a diabetic with a bone infection and what started out as a toe amputation became a mid-foot amputation because that was the first sign of healthy tissue. They both have declared this experience was absolutely disgusting but intriguing. It is amazing how you can get put to work down here. Before long, Nick and Susanne were running around getting things the surgeon needed.

While this was going on one end of hospital, I was working in peds. I apologize for sharing more heartfelt stories…

An American family was in the process of adopting a little boy from Haiti. It was a two-year process for them. On their way to the airport, he had a seizure and as it turned out he had meningitis. When we arrived on Saturday he was intubated, periodically seizing and we were told he was essentially brain dead. Each time I go in and out of peds, I would look over at him and he seemed to be in a sweet state of sleep. I was curious how long he would remain intubated.

Well today, while working with one of my little girl babies, the family had finally made the decision to stop all care. This is where the cultures clashed. The Haitian staff are not used to withdrawing support and on top of that, they had grown very attached to this little boy. To be honest, in my short time here, I would check in on him and at least feel relieved that he appeared to be resting comfortably. So... in the middle of an open pediatric ward, this lovely husband and wife are trying to have their last moments with the child they waited two years to have and every patient and their family member and staff from all over the hospital are coming through the unit to see what is happening. The poor RN Lauren is politely telling the Haitian staff to stop interfering with unnecessary care and she is having to do this through a translator.

I'm watching this through the corner of my eyes and am very aware that I am emotionally drained and starting to cry as is the mom of the baby I am working with. I remembered seeing a privacy screen in a few areas around the hospital and decided to go and grab one from triage. This allowed the family to have their last moments with some dignity before the staff would begin the post-mortem care.

My little guy Serginio was on the far bed watching what was going on, so I decided I needed to get him and me out of there. We were playing out in front of the unit when the parents finally came outside. While I never introduced myself to them while their son was alive, I felt compelled to tell them how much I admired what they had done and how sorry I was for their loss. I hugged the mom and we cried together and then I hugged the dad and he just sobbed in my arms. There is no arguing that this was best for the boy, but it is still a very emotional experience to see.

Now to lighten things up...

Susanne and Nick: Dinner at the U.N.

I have assigned Jerry the job of playing with Serginio and the two of them do soccer drills and we finally saw a dimple on Jerry's left cheek.

We had a lot of laughs at the UN eating. The group is really bonding and unlike last year, I feel much more similar to this group and really enjoying the friendships we are all making. Being here takes its toll on your emotions, but having a fun and lively group makes it far more bearable.

Off to bed.

Jen