So today, we found out that our newfound "go with the flow" mentality would land us in odd places. Ana and I became inducted into our roles as the new pharmacists of the Jimani mission. Exactly how this came to be was a coincidence, not to mention somewhat unexpected. As we sat on the 2nd floor hospital balcony, sipping a disgusting brew of instant coffee and commiserating about not having anything useful to do, the hospital pharmacist finds us. We soon learn that he was going to be leaving tomorrow and basically needed someone to run the pharmacy until the real pharmacist came back sometime next week. We then proceeded to have a comical exchange that proceeded something like this:
Him: "So, do you think can help me out in the pharmacy?"
Us: "Yeah, sure."
Him: "Ever had any experience doing anything in the pharmacy?"
Us: "No"
Him: (pause) "Well...then I think we'll just keep things real practical today."
We spent the next few hours doing practical things indeed. Ana and I were quickly put in charge of reconstituting IV medications, doling out narcotics, and drawing up medications for the operating room. At the same time, Tom, the pharmacist would be tucked away in the back, trying frenetically to organize the pharmacy in some sort of logical pattern so that we wouldn't be overwhelmed. The mornings was quite busy, with nurses from the tents dropping off list after list of medications that would need to be filled as soon as possible. It was there in the pharmacy that we spent the majority of our day, trying to milk Tom for as much experience as possible. "Remember...you guys may be the only ones running the entire pharmacy tomorrow." he reminded us, "So learn as much as you can."
Around midday, we started hearing screams coming from the operating room. Minutes later, one of the surgical nurses came stumbling through the door of the pharmacy, mask half-hanging from his face, saying "Give me 2 of Fentanyl and 2 of Versed, now!" Nervously, I drew up the meds, looking quizzically at the pharmacist to check if I was using the right syringe or if I had the correct amount. The nurse took the syringes and left, only to return ten minutes later for more medication when the screams hadn't stopped. We heard bits and pieces of the story as the nurse popped in and out of the room. Apparently the patient was a young teenage girl who had been taken to the operating room to fix a leg fracture. The anesthesiologist who had been at the hospital for the past two weeks had returned to the U.S., leaving the surgeon no choice but to sedate the patient herself. As a result, the patient had been under-medicated and was now in severely intractable pain. In addition, one of the drugs she had been given (Ketamine) was notorious for producing hallucinations, and it was said that she was stuck in a dream where she thought that the surgeon was cutting off her leg rather than attempting to fix it.
An hour passed. Several doses of Versed and Fentanyl later, the girl had finally quieted down, but it was clear that her bloodcurdling screams had touched all who heard them. As for me, I couldn't stop picturing in my mind the pain she must have felt as the surgeons operated on her leg. The image would stay with me all day as I drew up more syringes filled with painkillers. I knew the root of the problem was the fact that the whole Haiti relief effort operates on a constant rotation of medical teams with staff who have different skill sets. How I wished for a new anesthesiologist to arrive who would make things better!
Ana and I spent the rest of the day in the pharmacy, familiarizing ourselves with its contents and reorganizing where we kept key medications. We also got acquainted with the huge donation pile sitting outside the hospital doors:
It is amazing to see the things that people donate. There are, of course, boxes upon boxes of medical supplies. Indeed, we have everything from multiple cases of Vicodin to boxes of IV antibiotics. There are surprising amounts of "big gun" drugs present...everything from Meropenem (a really strong antibiotic) to bottles upon bottles of Gabapentin (a drug used for seizures and/or nerve-related pain).
The day passed by quickly for Ana and I as we continued our work as "junior pharmacists." I was struck by the sheer absurdity of the situation that all these licensed medical professionals were trusting us and our amateurish skills in light of such important work. Never in a million years did I imagine I would be reconstituting drugs or determining appropriate doses for patients...and certainly, this sort of situation would never happen back in the U.S.
We were late for dinner service that night (which was probably the same spaghetti and spam served the night before), so Ana and I had a somewhat improvised supper of tuna fish, ketchup and mayo on stale loaves of bread. But the after-dinner company sure made up for it. We spent the remainder of the night hanging out in the ICU, trying our best to learn Haitian Creole from the patients and their families. It turns out that they are all wonderful teachers, hungry for company and for human interaction to comfort them in times of great tragedy.
Tomorrow, it looks like Ana and I will be staffing the pharmacy part time as we train another nurse to help with our duties. So I hope this means that we will be transitioning to patient care responsibilities. We shall see...
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