DAY 6 IN HAITI

“Be safe”… probably the most common statement made to me as I prepared for my trip here. I appreciated the undertones of comfort and security. A nurturing statement that my mom would have said as I walked to preschool.

“Be safe”.  It infects nearly every decision.  Because the water is not drinkable, a slight mistake brushing your teeth can lead to days of diarrhea.  The dirt road separating the hospital from our cabin has large trucks and buses barreling along at 45 mphs.  Besides getting run over, the shower of rocks and pebbles pelt my surgical eyeglasses and headlamp that I wear all the time.  If you forget your bug repellant or your malarial medication, any one of my numerous and growing mosquito bites would be the concern for serious illness.  During one of our surgeries yesterday, safety was never more evident as one of our very own team members sat in the corner with an IV to hydrate as we addressed a child’s perforated intestine.

Safety is a constant process that weighs on every decision.  In surgery, we have to organize our own equipment.  Because there is only one sterilizer, if you forget an instrument, a scissor, a scalpel, or a screw, you will have to wait nearly 30 minutes before that critical tool is available.  Forget twice and it’s an hour. An hour more of anesthesia is also an hour more for the flies to roost on your surgical field and an hour more of danger for your patient.

There is no easily available x-ray.  To x-ray a patient a team member has to transfer the patient on a wobbly wooden stretcher and pull the cart across the gravel road 300 yards to the ancient machine where a near nuclear dose of radiation will produce a gray plastic image to be read like tea leaves.  There is no safety in making orthopedic decision without x-ray.  There is no safety in surgery without proper instruments.  How would we know if our bones are straight or if our screws are too long or too short?  How would we put a screw in without the proper screwdriver? Like Hamlet agonizing over death, we ask, “to be safe or not to be safe”.  I wonder which will lead to more regret.  I know what it means to be safe.  But do I know what it means not to be safe?

There is a patient here with a complex femur fracture.  We were planning an operation to fix it without x-ray or the proper insertion equipment.  If the surgery went smoothly, we could straighten his crooked leg in 30 minutes.  If it went badly, we would struggle for hours and then amputate his leg.  In the aftermath of our recent death, I chose to be safe. Far better, I reasoned, for him to have a crooked leg than no leg at all.  There was no need to be dangerous.

As I unpacked newly arrived crates of equipment today, the insertion tools for his operation hid in the corner of the box.  Then a pick up truck began backing into the dusty entrance with an 1800 lb crate protecting a full size portable x-ray machine.

Goethe said, “be bold and great forces will come to your aid”.  As I looked at the newly arriving aid, I regret the decision I made for my patient.  It is too late in the week to tackle such a large operation. Fortunately, it will be an easier decision for next week’s team.  So I wonder about the words “be safe”.  What is the opposite?  Is it “be dangerous”?

Like a man standing in the middle of the highway, he must decide to jump left or to jump right.  Because to play it safe and stand still will lead to a far worse outcome.

The opposite I think is “be bold”.  By coming to Haiti, I have learned that I may never have enough information or equipment to make a perfect decision and that even an imperfect decision may be better than no decision at all.