Late-night transfer

I had a really sick child come in to the hospital Thursday. He happens to be the son of the woman who works at a local orphanage, from which my friends are adopting a baby. We did all that we could for him, which wasn’t really enough, and I left the hospital yesterday evening with that doomed feeling I get when I know a child needs more support than we can provide. I was bracing myself for the worst.

Once I was home I started talking with my friend (the one who is adopting) and she suggested I look into transferring the patient to a private hospital. Usually my patients can’t even afford an ambulance transfer ($62 US) let alone a private hospitalization, so I hadn’t been thinking of it, but in this case I knew that wouldn’t be a problem*. So we started making phone calls, and in several hours I had an ambulance, a place for him at another hospital, and security clearance.

We left Saint Marc about 11pm, and got him there safely. I had never been the passenger in an ambulance before, let alone a Haitian ambulance. It was a fairly bumpy ride, but our driver was very skillful at navigating the bumpy, obstacle-filled roads as quickly as reasonable. He even used the siren. To make things more interesting, there was a heavy rain storm while we were on the road too. The ambulance only leaked a little.

On my return, I got a scolding for the way that everything came together – apparently there are official channels one must go through in order to make a transfer such as I did, and I failed to go through those channels. My boss here questioned the necessity of the transfer, and reminded me that there are important safety considerations when traveling in or near Port au Prince, especially at night time. In my judgment the patient’s breathing was so bad that he had a high risk of dying overnight without further intervention; the receiving hospital agreed – they intubated him as soon as we arrived so that they could put him on a ventilator.

Once I further explained the situation my boss agreed that I had made the right decision, even if I hadn’t executed it in quite the way that he would have hoped. The tone of our conversation at that point changed to a more congratulatory one, and he said I had done the right thing for the patient – whatever it takes. In this case whatever it takes meant a bumpy middle-of-the night ambulance ride and risking the ire of my superiors by doing things a bit outside the usual system, but it got the patient the care that he needed, and that is the most important thing.

We got back from the hospital around 3am, and I got into work Friday morning feeling like a post-call intern – tired but knowing I had a long day ahead of me. Sure enough, it was another busy day. I got home and happily got into bed to take a much-needed nap. Another exciting week in Haiti!

*The issue of transfer status being impacted by the patient’s ability to pay is a whole other kettle of fish which I will address in another post soon. In discussing the transfer after the fact I have heard that there may be money available to support transfers for patients who cannot afford it. Information I wish I’d had months ago. Layers on layers of inequality here.

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6 Comments

  1. Mom

     /  April 14, 2012

    Wow, Sara…..just when you (or perhaps I) think that things may be settling down to semi-normal, a situation like this occurs. Obviously you made the right call, and again, I think that your decision is a reflection of the excellent training that you received at GMC. If you had done nothing and the patient died, you would have that on your conscience forever. Instead you chose to go above and beyond. So bravo for you that you stuck your neck out & did what you had to do. And thank God that you, your patient, & the driver were all safe. That is information that parents are better knowing after the fact.
    Love, Mom

    Reply
    • Yes, I am thankful that everything went as smoothly as it did. The patient is still really sick, but at least we got him there.
      Better to hear about these things after-the-fact, I think. All’s well that ends well, right?

      Reply
  2. Barbara

     /  April 14, 2012

    Hi Sara,
    Wow, that was some adventure, physically and emotionally. I am very happy for you that all turned out well thanks to your courage, timing and some luck. Thank God you made the trip safely with your patient. I hope the patient does well and grows up to tell the story of how his/her life was saved.

    Love,Aunt Barbara

    Reply
  3. Another wake up call reminding me how much I both love, and respect you.

    Reply

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