The Earthquake Surgeon

I arrived in Port-au-Prince four days after the earthquake. The city looked like a war zone — buildings collapsed into rubble, roads blocked by debris, bodies still being pulled from the wreckage. The field hospital where I was assigned was a collection of tents in a soccer stadium, staffed by a rotating team of international volunteers and Haitian medical personnel who had been working without rest since the first aftershocks stopped.

Our surgical suite was a tent with a portable operating table, a single surgical lamp powered by a diesel generator, and a supply of instruments so limited that we had to reuse gloves — washing them in a bleach solution between cases. We had no CT scanner, no blood bank, no ICU. The closest thing to intensive care was a tent where the sickest patients were placed closer to the nursing station. Patients died there every day — from sepsis, from tetanus, from crush syndrome, from injuries that would have been survivable in any American hospital.

The choices we had to make were brutal. With limited resources, you had to triage not just by acuity but by resource consumption. A patient with a severe head injury who would require hours of surgery and weeks of ICU care? Comfort care only — you couldn't justify using that many resources on one patient when those resources could save five others. A patient with a crushed leg that could be amputated quickly? You amputated. You didn't spend four hours trying to salvage a limb when the next tent held a child with a perforated bowel who would die without surgery.

I performed thirty-seven amputations in my first five days. Some of them were performed without adequate anesthesia because our ketamine supply ran out and we had to make do with local lidocaine and physical restraint. I held the hands of patients while they screamed. I told mothers that their children's limbs could not be saved. I wrote death certificates for patients whose names I never learned because they arrived unconscious and never woke up.

The disaster response community talks about "psychological first aid" for survivors. Nobody talks about psychological first aid for the providers. When I returned to Boston after three weeks, I could not sleep. I could not stop seeing the faces of the patients I had failed to save. I could not reconcile the precision and resources of my practice at Mass General with the impossible choices I had made in a soccer stadium in Port-au-Prince.

What helped — what finally helped — was talking about it. With colleagues who had done similar deployments. With a therapist who specialized in treating humanitarian workers. With the Haitian surgeons who had worked alongside me and who faced those impossible choices every day, not just during a disaster but as their daily reality. The silence was what nearly destroyed me. The speaking is what saved me.