Haiti Update: Listen to interview with Dr. Menon as he heads home #HaitiDrDispatch

(download)

 

For the past two weeks, I have blogged updates from my friend and college roommate, Dr. Anil Menon, as he used his emergency medical expertise to assist in the aftermath of the Haitian earthquake. In all likelihood, this is Anil's last dispatch from Haiti itself, and it includes the audio from an interview he did with KCBS in which he praises the resilience of the Haitian people and describes some of the long term medical needs of the country. He sent it Friday January 29, 2010 at 09:12

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From: Anil S. Menon
Sent at 09:12 ET/Haiti Time

Headed home now.  Thanks for your support.

Anil S Menon

Sent from iPhone

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti Update: Our fearless leader collapsed on the floor #HaitiDrDispatch


I received the following from Anil on Thursday, January 28, 2010 at 15:01 ET. I've also made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

From: Anil S. Menon
Sent at 15:01 ET/Haiti Time

I remember the smell of infection and the small room we used for triage to the OR. There were a few Haitian doctors, but most were suffering from the trauma of the earthquake, and it seemed like we would never sleep. 

Now the waves of amputations have slowed, we have a handle on the closed fractures, and some endemic disease is appearing. I heard an orthopedic surgeon say "I think we just got kicked out of the OR," which can only be a good sign of the Haitians taking over the reigns. Of course there is plenty of work to last through the years, but this early evolution is good to see.

Dr. Paul Auerbach collapsed on the floor

Dr. Paul Auerbach collapsed on the floor

Our fearless leader and wilderness guru, Paul, took his last meeting at noon and then collapsed on the floor. Right this moment I sit beside him as he recovers and is able to piece together a joke and has already received seven liters of fluid. 

He pushed it to the last moment just like Gaby, Jonathan, Heather, Julie, Bob, and Ian. Of course we get a chance to rest unlike our patients. That's what makes it hard to leave. Like Bob said: "No matter how long you stay, you'll never be ready to leave."

I thank everyone for their support as it has really made me stronger for the mission. [I especially want to thank] Stanford, IMC and the 173rd Fighter Wing.

Anil S Menon

Sent from iPhone

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

 

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti Update: We are nearing the end of our tenure #HaitiDrDispatch


I received the following from Anil on Thursday, January 28, 2010 at 15:01 ET. I've also made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

From: Anil S. Menon
Sent at 15:01 ET/Haiti Time

We are nearing the end of our tenure for the Stanford ER physicians and nurses. A new group from Stanford will be coming, including Rebecca Walker and Jessica Pierog, and Lucile Packard Children's Hospital has agreed to donate another $20,000 in supplies (wheelchairs, prosthetics, and other materials). International Medical Corps will have a sustained presence over the coming year with over 50 staff and help fill the need for continued care created by so many amputations and injuries. 

The city of Port-au-Prince is devastated, but the resilience of the Haitian people is apparent. There is a lot of work to be done, but there is a feeling of normalcy in the hospital now. It might be just the contrast to the initial chaos.  

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti Update: I got into this business to help people #HaitiDrDispatch


I received the following from Anil on Wednesday, January 27, 2010 at 20:58 ET. I've also made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

From: Anil S. Menon
Sent at 20:48 ET/Haiti Time

U.S. Armed Services in Haiti

US Armed Forces in Haiti

As a member of the Armed Service, I am very proud of our humanitarian effort. Not only did I arrive in Haiti with the permission of my commanders at the 173rd Fighter Wing, but I have also worked with the 82nd Airborne and the U.S. Navy to move 50 patients today to receive definitive treatment. These complicated surgeries could be performed only on the USNS Comfort, and we expect another 50 tomorrow. I got into this business to help people, and thanks to this support we have the capacity to help to the fullest.

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti Update: There are always problems you can't fix #HaitiDrDispatch


I received the following from Anil on Tuesday, January 26, 2010 at 23:48 ET. I've also made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

From: Anil S. Menon
Sent at 23:48 ET/Haiti Time

At some point Paul Auerbach turned to me and said, "Isn't funny that no matter where you are, kids are always the same?" We were driving to the General Hospital and looking at two children playing and happy, ignoring the rubble that surrounded them. For the most part, Paul was right. Despite the endless sad stories contained in the hospital walls, the people of Haiti exhibit the same resilience as those kids. There is enough strength and hope and belief to keep moving forward. Enough to keep us going.

Some people have to stop, and some good friends are moving on, like Mike, Benjamin, and Abby from Mount Sinai. I never really learned their last names, but Mike may have been their chair of surgery. You wouldn't know it because he was the first surgeon to leave the OR and make daily rounds through the entire facility with me. We pulled patients from a wooded area on campus and took them directly to the OR or cleaned their wounds where they rested. Right about the time that Sanjay Gupta was considering the fact that there was too many doctors, 
[Mike] was identifying the real issue as a lack of organization and quickly building a structured surgical service. By the time CNN aired its show the confusion of multiple surgeons working independently was fixed.

There are always problems you can't fix. We want to give everyone a job but have to work with the hospital administration to fill positions. Guyto, Davidson, Reggie and Lawrence worked with me from day one as a service to get things moving, but I can't find then all spots here.

The most poignant moment came when Bob [Norris] found the cousin of the woman who died in our care yesterday when we rushed her to DMAT in the back of a pickup. He always takes personal responsibility for people (which makes him good) and had to tell her that her cousin died. It is never something you get comfortable with, but he did his best. She cried, thought about the future and just asked for a job at the hospital so she could make it without any relatives. Knowing he couldn't get [her] a job I think he gave went into the headquarters and gave her all the money he had.

I don't think any of us expect to leave with anything.
--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

 

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti Day 8: Four days ago a woman was shot #HaitiDrDispatch


I received the following from Anil on Sunday, January 24, 2010 at 23:38 ET. This is the second half of the email. The first is posted here. I've also made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

From: Anil S. Menon
Sent at 23:38 ET/Haiti Time

The end of each day delivers a blow, and today was no different. 

Four days ago a woman was shot. She was 32.

She survived the earthquake, but during an aftershock everyone scrambled from the house, and a shot misfired, hit her in the back, the right lung, left her paraplegic, and she went to another hospital. She must have had a pneumothorax, got a chest tube, and was sent here to get on the USNS Comfort. 

She looked okay, didn't seem to be in distress, even had her chest tube pulled by someone, but of course put back in a day later, but never made it on the ship. As a paraplegic, she might not regain her ability to move her legs, and she could wait for a little while before her bed sores got bad and infected. 

We could not have known she would develop a pneumonia today but she did. She began breathing 50 times a minute with an oxygen [saturation] down to 68% and only 90% [even when we put her?] on oxygen [support?], and her only chance was likely a transfer to another facility. To be sure, we checked her lung and heart and abdomen with an ultrasound, gave her more antibiotics and fluid and began to transfer. 

It was tough to find a small bottle so we moved the large oxygen bottle onto the truck, moved her onto the truck, and she began to really decompensate. She was frothing at the lips, moaning, and breathing heavily. I jumped behind her to prop her up and elevate her chest. Bob sat beside her and lifted her chin, and we scrambled to get this old pick up truck running. 

As we moved out of the compound, I thought she would slip out of the back of this pickup, but Bob said "don't worry I got her head in my hands" as he lifted her jaw for better ventilation. I just focused on bagging her as we drove through the crowded streets, and was glad to have a national expert in airways at my side. 

There was actually another patient sandwiched in the back of this open pickup truck, another septic young woman, and Bob kept reassuring her: "Don't worry, I won't let you slip. I got you". He didn't, and we made it to the DMAT tent. 

We told them to get an airway together immediately, but they seemed a little too calm. There is a fine line between composure and delay. Luckily, the Army escort helped us rush her to the treatment tent while we asked for an airway. A cardiothoracic surgeon told us he would intubate, and Bob was reluctant but in someone [else's] turf. 

He of course forgot his stylet, couldn't see anything, and put it in [the patient's] esophagus. The fluid coming from the tube was enough to suspect this but, the air bubbles in her stomach confirmed it. Bob snatched the tube and quickly put it in. Unfortunately, her heart had stopped. CPR wasn't enough, and she didn't make it. 

There were so many turns that could have changed events from transferring her earlier, not initially disconnecting the oxygen, recognizing her earlier, and better communication, more assertiveness with the various care teams. I tell myself that it would have been tough being a paraplegic, but it was tough to lose her. I really thought she was fine this morning. I couldn't find he family since they got lost in the chaos.

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti Update: The top five rules in a disaster #HaitiDrDispatch

 

I received the following from Anil on Sunday, January 24, 2010 at 23:38 ET. I've split the original email into two posts. I've also made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

From: Anil S. Menon
Sent at 23:38 ET/Haiti Time

The top five rules in a disaster.

1) Smile and Care 
"It means more than any treatment you might render." [Stanford Hospital Palliative Care Nurse] Garrett Chan told me this, and I am believing it to be true. The more I do, the more questions I get asked, the more directions I get dragged in, the more important it seems to be there when I'm there.  The people that smile the most, that I will remember, and the situation I will always remember positively was my very first patient.

My first patient ever
My first patient ever

He was 16, and he had a swollen leg with obvious cellulitis. I met him on day 1, and his 1st through 3rd toes were completely necrotic and hanging off his foot like autumn leaves. I was overwhelmed that day, but I couldn't walk away, even though he was supposed to be someone else's responsibility (by our triage system). Everyday, I stopped, smiled, changed his dressing, and eventually got him to see Dr. Pier [Boutin], who removed those toes, and now see him everyday in the post-op area. Someone said he will probably win an Olympic race. I wouldn't be surprised.

2) Be flexible - Every day is a new day.
On the first day, I was a mostly an intern, seeing a few patients, referring them to the surgeons, and sweating to see everyone that walked through the door. Some of the time I might have been a tech, a nurse, a transporter, or a scribe. On the second day I replaced Bob Norris to run an area, know all the patients, and triage the patients for the surgeons.

On the third day, I spent much of my time taking Bob's job that he just vacated: running the triage pre-op area and doing more administrative work, meeting with 
surgeons so they don't step on each others [toes]. A few doctors came, wanted to help, but really only wanted a few specific tasks, things that they found fulfilling (reductions, no nights, of course the minority). A disaster veteran, Dr. Tascone who has made 25 trips to 
Africa as part of a reconstruction process, took the night watch. 
This leads me to the third point.

3) Keep the broader goal in mind
You came to help in any way, and with that, all other problems are solved.

4) Work until you drop
There was a plastic surgeon by the name of Silver who could barely walk by the end of the day. He was older, but he maximized his effort, and I figured I could do the same.

5) Take care of yourself
I think you can recover physically like Dr. Silver, but it's more difficult to be present emotionally day after day. That's why I write, and that's why I appreciate all the support I have received.

[Note: the second part of this email will be published in a separate post]

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

 

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti Update: Life moves on #HaitiDrDispatch


I received the following from Anil on Saturday, January 23, 2010 at 21:55 ET. I've made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

Playing with a ball near the medical tent #HaitiDrDispatch

Playing with a ball near the medical tent

The very first x-ray #HaitiDrDispatch

The very first x-ray

Apparently, not everyone got hurt in the earthquake [but] I wouldn't have known it from what I have seen. I saw a young kid playing with his ball amidst the rubble and realized that life moves on no matter the magnitude of the problem. I'm worried that we will move on and forget the external fixtures that protrude from so many legs or a nation full of amputees and without infrastructure. [College classmate and Dr.] Greg Feldman told me he wanted to wrap up his residency in time to contribute to the continued surgical effort later this year, and I thought that is a sign of true valor and concern and commitment.

[Note from Baratunde: Anil sent another photo, but again, I judged it too medically sensitive to post publicly. The comment attached to the image, however, was: "Decubitus ulcer is our longer term enemy in handicapped patients as time moves on."]

Anil S Menon

Sent from iPhone

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

 

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti: It does feel good to see people turn around #HaitiDrDispatch


This is Anil's final email from Saturday, January 23, 2010. He sent it at 05:47 ET (am) and wrote it at the end of his sixth full day in Haiti. I've made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

Haiti: Child from the rubble returns #HaitiDrDispatch


Child from the rubble returns
(In this photo is 5 year old Monley Elize in the arms of Stanford ER nurse Gabriella "Gaby" McAdoo)

I'm reminded of the boy pulled from the rubble recently that is featured on CNN and LA Times [also Discovery]. Gaby helped this child, and he returned to visit her. He looked so dry initially, and it does feel good to see people turn around, especially those with so much left to see.

Anil S Menon

Sent from iPhone

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

Tagged citizenjournalism doctor haiti haitidrdispatch stanford

Haiti: It must have seemed like anyone who went to the hospital got an amputation #HaitiDrDispatch


I received the following email from Anil on Saturday, January 23, 2010 at 05:39 (am). He wrote it at the end of his sixth full day in Haiti. I've made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.

(Note: Anil included a photo with this post but wrote, "Blank out face or omit if it seems too much." After seeing the image of a recent double amputee, I opted to omit it. It was too much for me, and so I decided it would be too much for this series. The words are difficult enough on their own.)

05:39 ET

The next person I looked for was an older woman named Official who lost her right arm and leg in the earthquake. She just came in because her son struggled to get her here. Dr. Pier [Boutin], the lead surgeon [from Fairview Hospital in Great Barrington, Mass.], took her to the OR immediately for wound cleaning, debridement and amputation (it must have seemed like anyone who went to the hospital got an amputation - I'm sure that stopped many from coming). 

Though she looked good the day before, given those injuries, she did not look good that morning. She couldn't talk as before and she struggled to breathe. Early on, her 13 year old son asked if she was Alive. Of course she was alive. I looked over, and she wasn't breathing. She didn't have reflexes either. 

My lowest point came when I [told] her son she was not alive. I held him as he cried and asked if he had anyone to help. He didn't because they were all crushed by the ceiling. It was hard to leave, even with an older woman to take my place. It felt cheap to give him food because it wasn't enough. Worse yet he left sometime in the afternoon before we could be sure he had any support. I won't ever forget his face.

Anil S Menon

Sent from iPhone

--

Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.

This entire series is chronicled under the HaitiDrDispatch tag

Tagged citizenjournalism doctor haiti haitidrdispatch stanford
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