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January 25th, 2010
11:56 AM ET

Doctors find themselves 'playing God' with injured Haitians

Doctors in Haiti have difficult decisions to make, such as whether to send Maudeline Michel to the United States for surgery to fix her hand.

Doctors in Haiti have difficult decisions to make, such as whether to send Maudeline Michel to the United States for surgery to fix her hand.

Every rescue from the rubble in Haiti is cause for celebration, but the staggering number of injured is forcing doctors on the ground to make agonizing decisions about who among the critically injured will be lucky enough to go to the United States for treatment.

The unlucky ones – the critically injured who stay in Haiti – will most likely die.

One night last week at a field hospital run by the University of Miami, Dr. Karen Schneider came to me with tears in her eyes about one such decision, where a boy’s life hung in the balance.

“I have a patient who’s about to die if he doesn’t get out of here, and I don’t know what to do,” she said. “There’s a plane leaving in an hour, and if he’s not on it, he’ll be dead in 24 hours. There’s no question in my mind.”

The boy’s mother, who had lost her three other children in the earthquake, was at the boy’s bedside, begging Schneider to help her only son.

There were three seats on this University of Miami plane, and Schneider was pushing for her patient to be in one of them. But this boy’s situation was so precarious, the doctors in charge didn’t want to put him on the flight, preferring to hold the precious spots for patients with a better chance of living through the trip and making a full recovery.

The boy’s name was Charles. He was 12, and both his legs had been crushed and were infected. He’d just spiked a fever, indicating that the fever was spreading throughout his system, which could very quickly lead to septic shock and death.

A separate disease loomed on top of the infection. When muscles are crushed, they release proteins into the bloodstream and the kidneys can’t handle the proteins and shut down. The disease is called rhabdomyolisis, and it causes a swift death.

Schneider didn’t know which would kill this boy first, the infection or the rhabdomyolysis. All she knew was he needed both legs amputated and fast.

The tiny operating room in the University of Miami hospital couldn’t handle a double amputation. The loss of blood would be substantial, and they had no blood to give him.

“Did you try to get him to the Israeli field hospital?” I asked her. A much better-equipped hospital, I knew they could do more complicated surgeries there.

“We brought him there and they sent him right back,” she answered. They, too, couldn’t handle a double amputation.

The only option she saw was to get him on the University of Miami plane back to Florida. “He was on the list to be on that plane, but then they took him off and replaced him with someone who has a better chance of making it,” Schneider said.

As frustrated as she was, Schneider, a veteran of dozens of medical missions to poor countries around the world, understood the need to make tough decisions. Not only were the plane seats precious, but her patient was so sick he’d need weeks of very expensive intensive care once he arrived at the U. S. hospital. That money to save one life could instead be used to save many, many others.

Making these decisions is like playing God, I said.

“Yes, it’s like playing God,” agreed Schneider, who as a member of the Sisters of Mercy, a Catholic religious order (yes, she's both a nun and a medical doctor), knows a little something about divine decision making.

As Schneider and I pondered what her next step should be to save this boy, I remembered a conversation I’d had with Dr. Veronica Diaz, a surgeon at the University of Miami hospital.

Maudline Michel, age 11, had come into the University of Miami field hospital with a “degloving” injury to her hand, which is just what it sounds like: The skin is completely removed from the hand.

Diaz, who’s doing a fellowship in hand surgery at at Allegheny General Hospital in Pittsburgh, cleaned out the wound and dressed it, but unless she got help quickly from a modern hospital, Maudline would lose use of the hand completely.

“Fixing her hand isn’t hard, we just need the right equipment, like microscopes, which we don’t have here,” Diaz told me. “This place is so sad. I feel so frustrated I can’t take care of her definitively. I just wish there was some way to get her to a hospital in the states.”

Getting Maudline on one of the University of Miami planes, at least last week when I talked to her, was out of the question, as her life was not at risk. So she remained in Haiti and will most likely lose use of her hand.

Schneider’s patient, however, had the opposite problem, which was that her patient was too sick to get one of the coveted spots on the airplane.

Then I had an idea.

“Have you talked to Barth Green?” I asked Schneider. Green is the University of Miami doctor who’s ultimately in charge of the hospital. I’d seen Green move mountains, the kind of guy who can stop a tsunami with a phone call. Schneider immediately went to find him.

A few hours later, Schneider found me again, but this time she had a big smile on her face. “Green got the boy on the plane,” she told me.

“The boy has relatives in Miami, and they called his Mom to tell her he’s doing fine. He’s doing fine.”

Reflecting this weekend, Schneider said, "I have no idea how" Charles got out of Haiti. "All I know is he got on the plane."


Filed under: Elizabeth Cohen
soundoff (11 Responses)
  1. Vondra

    Your stories are one sided.

    January 25, 2010 at 1:47 pm |
  2. John Tyler Pa

    This must be a very stressful for all medical personal. They left hospitals that had provisions to handle all types of situations. Now they're faced with conditions they have no control over. Their requests are being handled by third party personal that are overwhelmed with more requests than they can handle due to logistical limitations. When these medical people return they will face similar problems that our troops returning from any battle type situation encounter. God Bless them.

    January 25, 2010 at 2:02 pm |
  3. Leob

    how would $35 million created 0 jobs done in Oklahoma look or be in interest?

    January 25, 2010 at 2:59 pm |
  4. Callahan S

    Beautiful story.....it must be so hard for the Doctors. Seems like the Sister/Doctor had a little divine intervention through a network of individuals. This child has a 'real' story to tell in the future!

    January 25, 2010 at 7:09 pm |
  5. Eileen G. Curras widow to Hernandez (WWII)

    The bottom line is that more people will die in Haiti and your comment from a University of Miami doctor sounds to me as a shock when JMH doctors send patients to their houses at 2:00 am without medication and no care with chronic conditions. It does not sound to me to be JMH material or the truth and it seems to that the University of Miami did not send the appropriate material to Haiti. Doctors at JMH play God all the time when they denied medical attention to patients and that happen to me in 2004. Then I had to make a decision to go back to Puerto Rico were the ADA Act is not enforce.

    January 26, 2010 at 7:27 am |
  6. J. A. Louis (NY)

    It is not appropiate to compare this emegency treatment in Haiti to current care in American hospitals . this is money well spent. We need more efforts though to improve American healthcare but the choices that are made each days in every hospital in treating patients all seem to be "Acts of God" . I just hope that the training and selection of hospital personnel allows for the intervention of a higher power to make life saving decisions reflects wisdom on the part of the Human resources of all these Hospitals and Universities! . J.Louis

    January 26, 2010 at 10:45 am |
  7. Kaea

    Triage is critical in Haiti now. When you have 3 doses of antibiotics, and no more, you give them to the people who have the best chance of survival. How awful to have to make that decision! Dr. Miller, you and your colleagues have my prayers and sympathy. But I think the people who are "playing God" are those responsible for the awful lack of distribution – those supplies, and many others, and a lot of food and water, are sitting at the airport. WHY aren't they getting to the doctors and field hospitals? And don't tell me "logistics" or "security". That's so much cr*p. Thousands of people have died from lack of medication, lack of treatment, lack of food, lack of water, just since the earthquake itself. That's OUTRAGEOUS! People who are treated medically and fed and watered are FAR less of a security problem than those who aren't! Gen. Honore has the right ideas. USE the people, don't let them die! Why hasn't someone organized a "fire brigade" type of thing – let those people who are in desperate need line up all the way to the airport and start passing those supplies if the roads are blocked! Since there are so many "security" people there, let them line up too! Use them to SAVE lives, not protect supplies!

    January 26, 2010 at 11:17 am |
  8. K. Johnson

    These criticisms of the stories presented by the CNN medical corespondents boggle my mind. Because they are medical professionals, their hearts and their ethics compel them to both report and to offer help. We are fortunate to have these and the other gifted CNN messengers (you know who you are) telling what they see. Don't shoot the messengers!

    It fills me with sadness to think of what the medical people in Haiti were witness to in the first days. What have endured mentally, day after day awash in a sea of suffering and gangrene with no kind of supplies? What were they exposed to? I would like to see a news report about that.

    When I think of how all this happened day after day, meanwhile over at the airport the US military was quite literally sitting on a large stockpile of other countries' medical supplies, it fills me with loathing. It is an atrocity.

    January 26, 2010 at 11:35 am |
  9. Karen Pursel

    I'm confused! I thought the USS Comfort was sent to Haiti to handle a large percentage of the critically injured. Does anyone know what that ship can actually handle in the way of life threatening injuries?

    January 26, 2010 at 2:09 pm |
  10. Pat Sullivan

    Such stories are heart rending and the decisions these doctors and nurses are making are difficult and may seem impossible. Somewhere though we seem to loose the immensity of the tragedy in looking at the specifics. Even with a large outpouring of support from the wonderful doctors and nurses who have gone to Haiti the numbers are overwhelming. Even if the facilities had been well supplied there is no way to give the care one wants to give. Is there anyone in charge? I think the tragedy of the collapse of the UN building cannot be overstated. They need a Haiti 'CZAR" someone like General Honore. But even if he were there and put in charge today there would still be HUGE problems. Count the number of meals needed and divide it among the hungry people. There is risk of chaos.

    January 26, 2010 at 2:43 pm |
  11. Dr. Ron

    It's hard for most people to imagine what goes through a doctor mind when they are treating a patient. Trying to justify a treatment for an individual when you know that you can spend the same amount of time treating several others. Is it right to ignore several patients to help one. This is a decision that all the doctors in Haiti are going through right now. So before you cast judgement on these doctors, just remember that, what ever thier decision is, is the decision that they will have to live with for the rest of thier life. These decisions are not easy and I have seen many of good doctors never recover from a decision that they have made in the past.

    January 27, 2010 at 1:31 pm |