E.R.: Port-au-Prince

Posted on 15 January 2012


Published: January 13, 2012

It was 2 a.m. when the Haitian National Police brought the rape victim to the emergency room. I was the physician covering nights. The E.R. had only two gurneys, and one was occupied by a gray-haired man receiving IV fluids, asleep despite the overhead fluorescents. I hadn’t slept well in days.

When my wife, a nurse, and I first arrived in Port-au-Prince and I was assigned to work in the E.R., I panicked. I’m not an E.R. doctor. I’m an internist. Working in the E.R. means dealing with trauma, obstetrics, pediatrics — stuff I hadn’t faced since medical school. We volunteers had been cautioned to expect to work outside our expertise, but this rotation was way outside mine.

 The rape victim, dark-skinned and slender, was 22 but looked well over 30. She was brought in from the tent camp where she’d lived since the earthquake. Wearing tattered jeans and a stained white top, she was helped onto the empty gurney.

 She spoke no English. I spoke no Creole. I waited while an unemployed musician, hired to translate, and a Haitian nurse took down her history and then gave her a sheet to cover herself up. Once undressed, she would need to be examined.
I couldn’t recall the last time I’d done a rape examination — probably decades ago. It unnerved me now that I might overlook a gynecologic injury or botch the “chain of custody” used to collect forensic evidence in these cases.

The translator told me that the nurse had offered to do the exam. I nodded my assent. Had they sensed my unease?

I stood back and watched as the nurse callously performed the examination, roughly and mechanically swabbing the woman’s vaginal cavity. She offered the patient no words of comfort or explanation. I cringed and glanced at the patient staring numbly at the ceiling, her expression betraying nothing.

No forensic evidence was collected, the overworked cops having long ago disappeared into the night. I remained standing behind the nurse, not wanting to offend her by stepping in and taking over. Should I have at least placed a reassuring hand on the patient’s shoulder?

Afterward, I ordered antibiotics and pills to prevent pregnancy and H.I.V., a complicated five-drug regimen I had to look up using the pharmacy app on my tablet computer. There was nothing more the E.R. staff or I could offer her. Her family would be taking her back to the same ragged tent camp where she was raped.

By 4 a.m. the patient had been gone for some time, out of the building but not out of my mind. My complicity in the way she was handled ate at me. What was done was medically correct, and it would have been the same exam had I not come to volunteer. Still, the worm twisting in my gut wouldn’t let me forget I’d been immobilized by weakness and uncertainty, unable to provide the compassion she needed.

Outside I sat down on a cement step and scanned headlines on my tablet computer. A volunteer nurse named Megan emerged from the nearby sleeping quarters, her eyes red as if she’d been crying.

“Can’t sleep?”

She nodded.

“Tough day, huh?”

She nodded again. I’d heard about a patient of Megan’s, an 8-year-old boy born with severe sickle-cell anemia, who had a difficult operation with unexpectedly heavy blood loss. There was no blood for a transfusion, and he died.

“Come sit,” I said and patted the cement next to me. She sat. I pointed to the tablet’s screen. “Where would you like to go?”

The app I had open connected to street cams around the world. A few taps on the touch screen and we were looking at Eighth Avenue and 34th Street, snow along the curbs, traffic in the street. I smiled.

“There you go,” I said, “the city that never sleeps. Just like us.” She smiled, too.

“Ever been to Paris?” Two taps and we were in the City of Light.

I kept tapping. For 30 minutes we were transported by urban snapshots, marveling at the wonders of anywhere that wasn’t here. Then I switched off the tablet.

Megan got up and went back to bed. I looked up at the Caribbean moon, mute and unblinking. At 62, you think you know who you are but you’re never really done figuring it out. There ought to be an app for that — not only for calculating when to open your heart, but also for adding up the reasons you don’t.

H. Lee Kagan practices and teaches medicine in Los Angeles and is a contributing writer for Discover magazine.


Posted in: Haiti, rape