Haiti, an operating room, and a song

In January 2010, when a large-scale earthquake struck Haiti, I was still in my first years of clinical practice. Reports were coming out from the country, eventually estimating that 300,000 people died, making the earthquake's aftermath one of the worst natural disasters in recorded history. A team of physicians and EMT's from Portland, Oregon were heading down to volunteer in relief efforts and I was invited to join them—three weeks helping out in a country that had just been devastated.

After a long journey through the Dominican Republic by bus, we arrived to find Port-au-Prince's main hospital barely functioning. The Haitian medical staff—dead, injured, or caring for their own shattered families—had largely disappeared. In their place: an improvised team of international doctors and volunteers communicating in fragments of English and French, sleeping on mats in hospital corridors, working with sporadic electricity and almost no medications or equipment.

I had never worked in a hospital before. The care I had learned to give, during my naturopathic and Chinese medical training over 6 years, centered around chronic disease, integrative medicine and pain management.

The nurse overseeing our placements in the hospital asked me if I had ever delivered a baby. "No." I said. She asked me - "well can you learn?" "I guess so" I responded. And so on my first overnight I found myself in the labor and delivery part of the hospital. Before leaving me on my own and in charge, the attending midwife walked me through the patients under our care - who might give birth that night, who had time, who had family present, who was alone. Then she brought me to a bed where a new mother lay in the grip of postpartum shock: high fever, violent shaking, sweat pouring off her body. Disoriented, she couldn't attend to her newborn. Her family pressed around the bed, their eyes moving between the mother and the infant she wouldn't feed.

The midwife looked at me. "Can you do anything for her?" she asked.

I pulled out my bag of needles and began to give her acupuncture. As I began to insert them, the medical director—an MD from Texas—stopped by and asked what I was doing. He had never experienced acupuncture, much less seen it being done in a hospital setting. I felt a bit nervous - was he challenging me and this method? I was unsure, but kept going.

What happened next was as near to a miracle as I had ever witnessed. Within ten minutes of placing the needles, the new mother stopped sweating, stopped moaning. As I removed the needles, she seemed to wake from her stupor, picked up her newborn baby, and put that baby to her breast. The family breathed relief. I was in awe.

The medical director said, "You're coming with me."

For the next thirty hours, he brought me to different sections of the makeshift hospital—the triage tent area that sprawled across several acres outside. There, with the help of a young Haitian translator, I found many people in severe and acute pain. The pain protocols I'd learned in school brought immediate relief so quickly I almost doubted what I was seeing and hearing from the patients receiving the treatment. Were they trying to please me? Was it the novelty of receiving this one to one care? Perhaps this was part of the therapy too. In the post-surgical area, where a lack of pain medications demanded some other method of anesthesia, acupuncture could provide it. I was on my feet nonstop, the need so great that it was only thirty hours later that I finally laid down in my little corner in a hospital corridor to sleep. But - it was not to be.

Within minutes, the medical director was back."Come as quickly as you can to the operating room."  Rest would have to wait.

I followed him down the hall into a bare room with fluorescent overhead lights and a metal table, upon which lay a large Haitian woman, clearly pregnant, clearly in distress, whole body swollen. She too was in a kind of stupor, moaning and agitatedly moving on the table.

The anesthesiologist and surgeon were the only other two in the room. They explained: this woman had severe preeclampsia (the leading cause of maternal mortality in the world) and would die if the seven-month-old baby was not taken from her body by C-section. But her blood pressure was dangerously high. In severe preeclampsia, the blood vessels constrict and blood pressure can spike to stroke-level ranges. Operating under those conditions meant she would likely hemorrhage uncontrollably on the table, bleeding out faster than they could save her. They needed her blood pressure down before they could safely cut.

That's why I was there. Could I do something?

Once again I was in a totally novel situation. This time, uplifted by the success of the day, I felt hopeful—despite being bleary-eyed, sleep-deprived, and in my pajamas.

The patient was hooked up to a blood pressure monitor, the kind that beeps with every heartbeat, its digital display glowing red with dangerously high numbers. She was also receiving IV magnesium sulfate, a first-line treatment that relaxes the blood vessels and helps prevent the seizures that can come with severe preeclampsia. It was already running through her veins, but it wasn't enough.

I began inserting a few points, shocked by the tautness of her skin—stretched tight and shiny over the massive edema that had accumulated throughout her body. In severe preeclampsia, the placenta doesn't develop properly, releasing proteins into the mother's bloodstream that damage blood vessel walls. The vessels constrict, blood pressure skyrockets, and fluid leaks into tissues—her face, hands, legs grotesquely swollen. Her kidneys were likely failing, protein spilling into her urine. The baby, starved of oxygen and nutrients through a compromised placenta, needed to come out. The only cure for preeclampsia is delivery—removing the placenta that's poisoning her system. But first, we had to bring her back from the edge.

Once needles were placed, I stood behind her, cradling her head in my hands. What happened next—though I know it's true and I was there—was like a dream.

In the short time I'd already spent in the labor and delivery rooms, I had witnessed other Haitian women begin to sing when a woman went into labor. And so somehow it felt appropriate—me, the only other woman in the room, to sing to this woman on the table. Perhaps it was the fatigue, perhaps it was the strange circumstances we were all in together, but without fully being conscious of it, I began to sing to her.

Under the fluorescent lights, with the beeping of the heart monitor, in the presence of the anesthesiologist from Russia and the surgeon from Israel, I began to journey and to sing in the middle of this anesthetized scene. I poured myself into the tending and nourishing of the moment—this woman and her being all alone in the midst of a strange circumstance, in the midst of devastation, bringing a child into this world. Who knows if she had any family or what trauma she was in. Where was her family? Did she have a home to go to? All of this was in my consciousness, as was the present moment of the operating table, my hands cradling her head, her body swollen and laboring beneath the harsh lights.

Suprisingly and steadily, her blood pressure came down. The numbers on the monitor began to drop—160, 155, 150. As I sang, the woman stopped moaning and fell asleep on the table. Her face softened. Her breathing deepened. Finally her blood pressure stabilized in a range where they could safely operate. I took the needles out and left the room, floating through the corridor, my hands and body still trembling with whatever had just moved through them.