He came to our Emergency Department gasping for air – the picture of respiratory distress. Each breath was labored and accompanied by a short groan. Our hospital had just posted a notice saying that we could not accept any more urgent respiratory cases because our isolation unit was at capacity and our oxygen supply was critically low. But it is much easier to write a notice that the hospital is on diversion than it is to deny entry to someone who is gasping for air in front of you. Our ED staff had done their best to redirect the patient to another facility where they could possibly get help (highly unlikely because most hospitals were in a similar situation). But when our internist, Dr. V, and I saw the patient, we made a decision to use our second-to-last bottle of oxygen to bring him some relief – it was 3/4 full. Our last half tank was being reserved in one of our operating rooms for emergency surgeries. We had more oxygen on the way. It was expected to arrive by the end of the day. We had sent a team to Les Cayes, a 4-hour drive to the south, to fill 17 bottles of life-sustaining oxygen. They had left early in the morning, but it was taking longer than expected to fill the bottles. We had to source our oxygen from Les Cayes because gang violence had blocked the roads between our hospital and all the local oxygen suppliers, which are based in downtown Port-au-Prince. We had waited for the roads to clear up, but day after day went by and the violence continued…all the while our oxygen supply was diminishing…at a rate of 34 liters/minute to be exact. There were two patients upstairs in our isolation ward who were really sick, requiring increasing concentrations of oxygen, and needed to be transferred out to a higher level of care. The COVID centers in Haiti were all saturated, so Dr. V and I were working with the families of these patients to transfer them to the US as soon as possible. I called the team in Les Cayes mid-late afternoon. They were not quite done filling all the tanks, but I urged them to come back right away because we needed the oxygen badly and I was concerned about them driving at night.
The last couple weeks had been busy and stressful due to the current COVID spike caused by the presence of the UK and Brazilian variants. Scott, our medical director, was out of the country so as the assistant medical director, I felt more of the weight of responsibility for the day-to-day decisions, including ensuring that our oxygen supply was sufficient to meet the needs of our patients. Due to the COVID spike, oxygen suppliers across the board were running low on oxygen and were only able to supply us with up to 10 tanks at a time so they had enough to distribute to the rest of their customers. To make matters worse, gangsters stole a truckful of oxygen tanks heading to Hôpital Universitaire de Mirebalais (HUM), the largest COVID center in the country, so oxygen suppliers were sending their oxygen tanks to HUM to make up for the loss. We explored all the options we could think of. Hôpital Albert Schweitzer, located 3 hours away, generously offered to supply us with oxygen, but when we attempted to go there, the roads were blocked by gangs in Martissant, one of the most problematic areas, which is uncomfortably close to our hospital. We asked the other hospitals in our area where they were getting oxygen – all of them got their oxygen from downtown, on the other side of Martissant. We asked an air ambulance service if they could help us, but they’re not able to transport more than one small oxygen tank and the cost would not be worth the trip. The mayor of Carrefour helped us arrange a last-minute transport via a Coast Guard boat, but our oxygen supplier said they were unable to reach the destination port because of insecurity surrounding that area as well. Land, air, sea – all blocked by insecurity. But the Lord provided a way for us – our CFO, who started working at our hospital ~6 months ago, used to work in Les Cayes and for some reason, he had connections to a company that could potentially supply us with oxygen. But it was 4 hours away and it would take 2 days for us to get the oxygen due to the filling time. And if there was an opening, even for just a few hours, that would allow us to go to town to pick up oxygen, the 2-day venture was not necessarily the best choice. But as the oxygen tanks were used up and the roads continued to be blocked, we made the call to go south.
“He’s out of oxygen.” It was around 7pm and I was walking through the ED when the ED doc informed me that the gasping man’s oxygen tank had run dry. Where was the team that went to Les Cayes? They should be pretty close by now. I gave them a call. They had decided to stay and fill all the tanks before heading back up and were still very close to Les Cayes. I remembered the tank in the operating room being reserved for emergency cases. We could use that one and hope that there were no emergency cases requiring oxygen for the next 4 hours. I went to the operating room with a security guard to help me get the tank. We were stopped by the nurse on duty that night who adamantly refused to let us take the tank. We explained that there was someone who had ran out and really needed it – it was an emergency. But she would not budge. “What if there was an emergency surgery?” she argued. “What it there was a C-section and a baby who needed oxygen?” I was irritated at the resistance from this nurse I had never met before, but the idea of a potential newborn baby gasping for breath convinced me to run upstairs quickly to double check that we didn’t have any other tanks or concentrators that we could use instead. I found one – there was an oxygen concentrator at the bedside of a 6 month old boy with cardiac issues who was being trialed off of oxygen for the night. The relatives of the baby boy were worried that he might need it, but I explained the situation and reassured them that we would have oxygen soon. They reluctantly agreed and I prayed with them for the baby boy. I went back downstairs to the ED, oxygen concentrator in hand, and I saw the ED doc opening the door pulling a dolly that was usually used for oxygen tanks. Had they found another tank somewhere? But the doctor’s face and body language told me something was wrong. It was also strangely silent in the ED – there was no more gasping. “He died?” I asked. “Yeah, he died,” he responded, shaking his head. We sat together briefly on a nearby bench, a mixture of emotions swirling inside my heart – frustration, sadness, anger, regret, helplessness.
I should have insisted on taking the tank from the operating room. I should have acted faster upstairs. I should have been more insistent that the team from Les Cayes return right away. I should have put my foot down and made things happen quickly to save this man’s life – relationships could be repaired later. On the other hand, maybe we shouldn’t have accepted the patient in the first place. I shouldn’t have undercut our ED staff and made them look like the bad guys when they were doing their best to do what they were told to do. We should have been consistent with the hospital notice and sent the patient away…but how could we? We would have sent him away to die. Our mission is to continue the healing ministry of Jesus Christ. Jesus never turned anyone away unhelped. But if we didn’t divert people, our hospitalized patients who needed oxygen could meet the same fate as the gasping man in the ED. But now, the gasping man had died anyways and we were short one 3/4 tank of oxygen. What was the right thing to do?
The security guard interrupts my thoughts and informs me that two of our patients upstairs had also run out of oxygen and one of them really needed it. I immediately headed into the operating room. I told the nurse that the man in the ED had died due to lack of oxygen and told her that I would be taking the spare tank for another patient who needed it upstairs. She didn’t protest this time. I prayed that there would be no emergency surgeries before the full tanks arrived later that night.
I head out of the ED back home. I see Tim taking out the trash, heading to the dumpster. He asks me how I’m doing and I tell him briefly what happened. He comes over, gives me hug and prays for me. While he prays, some of the stress from that day and the last couple weeks is released as tears run down my cheeks and a few beats of a cough-like sob rack my body.
Looking back, I see plenty of evidence that God is taking care of us in the midst of all the challenges we are facing.
– There were no emergency surgeries that night.
– Aside from that day, we have not run out of oxygen again, although there have been plenty of days when it has gotten close due to continued insecurity. We have had more patients die from respiratory failure, but not due to lack of access to oxygen.
– When we were first realizing that our oxygen supply was going to be severely compromised, one of our volunteers, Annika, an ICU-nurse and nurse educator rallied the troops and pulled together the major stakeholders at our hospital to strategize how to both minimize our use as well as work on acquiring more oxygen. I’m so grateful for her leadership during this time of crisis.
– On that day we met, God delivered two bottles of oxygen directly to our campus. A truck from a hospital in Leogane had somehow made it past the blocked roads with several tanks full of oxygen and they generously stopped by our hospital on their way back and sold us two of their bottles. Those two bottles were critical. By the time we were able to get our next refill of oxygen, we were down to the equivalent of 1.75 tanks split between 3 tanks.
– Our two working oxygen concentrators have prevented us from running out of oxygen multiple times.
– Our need for oxygen has correlated remarkably with our oxygen supply. When our oxygen supply was running low, our oxygen requirements also decreased.
– Towards the beginning of this crisis, the oxygen supply lasted far longer than we predicted, reminding us of the story of Elijah and the widow of Zarephath whose jar of flour and jug of oil never ran out.
– Ricardo, our CFO, knew the right people in Les Cayes to make sure we had priority at the oxygen filling station. One of the other hospitals gave us their place so that we could get oxygen sooner. Ricardo went down with the team on his wife’s birthday in order to make sure that they were able to successfully fulfill their mission.
– Our driver, Janvier, and oxygen manager, Justin, have made multiple trips to Les Cayes and have driven in the dark, in the rain, for long hours without any serious accidents. Our vehicle broke down on one trip and had to be towed 4 hours back to the hospital, but they were unharmed. They have also made several trips into town and have been on the road during shootings between gangs and between the gangs and the police, but have been able to make it back safely.
– I was a little worried that once I left campus for this short trip to the US that our oxygen supply might run out since I was not there to keep a close eye on our oxygen supply status, but despite continued and even worse road conditions, oxygen tanks have been delivered to our neighborhood depot so we have been able to keep up our supply more easily. During the 2 weeks I was there, oxygen tanks were only delivered once to the neighborhood depot. Our COO, Mackenson, has been doing an excellent job coordinating things in my absence.
I lift up my eyes to the mountains—where does my help come from? My help comes from the Lord, the Maker of heaven and earth.
– Psalm 121:1-2