chemo day in haiti

I just realized I didn't send this a few days ago...

SOP (Standard Operating Procedure) for mixing chemo in Haiti:

wear gloves, closed-toed-shoes, and face mask (if available). Do procedure in the parking lot, not in an enclosed, non-vented space. DO NOT get pregnant anytime soon...

I'm typing this as I'm waiting for the pre-chemo IVFs (a liter of normal saline with 20 MEQ of KCl and 2gms of MgSO4) to run into my patients veins. She looks like a pin cushion; came in super dehydrated and we had to start the IV at the wrist, but we can't infuse the chemo that way. I'm praying the fluids will "plump her up" so we can find a good vein on her arm. Otherwise, it's an IJ (intra-jugular) on the right side so it dumps into the vena cava (thanks, Anu, for that clinical pearl!)

For the record, we don't do chemo at our facility in Haiti. But the Haitian oncologist who agreed to carry out the palliative chemo plan for this lady designed by the providers in the states totally bailed, and, well, I'm a softie for cancer patients. Always have been.

I was sitting there talking to her parents through a translator, holding back the tears.  This isn't my first rodeo, and while it gets easier to hold on, it's still a bumpy ride.  Palliative chemo is not curative, which is a hard concept to get in the states, much less through a translator in a third world country. We're doing some sublingual morphine intensol to help with the pain, and have nausea meds on hand just in case.

Chemo isn't something I normally "play with", and I got nervous about the base IVFs suggested by the doctor - after some research and a "phone a friend" call to Toni at Samaritan, we changed it to the correct ones.  I am so grateful to all of the teachers and mentors I have had along the way.  It really does "take a village," and mine is a global one.   So with the right recipe in hand, time to wait to see what sort of access we were going to get.

... a few hours later...

A liter and a half of fluid, and still no luck getting good IV access in her arm.  An IJ it is then.  Well, actually, to be precise, an EJ.

Per our "SOP," I mixed the chemo outside.  We have no hood, no real ventilation in the pharmacy, so it's actually safer for me to mix outdoors.  It was quite the show, quite the drama for a few needle punctures, but there needed to be some safety measures beyond what is normal in Haiti.  On went the closed-toed-shoes, the face mask, and gloves.  Rony, Shane, Hannah and Sam stood watch - both to watch me, and to keep others from coming to "hang out" while I was mixing poison (or as I explained it to Shane, mixing radioactive waste).

The bag was hand carried over, and I hung it myself.  Spent the rest of the day checking in on her - monitoring pain and nausea.  We kept the pain at bay, and the nausea too, so I'd chock it up as a success.

After the chemo, we did more supportive fluids, and I chatted with the parents about making sure she is well hydrated before next month, so we don't have to do another EJ.

I emailed Matt, the doctor whose overseeing care from the states.  His email back was short, and the lyrics brought a smile to my face:

"Some will fall in love with life and drink it like a fountain that is pouring like an avalanche coming down a mountain. I've only met you once, but I think it fits you. Thanks."

~PJ