I walked between cots checking to make sure that no one had lost consciousness, or worse, since the last pass. There were hundreds of patients on cots in the open courtyard, in the radiology suite, and in every available clinic space. That day nearly 1,000 people came to the hospital gates: some barely conscious, some with no palpable peripheral pulse.
We were ready, with a shoulder bag of IV kits and syringes loaded with epinephrine. When IVs could not be placed into peripheral veins, we forced them directly into bones, secured in place with juice box tops or plastic cups. I can still smell the cholera, sickly sweet, mixed in with the pungent sting of bleach.
I still feel the urgency of squeezing IV fluids into a man with severe shock, four bags through four IVs, alongside a Haitian medical student and the man’s brothers, deputized to help their loved one make it through the night. We had to adjust on the fly to stay afloat. We changed procedures after finding out that a woman had died while waiting to register.
After a week of pandemonium, the in-hospital death rate dropped drastically. When misinformation receded, people took heed of motorcycle criers who implored people to boil their water and come to the hospital sooner if sick, while more patients came to drink fluids in the hydration tent until they improved.
If patients did not improve, their bodies were carried by a former Marine medic and my brother, then still a medical student, into a hut to be wiped with bleach before they could be returned to their families for safe burial. In 2010, in the Artibonite region of Haiti, the cholera epidemic was gaining momentum. There was no cholera in Port-au-Prince yet, officially, never mind a new diarrhea ward full of people with severe dehydration; no tests had been ordered to prove it was cholera, so it wasn’t. Sticking our collective heads in the sand is not a successful physical exam maneuver.
As I began to read reports of the new COVID-19 epidemic emerging throughout Asia and Europe, memories of cholera flooded back. We believed it would not happen here. The U.S. is the richest country in the world with an elaborate health care system, the most technologically advanced and expensive in the world. When I saw press photos of cots lined in Italy, a country with health care so good it treated my visiting father-in-law in an ICU for a month without charge, I could not shake my memories of cholera. To my brother, the image of refrigerator trucks brought back memories of bodies and bleach. We gave any number of reasons why rows of cots wouldn’t appear here. The U.S. gross domestic product per capita is more than 60 times that of Haiti after all; our resources and technology should be able to prevent this.
I should not wake up at night and wonder if I will be fashioning a mask from a feminine hygiene pad or rigging together a splitter to put two patients on the same ventilator. I still can’t shake this recurring memory of walking through row after row of cots looking for those losing ground to disease, or scrubbing bodies with bleach.
These memories will haunt me long after we have edged onto the downslope of the curve when most states will have passed their peak hospitalizations and we can begin to forge a plan for responsible societal re-entry. These memories will haunt me until, as a society, we can guarantee that health care is a human right, that people do not fear losing their health insurance if they lose employment or have to stay home from work.
My hope is that we emerge from this experience with a collective memory so fierce that none of us is willing to return to the previous state in which politics prevented cohesive public health response and ability to provide medical care for our whole population. We must be constantly reminded that American values, wealth, expertise, science and work ethic can and should align toward demanding better for all of our citizens.
Before the images fade of health care workers in New York striding into danger outfitted in garbage bags while refrigeration trucks line up outside, we must galvanize our fellow citizens and pressure our elected officials to make lasting positive changes. Then, and only then, will the smell of bleach dissipate.
Drs. Rachel Bender Ignacio and Aron Bender are siblings who grew up in Spokane. Both are graduates of Lewis and Clark High School and attended universities out of state. Aron Bender is a fellow in cardiac electrophysiology at UCLA, having graduated from Rosalind Franklin Chicago School of Medicine, completed residency in internal medicine at UC San Diego, and a cardiology fellowship at Oregon Health and Science University. Rachel Bender Ignacio graduated from the University of Washington School of Medicine and the School of Public Health and Community Medicine with a master’s in Public Health-Epidemiology. She completed residency at Harvard Medical School’s affiliated Massachusetts General Hospital and an infectious diseases fellowship at the University of Washington, where she is on the faculty in Infectious Diseases.
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