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14 days and counting. I got the message yesterday that a group would like me to go to Haiti. I'd already thrown my name in the hat in the beginning, but they all needed (appropriately) surgeons. Or nurses. But now the situation has morphed, and when the call came my insta-gut response was "yes." Afterward, a tiny flicker of stomach-butterflies set it. Maybe it was the fact that I don't (and maybe won't) have a confirmed return flight home. The estimated time for being there is a week (very do-able), but no guarantees on that estimate (um, less do-able?). Or maybe the butterflies were in part because of the way the lead doctor emphasized (three times!) the fact that we would always have Security with us (clearly said with a capital S). But I knew I wanted to go. When it comes to Haiti, so many of us want to do something. And so I thought you might like to go with me. Which is why I'm going to write about the trip, probably more openly and personally than anything I've written to you before. But first, just so we're all clear, here are the rules:



Doc Gurley's Haiti Manifesto



Rule #1: Why me? Altruism is a gift that benefits the giver. Never more so than when despair hovers. It is amazing how, when I told family, friends and co-workers that I was going to a life-threatening disaster zone, rife with disease and unspeakable deprivation, the uniform first response has been a blurted out: "You're so lucky!" followed a shocked moment of horror-filled realization as they heard their own words, then "Not lucky, I mean, it's going to be hard, really hard, it's just that I wish I could do something like that, well, you know what I mean..." Sometimes it's even difficult to verbalize exactly why we feel that spike of jealousy. I think it's because we all wish we could do something tangible. Something with our hands and our backs. Heavy lifting. Hey, we all know the checks are important (VERY important), but after a while they feel the same as handing your kid a twenty on her birthday. Like something crucial is missing in the act. Could that urge to do something, anything, be the reason I'm going? I've thought about it - am I taking the place of someone else who should go instead (keeping in mind that it can be too easy to think that maybe someone else ought to go, and, if we all do that - no one goes). But I don't think I am taking someone else's place. Here's why: a) I'm an internist, a grunt, a flea, a sickest-of-the-sick-adults'-doctor, one with extensive ER and hospitalist experience, the type of doctor (after the surgeons have left) that they need now, and b) I currently see patients in a homeless clinic with a strong culture of collaborative care so - while it's admittedly still not Haiti - I don't tend to have the typical easily-offended doctor amount of either ego or fastidiousness, and c) I speak good-enough French to have worked for three months in a monolingual medical environment, and d) I did those French-speaking healthcare months in a Third World country in Africa, a place somewhat like Haiti in that the generators turned off every night and mosquito netting and hungry bats were our major malaria interventions, and e) frankly I am lucky enough to have the job/benefits/luxury of being able to go on short notice while not paid to do so like a disaster team is, and f) while the fact is that I'm not a nurse (okay sure, I ran an IVAC once, but all I remember of the experience is a panic-filled blur of jabbing buttons while machines beeped at me in a decidedly contemptuous fashion), and would never claim to be a nurse, I can honestly say that if there's a bandaging, dosing, vital-sign-taking, bedpan-changing, spongebath giving, floor-mopping job to do, well, like most of us peri-menopausal moms, I'm your Gurley. All of which leads to Rule #1 - the better candidate goes. That means if someone more qualified or adept can take my slot, I step out. Even at the eleventh hour (that would be 4:30 am, February 15, in a United terminal at Chicago's O'Hare, in case anyone's keeping track).

Rule #2: We go there to work. There will be NO ethically weird moments when the camera swings, Gupta-like, in my direct and I orthodontially blind you while simultaneously performing surgery. I'm going there to work. As a doctor. I'll be sweaty, I won't waste suitcase space on make-up, and God knows what my hair will be doing. Sweaty doctor - that's it. There is no sub-clause, no asterisk, no employer, no other job title. There is no conflict-of-interest. The Chronicle/SFGate is not paying me anything, not transport, nada. Heck, I can't even get a satellite cell-phone out of them to make sure I can send and/or upload posts (but maybe! they're working on it!). Any sharing of the experience from me to you happens after the work is done. But as much as is humanly possible, we'll go together. Every step we can. Because whether you're frustrated, or despairing, or hungering to do something, or rage-filled about our own neglected problems at home, there are moments when it's best to share. And an epic disaster is one of them. Join me. We'll go together and do what we can to help.

Rule #3: HIPPA goes to Haiti. People the world over deserve their medical privacy. And no one - especially the very desperate - should have to wonder what their doctor's motivation really is. If I write/blog/video/audio record about a patient, or a situation, either that person will NOT be one of my patients, or their identity will be so changed that no one will ever be able to know exactly who that 12-year-old girl with a head injury really was.

Rule #4: It takes a village to help a village. It's been less than 24 hours since I found out I was going and friends have already stepped up. An Eagle Scout mom has an ultra-small sleeping bag for me (so I'll have more room for medical supplies in my luggage). Colleagues are pitching in to cover shifts they have NO obligation to work (thank you, Barry! thank you, Mary!). Churches - here and there - are helping with logistics and food. Total strangers are coming forward with airline miles for me to use, and a place for me to bunk in Chicago while I wait for my flight out. You too are welcome to go with me to Haiti in spirit. And if you would like to go with me in a more tangible way, I'll let you know of opportunities. But, when it comes to "stuff," I am limited to one 50-lb checked bag. In contrast, there is no limit on goodwill, or funds for those suffering there. I am not wasting time or energy picking apart anyone who wants to help - I don't care about your politics, religion or cash reserves. You want to roll up your sleeves too, well, you're my kind of Gurley...



So here we are, Day 14 and counting:

1) Told my kids I was going. Squeals, hand-flapping, "I'm so jealous," then silence while it sunk in. They're teens, they'll be fine. But I notice how the 15 year old wants to sit closer to me on the couch than she has in years, virtually sinking into my right side. I don't say anything about it, of course. I just let her sink into me too.

2) Shots today. I went to the phenomenal folks at the Traveler's Clinic at the Department of Public Health (conflict-of-interest disclosure: NONE. They don't pay me, I never saw them before today). Dropped in without an appointment at 12:45 pm, was asked by the receptionist in a stricken voice "Would 1:10 work?" After a stunned silence, I squeaked out a "You mean today?" and when she nodded (apologetically) "yes," I had to do a double-take to make sure I was actually standing in an American medical clinic. Who are these people? This is so NOT how medical care works. I got three shots - a hepatitis A, tetanus, and typhoid shot ("ooh, those are going to ache" the lovely NP said, as well as "too bad there's not time for the rabies series - you know it's rampant there, don't you? Just be sure and get airlifted out if anything furry breaks your skin"). The ooh-that's-going-to-hurt shots didn't seem to hurt at all. Being a macho internist, I nodded in agreement while thinking to myself good thing I'm stoic and not a big weeny like their other patients are. Three hours later, I promise you, I'm so sore I would not lift my arms up from my sides unless my hair caught fire. Even then I'd have to think about it. I'm getting a little panicky, in fact, about which side I'm going to sleep on - I'm imagining a night ahead of me composed of "ow" and then "ouch" muttered in the dark as I roll endlessly from side to side in my sleep.

3) Am now panicked about my "functional" French. I have been known on two prior occasions, when I spoke French in Paris, to provoke, from Gauloises-smoking, too-cool-to-sneer citoyens, a shocked guffaw of snorted laughter. One Parisienne laughed so hard she hiccuped. Apparently I tend to speak French with a thick West African accent. But see, French is the only foreign language it's almost impossible to use in the Bay Area (at least medically). Oh God, what if I've forgotten it all? So I ran to my town's fabulous library and checked out every single (non-beginner) French language item (yes, I am the pig who took them all, staggering out of the library under a teetering skyscraper of perilously stacked books): four textbooks - including one Haitian-Creole dictionary - and five massive boxed sets of CDs. Including one two-disc set from The Language Teacher To The Stars - Mel Gibson! Barbra Streisand! Woody Allen! Which makes me wonder what will happen if I visit Paris and speak french to sneering Gauloises-smokers in a thick Mel Gibson accent?

So, in the few moments while I'm not going ow and then ouch during the night tonight, I plan to be subliminally absorbing the nasal tones of a total 189 hours of French audio-lessons I checked out ("ne mange pas ce gateau"...).

But who am I kidding? Sleep is unlikely to occur. Because I've already started fretting over Ethical Haiti Dilemma #1. Let me lay it out for you:

Exhibit A: The supplies MOST in need in Haiti now are wound care, debridement/incision kits, rehydration and dressing supplies, as well as antibiotics and analgesics.

Exhibit B: Most of those supplies are too bulky for me to bring many of them in a suitcase. Except for pills (which are surprisingly heavy, but compact).

Exhibit C: Expiration dates on drugs are arbitrarily set by pharmaceutical companies (who have an obvious conflict of interest), and reliable sources have studied the issue and found that almost all pills and powders are still completely effective years after they "expire."

Exhibit D: I have a legion of eager-to-give-something neighbors, friends and acquaintances with bathroom medicine cabinets bulging with leftover pills.

Ergo: Should I take a half-suitcase of potentially expired, but still-effective antibiotics to Haiti? And...

Algebra Problem of the Day: If I board my connecting flight to Chicago, hurtling at 31,267 feet for 3.87 hours, while carrying a 4-liter grocery bag of donated 2 oz. pill-bottles labeled with 34 different individual names, and each bottle is 3/4 full of highly regulated narcotics, then please calculate how many DEA agents, on arrival at O'Hare, will force me to undergo how many body-cavity searches? Please express your answer in mucosal centimeters. Extra Credit: And, more importantly, given an estimated factor of X minutes per search will those body-cavity searches cause me to miss my Haiti flight? Hmm...

Should I "recycle" drugs for Haiti? Or is it ethically wrong to dump them on a people who have no choice? Share in the comments section - and tune in for the next in the series to get details about the Haiti trip - what will I panic about next? What DO they advise you to bring to a disaster? Keep up on the Haiti trip and the latest health issues in the news by signing up for a Doc Gurley RSS feed by clicking here. Look for future pics and other articles at Doc Gurley! Also check out Doc Gurley's joyhabit and iwellth twitter feeds - so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your wellth this coming year.