Taking a patient to Hospital Atlántida in La Ceiba

Note, the names of the victim and his wife in this story have been changed to protect their privacy.
As Brad and I pulled into the ER at Hospital Atlántida with Fernando lying across the back seat, head in his wife, Maria’s lap, I breathed a quick sigh of relief and a prayer for what we would find inside.  I hoped for the best, but would soon find out that we were to get something much less than that.  I walked into the ER with my transfer papers and presented them to the medical attendant sitting at the desk in the middle of the sea of chaos that is the ER at Hospital Atlántida.  I explained that I had a gunshot victim in the back seat of my truck, to which the very unimpressed attendant answered, “We have three other gunshot victims over there.  He’ll need to wait with them.”  My mind drifted back to the events of the evening that had brought me to this very surreal moment as I surveyed the line of three gunshot victims lying in a row and contemplated our chances of seeing a surgeon this night.
About four hours earlier a relatively peaceful Sunday night had been interrupted by the news that there was a gunshot victim down at the hospital.   This, in and of itself, was not entirely shocking news as we are a rural hospital in a very violent country.  I was asked to go to Balfate, a village a few miles down the road and retrieve Tomas, our X-ray tech so that he could come in and take X-rays of our somewhat stable gsw (gunshot wound) victim.  Further, someone had told me that this was Fernando, Maria’s husband.  The couple is known by us and known very well by our good friends the Aldens.  They attend church at a local church that many of us were connected to and Maria frequently works as a part time housekeeper for several of the missionary families.  In short, she is well known to all here and to hear that her husband had been shot gave us all more than a little extra anxiety.  As I raced out of the gate to get Thomas from Balfate a call came for me on our local Ham radio.  The ER doctor – Dr. Abby – had asked that I return to the ER and told me that someone else was going to go get Tomas.  Further, I was asked to get my firearm and return to the hospital to act as security.  We came to learn that the person who had shot Fernando was still at large and it seemed good to have someone around who was armed. All of my time in the states at the shooting range and my love of handguns has meant that I am one of the missionaries here at the hospital who is armed in times of security concerns.  Ok, I headed back to my house and retrieved my handgun and headed down to the hospital to hang out with Dr. Abby and see how I could help. 
I was saddened to see our dear friend Maria so distraught after having been through such a difficult time, but gladdened to see Fernando lying on the bed in the ER – mostly stable.  The bullet had entered into his back midway down on the left side and amazingly at that time – didn’t seem to have hit the spinal column or the lungs.  Ultrasound seemed to reveal some internal bleeding.  Dr. Jeff showed up about that time and reviewed the case with Dr. Abby.  Dr. Jeff – our leader and surgeon – was put in the unenviable task of having to make a tough decision about sending Fernando into La Ceiba for surgery due to lack of resources here at the hospital.  The next time you find yourself praying for Hospital Loma de Luz, please pray for a full time anesthetist for without one, we can (and do) have a very talented surgeon that can’t perform his duties and often has to send patients in to La Ceiba when we could otherwise treat them.  Dr. Jeff made the difficult, but obvious, decision that we could not operate on Fernando with the limited resources that we had at the hospital at that time and the decision was made to transfer him. 
While this assessment and decision was being made, I was able to spend some time praying with Maria.  I prayed that God would give her peace and we prayed together that God would touch her husband and heal him.  I was aware that another one of our missionaries (It is truly amazing how our little group of missionaries acts as a team when a critical case arrives) had gone to Balfate to get the police.  In our rural area, we do have police, sometimes, but they don’t have a car.  So if you need them, you have to go and get them.  We had done just that and on this Sunday evening, John had found our local constable enjoying a cool one at the local bar.  He brought the young man (couldn’t have been more than 20 yrs old) from the bar, out of uniform and smelling a little bit like beer, directly to the hospital.  Remember that I had told you that there was a little bit of concern that the shooter was still at large.  Well, the little bit of concern turned into a bigger amount of concern when a young man arrived at the hospital in street clothes, smelling a little bit like beer, claiming to be a cop and wanting to see the patient.  Penny, our dear friend and nurse, was ready to pummel the poor young lad right there in the hallway.  My role as guardian and protector quickly became one of protecting the young policeman from Penny as she was quite concerned that he was indeed the shooter, come back to finish the job.  Penny was raised in a Catholic school and let me tell you – the Sisters would have been proud of her.  I explained our policy that only uniformed police were allowed to be armed there at the hospital and asked the young officer to please surrender his weapon to me to hold  – for the comfort of “the nurse.”  He was only too happy to give me his firearm as long as it meant that Penny would stand down. 
Hearing that the decision had been made to transport Fernando to La Ceiba, I asked if I could be permitted to take him into town in my vehicle.  I knew that the local Red Cross ambulance ride would be really hard on Fernando and I wanted to give him a more comfortable and secure ride into town.  I also wanted to try and be there at the hospital for he and Maria to try and help them secure the best care available.  And so the request was granted and we loaded Fernando into the back of my truck, lying on his side with his head on his wife’s lap.  He groaned loudly in obvious pain as I went over each bump (20 miles of hard, rough dirt road and then 40 miles of pavement with potholes the size of small ponds) and through each pothole on the hour and half trip to Hospital Atlántida in La Ceiba.        
And so here I find myself in the ER, being told to wait behind three other g.s.w. victims and worried sick about Fernando.  I was standing in the middle of an ER that simply defies explanation to anyone who is used to an American Emergency Room, clean and orderly.  There aren’t enough nurses to go around, so the family members become the primary care takers of the person in the ER.  To my left, an elderly mother tries to comfort a young man who has been shot in the chest and undoubtedly has a sucking chest wound.  He seems to be literally bleeding out in front of me.  Farther over to my left a very large woman (easily 300 lbs) is following some strange rhythm of scream, cry, vomit, repeat.  Occasionally adding brief pauses for emphasis, she doggedly sticks to her routine in a desperate attempt to get some attention.    An old man looks like he is dying.  A young girl looks scared and quiet.  There are no beds.  Fernando is still in my truck and I’m not really getting anywhere.  I say there are no beds, but there is one bed – off in the corner – broken and stuck in a 45 degree “reverse Trendelenberg” position with the head up and feet down.  Brad and I try and fix the bed in the corner, hoping to be able to straighten it out.  As we are working on it, I realize that there is a terrible smell in that corcer of the ER and look down to find that I am standing in a pool of blood and urine.  I give up trying to fix the bed and realize that I’m not about to put Fernando with internal bleeding into such a position (head up – feet down), so I complain to the nurses who walk by with a blank expression that gave up trying to explain their situation long ago.  I’m told that I can have the mobile bed (one with wheels) that the sucking chest wound is currently on as he is about to be shipped up for surgery.  I breathe a sigh of relief that he (sucking chest wound) will not die right there in front of me and that we will soon have a bed.  An orderly – (about 14 years old in appearance) rolls another bed into the room and the orderly and the elderly mother move sucking chest wound from the rolling gurney onto the other rolling bed and begin to wheel him out of the room.  Problem: sucking chest wound left about an inch deep pool of blood on the gurney that we are now supposed to use to get Fernando out of the truck with.  I look around in vain for someone to clean the gurney.  I ask the nurse where the cleaning supplies are and she points vaguely off to our left.  I wander around, looking on the shelves and find a likely looking bottle.  One sniff confirms that this is indeed bleach – perfect.  Now for some towels.  The best I can do is a pile of what I hope and pray (but doubt) is clean sheets.  I use one to soak up the one inch pool and then use the second one to put as much of the bleach as possible all over the bed and get it as clean as possible before wheeling it out to my truck.      Brad is a rock during all of this and dutifully hauls Fernando out of the truck and onto the bed.  We wheel him into the ER where we find a spot near the broken bed but far enough away as to be out of the pool of blood and urine.   We’re told to leave him there and that the surgeon will see him just as soon as he is out of surgery.  We pray with Maria, who is back in shock now given all that has happened since we arrived.   We leave feeling like we were leaving our friends in an impossible situation.  As we get into the truck Brad sums it up perfectly and says, “Well, if Atlántida doesn’t kill him, I think he’ll be ok”.  
We spoke with Maria the next day to find out that they still hadn’t seen a surgeon.  We started making plans to go back and get Fernando, not sure what we would do – but knowing that we had to do something.  Not too long after that, we heard that he was indeed being taken into surgery.  We later found that they had operated on Fernando and while in a considerable amount of pain, he seemed to be stable.  Several days later he was released and spent the next several weeks recuperating at home.  He is up and moving around now – well, mostly.  They are fearful that the man that they surprised down in the ditch alongside the road that night will come back.  They are afraid of the senseless, meaningless violence that almost ruined their lives.  The policeman all but told them that night that there wasn’t anything he could do and he was most probably right.  There won’t be any justice, this side of Heaven it seems; for Fernando – only gratitude that it all didn’t end that night for him and that Maria doesn’t have to try and raise their kids alone.  I wish I could tell you that everything is ok for them.  I know that it isn’t.  I know that they face unimaginable challenges amidst their fear and their poverty.  I’m told that Fernando is back at church and that he is speaking up and participating in ways that he wouldn’t have done before.  I’m hoping and praying that his close call brings him closer with God and that he heals emotionally, spiritually, and physically.