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Trauma Surgeon Makes Difficult Calls in Haiti

U.S. Navy trauma surgeon, Commander Zsolt Stockinger, assesses patients as they arrive at a combination triage facility-helicopter landing zone the U.S. military established on the shore of Port-au-Prince. On this day, at Terminal Varreux, he decides which patients should be treated aboard the hospital ship Comfort. The decisions might be clear-cut, but they are not easy to relay.

The trauma surgeon's words are translated into Creole so the mother can understand the news about her daughter. The five-year-old girl in a pink striped shirt lies motionless on a stretcher between the surgeon and her mother.

The news inside the tan medical tent is as devastating as the earthquake that wrecked Port-au-Prince two weeks ago.

The mother makes no sound, and her face falls almost imperceptibly. She has just been told that her daughter suffered brain trauma so severe that there is no hope of recovery.

Doctor Stockinger tells her there is no remedy - not in any hospital, not anywhere in the world.

He speaks these words to her: The last thing that she remembers is before the earthquake, when she was still happy.

Later in the day, after hours of assessing patients and making difficult calls, Doctor Stockinger sits on a metal storage trunk, finding shade in the shadow of a tent. In this dusty spot, between the grassy field where helicopters land and lift and the sea that shines in the sweltering Haitian sun, he discusses the decisions he needs to make and needs to accept.

"And I just have to explain that to her that I am sorry and I would like to help but there is nothing that can be done," said Zsolt Stockinger. "I have said that a lot today, unfortunately."

He bases these decisions on the resources available on the hospital ship - the surgeons, the equipment, the numbers of patients awaiting different procedures. The criteria changes, depending on the needs of the patients already on board.

"There are obviously tens, hundreds of thousands of people who are injured and need care, and they will not all fit on the ship," he said. "So someone has to decide who is going to go to the ship for care and who is not. And that is really what I am out here for."

He says he decides what requires surgery, what could be handled by some other medical facility, and what, in his words, there is no point operating on.

"Here it is more a question of, 'Can they get better at all? Or is the amount of resources we apply to helping that one person worth it because then we will be taking resources away from several people who could benefit from those same resources?," asked Dr. Stockinger.

Dr. Stockinger draws on his experiences as a trauma and critical care surgeon in Iraq and Afghanistan, but he adds that these circumstances are decidedly different.

He says the toughest part here is not deciding who will get treatment on the Comfort hospital ship, as it can be clear if the ship offers the medical opportunity to help the patient. The challenge, he says, is relaying that information to the parent or doctor or nurse who accompanies the earthquake victim.

"For example, the mother of that baby," he said. "I mean it is a horrible injury, but there is nothing on earth that can change that."

Vehicles drive up the dirt path to the tan triage tents, kicking up dust. At one point, three ambulances, buses and vans are in front of the tents carrying patients awaiting Doctor Stockinger's eyes. Sometimes the patients are sent to a tent to await helicopter transport to the Comfort. Sometimes he must bear far more dire news.

"As I have said, I have done it before," said Commander Stockinger. "I will not say you get used to it, because if you get to the point where you get used to it, you have to stop doing it."

And, with each decision, he looks to the future.

"You say to yourself, 'I am doing this to save someone else," he said. "I have not met that person yet. But, by saying no to this one, I am saying yes to
someone else who will come in next or later and I am saving that
person's life by saying no to this person."

As for the little girl, Doctor Stockinger tells the mother that caring for her and feeding her - as the mother has been doing - are the only things that can be done.

A representative of the Haitian government is on site, and he says he has arranged for the girl to be taken to a pediatric hospital run by a Catholic priest. She is loaded into a van, and her mother climbs in beside her. It rumbles off, kicking up dust.

When a brightly colored truck pulls up to the triage unit later in the day, bearing still more patients for Doctor Stockinger to assess, the mother is in the back of the truck, still holding her motionless daughter in her arms.

Neither's expression has changed.