28 Feb, 11 | by BMJ
The following account is based on an email I wrote to my friends and family on 23 February, describing my experiences working as a house officer at Christchurch Public Hospital when the devastating earthquake struck on 22 February 2011.
I was at work on the third floor of the hospital, a building which was commonly believed not to be “earthquake-ready.” It started like all the thousands of aftershocks we have experienced; you have a split second warning as the ground rumbles and the building starts to creak. Almost instantly we knew it was big; you instinctively throw yourself in a door frame, mine was the entrance to a four bed bay on the respiratory ward. The noise was incredible as beds broke off their brakes and oxygen cylinders crashed over. Hand on heart, I thought it was going to collapse. I remember the feeling of resignation as I realised just how powerless I was to save myself. But in our case, the building stood.
As soon as the shaking subsided the priority was to ensure the patients were okay. Things such as checking chest drains were still in place, that no one had fallen, and that no one was trapped in the bathrooms. Make the care of your patient your first concern – I don’t think anyone on the ward had been studying the General Medical Council’s “duties of a doctor,” but I witnessed that in its truest form. Most staff on the ward stayed, regardless of concerns for themselves and their loved ones, and I can promise – you just want to run out and never come back.
Although the fire alarm was instructing us to evacuate, we were to wait on the ward for further instructions. When the word came of the casualties lined up outside the emergency department, a few of left to see if we could be of more use. There were two waves of patients – initially horrible, horrible trauma. Status 1 patients arrived one after the other, every resus bay was filled with a full team attending to a critically ill patient. An ED consultant organised everyone over the tannoy, providing some sort of order and keeping us from panicking as further shocks rocked the building. I hope she is recognised for the job she did. When you think of major incident planning you think of how the hospital will manage the casualties. But when the hospital itself is damaged it is something else. The lifts didn’t work, the CT scanner didn’t work, the back-up generator went, and for a while everything was done in semi-darkness.
With most of the other medics I stayed to help in minors – “minors” yesterday meaning stable pelvic fractures, huge lacerations, spinal injuries. My first case was a lady with a huge scalp laceration from a wall of glass that had hit her on the head. I hade never worked in ED but you go back to basics and do what you can. For me this was fitting a hard collar to her tender cervical spine and cleaning and injecting local into the wound before more experienced help came from the plastics registrar. It was amazing how fast we ran out of things like staples and blood. One thing we were never short of was staff.
We were away from some of the worst things I think, but helping in majors throughout the evening we started to get more and more crush injuries in. Massive pelvic traumas were very common – one man with both legs amputated at the scene and a girl younger than me, newly paraplegic with a potassium of 8 from her pelvic injuries. ICU was overflowing within a few hours with many more in theatre and recovery all at once. I think so far I have been very sheltered from unwell children and young people, but these are the majority of cases – people who were working or out and about in town. My housemates work in ED, neonates, and O&G – again more horror stories.
The overwhelming feeling was of uselessness. I will be training in anaesthetics next year, and I cannot tell you how much I wished to have more to give that day. The instinct for everyone is to run to resus and offer your help and you could barely move for staff in ED. What was needed was for the hospital to remain functional and efficient so that those with most expertise could do their job. That day I acted as a doctor, porter, social worker, and water carrier.
Mid way through the evening I was transferred over to the Princess Margaret Hospital – a rehab hospital a couple of miles away where we were moving the more stable medical patients who could not go home. When we got there however, the day case unit had been turned into a makeshift ED with two ST1s and a couple of volunteer GPs running the show. I stayed helping them with a smaller but steady stream of patients - splinting arms with cardboard as they had nothing else. We stayed till about 3 am when things had calmed down and then drove back. The streets are a mess, huge cracks and massive amounts of silt everywhere from the liquefaction.
Anything that could break has broken but, as you hear very often here at the moment, “It’s just stuff, isn’t it?” The house opposite will need to be demolished, and one down the road has already collapsed. A lot of people are catching the first flight to Australia and aren’t planning to come back.
I’m now back at work and its actually amazingly peaceful (hence the long email). There are plenty of extras helping out, but the workload has fallen right off, partly as anyone who could be discharged, has been.
It is very early days at the moment. I have only just found out that one of the nurses I work with was killed after a building fell on his car. The city centre is obviously completely shut down, and RNZAF helicopters are making regular fly-bys. We have to go through army check points to get to the hospital. Despite all of that, everyone remains dedicated, supportive, and as positive as possible. A lot of people are saying this will break Christchurch – I hope not. Seeing the number of people working 24 hours to keep the city functioning is astounding. It is all very well watching the surgeons/anaesthetists/ED docs bring back people back from the brink, but there are a lot of very unglamourous heroes here – as cheesy as I know that sounds.
Monica Jackson is a house officer at Christchurch Public Hospital.