Haiti

Haiti becomes a testing ground for disaster medicine after the January 2010 earthquake, but the account turns on more than the scarcity of supplies: it asks what happens when a triage decision removes a treatment from an informed, conscious patient without explaining why. At a tent hospital in Port-au-Prince, Nathalie LeBrun’s unstable access to oxygen exposes the distance between a policy’s abstract calculation and the person who must live through its consequences. Her later stabilization does not settle the ethical problem; it sharpens the question of whether a decision made for the sake of limited resources can be justified when those affected are neither included nor informed.

A Disaster Field Hospital

In January 2010, the book’s narrator traveled to Haiti after the earthquake and embedded with US federal disaster medical teams. Some team members had worked at the New Orleans airport after Hurricane Katrina. The reporting was intended to examine what those professionals had learned and how prepared they were to respond to another disaster in the United States, while also observing triage where critically injured patients initially outnumbered the medical system’s capacity. The account treats the setting as different from an American emergency in important ways, while holding open the possibility that the underlying decisions about patient care might be similar.

The American team established a field hospital in tents on a college campus in Port-au-Prince. Even basic record-keeping was difficult: unfamiliar names were hard for staff to record, so patients were assigned numbers. One woman entered the records as Jane Doe 326. She was Nathalie LeBrun, thirty-eight years old, and her medical problems had begun before the earthquake. Through a translator, she explained that she had difficulty breathing and swelling, conditions that had worsened since the disaster. The number in the chart and the name she gave through an interpreter mark two different pressures in the temporary hospital: the administrative need to process patients quickly, and the effort to recognize the particular person behind each case.

LeBrun’s Interrupted Oxygen Supply

The team connected LeBrun to oxygen, but the tank ran out overnight and her blood oxygen level fell dangerously low. A nurse who believed that LeBrun was dying stayed beside her, crying, after being told no more oxygen was available. Doctors called for assistance, and staff found another tank; once oxygen was restored, LeBrun’s breathing eased. The episode made clear that a patient’s immediate prospects could turn on a supply chain that was already failing.

That supply problem extended beyond her bedside. The brother of another Haitian patient obtained a large oxygen tank from elsewhere in the city, while LeBrun was moved to a portable oxygen concentrator. The device extracted oxygen from the air, but repeatedly overheated and shut down. It also depended on electricity, while fuel for the generators was in short supply. At a staff meeting beneath a mango tree, a logistician reported that only one can of diesel remained for each generator. Oxygen, equipment, fuel, and power were not separate concerns: the ability to keep one patient breathing depended on a fragile chain of resources.

Shortly after five in the afternoon, a hospital staff member unplugged LeBrun’s concentrator when medics from the 82nd Airborne Division arrived to transport her. The medics did not know the plan and tried to reassure her that she would receive care elsewhere. When a military doctor noticed her breathing difficulty, an oxygen tank was available in the ambulance, but a member of the field hospital’s command staff described the problem as chronic. Under the triage decision, the team provided no oxygen during the journey. LeBrun struggled to breathe in the ambulance and repeatedly used an inhaler she believed contained oxygen, calling for the treatment she knew she needed. The decision had been made in her name, but not explained to her.

A Decision Reversed by Further Treatment

The book acknowledges that, considered only as a utilitarian calculation, removing LeBrun’s oxygen could appear logical. It then draws attention to the way the decision was carried out: the professionals involved were unwilling to face her and explain it or to be present in its implementation. A policy can make the denial of treatment sound procedural, but the patient experiences the absence of that treatment directly. The account therefore distinguishes selecting a course of action on paper from taking responsibility for communicating and carrying it out.

The story does not present a gentle alternative as automatically preferable. At a destroyed Haitian hospital, Dr. Paul Auerbach, an emergency physician volunteering there, found a tank with a small amount of oxygen left. He treated LeBrun aggressively that night with low-cost diuretics to reduce fluid in her lungs. Her condition stabilized enough that, at least temporarily, she no longer needed oxygen. This outcome complicates any claim that the earlier withdrawal was the only possible response to scarcity: another clinician found a way to help with limited supplies and a different treatment. It does not establish that every patient in the same circumstances could have been treated this way, but it shows that a triage judgment may not exhaust the available medical options.

Haiti as an Ethical Test Case

LeBrun’s case leads into the book’s broader question about whether viable, aware patients—or their families—should be informed and involved when potentially lifesaving resources are withheld. Disasters force recognition of rationing that ordinary medical practice can leave less visible. Yet the existence of scarcity does not itself answer who should make the decision, what information should be shared, or how a patient’s experience should count. In the field hospital, LeBrun’s repeated need for oxygen and the team’s failing supplies made those questions immediate rather than theoretical.

The Haiti account also connects the field operation to later emergency planning. Years afterward, as Hurricane Sandy approached Bellevue Hospital Center, critical-care medical director Laura Evans faced choices about which patients could use the few power outlets expected to remain available during an outage. She drew on New York State ventilator-allocation guidance, repurposing plans inspired in part by the experience of Hurricane Katrina. The comparison does not make the situations identical: LeBrun was a patient during an active transfer, while the later hospital faced a looming power crisis. Instead, Haiti’s role in the narrative is to show how disaster protocols travel between settings, and how their apparent clarity can falter when applied to specific people. LeBrun’s case remains the account’s concrete measure of that gap: a numbered record, a precarious oxygen supply, an unexplained interruption, and subsequent treatment that temporarily restored her stability.