There was no briefing when Dr. Nikolaj (Nik) Wolfson arrived Jan. 22 in Port-au-Prince, Haiti, where he would operate on so many victims of the Jan. 12 earthquake that he stopped counting.
“They said, ‘Here you are, here is the knife, go to work,’” the orthopedic trauma surgeon recalled Feb. 3 from his home in San Francisco.
So Wolfson, who works at San Mateo County and Mills-Peninsula hospitals, and California Pacific Medical Center in San Francisco, entered a makeshift field hospital erected by the University of Miami, and got to work.
It was like a war zone, Wolfson said. He would know, having lived in Israel while attending medical school, and served in the Israel Defense Forces in the Lebanon War.
But in many ways, Haiti was far worse.
Doctors put together parts of medical equipment — like mismatched puzzle pieces — that had been donated by different companies. There was no general anesthesia equipment for patients, so surgeries were performed under sedation, or at times using regional and local anesthesia.
Improvising was a must.
“It was extremely challenging for the patients and doctors,” said Wolfson, who was invited to Haiti by the American Academy of Orthopedic Surgeons. “It was like going back in ages as far as the environment was concerned and the treatment we provided. I felt like I was operating in medieval times.”
Wolfson performed eight surgeries on his first day in Haiti. After that, he stopped counting. He amputated limbs on adults and children who had sustained open fractures, many of which were infected.
When he forced himself to step away from the patients for rest, Wolfson slept for an hour or so on a folding bed in a sleeping area with 80 other doctors, nurses, medical technicians and volunteers.
After a short stay at the University of Miami field hospital, Wolfson was flown by helicopter to the USNS Comfort, a floating medical treatment facility commanded by the Navy. Sleep-deprived and overwhelmed by the 50 to 60 orthopedic trauma patients streaming in daily, Wolfson at least found far superior conditions on the ship than in the field hospital.
Equipped to accommodate more than 500 patients, the Comfort was sterile and organized. Wolfson operated with a team of seven orthopedic surgeons, in addition to doctors from the Air Force.
“Right from arrival [on the ship], I was taken to the operating room and started operating,” he said. “I saw all open fractures and performed amputations, both on adults and pediatrics. There were lots of complications and infections.”
To manage the influx of patients, Wolfson suggested incorporating night shifts into the schedule. He operated for the next two nights, in addition to performing surgeries during the day. The “nice bed” he was given inside a cabin with six other medical professionals was rarely used.
“To be honest, I could not sleep,” he said. “I was totally overwhelmed by the extent of the environment.”
And he believes that “the injuries we saw at this stage are just the tip of the iceberg. The number of complications from initial trauma will be even more extensive and more challenging to manage.”
Wolfson’s experience in Haiti is hardly the first time he’s been thrust into a traumatic situation.
Upon graduation from the Sackler Faculty of Medicine on the Tel Aviv University campus, Wolfson served for four years in the IDF as a paratrooper battalion doctor during the Lebanon War and as a naval captain, where he served as chief of the submarine medical corps.
Before moving to San Francisco last year to be with his fiancée, Luba Troyanovsky (a member of the S.F.-based Jewish Family and Children’s Services board of directors), Wolfson was a full-time attending physician in the department of orthopedic surgery at Los Angeles County/USC Medical Center.
When he returned from Haiti on Feb. 2, Wolfson went straight back to work — though he saw just a few patients, a stark contrast to the hundreds he had seen just a day before.
The past two weeks have been a whirlwind. Once tapped for the mission to Haiti, Wolfson couldn’t sleep for two nights prior to taking the two red-eye flights that would carry him to his destination.
Wolfson credited his physical and mental stability throughout the ordeal to living in Israel, which “prepares you for disasters on a daily basis.” He also noted that Israel was one of the first to erect a field hospital in Haiti, and will organize training exercises for disasters similar to the earthquake.
“You’re never used to human tragedy,” Wolfson said. “But when you live and go through this type of situation in your previous life, you face what you face. You just have to prepare yourself for whatever comes your way.”