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A Piece of My Mind |

The Line

Thomas D. Kirsch, MD, MPH; Margaret R. Moon, MD, MPH
JAMA. 2010;303(10):921-922. doi:10.1001/jama.2010.239.
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The Line starts forming at about 5:30 AM, although, in fact, it never really disappears. By the time our bus pulls into the hospital compound at about 7:10, there are 75 to 100 people waiting. The “emergency triage” area has three 40×15–foot tents and is staffed by 7 doctors, about 6 nurses, and a couple of midlevel providers. We see 350 to 475 patients by 5:30 PM. The tide is unrelenting, in numbers, in illness, in injury, and in heartbreak. Three weeks after the earthquake, most of the patients now have relatively minor health problems, although 10% to 15% still present with untreated earthquake injuries, and some are critically ill with infections. All of them have overwhelming social and emotional problems: dead husbands, wives, children, or parents, or maybe all of the above. They live in tents in parks and football fields. They have no money; there is no money. There is no work. Food is fairly, but not consistently, available. The water situation is getting better. And they come to us with “tingling skin,” “headaches,” “dizziness and weakness,” and so many other vague or whole-body complaints. All of these symptoms have been present for 3 weeks, all since the earthquake that crushed their city, their family, and their lives. They have nowhere to go and want us to provide answers, to give them a place, to make things better. But we don't have the resources or the answers. And then there is The Line. The Line never ends. It is an unrelenting surge of humanity whose stories are repetitive and so very achingly sad.

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