Jan. 29--ST. THOMAS -- When Dr. Brian Bacot went on a humanitarian mission to Haiti, he did not realize he would carry something home with him -- guilt.

The orthopedic surgeon volunteered to be one of the first doctors from the territory to travel to earthquake-ravaged Port-au-Prince.

His expertise was in high demand. The injuries and broken bones suffered by Haitians outnumbered the combined hours in the days the V.I. doctors were there. To enter the hospital, Bacot had to step over the living. What he did not foresee, however, was that he would have to do the same to go home four days later.

"I walked over them to get to help them. I walked over them to leave," Bacot said. "When I got there, I knew I was going to go home back to my soft bed, my nice, big job, my beautiful wife, my beautiful child. That person I'm walking over to go home doesn't have that and you want to give that to them."

Bacot is not alone when it comes to lugging baggage back from Haiti. The most seasoned medical professionals share the same reaction.

Dr. Frank Odlum, general surgeon and chief of surgery at Schneider Hospital for 12 years, returned after a week of seeing patients without as much as a cot to lie on smile and thank him, was dogged by the same emotion.

"When I got back home on Saturday and I walked in my house and felt guilty -- I felt guilty for having running water, a roof over my head, a soft bed to sleep in," Odlum said. "They were happy to stay outside. For us here, that would seem the worst possible thing but to sleep outside on a mattress on the ground was totally fine with them."

As the medical teams divorced themselves like they were instructed so they can concentrate on the task at hand, there are the patients they cannot forget.

An otherwise strong and healthy young man was before Bacot with a grave leg injury. In the stark reality, a glimmer of hope existed: The man could move his toes.

Bacot, who has his own practice, thought the case was a "slamdunk"; the proverbial sure thing. He would save the leg, he said.

It was not to be.

A closer look revealed the man's condition was everything but a foregone conclusion. Puss drained out of both ends of the broken bone. If they were anywhere else but Haiti, Bacot would have been equipped with the tools to do the complex surgery he would normally do and preserve the man's quality of life.

"You are picturing the patients you worked on. You always think you could have done something better. A lot of guilt comes along with it," Bacot said. "For a surgeon, we want immediate change. We expect decisive and conclusive results. I am now thrown into a situation where I feel I am giving people a little less degree of quality of life. Even now, there hasn't been a day where there hasn't been probably two hours in a row that I haven't thought about the situation."

In Port-au-Prince, in a hospital with no supplies and too many patients, the goal was to save lives, not the quality of it.

The young man became one of 122 amputations that Bacot and Dr. Julia Gardner completed in those first four days with the help of the medical team from USVI Haitian Relief.

Racked with guilt over what could have been, Bacot went on to treat other patients. The man could not forget Bacot either.

"He looked up and said, 'You ruined my life.' I hurt because I already thought that myself," Bacot said. "Every time I walked by, it was this constant knife in my gut and I had already put the knife in my own gut."

After Bacot came home on the donated Falcon 2000, greeted with Cruzan Rum and Coke, he was down, not as communicative, distracted at work and needed time alone, he said.

What he experienced were symptoms of post-traumatic stress and that's quite normal, said Dr. Tom Tyne, a St. Thomas-based psychologist.

Physicians and first responders often think they have seen it all and question their reactions in disastrous situations, but they should not. And just because the medical teams and first responders did not live through the earthquake does not mean they will not experience post-traumatic stress, he said.

"The first thing they do is question how they are feeling. They should know it is exactly how they should be feeling," Tyne said. "You have to first validate that how you are feeling is how you are supposed to be feeling."

The reactions can vary.

Some become more irritable than usual. Some experience out-of-character mood swings. Problems with eating, sleeping and fear of recurrence can happen, Tyne said.

Although Bacot's training at Ryder Trauma Center at Jackson Memorial Hospital in Miami taught him to divorce himself emotionally, he was not immune to the suffering he witnessed.

"There was this sense of depression," he said. "The first two days were very rough mentally and emotionally because you are trying to process those things."

Doctors used to saving lives, crippled by a lack of tools needed to do so, often experience a sense of guilt borne of the helplessness of their situation, Tyne said.

"Even though you get people who deal with life and death situations on a daily basis, here it's just so incomprehensible, because here, we have so many people dying around us that don't have to and it doesn't make sense. It causes dissidence," Tyne said.

James Warshauer, a respiratory therapist who volunteered in Haiti last week, watched one woman die because he did not have the equipment to save her life.

During his 96-hour shift, Dr. Selwyn Mahon had Warshauer respond to a "Code Blue" as is routine in hospital settings. The woman was in her late 40s and was septic after surgery. She died because Warshauer had nothing to intubate her, he said. That was not routine.

She died hours before the equipment to save her arrived at the hospital.

"We save patients all the time. There was just this look of desperation between us. We had nothing to save this patient with," he said. "If she would have made it eight more hours, she would have lived."

Through it all, the volunteers describe the Haitian people as resilient and positive despite their collective fate.

The strength of the people was exemplified in a 6-month-old with a crushed leg Warshauer tended. The boy had seven pins in his legs, a successful attempt to save the limb, he said.

"This little boy, as painful as it was, didn't complain -- not even a tear," Warshauer said. "I don't know if it is in the blood of the people or what it is."

That strength and stoicism is needed to help the people of Haiti recover from the worst natural disaster their country, which has experienced terrible calamities before, Tyne said.

"We know there is a clear mind-body connection," he said. "What these poor patients are going through is going to effect their immune systems. The stress reaction because of the mind-body connection will limit their recuperative powers."

The same is true for returning volunteers. They must recognize how they are feeling and address it, Tyne said.

Bacot talked about his feelings with his colleagues who went to Haiti.

Peer counseling like that can be very effective, but if the symptoms persists, those experiencing post-traumatic stress should seek professional help.

Before Bacot left, his most memorable amputee, stopped him once again but this time, the man thanked him for saving his life. Generally, the patients were appreciative, Odlum said.

"For people to have so little and be fine with it -- that impressed me. I think it impressed all of us. I'll have a hard time complaining about anything for a while," he said.

- Contact reporter Ailene Yasmin Torres at 774-8772 ext. 304 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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