Puerto Rico doctor: 'Medical schools don't prepare you for this'

SAN JUAN, Puerto Rico — Two weeks after Hurricane Maria ravaged this island, doctors and nurses are still in nonstop triage, working furiously to save lives and ease pain while struggling to contend with power outages, hospital evacuations, dwindling supplies and even crime outside their doors.

"The hospitals are still in crisis," said Dr. Ubaldo Santiago, director of emergency services for several San Juan hospitals and clinics. "Many are still working on generators. It's tough, and the doctors are giving their maximum."

Santiago said he has twice had to evacuate the Hospital San Francisco in San Juan, the capital, because of generator failures.

“The first thought was, I hope nobody dies because of this," he said. "I hope nobody dies because there’s delicate patients there, ICU patients."

The struggles are not confined to the hospital walls. A few days after Maria hit, five men held up an X-ray technician and some paramedics at gunpoint outside the emergency room of the Metro Pavia Clinic in the San Juan neighborhood of Cupey, said Dr. Miguel Rosado Serra, who works there.

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CAROLINA, PUERTO RICO - OCTOBER 03: President Donald Trump and Melania Trump greet U.S Air Force airmen as he arrives at the Muniz Air National Guard Base as he makes a visit after Hurricane Maria hit the island on October 3, 2017 in Carolina, Puerto Rico. The President has been criticized by some that say the government's response has been inadequate. (Photo by Joe Raedle/Getty Images)
U.S. President Donald Trump throws rolls of paper towels into a crowd of local residents affected by Hurricane Maria as he visits Calgary Chapel in San Juan, Puerto Rico, U.S., October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump talks with Puerto Rico Governor Ricardo Rossello (L) as they take their seats for a briefing on hurricane relief efforts in a hangar at Muniz Air National Guard Base in Carolina, Puerto Rico, U.S. October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump visits with residents while visiting Puerto Rico to survey relief efforts following Hurricane Maria in Guaynabo, Puerto Rico, U.S., October 3, 2017 REUTERS/Jonathan Ernst
U.S. President Donald Trump gestures as he walks through a neighborhood damaged by Hurricane Maria with first lady Melania Trump as the president tours hurricane damage in Guaynabo, Puerto Rico, U.S., October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump talks with residents as first lady Melania Trump (C) and U.S. Rep and Resident Commissioner of Puerto Rico Jenniffer Gonzalez (R) look on as the president visits areas damaged by Hurricane Maria in Guaynabo, Puerto Rico, U.S., October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump greets troops as he arrives aboard Air Force One, to survey hurricane damage, at Muniz Air National Guard Base in Carolina, Puerto Rico, U.S. October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump shakes hands with San Juan Mayor Carmen Yulin Cruz before a briefing to survey hurricane damage, at Muniz Air National Guard Base in Carolina, Puerto Rico, U.S. October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump, sitting between Puerto Rico Governor Ricardo Rossello and first lady Melania Trump, sits down to a briefing on hurricane damage, at Muniz Air National Guard Base in Carolina, Puerto Rico, U.S. October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump and first lady Melania Trump depart the White House in Washington, U.S., on their way to view storm damage in Puerto Rico, U.S., October 3, 2017. REUTERS/Kevin Lamarque
U.S. President Donald Trump throws rolls of paper towels into a crowd of local residents affected by Hurricane Maria as he visits Calgary Chapel in San Juan, Puerto Rico, U.S., October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump and first lady Melania Trump (L), wearing boots, arrive aboard Air Force One, to survey hurricane damage, at Muniz Air National Guard Base in Carolina, Puerto Rico, U.S. October 3, 2017. REUTERS/Jonathan Ernst
US President Donald Trump and First Lady Melania Trump visit residents affected by Hurricane in Guaynabo, west of San Juan, Puerto Rico on October 3, 2017. Nearly two weeks after Hurricane Maria thrashed through the US territory, much of the islands remains short of food and without access to power or drinking water. / AFP PHOTO / MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
US President Donald Trump and First Lady Melania Trump visit residents affected by Hurricane in Guaynabo, west of San Juan, Puerto Rico on October 3, 2017. Nearly two weeks after Hurricane Maria thrashed through the US territory, much of the islands remains short of food and without access to power or drinking water. / AFP PHOTO / MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
U.S. President Donald Trump throws rolls of paper towels to a crowd of local residents affected by Hurricane Maria as he visits a disaster relief distribution center at Calgary Chapel in San Juan, Puerto Rico, U.S., October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump and first lady Melania Trump greet troops as they depart the USS Kearsarge off the coast of San Juan, Puerto Rico, U.S. October 3, 2017. REUTERS/Jonathan Ernst
U.S. President Donald Trump talks with local residents during a walking tour of areas damaged by Hurricane Maria in Guaynabo, Puerto Rico, U.S., October 3, 2017. REUTERS/Jonathan Ernst
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The technician's husband, a police officer who had come to pick her up, traded gunfire with one of the robbers. The suspect was killed, but the other four escaped. The officer was critically wounded.

“What hurt me the most," Rosado said, "is when she came in, so soon after just leaving, and she asked me to save her husband — to please not let him die."

In other areas of the island, some hospitals have essentially shut down, stuck without the diesel fuel needed to run generators or the ability to communicate with doctors and staff members.

Hurricane Maria didn't just create new problems for Puerto Rico's health care system; it exacerbated old ones, as doctors were already stretched thin by the island's economic crisis, especially in less populated areas.

“Those pockets that are not accessible right now, we’re good compared to those people,” Santiago said. “What you are seeing around here, it’s heaven compared to some people in the inland, in the mountains.”

Most hospitals are offering only the most critical services, he said. Doctors lack basic medical supplies and, in some cases, the space to treat patients.

“We’ve been in touch with pediatricians who have reported problems with access to even vaccines, so what we’re talking about is pretty much basic stuff,” Gonzalo Solis, a health care executive at Yale-New Haven Hospital in Connecticut who is coordinating with doctors on the island, said in a phone interview.

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COROZAL, PUERTO RICO - SEPTEMBER 27: Luis Lugo and Awilda Valdez bath in spring water since they have no running water in their home since Hurricane Maria passed through on September 27, 2017 in Corozal, Puerto Rico. Puerto Rico experienced widespread, severe damage including most of the electrical, gas and water grids as well as agricultural destruction after Hurricane Maria, a category 4 hurricane, passed through. (Photo by Joe Raedle/Getty Images)
MOROVIS, PUERTO RICO - SEPTEMBER 27: Hector Ojeda and Sonia Robles and Tony Ojeda cross a river on foot after the bridge was washed away when Hurricane Maria passed through on September 27, 2017 in Morovis, Puerto Rico. Puerto Rico experienced widespread damage including most of the electrical, gas and water grid as well as agriculture after Hurricane Maria, a category 4 hurricane, passed through. (Photo by Joe Raedle/Getty Images)
MOROVIS, PUERTO RICO SEPTEMBER 25: A man helps a kid cross the San Lorenzo River in Morovis. Residents of San Lorenzo neighborhood can't access their houses because the river destroyed the bridge that communicate them with the main road of access. The mountain town of Morovis, in the south west of San Juan, is one of the most affected after the pass of Hurricane Mar�. Hurricane Maria passed through Puerto Rico leaving behind a path of destruction across the national territory. (Photo by Dennis M. Rivera Pichardo for The Washington Post via Getty Images)
Maria Martinez stands next to her house which was damaged by Hurricane Maria in Yabucoa in eastern Puerto Rico on September 28, 2017. A week after the Category Four storm stuck, the White House said US President Donald Trump had made it easier for fuel and water supplies to arrive to the ravaged island of 3.4 million US citizens. / AFP PHOTO / HECTOR RETAMAL (Photo credit should read HECTOR RETAMAL/AFP/Getty Images)
SAN JUAN, PUERTO RICO - SEPTEMBER 28, 2017: After eight hours in line, Solymlar Duprey, age 47, holds her daughter Miabella Lawston, age 5, as they try to get on an evacuation cruise ship leaving San Juan. 'The situation is so critical. There is no electricity, fuel, water,' said Duprey. She was trying to locate her confirmation number to board the cruise ship. A Royal Caribbean cruise ship is evacuating over 2,000 people from Puerto Rico, St. John, and St. Thomas free of charge. People are attempting to get off of the island as lack of fuel, electricity and running water has crippled Puerto Rico in the aftermath of Hurricane Maria. (Photo by Carolyn Cole/Los Angeles Times via Getty Images)
Maria Olivieri removes a tree branch from her backyard a week after the passage of Hurricane Maria in Aibonito, Puerto Rico, on September 27, 2017. The US island territory, working without electricity, is struggling to dig out and clean up from its disastrous brush with the hurricane, blamed for at least 33 deaths across the Caribbean. / AFP PHOTO / Ricardo ARDUENGO (Photo credit should read RICARDO ARDUENGO/AFP/Getty Images)
COROZAL, PUERTO RICO - SEPTEMBER 27: Irma Maldanado stands with Sussury her parrot in what is left of her home that was destroyed when Hurricane Maria passed through on September 27, 2017 in Corozal, Puerto Rico. Puerto Rico experienced widespread damage including most of the electrical, gas and water grid as well as agriculture after Hurricane Maria, a category 4 hurricane, passed through. (Photo by Joe Raedle/Getty Images)
Residents with gas canisters wait for fuel after Hurricane Maria in the Miramar neighborhood of San Juan, Puerto Rico, on Tuesday, Sept. 26, 2017. President�Donald Trump�said he will travel to Puerto Rico to survey damage. He told reporters that the federal government is 'doing a really good job' in relief efforts and has shipped 'massive amounts' of food and water. Photographer: Alex Wroblewski/Bloomberg via Getty Images
A vehicle drives through streets filled with floodwater near destroyed homes from Hurricane Maria in this aerial photograph taken above Barrio Obrero in San Juan, Puerto Rico, on Monday, Sept. 25, 2017. Hurricane Maria hit the Caribbean island last week, knocking out electricity throughout the island. The territory is facing weeks, if not months, without service as utility workers repair�power�plants and lines that were already falling apart. Photographer: Alex Wroblewski/Bloomberg via Getty Images
AIBONITO, PUERTO RICO - SEPTEMBER 24: People wait in line for water as they wait for gas, electrical and water grids to be repaired September 24, 2017 in Aibonito, Puerto Rico. Puerto Rico experienced widespread damage after Hurricane Maria, a category 4 hurricane, passed through. (Photo by Joe Raedle/Getty Images)
Customers stand in line outside a grocery store in the town of Dorado, west of San Juan, Puerto Rico, on Thursday, Sept. 28, 2017. Trump�ordered the Jones Act to be waived for shipments to hurricane-ravaged Puerto Rico immediately�at the request of Governor�Ricardo Rossello, White House press secretary�Sarah Sanders�said Thursday. Photographer: Alex Wroblewski /Bloomberg via Getty Images
SAN JUAN, PUERTO RICO SEPTEMBER 22: Power lines and fallen trees block a sidewalk at the University of Puerto Rico, Rio Piedras campus, after Hurricane Maria at Ponce de Leon Avenue in San Juan, Puerto Rico on September 22, 2017. (Photo by Pablo Pantoja/Anadolu Agency/Getty Images)
SAN JUAN, PUERTO RICO - SEPTEMBER 25: Yancy Leon who has been waiting in line for two days to get an American Airlines flight out of the Luis Munoz Marin International Airport continues to wait as she tries to escape the conditions after Hurricane Maria passed through the island on September 25, 2017 in San Juan Puerto Rico. Some of the people have waited days at the airport in hope of getting onto a plane after Hurricane Maria, a category 4 hurricane, passed through. (Photo by Joe Raedle/Getty Images)
Workers fix a light fixture at the San Jorge Children's Hospital in San Juan, Puerto Rico, on Thursday, Sept. 28, 2017. Trump�ordered the Jones Act to be waived for shipments to hurricane-ravaged Puerto Rico immediately�at the request of Governor�Ricardo Rossello, White House press secretary�Sarah Sanders�said Thursday. Photographer: John Taggart /Bloomberg via Getty Images
Travelers stand in line outside of Luis Muoz Marn International Airport after Hurricane Maria disrupted flight service in San Juan, Puerto Rico on Wednesday, Sept. 27, 2017. President�Donald Trump�said he may temporarily suspend a law that restricts the use of foreign ships operating in U.S. waters and between U.S. ports in order to accelerate the delivery of aid to Puerto Rico, where his administration faces mounting criticism over its response to Hurricane Maria. Photographer: Alex Wroblewski/ Bloomberg
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“Even the people that have more severe conditions like cancer, that may not be as critical right now. Their care is being delayed," he said. "So it’s pretty bad, what’s going on."

The few hospitals in Puerto Rico where electricity has been restored remain in a precarious position, said Marcos Águila, executive director and CEO of Hospital Pavia Santurce, in San Juan.

“Right now we have electricity, but electricity is not stable," he said. "It is on and off all the time.”

The power went out at the hospital on Tuesday afternoon, triggering the facility’s backup generator. Every time that happens, hospital workers with walky-talkys inspect the entire facility, Águila said.

“I’m out of power for I don’t know how long — maybe 12 hours, 24 hours — and then it will come back,” he said.

In the emergency room, Dr. Julio Ramos de Velasco said the patient load had doubled since the storm.

“When you come into the emergency room now, you would see the halls full of patients in stretchers and wheelchairs because we don’t have enough stretchers,” he said. “This is not usually how this ER works. There is just no more room to put patients.”

Because there is still not a reliable delivery of diesel, Águila, out of desperation, persuaded a trucker who was waiting in line to deliver his fuel to the hospital rather than where it was originally intended to go. “It’s a lot of improvisation,” he said.

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Águila has also been siphoning off some of the fuel from the hospital's diesel tanks into a truck to move the precious cargo to other hospitals to keep generators going and electricity flowing.

Then there was the 600-pound patient on a ventilator who had to be moved to another hospital after the power went out.

“We got inventive there," Águila said. "We put mattresses on the stairs and were able to slide him down the stairs.”

The Federal Emergency Management Agency said on its website that 64 of 68 hospitals on the island are "open," but did not say how functional they are.

Fourteen hospitals had their power restored and the Defense Department’s hospital ship, the Comfort, arrived a day earlier with medical equipment and supplies, as well as 250 available hospital beds, FEMA said.

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Life in Puerto Rico amid devastation
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Life in Puerto Rico amid devastation
A man stands inside of a destroyed supermarket by Hurricane Maria in Salinas, Puerto Rico, September 29, 2017 REUTERS/Alvin Baez TPX IMAGES OF THE DAY
Local residents collect water from a broken pipe at an area damaged by Hurricane Maria, in Cayey, Puerto Rico, September 29, 2017 REUTERS/Alvin Baez
Mayor of San Juan Carmen Yulin Cruz (R) embraces Esperanza Ruiz, a city administrator, outside the government center at the Roberto Clemente Coliseum after Hurricane Maria, in San Juan, Puerto Rico September 30, 2017. REUTERS/Carlos Barria
An aerial photo shows damage caused by Hurricane Maria in San Juan, Puerto Rico, September 27, 2017. Picture taken September 27, 2017. REUTERS/DroneBase
People queue at a gas station to fill up their fuel containers, after the island was hit by Hurricane Maria, in San Juan, Puerto Rico September 28, 2017. REUTERS/Alvin Baez
An aerial photo shows people lining up at a gas station follwing damages caused by Hurricane Maria in San Juan, Puerto Rico, September 27, 2017. Picture taken September 27, 2017. REUTERS/DroneBase
An elderly woman stands after receiving food during a supplies distributions at an area affected by Hurricane Maria in Salinas, Puerto Rico, September 29, 2017 REUTERS/Alvin Baez
People line up to board a Royal Caribbean cruise ship that will take them to the U.S. mainland, in San Juan, Puerto Rico September 28, 2017. REUTERS/Alvin Baez
A man carrying a water container walks next to damaged houses after the area was hit by Hurricane Maria in Canovanas, Puerto Rico, September 26, 2017. Picture taken on September 26, 2017. REUTERS/Carlos Garcia Rawlins
A woman drinks from a bottle after filling it with water from a tank truck at an area hit by Hurricane Maria in Canovanas, Puerto Rico, September 26, 2017. Picture taken on September 26, 2017. REUTERS/Carlos Garcia Rawlins
A boy climbs a tree at an area affected by Hurricane Maria in Salinas, Puerto Rico, September 29, 2017 REUTERS/Alvin Baez
An aerial photo shows damage caused by Hurricane Maria in San Juan, Puerto Rico, September 27, 2017. Picture taken September 27, 2017. REUTERS/DroneBase
People queue to fill containers with water from a tank truck at an area hit by Hurricane Maria in Canovanas, Puerto Rico, September 26, 2017. Picture taken on September 26, 2017. REUTERS/Carlos Garcia Rawlins
A man rides a bicycle by damaged electricity lines at an area affected by Hurricane Maria in Salinas, Puerto Rico, September 29, 2017 REUTERS/Alvin Baez
People queue at a gas station to fill up their fuel containers, after the island was hit by Hurricane Maria, in San Juan, Puerto Rico September 28, 2017. REUTERS/Alvin Baez
A shows the damages of his house after the area was hit by Hurricane Maria in Canovanas, Puerto Rico September 26, 2017. REUTERS/Carlos Garcia Rawlins
Children play on the roof of a damaged house after the area was hit by Hurricane Maria in Canovanas, Puerto Rico September 26, 2017. REUTERS/Carlos Garcia Rawlins
Damaged houses are seen after the area was hit by Hurricane Maria in Canovanas, Puerto Rico September 26, 2017. REUTERS/Carlos Garcia Rawlins
People wake up after sleeping in a shelter set up at the Pedrin Zorrilla coliseum after the area was hit by Hurricane Maria in San Juan, Puerto Rico, September 25, 2017. REUTERS/Carlos Garcia Rawlins
Monica Lopez (R) looks at her dog at a shelter set up at the Pedrin Zorrilla coliseum after the area was hit by Hurricane Maria in San Juan, Puerto Rico September 25, 2017. REUTERS/Carlos Garcia Rawlins
People queue at a gas station to fill up their fuel containers, after the island was hit by Hurricane Maria, in San Juan, Puerto Rico September 28, 2017. REUTERS/Alvin Baez
Damaged houses are seen after the area was hit by Hurricane Maria in Canovanas, Puerto Rico September 26, 2017. REUTERS/Carlos Garcia Rawlins
A woman cleans her house after the area was hit by Hurricane Maria in Canovanas, Puerto Rico September 26, 2017. REUTERS/Carlos Garcia Rawlins
People wait for their cellphones to be charged outside a store during a blackout after the area was hit by Hurricane Maria in San Juan, Puerto Rico September 25, 2017. REUTERS/Alvin Baez
A man tries to rebuild his house after the area was hit by Hurricane Maria in Canovanas, Puerto Rico September 26, 2017. REUTERS/Carlos Garcia Rawlins
People use their cellphones on the street during a blackout after the area was hit by Hurricane Maria in San Juan, Puerto Rico September 25, 2017. REUTERS/Alvin Baez
Carlos Cruz (L) wakes up after sleeping in a shelter set up at the Pedrin Zorrilla coliseum after the area was hit by Hurricane Maria in San Juan, Puerto Rico, September 25, 2017. REUTERS/Carlos Garcia Rawlins
A woman uses her cellphone on the street during a blackout after the area was hit by Hurricane Maria in San Juan, Puerto Rico September 25, 2017. REUTERS/Alvin Baez
People wait at a gas station to fill up their fuel containers, in the aftermath of Hurricane Maria, in San Juan, Puerto Rico September 27, 2017. Picture taken September 27, 2017. REUTERS/Alvin Baez
A man tries to repair a generator in the street after the area was hit by Hurricane Maria in San Juan, Puerto Rico September 25, 2017. REUTERS/Alvin Baez
Hilda Colon wakes up after sleeping in a shelter set up at the Pedrin Zorrilla coliseum after the area was hit by Hurricane Maria in San Juan, Puerto Rico, September 25, 2017. REUTERS/Carlos Garcia Rawlins
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But even as they deal with pressing day-to-day problems, doctors are bracing for what they fear is sure to come — particularly infectious disease.

“Right now my major concern would be problems with influenza virus, stomach diseases," Ramos de Velasco, the emergency room doctor, said. "There’s many places that don’t have water, whatever water they can get is not really drinkable water."

Still, Santiago said the medical community in Puerto Rico was “making the best of what resources we have now,” working round-the-clock to keep their fellow islanders healthy. 

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