Surgeons working for Doctors Without Border, operate on an earthquake victim in a temporary clinic in Port-au-Prince, Haiti.
In his Thomas the Tank Engine button-down shirt, Graddensky LaPlante looked like a typical 5-year-old. But two gaping wounds in his scalp that cut clean to his skull and a bandaged right leg easily identified him as one of the thousands who were injured by the earthquake. "When the earthquake happened, the roof just collapsed on him," says his father Jean-Robert LaPlante, who brought the child to the Admiral Killick Naval Base, in the Carrefour district of Port-au-Prince.
On Jan. 20, eight days after the 7.0-magnitude quake, Colonel David Cancelada, a U.S. Army surgeon, took one look at Graddensky and said, "We need to hydrate, or the bone can dry out and get infected." Cancelada is part of a joint task force based in Honduras that arrived in Haiti on Jan. 19 to help relieve the medics of the U.S. Coast Guard, who had been among the first on the scene. What started out as a makeshift clinic with an operating table on the floor blossomed into a first-rate field operation, with an operating room run from an air-conditioned tent.
The surgical team working on Graddensky included troops from Wright-Patterson Air Force Base, in Dayton, Ohio; and Keesler Air Force Base, in Biloxi, Miss. "Biloxi got wiped out in Katrina, and now it goes full circle," says nurse anesthetist Lieut. Colonel Ken Williams, who was assigned to Keesler before joining the joint task force. Joining Cancelada and Williams in the operating room were nurse Rick Schott and Sergeant Kelly Preston, both from Wright-Patterson, as well as nurse Alberta Carter from Keesler. All of them serve together in Honduras. Most have spent time in Iraq. "In a lot of ways, this is worse than Iraq because there is no infrastructure," Cancelada says about the working conditions in Carrefour. "I've been deployed to Iraq twice. This team has a lot of trauma experience, but seeing all this is pretty daunting. In Iraq you had command and control. Here it is chaotic. It's hard to say who is in control."
Carter and Williams took charge of sedating the boy. Williams explained that he had to rely solely on intravenous drugs to knock out Graddensky. He used two IV drips, one with Vericet, the other with ketamine. He did not use an anesthesia machine because none was available in the surgical tent. "Another thing we cannot control is usually we have our patients not eat or drink anything before an operation because they can throw up and get stomach acid in the lungs," Williams said. "That can get really bad because it eats away at the tissue."
Once Graddensky was unconscious, Williams placed a breathing tube down the boy's throat, just past his voice box. All the while, Williams used an Ambu bag to ensure that Graddensky continued to breathe. The tube was in place, but Graddensky was breathing on his own.
Cancelada first cleaned the boy's head wound and cauterized it. Then he began trying to fit the pieces of skin together. He cut some of the skin from the base of the scalp so that he could stretch it to cover the bone and then suture the wounds closed. It took a total of 30 stitches to close both wounds. The child will recover but will have a lot of pain, Cancelada predicted, adding that he won't need a skin graft but will have an ugly wound.
As dramatic as Graddensky's wounds appear, they were not so severe that he needed an emergency evacuation. Dozens of other patients, many with compound fractures that needed to be set by an orthopedic surgeon, were lined up on stretchers near a field where Navy helicopters would arrive to take them to one of two naval vessels, the U.S.S. Bataan and the U.S.N.S. Comfort. The Comfort sounds just like its name, with 500 beds, six operating rooms and two orthopedic surgeons.
Prior to the Navy's arrival, the U.S. Coast Guard began evacuating the most critically wounded people to Sacred Heart Hospital in Milot, a town in the north of Haiti that was unaffected by the quake. Rather than directly fly the injured out by helicopter, the Coast Guard transported them by boat to one of two cutters, the Mohawk or the Tahoma. To date, the Coast Guard has evacuated 62 people, and the Navy another 17, says James P. Spotts, commanding officer of the Tahoma.
The Mohawk arrived in the Haitian harbor the day after the quake to facilitate tending to the injured. It has since left Haitian waters, and only the Tahoma remains. Spotts told TIME that he and his crew felt the 6.1-magnitude quake that hit just west of Port-au-Prince around 6 a.m. on Jan. 20. "We felt the aftershock," Spotts said. "I thought we hit something."
But the ship was O.K. So was Emerson Refusé, a 9-year-old being treated by Erin Hunter, a health service tech with the U.S. Coast Guard. Emerson emerged from the rubble of his home in Carrefour on Jan. 20, eight days after the devastating quake. "We found him today," Hunter said. "It's the eighth day with no water, nothing." Hunter monitored Emerson as he lay sleeping in a gurney inside the Killick Naval Base.
The boy's mother knew her son had been watching TV in the living room when the quake leveled their two-story house. The youngest of Marlen Merizier's four children, Emerson survived by hiding under a table. When someone walked by the flattened house Wednesday morning, Emerson called out, "I'm here. I'm not dying."
Merizier says she had already begun grieving for her son because she was convinced he had died. Two of her other children had been crushed to death by the concrete home. "I thought he was dead because I knew he was in the house, and the others had already died," she says. "All the family was crying. I was crying more when I saw him today." But those were tears of joy for a resurrection amid the rubble.
Read more in the new book TIME Earthquake Haiti: Tragedy and Hope and support TIME Haitian relief efforts