By DEBORAH SONTAG

PORT-AU-PRINCE, Haiti - The foreign doctors who performed the first amputations after the earthquake used hacksaws. They relied on vodka for sterilization, substituted local numbing for general anesthesia, jury-rigged tourniquets from rubber gloves. Working around the clock in improvised operating rooms, they sacrificed limbs and lost patients to injuries that are no longer supposed to be disabling or deadly.

Now back in their antiseptic, hightech offices in the United States and elsewhere, the medical professionals who initially flew to Haiti’s rescue are haunted by their experiences, “overwhelmed by conflicting feelings of accomplishment and guilt,’’ as Dr. Louisdon Pierre described it.

They witnessed what Dr. Laurence J. Ronan of Massachusetts General Hospital described as a “mass casualty horror show.’’ They practiced what Dr. Dean G. Lorich of the Hospital for Special Surgery in Manhattan called “Civil War medicine.’’ They saved lives, probably by the thousands. But their accomplishments were limited by the circumstances, and then they left, uneasily, before conditions started improving.

Most of the doctors interviewed said they were committed to returning to Haiti and to marshaling the medical community’s resources to deal with the thousands of Haitians who sustained permanently disabling injuries.

The needs are staggering: from basic wound care to skin grafts, revision surgery, physical and occupational rehabilitation, prostheses and trauma therapy.

“Everything that everyone did during those first two heartbreaking weeks will have been for nothing if these patients don’t get continuing care,’’ said Dr. Elizabeth Bellino, a pediatrician based at Tulane University in New Orleans who worked in Haiti right after the earthquake.

In Uganda now on a project, Dr. Bellino, 34, said she closed her eyes and saw the beaming face of a 12-yearold Haitian boy named Mystil Jean Wesmer who ended up comforting her when she dissolved into tears. As she recounts it, Mystil smiled gently and, sensing that she was overwhelmed by the need around her at a field hospital run by Americans, said: “ ‘Go take care of the sicker kids. I’ll be O.K.’ ‘’ He himself was waiting to have his leg amputated.

“All he wanted to know was how he was going to walk to school and church,’’ Dr. Bellino said. “I said, ‘Well, we’ll figure that out.’ But now I’m so worried about him, about all the kids.’’

Dr. Pierre, a Haitian-American who is the director of pediatric intensive care at the Brooklyn Hospital Center, said he thought constantly about the patients he left behind, too. Even as he plans his next trip - he and Dr. Stephen Carryl, the chairman of surgery at his hospital, will be returning with a prosthetics maker - a few memories plague him.

Back in Brooklyn, he still hears the loud, shrill cry of a mother at the moment her small son died of a raging infection on the lawn of a hospital in the Carrefour neighborhood. The mother and father, one child already lost to the earthquake, had implored Dr. Pierre to help their 4-year-old, who had been eviscerated by a concrete block and hurriedly stitched back together by a local doctor.

But the boy, lying in a crib under a tree, his heart rate racing, his breathing way too fast, was clearly suffering septic shock, and Dr. Pierre, equipped only with his stethoscope, could do nothing. “I felt so helpless,’’ he said, and not long afterward, while he was deeply sedating another patient for surgery, he heard the wail that told of the boy’s death.

Later, amid the patients strewn across the hospital’s grounds, Dr. Pierre spotted a wrapped bundle in what appeared to be an abandoned incubator.

The bundle, mewling, was a premature infant whose mother had died in childbirth. Dr. Pierre and a pediatric nurse from Brooklyn, Sharon Pickering, frantically tried to find a way to hydrate the baby.

“This is something we know how to do,’’ he said they told each other. Finally, they managed to insert a needle in a bone cavity and get the baby some fluids. But the next morning, Dr. Pierre found the incubator empty.

Such losses were shattering but it was hard to react at the time, the doctors said. There was too much to do, and the circumstances were disorienting. Dr. Lorich, an orthopedic trauma surgeon at the Hospital for Special Surgery, said it was hard to adjust to the grim reality of mass amputations. “I am in the habit of saving legs,’’ he said.

In Uganda, three weeks away from her return to Haiti, Dr. Bellino said she could not stop wondering how the 12-year-old Mystil had fared after his amputation.

Through an uncle, the boy was found at the World Harvest Missions/ New Life orphanage, where American volunteers are looking after wounded children who have been discharged from field hospitals.

Mystil was lying on a mattress on the concrete floor of a church with a roof damaged in the quake. Sarah Wimmer, a paramedic from Arizona, said that Mystil’s wound was healing well, and that he was receiving some physical and emotional therapy. When his stitches are removed, he will be sent home to his parents, who are living outside their cracked house, but he will be considered an outpatient, Ms. Wimmer said.

Reached in Africa, Dr. Bellino sighed. “I can breathe now,’’ she said .


Mystil Jean Wesmer, 12, an earthquake victim, was in a Port-au-Prince hospital after his leg was amputated. / LYNSEY ADDARIO FOR THE NEW YORK TIMES