Jacques Lorblanches will never forget the ghastly conditions, and has lost count of the number of amputations he has performed in the past 48 hours in Haiti, but he will never forget them.
"I have never seen anything like this -- infected wounds full of larvae," said the experienced French doctor, recounting a scene reminiscent of a field hospital on a bloody 19th-century battlefield.
"I did my first amputation with three forceps, five scissors and a scalpel, without water, and just a flashlight to illuminate the injury," said the surgeon, who is part of a team sent by the humanitarian organization Doctors of the World.
Such are the nightmares brought to horrifying life across Port-au-Prince after last week's cataclysmic earthquake plunged the Haitian capital into ruin, killing a feared 200,000 people and injuring countless more.
For many of the injured lucky enough to be rescued, a new horror begins with the drastic amputation of one or more limbs -- and, after eventual recovery, the prospects of a life of grinding poverty.
Since Saturday, out of 30 operations performed by the French team at the General Hospital in Port au Prince, 28 ended in amputation.
And even as some of the world's most advanced mobile medical facilities are just a short helicopter flight away, aboard a US aircraft carrier and other ships in the waters off Haiti, the story is the same.
"Of the 48 operations performed over two days, almost all were amputations," said doctor Amit Assa, at another field hospital set up by an Israeli team on the outskirts of the capital.
The wounded are brought in wheelbarrows or on stretchers fashioned out of doors by pleading relatives or mute strangers.
Arriving with gangrenous limbs crushed days ago by concrete walls or metal beams, doctors explained that it was inevitable that many, many surgeries would end in amputation.
Like a city gripped by war, Port-au-Prince will be home to thousands of fresh amputees when all is said and done, exacerbating an acute crisis in the western hemisphere's most wretchedly poor nation, according to the surgeons.
An emotional Lorblanches recalled the case of a girl injured when a wall collapsed and crushed her hands, both of which were amputated by his team on Sunday.
"We cut to save lives," he said. "Our work is a small drop in this tragedy."
But the cut has become the norm. After the operation, there is only time for a brief cigarette break before starting anew, on a Haitian man whose left leg had been crushed.
The desperate conditions force the doctors to do rapid triage more familiar on a war's front lines than in a quake-hit capital.
"Doubt can mean death," observed anesthetist Igor Auriant.
A few paces away, Marie-Francoise howls in anguish in the aftermath of the loss of her left arm.
Her parents perished in the family home when it collapsed in the temblor, and while Marie-Francoise spent hours trapped under the rubble, she was eventually rescued by neighbors.
"I feel happy because I'm alive, but I do not think about my future. I lost everything and I can not work," she said between sobs.
The scene is repeated in badly damaged hospitals and makeshift medical centers.
In the city slum Carrefour, dozens of wounded and dying have lain for hours, even days, under a sweltering sun waiting to be treated. Inside a tent, amputations are performed one lot after another.
"There is gangrene everywhere and you amputate on the go," said Hans Van Dillen, for years the head of a Doctors Without Borders (MSF) mission here that is now conducting 100 surgeries per day under shocking conditions.
"On day six, you conduct radical surgery. There's nothing more you can do."
And with the number of casualties needing immediate treatment skyrocketing -- skull fractures, severe burns, open wounds -- "we are completely overwhelmed," he said.
Medical equipment has been late in arriving, and the wounded are sorted like casualties of war: forget the hopeless cases, postpone care for the less serious ones, and focus on the critically injured who can be saved.