NUEVA SAN SALVADOR, El Salvador — A young musician who gave his beleaguered country hope by surviving more than 30 hours trapped in rubble struggled Monday to stay alive, as the official death toll from Saturday's magnitude 7.6 quake rose above 600.
The rescue of Sergio Armando Moreno was a tale of heroism, as volunteers dug tunnels through the debris to administer oxygen and intravenous medicine to the victim, and talked and prayed with him around-the-clock.
But shortly after he was lifted from the ruins, the hope that Moreno's rescue inspired turned to resignation, and he became a symbol for a nation facing the Sisyphean task of providing relief despite continuing tremors that destroyed hours of work.
To reach the nearly destroyed town of Comasagua, across the Balsamo mountain range from San Salvador, workers had cleared a single road, but it was blocked again Monday by landslides triggered by aftershocks.
And quake-ravaged areas to the west of San Salvador, the capital, were too remote to receive quick aid. Armenia, where the death toll was 23 and 80% of the town was in ruins, appeared to be the community most damaged in that part of the country--but nearly all the help it has received has come from other western towns, said Mayor Moises Alvarado.
Among the volunteers was a trio from the King's Explorers, a religious group akin to the Boy Scouts, who loaded paper plates with tortillas, beans and rice for residents of one Armenia neighborhood. The young men were from nearby Izalco.
Throughout the country, 1,830 people were injured and nearly 34,000 houses were damaged or destroyed, officials said. About 18,000 people were evacuated. The Pan American Health Organization said water service was cut to as many as half the country's 6 million people.
In Guatemala, the death toll rose to six. The quake was also felt in Nicaragua, Honduras and Mexico.
The brunt of the tragedy fell on the central province of La Libertad, where the national government reported 492 dead. The coroner said that 251 of those fatalities were in Las Colinas, a neighborhood of Nueva San Salvador outside the capital, and that hundreds more bodies are expected to be recovered.
Police ordered hundreds of volunteers shoveling through the mud to move off the unstable two-story mounds to clear the way for search dogs that had been brought in from Mexico and Spain.
Veteran rescue workers took that decision as a sign that authorities have given up on finding more than the five people rescued among the ruined townhouses that were buried when a deforested hilltop was shaken loose by Saturday's earthquake.
Moreno was one of those five. The 22-year-old keyboard player was on his aunt's small patio when the earth began to shake. He was trapped at the hips under a fallen balcony, with a concrete washtub pinning him in on one side, rescue workers said.
Rescuers were able to climb through a window into the room next to the patio within three hours of the quake. One of them was Jorge Vasquez, 35, a nurse and veteran of the Green Cross volunteer corps.
"I saw my old boss from when I was in search and rescue, and he said, 'I have a job for you,' " said Vasquez, who was assigned to talk to Moreno to help keep his spirits up.
After rescuers dug a tunnel into the patio so they could reach the musician's left arm, Vasquez crawled in and began administering medicine and liquids intravenously. Oxygen was piped in through a garden hose. At one point, the nurse recalled, Moreno told him, "You are going to be the one who sees me die."
Vasquez insisted, "No, we are here to rescue you."
Moreno's uncle, Napoleon Garcia, and a longtime friend, Douglas Angel, volunteered to take Vasquez's place in the tunnel, allowing him to join the team still trying to dig down to reach the musician.
"Once, while I was in the cave with him, he asked to pray," his uncle said. He asked Garcia to tell his family that he loved them very much.
"He wanted to live," Garcia said.
Vasquez and his colleagues tried desperately to make that wish come true. They dug two tunnels to Moreno, but they could not move the balcony pressing on him.
Finally, a Mexican rescue team arrived with hydraulic lifts and moved the debris, freeing Moreno. He was lifted to the surface and his father's embrace, then whisked by ambulance to a state hospital.
Entering the emergency room, he suffered a heart attack and kidney complications and fell into unconsciousness.
Intensive-care specialist Dr. Victor Seguro said that Moreno suffered from "crunch syndrome." He compared his condition to a river that has been held back by a dam. Suddenly, the dam breaks and the river, loaded with stones and branches, rushes forward.
In Seguro's analogy, the blood is the water and the debris is the toxins that the blood normally carries away from tissues. That rush of toxins caused a massive failure of Moreno's organs, he explained to the young man's father, Juan Cruz.
"His chances of survival are barely shadows," perhaps 10%, he told the somber-faced parent. To save Moreno, surgeon Eduardo Castillo explained Monday morning, he would need to amputate both of his legs.
Moreno might not survive the surgery. Still, hospital officials reported at 6 p.m. that he was in stable condition.
"We believe that he is going to keep struggling for his life," said hospital director Aleli del Cid. "It is a miracle."