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Katrina’s Dance

  • Dhruv S. Kazi
    Affiliations
    London School of Economics and Political Science, London, UK, Former Chief Medical Resident, Ben Taub General Hospital and Baylor College of Medicine, Houston, Tex
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      Dedicated to the house staff at Baylor College of Medicine, the key role they played in the disaster response, and the spirit of volunteerism that made it all possible.
      “Good afternoon, Mr. Johnson. What brings you here today?”
      I had just started my shift in the emergency department, and Mr. Johnson was the first patient I had seen. He was a 72-year-old African American man, healthy except for long-standing hypertension. A bright orange sticker on one corner of the chart informed me that he was a Katrina evacuee.
      “Mighty fine, sir, mighty fine. I’m just here to get a new prescription for my blood pressure medicines. And to thank you and the city of Houston for taking good care of us.”
      The toothless smile conveyed genuine gratitude and revealed nothing of the turmoil within. We talked about his medical problems and of the changes in his life during the last 6 days.
      Through countless visits to news websites and poignant National Public Radio coverage, I had followed closely Katrina’s dance of death and destruction along the Gulf Coast during the previous week. The initial relief that New Orleans had been spared the worst was quickly replaced by the horror of broken levees and nightmarish scenes of people perched on roof tops, waiting desperately for help. But all this was happening hundreds of miles away, and I was a distant spectator.
      When it was announced that the masses holed up in squalor at the Superdome were being evacuated to the Astrodome in Houston, it became immediately apparent that I would no longer be far removed from the disaster. As the chief medical resident at Houston’s major county hospital, less than 5 miles from the Astrodome, I found myself immersed in intense planning as the hospital prepared for a surge of patients. New medicine teams were created to handle the projected increase in admissions, as some of New Orleans’ most disadvantaged people were evacuated to our city. We discussed the nature of medical conditions we expected to see and strategized with the administration on how to increase the hospital’s already strained bed capacity. Meetings were held at all levels to plan the hospital’s response to the disaster that had now relocated to our doorstep.
      Although these hours of intense planning had produced a robust disaster response plan for the hospital, they had failed to prepare me for my first personal encounter with a patient whose life had been devastated by Katrina. Mr. Johnson spoke slowly and chose his words carefully. As we continued to talk, his expression changed, and he began to open up. He spoke of how he had wanted to evacuate, but his wife of 50 years would have none of it. So they had stayed. The day after they thought the storm had passed, the water level began to rise quickly, and he and his wife rushed to the attic. He didn’t have the time to rescue his dentures or his medications, he said almost apologetically, and no longer knew where their cat was. With a jackhammer he kept in the attic, he made a hole in the roof and the two of them climbed through. There they waited patiently for 4 days, combating the blazing sun above and the stifling heat in the flooded home below. Finally, help had arrived; they were rescued by helicopter and then evacuated to the Astrodome by bus, where they were allotted two little cots surrounded by a sea of humanity. The stress of the last 4 days got to his wife. She had a nervous breakdown on the floor of the Astrodome and was taken to the psychiatry emergency department, he said, holding back the tears that his eyes were brimming with.
      What does one say to a 72-year-old who has seen all his life’s possessions washed away? What does one say to a man who has waited on his roof for 4 days and is still grateful for the care he is being provided? We sat there in silence as I wrote out his prescriptions. As he walked out, he thanked me profusely for my time.
      Over the next week, I heard the story repeated over and over again—of families separated, property lost, of the growing desperation among people waiting to be rescued, and of gratitude for the help the city of Houston was providing.
      Almost overnight, the Astro Arena was converted to a massive clinic with a host of outpatient services, including a well-equipped laboratory, x-ray facilities, and a well-stocked pharmacy serving the medical needs of the shelters that had sprung up in the city’s sporting venues. House staff and faculty volunteered to staff the clinic round the clock for more than 2 weeks, giving of themselves and of the resource they valued most—their time. Many residents worked around their rotation requirements and call schedules to spend time at the “Arena clinic,” as it was fondly named. The residency program released several residents from their rotations so that they could be redeployed where they were needed most. One resident canceled a planned holiday to volunteer; most made it a point to work on their days off. One of my fellow chief residents coordinated the house staff volunteer schedule, to ensure continuity of care at the clinic, as well as the safety of residents working there in shifts. There was a unifying sense of compassion coupled with urgency and pride in the city’s response to the catastrophic events of the past week. Within days, a fully operational medical facility had sprung up at the site of the city’s landmark sporting venue.
      However, we were still in the midst of the Atlantic hurricane season, and 2 weeks later hurricane Rita was brewing in the Gulf, forecast to be headed for Houston. The Katrina evacuees were evacuated once again, to distant, safer lands. Well-meaning officials struggled to provide an organized response, but the city that had given so generously in the aftermath of hurricane Katrina was now confronted with its own vulnerability. Contingency plans were redrawn, this time to protect the institutions that had played a central role in helping Katrina’s evacuees.
      Fortunately, Rita did not keep her date with Houston, and life limped slowly back to normal over the next week as millions returned to the cities they had evacuated. But “normal” is a relative term.
      Many of the patients I met after Katrina and the stories they told me made a lasting impression. I sometimes wonder where each of them is now and how they are coping. Take, for instance, Mrs. Jones; I met her during a night shift at the triage clinic at the Reliant Center in the early days after Katrina. It was 4 a.m., the volunteers weary after a long night of work in the makeshift clinic. Most of the 3000 evacuees were still asleep in the vast atrium of the dimly lit exhibit hall, but Mrs. Jones had showered already, her hair pulled back in a neat bun; she had a regal air about her that was uncommon in those parts. She told me that she had evacuated in time, but her home of 30 years had been destroyed in the flooding that followed. She was now in the shelter with her daughters and grandchildren. She insisted she did not want her kids to see her cry because they counted on her for support, then added that some times she could not help herself. She wept silently as I mumbled something about grief being a natural response and of the need to be honest with one’s own emotions.
      I have dealt with death and disease in medical school and residency, but nothing prepared me for this. An entire city ravaged by a foreseeable natural disaster, with the inestimable loss of uninsured property, and what is more, a lifetime of memories. Most of what I did in the clinics had little to do with my skills as a clinician. I listened. I conversed. I counseled.
      In the aftermath of Hurricane Katrina, there was relentless press coverage of the destruction left in her wake and of the outpouring of altruism that followed. One aspect of the tragedy was easily overlooked: the emotional toll of the tragedy on its medical responders. Toll is perhaps too harsh a word, because events such as these are, in fact, perspective-defining. For all of us involved in the Katrina response, our lives have changed in an intangible way. There have been many lessons learned—of disaster management and of the preparedness of the medical system, of grief and gratitude. And now more than ever, of the need to understand human illness in the context of the torn fabric of human society.

      Acknowledgments

      The author is indebted to Ms. Gouri Dange for her editorial support.