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Dispatch from Ellington Field: A Personal Memoir of
Caring for the Victims of Hurricane Katrina
A Personal Memoir of Caring HOUSTON - On August 31, 2005 as Hurricane Katrina was devastating the Gulf Coast, the National Disaster Medical System (NDMS) was activated. In Houston, this meant area hospitals began gearing up to receive patients from the hurricane-affected areas under the coordination of the Michael E. DeBakey VA Medical Center (MEDVAMC). That day, the MEDVAMC began moving supplies, equipment, and personnel to Ellington Field to establish a Patient Reception Team (PRT). A PRT is comprised of physicians, nurses, pharmacists, technicians, housekeepers, facilities management, police officers, and health administration personnel. With the first C-130 military transport aircraft arriving that day at 9 p.m., the MEDVAMC PRT medically triaged more than 700 patients from 21 flights in the next five days.
Leigh Bishop, M.D., a psychiatrist at the MEDVAMC, worked with the PRT at Ellington Field. What follows are his personal observations of the hurricane relief efforts in Houston.
"We had not heard from Jessica in more than 24 hours.
A freshman in her first week at Belhaven College in Jackson, Mississippi, my daughter and her fellow students had held out in the powerless, waterless residence hall for 36 hours after Hurricane Katrina, that brutish and overweight angel of death, passed by. She was able to call a few times by cell phone and clearly was in the high spirits that many survivors of disasters initially experience. (Besides, what could be more fun than being at college and not having to go to classes?) But you could hear a growing edge of worry in her voice as conditions on campus deteriorated. Then she got into a car with her friend, Emily and headed east, right into the wake of the storm.
We lost all contact.
Wednesday, at my desk in the mental health clinic at Houston's Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) it was increasingly difficult to concentrate. The immediacy of caring for hospital patients helped to focus my attention. But once in the office again, my mind quickly wandered back to concerns about Jessica, and the increasingly disturbing reports coming out of New Orleans. I felt restless and helpless, and contacted one of our clinical administrators to volunteer in case the VA would be sending physicians into the disaster zone. She declined the offer. "Once the evacuation starts, you'll probably be needed here more than there." Her reasoning made sense, of course. But, it did nothing to ease the restlessness.
We finally heard from Jessica on Wednesday evening. She was tired but safe at the house of Emily's grandfather in eastern Mississippi. There, they at least had water and such power as could be provided by portable generators. But she clearly was straining to hold back tears. Home in Texas was sounding sweeter and sweeter.
Thursday morning, four days into the aftermath of the hurricane, our VA medical staff arrived at work to find that the National Disaster Medical System had been activated the night before. NDMS is the primary contingency plan for mobilizing federal physicians and health care workers in a national disaster. Our first team already was on the ground at Ellington Field, the former air force base that now serves as the hub of Johnson Space Center's aircraft operations and local National Guard activities.
Since this was my research day, I had missed an early staff meeting, only learning afterward that the executive of the Mental Health Care Line had called for psychiatrists to volunteer for duty at Ellington. While most of the front line physicians were primary care providers, psychiatrists would be needed to address acute mental stress in storm victims as well as to provide general medical care and triage in case the other docs were overwhelmed with cases.
Many of the mental health staff were hesitant initially. How much need would there actually be for psychiatrists? Perhaps, they merely would be in the way. And after all, they spend most of their time treating mental illness, not physical injuries and the effects of severe exposure to the elements.
I could understand the reluctance. It has been years since I was last assigned to an internal medicine service.
On the other hand, early in my career, still unsure of my ultimate direction, I chose to take more training in general and emergency medicine than is required for psychiatrists. And personal experience had taught that, as long as expert back-up is available-as it surely would be in this situation - almost any licensed physician, especially one who works in a hospital setting, has enough skill and knowledge to provide basic care and triage, which would be the primary task of the team. (In the military, dentists are often assigned to perform medical triage for mass casualties so that the surgical and medical specialists are free to provide more advanced assessment and treatment.)
After wrestling over the decision for a few minutes, I sent an e-mail to Dr. Kim Arlinghaus, assistant director of the Mental Health Care Line, stating that I would be willing to go.
The answer came more quickly than expected. Twenty minutes later, while talking with my father by cell phone about Jessica's situation, the desk phone rang. "Can you be on a van to Ellington in five minutes?" Kim asked.
Surprised, I fumbled for a response. My first thought was that my stethoscope and penlight were at home, this being a research day. "You can borrow mine," she said. "Do you want a set of scrubs?"
I ran to her office, on the other side of the building. "I don't know how long it will be before we can relieve you. I hope that's okay. We're still getting this thing organized. But Dr. Garza [Robert Garza, M.D., a colleague in the department] was out there all night and no one from our group is there now. The military is bringing in more flights from the New Orleans airport. They say that they're full of sick people from the hospitals, as well as some people who have been floating in the water for days."
I grabbed the stethoscope and headed for the elevator. Halfway to the carport by the Spinal Cord Injury Unit, recalling that I still did not have a flashlight, I doubled back to the hospital canteen and bought a cheap one. A breathless secretary caught up with me in the hallway and handed me the scrub suit. When I finally got outside, a group of nurses and support staff was gathered around the gray hospital van, the transportation specialist checking their names off on a clipboard. "Are you Dr. Bishop?" he said. He held out a set of keys. "Would you be willing to drive?"
Unsure of why being a doctor qualified me any more than others to drive a government van, I climbed behind the wheel and dropped my scrubs and bag on the floor beside me. Someone jokingly asked if I had a commercial license. "No, but don't tell anyone." I hoped it would be the only thing I would face that day for which I was not prepared.
At the gate into the airfield, we sat for several minutes in the heat while the uniformed guard awaited our clearance. Once inside the security fence, I parked the vehicle and we climbed out in front of the gaping entrance to NASA's Hangar 990.
It was like a scene from a movie.
Think of the set piece near the end of "Close Encounters of the Third Kind"-where scores of specialists and technicians move about like so many ants, hurriedly setting up a high tech encampment, awaiting unknown visitors from the sky.
Convoys of ambulances were parked in long well-ordered lines, drivers and crew milling around and checking equipment. Under the brightly lit canopy of the hangar, doctors and nurses clustered in small groups consulting with one another or with disaster relief coordinators and communication staff at long tables. To the sides, someone had arranged rows of chairs to accommodate those patients who could walk without difficulty. Further back, four emergency medical stations had been set up beside the pharmacists' tables, white sheeted gurneys and IV pumps waiting silently for the next planeload of storm victims. Hovering behind it all, like a great albatross with its white wings stretching the width of the hangar, was one of NASA's high altitude jet aircraft, its ground crew casually going about their maintenance duties as though having a makeshift emergency room suddenly appear in their midst was an everyday occurrence.
I quickly found Dr. Jagadeesh "Jay" Kalavar, director of the MEDVAMC Patient Reception Team. We agreed that I should float between stations, focusing primarily on psychiatric needs but also providing general care and triage as needed. Five planeloads from New Orleans had come in during the night, and more were expected soon.
After changing into scrubs, I went to the pharmacy, which consisted of stacks of large plastic containers filled with the standard medicines used for emergencies in the field. "What psychiatric medications do you have?" I asked.
The pharmacist rummaged though the boxes and found nothing. "I can get whatever you need on the next van from the hospital," he offered. I told him to ask for lorazepam, injectable and oral, as well as injectable haloperidol and rapidly dissolving olanzapine, both of which are antipsychotic medications. New Orleans, like any large city, has its share of severely mentally ill living in the streets. Undoubtedly, at least a few of them would be on incoming aircraft.
As the next inbound flight was announced, ambulance crews began lining up their stretchers side by side at the entrance to the hangar while support staff handed out earplugs to doctors and nurses. Health technicians moved wheelchairs into formation near the stretchers. Canvas litters leaned against the outside wall of the hangar. Order formed out of apparent random chaos.
Then we waited, and waited. People moved about restlessly. Someone announced that the flight had been delayed. We relaxed, leaving the equipment in place and reminding ourselves that "hurry up and wait" was a rule that applied in more settings than just the military. In the meantime, I shadowed Dr. Kalavar, trying to learn a few things about medical disaster management.
Finally, one of the communications staff announced that the flight was five minutes from the runway. Regrouping, we soon heard the drone of the approaching aircraft rising above the echoes of the hangar. Within minutes, a C-130, military drab, taxied from the runway and parked about fifty yards out on the tarmac. Stretcher teams held back while doctors and charge nurses walked out through the prop wash. As the rear ramp was opening, we could see into the darkened interior of the plane. Closely packed columns of canvas litters hung suspended on either side of the center framework, each holding a sick or injured evacuee. The flight surgeon reviewed the passenger manifest briefly with Dr. Kalavar, detailing the numbers of critical and ambulatory. A few passengers with minor injuries walked down the ramp. Then, the air crew began carrying the litters out of the hold, transferring each patient to an ambulance stretcher wheeled into place below.
Back in the hangar, nurse assistants rapidly moved urgently ill patients through the minimal registration process to each triage station. Nurses took vital signs while doctors obtained brief histories. Most of the patients had been in New Orleans hospitals, evacuated because of dwindling medical resources to care for them, and an increasingly unsafe environment. Some were post-operative patients who had recently been released from inpatient care. Before their wounds could fully heal, they found themselves struggling for hours in the infectious waters of the drowned city, incisions opening to form large, draining abscesses.
Several others had chronic kidney failure and, for lack of electrical power, had not undergone dialysis in many days. One who initially appeared stable sat in a chair off to the side until she fainted. We rapidly downgraded her condition to urgent, and moved her to an ambulance.
A frail looking elderly man from a flooded nursing home, obviously somewhat demented but determined not to be cowed, looked out at me with fierce eyes and wide gaps in his few remaining teeth. "There's nothing wrong with me. I feel great. I'm just hungry. I could eat a steak. Do you have a steak?" I told him that I did not have a steak (doubting that he could chew one if I had), but assured him that I could get him something almost as filling. Testing his orientation, I asked if he knew what month it was. "December?" he said.
"Hmm, kind of hot for December, don't you think?"
He considered this thoughtfully. But the news that it was September and he was in Houston didn't seem to interest him very much.
The last I saw of him, he was sitting at one of the side tables, happily downing fruit cocktail and granola bars.
The doctors worked rapidly, examining each evacuee and writing their condition and level of urgency on a colored tag attached to the clothing of each. As soon as one was wheeled away, nurses in green scrubs immediately signaled for the next in line.
A medical technician called me over to one stretcher where nurses looked somewhat perplexed. "I think she's catatonic," one of them said of the mute woman lying before her. She was indeed. Her eyes, barely making contact with mine, were vacant. There was no evidence of physical injury. Whispering a barely coherent yes or no to a few insistent questions, she had the characteristic feel of schizophrenia, so hard to describe but so familiar to those who see it daily. A tag on her sleeve said simply, "Haldol IM given." I spoke to her in reassuring tones, asking her when the medication had been given to her. No answer. It was all the information we would get. "She goes to inpatient psychiatry," I said to the EMT standing by.
Someone pushed a man up to me in a wheelchair. He was grizzled looking, in his fifties. I glanced at his tag and asked him, by name, how he was feeling. He grinned and said that most people outside of Louisiana don't pronounce his name correctly. Apparently I had got it right. "Are you from Louisiana?" he said. I told him no, but that I had visited there several times. He said that he had chronic lung disease. "Do you use oxygen?" I asked. "Have you had chest pain recently? Are you having trouble breathing now?" Negative to all.
He talked while the nurse attached the pulse oximeter and took his blood pressure. "Man, you can't imagine what it's like in New Orleans right now. There was a gun battle just outside the place I was staying. At least a hundred police and about as many criminals. Those idiots were even shooting at the helicopters that were trying to come in. What kind of people would do that?"
I could only shake my head. As the nurse assistant wheeled him away, I said, "Welcome to Texas."
"Glad to be here, "he said. You could tell he really meant it.
In about twenty minutes, the crowd of waiting wheelchairs and stretchers had thinned considerably. Seeing no one waiting for attention, I walked toward the open space behind the hangar threshold.
Looking back, a small group of people huddled around Ed Tucker, MEDVAMC director. The giant albatross brooded in the background. Tucker signaled for me to come over, and gestured discretely toward a burly young man standing to the side in a rumpled scrub suit. One of the docs in the group nodded: "I think you should talk to that guy. He came in with the hospital staff on the last flight, and was walking around kind of frantic, like he was about to come unglued."
I walked toward him. He paced back and forth like an agitated bear until I caught his eye and was able to introduce myself. With barely an acknowledgement, he began talking rapidly. He was a critical care specialist, on duty since before the storm rolled in. "You can't imagine what it's like back there." I was to hear that several times in the next two days. "Try to imagine carrying a patient on a heart-lung machine down a darkened stairwell. We were running out of medications, running out of fluids. There was shooting outside. We did this for four days. And the airport is unbelievable-total chaos. Ambulances dropping people off like packages and immediately leaving to pick up someone else. They are putting patients who aren't expected to make it off to one side, black-tagging them so that they can deal with the ones who can still be saved. I'm too tired to move, but I don't know if I'll even be able to sleep tonight. What I want right now is a shower and some alcohol." His speech began to lose some of its pressure as he talked.
I asked how much sleep he had had, and how recently. "I don't know. Maybe this afternoon for about twenty minutes. I can't remember." He paused, eyes glazed a moment. "There were bodies in the water everywhere. Someone said that you could see sharks in Metairie from the air."
Much of my time, both that day and the next, was spent with traumatically stressed medical caregivers who were evacuated with their patients. All of them were worn to the point of exhaustion. Almost invariably, their first request was for a telephone to call family members who had not heard from them since the hurricane went through.
Ed Tucker took me aside after the first ones came in. "Do whatever is necessary to take good care of these people. For now, they're mine...treat them like they are our own employees."
That night, at about 8:30 p.m., I was relieved by Dr. Anna Teague, our program director at MEDVAMC. I went back to the hospital to collect my belongings before going home. Once again, I drove the van, this time with a different group of VA staff as passengers. They were somewhat perplexed that their driver was a physician. "It's my new job," I told them. "Less stress than being a doctor." The joke fell a little flat-we had seen stress levels in both doctors and patients that few of us would ever experience.
When I arrived back at Ellington the next morning, Friday, to relieve Dr. Teague, there was a single military cargo jet parked on the tarmac by the hangar, engines whining. Strangely, there was no activity going on around it, and there were a lot fewer ambulances than the day before. When I walked into the hangar and found Dr. Teague, she was near tears. "They won't let us take the patients off of the plane. They are going to send them away and close us down." Apparently, someone had ordered our operation to shut down, confused about the availability of more hospital beds in Houston. The aircraft, motionless and waiting for orders, was to be diverted to another city. Kalavar was on the telephone, trying to cut through the red tape.
I stowed my bag and waited with the rest of the staff to see what would happen. Minutes ticked by slowly, like the beat of a failing heart.
Finally, Dr. Kalavar emerged from one of the side offices looking slightly harassed, but determined. "Let's get these people off of the plane."
A few people cheered. Everyone brightened. They began preparing to receive patients. It turned out to be a larger group than any of the previous day, with a number of very sick people as well as some who walked off under their own power. Gaining efficiency with experience, the team rapidly evaluated them and sent them off to the appropriate clinic facilities.
Whatever the confusion about hospital beds, it appeared to be worked out. We didn't shut down. And Dr. Kalavar began planning staff rotations for the Labor Day weekend.
The flights began to slow. Perhaps they were choosing to overfly Houston for other cities with unstrained resources. Or perhaps operations in Louisiana and Mississippi were on track again.
As the hours passed without further arrivals, staff gathered to watch the unfolding social disintegration in New Orleans on a small portable television that one of them had stuck on a medication stand. Someone speculated that it would only be a matter of time before Houston experienced something very similar. A vague recollection of St. Patrick's "Breastplate" broke the surface of my memory: "Christ between us and evil."
Later that afternoon, while I stood outside the hangar enjoying an unusually cool breeze from a nearby thunderhead, my cell phone rang. It was Jessica. She was doing well, her voice much more upbeat. Power was expected to be on at Belhaven the next day, and she would be going back to college. As if she hadn't just received an education-unlike any listed on a registrar's bulletin.
I told her that I loved her, and to be sure to call when she arrived back at the school. I also described how I had spent the last two days. Compassion comes easier to my daughter than to my own more jaded heart. And she views humanity accordingly. If you say "New Orleans after the storm," she thinks of helpless people floating in water. I'm just as likely to think of armed hyenas joy banging at rescue choppers. She was pleased to hear what I had been doing.
Relief at Jessica's news mingled with the pleasure of seeing the wide clear spaces of the airfield before me and an approaching T-38, just possibly carrying an astronaut. It dipped toward the runway before swooping up again in a go-around. "Must've been flagged off because of that corporate jet about to roll," I said to a bearded gentleman who had walked up beside me quietly. He was slightly older than me, wearing one of the many different agency polo shirts to be seen among the NDMS participants.
We talked casually for a few minutes about the various aircraft scattered around the field, including NASA's whale-like Super Guppy parked a few dozen yards away. He reminisced about his days at Ellington with the Civil Air Patrol, and speculated about the possible effects of a category 5 hurricane on Houston. "We'd be under water right now if Katrina had come through here," he said. I'd seen enough coastal flooding projections to know that he was right. Houston, especially after Allison in 2001, was better prepared than any other city to understand New Orleans's suffering.
A C-130 swung off the taxiway toward us, and we turned for the hangar.
Later that day, after getting some sleep, Anna Teague called. "Go home and rest," she said. "You've done enough for now. Some of the other docs are going to rotate into the schedule for the weekend."
I felt a little wistful that, for the present, it was over.
Physicians and other health care professionals in the VA have the uncommon privilege of commonly getting to know and care for heroes. They develop a sense for what is truly valiant. Ours had been good work, the work of mercy. But not heroic. We simply did our jobs, though in unusual circumstances. The heroes of Hurricane Katrina are the doctors, nurses, and other hospital staff that stayed at their posts unprotected when danger surrounded them, doing what they were trained to do and much that cannot be taught. In the classrooms and lecture halls, you can't learn how to carry on professionally through day after day without electricity, without water, with little sleep, and with running gun battles in the streets outside. Not even oaths solemnly taken in graduation ceremonies can account for such fidelity and endurance. They arise only from character.
I spoke with one young doctor, only a few months out of medical school. Nothing had prepared him for this. When I approached him, he asked to borrow my cell phone to call his family, to tell them that he was alive and in a safe place. Later, he spoke of being abandoned by his supervisor, a more experienced doctor who put his own needs first and got out of town, or so he suspected. (I shuddered inwardly. God grant that I never have to choose between the safety of my family and the welfare of my patients.) He described the primitive conditions in his hospital, the heat, the darkness, the stench, the strain of carrying patients on pumps and IVs down stairwells lit only with by flashlights, the bodies floating in the water outside. I listened quietly as he ventilated the sorrows and frustrations of the past few days, and thought how young he was to carry such responsibility, and how well he had done so.
"We heard there were gun fights just outside of the hospital," I said, probing gently.
He blanched, swallowed, and his eyes moistened. He said nothing and changed the subject.
It had been a very tough few days, even for heroes."
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Note from Dr. Bishop: This memoir was written for myself as much as anyone else, before I forget some of the details of the historically catastrophic event that was Hurricane Katrina, and the small part I was privileged to play in the relief effort. Ethical medical practice requires that physicians not disclose any information that might identify their patients without that individual's consent. However, under the current circumstances, the medical histories and experiences of Hurricane Katrina victims are shared by so many evacuees that they would be virtually impossible to identify as individuals. In at least one case, I have changed non-essential information to be absolutely sure. |
