Emails Home From Katrina

This morning I read a blog post by my teammate Maggie about her experience living in New Orleans during Hurricane Katrina. With the impending storm, and the 7th anniversary of Katrina, I went back through the emails I sent home while we were providing medical care in the wake of the Hurricane. Rich (a co-worker and I) headed to Mississippi and then Louisiana after being told by the Louisiana Medical Board that they needed any help they could get. I have since joined the Maryland Disaster Medical Assistance Team so I can provide assistance formally through the National Disaster Medical System (NDMS). As I reflect on this 7th anniversary, here are excerpts from some of my emails home:

From: Kiersten Henry
Date: Sep 2, 2005 7:08 AM
Subject: Good Morning From Mississippi

Good morning from MIss. We are 30 min from Baton Rouge (it is 1 hour earlier here), and headed there this morning. We will either work at the makeshift hospital at LSU or at Baton Rouge General. Sprint service sucks here, so I have not been able to call on my cell. We already have some interesting stories about gas shortages (3 hour wait at the pump, but it only costs 2.51 a gallon). We met a woman who was evacuated by her brother, but left her parents and her husband in their flooded town with her quadraplegic brother while they waited for help. People are very grateful that we are here. We'll see what today is like. No worries..we will stay far away from New Orleans.

From: Kiersten Henry
Date: Sep 2, 2005 12:03 PM
Subject: Update from LA

Good morning from Louisiana. You may wonder how I have time to send an email right now, but I'll get to that piece in a minute... Rich (an RT from Montgomery General) and I got to Jackson, Miss last night. The first thing that struck us was the gas shortage..though the cost is still $2.51 a gallon, most of the pumps have trash bags over the handles because they are out of gas. They were out of economy cars at the Hertz counter, so we ended up with a Chevy Tahoe (roomy, comfortable, but a total gas guzzler). We came across a gas station where we were able to top off our tank in the event that there was difficulty finding gas.

At the WallMart in McComb, there were about 20 coach buses from the Carolinas staging to go to New Orleans and evacuate in the morning. We also met a family from coastal Miss. A woman and her daughter were evacuated by her brother-in-law from Northern LA. They lost their house, and her husband and parents had stayed behind in their flooded house with her quadraplegic brother. The stewardess on our flight down had given us a box of trail mix, and a bag of peanuts, so we were able to offer that to the family as they waited for a family member to bring them gas. Despite their incredible loss, they were so gracious, and gave us hugs to thank us for coming. Another local man was bringing fried chicken to the refugees who had parked in the parking lot.  

 We stayed at Rich's parents' house (they showed us tremendous hospitality, with a full breakfast at 6am). We headed to Baton Rouge this morning, with few signs of Katrina's destruction other than trees down along the road. Rich being a HUGE LSU fan, we went to the LSU campus where they had set up a "Special Needs Shelter". (This is basically a hospital shelter, complete with code carts, a peds unit, etc.). We reported there, and they were amazed that we had come from MD. They currently have 180 patients, with the expectation of 500 admissions today or tomorrow. They have critically ill patients, and apparently had a code last night. The saddest thing there is the area for lost children. The thing we can be thankful for is that these kids have food, dry clothes, and shelter.

Anyone watching Fox news network right now...we are not at the shelter with no physicians....ours is well staffed with docs from LSU.

We told them of our critical care experience, and they asked if we would please work the 7p-7a shift. We are thankful that Rich's high school friend Mary lives in Baton Rouge. We are at her house now, planning to rest, grab a bite to eat, and go back at 6pm.

The plan that we heard from the Head Nurse of the center was that they would get the less critical patients out, and turn the field house into a more critically focused hospital. (They are also talking about turning the neighboring building into an ED). They were thrilled that Rich and I could lend our critical care expertise, and that we would take on the night shift duties. If we get the expected influx of patients, it will be a busy night triaging patients and providing care.

Thanks for everyone's kind words (and to Tommy for taking on single parenthood....and everyone at MGH for covering for us when we picked up and headed down here). I'll try to keep everyone posted over the weekend. We hope you all are well. Celll phone service is great if you have Cingular (which Rich does), but Sprint is horrendous (which of course is what I have). 

Take care, ya'll. (Just kidding...I am trying to shed my "Yankee" nickname, which the doctor at the shelter bestowed upon me).

The hospital at P Mac arena.

A softball friend of Tommy's that I ran into in Baton Rouge.

Our critical care unit at P Mac.

From: Kiersten Henry
Date: Sep 3, 2005 9:22 AM
Subject: Re: Update from LA

So, we've just finished a 13 hour shift at our makeshift hospital at the "P Mack" stadium (LSU's basketball stadium). The entire floor of the arena was transformed into a makeshift hospital, complete with designated units (ICU, Peds, walkie-talkies), a pharmacy, a lab, and xray. The LSU students are awesome. Their school is cancelled until Tuesday, so they are all volunteering to serve meals, work in the supply room, empty urinals, change bedpans...We joked with them that this was not what they usually do on a Friday night at LSU (no loud music, water instead of other beverages). They are great sports, and everyone is just amazing. (Editorial Note: I still keep in touch with Tam, one of the students we met at P Mac)

 We saw a variety of patients, and are still seeing those that are being plucked from their roofs by rescue helicopters. Our "unit" (the red zone) was an ICU complete with vents, ABG machine, and lots of med students. Here are some examples of the patients we saw (our job being to triage, stabilize, and transport to the appropriate facility if necessary):

- A man who had been in his house (with 12 feet of water) for 4 days, and was GI bleeding

- An 8 year old boy who was in the projects in N.O. with his mom and younger brother. The mother was burning alcohol for light, and the bottle exploded, causing him a 3rd degree burn to the leg.

-Several chest pain patients (all of whom ruled out for MI).

-A hemorrhagic stroke that acutely decompensated, requiring rapid intubation and transport.

-There were so many stories of people still being rescued by the coast guard, and others who spent days in the Not-so-Super Dome. We did several transports to the hospital when the ambulance crew was not equipped for critically ill patients.

-One man was a trach patient on a ventilator at home...his daughter manually bagged him for TWO DAYS (with some help from others). After several hours at the "hospital", we found out that the daughter was a diabetic, and she had a blood sugar of 450. 

Some of the more humerous things we saw (because there always seems to be humor in these bleak situations):

-A med student who had a name tag that said "First Year med Student" (I politely asked if he had actually started med school, since school at LSU was on hold. He was getting quite an education).  

-My favorite name tag was "Henry. Ambulance Chaser" (his job was to get triage information from the ambulances coming in).

There is much more, but I am exhausted. We have met some great people here, and Mary is a fabulous hostess. Hopefully we will get some much-needed sleep today, so we can go back tonight and do it again. The great thing about being here is that there are so many stories of strength and sheer determination...you can't help but feel inspired by the people here.

Thanks for all your kind thoughts!

Sunday, September 4 2005

Well, apparently even disaster hospitals can go on "divert". Our P Mak hospital was inadvertently placed on diversion yesterday so they got no patients during the day. The nurse-patient ratio was about 6-1 for a good portion of last night, until they figured out that the operations center had us on divert and that was why we were not receiving patients. We did get several dialysis patients who hadn't been dialyzed in about a week, and some chest pain patients. The biggest difficulty seems to be sorting out the patients who were in nursing homes...we have no information on their baseline history, so we can't sort out whether they have dementia or a change in mental status related to a physiologic cause. For that reason, they are critical until they are hydrated and we get labs back (or we confirm a history of dementia).

A group of docs from CA showed up this morning, with a story similar to ours of banging their heads against the wall with Red Cross and fema trying to figure out if help was needed here. They finally just packed up and came, and we were very happy to see them.

The onslaught of patients started at about 6, when schoolbuses filled with patients started rolling in. As a colleague said, many are carrying a bag or a box that contains all their wordly possessions, while many of us have enough clothes that we never wear to fill several boxes. Despite their overwhelming loss, we have encountered very few patients who are unpleasant in their interactions with us. We are starting to see people withdrawing from alcohol and drugs, as well as lots of people with chronic issues that haven't been addressed for months (hypertension, diabetes, etc.). Those that did have good medical care haven't gotten their medications for days (antihypertensives, insulin, etc.).

We are well-protected in the arena, with military MPs, and police officers from all over looking out for us (nothing like being in a hospital where the security personnel have assault rifles!!!!).

The thing that I am most touched by is the people who have lost everything (houses, jobs, etc.) that are volunteering at P Mac. We had a pre-med student who was with us most of the night, and willing to do whatever we needed. I found out later that his family lost their house, their cars, and several friends. His attitude was that he could sit at home and be depressed, or come help others who were even less fortunate than him. If you are finding the news depressing, know that the atmosphere here is not depressing...the people are so amazingly resilient, and so very greatful. I am really in awe of some of the nurses that are working hours on end, despite the fact that their hospitals are gone, their homes are gone.... For every sad story you see on the news, there are so many happy stories of families reuniting and people who escaped. As they are saying on the news, we have no idea of what the big picture is. We don't know how many patients are left to come, and the rumor mill runs rampant in the arena (we hear that 500 patients are coming, then 4 hours later we get 100).

We are tired, having worked 17 hours, but we'll sleep and then go back tonight. We hope all is well with everyone!

By the way, all of the teams from different states have fancy names (DMAT, imet, etc.)... we have decided to name ourselves "MEAT" (Maryland Emergency Assistance Team).

We hope you all are well!

Kiersten

From: Kiersten Henry
Date: Sep 4, 2005 5:23 PM
Subject: Re: Update from LA
We are headed to the N.O. airport, where 9,000 sick patients are with lots of Army folks and some civilian healthcare providers who are working 24-7. They are in desperate need of assistance. We are not sure when we will be back in baton rouge, but there is plenty of security, and the people left truly are sick. Brian Hunt is our point person at home. We will be in contact as soon as we can, but cell phone service is impossible here at this point.

Love to all,
Kiersten

From: Kiersten Henry
Date: Sep 6, 2005 2:30 AM
Subject: Katrina Relief Update for Monday

Today was by far the most incredible day we have had during our time in Louisana. The trip to the airport yesterday was a bust. There were 5 healthcare providers for every patient, which just exemplifies the lack of communication that seems to occur here. We headed back to LSU yesterday evening, and Andy and I worked in the P Mac hospital. By the way, they told us that this is the largest ED (and the largest field hospital) ever erected in the US. We have treated lots of chest pain patients lately, as well as some with more chronic illnesses.

We were at P Mac this afternoon, when a medic came looking for help with gathering supplies. She told us that her crew and several MDs were going to set up a clinic for some of the New Orleans PD officers. We offered to assist, and to transport supplies in our vehicle. The drive into the city from Baton Rouge is over an hour, and we had the opportunity to survey a lot of the storm damage (many trees down, rooves torn off, etc.).

Driving into New Orleans is such a surreal sight. There are military helicopters everywhere, and a strong troop/police presence. We drove past some of the burned out, collapsed buildings you saw on the news (as well as the "staging area" for all of the news trucks.

If you look closely at the plywood, there is a sign that says "EMS" with an arrow to show them the way out of town.

A police car missing tires outside the convention center. 

The station we were headed to is the 8th precint in the French Quarter. The officers are actually staging in the Omni hotel a couple of blocks from the station, so that they have somewhere to sleep. They were very happy to see us, and we provided a lot of basic care (blood pressures, dealing with the rashes and cut feet that many of them had). It was unbelievable to me that we were standing in a hotel room in New Orleans, and I was taking the blood pressure of a Deputy Police Chief.

While we were in N.O., several officers told us that they had prescriptions (antihypertensives, diabetic medications, anti-seizure medications) that had run out. We tracked down as many officers as we could to find out who needed medications. There was a Walgreens across the river where medications could be obtained, but it was dark and we were having difficulty finding someone to make the trip with us (all of the officers were very busy). There was another Walgreens two blocks from the station, so Rob (an officer who moved here from Minnesota 3 years ago) drove Andy and I to the store and served as our armed guard and "pharmacy assistant". The store had been looted, and it was almost humorous that all of the drugs starting wtih "Z" were gone because that was the closest letter to the door of the locked pharmacy section of the store. While we were "shopping", Rob told us that yesterday was his birthday. What a crummy way to spend your birthday....especially because they are watching the news and hearing so many negative things. We kept telling the officers that none of the people we had cared for at P Mac had anything bad to say about the police. These guys worked so hard with so little to try and regain order in the city,

Many of the medications we needed had been looted, but thanks to the Tarascon pharmacopeia (those in school with me know what I am talking about), I was able to find substitutions to all but two medications. (For example, someone was on Lasix but all the Lasix was gone, so I grabbed all of the other loop diuretics to let the docs determine which one to give). If you are wondering what gave us the liberty to take all of these meds, the police had commandered the pharmacy and were obtaining many supplies there.

Most of the narcotics had been looted, but the thieves left all of the amphetamines and the antidepressants. Andy collected over-the-counter medications, and lots of antifungal creams as many people have athlete's foot. He also had the foresight to get prescription bottles and medications so we could dispense them to the staff. 

Back in the ballroom of the hotel, which is where our clinic was set up, we went to work substituting meds as necessary and preparing prescriptions. It was a great example of interdisciplinary teamwork, as I read out each person's individual prescription, and three of the docs helped me with any necessary substitutions. I was pretty proud that I was able to find medications to substitute for almost all of the needed prescriptions.

The NOPD officers were so grateful for our assistance, especially because they said we were the first healthcare providers they had seen. They are so tired, and living in a building with generator power (no elevators, limited lights and AC). They have worked so hard, and what they really need is to hear a little more often what a great job they are doing. It is obvious that most are shell-shocked by the things they have seen, and there is no support for debriefing because they are still in the middle of this crisis. They have seen so many horrible things in the last week, and truly feared for their lives. We felt so honored to be able to help them, even if it was just to take care of their heat rash and refill their prescriptions.

We plan to head back there tomorrow afternoon to assist anyone that wasn't there today, and then fly back Wednesday morning. Please keep these police officers in your thoughts.

Kiersten 

From: Kiersten Henry
Date: Sep 7, 2005 9:42 PM
Subject: Katrina Relief Update for Wednesday

Good evening. This is my last Katrina Update email, as we arrived home today. It has been a long week, but we really feel that we contributed to assisting some of the victims of Hurricane Katrina.

We spent our last day and night back at the 8th Precinct's temporary headquarters at the Omni hotel. This time, we vaccinated all of the officers against Hepatitis A and B, and Tetanus. Some of them were out on patrol, so we waited outside the hotel (there was usually a crowd hanging out there to get fresh air, because the generators did not fully power the air conditioning). As teams of officers drove by (usually in the back of Pickup trucks, with each officer carrying an assault rifle), we would snag those who needed vaccinated. They were thankful to have us coming to them, because the alternative had been for them to go across town to get vaccinated. By the end of the night, we had vaccinated about 40 officers. We also treated various minor ailments.

We stayed at the precinct until 5am, when we left to head back to the airport in Mississippi. Prior to leaving, I got a 2am tour of downtown New Orleans. The French Quarter is very secure now, with police officers and members of the 82nd airborne patrolling the streets. I was able to see some of the historic landmarks (though it was dark), as well as some of the storm damge and looting. There are several burned out buildings, as well as cars that have been vandalized. (As if a new set of headlights is really that important after a hurricane). The Brooks Brothers store had been looted, which seemed ridiculous (at least you can wear a nice suit when you are evacuated). Some of the galleries and museums were damaged. I saw the street on which one of the big gun battles between police and looters occured last week. There were several officers who had never shot anyone before this point, and unfortunately have now been engaged in major gun battles with the armed looters. The most amazing thing about the tour of New Orleans was that it was so dark in the city that you could see the starts as clearly as if you were in a planetarium. It was beautiful to look up and see a sky full of stars above the historic cathedral and Jackson park.

I am attaching a picture of our field hospital at LSU, as well as an article about the field hospital. Thanks again to everyone who supported us and made this possible. It was through your assistance that we could go and aid those in need. Thanks and much love to all of you!!!!!

Kiersten