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First published in Hospitals & Health Networks OnLine, October 3, 2005
For days, New Orleans health care workers, under impossible conditions, with little food or water, risked their lives to tend the sick.
Author's note: My column this time was supposed to be about the different levels of health care in the United States. It was entitled "A Flood of Tiers." Given the overwhelming tragedy that has swept over the Gulf Coast and especially my beloved city of New Orleans, where my family's forebears first settled in 1810, I did not think it appropriate to publish a piece whose title was a cute pun about floods. That column, with a different title, will be published at a later date.
They could have left. They are physicians, nurses, physical therapists, pharmacists, orderlies, aides, housekeepers, security staff, dietary workers, and other hospital employees who have cars or who know people who do and who had somewhere to go. They knew what was coming--they thought. Even when what came was worse than their most terrifying nightmares, many of them still had a chance, however fleeting, to get out. Hundreds of thousands of people did, even including some police officers. (Although, despite news reports to the contrary, most members of the New Orleans Police Department stayed and did their jobs, sometimes at grave risk to their lives. In the face of the horrors they experienced, at least two officers committed suicide.)
But at Big Charity, University, Ochsner, Lindy Boggs, Touro, Memorial, Chalmette, Kindred, the VA and other hospitals in the stricken city, the people who worked there stayed. Indeed, many who weren't on duty chose to come in to help their colleagues and patients.
Their reward was five days of pure hell.
Hurricane Katrina, a Category 4 storm, made landfall on Aug. 29 and inflicted significant damage on many area hospitals. Then on Aug. 31, the levees (actually, canal walls) in New Orleans broke, and the waters began to rise--swiftly. At Charity Hospital of New Orleans, one of the most prestigious public teaching facilities in the country and the biggest hospital in Louisiana, the generators began to run low on fuel. Nurses had to hand-pump breathing apparatuses for ventilator-dependent patients. Newborns were evacuated by helicopter from Charity's parking garage. "Everyone knows we're all in this together," said Mitch Hanrich, a Charity nurse manager.
Lindy Boggs Medical Center and Memorial Medical Center began to evacuate. Ochsner Clinic, situated only 8 feet above sea level, tried to keep going, despite broken glass, darkness and no air conditioning; it was running on generator power. Several babies were born there during the ordeal, but, as Ochsner spokeswoman Katherine Voss wryly noted, "no one named Katrina."
And still they stayed and kept working.
It got worse. Armed thugs invaded Charity and forced physicians to give up stores of narcotics at gunpoint. That meant some patients would have to go without pain-killing medication. A woman floated her husband's corpse on a door to the hospital.
Helicopters evacuated 300 patients and hospital employees from the roof of Chalmette Medical Center as it was overcome by the rising water. At Louisiana State University Hospital, CEO Don Smithburg reported, "The situation is grave. [We are] desperately short of raw materials. We have no food, no water, no toilets, and we don't have fuel to operate our generators…. We're simply out of juice."
By Sept. 1, the 600 remaining patients and staff members at Charity were living in the dark, with water filling the lower floors. The morgue was under water; more recently deceased patients were being placed in stairwells. "We're functioning as if we were in a developing country," reported Kiersta Kurtz-Burke, M.D., on one of the few still-working telephones. Ochsner managed to evacuate 12 of its 13 preemies by air.
The Louisiana Hospital Association reported that 10,000 patients, staff members and their families needed to be evacuated.
And still they stayed, sending their patients ahead of them to other hospitals in the region, which, in their turn, did an astounding job of saving lives despite being inundated with the sick and injured.
Evacuations at Charity began on Sept. 1. Most reasonably healthy patients had been sent home before the storm struck, so those who were left had to be handled gently. They were, Dr. Kurtz-Burke said, "The immobile and the unmovable"--stroke patients, amputees and those in need of intensive care.
The kitchen at the hospital remained open for the first days--let's hear it for the dietary staff!--even if all they could offer was cold canned food. Staff throughout the hospital were sleeping on air mattresses, when there was time for sleep.
The workers in the infectious disease unit on the ninth floor hung a banner out of the window that declared: "9-W HAS A HEART; KATRINA CAN'T TEAR IT APART."
Efforts to achieve a full evacuation of the hospitals were stymied by gunshots and logistical problems. Desperate hospital workers started loading patients onto boats, but the boats could not find safe harbor and were forced to return to the hospitals. Lee Harmon, M.D., chairman of medicine at the Tulane University School of Medicine, visited University Hospital and Charity by canoe: "The physicians and nurses are doing an incredible job, but there are patients lying on stretchers on the floor, the halls were dark, the stairwells are dark. Of course, there are no elevators. We're afraid that somehow these two hospitals have been left off . . . that somehow, somebody has either forgotten them or ignored them or something, because there is no evidence anything is being done."
And still they stayed.
By mid-Friday, Sept. 2, an e-mail was received by a New Orleans city official: "My sister Susie is a nurse and has volunteered to help at the Astrodome here in Houston. She just told me that the doctors and nurses at Charity Hospital are giving each other IVs of nutrition because they have had no food since Tuesday." Staff at University were doing the same, according to Smithburg. Oscar Ballester, M.D., and his wife, Gabriela Ballester, M.D., reported from Ochsner that the staff had been rationed a liter of water a day (this in heat above 90 degrees) and that they had almost no food left.
The final evacuations at Charity and University took place on Sept. 2, of patients, staff and family members of both groups. They got the babies out first. All in all, some 2,200 people were evacuated, including 363 patients, three of whom died during the process. Smithburg said he did not know how many may have died "waiting for help."
In the meantime, at University Hospital, physicians working by flashlight delivered an 11-pound boy to a mother who had been in labor for two days. At Memorial, in the parking garage where patients had been moved, a cancer patient who had been without pain medication for a day, and who was suffering, told a nurse, "Thank you so much for all you're doing for me." Unbeknownst to her, nurses were excusing themselves so that they could go cry their eyes out; they then returned to their duties.
Everyone was evacuated from Lindy Boggs Medical Center, except for one physician who stayed behind to tend to hospital staffers' pets.
On Saturday, Sept. 3, the last staff member at Charity, Rene Morrisey, M.D., left the empty hospital. "The five-day ordeal is over," wrote an independent journalist. Asked what he was doing, Dr. Morrisey replied that he was having a cold beer and was then heading for Washington, D.C. Most of the other evacuated physicians were going to Baton Rouge, La., where thousands of sick evacuees awaited them.
I want to make it very clear that the hospital workers of New Orleans were not the only people besieged by this disaster who deserve our admiration. Those working at the hospitals that were still functional did amazing things. Hundreds of clinical professionals volunteered to come to the stricken areas and care for the sick, even if they did not know whether there would be water, or food, or a place to lay their heads. Many hospitals in other states volunteered to accept the sick and injured. Although long-term care was not that much in the news (what else is new?), I am sure that many nursing homes did the same.
It is not that these people and organizations did not do a marvelous job under very challenging conditions. It is just that those facing disaster and perhaps their own deaths in the New Orleans flood did even more.
One of the hot new buzzwords--I suppose one should say, for the sake of accuracy, "buzz phrases"--in health care these days is P4P, or "pay for performance." The idea is that health care professionals should be paid on the basis of the quality of their work. If we apply that to the hospital staffs of New Orleans, what could possibly suffice to compensate these heroes of the storm for their courage, their compassion and their refusal to give up?
From where I sit, at this moment, all I can offer is the deepest of thanks to them for being shining examples of the profound human decency of which we all are, or should be, capable.
The hospital associations of Alabama, Louisiana, and Mississippi have established a fund to assist the thousands of hospital workers who have been displaced from both their jobs and their homes in the disaster area. The American Hospital Association has pledged $100,000 for the effort. Please visit www.thecarefund.net or your state or local hospital association Web site for further information, and do what you can to help them. Thank you. Thanks also to Ellen Pryga and Carmela Coyle of the AHA for their help in getting this information out.
First published in Hospitals & Health Networks OnLine, October 3, 2005
Correction: This column, "Heroes of the Storm," was written as the events on the Gulf Coast and especially in New Orleans were unfolding. As a result, a good deal of misinformation was released, and I inadvertently published some of it. This correction was provided by Katherine Voss of the Ochsner Clinic Foundation in New Orleans: "The persons you quoted in your article, Oscar Ballester, M.D., and Gabriela Ballester, M.D., do not work for Ochsner, and the information provided is factually incorrect. We did not ever have to ration water, food or anything else during or after both major storms. Ochsner remained fully operational during and after the storms. Ochsner has a disaster plan in place that prepared us well for such a situation. We also gathered data and information from other hospitals along the Gulf Coast who had experienced major storms like Hurricane Ivan last year to find out how to prepare ourselves for such an event. We have fared quite well during this time. Today [Oct. 5], Ochsner is up to near normal volumes with today's patient census of 329 beds full."
I subsequently learned that the Ballesters work at University Hospital in New Orleans, which did experience severe difficulties and remains closed.
My apologies to Ochsner, which has accepted them, and to my readers.
© Emily Friedman 2005