“Late Monday, a random boat pulled up to the ED ambulance ramp, which had become a makeshift dock. On board was the boat pilot, a New Orleans police officer, and two chronic ventilator/PEG nursing home residents. Our ED staff informed the cop that there was no way we were able to take these patients and care for them given the rising water levels and impending loss of even backup generator power.
“The cop insisted, stating, ‘This is not my problem.’ He laid the patients on the ED ramp and promptly departed. This incident caused quite a ruckus as no one really knew how to handle it.
“Hospital security quickly stepped in and barked, ‘Everybody inside. We’re locking down the building.’ I guess this was a desperate attempt to control a situation that was obviously way out of control by now and discourage any further ‘dumping’ of patients. All of the staff and residents quickly retreated inside the hospital in a knee-jerk reaction to the mandate. As we filed into the hospital like lemmings, Josh Willis, MD, one of our chiefs, suddenly realized the ethical mistake we were making by abandoning the cast-away patients lying on the ED ramp. ‘What kind of doctors are we anyway?’ I remember hearing him inquire rhetorically.
“This statement seemed to summon forth the quiescent words from the oath of Hippocrates when we had pledged to ‘ … apply dietetic measures for the benefit of the sick according to my ability and judgment … [and] … keep them from harm and injustice.’ We realized our mistake, turned around, and went back outside to bring the two patients into the hospital.
“Through early Monday evening, three to four similar trach/PEG patients were delivered from the same nursing home via watercraft. A piece of tape adhered to their threadbare gowns on which was written the name of the nursing home, the patient’s name, and their social security number. This was hardly a thorough past medical history or active problem list. We situated these patients with the other cast-offs inside the ED. It was apparent by initial observation that several of these patients were in dire medical straits at baseline, let alone having to deal with a natural disaster to boot.
“By early Tuesday morning, our backup generators went down. We had no labs, no chemistries, no ABGs. We were shooting from the hip, so to speak, in terms of treatment. Those nursing home patients brought in by boat remained not only in the ED, but also at the bottom of the ‘salvageable’ list.
“Besides just holding their hands, we could only give them supplemental oxygen. Meanwhile, on the roof of the hospital, a couple of smaller portable generators were running with lines powering three to four vents. Somehow it seemed that all the patients who really needed vents and who had made the salvageable list were getting them. By now, we already had to let one patient die … .
“By Tuesday afternoon the hospital had become—for all intents and purposes—entirely useless. The order was given to evacuate the entire hospital. The first order of business was to evacuate the most critically ill, salvageable patients. The house staff instructed the residents to accompany two patients each to Baton Rouge. One of my patients had West Nile virus and the other had dermatomyositis with ARDS in the fibroproliferative stage. The latter patient had been requiring 50%-75% FIO2. With only supplemental oxygen, trach tubes, and bags, we began our journey through the oppressive heat of late summer New Orleans.
“A boat took us to the Claiborne Avenue/I-10 ramp, which had also become a boat launch with awaiting ambulances. As we drove on the overpass past the drowning city, I could see hordes of wayward and destitute people lining the interstate and around the Superdome. The image was surreal. It looked like some third-world country in the throes of utter civil war chaos. The slings and arrows of outrageous fortune continued their incessant barrage as the ambulance I was riding in ran out of oxygen. The O2 sats on my ARDS patient began dropping precipitously into the low 80s. Before we could reach the safety of Maravich Center [now hospital] in Baton Rouge, we had to stop the ambulance so I could wave down a trailing ambulance and obtain more supplemental oxygen. With a wide-open valve on one tank, I alternated between patients until I was able to drop them off at triage. I called my fiancée who also happens to be an RN to pick me up, and we went to Bunkie, La., to await our next move. After two days, we traveled back to the Maravich Center to volunteer. We were told that our help wasn’t needed.