My mind has been very much on New Orleans and the Gulf Coast the past couple of weeks. The utter devastation wrought by Hurricane Katrina, and the horrific images of stranded people clinging to rooftops, are shocking. Sitting in San Francisco it was hard to imagine just how terrifying and chaotic it could be.
What a different image than the one I had during my first visit to New Orleans in 1999 for the 2nd Annual Meeting of the National Association of Inpatient Physicians. I remember being enchanted by New Orleans and thinking how it seemed more European than American and the most foreign of any American city I had visited.
I brought my family to the meeting, and we had a wonderful visit. We stayed near the convention center and enjoyed strolling the streets of the French Quarter, eating beignets, and riding the streetcar. I had an unforgettable dinner at Emeril’s that still ranks among the finest I’ve ever had. These memories are completely at odds with the images in the newspaper and on television. Some of the most vivid stories I read of Hurricane Katrina were e-mails from hospitalists on the ground in New Orleans and from others helping to care for sick patients evacuated from hospitals in Louisiana.
The first-hand accounts from hospitalists in New Orleans were gripping. I read the now-familiar stories of trying to live in a city with no electricity, no safe drinking water, no sewer system, and no government. I read of one physician entering a darkened pharmacy under police escort so that he could gather life-saving medicines for people whose prescriptions were destroyed along with their homes. Steve Deitzelsweig, MD, FACP, a hospitalist at Ochsner Clinic in New Orleans described the fear of epidemics in the Wall Street Journal, as well as in The Hospitalist (see October, p. 1). The possibility of a typhoid outbreak in 21st century America seemed more like a plot from a bad movie than a headline in a major newspaper. Even hospitalists far from New Orleans enlisted in aiding evacuees.
E-mail dispatches from Pat Cawley, MD, in South Carolina and others described hospitalists helping care for the sick airlifted from Louisiana, Mississippi, and Alabama. Jeanne Huddleston, MD, SHM’s immediate past president, described her role leading a team of doctors from Mayo Clinic who went to Louisiana to care for the sick and injured.
Perhaps the most frightening images were of doctors and nurses caring for critically ill patients without the help of monitors, ventilators, or other equipment when the emergency power went out. The images of patients waiting for helicopters to airlift them to safety were harrowing. Also striking were reports from hospitalists whose families had been evacuated, their homes destroyed—and they were at the hospital caring for those who were sick prior to and because of the hurricane.
My gratitude and admiration go out to all of the doctors, nurses, respiratory therapists, pharmacists, social workers, chaplains, and others in the hurricane-devastated regions and elsewhere who worked so valiantly to help patients in the face of chaos. As president of SHM I am proud of the efforts of our members and of all hospitalists who continue to assist in the face of this tragedy.
The medical crisis caused by Hurricane Katrina is perhaps most noteworthy because it happened in America. Of course, physicians and nurses struggle to help their patients under similar or worse conditions every day across the world without the ability to airlift their patients anywhere. Nonetheless, to watch this happen in New Orleans was shocking and offered insights into what it must be like in war zones and the developing world.
In addition, this was the fist time I recall hospitalists playing a prominent role in the medical response (see “Tours of Duty,” p. 1 and “The Red Badge of Katrina,” p. 13). To be sure, hospitals and healthcare personnel responded actively to tragedies like this one before hospitalists. But to the many advantages we bring as hospitalists, we can now add being in place—in the hospital—when disaster strikes. I do not pretend that this reason will convince many hospitals to start hospitalist programs—there are better and more pressing reasons to do so. But the ability to respond to disaster is clearly a benefit of a hospitalist program.
Included among the many e-mails circulating on the SHM listserv and among hospitalists was the question of whether hospitalists were included in official disaster response plans including those by FEMA and other agencies. After Hurricane Katrina, we will be.
Among the many tragedies revealed by Hurricane Katrina perhaps none was so striking as the inequities in our society. Even if we are willing to accept that in a free-market society some have more than others, the desperate situation faced by so many in New Orleans who were left behind is an indictment of a system that pays too little attention to those who have no resources.
We are aware of inequities in healthcare evidenced in part by the fact that millions of Americans have no health insurance. This tragedy showed that, in addition to not having health insurance, being poor exposes you to the brunt of a natural disaster that those with money can escape. The buses that arrived days after Hurricane Katrina to take people to Houston and elsewhere should have been there days before the hurricane.
What role do we play in changing this system? I can’t say that I have easy answers. Many of us contributed our skills after the tragedy to help those in need. Some of us farther away contributed money or goods to assist those affected by the hurricane. Some of us will begin or continue to advocate for a more just system.
While some of these issues are beyond the scope of SHM, during our planned legislative day preceding the 2006 Annual Meeting in Washington, D.C., we will have the opportunity to meet with our elected representatives to tell them about hospitalists and hospital medicine. We should share with them our experience from the frontline of American healthcare: Every day we care for many people who present to the hospital with illnesses that could have been prevented or significantly ameliorated by earlier intervention if they had only had access to healthcare. We are direct witnesses to what befalls those who lack health insurance and have poor access to healthcare. I hope that one of the messages we bring to Congress is that all Americans should have access to healthcare with health insurance.
The scenes of the hurricane-ravaged Gulf Coast also led me to reflect on the fragility of life and its precarious balance. Here in San Francisco we are safe from hurricanes, but at the mercy of earthquakes. It is still true that anyone who experienced the 1989 earthquake here in San Francisco can tell you exactly where they were and what they were doing at the time.
In the wake of Hurricane Katrina my wife and I have been talking a lot about earthquakes and how to ensure that we are prepared—if such a thing is even possible. The news reports tell us to have 72 hours’ worth of food and water, a battery operated radio, gas in the car, flashlights, and other necessities. We promise ourselves to get all the supplies we need and believe we will do so. But I also realize that denial is part of life and that in living near an earthquake fault denial might be necessary; just as living on the Gulf Coast may require a certain denial about the destructive power of hurricanes. But as one e-mail correspondent from New Orleans wrote, “Despite it all, this is a soul-edifying experience.”
Perhaps the tragedy that hit the Gulf Coast will help each of us edify our souls through less drastic measures and remind us that any day can be our last. This knowledge is a gift to help us spend our time in the best way possible. Those who are helping the people whose lives were ravaged by Hurricane Katrina remind us of the good that we can do in the world. As hospitalists we get to experience this good every day at the bedside through the privilege of patient care. May we cherish this opportunity and fulfill it with dignity and pride. To all those involved in hurricane relief efforts, thank you, and to all those whose lives were ravaged by the hurricane I wish you strength and recovery. TH
SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.