AAOS Bulletin - October, 2005

In Katrina’s wake

By Duane Belongie, MD

The scene was surreal. With nine orthopaedic residents, our five staff members and a multitude of other teams of health care workers who had drawn hurricane duty, we weathered the storm and its aftermath for five days at Tulane, Charity and University hospitals.

The storm was set to make landfall on Monday morning, so the hurricane team was ready on Sunday. I was fairly certain that this would be a big storm and that the levees that were supposed to protect us would fail. If we were doomed to be flooded in, I didn’t want to be stranded at Charity Hospital. So I went back to my boarded-up house and loaded my old canoe onto my truck.

All photos courtesy of Duane Belongie , MD

Patients from University Hospital were moved into the Tulane parking garage while they waited to be evacuated.

At the parking structure, I lashed the canoe to a concrete pillar and locked it to my truck. Then I headed back to the Charity call room and waited. A group of us made our way up to the roof of Charity to take one last look at the city. The gusting winds gave a chilling taste of things to come.

Katrina explodes

At about 1 a.m., the windows began to explode into the darkness. Water started to creep in from under locked doors, quickly soaking the hallway. The winds continued to howl as the sun rose. Eventually the winds decreased in intensity as the eye passed directly over. The tail end of the storm was less violent, but we could see the damage. Trees and building materials were everywhere. There was water everywhere inside the building, but there didn’t seem to be much outside.

There was relatively little activity in the Charity accident room on Monday. With no power, the elevators were out of commission, as were computers, the pager system and the overhead public address system. Since the operating rooms on the 12th floor were unavailable, a two-bed operating room was set up in the first-floor casting clinic, with one portable X-ray machine.

A changed landscape

By Tuesday morning, the view had changed substantially. The levee had failed in several places, and my canoe was definitely going to get some use. I just hoped that it had survived the hurricane and had not been stolen. Allen Butler, the chief resident, and I donned shrimp boots and waded across the street to the parking lot where the canoe was waiting. We found it intact and unlashed it from the concrete pillars. We portaged the canoe down to the ramp and pushed off onto Gravier Street.

Apart from the obvious surreality of canoeing down the street, there was an overriding sense of worry arising from the fact that we were essentially the only mobile entity in the area. This made the canoe potentially quite valuable, and us quite vulnerable.

Many cars were submerged, most of them with windows broken out by the storm or by the first wave of looters. Several times we were threatened and verbally assaulted for not giving up the canoe or picking people up. We circumnavigated Tulane Medical Center, then headed to University Hospital (UH) to check on our patients there and to see what the overall situation was like. The streets were littered with debris, dead birds, oil slicks and human waste.

Rescuing preemies

Our patients were doing fine, so we boarded the canoe again and planned to return to Charity Hospital. Since communication lines were nearly absent, and transportation even less available, we agreed to return to UH as soon as possible with needed medicine. Upon reaching the Charity ER “dock,” we responded to several transport requests, transporting fuel for the generators at CH and UH while waiting for an anti-cancer prescription to be filled.

As we headed back down to UH, we noticed a fire and rescue truck. Clearly the water was too deep for it to go further, and we soon found out what their mission was. When we arrived at UH, a neonatal intensivist met us at the entrance and asked if we could transport two ventilator-dependent preemies to the fire truck. We looked at each other in relative disbelief, and I said that I didn’t think we could bag them both at the same time and safely get them to the rescue truck, but we could do one at a time.

Then they asked if we were emergency medical service (EMS) or emergency medicine residents. We replied that we were orthopaedic residents. The silence was palpable for several seconds, because there is probably no service in all of medicine less likely to offer to bag a 2-pound preemie under any conditions. However, we had the canoe, so they showed us how to deliver short, quick breaths to the infant, and off we went to deliver the first preemie. The second trip was flawless as well, and the diminutive pair was quickly whisked away to the children’s hospital.

News vs. reality

It was very unclear who was in charge at the hospitals since lines of communication were essentially absent. Initially we were told that all Charity patients would be transferred to UH, and Charity Hospital would close. But within minutes, we learned that UH was worse off than Charity, so we were told to stay at Charity and wait for further instructions. There was no running water or flushing toilets. ER patients were being carried to the second floor auditorium until further evacuation plans could be made.

The details began to blur as the disaster unfolded. We had no television or worthwhile radio stations to inform us of the outside situation. The news that came in did not jibe with what we knew was actually happening. We eventually learned that the plan for the hospitals was to get all the patients evacuated by helicopters, and then the staff would be free to leave. How this would be done was not clear, but at least we had a goal.

Given the poor communication at all levels, the orthopaedics group got together for our own brainstorming session. Our chairman, Dr. [Raoul P.] Rodriguez, was the cornerstone of our effort, bringing everyone together in his office, maintaining a thread of solidarity and familiarity. He was pivotal in gleaning information from Tulane, HCA and the outside world. The statement made by his mere presence, along with his wife, on the front line was priceless.

Lauren Friend, MD, an orthopaedic resident at Tulane, helps prepare patients for evacuation on Thursday after the storm.

Lives in danger

At this point there was reason to believe that our lives were in danger the longer we stayed. The National Guard, which was supposed to evacuate the Charity patients, had never shown up. Large groups of desperate refugees were in the streets and stationing themselves on the on-ramps in threatening fashion. Electricity and running water were gone, cell phones had lost signal and Tulane’s phone lines had failed overnight.

We first needed to address our responsibility to the patients. The best-case scenario would be that all patients in all hospitals would be evacuated within the next 24 hours, and then we would use our own helicopters to evacuate. But nobody seemed to have a plan to get the patients out.

We did not think it was necessary or advisable to keep our entire department behind to babysit the evacuation of 15 stable patients. But it also didn’t seem right to put our desire to get home in front of our patients’ evacuation. In the end, Dr. [Kyle F.] Dickson boarded the canoe, crossed the canal to speak with the Charity emergency team leaders and got permission for us to pull out as soon as we had a chance. Drs. [Kathleen A.] Robertson and [Lauren] Friend volunteered to stay until all patients were evacuated.

There were a lot of details to work out before we could put a helicopter evacuation plan into play. Dr. [J. Ollie] Edmunds knew of a small airport adjacent to one of his properties in St. Tamany, which could possibly be a safe transfer point. Dr. Dickson went to the helicopter pad to gain some information regarding landing. Dr. Rodriguez contacted people in Baton Rouge regarding secure bus transportation. Dr. [James T.] Bennett tried to get information regarding the HCA and Tulane plans for our evacuation. Our fear was that nobody seemed to be looking out for us, and getting out as soon as possible became our goal.

The Tulane team gather for one last group photo: (from left) Michael Cox, MD; Duane Belongie, MD; Wendell Heard, MD; Shelby Jarrell, MD; Allen Butler, MD. Tulane residents are now completing their training in other programs.

Lifted to safety

As it happened, the evacuations from Tulane went well on Wednesday. We were told that nearly all patients had been evacuated. Patient family members, followed by employees and their families and then Tulane staff and families would be evacuated to the New Orleans airport by choppers starting in the morning on Thursday. We would all then board secure buses and be transported to Lafayette, where transportation to a final destination would be coordinated. Nineteen patients from Tulane joined about 300 family members, staff and employees on Thursday morning for evacuation.

In addition to the Tulane patients, arrangements had been made to bring over 20 of the critical Charity patients who were to be evacuated by two Black Hawk helicopters. Their arrival was supposedly timed to coincide with the helicopter arrivals, as several were ventilator-dependant and required manual bag ventilation. But for eight hours, the Black Hawks never came. Two of the ventilator-dependent patients died on the ramp awaiting transport.

Our chopper was supposed to arrive at about noon, but by 4 p.m. it had still not arrived. It had started to rain, and the weather threatened to derail the entire evacuation effort. Hope was dwindling for an escape before nightfall.

Finally, we heard that the Black Hawks were on the way. In addition, two Chinook military transports would be arriving, which could take 30 passengers per trip. In a matter of hours, almost everyone was lifted to relative safety at the New Orleans airport.

As we pulled away from the airport, we could literally feel the weight of several days of captivity dropping away. The view of the city from above was eerie, every street in sight glimmering as the sun reflected off the flood waters. The only signs of life were in the air, which was buzzing with helicopters across the entire horizon.

At the airport, as we waited for an armed vehicle to escort us off the tarmac, we were delayed momentarily for the unloading of a large military transport plane, reportedly filled with medical staff to tend to the staggering 4,000 estimated patients from all of the local hospitals, now housed in the airport. Apparently there were only a handful of medical personnel available prior to their arrival, and things were awful inside, with insufficient supplies and staff, and people dying.

A pang of guilt shot through me, as I was escaping to relative safety. I guess I was na´ve to think that simply getting those patients off the roof at Tulane was somehow going to make everything better. I can’t speak for everyone else, but I was so fixated on getting those patients transferred out, that I never even considered where they were going and what they were in for.

I also realized that what we endured was but a tiny ripple within Katrina’s wake. The scope was so huge that the city and the nation were stunned, delaying the initiation of meaningful relief efforts. It will take a long time to return to a sense of normalcy, and even then, things will truly never be the same.

Duane Belongie, MD, was an orthopaedic resident at Tulane University during Hurricane Katrina. He is continuing his training at the Campbell Clinic in Memphis, Tenn.


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