Powerful. Capricious. These are adjectives that physicians don’t like about diseases and meteorologists don’t like about storms.
In the days after Katrina’s landfall, the news about her compounding tragedies propelled some of my partners and me to our conference room at Chicago Lake Shore Medical Associates for an ad hoc meeting on how we could get ourselves down to the Gulf Coast to help.
Familiar Web sites–federal and social-service agencies, professional associations, university medical schools–seemed impressively well-prepared for our eagerness: They offered elaborate application forms by which physicians could volunteer to take care of Katrina’s victims. Each of us filled out all the Web site forms we could find. I’m told that about 100,000 physicians from across the country filled out such applications.
Then we waited . . . for the phone to ring, the e-mail to come, the urgent assignment to arrive. Waiting was the hardest part, I think. We tried to be patient. We received a few responses, with promises that our applications would be kept on file until the organizations were prepared to dispatch their medical teams, “in a few months, when the needs still will be great.” University medical centers in Chicago, such as Rush, Northwestern and Loyola, opted for time to hammer out institutional protocols and sort out the knotty liability problems, to make sure that everyone involved would be properly protected. Still, we tried to be patient.
A few days later, stories came out about babies who died of dehydration in the midst of the flood. Children of the richest, most powerful and technologically advanced country in the world were dead because no one figured out how to get them a drink of water. My partners and I couldn’t bear to stay here while that was going on there. Not as doctors. Not as humans.
Our immunizations were up to date. We were ready to go. We could no longer wait for others to respond. We started dialing. Friends. Friends of friends. Anyone we could think of who might have useful information or resources. Religious groups–particularly nuns and laywomen–emerged as those with the strongest bias for rapid action. Not a big surprise, when we thought about it. They were unfettered by motives (beyond “love thy neighbor”), by bureaucracy or by organizational reporting systems (beyond the Big One).
The Chicago archdiocese’s Carol Fowler closed the circle for us. She made a Bayou contact with nuns who were overjoyed to learn that the services of nine of us–three internists, a neurologist, a pediatric infectious-disease specialist, a resident physician, a nurse practitioner, a retired Chicago cop, and an indispensable friend–were available to them.
36 hours to get ready
We were invited to arrive in Baton Rouge in a couple of days. That gave us 36 hours to get ready. We had more to do than just clearing appointment books and packing a bag. We had to make lists of the kinds of needs we thought we would find there, then twist the arms of our partners, colleagues, patients, vendors and others (including the archdiocese itself) to supply what we would require to fill those needs.
We would need supplies for people who had been separated from pharmaceuticals for their chronic conditions (anti-hypertensives, medicine and testing supplies for diabetics, HIV drugs, asthma medications and inhalers). We would need lots of antibiotics, dressings, ointments. We would need mountains of syringes, protective gloves and gear. We would need all the formula and Pedialyte we could get, diapers of every description, and everything else we (or someone else) could dream up and provide, including as many bottles of water as would cram into our (donated) supply train of three vans.
Fowler aptly observed that this stunning outpouring of critical supplies was far more opulent than it might have been had we given our donors 12 days (instead of 12 hours) to decide and deliver.
As we loaded our vans with all this precious plunder, the night air was charged with enough electricity to light up Streeterville. There was something we could do. And with the help of scads of people hard-wired for quick mobilization, we were doing it. It was a shout-out for all of us who had felt so paralyzed. Now we were able to do something concrete.
Rev. Tom Nangle, the Chicago Police Department’s chaplain, dispatched us with a prayer for our journey, observing that we medical people are like cops. We’re not afraid of things that are full of pain, chaos and seeming senselessness, as long as there’s a reasonable chance we can be useful.
All of us were quiet as we drove toward the emergency operations center in Baton Rouge. Our sense of urgency hadn’t waned at all. But now we were acutely aware that we didn’t know what we would encounter.
After our credentials were vetted, we were assigned to serve largely ambulatory evacuees and first responders. We had guessed right about the drugs, equipment and supplies we would need. We were well-prepared to manage all of it, despite the adverse conditions. Hey, we know how to take care of people with chronic medical problems who haven’t taken their meds in two weeks; this is what internal medicine is all about!
We saw sick people. Exhausted, lost, lonely, terrorized, sick people–people who had waited in lines so we could take care of them. Waiting might have been the hardest part for them too, but they had lots of practice in recent days. They wanted to talk with us. They longed to tell us stories of what they had lost and what they had left. As we took care of their medical needs, we each tried to communicate that we cared for them. Most didn’t ask for more than we could deliver. They were heartbreakingly gracious. Almost every patient was surprised and grateful that we had come “all the way from Chicago, just to take care of us.”
We had talked about it on the way down: With each and every patient–whether an evacuee who had been moved to five shelters in two weeks, or an exhausted FBI agent–we vowed we would say out loud that we not only cared, but that the care and prayers of Chicago, the nation and the world were with them.
Taking care of countless patients from before dawn until well after sundown was the most important and best work I’ve done in my life. When I talked with my colleagues at the end of each day, we agreed that we had never before been so tired–and we had never been so grateful to be doctors, because we were prepared and privileged to care for these people.
Their stories
Physicians are trained as scientists. We’re warned to be skeptical about anecdotes and to make medical decisions on the basis only of unassailable findings that emerge from meticulously disciplined, peer-reviewed and published clinical trials. But the truth is that we love the stories, the case histories and the anecdotes. They fuel us. I’m abashed that I don’t remember every one of my patients’ stories in detail. But here are a few I do remember:
– A retired cop came to our medical section for decontamination. As a first-responding volunteer for a major social-service agency, he had been dispatched to clean 50 motel rooms so police officers would have a clean place to sleep after their long shifts. His wife was alarmed because he wept deeply as he related the story of what he had borne witness to, and the work he had done. As a veteran police officer, he had seen all manner of crime scenes, viciousness, failure, tragedy and human decay. He told her, “I don’t know. I don’t know why. I just can’t stop crying.”
– A lovely old gentleman lay on a clinic cot in Slidell. He had no idea what had happened to his siblings. His home had been flattened. He knew his children were split up; he prayed they were OK. He was alone and seriously sick. After attending to his medical needs, we asked if we could do anything else for him. He smiled sweetly and gestured to the slightly younger, equally sick gentleman on the cot next to him: “I’m just fine, thank you, as long as I have my friend here. We watch out for each other.”
– A young mother we met in another shelter had done a perfect job of taking care of her newborn, despite having had a Caesarean section two days before Katrina landed, then being evacuated to the Superdome (where, she told us, her own mother had died). She was a portrait of courage and competence.
– An elderly man arrived at our shelter, bearing six huge and beautiful peach cobblers that his wife had just baked for evacuees. From the looks of him, we deduced that the gift represented a substantial economic investment for the couple, yet they wanted to give something that “tasted like home” to comfort people less fortunate than themselves.
– In another shelter, we met a black woman who was unable to speak. She could write, albeit laboriously. She had made friends with a Caucasian woman who could read and absolutely loved to talk. They had become inseparable.
Each member of our team has lots of stories like that, of people in the midst of their own tragedies, offering loving and life-altering service to one another. I doubt these people would identify themselves as heroes, but we did. We told their stories to one another on our way home. We told them to others after we arrived home. It’s important for others to hear them.
And it’s important for others to know that our greatest concern for the people we had come to care for was that no doctors replaced us after we departed.
I checked my e-mail when I arrived home and found a message from the surgeon general’s office. It thanked me for my application to serve, cited impressive numbers of the agency’s disaster-recovery accomplishments to date and promised to be back in touch if it were determined that my skills “fit within our deliberate and evolving deployment strategy.”
Our little team of nine couldn’t possibly have done what we did had we been a troupe of 90, 900 or certainly 9,000. Had we served under the auspices of a huge bureaucracy, government or otherwise, our experiences and the experiences of our patients would have been different.
The larger issues (and the shock and bewilderment that accompany them) surround the abject failure, on virtually every level, of everyone charged with the responsibility to preserve, protect and defend the citizens of the Gulf Coast from total devastation.
Many years ago, my social-justice mentor told me that what he detested most in the world was having to watch a little guy get pushed around. I understand that now, at new depth. I understand that total abdications of leadership result in pushing people around, and in catastrophic consequences for them and others.
We’re eager to tell the stories of our patients. But those larger issues have made us almost mute. We now understand the real meaning of the overused word “unspeakable.” We’re not sure we can do it justice if we give it voice. At least not yet.
On a different level, we’re afraid that not talking about the abdication of our society to protect the vulnerable might permit it to slither into the Pretend File: Let’s pretend this horror didn’t happen; let’s pretend the heroism of the victims mitigates the impact of the “system’s” failure; let’s pretend we understand what it means; let’s pretend we know how to fix it; let’s pretend that if we blame and punish someone, it will all go away.
It won’t all go away.
The aftermath of Hurricane Katrina has revealed an American malignancy so devastating that it resulted in “multisystem organ failure” that we see so often shortly before a patient dies. It’s our human inclination to try desperately to find any kind of hope, just as Katrina’s victims reached desperately for any kind of lifeline.
It’s tempting to put Katrina’s horror in a comparative framework that makes us look more acceptable to ourselves: “Look at how much we learned from Katrina! Rita was a horrific storm, too, but look how much better we did!”
That’s true enough, but it’s a dangerous distraction because it dilutes and discounts the dignity of Katrina’s victims, and Rita’s victims as well. Yes, Katrina revealed a tsunami of poverty in New Orleans that had been all but ignored or dismissed. We owe it to the victims to remember the truth and to change it. Yes, Katrina revealed appalling vacancies of leadership and accountability that must be corrected if we are to move forward as an honorable, civilized nation.
Respect, responsibility, resolve
We owe it to the victims–and to ourselves–to practice the three R’s of Katrina recovery:
– Respect. Respect for the dignity of the victims. Respect for the essential promise of the goal. No expedient answers. No quick fixes. No Pretend Files. Decades ago, my Latin teacher observed that respect literally translates as “to look again.” We must look at the aftermath, in concept and detail. Then we must look again. We owe that respect to the victims.
– Responsibility. Literally, the ability to respond appropriately, fully, promptly. Virtually all would agree that leaders and agencies were irresponsible after Hurricane Katrina. We can’t afford to pretend any more. We owe that responsibility to the victims.
– Resolve. Commitment to the goal, no matter the political or economic costs. We owe that resolve to the victims, and to ourselves.
We identify America as the richest, most powerful, most generous nation in the world. We have almost unlimited resources and an authentic and powerful drive to share them with people in need. We also have American citizens who have almost unlimited need. It seems as if it should be easy to get the two together. We owe it to the victims to effectively match our vast resources with our vast needs, so this kind of tragedy is never permitted to happen again.
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Dr. Frances J. Langdon practices and teaches internal medicine in Chicago at Northwestern University.
