Published in the October 2005 issue of Today’s Hospitalist
Through a harrowing night and day, five hospitalists in Pascagoula, Miss., lived “and worked “through the storm that has been described as one of the worst natural disasters to ever strike the United States.
The physicians dodged puddles of water that leaked through hospital windows and listened to 130-mile-per-hour wind gusts that ripped off part of the roof of Singing River Hospital. And throughout it all, they cared for an extra-full load of patients who had nowhere else to go.
Yet as difficult as that experience was, it would prove to be only the beginning of a long ordeal. These and other hospitalists in the Gulf Coast region not only had to ride out the storm at the hospitals where they worked, but they have since played a central role in caring for patients in the aftermath.
That has left them in the difficult position of trying to pick up the pieces of their personal lives while working around the clock and sometimes living at the hospital. Here’s a look at how three hospitalists survived Hurricane Katrina and its aftermath.
The aftermath
As soon as the worst of the storm subsided in Pascagoula, the five hospitalists on duty began to take turns leaving the hospital to check on their homes and families. Randy Roth, MD, medical director of IPS, the nine-physician hospitalist group that works at Singing River Hospital, found that his house, which had stood on the shore of the Gulf of Mexico for more than 100 years, was gone.
“There is nothing on my lot right now,” he notes. “I have nothing but a couple of bricks, one or two pots and pans. I found some personal stuff as far as six blocks away.”
Dr. Roth is far from alone. Like many Mississippi residents, six of the group’s doctors lost everything, as did three of the nurses.
As Dr. Roth explained in an interview a week after the storm, it’s difficult enough to practice medicine without any kind of phone service, with only limited supplies of drinking water and no water pressure, with three days of generator power and threats of fuel shortages, with nowhere to discharge patients to, and a steady stream of patients coming in. It is even harder to do that when you’re worrying about your family’s well-being.
“The toughest part is being able to come to work and stay focused and then to go home and try to deal with everything,” Dr. Roth explains.
As a result, paying attention to the emotional needs of the physicians “so they in turn are strong enough to care for others “is turning out to be imperative. “We need to hold it together.”
Besides, Dr. Roth notes, there is a silver lining: All of the group’s losses were material, and none of the staff lost a loved one.
Squashing rumors
At the Ochsner Clinic’s 500-bed hospital in New Orleans, hospital medicine chairman Steven Deitelzweig, MD, has similarly made supporting the emotional and psychological needs of his hospitalists a top priority.
Since the storm struck and left Ochsner as the only full-service hospital still operating in the city, Dr. Deitelzweig has been convening two departmental meetings a day. The meetings address the hospital’s ever-changing logistics and try to keep everyone up to speed on what work needs to get done, where the hospitalists are needed most, what floors are operating, and what lab and imaging services are available.
But these meetings have served another important purpose: keeping morale up and rumors down. Reports of several police officer suicides in New Orleans, Dr. Deitelzweig says, drove home the need to deal head-on with the emotional needs of the doctors.
“I tell my folks that clergy is available not just for the patients, but for us,” he explains. “I tell people that if they are having a difficult moment, I would rather them come to me and do it in private because everything has a domino effect. We are the leaders of the place.”
Rumors, which spread so quickly, have damaged morale. One rumor that required special attention said that Ochsner was so desperate for supplies that it was looting a local Wal-Mart. Administrators took the time to tell staff that Ochsner logged and paid for all supplies it got from Wal-Mart, and that Wal-Mart executives themselves helped load the Ochsner van.
“No comparison” to other storms
In the back of everyone’s minds, Dr. Deitelzweig says, are memories of the storm itself. “I’ve been through hurricanes before, but there was no comparison,” he explains. “It was scary. I was walking in the hallways and windows were breaking.”
Because Ochsner sits on high ground “it is perched directly on an intact portion of the now infamously breached levy “the facility didn’t have to deal with flooding. While that provided some solace, the infrastructure around the building was a mess.
“Immediately afterward,” he recounts, “we were in a survival mindset. There were no utilities, no running water, no electric, no air conditioning. It’s 105 degrees outside. If you took somebody’s water, they would look at you cross-eyed. Food was rationed. For some meals, you just had a fruit cup and a roll.”
Every time you looked out a window, Dr. Deitelzweig adds, you could see helicopters hovering overhead. “It raises the anxiety levels,” he explains. “Everybody has really been under stressful, unsanitary conditions for a period of time.”
Interviewed just a week and a day after the storm hit, Dr. Deitelzweig reported some good news. Physical conditions were improving daily. There was plenty of food and bottled water, enough water pressure to flush toilets and take showers on the first through third floors. Buses were transporting workers to and from Baton Rouge, 65 miles away, each day.
The most critically ill patients had been evacuated to hospitals from Houston to Pensacola, and the first outpatient clinics re-opened for business. The part of the hospital’s roof that lifted off was repaired, and the dozen or so broken windows had been fixed.
Lessons learned
Looking back, Dr. Deitelzweig says he has already identified some lessons learned.
The most important take-home point, he says, is “to anticipate higher volumes.” Along those lines, he says that one of the best decisions he made was to call in more hospitalists than hospital administrators thought would be necessary during an emergency like a hurricane.
Under its hurricane contingency plan, Ochsner identified essential staff and divided them into two teams. As Hurricane Katrina barreled over Florida, Ochsner called on its team A to come to the hospital. Dr. Deitelzweig decided to take that plan a step farther and called his A and B teams on site.
“I was thinking that if this was going to hit,” he recalls, “it was going to be a very significant catastrophe. If not, I was inconveniencing four people.”
Because of his decision, there were more hospitalists on-site through the emergency than physicians from any other medical specialty, including the emergency department. “We made an immense contribution,” Dr. Deitelzweig says. “If you want job security during a hurricane, become a hospitalist.”
He is quick to add that he would do some things differently, like including social workers on essential personnel teams. While hospitals tend to think of essential personnel as only those individuals who provide patient care, that’s not entirely accurate.
“When the emergency passes,” Dr. Deitelzweig says, “you need the people with the most skill at coordinating, accessing families, utilizing available resources and working with the Red Cross and FEMA. Doctors and nurses don’t do that well. Social workers do.”
Martial law and long hours
Now that people are able to get about the city “and because many people have been coming back at least temporarily to assess the damage and retrieve possessions from their homes “patients are arriving at the hospital. They need treatment for everything from waterborne ailments and wound infections to dehydration, diarrheal ailments and exacerbations of existing diseases because they had run out of their medicine.
“If you are the surviving facility, like we are, you will grow from being a market leader to being a market dominator,” Dr. Deitelzweig says. “The other people are not in business any more. There are hospitals here that will never come back.”
To cope during the near future, says Dr. Deitelzweig, one of the first things he did was to change hospitalists’ schedules to reflect changes in staffing. The group is working at about 40 percent of its usual size; the other physicians are treating patients in Ochsner’s facilities in Baton Rouge and other communities.
As a result, the hospitalists who are working in the hospital will work 24/7 one week on and one week off. They’ll stay in the hospital for a week at a time, which reflects another reality of post-hurricane New Orleans: “We are under martial law here. Once you are here, you can’t leave,” Dr. Deitelzweig explains. Besides, he adds, there is only enough gas available to do a minimal amount of driving.
The discharge crisis
Back in Pascagoula, Dr. Roth says he too quickly realized that one of the first things the group would have to do for the near future was change its work schedule. After initially assessing everyone’s personal situation and giving everyone time to secure temporary housing and make sure their families were safe and secure, the group decided to also go to a 24/7 schedule with five days on/five days off.
The advantage of this schedule is that doctors will have time to see their families, who are now several hundred miles away, and to begin the task of rebuilding and repairing homes and lives. But the block schedule also means that when they’re at work, the physicians can concentrate solely on the business of providing the health care, in a situation that is likely only to get worse.
“We are already seeing some water-associated problems, fecal-oral infections, some vibrio vulnificus infections, some dysentery,” Dr. Roth says. “What we are talking about now is what we have to prepare for. Mosquitoes will be worse. We haven’t seen a snake bite or a rodent bite, but we will. Potable water is going to be a problem. We have to prepare. And we have to start contacting nursing homes to help them, because a lot lost everything.”
Just as at Ochsner, Dr. Roth says, having extra hospitalists in the hospital during the storm was also crucial. Singing River Hospital, unlike other hospitals along the Gulf coast, never shut down. The hospitalists’ patient census increased dramatically “from the 76 to 85 patients a day the group used to see on a typical day to 100 a day for the week following the storm.
“The main issue is that we can’t discharge,” Dr. Roth says. “Patients don’t have anywhere to go. You can’t send them back if the nursing homes aren’t there anymore.”
Digging in and hunkering down
About 70 miles inland, at Forrest General Hospital in Hattiesburg, Miss., hospitalist Steven E. Farrell, MD, says that in addition to comparable problems discharging patients, the 525-bed facility encountered problems during the first few days following the hurricane. Hundreds of dislocated people from the community inundated the hospital looking for shelter.
“Many people in the community looked to the hospital as a place that had power and water and served meals,” Dr. Farrell recalls. “We had to implement a lockdown where we couldn’t take people from the community. We had to cut meals down to one meal a day for staff and two meals a day for patients.”
Bottled water started to run low. There was no water for cleaning. Dialysis patients had to be evacuated to another nearby hospital that hadn’t lost water.
The generators started to fail after 48 hours, and it took an additional 48 hours to get replacements. There was no air conditioning, no refrigeration, no pagers and no phones.
A few days later, however, Dr. Farrell says, conditions improved dramatically. Just short of a week after Hurricane Katrina struck, Forrest General was admitting patients again. The problem then, he says, was that most people didn’t have enough fuel to drive to the hospital.
Of the 12 hospitalists who work at the Hattiesburg Clinic, seven came in before the storm and stayed in Forrest General overnight and the next few days. Having the hospitalists there meant that other physicians didn’t have to try to make it in while conditions remained dangerous.
“We could cover for them,” Dr. Farrell says. “If we had not been in place, it would have been a lot more confusing and a lot more difficult for the community doctors and the hospital.”
“I was in the hospital during the storm, and it was very scary,” Dr. Farrell recalls. “I have been through tornados before, and I have never seen anything like this. The wind was coming from three different directions at one time. And there were trees just folding over and snapping off like matchsticks.”
Back in New Orleans, Dr. Deitelzweig says the week following the storm was the longest of his life. He also notes that the stress and awful conditions have brought out both the best and worst of humankind.
“I looked in the mirror today and said to myself, ‘I look a lot greyer today than I did a week and a half ago.’ The emotional part of being a doctor has been ratcheted up 10 notches. You have never done more meaningful work. But there is not a person I see that hasn’t been affected, and some of the stories are devastating.”
Deborah Gesensway is a freelance writer who reports on U.S. health care from Toronto, Canada.
