By Steven D. Lerner
Sunday, September 25, 2005
After Katrina, I went to Louisiana to help with the medical relief effort there, but I doubt I'll do the same if the need arises after Rita clears out of Texas. I'm confident they'll have things well covered down there. Here's why.
It was a CNN report one night soon after Hurricane Katrina and the flooding of New Orleans that did it for me. Doctors were described as working ridiculously long hours and manning intensive care units to the point of exhaustion. A lone pathologist, the report said, was wandering through New Orleans helping desperate people. "A pathologist?" I thought to myself. "A pathologist probably hasn't seen a live patient in years!" If a pathologist was out there ministering to hurricane victims, then what was holding back the rest of us doctors?
So I decided to join George Washington University's Hurricane Medical Relief Team for deployment to Baton Rouge. I had the best of intentions. But so, it turned out, did hundreds, even thousands, of other physicians and medical personnel from around the United States. And that, surprisingly, turned out to be a little bit too much of a good thing.
For me, the decision to volunteer simply seemed right. My father, a retired physician, had just passed away. In the midst of the Depression, he had traversed Northern Manitoba caring for Native Americans, then served his country in World War II. What have I done? I've practiced internal medicine in the Washington area for 23 years and am a sub-specialist in pulmonary diseases with training in critical care. My son has just started his first year of medical school. Surely this was the moment to answer my profession's call as both a testimonial to my father and an example to my son.
My family was worried about my going. My wife felt I should stay home and offer my services to evacuees brought here. My children were concerned that I could be exposed to all sorts of diseases. My partners thought my decision was admirable, but crazy. My friends thought it was heroic. The soccer team I coach even vowed to win a game for me.
There were no hotel rooms in Baton Rouge, so our response team would be sleeping in tents. My son gave me his special compact sleeping bag. My wife loaded me up with insecticides and waterless antiseptic soaps. She threw in a bag of Power Bars, but said it wouldn't be such a bad idea if I lost a little weight during the mission.
On Monday morning, Sept. 12, we arrived in Baton Rouge on a donated private jet, then were taken downtown to the state command center for emergency medical services. The place was buzzing with activity and packed with EMTs, nurses, doctors, administrators and clerks. I even saw several trucks from the Israeli rescue and response team in the parking lot.
We were told to pitch our tents under some nearby pine trees. It was sweltering, and by the end of the afternoon I was soaked in sweat. After dinner in the command center, we awaited our assignments. Finally, around 9 p.m., a harried third-year pediatric resident from Tulane University Hospital told us that we were being assigned in small teams to various areas. I was to head the team going to the second district police station in New Orleans. We were to report to the command center by 5 a.m. Excited, I retired to my tent and tried to sleep.
At 4:30 I got up and gathered with my group, which consisted of six EMTs, one ICU nurse, one fourth-year medical student and me. We left for New Orleans at 6:30. As we drove through the all but deserted streets, I was struck by how good New Orleans looked despite the damage. Yes, there were dead trees everywhere, and you could see damaged houses, but the roads were clear, and most of the dwellings looked livable. There was no flooding in this part of the Garden District. We drove down St. Charles Avenue with its stately homes to the second district police station on Magazine Street.
We had plenty of medications and supplies for immunizations -- and an abundance of manpower. The police officers were very hospitable as we set up a clinic. The only thing missing was . . . patients. We immunized a few officers against hepatitis A and tetanus (due to the polluted flood waters), treated one officer's rash, and looked over two other officers with abrasions. But that was it. It would have been a slow day for my cousin the school nurse.
Where, I wondered, were all the people with breathing problems or significant illnesses whom the news had led me to believe I'd encounter here? I suggested I go on patrol with an officer and see if I could be of any help on the streets. I was told to go out with an officer named Walt, but then his assignment changed. So basically, we all sat there.
After a few hours, anxious to do more, I set off on a three-mile walk down Magazine, through an area that had been looted after the storm. I came across the occasional person packing belongings. Two women-- lawyers loaded down with boxes of documents -- were transferring their office to Baton Rouge. Two other women were pulling their payroll records and computer out of their damaged store. As I approached to see if they needed some help, they eyed me nervously and declared that they had a gun. I told them I was a doctor and pulled out my stethoscope. Then I helped them lift their things into their van.
I chatted with a couple who owned a seafood restaurant who said it would be a year or two before they could reopen. I was approached by three young National Guardsmen from Oklahoma, who reported that it had been extremely quiet. When I returned to the station after a few hours, I again asked if I could be of useon patrol. The sergeant thanked me, but said it wasn't really necessary. Kindly, she suggested we return to Baton Rouge and have a good steak dinner. So we packed up and headed back.
I felt frustrated. I wanted to be of more use. When we got back to Baton Rouge, I asked to talk to those in charge of assigning physicians and was introduced to a very nice young man, another pediatric resident-turned-administrator, who appeared to be at his wits' end. In a nutshell, he told me they were having a hard time finding jobs for all the medical personnel who had descended upon Baton Rouge. I volunteered for anything -- search and rescue on the boats patrolling New Orleans, hospital work to spell tired physicians, or helping out on the USS Iwo Jima docked in the harbor. He kept repeating that there just weren't any more assignments. The shelters had plenty of medical personnel, the hospitals didn't want any more doctors, and the federal government hadn't communicated any need.
Figuring that there may, in fact, have been a communication problem between the various groups, I called one of my patients back in Washington who is chief of staff to a member of Congress from the Gulf region. Perhaps he could iron out any red tape. The next thing I knew I was escorted to the nerve center of the entire rescue operation. I met the governor's chief of staff, the head of the federal Health and Human Services team, the coordinator of the state hospitals and a FEMA representative. They were all trying desperately to find a place for a physician with my skills.
The end result: There really was no need. Most of the evacuees had been treated or dispersed to other places. Area hospitals were adequately staffed. The military staffs its own ships. There was no need at this time for a pulmonologist, let alone a critical care physician. We had, in short, responder overkill.
It was at this point that I realized that these hardworking people were actually wasting their time trying to accommodate the goodhearted response of all the medical personnel flocking to the scene. That's when I decided to return to Washington. I caught a flight on Thursday, a few days before my team was due to head home.
My experience as a medical responder wasn't what I had expected from watching TV and reading the news. But it did teach me a few valuable -- and humbling -- lessons about emergencies and how they play out here in the United States. First, I don't think there's any doubt that there will be an intense medical response to any tragedy that strikes this country. Our doctors and other medical personnel, like people from scores of other fields, will react with an outpouring of time and effort to help their fellow citizens in any way they can.
The second lesson, though, is that this response should be coordinated and stratified. There should be a pre-set list of first, second, third and fourth responders ready to be activated and sent to a disaster area as needed by a central command. That way, people would be less likely to inundate an area with more volunteers than are needed at any given time.
And the final lesson is this: Don't believe all you read and hear from the media about the situation on the ground. Yes, many mistakes were made, and yes, many people suffered, some of them terribly. But through the tireless, selfless efforts of tens of thousands of people, the federal, state and local governments are righting the situation. That news may not be as dramatic for the media as reports of lone physicians braving the elements to help the distressed, but if you ask me, it's closer to the reality of how our country works.
Author's e-mail: email@example.com
Steven Lerner is an internist and pulmonary specialist in private practice in the District and Chevy Chase.