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NEUROLOGISTS SHINE IN DARKNESS AT CHARITY HOSPITAL

Avitzur, Orly, MD

TALES FROM NEW ORLEANS
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On Saturday, August 27th at Charity Hospital in downtown New Orleans, Dan Dumitru, MD, made his rounds somewhat distractedly. He'd heard the news: Katrina, a Force-Five hurricane, was amassing energy in the Gulf and poised to blast the city. As Chief Resident in Neurology, he had a choice to make. Should he discharge his patients, all nine of them, the very poorest and ill of New Orleans? Or should he and his staff just hunker down in the massive stone structure and wait it out? Charity had withstood many storms in its 200-year history. Dr. Dumitru decided to stay.

By week's end – after five days of operating without plumbing, electricity, food, or sleep – Dr. Dumitru had reason to question that decision more than once. “I kept wondering if I had made a mistake,” he said.

Dr. Dumitru was lucky, however, in one respect: The two residents who showed up Sunday turned out to be not only incredibly resilient but also singularly resourceful, managing to care for incapacitated patients without the benefit of monitors, often in total darkness, without water for washing and without any offer of relief.

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NO ONE COULD LEAVE

Michael Garbee, MD, a second-year resident and commissioned army officer, volunteered to come in when he heard the weather forecast. Dr. Garbee had spent four and a half days alone on the service at Charity the previous year when Hurricane Ivan hit. Patrick Glynn, MD, the first-year resident on call that Sunday, was a former firefighter. Neither flinched when they learned that afternoon that the hospital had gone “Code Gray” – meaning no personnel were permitted to leave.

Morning rounds passed uneventfully, but by nightfall the residents, housed on the 15th floor of the 18-floor hospital, felt the storm bear down. The old windowpanes began to rattle ominously. “When one window broke,” recounted Dr. Glynn, “the force was so strong that it sent an air-conditioning unit flying across the room.” Glass shards flew with it. The three neurology residents promptly moved their mattresses to the middle of the hospital hallway to avoid being injured by glass and flying debris.

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By Monday morning, there was no electricity – no elevators, no monitors, no connection with the outside world. After checking on their patients, Drs. Glynn and Garbee headed out into the district to gather information. The news wasn't good: A levee, a fellow firefighter told Dr. Glynn, had been breached twice. The two residents collected scores of MREs (the military term for Meals Ready to Eat) for rationing, if it came to that.

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RISING WATER, FAILING SYSTEMS

Tuesday morning, Charity lost plumbing. The toilets stopped flushing. No water came out of the taps, but water was meanwhile filling up the hospital basement, forcing staffers to move emergency-room patients to the second-floor auditorium. Through the windows, Drs. Glynn and Garbee watched people outside wade in waist-deep water towards the Superdome. Some sought refuge at Charity, only to be turned away by guards. They spotted one young woman on a small raft holding a tiny infant, whirling down the new waterway that separated Tulane University Hospital from Charity.

Rising water and failing systems were but middling concerns for the three residents, who were the only LSU neurologists in-house. Their biggest concern was for a young man in the neuro-intensive care unit on the seventh floor who had sustained a severe head injury. The residents lugged generators up flights of stairs so that he and other ventilator-dependent patients could survive. When the generators went out, they rushed to bag patients.

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WORSENING PATIENT CONDITIONS

An older woman with bacterial endocarditis required intravenous medication, including gentamicin. Unable to check her blood levels, the doctors tried to monitor for kidney damage by following urine output. A 100-year-old woman with a left middle cerebral artery stroke was admitted from the nearby Superdome. She had had a head CT on Sunday before the power failed, but no further tests could be administered. Worse, her condition left her unable to speak or use her right arm and leg. “We did what we could for her, but we could tell that she was miserable,” said Dr. Glynn. The building's oppressive heat was making them all miserable. Concerned that the patients would become dehydrated, the residents broke windows to restore air circulation.

Food and water became immediate concerns. What stores the hospital had on hand were moved to the sixth floor, where patients and staff waited in long lines for rations doled out in small Styrofoam cups: two Viennese sausages, or a piece of fruit, or a partial serving of soup.

“It is hard to describe what happens with the loss of creature comforts,” Dr. Garbee reflected. “Sanitation was a big problem. Also, the heat was stifling. We were only able to sleep a couple of hours a night. If it wasn't for the availability of bottled water, we would never have made it.”

No one could change their clothes; some doctors had ripped off scrub pants at the knees because of the unbearable heat. By midweek, the nurses had run out of clean sheets and towels to care for the patients. “Without running water,” Dr. Garbee noted, “all hygiene became impossible.”

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EVACUATION BEGINS

Wednesday saw the evacuation of some of the more critically ill. ICU patients, including the head-trauma victim, were triaged out first, strapped onto backboards, and then carried from as high as the twelfth floor down to the first. Each flight of stairs had 20 steps. “We counted them over and over and over,” Dr. Garbee recalled. “We were bleeding sweat.”

The residents worked in pitch-blackness, with only penlights providing illumination. When they ran out of backboards, they carried patients on tabletops. When these too ran out, they used doors they removed from the X-ray department.

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But evacuation at Charity was at best spotty. While the more affluent Tulane hospital loaded patients onto a steady stream of helicopters and other vehicles, the residents at Charity put some patients on fan boats, others onto tractor-trailers. Sometimes it was the state police who arrived to help, other times it was members of the Game and Wildlife Commission or just nameless volunteers.

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SOUNDS OF A ‘WAR ZONE’

“I became more scared each day,” Dr. Glynn admitted. “We often saw military guards pointing guns right at Charity. Our information was sparse and we did not see what the rest of the world was seeing. Thursday night, a neurosurgical resident warned, ‘They are storming Charity – go lock yourselves in a room!’”

“The area was looking and sounding like a war zone,” Dr. Garbee agreed. “We saw people firing at helicopters and at trucks.” Up on the fifteenth floor in their quarters, the residents observed huge fireballs in the sky, explosions from the destruction of a nearby oil refinery. Night noises, including gunfire, were particularly unnerving. At one point the residents believed they were under direct attack; in fact, a car generator had blown up. Only the sound of helicopters was comforting … until it faded. “Then we felt utterly deserted,” Dr. Glynn said.

By Friday, all the ill and infirm had been evacuated – and none visibly worse for all the wear and tear. The patient with endocarditis was doing well; even the 100-year-old stroke victim had survived. Not one of the nine original neurology patients, including the head trauma case, died under the residents' care.

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GETTING OUT

Later that day, all personnel lined up to be transported out in fan boats. The residents were told to go get their bags. “We were so exhausted,” said Dr. Glynn, “that we crawled back up the flights of stairs.” They put on the only clean T-shirts they had and packed their belongings. By the time they stumbled back down the stairs, however, everyone was gone.

“We were in such disbelief we couldn't even speak,” said Dr. Garbee. “The emergency room halls were empty and the sliding glass door was closed. We stared at each other, feeling completely forgotten.” Finally a fan boat of volunteers agreed to take them to a bus. “My boots were literally the last to leave Charity,” Dr. Garbee said.

The bus brought them to a shelter in Lafayette where Dr. Glynn's wife picked them up. Later, at her hotel, they were able to take their first showers in five days. Physically exhausted and emotionally drained, Drs. Glynn and Garbee nevertheless stayed up watching CNN for hours. “It was surreal to be comfortable and clean while watching footage of the very place we had just been,” said Garbee.

Dr. Dumitru elected to stay in the Cajun Dome Shelter, where he remained for the next ten days as resident # 21587. “It had been my decision not to discharge our patients before the hurricane,” he reflected. “In retrospect, I can see they would have been better off if I had.”

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WHERE ARE THE LSU NEUROLOGY RESIDENTS NOW?

Of the nine residents in the Department of Neurology at Louisiana State University, two have decided not to return, and one has taken maternity leave. Two others, who had been scheduled to be evacuated to Puerto Rico, have yet to be placed in other training programs. Only four will relocate to Baton Rouge to complete their training, among them, the three at Charity Hospital who survived Katrina. Most residents, including Dr. Glynn, lost their homes and all their possessions: books, equipment, cars, and clothing.

Diana Barratt, MD, MPH, is coordinating the effort to help with replacements. In an outpouring of support, neurologist editors, authors, and their publishers have shipped textbooks and manuals for the relocated house-staff. Software companies and vendors have promised supplies and equipment including AEI, Epocrates, MedLink, PatientKeeper, reflexhammer.com, stethoscope.com, scrubs.com, scrubsunlimited.com, and others. If you would like to help, please contact the LSU Neurology Residency Program Director, Amy Gutierrez, MD, at gutierrezneurology@yahoo.com.

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COVERAGE OF NEUROLOGY, POST-KATRINA

Neurology Today writers rely on e-mail, telephone, and cell phones to contact and interview sources for stories. But when covering Hurricane Katrina for this issue, the standard tools failed: sources were scattered to different cities and not available through listed e-mail and phone numbers; e-mail did not work – if only sporadically; and cell phones and regular telephones went in and out of service. Neurology Today tracked down the sources for these stories by relying on second-hand reports of people who had spoken to or spotted them in the chaotic days both before and after the levees in New Orleans broke.

At press time, there were several neurologists and faculty at the area medical centers that had not yet been located. We will continue to cover the recovery efforts for neurology. If you have been in contact with a neurologist or patient in the area, or you are in that area and want to let others know about your whereabouts and condition, feel free to e-mail us at NeuroToday@lwwny.com, or fellis@lwwny.com; fax, 646 674–6500, Attention: Neurology Today.

©2005 American Academy of Neurology