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A NEUROLOGIST AND HER FAMILY FIND FRIENDS WAITING TO BE MET

Avitzur, Orly, MD; Vatz, Kenneth A., MD

TALES FROM KATRINA – NOT JUST ANOTHER DISASTER STORY

Consider for a moment this scenario: One day, you're a neurology resident about to start your fourth year in a busy hospital; and, the next, you have lost your home, your job, and all your possessions. Your family, forced to evacuate, has tenuously relocated in a city thousands of miles away. You discover that your husband's early renal failure is rapidly worsening, probably due to stress, and to avoid dialysis, he will need a kidney transplant much sooner that you had ever expected.

Your PPO offers your husband three choices: commute 130 miles to a clinic on your plan, return to your devastated home state for local coverage, or pony up an estimated $90,000 for out-of-network costs for your care.

These were, for neurologist Renu Pokharna, MD, and her husband, Kishor, the seemingly insurmountable circumstances they found themselves facing after Katrina plowed through their hometown of New Orleans in late August. However, their story is not one of misfortune and despair, but rather an extraordinary chronicle of human kindness and compassion. So much so, that today they would tell you that you have but to trust in the essential good-heartedness of people and even the most daunting of setbacks can be overcome.

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A FAST EXIT

The Pokharna story begins on the night of August 27 with Renu's exit from New Orleans. As Chief Resident in Neurology at Louisiana State University (LSU), she had to make sure that all patients in the hospital had house doctor coverage despite the deteriorating forecast. This was no small task as landlines were already down and cell phone networks were congested. After ten hours, she finally succeeded, quickly grabbed a change of clothes, and packed her two children into a car. The ride to Baton Rouge, an 80-mile trip that normally took 90 minutes, dragged on to more than 12 hours due to rains, winds, and traffic jams.

Stranded in Pittsburgh on a business trip, Kishor was frantic with worry. Renu and the children were being housed by strangers in Baton Rouge, had little cash, and could not return home. Meanwhile, Kishor was becoming too ill to travel. Diagnosed with mild renal failure several years ago, he had just been told that he needed a kidney transplant. He tried to buy his family airline tickets, but the bank-issued credit cards were declined as New Orleans sank into financial disarray.

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A CHANGE OF FATE

Then Kishor made a decision that would change their fate. He attended a meeting of the Rotary Club, a volunteer organization of community business leaders and professionals dedicated to humanitarian service. At the conclusion of the meeting, when members of the Beaver, PA, Rotary Club invited Kishor to tell them his story, he just broke down. By the time he had finished speaking, members had encircled him, some offering cash, and checks, others their homes, one even giving him his coat. With money on hand, Kishor was finally able to arrange for his family to travel. “Their concern was overwhelming,” said Kishor.

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A NEW HOME FOR THE FAMILY

But the Rotarians had only begun to spring into action. Reginald Henry, a longtime member, told his wife, Priscilla, about the new family. She arranged for full private-school scholarships for the two Pokharna children, ages nine and eleven, at the Sewickley Academy where she worked. She then contacted another Rotarian, David Atcheson Jr., DMD, a local oral surgeon. The Atchesons, who had built a new home in Beaver Falls several years ago, insisted that the Pokharnas come to live in their former home, right next door on a 100-acre farm. David, his wife, Delana, and their three children spent the next several days packing up the house and completely refurbishing it for the Pokharna family. “They had thought of everything,” said Kishor. “When we walked in, the kitchen and bathrooms were fully stocked, the children's rooms had toys, and even the closets were full of clothes.”

Dana offered Kishor her car so that he could travel back and forth for his medical care. When Kishor's infusions ran late, Delana picked up the children from school and baby-sat them until he could return home. “The Atchesons were a godsend,” Kishor said. “They made us feel like we were part of their family.” And the Atchesons were equally impressed. Delana noted, “Despite everything, the Pokharnas were always smiling – each morning and evening.”

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A SHOPPING SPREE

Neighbors of the Atchesons gave the Pokharnas gift certificates. Tim Veith, General Manager of the Beaver Valley Mall, prepared a shopping spree at his mall, and many of the stores added gift certificates as well. One clerk bought Renu a new suit – out of her own pocket. “You will need this when you find work,” she told her.

With a roof over his head and his family situated, Kishor's next immediate task was to sort out his insurance issues. Without an office to make calls and transmit paperwork, negotiating for a new kidney would be nearly impossible. Norm Mitry, President and CEO of the Heritage Hospital System in Beaver, PA, arranged for one at the hospital – along with full access to telephone lines, copier, fax, and modem – so that Kishor could try to get his life back together.

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FREE MEDICAL CARE

Ratnakar Shetty, MD, a pulmonologist at Heritage, provided Kishor free medical care, including a month's worth of medication samples and iron replacement therapy. He also prescribed epoetin (Procrit) treatment that was critical at this stage of Kishor's illness. Heritage agreed to pick up the tab for the medications and the expensive drug if the insurance didn't come through.

A new kidney for her husband was also Renu's most pressing matter. Transplant treatment protocols varied tremendously in different programs. The best, she believed, was the Thomas E. Starzl Transplantation Institute of the University of Pittsburgh (UPMC). It had pioneered a method for preventing rejection that required far smaller doses of immunosuppressive drugs than usually given, but with better survival rates for organ transplants. As it happened, prior to starting her residency at LSU in neurology in 2002, Renu had been a published researcher with the Starzl group. “If Kishor needed a new kidney, I wanted him to be at UPMC,” she explained.

Securing a place for her husband in this top-notch program, however, presented a different set of obstacles. UPMC was willing and able to begin the process of typing and matching for suitable donors, but it would cost up to $150,000 for the surgery and care that transplants entail. Three weeks post-Katrina, the Pokharnas called their insurance company and were given three choices – move back to Louisiana, commute 130 miles to the Cleveland Clinic, a participating facility, or receive limited, partial coverage, if the transplant were performed at UPMC. “We could not move the family yet again and we just could not afford it … these were non-options,” said Renu.

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A NEW JOB

But Renu realized that if she could get a job, employee benefits might extend to her husband. In mid-September, the Pokharnas called UPMC to investigate the possibility of a transfer for Renu. Dennis Zerega, a Vice President there, not only arranged an interview with Mark L. Scheuer, MD, UPMC's Neurology Program Director, but extended the hospitality of his own home. When Dr. Scheuer heard about the request, he immediately offered Renu a position pending the approval of Amy Guttierez, MD, LSU's Neurology Program Director.

The most difficult part was trying to communicate with LSU because of e-mail and telephone access problems in the weeks following Katrina. “It is a tribute to Dr. Gutierrez's dedication that the bureaucratic aspects of the transfer were overcome so quickly,” said Dr. Scheuer, who was amazed that Dr. Guttierez was able to focus on her residents' welfare from her temporary refuge in a fishing cabin.

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A NEW LIFE BEGINS

On September 26, Renu resumed her fourth and final year of neurology residency – at UPMC. Through Renu's new job, Kishor became eligible for complete coverage for his kidney transplant. Only one month after their ordeal had begun, things had begun to fall into place: Renu had a job, the family had a home, and the children were happy at school. While a suitable donor still had to be found, the process of typing and matching was underway.

Kishor ponders the far-reaching effects of his decision to attend the Rotary Club meeting. “I just keep thinking how differently things could have gone,” he reflects.

But it was not pure serendipity that led Kishor to the Rotary meeting in Beaver – he has been a member of Rotary International since his youth. Several years ago, Kishor had developed a program through Rotary called “Caring Habits.”

Through this initiative, he and other members of the professional and business community visited middle schools to speak to students about the rewards of setting goals and to offer strategies for reaching their full potential. According to Kishor, our mission in this life is to help other people. “There are no strangers in the world, only friends waiting to be met,” he explained.

©2005 American Academy of Neurology