The aftermath of Hurricane Katrina's catastrophic legacy in the Gulf Coast shook a significant segment of the normally orderly and regularly scheduled world of oncology care into an acute-care, emergency-medicine triage mode.
As the world watched the death, destruction, and despair in New Orleans and neighboring environs, the oncology community mobilized to continue cancer care for evacuees, and to contact displaced oncologists, researchers, oncology nurses, and other cancer care professionals.
The effort combined the resources of various governmental, professional, institutional, and advocacy agencies and organizations in what may have been an unprecedented opportunity to work together to help evacuated cancer patients and offer institutionless cancer clinical and research professionals opportunities to continue their work elsewhere.
The articles in this issue resulted from a series of telephone interviews conducted during the week of September 5, the first full week following the floods that ravaged New Orleans, and a week shortened by the Labor Day holiday.
The information reflects various calls to action, alliances, and individual and joint efforts directed to returning cancer patients who were hurricane victims to some sense of normalcy.
One disconcerting and prevailing comment heard from multiple sources throughout that week was the lack of contact with medical and radiation oncologists from the Gulf area. Many noted the lack of communications in the devastated area and the inability to find out anything about the status or whereabouts of virtually missing-in-action physicians.
Roy S. Weiner, MD, Director of Tulane Cancer Center
That first Friday, however, OT was able to reach Roy S. Weiner, MD, Director of the Tulane Cancer Center and Co-Director (with Oliver Sartor, MD) of the Louisiana Cancer Research Consortium.
Dr. Weiner was then stationed in Gainesville, FL, where he had previously lived and worked before joining Tulane in 1992.
He was reached through the help of Margaret Foti, PhD, CEO of the American Association for Cancer Research, who, according to Dr. Weiner, had persistently tracked him down via his only-intermittently working New Orleans's cell phone number.
Dr. Foti was also able to reach Dr. Sartor, Director of the Stanley S. Scott Cancer Center at Louisiana State University Health Sciences in New Orleans, and to begin discussions with them and others to access how AACR could best help with the relief effort.
Dr. Weiner said he and his wife had left New Orleans on Sunday, Aug. 28, in anticipation of Katrina's striking the city.
“I made coverage arrangements, and we drove to Birmingham for what I thought would be a night. I had every intention of returning to Tulane the next day,” he related via a new cell-phone with a Gainesville area code, but of course that return was not to happen.
After four days in Birmingham, he traveled to Gainesville, where he intends to stay, he said, “until the moment I can be more useful somewhere else. It really doesn't matter—I know I cannot return to my home, and our children are grown so we are flexible.”
When asked about the whereabouts of his Tulane colleagues, Dr. Weiner said he had made contact with a large part of his faculty who were dispersed throughout the country in a modern-day “Diaspora.”
He also said the basic researchers seemed more independent and adept at contacting colleagues around the country to set up new labs, and were pretty much taking care of themselves.
Dr. Weiner said he considered his main job at that time to serve as a communications link. He said Tulane was in a totally desperate state, but that some electronic medical records might be restored since they were at another facility; however, he did not think that research records would be restorable.
“The physical damage was great. At this time, we intend to rebuild and resume our work, but it is far too early to know any of the details, or even know which options will be feasible or not. Rebuilding the structures at Tulane will be in everyone's best interest.”
Electronic Message Boards
He said he had a limited clinical practice, but had been in contact with some of his patients as well as some of the oncologists currently treating them.
He was also able to make several referrals, and praised both AACR and ASCO's efforts (see article on page 28) at creating electronic message boards.
“The deficit I feel most was the lack of communications during the first few days. This is a very tough time,” he said.
Oliver Sartor, MD, Director of Louisiana State University (LSU) Stanley Scott Cancer Center
Dr. Sartor, interviewed the next day, was staying with a friend about 70 miles from LSU's campus in Baton Rogue, where he had set up an office. He and his wife were vacationing in Paris when they heard reports about Hurricane Katrina's approaching New Orleans.
“The French news reported that the brunt of the hurricane had missed New Orleans and was heading to eastern Louisiana and Mississippi, so when we were crossing the Atlantic we had no idea about the flooding until we arrived back in the United States,” he said.
His son was away at college, and his 15-year old daughter and the family dog had been evacuated from their home, which fortunately wasn't flooded due to its higher elevation. His 15-year-old cat, however, was left to fend for himself for 10 days until he was finally rescued by the returning Sartors, who were amazed the cat hadn't fled through the cat door.
Admitting that his own and his family's anxieties were minor compared with others, he was determined to locate as many of his patients as possible. When we spoke on Sept. 10, he proudly noted that he'd made a house call that day in addition to participating in multiple meetings and conference calls and answering 120 e-mail messages, which were able to reach him through his personal Yahoo address.
At that point he had located nine of his 10 sickest patients; had tracked down others dispersed in Wyoming, Colorado, Arkansas, Texas, Georgia, Mississippi, Kentucky, and Florida, as well as other parts of Louisiana; and knew the whereabouts of all members of his hematology/oncology department, and all his fellows.
Dr. Sartor said he was upset he could not find many members of his basic research faculty, including the head of basic science. He also said these researchers were resourceful in finding laboratories, and that he was grateful for the ASCO and AACR Web sites.
It was happenstance that he wasn't in New Orleans during the hurricane and subsequent floods. When Dr. Sartor learned he had to be in Paris for a meeting prior to his vacation, he switched schedules with a new recruit, who ended up stuck in a New Orleans hospital for several days.
Another new hematology/oncology recruit, Deborah Kennedy, MD, had arrived in New Orleans only 10 days before the storm. According to Dr. Sartor, she has been running a clinic in a shelter filled with 500 people and intends to continue for the time being.
Dr. Sartor is a native of Shreveport, LA, and had spent eight years at Tulane receiving his medical education and training before returning to the city for his post at LSU. He said that he and others from the region had a pretty cavalier attitude about hurricanes, never imagining that what happened could ever happen. He initially thought he'd be able to return to New Orleans permanently after two or three days.
Since then, he has traveled back to the besieged city to try to retrieve medical records and personal effects. His wife, a reproductive endocrinologist, was escorted by police, and game and wildlife personnel in boats to rescue human embryos from her clinic.
The Power of Text-Messaging
Dr. Sartor's success reaching his colleagues and patients was partially due to his daughter, Abby, who figured out that even though cell phones were inoperable, text messaging worked. It was through this means—and his BlackBerry and Palm devices storing some 3,000 contacts—that he was able to start networking with others.
He obtained a new cell phone with a New York area code when he was visiting the city, and used the opportunity to travel to Lawrenceville, NJ, to try to enroll Abby in boarding school, since the family realized they'd be without a stable home for quite a while.
When the Sartor family was viewing the campus he thought he spotted a former classmate from Tulane. It turned out that the man—another displaced physician from New Orleans—was also trying to enroll his own daughter.
Both girls were subsequently accepted by the headmaster without any transcripts or other official paperwork, and when Dr. Sartor was asked to write a tuition check, he realized he couldn't because he no longer had a checkbook.
During our conversation Dr. Sartor described the incredible ruin and debris spread throughout the entire city, including the parts unaffected by the flooding. He said he was unable to find hotel accommodations within an 80 mile radius of New Orleans, and could not even get lodging in a hotel owned by his cousin.
On one trip to Houston, he said he rented literally the last car from that city. He also said he'd be more diligent about creating a cell-phone database on his PDAs in the future since using those phone numbers through text mail was the only link he had to contact others.
On Sept. 8, the Association of American Medical Colleges announced that Tulane University School of Medicine was planning to continue medical education at various medical schools in Houston and other Texas sites; and Louisiana State University at New Orleans School of Medicine was transferring medical education to LSU's Baton Rouge campus.
But those announcements may be a little misleading since they refer primarily to medical students and residents, and don't take into account the countless patients with cancer and other medical problems who are widely dispersed and may never return to medical facilities in New Orleans.
Dealing with them—and placing cancer professionals in new clinics, hospitals, practices and labs—will largely be up to the efforts of the national cancer community, plans detailed in the article above.