Good news. Got an e-mail from my friend Jeff.
We got there at around 6:15 PM, as we were supposed to relieve the 7A-7P shift. We were allowed to drive right up to the Astroarena. People were everywhere, camped in groups of 5 to about 20 throughout the parking lot. Most carried Hefty bags, carrying what I assume was a lifetime of possessions.
The Astroarena is a large empty space, which used to be used for car shows until the spiffier new Reliant Arena opened. Now it is used for the Houston Livestock show and for medium sized concerts and not much else. The foyer had been subdivided by police barricades, funneling people into triage and registration desks. In the middle of the foyer were large pallets of sodas and water, next to them were bins of fruit. There was a crowd several deep all along the barricades. We were waved through and to the medical services table “at the very back.”
The large empty space had been divided up into staging areas by what appeared to be orange shower curtains hanging on metal rods. It was one of those things where you wonder who is stockpiling all of these orange shower curtains or did they just go to Target online and click Add To My Basket and change the quantity number to 5000. It was, I must say, very well organized given that it had only been there for about 24 hours. The entire Astroarena had become an adjunct hospital of the Harris County Hospital District (HCHD runs all of the community/indigent health care around here) so after working many months at Ben Taub, even me, a fourth year med student, knew all of the forms, the procedures, the formularies, the lab sheets, the computer system, etc. The orange curtains formed “rooms”, including a lab, a pharmacy, two different medicine areas, a psych area, a peds area, an ortho area, an ENT area, and a “Fast Track” area for med refills and nonemergent conditions.
We found the medical personnel desk and within 5 minutes we were registered. We were told to go to the Internal Medicine area, but nothing was happening there, and we heard about a backlog in Fast Track, so we mozeyed on down there after about half an hour. Well good thing we did because there was a huge backlog of patients. I picked up a chart and began to go. Ant bites, skin rashes, cuts in dirty water. Heart failure, diabetes, hypertension without meds for a week. Before I knew it, it was 11 PM and I had seen probably 10 patients by myself and my buddy had seen about 15. People were coming fast and furious and I forgot to get some of my charts and prescriptions cosigned. When they didn’t come back to me complaining that the pharmacy wouldn’t fill their prescriptions, I assumed what most doctors and nurses were telling me was true – medical student (and nurses and PAs) were basically free to prescribe and write orders autonomously. While this was a bit unnerving, whatever. It only made me more efficient. Liability, medicolegal principles, and medical student ethics will be sorted out later.
Of course there were the inevitable mis-triages. Nurses call me over and say “Here’s an easy one, let’s get this one seen and out.” Adult onset diabetes now insulin dependent, accucheck was in the 700s. Order 12 units of regular insulin, sit around for an hour and in the 400s. But the real reason he’s here is because he was bit by something. On both feet, and now it hurts. Well, let’s take a look – two little bites but lo and behold a) they’re draining b) they’re red c) they aren’t just one bite but two little holes next to each other. Uh oh – brittle diabetic, poorly controlled for many years, and now with possible snake bite. Cellulitis with erythema extending to the sole of the foot. This guy definitely needs IV antibiotics, cefepime and vanc wouldn’t be a bad choice, perhaps an antivenin, and maybe an insulin drip for possible DKA/HONK. The formulary has no IV antibiotics, he has bought himself a ride to BTGH. But that’s gonna take several hours to arrange. In the meantime, I give him a gram of Cipro XR and the 12 units, and follow his mental status. Luckily, he stays with it and we get him over to the Ben Taub. I had two patients with systolic BPs over 200 and headache (one with visual changes, who was hypertensive med naive) that I walked over to the general med area. I wrote Bactrim DS (for UTIs and skin infections with MRSA coverage) like candy. Lots of 1% hydrocortisone as well. Plenty of asthma meds, HCTZ, and lasix as well.
With another patient, I write 22 scripts, including maxing her out on Tegretol, Depakote, Abilify, Atarax, Klonopin (which she wasn’t taking PRN) and Topamax for schizophrenia, anxiety, and seizure disorder. She had her previous med list with her. Also gave her dig, Spiriva, montelukast, HCTZ, lasix, and a bunch of others for CHF and COPD. You best believe I got those scripts cosigned and sent her to psych before I had her fill them.
At around midnight, we took a break for some snacks and a quick peek over at the Astrodome. We showed up there and were waved in. We went up the ramp to the mezzanine concourse, which was crowded with cots. Went to the edge and looked over and saw a sight I will never forget. Every last inch of field space was occupied with cots, and all of the lower deck was filled with overflow people, asleep or trying to sleep. We were approached for help half a dozen times before we left, and we tried to refer people to the right places. As if we needed any more convincing, the sight of the Astrodome really hammered the nail home. This was a refugee situation, right out of the movies, no ifs ands or buts. This was the American equivalent of a tent city – temporary housing to 20,000. Books and movies will be written…
We went back and saw more of the same. There was a persistent rumor of 27-60 buses en route, bringing another 3,000, so they didn’t want any of us to leave. (Thankfully?) only one of those buses arrived, with others going to the George R. Brown convention center, which took a few thousand, and others going on to DFW or San Antonio. The constant flow kept on until about 3 AM, and then reduced to a trickle until people started waking up at about 5, when it returned to a flow. My last patient was a 24 year old who woke up with nausea and vomiting, and from a preliminary exam performed in a chair had massive hepatosplenomegaly, and had mistriaged to Fast Track. Took him over to medicine as well, hoping he didn’t have anything too contagious that will spread like wildfire. I bet he ended up at BTGH. All night we were super vigilant for “worst headache of my life/rash on my ankles” that could have signaled eminent disaster for the whole operation (meningococcus meaning that 20,000+ would need prophylaxis treatment), but luckily we didn’t see it. I pray to the Invisible Pink Unicorn, blessed be her name, that we won’t.
By the end of the night (and through the weekend), we had heard some reports of bad behavior. Looting (well, really, just shoplifting) of stores in the area, and a few people accosted in the Astrodome complex. I have seen a marked increase in panhandlers in the region, most of which are wearing the pink wristbands signifying Astrodome evacuees and quite a few of them are wearing clothes which are suspiciously nice and new (I try not to imply anything but one can’t help noticing…), much more than the donated clothes which most evacuees that we saw were wearing. But I have to say, our experience was very good. These people were angry, but they were very courteous to the medical staff, especially with our offers of help. Besides their near unimaginable loss, besides the crushing worry that so many have for lost relatives and friends, many were irate at the abandonment they felt by their government (not pointing fingers, but IMHO there has been a failure in all levels). Many of them were in a filthy Superdome, living among dead bodies and piles of waste for days without food and water. When help did arrive, they had to line up for days to get on buses or to get aid. Again, I’m not making this political, because I think there is enough blame to be spread out. But these were the people who are most dependent on government as they have the fewest resources, and were most severely affected by the abject failure of planning/preemptive evacuation/shelter/relief/post-hurricane evacuation. We, as Americans, should all be carefully looking at every point of this in an honest, nonpartisan (yeah, right) way, with immediate goals of how to make the next one better. It could be San Andreas, it could be a dirty bomb in downtown Chicago next. Keep that in mind. We all, in some ways, are just as vulnerable as New Orleans.
Tonight, I went to a black tie wedding at a five star hotel. I didn’t feel that celebratory, let me say, but of course I recognize that life goes on outside of this tragedy. A family friend is a department chair for UT-Houston, and he headed up a shift at the other evacuee site, the George R. Brown convention center. He said it was a bit more organized, and he is going again from 3 – 11 PM tomorrow. He will give me a call and I will hopefully be there tomorrow (if I am needed). I will take the list and I will try to get some names for all of you to phone. Thanks again for the offers of help.
Thanks and bless you for your good work, Edwino.
Good on ya, thank you.
-Tcat
a very poignant scene description, which leaves me in a continued emotional angst over the entire Katrina crises… though the govt failed to respond as quickly as they should have, thank heavens for the rapid response of compassionate individuals like Edwino!
Many blessings to you, Edwino.
I think it just goes to show that the citizens and private organizations can mobilize faster and with more efficiency that the gov’t. We’ll need the gov’t for the big stuff, like fixing the levees, and damn if the Coast Guard wasn’t airlifting people on the second day, but us common folk can move mountains when we put our minds to it.
Worked 3 PM - 8 PM at the George R Brown Convention Center. A lot less crowded and a lot more organized than the Dome. No unsupervised scripts (thankfully). In fact, we were recruited to help interview evacuees to keep track of public health, asking them about serious transmissable diseases by section numbers (diarrhea, sore throats, conjunctivitis, vomiting, fever, etc.) There are 4000+ cots there (and many air mattresses even!), and only 1700+ evacuees sleeping there, although the medical service is seeing 3000+ per day, meaning many of them are living elsewhere and coming back for medical service. That’s fine by me, I don’t know about the people doing the organization.
They are starting to report diarrheal outbreaks in the Dome/Astroarena complex, which people are (tasteless but it’s still funny) starting to refer to as Guantanadome. I’ll try to pull a few evening shifts later this week, although they are swamped with volunteers, meaning that the medical students get to do very little – a good thing when efficiency is key. Perhaps I can be of more service later in the week as people tire out and the need for volunteers starts to rise again.
I hung out with a family friend, the medical director of the GRB effort. It is remarkably well organized as well, and done so in a very short period of time. I have a tremendous amount of criticism about how the whole thing was handled, but I have to say that Houston and the Med Center in particular has done made me proud. This was basically the bioterror/nuclear/disaster scenario that they had been scrambling for since 9/11, and it was handled with as few roadbumps as one could anticipate. Just instead of setting up triage/med facilities in Hermann Park (directly north of the Med Center), everything was moved south to the Dome/Astroarena or northeast to GRB.
I also had a very interesting conversation with a Baylor Derm faculty member (who I had met at the Astroarena). She also happens to be a City Council member. Now I’m pretty much a knee-jerk liberal and she apparently is pretty conservative, but we both were down there in the trenches and during a lull I approached her and asked what plans were being made now for job training, for housing location, for employment, and for resettling the 5-10,000 refugees in Houston who were destined to become permanent residents (and would be stuck in the Dome until the Dome was closed down). I suggested that she bring this up sooner, and perhaps someone could get started with both trying to train them and a nationwide search to find jobs. And she, to my amazement, said that our mayor (a good old Texas Democrat), was basically refusing this. Because, she suspected, these would be Democrat voters. My jaw went agape. I mean this was a clusterfuck to begin with, and here we have Houston government just inviting a clusterfuck on themselves for political reasons. Nothing gets me more angry that politics for politics’ sake. I mean this entire catastrophe has been doomed by politicians who care more about looking bad on camera than putting together a rational course of action. How did we get these morons in every level of government, from the mayors on up right to the top? This seems not to be a case of a rotten apple spoiling the bunch, but an entire rotten bunch of apples with maybe one good one stuck in there that is trying desparately to save the bushel…
Anyway, /rant off. I know this is MPSIMS. I’ll let this thread die. I’ll probably continue volunteering through the week and if anything interesting happens, I’ll fill you guys in. Email if you want me to find someone or have any suggestions about how someone in the thick of it can improve the lives of these poor souls. But the situation seems to be gradually improving, and more efficient routes of access are arising for everyone. Thanks for all the encouragement, I really don’t think I have done anything extraordinary as it has been pretty common to see all kinds of people donating all kinds of resources throughout the city. Mainly, as a news junkie, this was a story happening on my doorstep that I didn’t want to be left out of, and I also felt that I couldn’t just sit there idly while it unfolded right here… I’ll shut up now and go to bed. Back to work tomorrow.
Edwino, thank you.
CJ