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The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.


All Hallows' Eve: Night Shift

The night shift at the old Charity Hospital was morbidly still. In New Orleans, Halloween was a noisy, boisterous time, but in Big Charity, an iceberg of concrete jutting above the crumbling storefronts of Tulane Avenue, even the noisiest of celebrations was reduced to the silence of a tomb. When we worked the night shift, if we wanted to know what the world was doing, we could open one of the metal sash windows and listen to the shouts coming from the dark neighborhoods of Mid-City in the distance like ghostly cries from the cemetery. And we would slam the window shut, preferring the suffocated silence.

We worked on 7 West, a general medical unit. I was charge nurse for the shift, and had just finished dividing up the patients among the four nurses on the unit when I heard the screech of the elevator door opening. A dark figure stepped out. It was a relatively warm night for October, so I was surprised to behold a man heavily dressed. If he had worn white I would have thought he was an attending doctor, as long his coat was, but it was all black. He seemed to know precisely where he was going, and came up the hall straight as an arrow, not a single step or motion wasted. He glided, almost as though he were used to the idea of flight. Perhaps he was a pilot, on a Halloween caper in the French Quarter? New Orleans would certainly be a preferred layover on Halloween for people in the airline business.

As he approached the nurses' station, the seam of his long cloak divided, which on closer examination proved to be a cape, and he produced from behind its curtains a manilla folder.

"For the charge nurse," he said. His voice was flat, cold, without inflection or accent. "I am a direct admission from Dr. Frankl."

Dr. Frankl. I turned my head to the other nurses and asked with my eyes. They all shook their heads.

"No one here knows a Dr. Frankl," I said at last. "Is he a staff physician here?"

"He most assuredly is," the man responded. His long hair was combed straight back, and neatly flowed over the collar. "He has admitted me here before."

He offered me the folder. Inside was a hospital order sheet with the words "Admit to Dr. V. Frankl" written on the first line. The rest of the order sheet consisted of routine admission orders, including an order to start an IV, medication for nausea, morphine, and an order to transfuse two units of blood. Whole blood, type A positive.

It was rare anymore to transfuse whole blood. In the modern era, blood was usually separated into plasma, platelets and red blood cells, so that one unit served at least three purposes, and could be used for three people instead of one. 

I looked up at the visitor. "In my time here I don't believe I have transfused whole blood more than once or twice. This is peculiar. I’ll have to check on this." 

“Please, be my guest. You are welcome to check, and you will see everything is in order. Dr. Frankl made arrangements with the blood bank for the blood in advance." 

Nodding, I picked up the phone and dialed down to the blood back. My friend Hank picked up. "Blood bank." 

"Hank? Laura here. I have a patient up here for admission who has a very strange order with him. From a Dr. Frankl." 

"Yes, and I have a very strange order down here. Someone called the bank a few days ago and requested that 2 units of whole blood be made ready for tonight. I had no idea about the order until I came on shift at 7. Very strange, whole blood.” 

“The patient is up here on the floor, and he wants his blood." 

"Near as I can tell, everything is in order. We can do the transfusion tonight." 

I hung up the phone and looked at my friend Jenny. “What should we do?” 

Jenny shrugged. “Put him in a room. I’ll put his chart together. We can check on this Dr. Frankl, see if he’s really an admitting physician here.” 

At the end of the hall there was an unused room. I had decided already I wouldn’t put him in the room with anyone else. Motioning towards it, I started down the hall. He turned and followed, moving so silently that I had to look back to see if he was still behind me. I told him to undress and get into the bed, laying a hospital gown on the clean white sheets. 

“We will work this out,” I said. “This is just unusual. Almost all of our admits come from the ER. And we never get direct admissions this late.” 

“My apologies, then. That was my request,” the man said. “Dr. Frankl was going to admit me first thing in the morning. I wished that the transfusion be done overnight. So as not to disturb my day. A transfusion will not keep me awake.” 

“I understand. We have a few details to work out before we can begin the transfusion.” 

“I am in no hurry.” He blinked when I turned on the fluorescent light, as if even this were too much brightness for his comfort. With a single motion, he swung the cape off his shoulders and onto the back of a wooden chair. Underneath he was dressed in black slacks and shoes, and a white loosely fitting button-down shirt. I kept looking, trying to decide if he was in a Halloween costume. His skin was very pale, accentuating his dark hair, and without blemish. As soon as I reached the door he had turned the light back off and stretched out on the bed. 

When I returned to the nurses’ station, Jenny had a physician’s directory on the desk and was looking through it. “Here it is. Frankl is indeed registered as an admission physician at this hospital. So it is all legit.” 

Somehow this did not quell my uneasiness. But at least I knew I would not get in trouble for admitting the patient. 

Other than the transfusion, the patient did not require anything, so I did not give him any medication or treatment while we waited for the blood to be sent to the floor. The man was patient. He lay in bed, the television in the corner of the room switched off. He had nothing to do and seemed uninterested in doing anything. After I had caught up with my paperwork and checked out the other patients I returned to his room. 

“It won’t be long,” I said. 

“You are probably wondering why I am here. I have a very rare blood disorder. It causes severe anemia, and abdominal pain. Every few months my blood count goes down, and if I do not receive a transfusion the abdominal pain returns. This transfusion will set me aright for the time being. And it may…keep me out of certain kinds of trouble.” 


“I shall only say that my illness, when left unchecked, leads to certain atypical behaviors. I must say no more.” He licked his lips. I got out of there. 

A courier had arrived on the floor with the two bags of blood. After signing for them, I gave bedtime medications to two of my patients and went back into the room to start the transfusion. Hanging the bags on the IV pole, I looked around for a needle to start an IV. 

“I could have sworn I brought a 16 gauge needle in here,” I said. I looked over at the patient. The lights were very dim in the room, but his eyes shone in the gloom. 

“A mistake anyone can make,” he said. “As I said before, I am patient. Please, by all means, take your time and do the job right.” 

When I returned to the nurses’ station, Jenny was talking to one of the the other nurses. “Laura, you have to hear this! Cindy here says she remembers Dr. Frankl. Tell her, Cindy.” 

Cindy turned anxious eyes to me. “Yes, I remember Dr. Frankl. Never met him…he was in the news…last year, I think. He was an old man, practiced for 40 years in Gentilly, maybe more. He died. Well, they found his body by Bayou St. John on All Souls Day a year or two ago.” 

We all turned and looked down the hall. The door to the stranger’s room was open, but the room was dark, and the darkness seemed to be consuming all of the light at the end of the hall. It was as if black fog was spilling out of the room and filling the end of the corridor. 

Cindy’s voice was very quiet. “The coroner said someone had drained his body of all of its blood.” 

My heart pounded in my chest. Whole blood. What did it mean? Did this strange man collect blood? Could he be Frankl’s killer? Or were we crazy? 

“That’s ridiculous, isn’t it? Somebody stabbed him and he lost all his blood. Maybe a robbery. That can’t be right. You said, Cindy, you said Frankl was on the list of admitting doctors. That means he is still alive, we must have the two names mixed up. There are many doctors named Frank, Francis, Franco, maybe you remembered it wrong.” 

“I’m sure you’re right,” Cindy said. “I’m just telling what I remember, but I misremember a lot of things, you know?” 

“Yes,” I said, reaching for the IV tray on the station desk. “Why don’t you two girls come with me when I go to put in the IV.” 

“Do we have to?” Cindy said.  

Jen poked Cindy in the side with an elbow. “Yes, of course we will come with you,” Jenny said. 

We walked down the hall, three abreast. It was only a hundred feet or so, but it seemed much farther. With each step the air felt more and more damp, and the lights seemed to dim. It wasn’t that the fluorescent lights weren’t working, or even that they were putting out less light, it was as if the light was somehow scattered, or absorbed, as it passed through the air, the intensity absorbed like sunlight cast into the ocean deep.

We arrived at the room. It was dark, as before, lit up only by the pale light shed by a footlight near the window. Nothing moved. We paused, frozen in the doorway. I looked hard, and in the gray shadows I could make out the bedsheets, which were rolled back as if the occupant had gotten out of bed and pushed the covers back. The window was open, and a breeze passed through the room, rustling papers I had left at the bedside only a few minutes before. Something else was moving above the bed, two fluttering surfaces, like an animal flailing in the darkness. 

At last I whispered to my companions, “This is crazy. It’s just a patient. We’ve all had a million of those.” Walking into the room, I switched on the light.  

The darkness disappeared, and the room was empty. We could now see that the fluttering above the bed was two empty blood bags.   

“I thought you said you brought two units of blood in here,” Jenny said. “These bags are empty.” 

“There was blood in them. Two units. The bags were full, I swear they were.” 

Jen examined the bags. “Name’s right on the bag. But there isn’t a drop of blood in them. Clean as if they had never been used. And look at this.” She showed me the base of the bag, and her fingers touched two puncture marks in almost the same place in both of the bags. 

At the bedside table, there was a piece of paper folded once over into a little tent. The word “Laura” was written on one side. I picked it up. It read: “I thank you for your assistance, and regret that I was unable to wait until you properly placed the IV and infused the blood the proper way. I regret that I lied to you — I am not a patient man — I could not wait. 

“You are an attractive young lady and I hope perhaps we shall meet again. In my younger days I might have considered asking you out for a drink, but my doctor informs me that I have a drinking problem, and I am trying to abstain from consuming my favorite beverage in its fresh form. That is why I came by tonight, to keep from going out drinking. 

I wish you a pleasant night shift. 

Your most obedient servant, 



Ben Carson and Gun Control

“I would not just stand there and let him shoot me. I would say: ‘Hey, guys, everybody attack him! He may shoot me, but he can’t get us all.’ ” -- Ben Carson on Fox News, October 6, 2015
“I think the likelihood of Hitler being able to accomplish his goals would have been greatly diminished if the people had been armed. I’m telling you that there is a reason that these dictatorial people take the guns first.” -- Ben Carson on CNN, October 9, 2015

Ben Carson holds many views that seem incompatible with being a physician. His defense of creationism, which involves wholehearted attacks on evolution and Big Bang theory, is one. Another, his weak-kneed support of childhood vaccination schedules, is especially concerning coming from a man who is not just a neurosurgeon, but a pediatric neurosurgeon.

His comments about guns, which on the surface seem to have little to do with medicine, also betray a thinking alien to a physician's training.

Telling the public that the Oregon shooting victims should have fought back is a way of blaming the victim. It is tantamount to saying that if you are killed in a mass shooting, you were too weak or cowardly to fight back. Gun-toters, in comparison, as this smarmy logic goes, are self-starters -- bootstrap people. Folks who would never put up with being shot.

As with his creationism nonsense, Carson's gun argument makes a joke out of logical thinking. They are certainly not the words of a man well-versed in scientific principles. The idea that the Jews would have survived the Holocaust if they had guns may be material for a bad "what if" science fiction novel, but it is neither science nor responsible fiction. There is no evidence for it, and it is not the kind of statement a person trained in evidence-based science would make. It is using a fairy tale in support of a public policy statement, and it is extremely sloppy thinking, even by political standards.

Ben Carson styles himself as a physician-politician, outside of Washington politics. As a president with a physician's sensibilities, he would be expected to apply the best information available to craft effective government policy. Isn't that his selling point? Instead, with his gun arguments he shows that he intends to base national crime policy on science fiction. This foolishness makes a joke out of politics, and out of his medical degree.

In my years as a practicing physician, I have taken care of many dying patients. One problem I have come up against, as has any doctor who seriously engages with the dying, is the patient with a terminal illness who thinks he has a moral duty to fight to the bitter end. This determination to fight, while often beneficial in the early stages of a battle, can be detrimental in the end. Patients often get tired, and if they could come to terms with death and decide to spend their few remaining days enjoying the time they have left and making peace with the inevitable, they would end their days more happily.

I have often treated patients whose bodies were riddled with cancer, truly at the end, who suffered needlessly because they couldn't give up, because they feared that giving up was a moral failure.

Losing a battle with cancer is not a moral failure. We all have to die one day. No less than 100% of the people in history, no matter how heroic, have died. No less than 100% of the living will also die one day. Dying is a part of life. It is what humans do.

When Ben Carson says the people who died should have fought back, he is tapping into that guilt. He is telling people that to die is to fail. This is not a statement anyone who ever practiced medicine with compassion would make.

A doctor would know that it is wrong to judge people who have died as failures. To say this is to deny the very purpose of medicine. It is to forget that the role of a doctor is not to save lives at all costs, but to help people live more comfortably and happily, and to help them accept that there is no shame in dying when dying finally comes.

I have to assume, based on what the media tell me, that Ben Carson once practiced legally as a physician.

But what kind of physician could he possibly have been? Certainly one without compassion for the dying.


Climate Change: A Parable

All of the people who deny climate change and the danger it poses put me in mind of a story.

Once upon a time there was a scientist who studied various cultures. He traveled far and wide in his studies, and one day took a journey on a ship that landed on a remote island.

Despite its remoteness, the civilization was fairly advanced. People lived comfortably, and there was enough food for everyone. However, the scientist noticed that there were very few trees on the island. Looking closer at the land, he saw many tree stumps, and realized that at one time the island was lush and green. But today, all the trees, except for a handful, had been cut down.

He saw that the islanders had no plans to save the few trees that were left, and if things continued in this way, the trees would all soon be gone.

The scientist sought out one of the leaders on the island and asked him about this. "I can see that your island was  once lush and green, and covered with trees. You seem to have cut them all down, except for a very few. Soon you will have no trees at all. Why have you cut them all down?"

The man said, "Look around you! We have an advanced civilization. With our technology we have been able to make wonderful things for ourselves, and to live comfortably."

"Yes," the scientist said, "but what does that have to do with the trees?"

"My good friend," the man said patiently, "many centuries ago, we were a primitive people. We needed trees to provide shade from the sun and protection from the weather. But now that we are so advanced, we have comfortable homes, and have no need for the protection of trees."

"Ah," said the scientist, "I see. What do you build your beautiful homes out of?"

"Wood," the man said.


Writing with Pen and Paper

Lately I have been reading The Artist's Way by Julia Cameron, a book that, although ostensibly about the craft of writing, is deep down about the practical problem of curing writer's block.

Ms. Cameron strongly advocates that all artists should engage in an activity she calls "Morning Pages," which consists of 3 pages of uninterrupted longhand writing, to be performed every morning as soon as the writer wakes up. Morning Pages must be stream-of-consciousness writing, set down as fast as the writer can go, must be ink-on-paper and not typed, and must be done daily, first thing in the morning. A fairly strict exercise, to say the least.

I have been trying out Morning Pages for the last few weeks, and have formed a few opinions about the practice. First, while it would be nice to open a day with 30 minutes of writing, this is not possible for me with my job. When I am off, I can do it. On workdays, forget it. It gets done when it gets done, and that is not always in the morning. Second, every day is not possible either. I do it when I can and leave it at that. Thirty minutes is a lot of time, and some days I don't have 30 uninterrupted minutes to spare. (I may have 30 minutes, but all in one block is another thing entirely.)

I do, however, like Cameron's prescription that the Morning Pages be stream-of-consciousness writing, getting words down as fast as possible, as soon as the words come into my head. This, in my view, is critical to Morning Pages, because stream-of-consciousness writing helps the writer to overcome that internal editor that often stands between an artist and a blank page. Stream-of-conciousness also is an efficient way to empty the mind each day, and helps me clear my brain of random thoughts. It is a daily brain dump that gets a lot of rattling concepts out onto paper, distractors that otherwise hinder clear thinking. Morning Pages sets the stage for more constructive writing.

And as a side benefit, it also leaves a written record of this cathatic process, so, if any of the results of the brain dump turn out to be worth keeping after all, I can recover them for later use.

But what I like best about the Morning Pages is Cameron's Luddite insistence that the pages must be done on pen and paper. No computer, no typewriter, and, God forbid, no e-tablets or Dragon Dictates. Just plain old pen and paper.

This has been unexpectedly valuable to me. The Morning Pages, it turns out, are something of a meditation exercise. A way to mechanically, methodically, focus on the process of writing for a finite period of time each day. Essentially, meditation through writing.

And when I do it, I find the best way to push myself through 3 written pages of stream-of-consciousness writing is to focus my attention of the tip of the pen as I write. As I fix my mind on the tip of the pen, the pen becomes the conduit of my mind, the contact point where ideas and the muscular contractions of my forearm and hand become sentences. Because I can focus all my attention in one place, at the pen point, I can develop much better than normal concentration on the writing process.

Compare this to writing at the computer. When I write on a computer, my attention is focused on my fingertips where they contact the keyboard, and also at the cursor on the computer screen. My attention is not in one place; it is divided between two. I can remedy this problem partially with touch typing -- by looking solely at the screen instead of at the keyboard, I can keep my attention mainly on the cursor on the screen. This works until I misspell a word.

But it is not the same as pen-and-paper. Even with optimal touch typing, my mind is still somewhat divided between fingertip and cursor, and this slight division makes a difference in my level of concentration. For the purpose of meditative writing, pen and paper is superior. Meditation is, after all, about developing focus, and centering everything on a pen tip is about as focused as one can get.

This raises the question: If this is so, does this mean that all writing should be done longhand?

I don't think so. That obviously takes a good idea too far. However, I do think it would be beneficial for writers if every important writing project involved pen and paper at some stage. An initial rough draft in longhand, longhand notes on index cards, an outline, a hard copy with pencilled in revisions -- at some stage, every bit of writing could involve pen and paper, even if the bulk of the work is computerized. This step could help writers focus on their writing, perhaps improving clarity and concision.

Would it improve the quality of writing in general? There are no studies to show, but my intuition is that it may not. There has been, in the last 20-30 years, a gradual shift from longhand writing to digital creations, and there has been no discernible difference in writing quality over this period. Sure, you will find critics who argue that the quality of writing in the digital age is going to hell, but I defy any of them to pick up a book off any shelf and tell me if it was written on a word processor or by hand. It can't be done.

I think the benefit of longhand writing accrues not the the reader, but to the writer. That is to say, writers should engage in longhand writing from time to time, not because it will improve the quality of their product, but because it make the writing process more enjoyable and therapeutic for the writer.

Since the writing process is a something of a journey, we can compare it to travel. If you travel from your own home to a friend's home, does it matter to him if you took the bus, your own car, or a bike? No, not at all. But it matters to you. The difference between a cycling trip, a walk, or a car ride is significant. On a bike, you feel the wind, the rain, the temperature. You have to be much more mindful of pedestrians, wet roads, mud, and the cold than you do if you ride in a car.

Auto drivers generally consider travel time to be dead time. In a car, you listen to music, adjust the climate control, and think about your destination. On a bike, you check the weather before you leave, both for the time you leave and for the time you will be coming back. You feel the wind, notice the hills, and curse at the indifferent motorist who cut you off. On a bike, you are much more focused on what you are doing than if you drive. The experience is entirely different, even if it has no effect on what happens when you arrive at your friend's house.

This, I think, is also true of longhand writing. Handwriting is more laborious, more careful, and you are aware of more things as you do it. You notice the sensation of your hand on the paper, the flow of the pen, the texture of the page, the ink smears as you write. When you dot the i's and cross the t's (or if you do). When your hand gets tired. The tactile effect the handwriting process has on the writer is much different from more clinical experience of cranking out words on a word processor.

I am not advocating abandoning the computer. I wrote this article entirely on the computer. (Nor would I advocate abandoning cars for every purpose and only relying on the bicycle.) But pen-on-paper is a different traveling experience from computer writing, and if you are the type of writer who writes not only to create product but also to allow the writing process to change you (which is the way I think all writing ought to be), then spending some time with pen and paper will benefit you. It forces you to pay closer attention to every word as it curls out, and puts you in more organic, concentrated, and undistracted connection with the writing process. It makes the writing process more present.

I know of no word that better describes it than presence, being in the moment, and thus being more completely in the writing. Pen and paper writing can take you to places in your mind that digital writing is not likely to lead you.

But like all writing craft, this sense of presence does not emerge immediately. You have to do it daily, and exercise it until, in time, it exercises you.





Katrina, Ten Years Later


This blog began in October of 2005, two months after Hurricane Katrina hit New Orleans and the Mississippi Gulf Coast. I started the blog to write about Katrina and its aftermath, which was a subject very close to me. At the time, I was living in my mother-in-law’s house in Metairie, Louisiana, one of New Orleans’s suburbs, because my house had been flooded with 12 feet of water, and a declared state of emergency prevented us from returning to our home in St. Bernard, because St. Bernard was still considered too dangerous for civillians to visit.

As I recall, the precise impetus was an online post. My mother-in-law didn’t have internet service, so I found one of those AOL CDs that gave you 500 free online hours (yes, it was that long ago) and logged in through dialup. On one of the AOL main pages was a link that said, “Is America Getting Katrina Fatigue?” The link connected me to a forum where posters were complaining that New Orleans had received enough money and it was time to move on. On to the next human disaster, I guess; the next American rubbernecking opportunity, brought to you by your favorite cable outlet. It was the end of October, mind you, not even 60 days after the storm. Half the city didn’t have electricity yet. But floods and hurricanes were so…you know, summer of 2005.

I joined the discussion, identifying myself as a displaced storm victim, and tried to gently push back. This storm was bigger than you know, I said. Over a million people have been affected. They will need time.

The responses I got were casually dismissive -- get a life pal, just move away to high ground, good luck but I pay taxes and we’ve paid enough, so long NOLA and thanks for the redfish -- that sort of thing.

That was when I decided to tell my story, to explain what happened in New Orleans, and why America needed to step up and help one of America’s more remarkable and fascinating cities. I started a blog.

That was 344 blog posts ago.

When I started writing about Katrina, there were dozens, perhaps hundreds of people online just like me, writing about their experiences. There were so many of us that there was talk of creating a Katrina Blogging Association, and from what I heard there was even a planning meeting to get the Association off the ground. But, as is so often true, enthusiasm for new the project peaked at the beginning, and as soon as the first anniversary passed, blogs began to fold and disappear. Today, besides me, I don’t know of anyone in this group who has continually written since 2005.

Despite my longevity, I cannot claim that even I have maintained a laser focus, and over the years my posts have been less and less often about the New Orleans recovery and more and more about whatever else was on my mind. But Katrina has never been far from my thoughts, and I have always returned to it. Like it or not, it was one of the defining moments of my life, and I am certain for the rest of my days I will think of my life as having two halves: Before Katrina and After Katrina. No one goes through something like that without being effected by it.

As the last man standing, I can tell you that even though blogs have gone out of style in favor of Facebook and Twitter and Tumblr and whatever else is coming next, I still prefer the freedom of this medium and have no intention of stopping any time soon. I hope to be writing about Katrina’s 20th anniversary, and the 25th as well. There is no reason for me to stop. It has been therapeutic work.

My family belongs to that part of the Katrina diaspora that never returned to New Orleans. Right after the storm, I would not have considered not coming back, but things didn’t turn out as I had planned.

Before the storm, I was working in St. Bernard Parish — a parish being Louisiana’s equivalent to a county — just east of New Orleans. St. Bernard was devastated as badly as any area hit by the storm; about 90% of the land in the entire parish was flooded. The parish was closed to residents for almost 2 months after the storm because all of the roads were impassible and it was unsafe for people to live there, or even visit. (Hence my exile to my mother-in-law's house.)

I admitted patients to two hospitals in the St. Bernard region and worked at an outpatient primary care clinic across the street from one of them, a 150-bed facility named Chalmette Medical Center. After the storm, the company that owned both of the hospitals, Universal Health Services of Pennsylvania, decided to cut its losses and never to reopen. That left me without a job. Facing student loan payments that the U.S. Government politely refused to offer an emergency deferment for, I took a job in McComb, Mississippi, about 100 miles north. After three years, I relocated to Jackson, MS, 200 miles from New Orleans, which is where I am now.

My job in McComb was a little better than the job I had in Chalmette, and my job as a hospitalist in Jackson has been much better for me than my job in McComb. If I had returned to St. Bernard, I would still be doing outpatient medicine instead of the inpatient medicine I am doing now, because St. Bernard did not have a hospital and would not get one again until 2013. Once I decided I liked hospital work better than the clinic, there was no opportunity for me to go back, because there was no hospital in my old community to go back to.

Overall, the drift 200 miles north allowed me to change my career arc, going from mainly outpatient medicine to 100% inpatient. The change agrees with me, and so I find, a decade later, whether I like it or not, that Katrina opened the door to a career path that has been better for me more than I ever would have thought.

This is one of Katrina's lessons. Change is often good, even if it is painful. New Orleans was always a city that resisted change, sometimes with a supernatural fury. Outside of the South, it is probably very difficult for most Americans to appreciate how little New Orleans wanted to change before Katrina. New Orleans was a place that treasured the tiles in the cracked sidewalks that spelled out the names of the streets. It was a place where a restaurant could trigger a customer revolt by changing its menu. Parents sent their kids to the same schools they went to, and their kids sent their kids to the same school again. Moving out of a neighborhood was the act of an expatriate. Half of the cultural calendar revolved around a social behemoth called Carnival, and the other half around a series of outdoor festivals that ran through the spring and fall. It was cozy, but closed. If you weren’t a native, it was nice to stand on a corner in the French Quarter with a hurricane (the rum drink) in hand and take it all in, but if you stayed — and for most people the crime rate was way too high and the schools way too bad to consider a thing as rash as that — but if you did, it would take years for you to break through and understand it. It was beautiful, and crazy, and closed, and corrupt, and violent, and poor.

New Orleans had to change, just as I had to. Some of the change Katrina brought has been good, some of it bad. But on balance the change has been good, because it has shown so many people in the city that change is possible, and that it is also possible to let go of things that seemed very dear, too dear to be parted with, and yet go on.

It is hard. It is necessary.

As a physician, I feel I have something to add here. Taking care of hospitalized patients all the time, I see death up close, sometimes on a weekly basis. I have personally witnessed the death of a patient probably 20 times now. About once a week I have to walk into a room and tell a patient he or she has terminal cancer. It is not something you ever get used to. But it is necessary. Death is necessary.

If no one ever died, there could never be change. Imagine if the plantation slaveholders were still alive today. If the Nazis still lived. If the ancient Romans still walked among us. How could we, with people like this in our midst, move forward? Humans can adapt to change, and some humans are better at it than others, but no person is capable of infinite change. So we all most go when our time comes. And at last, it is best that every one of us gives up our purchase on earth and move on, leaving it to future generations to use as they see fit, without having to worry about what we would think.

Officially, 1,833 people died in Katrina, but there were many smaller forms of dying that occurred. People who lost their churches. Their homes of many generations. Their pets, their schools. Their best friends and neighbors. In this sense every one of us, all the 1.5 million people who were displaced by that terrible storm, had something within us die.

Which also is hard. And also necessary.

The great lesson I learned from Katrina, one I paid a high price to know, I offer free of charge. I learned that there is no physical possession that a person has that he or she cannot afford to lose. When we left our home in Chalmette for the last time on August 28, 2005, I knew there was going to be water in our house. We tried to put everything of value up high, on shelves, on top of kitchen cabinets, on top of the refrigerator, and in the attic. But our attic got 2 feet of water. Absolutely nothing that we had was untouched by the floodwaters. What we packed in the back of our car — a few suitcases and a few household items we knew we might need if our exodus was more than a few days — was almost all we had left when it was over. I forgot to bring socks. I lost all my socks. Shoes, combs, books, family pictures, my CD collection, winter clothing, neckties, dinner dishes, Christmas decorations — every single thing that you can think of that you use on a daily basis, plus everything you don’t. Nails, wood screws, wash cloths. Extra light bulbs. Packing tape. Extra buttons. It takes years to accumulate all the crap the average American has lying around his home, most of it only there for the rare occasion when he needs it. But it is only when all that stuff is buried under 2 feet of swamp mud that he realizes how much of it there really is, even in the most modest of homes.

And you know what? We lived. Got it all back and then some. Bought new coffee cups, new T-shirts, new throw rugs, mechanical pencils, letter openers, staples, wicker baskets. A back yard thermometer. Electrical extension cords. A Snoopy with a Santa hat that stands on the front lawn and lights up. It took a long time, but we eventually replaced it all. And it wasn’t all that horrible. You learn that you are surrounded by junk, junk you spend years and years of your life accumulating, junk you are afraid to throw away because somehow you just know that one day you will need half a roll of electric tape and a 1994 edition of the Guinness Book of World Records. So you keep all that garbage, and it piles up, and it drowns you.

But it isn’t necessary. All you ever needed is people who love you. The rest can all go. It really can. You can try it and find out, or you can save yourself a lot of money and trouble and take my word for it.


Tragedies are never desirable, but this one did increase my faith in the relationship between loss and renewal. I have found that there is renewal in loss, although if you lack faith in this precept you may never see it. But it is there. My Katrina experience greatly increased my belief in this. What you lose, you will get back in another way. I think of it concretely, as God’s plan for the world. Part of the Divine plan is that there is gain in losing. Sometimes, it is impossible to gain without losing.

This does not mean we cannot enjoy the things we have. But we have to be careful not to cling to them. What we have may be taken away from us at any time, but in time we will receive more. Even people who have little religious faith must appreciate this — destruction is rebirth; with every death there is a successor, and sometime two or three.

To understand this is to see loss differently. Those who cling to their possessions do themselves no service. Every day has to be a preparation for loss. This does not mean rejecting what we have, or resisting putting down roots again. Of course I have begun my life again, and once again put down roots. But now I know that if I fall too much in love with what I have, then what I also am nourishing is an unhealthy lack of faith in myself, in my values, in my God. I have to trust that whatever I lose can be replaced by something new and better, just as New Orleans must trust that it can replace its past with something new and better.

To a large extent, the ability of New Orleans to recover finally from Hurricane Katrina depends on its ability to let go of its past. If it does, it will discover what I have — that many things can pass away, but that does not mean you will lose your identity as a result.

I have lost so many, many things, and yet not lost a single thing. I am more myself than I have ever been.


A year after Katrina, when I was still working in my clinic in McComb, I saw as a patient well-dressed African American woman who was clearly angry about something.

“Everyone talks about what happened in New Orleans,” she said. “It’s all over the news, all the time. No one ever talks about what happened in Mississippi. Katrina missed New Orleans. It hit the Mississippi coast head on. People act like Mississippi doesn’t even exist.”

To this day I am not sure what prompted that outburst. I don’t ever volunteer that I lived near New Orleans and in the path of the hurricane. It could be that she had read my blog. I also did a radio interview at a local station about my medical practice, and talked about Katrina and New Orleans briefly. Perhaps she inferred that I was from New Orleans because of my name, or perhaps my nurse said something. But I don’t know.

I must confess that her remark turned me against her. I was directly affected by the storm in a major way. I lost as much as anyone, except for those who lost their lives. What right did she have to say that to me? Did she know who she was talking to?

Although I kept within professional bounds, making no attempt to argue with her, she must have detected my attitude, because she never came back to see me again.

She had a point, though. Mississippi has been overlooked in the Katrina discussion on a national level. There were many more affected citizens in New Orleans, to be sure. But I passed through the Mississippi Gulf Coast several times in the months after the hurricane, and I can attest to the brutality of the storm there.

On refection, I have come to realize that I can relate to her complaint, because in a way, I experienced the same thing. Before Katrina we lived in St. Bernard Parish, which directly borders the city of New Orleans. The Lower Ninth Ward, the famous area that got so much press coverage, the area that President Obama visited on Katrina’s tenth anniversary, is no more than 3 miles from Chalmette, the town I worked in. What the Lower Ninth got, St. Bernard got also, in every way. We had to; there was nothing separating us from the Lower Ninth but a skinny little drainage canal. The water passed right through from them to us. (And just as much passed right through us to them.) But the whole world knows what happened in the Lower Ninth and Tremé. There was a story in the New York Times and the New Yorker just this last week about the Lower Ninth and Tremé. St. Bernard, equally devastated, was almost unmentioned.

This bothers me, but only a little. The Lower Ninth’s story was our story, in the end. Same hurricane, same degree of destruction. I would rather the reporters that cover the storm know one area well than skip back and forth between neighborhoods, confusing the whole thing. When I think about Hurricane Sandy as a counter example, this becomes clear -- I know the storm hit Staten Island fairly hard, but with limited knowledge of New York geography, I understand very little about the variations in damage between one neighborhood and another, or between New York City and nearby New Jersey. And I probably never will. TV cameras (and my mind) work best when they focus on one thing. It is simply the way things are.

While I realize that the Mississippi Gulf Coast was just as devastated as Chalmette was, I have to commit to the reporter’s mistake as well. I have to tell the New Orleans story. The St. Bernard story. Focus on one thing, and let the others slip. I have never concerned myself much with telling Mississippi’s story. Maybe that is unfair, maybe I owe my patient an apology, but I wasn’t living in Mississippi when Katrina hit, and I have written from personal knowledge and experience about a city I know intimately. I must write about what I know.


Because the tenth anniversary is upon us, there has been a resurgence of Katrina stories in the media. There have been stories in the New Yorker and the New York Times, in USA Today, stories in the local papers here in Jackson, specials in many of the national news networks and PBS. And NPR. Interestingly enough, only NPR is the only entity I know of that covered St. Bernard Parish in any depth.

The Katrina Revisited stories that I have seen so far fall into two categories: the New Orleans Overcame stories and the Katrina-as-racial-microcosm stories. Both are slightly discomfiting.

The NOLA Overcame stories are a varnishing of a terrible story. An attempt to fit Katrina into a familiar story arc, the tragedy that leads to a happy ending. Even President Obama was doing that when he told a crowd in the Lower Ninth that "there's something in you guys that is just irrepressible….The people of New Orleans didn't just inspire me, you inspired all of America.” As in most NOLA Overcame stories, the President proceeded to backtrack and say there is a lot of work ahead, but the damage was done. In these stories, Katrina has morphed from an inscrutable calamity into a good ol’ American success story.

Robin Roberts’s reporting for ABC follows the same script: “At the 10-year mark there has been great progress. There are more restaurants in New Orleans than ever before….The area is not only being rebuilt, but revitalized as well. But there is still much work to be done…Katrina is a story that's still unfolding. There are many wonderful chapters left to be written. It takes courage to believe that the best is yet to come.”

Yes, New Orleans has bounced back remarkably, but these bootstrap stories oversimplify the great challenges that faced New Orleans in September of 2005, and fail to come to terms with the successes and failures such as they are. New Orleans has always had a polarizing effect on visitors, and it has a history of inspiring both positive and negative national news stories in nearly even measure. This is because New Orleans has always been complicated, and doesn’t fit into any easy category. But post-Katrina, now it does. It can be slipped into a neat, familiar story form, complete with stunning visuals. But like all nonfiction storylines, it is partly fiction.

I would be remiss if I did not admit that it is gratifying to see so many positive stories about my hometown. It is always good to have your image buffed up. That being said, it isn’t the truth, at least not the whole of it, and I don’t cotton to myth-making.

The second type, the type the focuses on race and Katrina, troubles me as well. These stories take a national disaster and turn it into a controversy, something edgy and topical that fits into a different story arc: the national narrative that has emerged out of big stories like Ferguson and Baltimore and Charleston in the last year.

Clearly the Katrina story had a lot of racial tension in it. It was plain what color most of the people who stayed behind were. It was also clear that the Bush administration’s slow response to the storm had something to do with its congenital inability to empathize with the poor and people of color. Equally galling is a recent poll by Public Policy Polling showing that 29% of Louisiana Republicans blame Barack Obama for the poor Katrina response. Salt on a wound: It isn’t enough that racial prejudice underlay the anemic federal response; racism has to be involved in assignment of the blame.

Yes, all this is granted.

But it is easy to oversimplify. I have repeatedly heard the argument that in New Orleans the rich people lived on high ground and the poor (i.e., blacks) lived in the low lying areas. This is only partly true. I wasn’t poor. My house flooded. The Ninth Ward flooded, and it was poor. But so did Lakeview, a rich neighborhood, and Mid-City, which was racially mixed. Tremé, which was poor and black, got some water but is actually on relatively high ground; most of it was covered in only 1-2 feet of water, which is not extreme in a flood-prone city like New Orleans. Perhaps the fairest thing to say is that the flooding affected the poor and the African-American disproportionately, but some of this is because New Orleans was 67% black to start with, and in the black population, citizens were disproportionately poor. So statistically, if you were to flood New Orleans, the largest identifiable affected group would be poor and black, no matter how high above sea level they lived.

It isn’t that I object to looking at race as a factor in the outcome of the hurricane. But putting race in the center stage encourages the assumption that only black people were affected by the storm, which isn’t even close to being true. Kanye West’s assertion that “Bush doesn’t care about black people” was a welcome statement for me, but it wasn’t entirely true. President Bush wasn’t just ignoring black people. He ignored plenty of white people as well. Just the other day I saw a graphic on the news observing that 75,000 African-Americans in New Orleans left after Katrina and never came back. True. But even more white people did the same, and I have never seen a graphic indicating how many whites left and didn’t return. I am one.

Katrina was a natural disaster, which means it did not discriminate. Making the story about race confuses this truth. One might argue that this is acceptable because the African-American story is rarely told, and Katrina is an opportunity to tell it. Also that Katrina unearthed racial inequality in Louisiana that was already there. I fully understand that on occasion we have to let minorities have the center stage, without allowing other voices to run out into the spotlight and dilute the story. Cultures that are not heard from often enough need the microphone, and need not be interrupted. But while this is permissible, even right, it has to be acknowledged that this filtering is contrived. Focusing on one group by definition means that something else is being left out.

Maybe this is just a what-about-me cry, but I don’t think so. The problem with the Katrina-as-racial-microcosm story is it obscures what I think is an equally important, if not more important matter. Katrina unearthed a second problem, one not often talked about, because most discussions about what happened 10 years ago devolve into how much better things have gotten, or how much the disaster was all about race.


The great question Katrina leaves open is this: What resources should we mobilize to save our cities? This is a much more important question than most people realize.

America has always been a lucky nation. Up to now, or at least up to around the 1970s, we have grown and expanded without much effort. We moved west, we built upward, our cities sprawled, we migrated from one boomtown to another, and all without any planning or, really, without anyone even wishing it. No president led the migration to the Great West; no Congress authorized skyscrapers or ordered up the silicon chip. No one called in millions of immigrants at the precise time our great factories revved up. No one told hundreds of thousands of African Americansin the early 1900s to flee segregation in the South and move to the north just in time to help Detroit build the world’s largest transportation manufacturing hub. All of these things happened naturally, with very little oversight. This has led Americans to think that growth occurs without planning, that letting events run their wild course is the best way to keep a country strong.

But like a stock broker who rides a bull market to the top and mistakes his dumb luck for stock picking skill, America has given itself too much credit. The wind was always at our backs. We always had land, natural resources, enough able bodies, and isolation from the problems of the world to grow as we saw fit.

New Orleans is the counter example. Before Katrina, New Orleans was one of the poorest of America’s great cities. High crime, poor schools, corrupt politics, racial segregation. The city, once the largest and richest in the South, had hit the wall that many American cities will eventually hit: It ran out of easy resources. The wind stopped blowing at its back.

New Orleans is a river city, and its problems began when America built a rail and later a highway system that diverted the freight business away from river shipping. At first, as the shipping business ebbed, New Orleans simply shifted to another natural resource, oil, which Louisiana had a lot of. This secondary boom lasted until the late 1970s when oil became a global business. People didn’t talk about (or fully understand) globalization back then, but as oil became an international business, the city was deeply hurt. New Orleans lacked the big banks and financial markets to hold onto the real oil money. The globalization of oil meant consolidation of corporate oil into huge financial centers. In short, the big money went to Dallas and Houston.

Since the city was so heavily dependent on oil, the loss of big oil money devastated New Orleans, and it has never really recovered. I remember those days, during the recession of the early 1980s (few Republicans remember that Ronald Reagan presided over a deep recession during his first term), when unemployment reached nearly 20% in Southeast Louisiana. It was a very painful time for the city, one that is strangely forgotten. In Louisiana, the recession was so very deep because the economy in the city, and in Louisiana in general, was so dominated by the oil business that its withdrawal left it with little to fall back on. Everything in New Orleans since about 1980 has been about tourism, because after the big oil money walked, that is all that was left.

What Katrina exposed in New Orleans was a city without a vision. What the city needed in the 1970s and 80s was for the city and community to step in and step up civic planning, education, and infrastructure. It is possible to survive the loss of a huge industry like oil if you replace it with the proper long term planning. New Orleans was always too corrupt for planning, and so it slowly rotted instead. But the city remained interesting and different during this period for a peculiar reason — New Orleanians have always had a sense of easygoing resignation and a comfort level with dysfunction and decay that makes the place fun to be, even in bad times. Yes, New Orleans says, we’re on the train to hell, but we are going to have a good time on the ride down! There is something touching and charming about this devil-may-care attitude, but only up to a point. That point is the moment the hell-bound train reaches the terminal station. That point was called Katrina.

I could go on and on about the social and economic factors that I think led to the disaster of Katrina. But we can now go straight to the point. Once a city reaches the edge of disaster, once a town has fallen so far that it is almost — almost — beyond redemption, the question arises: What is a city worth? How much should a nation pay to save one of its own cities? What does culture and cultural diversity mean to a huge nation like the U.S.A? What is lost, if we leave one of our own cities to be reclaimed by the kudzu?

New Orleans may have been the first American city to face total destruction, but it won’t be the last. After Katrina, cities like Detroit, Flint, and Newark, NJ complained that their towns are also falling apart, but lack the glamour of a major hurricane to attract national attention and emergency help. And they are right. Many American cities are falling apart, not as dramatically as New Orleans did, but falling apart nonetheless, and we seem inclined to just let it happen.

Shortly after Katrina, Speaker of the House Denny Hastert (today of statutory rape fame) told the media that he thought New Orleans “could be bulldozed.” Hastert has been hated in New Orleans ever since for saying so, but he was only voicing a common thought. How much should we pay to save a city?

Given global warming, this is a question we will be asked again. In 50-100 years, rising seas will claim Miami. Most climate change models have all of Florida going under if seas rise as predicted, assuming we continue to do what we have been doing to control carbon emissions, which is nothing. So how much is Miami worth? How much is Lower Manhattan worth, which will also go under? What about Boston Harbor?

In the wake of Katrina, this question has barely been answered. As a native New Orleanian, I feel my hometown is absolutely worth saving. America sort of agreed, and shelled out just enough money for a partial rebuild. The city is trying to do the rest. It isn’t clear yet if its best effort will be enough. Another storm could take it out just as easily — while the levees have been rebuilt and even strengthened, little has been done to fix the massive damage to the wetlands around Louisiana that protect it from hurricanes. These wetlands have been largely destroyed as a result of decades of oil drilling and the dredging of shipping lanes. If this problem is fixed, New Orleans has a chance. If not, the rising ocean will take the Crescent City along with many other coastal towns throughout the world.

So the real question raised by Katrina isn’t merely a question of race. It is a question of culture. How much do we value New Orleans? Detroit? Miami? Newark? If we care about our great cities we will care for them. Detroit’s manufacturing money has run out, just as New Orleans’s oil money did. Are they disposable?

I think not. But the challenge in that answer is this: America has passed the stage where it will continue to remain strong despite neglect. We are at the point where, if we want to save parts of our nation, we will have to go out and do it. Actively, aggressively. Letting things take their natural course will not suffice. If we do, these great cities will dissolve and collapse.

You can’t always solve the problem of a blighted community by abandoning it and building beautiful tract houses somewhere else. We all know how that ends up — with a city where all the vitality is on the surface, out on the edges, and at the center is a rotten, empty core.

Ten years ago, New Orleans had its own rotten, empty core torn wide open. It was lucky. Most cities never get the chance to be cored out, washed clean, and to start again. The cities that do not get that opportunity have my sympathy. Katrina was not entirely unlucky.


Sunday, August 28, 2005. The last time I stood outside my house in Chalmette before it was destroyed, a neighbor approached us from across the street.

He was a retired widower in his late 70s. His son lived just down the street, and his daughter and her family were around the corner. He had spent his entire life in St. Bernard Parish.

“Looks like this is the big one,” he said. “I’m headed north with my daughter but all of this is going to flood. I hope you are leaving, too.”

“Yes, we are packing up,” my wife said. “I guess the river is going to overflow.” She meant the Mississippi, which roiled its way towards the Gulf of Mexico about a mile from where we stood.

“Oh, no,” he said, “The water will come from that way.” He pointed to the swamp on our east, to wetlands that were defended by a sagging 14-foot levee but were in tatters from decades of costal erosion.

He was right of course. The Mississippi levees held; instead, the storm surge came up the Mississippi River Gulf Outlet, a manmade shipping channel that for decades had been causing of vast wetland destruction in St. Bernard. MR GO, as everyone called it, formed a huge funnel that concentrated Katrina’s storm surge and injected it directly into Eastern New Orleans. MR GO was badly planned and rendered the eastern side of New Orleans extremely vulnerable to exactly the kind of storm Katrina turned out to be. MR GO is the reason New Orleanians blame the Katrina floodwaters much more on poor government planning than on the storm itself.

“Good luck to you,” our neighbor said. “I hope we all make it back.” We said goodbye, and he turned and disappeared into his home, where he continued his storm preparations.

We never saw him again. He evacuated north, headed towards the Midwest, and somewhere along the way contracted pneumonia and died in a hospital far from home.

Of course he didn’t die of pneumonia. He died because his heart was broken.

New Orleans is being rebuilt on a shoal of broken hearts. Sometimes when I think of the storm, I think of our neighbor, who technically is not included in the 1,833 people said to have died from the storm. But he was a Katrina victim nonetheless, as were countless others who fled the storm and died in exile.

The forgotten victims. This day is for them.