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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.

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Katrina Blog Project
« Saturday, August 27, 2005 | Main | Katrina, One Year Later »
Saturday
Aug262006

Friday, August 26, 2005

I remember August 26 as a very hot summer day. Temperature 95 degrees, humidity about 40%, no rain. There was a hurricane in the Gulf of Mexico, but that was nothing unusual. In the late summer there was always a hurricane in the tropics. Especially this year. Hurricane season officially runs from June 1st to November 30, but the active period is mid-August, September, and October. Usually there are no storms of note before mid-August. This year, however, was already a record season – there had been 10 named storms, and September was not even here yet. (A storm is named when it becomes a tropical storm – winds greater than 34 mph.) In a slow year 10 named hurricanes was easily a year's worth; 2005 would eventually yield 26 named storms, an all-time record.

Of course, for us it would only take one storm to set a whole lot of records.

On the morning of August 26, Hurricane Katrina was 150 miles north-northwest of the Key West, and heading into the Gulf of Mexico. Winds were 115 mph. Since it was not very close yet, and we were not in its predicted path, I would not have paid it any notice at all except that it had passed just north of Key West. My family and I had vacationed in the Florida Keys only 3 weeks earlier. I had fond and fresh memories of Key West, and hoped it had escaped meaningful harm. (In an ironic coincidence, we vacationed the previous year at Gulf Shores, Alabama, about 3 weeks before Hurricane Ivan ran ashore. In 2006, in case you are wondering, we went to Orlando.)

But my interest in the storm was no more than passing. My workday started at nine as usual, and at the time I thought I had more to worry about than the weather. I was a member of a three-person medical practice in Chalmette, Louisiana. We had the reputation as the busiest office in town – between the three of us we saw at least 100 patients a day, sometimes as many as 120. And that was just the office – our hospital census averaged in the 40s. For me, that translated into a thirteen-hour day, on average.

I was beginning to think that my days in Chalmette were quickly winding down to an end. My two partners owned the practice, and I, as the most recent member of the group, was its sole physician-employee. It was the end of my fourth year in private practice there, and I was long overdue for a partnership offer. In the medical profession it is usual for a practice to extend partnership to a new member after 2 years, 3 at the most. When I thought about it, which I tried not to do, the delay could have been taken as an insult.

On the desk of the senior partner, Dr. Tom Gold, was a letter. The letter was a list of my demands for partnership, and it had been there for almost a month. When periodically I would nudge him about it, Tom would claim he hadn't had time yet to review my proposal. I was beginning to think that he was lying – that he had seen it and was stalling for time to keep me as an employee without offering partnership. The other member of my group, John Green, had already privately told me he was fine with what I wanted. It was all up to Tom, and I suspected he enjoyed being in the veto position. As for me, I was getting tired of being strung along, and had already began exploring other employment options.

That Friday, our office was tumultuous as usual. Chaos was our office decor. We more or less had an open door policy, meaning that my partners and I were supposed to see walk-ins at any time, no questions asked. While John and Tom strictly adhered to this rule, I was more restrictive myself, only seeing true emergencies without an appointment and avoiding walk-ins unless there was an open slot in my schedule. But even still, our clinic was often busy enough to put many a self-respecting ER to shame. My partners thrived in this frenetic environment, but I was not comfortable with it. Sometimes I felt taken advantage of by the endless flow of patients who, knowing our lax schedule system, thought that ambling in at 4:30 on Friday without an appointment and being seen was a God-given right. Another thing I had to consider if I was going to stay.

My Friday office hours were relatively short. Tuesdays and Fridays I rounded at Lifecare hospital, a specialty rehab facility a few blocks from our main base of operations, Chalmette Medical Center (CMC). To make room for the extra hospital work, I left at four. (This Lifecare hospital was owned by the same parent company that managed the infamous Lifecare Hospital at Memorial Medical Center in New Orleans where 4 patients were reportedly euthanised after the hurricane.)

There are no clear memories of my last afternoon in my office. It was a routine Friday, which meant lots of patients with back pain. (Chalmette must have been the chronic pain capital of the world.) I remember sitting in my office after the last patient, surfing the internet and eavesdropping on a conversation some of the nurses were having with Dr. Gold.

Are we going to close the office on Monday, they were asking. They had all been following the storm's progress throughout the day. As was true in every office on the Gulf Coast, medical or otherwise, whenever a hurricane entered the Gulf, and especially a catagory 3 storm like Hurricane Katrina, it became part of the background noise of the day. People scanned the news radio stations. They kept an internet browser window linked to one of the major weather sites, breaking from work every hour or so to click on it and review the updated projections.

The forecast at the moment was for a direct hit somewhere along the eastern Gulf Coast. New Orleans was not the prime target yet. The storm could hit anywhere from New Orleans to as far east as Tampa. I still thought of it as "the hurricane;" it had been named, but I couldn't remember the name. Every year a handful of named storms entered the Gulf. This one had not distinguished itself just yet.

Dr. Gold was addressing the nurses. Always the workaholic, he was nowhere near conceding that the office would close even a day. There is nothing to worry about, he said. You just wait and see. We will all be here Monday morning, and the storm will be landing somewhere else.

Then it was off to my long evening rounds.

At least one of my patients at Chalmette Medical Center was very concerned about the storm. It was a middle-aged woman admitted with chest pain, as well as a diagnosis I hadn't seen in awhile, myasthenia gravis. She was eager to go home to prepare for the hurricane, but I told her I wanted the cardiologist to get a look at her before she left. She was taking the storm much more seriously than I was. I wanted her out too, since there was no reason to risk stranding anyone who could walk out the door, but I was in no hurry just yet. "Tomorrow," I said.

I wrote a note in the chart that she was to be discharged the next day if cardiology cleared her. I assume she got out the next day, but I never saw her again. My partner, John Green, was on call at CMC that weekend. He would have rounded on her on Saturday.

My next stop was Methodist in New Orleans East. I had whittled my census there down to less than five, more from pure luck than out of an earnest effort to clear out for the storm. Friday night Methodist was business as usual.

Finally I arrived at Lifecare. Lifecare was a long-term acute care hospital (we affectionally call them LTACs in the business), which means it specialized in chronically ill patients that required prolonged hospital stays and rehabilitation. Many of the patients there were bedbound, some on ventilators. Our practice group had about fifteen patients on our Lifecare census, and none of them were going home soon.

The staff nurses at Lifecare were talking more seriously about the hurricane than their Chalmette Medical Center and Methodist counterparts. Unlike the hospital, Lifecare cared for the chronically ill, patients whose medical issues could not be quickly cleaned up and sent home on short notice. It could not discharge most of its patients, even in a dire emergency. The entire census would have to be moved, and this meant advanced planning. Of the three hospitals I worked at, only Lifecare was completely empty when Katrina landed. Only Lifecare had zero fatalities.

In almost all the rooms, the nurses kept the televisions tuned to the Weather Channel or some other wall-to-wall hurricane coverage. The storm was intensifying, and it was continuing on its path to our region of the Gulf Coast. Most of the local stations had begun showing Katrina's coordinates and latest satellite videos in the lower right-hand corner throughout all programming. I saw those coordinates in every room I went into; after rounding on fifteen patients, I could have recited them by heart. And yes, I now knew her as Katrina.

And yet I was still partly blind to it. I had patients to care for, a practice to attend to. It was not possible for me to leave unless a direct hit were certain. As I rounded on patients at Lifecare, my mind wandered a bit, and I remembered an intense night only a month earlier – Cindy.

Hurricane Cindy is almost totally forgotten now, but it landed on the Louisiana coast on July 6, 2005 as a minimal hurricane. July 6 was a Tuesday night, and I was rounding in Lifecare the very moment Cindy rolled ashore near Grand Isle, Louisiana. I had carried on my regular duties as if nothing was going on, which shows how much regard I had for her. Cindy blew up quickly off the Yucatan peninsula on July 3, and then made a straight line for New Orleans, with final landfall three days later. Three days from a local shower in the Caribbean to a hurricane over Southeast Louisana. It happened faster than anyone could even think about it, much less worry. When Cindy landed late at night on July 6th, its winds clocked in at 74 miles an hour, making it a minimal Category 1 hurricane. As it approached the Louisiana coast, limping along as what looked like nothing more than a super-sized thunderstorm, no one paid much attention to it – least of all me.

Cindy crossed St. Bernard Parish when I was at Lifecare, and on my drive home after rounds I encountered the fiercest weather I had seen in a long time. I realized then that I was dealing with a little more than a summer thunderstorm. The weather raged all night, and my wife lay awake for several hours worrying that the tree in our front yard was going to fall on our house. As it turned out, my wife's instincts about the ferocity of the storm were correct: although Cindy caused no major damage in our area, it dumped about 6 inches of rain and fairly mangled the maple tree in our front yard.  There was so much debris in our driveway that I was unable to get into my office the next morning.

Close calls like that should raise awareness, but often it immunizes instead. That July 5 night I drove home in a hurricane; I think the experience made me fear them less.

There would be time to develop a healthy fear in the days to come.

To next Katrina Blog Project entry: Saturday, August 27, 2005 

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Reader Comments (7)

Great start to your Katrina remembrance Dr. Hebert. For once I'm thankful for my bad habit of staying awake late trawling the net. Though I know that your story is going to get more difficult and painful later on, for now it reads like a good novel. Thank you for posting this.
I especially liked your closing lines.
August 26, 2006 | Unregistered Commenterscan man
I'm with scan man. Reads well and promises to be very addicting. A daily serial. I imagine you have typed your fingers to the bone doing this.

August 26, 2006 | Unregistered CommenterPhillip Gordon
Very interesting Dr. Hebert. We all know as this story continues, we are going to experience alot of hurt and heartbreak. I will read every word that you type.
August 26, 2006 | Unregistered CommenterCathy
Dr. Hebert ... you have certainly put a lot of work into this. Thank you! You can count on my daily readership.

This first installment reads like a novel ... I have a feeling this is going be seriously engaging ...
August 26, 2006 | Unregistered CommenterMoof
Please tell me more...
August 27, 2006 | Unregistered CommenterBob
As usual, great writing, and compelling. The details of your life make it all the more real to those of us who were spared this disaster.Thank you for posting.
August 28, 2006 | Unregistered Commentertbtam
Holy S***...great read...and I like your version of what happened alot better than what I have seen on tv...will be back..jackie
August 28, 2006 | Unregistered Commenterjackie

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