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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
« Sunday, August 28, 2005 | Main | Friday, August 26, 2005 »
Sunday
Aug272006

Saturday, August 27, 2005

On the morning of the 27th things were rapidly changing, but I was not yet aware of that. The first item in my Saturday morning ritual was to read the police reports.

Prior to Hurricane Katrina, my family lived in Meraux, a small town east of New Orleans. Meraux (pronounced MEER-oh) is one of a string of towns that runs along the Mississippi River as it flows southeast from the city to the Gulf of Mexico. Meraux is in St. Bernard Parish, and is about 10 miles from New Orleans city limits (In Louisiana, we call our counties parishes.) One can visualize the geography of our area by thinking of the towns along the river as a train of boxcars parked along the east bank of the Mississippi. The first car after downtown New Orleans is the Lower Ninth Ward, now known worldwide, thanks to media coverage, as the epicenter of the worst of Katrina's damage. The next boxcar is Arabi, the first town in St. Bernard proper; then Chalmette, the parish seat and St. Bernard's largest town with a population of about 25,000; then Meraux. After Meraux comes Violet, and beyond Violet is mostly swamp country, an area usually referred to as Lower St. Bernard.

Meraux is not incorporated, so there is no specific population estimate, but I would guess at least 10,000 people lived there. It was a sleepy collection of subdivisions plus a K-mart, two grocery stores, a small Sears, about ten restaurants, a drive-through daiquiri shop, and a half-dozen churches. (As I liked to brag, St. Bernard had almost as many churches as bars.) It was also modestly affluent, though not impressively so — recent census data showed our zip code to be among the 5 with the highest average household income in the immediate New Orleans area. The people who lived there, especially the ones in my neighborhood, worked white-collar jobs in the city, or were in the oil business. A few were fishermen, primarily oysters and shrimp, but most people who fished for a living lived "down the road" in Lower St. Bernard.

St. Bernard Parish — or the Parish, as it was known to its residents — was, despite its proximity to New Orleans, a very isolated place. The Mississippi is to the south, the Gulf of Mexico to the east. To the north is swampland — it was a 10-mile hike up Paris Road through that swamp to reach civilization in New Orleans East. To the west is the Ninth Ward, the only direct contact the Parish has with improved territory. Longtime St. Bernard residents rarely strayed from its borders, giving the Parish a very definite air of isolation from the rest of Greater New Orleans. St. Bernard is both part of a large metropolitan area and a place all unto itself. It was a place where everyone knew everyone.

Which is why I routinely spent Saturday mornings with the police reports. Almost every week I found at least one person in it that I knew, and frequently it was several. It was a way for me to keep up with my patients, to learn the social history I never got in the examination room. I was not the only doctor in St. Bernard that checked up on his patients this way.

A brief scan of the police reports that pregnant Saturday yielded an unexpected find. A patient of mine and his brother had been arrested for running a prescription forging scheme out of his home. He wasn't caught with a single fake scrip. He and his brother had an entire operation for faking prescriptions and apparently (or allegedly, if you please) was trafficking both the fake scrips and the medications he got with them out of his home. It was a fairly serious busness enterprise. And, no doubt, some of those fakes had my name and DEA number on them.

I have been betrayed by patients before, so I can't say I was surprised. But I was disappointed. I had cared for this particular patient since I started practicing in Chalmette four years before. He was one of my very first patients. His need for pain medication seemed obvious enough — he had a severely disfiguring case of rheumatoid arthritis, and was unable to walk without crutches. Most of the joints in his fingers were frozen from the disease, and his right leg was fused at the knee in the flexed position, making even crutch-walking or sitting in a chair awkward. I had never doubted he needed pain medication, and could not believe he would break the law to get it. I had never turned him down. I could only surmise that his brother had put him up to it.

The report deeply disturbed me, because of all the patients I saw for chronic pain issues, he was the one I felt most likely had a real need for pain medication. As a physician, I carry this arrest with me to this day; if my most trusted patient was deceiving me, what was I supposed to think about all the others?

So I had that to consider, even before I turned to the television, which was now running Katrina coverage nonstop. Have you ever been watching television, only have the signal interrupted by a high-pitched screech and then an announcement that "This is a test of the Emergency Broadcast System"? That morning, for the first time in my life, after I heard that annoying screech an announcer said, "This is not a test" and then directed me to an emergency channel. The world, or at least St. Bernard Parish, really was coming to an end.

On Friday Katrina was forecast to curve through the Gulf and land somewhere near Apalachicola, Florida. Saturday, the projected path had shifted radically west, and the dreaded dashed line now bisected the city of New Orleans. We were about to get skewered. Katrina was a Catagory 3 hurricane by then, with winds approaching 115 miles an hour. She was 435 miles away. The Gulf of Mexico was very, very warm, and Katrina was expected to intensify markedly over the next 24 hours.
It was the first time I had to acknowledge to myself that his storm might hit us, and that it could be catastrophic.

Like most people who grew up on the Gulf Coast, I had inherited a natural nonchalance about hurricanes. Storms entered the Gulf almost every year. So many years, so many storms, and in all that time nary a scratch. Most of the time a storm projected to hit New Orleans veered to the east or west; this had happened so frequently in recent years that many New Orleanians began to feel our city was charmed. Prayers were our civil defense instead of stronger levees. In 1969 Camille struck the Mississippi coast just east of New Orleans. In 1992 Andrew passed through Florida and rolled through Morgan City to the west. Georges grazed the Louisiana coast in 1998 before fading to the east and hitting Pascagoula, and in 2004 Ivan, a truly devastating Catagory 4 storm, turned away from a direct path to New Orleans and crushed Pensacola, Florida.

The Ivan and Georges near-misses were particularly harmful to the ever-unrealistic New Orleans psyche. Both times the city was evacuated, with great confusion and cost, and both times the storms turned away at the last minute, hitting the Alabama-Florida coast. People who evacuated told stories of massive traffic jams and confusion. Some spent 14 hours in evacuation traffic just to get as far as Baton Rouge — and all for nothing. Folks were getting tired of leaving, and many now favored taking their chances at home instead of spending hours waiting on the interstate for a storm that just might veer away as the others did.

One of my indelible hurricane memories came courtesy of a hurricane no one remembers — a storm that threatened the Louisiana coast when I was in grade school in the 1970s. I remember the storm as Carmen, though I may have the name confused with another. It was a Catagory 3 storm at least, and was for a time projected to hit New Orleans. Then it drifted west and out of my memory, possibly hitting Texas or Mexico, or maybe breaking up into hurricane oblivion. Carmen whipped New Orleans with fierce winds as she sat indecisively off our coast. School was cancelled, and I spent my unexpected day off (the best holiday of all!) with friends, riding bicycles on our neighborhood street. We had contrived a thrilling game. The wind was so strong we could ride to one end of the block and raise up a trash bag on our handle bars. The trash bag, acting as a sail, would carry us down the street at close to 20 mph. It was great fun.

Unfortunately, that was my first hurricane lesson. Hurricanes meant school was out, and we could coast on our bikes in the wind in the street. Not exactly healthy respect.

A lot of people, including some of my friends and neighbors, felt that Katrina would be another close call. I wanted to share their confidence, but didn't quite. I had noticed that hurricane prediction had gotten much better in recent years. With Hurricane Ivan, for example, the National Weather Service predicted days ahead of time that the storm would head straight for New Orleans and then curve off to the east, which is exactly what it  did. The National Weather Service nailed Ivan's path so perfectly that I was not willing to write them off this time.

The NWS's prediction on Saturday morning: Katrina was going to hit the New Orleans area dead on, its eye possibly passing directly over my house. This was a storm to take seriously.

Since I had two children to think about, I was not going to ride this one out unless it was absolutely necessary. But I had patients to consider. One of my partners was on call for the weekend, but Katrina was to make landfall Sunday night. It was technically my responsibility to make rounds on Monday. If getting back on Monday was at all possible, I would need to do it.

Our medical practice had plans for an office party at Drago's restaurant in Metairie on Saturday evening. Although I was off, I had agreed to help my partner on call, John Green, by rounding at Methodist Hospital. This would allow him to finish up weekend rounds in time for the party.

After I took in the weather report, I headed out to Methodist to see my four patients there. Word was out that we were in Katrina's sights; Methodist was emptying quickly. On all the floors doctors were discharging every patient that could walk.
As I went in I ran into a nephrologist on the way out. He had just rounded on one of my patients, and I stopped to talk to him about her. I had intended to send her back to the nursing home where she lived, but we agreed instead to leave her in the hospital for Katrina. She needed dialysis, and we both thought she would be more likely to get this continuously if she stayed in a hospital, instead of a nursing home, where she stood a chance of being stranded. (As things turned out, Methodist flooded out and the patient eventually had to be evacuated by boat after spending days in the hospital without electricity or running water. The nursing home, on the other hand, evacuated prior to the storm. She would have been safer there.)

On my way through the ICU, I asked one of the nurses what the hospital plan was going to be. Methodist had evacuated for Hurricane Ivan, transferring all of its ICU patients by ambulance 120 miles away to Lafayette, Louisiana, and then back when the storm passed. The whole process was very, very expensive and very chaotic. I was concerned that, like the many citizens of New Orleans who had been burned by the disorganized Ivan evacuation,  Methodist administration might be likewise hesitant to evacuate again.

The ICU nurse told me that administration had not made a decision yet. The official word was that all staff scheduled to work Sunday morning were to bring an extra change of clothes. In other words, the Sunday morning shift could be asked to stay more than the customary 12 hours. I was surprised that plans were no more specific than that. Katrina was expected to make landfall in the next 48 hours. Of course, by Saturday morning it may not have mattered. It may have already been too late to get the ICU patients out.

I finished rounding and called my wife. The TV stations continued to report a direct hit. She asked me if I could pick up some hurricane supplies — diapers and batteries. I told her I would try, but when a storm is coming there is always a run on batteries in the stores.

The Sav-a-Center in New Orleans East was mobbed. Then I noticed an empty parking lot nearby — Toys R Us. Certainly a toy store could spare a few batteries.

Toys R Us was deserted. The only active cash register was at the customer service desk, and there were two employees in the entire building. But sure enough, the place was flush with diapers and batteries, as well as a treasure of junk food perfectly fit for a brief evacuation.

The store was disconcertingly silent. Toys R Us is usually a chicken coop on a Saturday, and it felt very strange walking though it by myself. Where were the kids running up and down the aisles, turning on all the toys? Where were the mothers shouting after the runaway kids? Usually the Nintendo section was a din of gunfire, skidding tires, laser beams, ninjas grunting. Today nothing. This was the first time I felt a pang of anxiety about Katrina. This was all wrong. Normal life was not going on.

People often say that a prime sign of a coming natural disaster is the silence of nature. All the birds gone. No chirping in the morning. All the dogs and cats quiet. All the squirrels hiding. I did not notice that, but for me that silent toy store was the same thing. The silence of coming disaster.

I got my diapers and batteries and got out of there.

I can pass on this piece of advice, though. If you are ever in an area where there is a pending civil emergency and you need batteries, go to Toys R Us. No one thinks of going there, but it is loaded with batteries.

From there I went home. I got back in touch with my partner John Green. Dr. Green was on call that weekend, and intended to ride out the storm in his home in Chalmette. We decided to cancel the office party that evening. My other partner, Bryan Gold, was the coroner of our small parish, and John told me he felt it was his duty as a public official to stay also. I thought both of them were crazy. Katrina was starting to look like a major storm, and there was no reason for any patients or medical personnel to remain in St. Bernard, a low-lying parish with water and levees on three sides. Chalmette Medical Center should be evacuated, and it was stupid that it was not. Even if CMC did not flood out, there were only three major roads into St. Bernard, and all three crossed over water and so could easily flood or even wash away completely. There might not be a way out. Why did anyone think there was a reason to stay?

Worse, Chalmette Medical Center and Methodist Hospital were both owned by the same company, Universal Health Services of King of Prussia, Pennsylvania. Why not at least move all Chalmette patients to the larger sister hospital? Methodist was at least 5 miles further inland, and a 7-floor facility. CMC was a few hundred feet from a levee, and only had two floors. Its intensive care unit was on street level.

But I was not the one in charge. I decided then that I was leaving. Between them John and Tom could handle the patients left, which for our group was now less than two dozen people. I had two children under the age of five to look after, and I had other doctors covering my patients. It was silly for all three of us to risk our lives. One was enough, two was overkill. Three was lunacy.

After the storm was over, I planned to get back as soon as possible to help.

The rest of the afternoon I mostly wasted. My wife was fairly industrious, organizing and packing a few days of clothing and collecting important papers. I spent my time trying to back up my computer hard drive onto an external firewire drive. The program I was using was cantankerous and kept crashing. After fighting with it for hours and hours, I would finally unplug my entire computer the next morning and toss it in the car in disgust. I am lucky I did that; I still have the computer today. If that worthless backup program had worked I would have taken the backup hard drive and left the computer behind. Sometimes bad luck turns out to be good luck in the end.

The only useful thing I did was to videotape the entire house inside and out for insurance purposes, in case of total loss. It is the last record I have of my house as it was. I got everything done except the back closet in our master bedroom. My daughter, fascinated with what I was doing, kept following me around, trying to get in the picture. The last 30 seconds of the video is nothing but a blurred picture and the sound of my voice yelling at my little girl to get out of the way.
All day the news reports were getting more and more dire, and the National Weather Service predictions of the hurricane path were not shifting even a single degree. This one was coming our way, and it was now a category 4, edging towards a category 5.

The phone never stopped ringing. My parents, my mother-in-law, my father-in-law (who was in Florida on business), my brothers. We were all comparing notes. Who was leaving, where was everyone going? My parents were going to stay with my aunt in Baton Rouge. One of my brothers was also going to my aunt's house. The other was taking his wife and children to Baton Rouge to stay with his in-laws.

My wife was concerned about her family. Her mother, who lived in Metairie, planned to leave with my wife's sister and her 3 children, but my wife's brother-in-law planned to stay. Another crazy one.

We also got word that a family friend, a practicing physician, was planning on staying in her home in Lakeview. Lakeview was a low-lying area and certainly not safe from flooding. (As it turned out, her house took on 7 feet of water.) Our friend wanted to leave but her father refused. Her father lived in the Rigolets, a string of small islands near New Orleans that were totally exposed to the storm. Our friend was able to convince her father to come stay with her in Lakeview, but he would not evacuate. So she was staying with him.

This would prove to be the case again and again. It was one of the tragedies of Katrina that many people who had the good sense and the means to leave would stay behind to suffer and possibly even die because close relatives refused to leave with them.

My wife and I worked into the evening trying to get our house in order. Our biggest fear was the wind — the reports were that Katrina would be packing 150 mph winds at landfall now — so we were moving valuable items to areas of the house that would be most windproof. I put some important items, including the Gibson electric guitar my parents gave me on my 16th birthday, in the trunk of my car and parked it in the garage.

But as the day progressed, it occurred to me that high water might be a problem. I started to put things on the counters and tabletops, and some of the most valuable items overhead. Little did I know that the 6, even 8 feet I thought would be safe would still not be high enough. We would eventually get 14 feet of water.

As evening came we heard hammering next door. Our neighbor George and a relative were boarding up his house. Unfortunately, the thought of boarding the windows on my house came to me way too late, and I was not a skilled carpenter. So I had put the idea aside, intending to trust my luck.

George came over and asked if we would like our house boarded also. George and his relative Juan were professional carpenters, and agreed to board up our windows for $200. I was pleased that at this late hour, when everyone was racing out of town, they would be willing to take the time to help us with our house. It was a first class act. Nor was it the first time George had helped me out. He also helped me cut broken branches off the tree in my yard a month earlier after Hurricane Cindy.

George and Juan took their measurements as the sun was going down. For such a frightening weather forecast, the sky was deceptively clear. They promised to come back first thing in the morning and get all the windows done.
That night we stayed up late, watching the weather reports continue to roll in.

One thing stands out in my mind about the broadcasts that evening. At about 10 pm, New Orleans Mayor Ray Nagin was on TV being interviewed about storm preparations. He was in a television studio, and he and the reporter interviewing him were standing in front of a phone bank. Behind them, a group from the New Orleans Society of Jewish Women were answering phone calls from viewers.

As I watched, I recall thinking, "What can those women be telling the callers? How to board up windows? How to swim? How to build your own coffin out of scrap plywood? What was there to say to a caller except "GET THE HELL OUT, GET YOUR ASS OUT OF NEW ORLEANS RIGHT NOW BEFORE YOU GET KILLED!" Why would anyone be calling instead of planning to leave?

At any rate, Nagin was standing in front of this phone bank, and the reporter, a fellow named Norman Robinson, was asking him if he planned on issuing a mandatory evacuation of New Orleans.

Nagin was saying well, he was looking into it, but he wasn't sure if he had the legal authority to do that, that he was talking to some lawyers and he hoped he would be able to get it done sometime in the morning.

And I was thinking, Ray, you are an idiot. I know you don't have the resources to evacuate a city of 550,000. There simply aren't enough cops to do the job.  Moreover, there are a lot of people who are simply too stubborn to leave town no matter what. (I should know, there were two of them working in my medical practice.)

Ray, I wanted to shout at the screen, you will get nailed for this one day. One day, after this storm has passed, people will wonder why the mayor did not order a mandatory evacuation. It just looks bad. So what if he has no legal authority to order it? Who cares about that now? And maybe, just maybe, a few people will hear the word mandatory and finally get out of town. It was worth a shot.

If I thought it would have done any good, I would have ordered a mandatory evacuation of New Orleans.

Nagin was more concerned about legal procedure than he was with getting as many people out the way as possible. As it turned out, his real concern was about getting sued. He was afraid if he ordered all the tourists out of town and the storm missed its target, the hotel owners would sue the city for lost revenue. I think that is the most pathetic thing I have ever heard, and it scares me to think that politicians really have these kinds of thought processes. That money comes before safety. But I know politicians think that, every day. I could read it in the eyes of the President and his pals all of Katrina week.

The mayor didn't have to ask me to get out. We were leaving. Better to be out of the way and safe, rather than rescued by boat. In a hurricane, people who are out of the way don't use up rescue resources.

Before I went to bed, I checked on my computer backup program. It had fouled up again, for about the 6th time. Then I looked up hotel reservations on the internet. My wife and I had discussed it, and we decided to flee to the east rather than west. Everyone was going west, and traffic delays to Baton Rouge were already reportedly over ten hours. So I had it in my mind to go in the direction of the hurricane path, to the east. We would go far enough to get out of harm's way.

I found a vacancy at a hotel in downtown Mobile, Alabama, put down a deposit with my credit card, and went to bed.

Worries frustrated my sleep a little; then I thought of old Hurricane Carmen, and drifted into quiet dreams.

To next Katrina Blog Project entry: Monday, August 29, 2005 

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Reader Comments (7)

Rivetting. I await day 3 eagerly.
August 27, 2006 | Unregistered CommenterPhillip Gordon
I don't know what to say other than to let you know I'am reading. Waiting for tomorrows report.
August 27, 2006 | Unregistered CommenterCathy
Dr. Hebert ... I'm so glad you're doing this, although it must be difficult for you to put it all into writing. I really appreciate the effort you're making!

I can see what you're saying ... those raised to feel that hurricanes were "days off" from the humdrum would face this sort of danger with what could be a disastrous attitude.

Thank you for making the effort to do this. It needs telling.
August 27, 2006 | Unregistered CommenterMoof
Awaiting your next installment! Always a pleasure to read your tales. I still hope you will republish that Gumbo recipe that I seem to have misplaced.
August 27, 2006 | Unregistered CommenterTara
The thought process of politicians goes 'Will I be blamed if this thing blows up?' 'Money before Safety' is a natural sequel of such a thought process.
How do people like your 'President & his pals,' the Mayor and the Governor sleep at night? Don't they get nightmares? Is there no guilt?
August 28, 2006 | Unregistered Commenterscan man
found you through cathy. it really shakes up my world that this is what happened...
August 28, 2006 | Unregistered Commenterkt
scan man: I place less blame on the governor than you might think. Gov. Blanco certainly panicked after the storm and was not as effective as she could have been. She, however, did not hesitate out of political calculation, I do not think. Her ineffectiveness was more because she lost control of her emotions and is not a natural leader.

She may be on the hook for other things, but I do not blame her for thinking of money or political gain at the last moment.

Thanks for writing.
August 28, 2006 | Registered CommenterMichael Hebert

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