We called in sick to work, and walked
The French Quarter banquettes instead,
The sunless winter sky pregnant
With moisture, clouds engorged and grayed
With frigid water -- a New Orleans
December day, cold enough to snow,
And gray enough, and yet it was
Near certain that it wouldn't. We went
Together to the river front
And watched the wind labor against
The River current, waves stood up on end
Between the forces of water and air
Like Claras in so many Nutcrackers
Now playing everywhere these days.
Our hands together, we forsook
The wind, walking up St. Ann's Street
Past the cafe, past the Cathedral,
Drawn on by trains of golden lights
Red bows, drooped garland greens, and pairs
Wandering like us, without purpose.
The cold, the humid cold, the wind
Struck at our cheeks through cross streets.
Each moment the gray sky loomed as if
About to burst, but it did not.
As if an age were near its end,
Another to begin, but the sky
Had not made up its mind just yet.

We took Royal Street to its end, and turned
Into a restaurant suffused with life.
The waiter led us to a window table
Frosted by the humans breathing,
And steamed potatoes. I felt the cold
That streamed off the window on my neck
As I removed my woolen coat,
And turned and sat, my back to it.
You asked for french fries, but they
Did not demean potatoes there,
And so you asked if they would please
Demean an onion ring? They would.
"New Year's," I say, " is the Millennium."
"I thought that was last year," you said.
"No, Jesus was born in A.D. one;
This marks two thousand years."
"Oh," you said, "I didn't know that.
"But you said Christ's birth was 4 B.C."
Oh yes, the monks could make mistakes.
There is no telling when one age
Has ended and the next begun.

Later, we went back out. The sky
Had still held back its moisture, though
The damp was everywhere. A few
Free radicals of brown hair broke
From under your scarf and played
In the air. It is all heat effect, I thought --
All wind, even cold, is driven by warmth.
In this old part of town, an antique
That has seen its day and waits
To birth a new one, we walked.
Two hours past noon the church bells
Rang in the rues, to mark the time
That passed since Jesus wound the clock.
The windborne sound waves rippled over
The Styrofoam cups and scattered beads
From Marti Gras parties* in the gutters.
We sleepily went, then, you and I,
Back to our warm, newlywed home,
And dreamt of this our now, leaving
The mystery posed by Christmas night,
An image of a sleeping child,
To dreamlessly care for itself.

* Though Mardi Gras is a spring holiday, tourists frequently throw Mardi Gras beads around in the French Quarter of New Orleans year-round.

I do not generally like to shill for commercial enterprises in this space, but today I will make an exception. On Monday, December 4, and repeating on December 18, the NBC drama Studio 60 featured the most beautiful rendition of "O Holy Night" I have ever heard.

Studio 60 is a show about a group of comedy writers and performers who put on a television show by the same name. In this particular episode,  one of the segments in the show-within-the-show was the performance of this song.

You can hear and download the song and see the video here.

The song was performed by a group of New Orleans musicians led by trumpet player Troy "Trombone Shorty" Andrews. (Yes, Andrews plays the trombone also.) All of the members of the band are associated with the Tipitina Foundation, an organization devoted to the revival of  the New Orleans musical community after Hurricane Katrina. (If you are looking for a worthwhile charitable organization to donate money to, the Tipitina Foundation is very worthy.)

The four minute piece is an all brass instrumental. The instrumentation is typical for a New Orleans marching jazz band, minus the percussion: trumpet, baritone sax, tenor and alto sax, trombone, and tuba. (For some reason the NBC website credits a drummer, but I don't hear it or see him onstage.) It opens in classic New Orleans style with a solo trumpet. The saxophones then kick in, at first as if they are improvising on the melody also. Then as more instruments join in a clear harmony emerges.

Andrews is spectacular. His trumpet leads are jazzy but never overstated. His restrained riffs enhance the harmonies, rather than leading them. The result is an economical but full and bright sound that is exceptionally warm and beautiful.

Just goes to show that yes, true genius still lives in New Orleans. This priceless recording alone is reason enough to rebuild a city, in my opinion. 

If you like the sound and want to hear more jazz in this style, I recommend one of my all-time favorite jazz albums, Miles Ahead by Miles Davis and Gil Evans. I think one of the reasons I liked this piece so much is that it draws much of its spirit from Miles Davis's cool jazz period in the 1950s.

Jessica had hurt her back, and it was a dog's fault. This alone did not make her story unusual, though. Over the years I have treated many a sprained back, more by far than I would care to, and over this time I have heard so many outlandish injury stories that even "my dog did it" does not stand out. One former patient of mine was hospitalized after she tripped over her dog and rolled down a few steps. Another patient, a middle aged man, laid himself up for a week after swinging a forty pound bag of dog food onto a shelf. Yet another had an encounter with a tree after swerving to miss his neighbor's dog on the way to work.

A dog-hurt-my-back story? It would take more than that to impress me.

"Well, it wasn't actually the dog itself that did it. I was on my way to Pittsburgh to testify in court to get my dog back, and I slipped on the walkway to the plane and fell on my back. It has been hurting me ever since. I have this pain just to the left side of my lower spine, and it shoots down my leg."

"Okay, wait. You traveled 1,400 miles to see a judge about your dog?" I shifted in my seat. This one might be good after all.

"Yes, I did. It was my son's dog, and I wanted him to get it back. A woman in Pittsburgh had it, and she wouldn't give it back to us."

Naturally I wanted to hear more about this story, but she had not come in to talk about her dog. I addressed the medical issues at hand. Once she had answered my inquiries about the mechanism of injury, and the intensity, location, radiation, duration, and character of the pain, I moved on to the physical exam. As I usually do during a physical, I asked Jessica a few personal and social questions. The layperson might call this small talk, but to bill for it we doctors prefer the term "obtaining a social history."

"Tell me more about this dog." I said, as I palpated her cervical lymph nodes.

She did. Jessica was a longtime patient of mine, first visiting me at my practice in Chalmette, Louisiana. After Hurricane Katrina destroyed Chalmette and forced me to Mississippi, Jessica found me. She and her family had moved to the country town of Amite, LA, and she still commuted to her old job in New Orleans.

Jessica rode out Hurricane Katrina with her husband and son in Chalmette. It is not clear to me why they decided to stay behind, considering the extreme danger and the fact that they had a three year-old with them. Jessica has always been rather vague about it, simply insisting that their car had broken down. At any rate, they did stay behind, and soon regretted their decision. Their home was flooded with 7 feet of water minutes after the levee broke, and the three of them had to scramble up the attic ladder to keep from drowning. They escaped from the attic by cutting through the roof with a hammer and chisel, and waited on top of their house for an entire day before being rescued by the Coast Guard. They fled first to a shelter in Baton Rouge, and eventually ended up in Amite. They lost everything they had to the hurricane.

Everything except, unbeknownst to them, their dog. Brownie, a 25 pound terrier mix, somehow survived Katrina and was picked up, fithy and starving, by an animal rights group a week later. Brownie first traveled to Tylertown, Mississippi, only 30 miles from where I live today, and then was forwarded to an animal shelter in Pennsylvania.

The animal rights group arranged to have every canine refugee placed in a foster home. To join the program volunteers had to sign an agreement promising that they would return the dogs immediately when the owners came forward. That was the arrangement, anyway.

After much suffering, Jessica, her husband, and her son, settled in a FEMA-provided trailer near Amite City. For the longest time they had no idea that their dog had survived the storm and was still alive. They were surprised and delighted when a letter arrived in their mailbox notifying them that that a dog had been rescued from their old residence.

The story should have ended there with a belated and happy reunion of boy and dog, but, this being America, the law had to get involved somehow. Jessica contacted the animal rights group at its headquarters in Utah. According to Jessica, the group was initially very unhelpful. First they said they did not know what happened to the dog. Then they said they were looking into it. Phone call after phone call and there was no progress.

With nowhere else to turn, Jessica petitioned the Louisiana State Attorney General's office. And, in the most shocking turn in this story, the Attorney General's office was helpful. Someone from that office, perhaps sensing that it might be good for public relations to help a three year-old boy find his dog, sent a letter to the animal rights group. In the letter, they tersely explained that the dog is the boy's personal property and that if they do not produce the pooch forthwith they could be charged with looting.

Next thing Jessica knew she was in possession of a name, street address, and email address of a woman in Pittsburgh.

Again, one would think the story should end there; but no, that would be too easy. The Pittsburgh woman refused to return phone calls. Jessica emailed her asking if she could have a picture of the dog to verify that it was in fact her son's. The woman emailed back: This is not your dog, and no I will not send you a picture.

Jessica persisted. Does the dog answer to the name Brownie? No, came the answer. Can we see him? No. After many weeks of exchanged email messages, Jessica finally threatened to go to court. The women wrote back, saying that by the time Jessica got a lawyer and got before a judge, the gate to her yard would inexplicably be left ajar and the dog would go "missing."

That was enough for Jessica. She contacted the Attorney General's office and the animal rights group. The group agreed to pay for a lawyer, and to fly Jessica to Pittsburgh to plead her case. But, lest anyone presume that the animal rights group was being generous on this count, Jessica says the group didn't agree to take this step until she let the Attorney General weigh in in on the conversation.

I asked Jessica why she went to such lengths to get her dog back. I am not a dog lover, and I suppose this question revealed my attitude. Not that I dislike dogs; I am simply indifferent to them. Jessica, adopting a somewhat schoolmarmish tone, tersely reminded me that they had lost everything in Katrina, including every toy her son ever owned. Brownie was her son's only possession that survived the storm. The only one. After swimming out of St. Bernard in the filthy swamp water and sewage, Jessica even disposed of his shoes and the clothes on his back. Her son wanted his dog and she was going to get it.

When she got off the plane at the Pittsburgh airport, she slipped on the walkway. Her back ached through the legal proceedings, so she took aspirin and pressed on. It worsened the days afterward, so she took more aspirin and contined to press on. Doggedly.

In the end, the Pittsburgh woman learned the hard way the first rule of law -- when you are accused of wrongdoing, keep your fool mouth shut. The judge interpreted the email in which she insinuated that the dog might go missing as an intention to defy a court order. He ordered the dog seized without warning or a prior hearing.

So this silly woman, who had endeavored to deprive a three year-old boy now living in a government-issued tin can in rural Louisiana of his beloved dog, got her comeuppance. It seems beyond comprehension that an adult would go to such lengths to prevent a child from getting his dog back. To do would require a degree of villainy that borders on the cartoonish, like a real world Cruella De Vil. I couldn't help but be amused by it, blackguard that I am.

I imagined this stupid woman sitting on her sofa in her Pennsylvania home. Here comes a knock, like the Stalinists in the night, and she opens the door. A cop shoves a court order in her face, and another darts into the house and snatches up Brownie as if he were ten kilos of prime hashish. Then the door slams, there is a whirr of a siren and the spinning red light in the distance throws red bursts across her sheer curtains, filling her room with crimson pulses. And there she stands, dogless. The fierce moral eyes of the universe upon her, judging her badly.

And the turn that might embarrass her most of all: One week later, a doctor in McComb, Mississippi sitting at his desk, busting a gut in amusement over her audacious misadventure.

It is not over. This woman has gotten her own lawyer and petitioned for a hearing. She is arguing that she was deprived of her animal without due process and that she has a right to confront her accuser. So Jessica has tickets to go back to Pittsburgh in a month, where the judge will again listen to the case. It is, however, impossible to imagine by what constitutional precedent a jurist would deprive a hurricane-displaced boy of his floppy-eared friend. He would have to have the heart of a Bush appointee.

The happy ending here is that the seized dog really and truly is Brownie. Boy and dog recognized each other immediately and there were many tears shed in that tin can in Amite when Jessica came home. The reunited pair are having a wonderful time together, and, as a family pet, it is my understanding that Brownie is doing a heckuva job.

Now you knew that last line was coming. 

As we all know, last Christmas season Black & Decker aggressively promoted its Snake Light, a flashlight with a flexible barrel that makes it perfect for every kind of repair work in darkness. America responded with the heartfelt generosity that only Americans can pour forth, and now every home in the country has a closet containing an unopened box with a Snake Light in it.

This year, Stanley Company answered the challenge of the Snake light, unveiling the Tripod Light. This latest indispensible item is a flashlight with legs. Now, rather than having your light snaked, you can enjoy it perched atop three cantilevered aluminum tubes. One wonders what discoveries Sir Issac Newton might have made about the properties of light had he such a miraculous light source, instead of the sorry sunlight he unjustly contended with.

I predict that next year, Black & Decker will respond to this aggression with the Tripod Snake, a combination of the two with all the benefits of both, and more.

I further predict that in January 2008 Black & Decker with withdraw the Tripod Snake from the general market, triple its list price, and announce that the Tripod Snake will be introduced into the medical market for gastroenterological and gynecological applications. It will also be wildly popular in the porn film industry.

My suggestion is that you adjust your financial investments accordingly.

Once again, I want to tell the story of Hurricane Katrina. Not the political one, but the ecological and engineering story. The story about the wetlands, and the levees that destroyed them. In the aftermath of Hurricane Katrina, this story needs to be told more than any other. It explains the magnitude of the Katrina tragedy, which was not only the a result of human and political mistakes that you may have heard of, but of long term errors you may not have.

The tale begins thousands of years ago, long before humans inhabited the Mississippi delta. Almost all of southeastern Louisiana was built up out of the ocean by the Mississippi River. The Mississippi, which drains runoff from 31 states and 2 Canadian provinces, carries billions of tons of silt annually to its mouth. Over the last 100,000 years, up until as recently as the early twentieth century, the river annually overflowed its banks, flooding thousands of square miles of wetlands and depositing the billions of tons of silt in the process. This annual flooding gradually built up a landmass that comprises most of the southeastern Louisiana, including the Isle of Orleans.

In 1719 the French explorer Jean-Baptiste Le Moyne de Bienville founded New Orleans. Realizing the need for a port city along this magnificent river, Bienville weighed many alternatives, and finally chose the current site for economic reasons. France needed a port near the mouth of the river, one close enough to the ocean to provide easy access for very large vessels, but far enough inland that city buildings would be well-insulated from storms and on high enough ground to resist flooding. The oldest part of New Orleans, where the French Quarter now stands, fulfilled these requirements. The land he chose was (and still is) above sea level, and thus resistant to annual flooding. It stood on relatively firm ground on the natural levee built up by centuries of river deposits, and was within a day’s sail of the Gulf of Mexico, making it a better port option than points further inland and on even higher ground, such as Baton Rouge.

Unfortunately, although the oldest part of the city was built on relatively well-chosen ground, as New Orleans grew it gradually overflowed its old footprint. New suburbs developed, houses sprung up in areas further from the riverbanks, and on softer, lower ground. The larger the city got, the more people moved to flood-susceptible areas.

The story of New Orleans’s growth in the nineteeth century is a fascinating one that I cannot go into completely here, but it can be summarized by saying that in the early days the city grew along the river banks on the high ground of the natural levee until the space ran out. Then growth followed several elevated ridges, including the Esplanade and Metairie ridges. After larger levees and more sophisticated drainage canals were constructed, people began moving into the lower areas. It is worth noting that after Katrina, none of these early high ground areas, including the ridges, flooded. The early settlers knew what they were doing. It was the modern builders who forgot.

In the later 19th century, the U.S. government recognized that a problem had developed. New Orleans had become one of America’s largest shipping centers, an absolute necessity for the continued growth of trade in the Ohio and Missouri river valleys, and yet large parts of it were exposed to flooding. More importantly, the annual spring floods that built up the land in the first place presented a practical problem. It was very difficult to negotiate an overflowing river, and commerce would often shut down when the river was at flood stage. To prevent this from happening, Congress authorized a plan to raise levees along the entire southern length of the Mississippi. This allowed for year-round deep shipping channels and kept the river commerce-friendly. (This story is extremely well told in John Barry’s book The Rising Tide.)

In 1927 the Mississippi had a record flood. It was the largest natural disaster in Southern history prior to Katina; the levee broke in 127 places and flooded 27,000 square miles, killing 246 people. The 1927 Flood is a remarkable story in itself, but its relevance to Katrina is this: After the flood, Congress decided it would increase the levee strength to guarantee that such a catastrophe would never happen again. The money was approved, and the Army Corps of Engineers executed the plan.

The plan was successful. Since 1927, the Mississippi has never again overflowed its banks along its entire length from Memphis to the Mississippi Sound. Unwittingly, though, in solving an old problem the government planners had created a new one. Since the Mississippi no longer flooded, the annual silt deposits that originally built up the land in the southern delta suddenly ceased. This interruption of an ancient and beneficial natural process would in time lead to disastrous environmental damage, and make New Orleans far more vulnerable to hurricanes.

The first sign of the harm that the end of the floods might cause was subsidence. Homes and developed land throughout southern Louisiana began to sink, as the soft alluvial soil settled and compacted. With the levees in place, and without continual silt deposits to keep the land healthy and growing, the swamps dried up.

As the swamps dried up, a much more serious problem developed — land loss. Without fresh river water to nourish it, the swampland was slowly eaten away by a process known as salt water intrusion. The Louisiana marshland is very close to the ocean, and only slightly above sea level. The constant flow of fresh water from rain and flooding creates a pattern of runoff from the land outward to the ocean that not only sustains the swamp, but also prevents the salty ocean tide from working its way in. Without this regular outflow and with the land slowly sinking, the ocean saltwater crept in, killing the trees, grasses, and wildlife. St. Bernard Parish, where I made my home prior to Hurricane Katina, has large expanses of old growth cypress forests that are now dead, a direct result of the incoming Gulf water. The process of saltwater intrusion is devastating to the wetlands. Eventually all the plant life is killed, and the soft soil crumbles away in the daily tides.

New Orleans is surrounded by wetlands, a civilized oasis on the edge of one of the largest expanses of swampland in the United States. Fully 40% of the land officially classified as wetlands in the continental 48 states is in Louisiana. As the march of saltwater intrusion continues, almost all of it could be gone within a generation. In all likelihood, the process of land loss began as the construction of the current Mississippi river levee system began in the 1870s and accelerated when the project was completed in the 1930s, but scientists did not begin to fully appreciate the damage being done until 1960s. By the 1980s it was clear that land was disappearing at an alarming rate, and that the process seems to be accelerating. It is estimated the Louisiana has already lost 1900 square miles of wetlands, an area larger than the state of Delaware. Another 500 square miles will be lost by 2050. Currently, the state is losing 24 square miles a year, or the equivalent of 2 football fields every fifteen minutes.

Like most readers, when I first heard these numbers I thought there must be a mistake. Land doesn’t disappear that quickly. But I have seen this land erosion with my own eyes, and the proof is in numerous satellite photographs taken over the last thirty years. See for yourself.

The levee system, unfortunately, is not the only thing that is contributing to this shocking land loss. There is one more complicating factor. Louisiana sits on the edge of one of America’s largest oil reserves, an offshore reservoir currently estimated at over 70 billion barrels. This does not include a brand new discovery in deep water near the Lousiana-Texas border, which could increase that estimate substantially.

The size of this huge oil reserve is reflected in the number of active oil platforms off the Louisiana coast. Numbering over 4,000, these platforms make up the largest concentration of offshore drilling platforms in all of the United States, including Alaska. In the early days of oil exploration, oil wells were scattered throughout the Louisiana wetlands and in the shallow waters a short distance from the shore, in shallow water. As technology has improved, platforms have moved into deeper and deeper water.

To supply this huge number of platforms, oil companies dredged canals through wetlands. These canals were heavily used in the early days, but as of late, as platforms have moved further off the coast, many of them have been abandoned.

These access canals have also been a source of substantial coastal erosion. Daily tides and hurricane surges have repeatedly forced ocean water up these canals, hastening the process of saltwater intrusion. With each tide, and each storm, the saltwater from the ocean kills trees and grass that hold the land together, and as the plant life dies, the land crumbles and washes away. I could give you statistics and scientific opinions, but you can see it for yourself by looking at maps of the Louisiana coast. All of the straight lines that cut across the land are manmade. They are destroying the land at a rapid rate, and very little has been done to stop this process.

There was a time, even in Louisiana, when wetlands loss was not considered an important issue. Wetland, after all, is just another word for swamp, and what good is a swamp? You can’t live in a swamp (unless you are a Cajun).  Swamps are desolate and useless, except when drained and put to good use. So if we lose some of it, or all of it, who cares?

That should be, given today’s state of environmental awareness, an easy question to answer. Louisiana’s wetlands are home to thousands of species of birds, including many endangered ones. There are more alligators in Louisiana than in Florida. The Louisiana wetlands produce the largest seafood catch in America, excepting Alaska, which is many times its size. And the Louisiana wetlands are the home of the Cajun people, a population of about 500,000 French speakers who comprise one of America’s most interesting ethnic groups. All of these things could be gone in our lifetimes.

The wetlands also serve a very important practical purpose here in Southeast Louisiana. They protect inland areas from hurricanes. Studies at Louisiana State University suggest that each square mile of wetlands could absorb as much as 1 foot of a hurricane storm surge. Katrina’s storm surge was about 28 feet in Louisiana. It is not hard to imagine that a landmass the size of Delaware could have absorbed much of this surge, saving many lives and billions in property damages, perhaps leaving New Orleans intact.

The process of land destruction in Louisiana started in the late 1800s when the first levee was erected along the Mississippi and has continued unabated since. Without annual flooding, the wetlands are unable to recover from the horrific damage a hurricane can deliver to the coastline. According to the US Geological survey, Katrina swept away 30 square miles of marshland in St. Bernard Parish alone, or roughly 5% of the landmass, in a single day. Before the levee system, that loss could have been rebuilt over many decades of natural flooding. After the levees, the loss is permanent.

This staggering loss of American soil goes on without any public comment on the national level. As more than one Louisianan has remarked, if a foreign nation were to invade the U.S. and occupy the state of Delaware, we would be outraged. But because the same land mass is washing away an inch at a time, no one gives a damn. We like to see dramatic stories in America. We respond with outrage when buildings blow up and bodies float in the street. But long term, gradual tragedies are not worthy of our attention, even though the net result may be far worse.

It is true that when the levee system that finally corralled the Mississippi was constructed, the builders had no idea that their work would result in wholesale destruction of public lands. In that sense, it is not fair to hold them morally responsible for the damage done. On the other hand, the destruction of the wetlands was well underway by the 1960s and well understood by Louisiana ecologists in the late 1970s. In his book Bayou Farewell, Mike Tidwell says that many researchers were aware of the damage by the early 1970s. In his book The Storm, LSU researcher Ivor Van Heerden says that he was actively publishing research on the subject by 1980.

In 1719, when New Orleans was founded, it was low-lying as it is now, but the thousands of square miles of surrounding wetlands made it far less vulnerable to hurricanes than it is now. This change in vulnerability was human doing, or to be more specific, the doing of the federal government through its efforts to maintain year-round navigability of the Mississippi river. As soon as the levee system was completed, the wetlands were doomed, and Katrina was no longer a mere possibility. It was inevitable. Inevitable that after enough land dissolved into the Gulf of Mexico, New Orleans would become so exposed that a hurricane would destroy it.

Insofar as the levee system was designed and built by the federal government, and insofar as the government ignored repeated warnings by scientists studying the wetlands that Katrina could happen, it is the responsibility of the government to at least make a good faith effort to correct the harm it has done.

The most unfortunate part of this story is that all of this was preventable. The lucky part is that, even at this late date, the coastal erosion is reversible. If the right individuals at the state and federal level recognize what is happening and choose to do something about it, much of the wetlands of Louisiana can be reconstructed. With the proper approach, the city of New Orleans could be protected from a category 5 hurricane, and the wetlands could be brought back.

In the second part of this series, I will explain how the wetlands can be saved.