Driving to Biloxi and Katrina

Okay, I couldn't stand it any more. After working nights the week Katrina hit, coming home and spending four and more hours a morning (when I should have been asleep for the next night shift), watching the latest depressing news from New Orleans, seething in rage at what I viewed as the incompetence of the elected officials, I finally looked at my boyfriend Friday night, as he looked at me, and we said, "Let's go." And it was decided.

Truthfully, we should have said something to our friends, and given them the chance to contribute to the expedition. But we moved so quickly and were feeling a little embarassed in our roles as 'angels of mercy,' that we just decided to collect (and buy) things we thought they could use -- diapers, formula, water, paper towels, toilet paper, and dry goods. (God, would we be sick of 'non-perishable food items' by the end of our little stent!) After waving goodbye to oru enighbors and supoorters, Ann and Barry, we headed south in his un-air-conditioned jeep at 8 pm on Saturday night, not sure what was ahead, but armed for everything from camping in the rough, to armed vigilantes. What we weren't prepared for was basically nothing. It was eerie driving through south Mississippi at 0300, after having heard in Meridian that it was dangerous to stop for anything, that people would rob you or even kill you for your goods and the gasoline in jerry cans we had lashed (under tarps) to the back of our trailer. It was very quiet with only occassional spotting of 18 wheelers barrelling off with goods in the night, and the equally infreqent convoys of trucks and vans, usually laden with supplies like ours, that passed us on Hwy. 59, then 49 out of Hattiesburg.

We saw plenty of destruction along the way, trees that had given up the fight, de-roofed houses, but no gangs or ravening hoards. Truckers in Hattiesburg warned us that we should have guns. We did. They warned us not to stop, and we listened, except for one quick pit-stop and gas tank refill in the Hattiesburg airport. Silent and well-lit. There was no gasoiline available south of Tuscaloosa. And the only place we ever felt threatened was at the last truck-stop west of Meridian where many of the mobile refugees from Louisiana seemed to have washed up. They seemed stuck, hanging about the nearly emptied store with no gas to carry them further. several of the young men seemed to eye our trailer a little too keenly, so he stayed in the jeep while I enquired within about road conditions and what lay ahead. Every time we moved forward it was an act of faith, and every time we saw headlights in the night coming up on us, it was with fear that we watched their approach. There would have been no one to help.

Finally we reached the coast and I-10, at least the portion between Gulfport and Biloxi was open. We had, originally, planned on driving to Baton Rouge to offer my services as a medical person, but after listening to Fox Radio and realizing thery were probably over-supplied there, I decided we might be more useful in the Mississippi Gulf coast. I had grown up in MS, attended professional school there, done my further training and my first job out of school over in nearby Mobile. This was my area of the country and I felt I owed them my first loyalty. We had expected to be stopped and inspected by the National Guard or the MS DOT or the Army, but there was nothing visible watching our approach except a couple of lighted and parked Hum-vees with guns displayed. We headed east on I-10 to Biloxi, having seen no town on the way that looked as if it were so devastated as to need us. We began to laugh that we might need to find some poor person and force him to take our supplies. Never fear, we had yet to reach the beaches. And, truly, we never did.

We didn't have the heart to go and stare at the devastation. It was bad enough a quarter to half mile inland. We drove over the I-110 bridge down into Biloxi and headed back toward Keesler becoming lost amidst the broken houses and finally asking a police officer, parked and watching us on the side of the road. I guess he figured if we were looters, we were going about it in the wrong fashion, importing goods, and he didn't seem particularly disturbed by our sudden appearance at 0400 on a Sunday a.m. He turned out to be one of a contingent of South Carolina police sent to relieve the stressed and over-worked force in Biloxi, many of whom had no homes to go to, had been up and unbathed for 6 days, and had no imminent prospect of a bath or a permanent home. He kindly directed us to Keesler AFB where we had (erroneously) been informed they were doing the medical triage for the region. But the gate sentries sent us on to the local hospital. Paydirt.

A DMAT team from Ohio, sent out by FEMA (yes, the same ones we had labelled 'feeblema') had dispatched them almost as Katrina left the area. They were triaging in the Emergency exit to take the load off the ED. It was the only brightly lit and (as far as we could see) inhabited space in a dead town. But it was the right place.

We drove up to an interested audience, obviously most of their patients were in bed for the night. (We later learned there was an 8pm-6am curfew, though the police would take you to the hospital to and from the shelters.) They watched us in curiosity, most of them in a uniform that identified them as part of a DMAT team out of Dayton. I felt a little shy, and tired, we had been running on adrenaline for almost 24 hours (and the whole week had been draining), but he just jumped right in. Soon we were chatting with the night rep who, while unable to take our supplies, was able to direct us to the police sergeant who could. When she learned I was a doctor, down to offer my services, things looked up. She made us promise to return whenever the police were finished.

While she was calling around, we got into a conversation with the DMAT team members and another self-propelled volunteer (respiratory therapist) from FL. Like myself he had trained in Mobile and felt a certain loyalty to the region, and, we soon realized, he had worked at the same hospital during the same era as I had. In fact, we had even been named in the same lawsuit. [It had been dismissed against me after preliminary depositions (I had only been the physician who showed up to the code) but he had had to go through the whole trial process before the case against him was dropped at the very end.] We both laughed and hoped the next time we saw each other we'd have something else over which to reminisce.

My boyfriend, originally from Ohio, was having his own 'old home week' with the team from Dayton. Soon, however, we were following "Curly with a K" to the disaster building as the sun started to rise. Behind the police department was a Catholic school that served as one of the distribution point for goods/food/water. As we drove through town more of the shattered old trees became visible. The whole town had a feeling of a junkyard. Everything was frayed, rubbed raw by the winds or seawater, refrigerators, stoves, carpeting, panelling, fixures, cabinets, all stripped form their water-damaged homes, sitting in disconsolate heaps before them. Downed power lines, like live oak moss, dripped down from aboveus; we swerved repeatedly to avoid them.

PART TWO

We arrived at the PD/Disaster Management Center to find another couple with a fully loaded truck of supplies. The Biloxi police unloaded us both with alacrity, taking the scarcer (and, therefore, more valuable) baby supplies inside. Large flats of bottled water stood everywhere and people walked around constantly with one in their hands. It reminded me how dehydrated I felt after a night of warm drivng with the air battering me from the open car windows and it was already getting warmer which magnified my sudden exhaustion. What I really needed now was a nap, but the cold beer he had packed seemed equally inviting. But where to consume it in front of folks who were glad for just the water? We asked Kurly and he laughed. "We'd all have one with you if we weren't on duty." We drove over to park under a decapitated ancient live oak at the back of the lot, and quietly sipped on a Heineken as we stared about us in the gathering light.

A man whose still-standing deck abutted the parking lot seemed to be cooking breakfast on his grill outside; there were no lights on in his house. He was in dirty shorts, shirtless in the heat, and wearing slippers that looked suspiciously like hospital issue. He laughed with a friend as they both watched us surreptiously drink our beers. If we'd thought to, we'd have packed more than a six-pack. When the police drove up or passed us various times, they always stopped to say hello, and thanks for coming to help, and not a one of them seemed to care about the beer-sipping occurring on official land, but we kept it to one beer anyway. I was fading fast.

We returned to the hospital as we'd promised V. (the night rep) after Kurly had told us he didn't think there were any safe places to set up a tent in their area. When we mentioned it to V, she also shook her head, but told us we could have an unoccupied room upstairs. Apparently about half the homeless nurses, techs, etc., were residing in the hospital, both because they had no other place to go and for convenience should they be required for some serious emergency. I also introduced myself to the administrators, nursing and otherwise, who looked, in dishevelled shorts and limp tee-shirts as if they, too, had been living at the hospital. My licenses were inspected, and my ID check before they asked me when I could work. I felt pulled to start right then, there were dark circles under many of the eyes around me, but knew I'd be a much better docotor for a few hours nap. I asked for a night shift, which turned out to be just fine with all the permanent ED physicians.

They had been there, more or less without break, for 6 days. All of them had lost their houses and had had to ship their families out of town. None of them had any place to stay, and lived at work. Unfortunately, the hospital cum dormitory had no running water, intermittent electricity, and only port-a-potties for toilets, even for the walking patients. Everyone had done their best, but showers were usually 'in a box' or consisted of baby wipes. No one smelled 'ripe,' but no one smelled daisy fresh either. Hair styles among the nurses were along the creative "Survival" modes -- many braids, kerchiefs, spiked, slicked down really flat. Anything to disguise the fact that the nearest shower and shampoo was several counties away.

We were also hungry about this time, having only had one sandwich en route to the Coast, and that one about 9p the last night. By the time we got settled in the patient room with our inflatable (and never used mattress -- the narrow hospital bed was much more confortable than the cold floor) we were trying to make ramen noodles with an inverter and heating element. Not very sucessfully. Finally, by inquiring (he was good at that) we determined that there was one working microwave and nuked the water for my lunch before tucking me into bed while he went off to satisfy his curiosity. I slept fitfully with constant din of crying babies, overhead announcements and construction noises as the workers continued through the long Sunday afternoon to repair the roof and electrical wiring. The generator they used was effective in keeping a temporary AC going, sometimes a little too well, but no one wanted to complain that it was 'too cold.' After the week before, in stupefying humidity and heat, that would have been sacrilege.

I awakened to a supper of peanut butter crackers, the summer sausage we imported, and bottled water before reporting to the ED in less than professional garb. Unfortunately, in our haste to pack I hadn't thought ahead to what I might wear, figuring wherever we were it would be hot and shorts and tees would be appropriate, that, or rubber waders (which we'd also packed.) I did have my ID badge so that, at least, they knew my name.

PART THREE

The guys, whom I had met about 1400 when they all seemed to gather together to plan out the coming week's renovated schedule, were a young bunch, mostly 30's and early 40's, all with children and wives, none with any home to go home to. One had a loaned RV, from his father-in-law, and was considered to be quite a target as all the nurses circled around him, hoping to be invited to use his shower with a freshly filled water tank that actually contianed usable water! He said he'd been elevated from refugee to trailer park trash.

Another doctor, who labelled himself 'the night shift king,' and lived in New Orleans had only been able to see his house via satellite as it was still underwater near the Garden District. His family had to evacuate to Mississippi and he had been on the last four nights and was trying, desperately, to arrange a ride to Kiln, on the road to Picayune, before his three-year-old (whom he'd not seen in that time) went farther north to her grandparents on Monday evening. He had neither car nor gas, but, being an Emergency Medicine Doctor was entitled to a gas ration card which FEMA was dealing out to those involved in rescue/medical/shelter work. (This explained the cordoned off gas pumps we saw from Meridian south which were labelled 'For use of Authroized Emergency Management Vehicles Only.') We worked a moderately busy Sunday night shift together, with the background his attempts to arrange a ride. It involved working around the curfew (which he was entitled to ignore, but Cam could not), the gas situation, and Cam's exhaustion. We finally sent him to bed at 0300 for a nap so that he could be fresh to drive at 0700 when Dr. J got off. Later, one of the FEMA personnel loaned him his personal vehicle and we allowed Cam to sleep undisturbed.

Meanwhile, back in the ED, we were busy keeping clean as best we could amongst the mayhem and jury-rigging, using only hand-gels. The makeshift AC worked until the switch was flipped reconnecting the hospital with Mississippi Power, shortly afterwards a huge blue arc was seen in the distance along I-10 and, once again, we were dark for 10 seconds or so. Then the hospital generators did their job, but no CT, no regular Xray (only portable films -- not as powerful), the chemistry machines in Lab (complex and finicky devies) went down, and, the AC was off, again. The ED crew shrugged philosophically, they were used to it.

We treated every diarrhea patient who might have drunk the water, as if he/she had cholera or salmonella. We treated every cellulitis (skin infection) as if it might be infected from seawater with v. vulnificans. Unfortunately, we weren't able to treat the elderly and debilitated as they needed. Many of the truly elderly, greater than 85 years old, simply needed a break from the overwhelming humidity and heat. They didn't have the metabolism to deal with >90 degrees F or >90% humidity, but we didn't have the beds, the AC or the nursing to deal with them. It truly was triage medicine, and on one of the ED doctors told me a stark story of having to decide, in the midst of the immediate aftermath, to black-tag a living person.

'Black-tag' means to label someone as 'unsalvageable.' It means they get 'comfort care,' i.e. pain meds, oxygen, hand-holding, but that they are not salvageable under current conditons. He had an elderly man who came in in Monday night, after the storm had ravished them, with upper gastrointestinal bleeding. He was vomitng up great gouts of blood and would have taken up their entire available supply of blood. Ordinarily they would have put out a call for more blood from surrounding hospitals, but the roads were blocked, lines were down, phones were down, they were on generator power, and the means to save him would have sapped their hospital of effectiveness to treat other patients who might be more saveable. This a terrible decision to have to make when you are used to the American way of health care -- everything for everybody-- but is not unfamiliar to those on a battlefield or those in third world countries. It makes us in health care very uncomfortable, to judge someone living as worth saving or not, but he had to make that decision. He'll remember this his whole life.