Hurricane Ike Feature - November 2008
Tex Med . 2008;104(11):47-49.
By Lee Frierson-Stroud, MD
Editor's Note: Dr. Frierson-Stroud was one of dozens of physicians who volunteered to care for evacuees at shelters coordinated by the Dallas, Bexar, and Travis county medical societies.
I'm beginning to feel like a veteran. Ike is my third Hurricane. I triaged at the foot of the bus doorsteps when bewildered, lost souls from New Orleans arrived at the Convention Center loading dock. I rounded on group home evacuees from Rita. Now I'm getting ready to return for my second tour of duty as part of the Travis County Medical Society's response to Hurricane Ike.
Perhaps because I was there the night that Ike slammed ashore, this hurricane felt like Katrina. The big screen TV was blaring as "Weather on the 8s" intermingled with reports of Austin's response to the hurricane. Concerned evacuees sat in front of the screen, taking in the information.
When I arrived, I was greeted by well-organized staff who gave me a necklace with a plastic circle, a.k.a. "the blue olive," which served to identify me as a volunteer. I made my way past a police contingent to where the patients were being housed.
The organization was impressive. There was a row of computers ready as patients walked or were wheeled or rolled in from the loading docks. After being checked in, they were triaged by the nurses and assigned a cot. The exhibit hall had been separated into essentially six areas. The first was the walkway. Then there were five rows called "pods," each divided by curtains. Each "pod" was then subdivided into seven nurses' stations (A-G). There were about 12-16 beds per station. The numbers were taped to the floor. Patients were being assigned primarily to Pods 1 and 2, with a smattering in Pod 4A. Pod 5 was for caregivers and their families. Each very low cot had been made, with even a pillow and blanket in place (one colorfully decorated Little Mermaid blanket topped one cot). At the foot of each cot was a blanket and towel. Row upon row of cots waited silently for inhabitants.
The problem patients - ones who needed to be checked on to be sure they had gotten up during the day, the psych patient who had just been placed on his meds, the gentleman who had just had an abscess lanced by a local ER MD, the three-year-old boy with a feeding tube and oxygen who desaturated when he cried, were all pointed out. This came in handy later when the psych patient ended up back in the triage line. I was able to connect him with his bed.
We would assess each patient as they came in. A week's worth of meds, if needed, would be prescribed. I had to call my office manager to get my DPS number - something about a new law. These prescriptions then were filled at the pharmacy, located in the concession stand. Orders were written, including getting oxygen concentrators and nebulizers for some. These would magically appear. A gentleman in his 40s who was to have a brain tumor removed was set up for possible clinic referral, depending on the Galveston situation. Patients who were more appropriately placed in nursing homes were triaged away, making room for others who would arrive later. I got my first request for a med refill today in my fax machine at the office. I'm going to have to figure out what to do about these requests.
Our tour guide's advice had been to just make the rounds. The volunteer nurses would call us over. The nurses were marvelous, taking care of these newcomers. They set up their MARs and carried out the orders as best they were able. One confused soul, who would later be taken to a nursing home, was patiently taken care of even to the point of one gentleman giving her a foot wash. When she was changed from her soiled undergarments, her dignity was protected as best they could with shields.
One gentleman had three shields strategically placed around his bed. This sharp 80+-year-old black gentleman had asked for the shields due to his need for a Foley. As a result, he had a nice peaceful little room in the middle of the controlled bedlam. He related how he had left his home in Baytown but had to leave his stubborn 50-year-old wife behind. He was worried because she'd not picked up her phone when he'd called.
Where needed, patients with psychiatric needs were given one-on-one support. This was embodied by one woman who ended up with a very patient volunteer caregiver for most of the night. One woman, wife of the gentleman with the brain tumor, just needed a hug and a hymn to let her know she was going to be okay.
Twice, my experience with diabetes came in handy. Due to limitations in what was available in the form of insulin, I needed to convert patients to Lantus plus Novolog.
The hardest decision of the night came when I was called over to help decide what to do about a 400+ pound patient. She had just arrived in a very narrow stretcher with her sister. She had spent some hours in the ER as they managed out-of-control sugars. She was better, so she was sent back to the shelter. She had apparently been promised a hospital bed upon her arrival. A few hospital beds began to appear but were in short supply. In fact, they were all in use at this point. The sister was getting madder by the moment. The ambulance attendants whose stretcher was in use were in limbo.
And Mrs. K., a sweet 90+-year-old black female, had finally been able to get situated in her hospital bed. This sweet little old lady had been sitting in some vehicle on its way to Austin, then in a wheelchair at the shelter as they assigned a cot that she couldn't get into. Someone had taken pity on her and assigned her a hospital bed next to which she sat for a while, until someone helped her get into it. But, she didn't absolutely need it. I went to her bedside and explained the situation. This little hero said it was okay for me to give someone else the bed. She just needed a thicker pad for the cot. A cot, with extra padding, held Mrs. K. with the help of some EMS gentlemen. And, the other patient was able to be placed. Before we left that night, I made sure Mrs. K. had been placed in a hospital bed. After all, she had taken one for the team.
Patients were looking after their fellow strangers. One lady, while being assessed for a cough, whispered to me that the smiling, elderly Oriental lady, wrapped like a sore toe, in the next cot was by herself. The patient couldn't understand how such a nice lady was being neglected by her family. I referred her to a social worker to decrease the risk of slipping through the cracks.
By the time my shift was over, I was an old hand at this. People were still trickling in at midnight. The next shift of EMS had shown up (hopefully to be stationed where they could help the elderly up from the cots for the patients' potty breaks). The nurses were looking for their replacements. The young director of nursing was working on placing yet another patient. CPAPs were plugged in. The children, who had been remarkably well-behaved, were through playing videos on the computers in the food service area and heading for bed. And my replacement, Terri Albright, MD, had arrived. We looked at each other and realized we were med school classmates. We'd not seen each other at least since our 10-year class reunion, if not since graduation. We caught up as I became the tour guide, pointing out the patients who needed special attention.
As I left, I reflected on what a wonderful expression of love and concern for others this massive undertaking had been. And, yet, it is so matter-of-factly presented. I am proud to have been a tiny part of it. Now I'm looking forward to going back on Thursday. Maybe I'll be able to say "hi" to Mrs. K in her comfy hospital bed.
Day Two/1:05 am
The care of the coastal evacuees is evolving in both subtle and dramatic ways. I had a front-row seat again today.
I went by the Convention Center first. The Exhibit Hall was no longer subdivided into pods. A sea of cots coated the now essentially wide-open room. Another room was similarly set up. The hospital beds were essentially gone. This is due to the fact that the patients with medical needs had been moved to The University of Texas J.J. Pickle Research Center.
When I walked in, at the Research Center's Common building, I found about 44 patients (down from greater than 90) in what is normally the basketball court. The nurses stations were on center-court. The pods, A-G still, were placed in a circle around the center. Cardboard boxes held the charts.
Again, the nurses, part of the City's Health Department, brought the patients to my attention. Most had already been initially assessed, but one gentleman had just arrived. We had to convert his insulin in the same manner as on my previous day. Most of the problems were pretty routine. Meds were refilled (some have been there the week and others are running out of their meds).
Patients were also referred to vascular and orthopedic surgeons, neurologists, and internists. Having seen before and after pictures of Galveston, patients from the island were referred to the clinics for longer-term care.
I was later joined by a pediatrician who felt a bit like a fish out of water. However, she did a wonderful job providing primary care. She bonded with the DON, usually involved with pediatric immunizations, over vaccines.
The saddest patient to minister to was a young woman who had a C-section about three weeks ago. Her incision had dehisced. She was getting home health to care for it, but she needed a VAC. She had a stony demeanor that was daunting. She didn't have a family, according to her. This made me wonder where the baby was. I was, frankly, afraid to ask her if it had survived. Fortunately, the pediatrician was able to tactfully ask her. With relief, I found the baby was with a friend.
I looked for Mrs. K, but she wasn't there. I hope she's gone home or to a nursing home. The 400+ pound woman was also not to be found. I recognized a few of the patients, including my old psychiatric patient. He's still a handful. The gentleman with the staph infection was still there, although he spent a lot of time in the TV area.
The cots for the most part were higher off the ground, thanks to pads including air pads. The narrow cots were occasionally taped together to make the bed a more comfortable width. Hospital beds were mainly along the edges.
One of the patients required a transfer to the hospital to rule out a DVT. Another was taken to a nursing home. The attrition will continue as the days go on. They are requesting volunteers through Sept. 25. I'm hoping to drag a medical student with me the next time I come.
I recognized the handwriting of one of my colleagues. He'd been there a few days before. I always thought he was a nice guy. Now I know.
As my shift drew to a close, I was happy to be relieved by a former hospitalist. I knew the patients would be in capable hands. I took him on rounds as I showed him the ropes, especially pointing out the problem patients.
This crisis continues to bring out the best in the medical community. A radiologist who is a medical school classmate (the second one I've seen since this started) was dropping off donations at the Convention Center. The pediatrician who left her comfort zone and family to come help those in need. The unknown number of physicians who have selflessly volunteered to care for their fellow man. Many, including the two I worked with today, are novices to this type of medical care. People like this reinforce what a wonderful community of physicians we have here in Central Texas.
Dr. Frierson-Stroud is an Austin internal medicine specialist.
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