Medical Education Feature - June 2009
Tex Med . 2009;105(6):41-45.
By Ken Ortolon
When Michael Rains, a third-year student at The University of Texas Medical Branch (UTMB), fled Galveston ahead of Hurricane Ike in September 2008, he had no idea he would never return to the island campus to complete his medical education.
However, more than eight months later, Mr. Rains appears set to complete his final year of school in Austin. In the meantime, he has been "living like a vagabond," shuttling from Austin to Houston to Dallas and back to Austin to complete his third year.
Mr. Rains is one of hundreds of UTMB students and residents whose lives and training were disrupted by the storm that devastated the school and much of Galveston Island.
While the medical school struggles to get back on its feet, many of the students and residents say their lives are still unsettled.
"This wasn't just a sole event," Mr. Rains says. "This has really impacted us, and this hurricane is still affecting us."
Many of the students were away from the island because of a break in classes when Hurricane Ike barreled into Galveston in mid-September, packing winds of 115 miles per hour. Other students, residents, and faculty fled ahead of the storm with what few possessions they could cram into their cars.
"I took enough clothes to last me two weeks because that's what we were instructed to do," Mr. Rains said. "But after the hurricane we were in a state of limbo for a week-and-a-half to two weeks because we weren't allowed back on the island. And when I went back, like many other students, I found there was little left to go back to."
Mr. Rains was able to salvage a carload of clothing and a few books. But he lost virtually everything else he owned, including yearbooks, photographs, furniture, and personal memorabilia from his childhood.
"That was the hardest part, not so much the material possessions, but the things you cannot replace," he said. "It was very hard to throw that away."
Second-year student Brian Masel fared a little better. Mr. Masel, who lived on the ground floor in student housing, says he lost clothes, furniture, books, even his stethoscope, "but nothing that couldn't be replaced."
Astrud L. Leyva, MD, a second-year internal medicine resident, lived in a first-floor apartment close to campus. By the time she could return to assess the damage, she had to toss out most of her possessions because they were covered with mold. She managed to salvage most of her clothes and her television, but little else.
While classes for first- and second-year students were suspended only for a few weeks, Mr. Masel says finding a place to live when they returned was difficult. A majority of students had to find alternate housing, he says.
Mr. Masel has had to make do with temporary housing. "Since the storm, I've moved three times, and I'm fixing to move again next week," he said in early April.
Even though he has finally found a new home, the storm is taking an economic toll on Mr. Masel and other students. With housing scarce, rent is going up. Mr. Masel paid $450 per month for student housing. "Now I can't find a place possibly any cheaper than $800 a month."
Residents on the Move
While first- and second-year students were able to resettle in Galveston quickly, it has been a different story for third- and fourth-year students, as well as residents. Since its hospital was closed for several months, UTMB had to find alternate locations for residents to continue their training and for students to do their rotations.
Erica Gregonis, MD, chief resident and assistant professor in UTMB's internal medicine program, says she and two other chief residents in the program had to find new positions for 108 residents immediately following the storm. Internal medicine is UTMB's largest residency program.
"We were very, very fortunate in the fact that the other Texas medical schools helped us," Dr. Gregonis said. "Within two weeks, our residents were back to work at other facilities."
She says internal medicine residents from UTMB were placed in San Antonio, Austin, Dallas, Houston, even as far away as El Paso and Brownsville.
While some residents were able to return to Galveston in November when the hospital reopened, others returned in phases over several additional months. Dr. Leyva says she spent five months at the UT Health Science Center at Houston before returning to UTMB.
UT Houston took 15 UTMB internal medicine residents into its program, which treats patients at Memorial Hermann Hospital and LBJ Hospital. Rather than the UTMB residents putting a strain on their program, UT Houston officials actually were glad to have extra hands, Dr. Leyva says. "They're a pretty busy hospital there, so there were plenty of patients to go around."
Dr. Gregonis says the situation at Austin's University Medical Center at Brackenridge Hospital was similar. "They were actually very overwhelmed with the patient volume, and our residents staying there helped them a lot," she said. "In fact, they even wanted our residents to stay longer than they did because it really was helping them."
But taking on extra residents did strain some programs. Dr. Gregonis says Methodist Hospital in Houston has a small internal medicine residency program. "There were only certain rotations that were open to our residents there. That's what they had to do to make sure their own residents weren't affected."
Going Here and There
Residents had to relocate for training for several months, but some third- and fourth-year students found themselves moving repeatedly to complete their rotations.
Mr. Rains says he was lucky in that he was scheduled for a rotation in psychiatry in Austin immediately after the hurricane and already had an apartment lined up there. But after that six-week rotation, he could not return to Galveston. Instead, he packed everything he owned in his car and went to Houston for a rotation in obstetrics and gynecology. Following a two-week break with his family in Dallas, it was back to Austin to finish the remainder of his third year.
"That was very similar to many students," Mr. Rains said. "We were living one rotation at a time."
While UTMB students have the option of completing their third and fourth years in Galveston or Austin, Mr. Rains planned to go back to Galveston after his psychiatry rotation. Now, that has changed. Tired of the nomadic existence, he has rented an apartment in Austin with another medical student and plans to do his fourth year there.
Even that, however, is not fully settled. He has been told he likely will have to go to Dallas for at least one rotation because there isn't space in Austin.
Picking Up the Pieces
UTMB officials say most of the students are back in Galveston, except for a handful who chose to finish out the academic year at their temporary locations. Also, 90 percent of residents have returned.
All residents and students will be back under UTMB faculty supervision at the beginning of the new academic year on June 29, but UTMB has reduced the size of its residency programs because it now has fewer beds and fewer patients in its hospitals.
Because of hurricane damage, currently there are 288 beds open, down from 599 prior to Hurricane Ike. That includes 56 medical/surgical beds, 150 women/infant/children beds, four burn intensive care unit beds, and 78 beds in UTMB's Texas Department of Criminal Justice Hospital.
That reduction is having an impact on both students and residents.
"I haven't had a chance to do a solo history and physical on a patient yet because there aren't enough patients now," Mr. Masel said. Instead, three or four students team up to do them.
Dr. Leyva says the internal medicine residency program also could stand to have more patients. "At least in the TDCJ we're still pretty busy with our inpatient load," she said. "But at John Sealy Hospital we could stand to have more patients."
Dr. Gregonis says one silver lining for residents is that they've received more outpatient clinical experience. "One thing that's actually been good for them is that their outpatient experience during residency has gotten a lot better since the hurricane because that's what we had operational at first and that's what educational opportunities we had," she said. "And I've found that people are a lot more likely now to explore those options in clinics, whereas before they always wanted to stay in the hospital and do inpatient rotations."
The toughest part of the entire experience for both students and residents may have been not knowing what the future holds.
"I would say it was the uncertainty of it all, not only having to worry about a place to live but also being unsure if we even had a hospital to return to," said Dr. Leyva.
Both Mr. Masel and Mr. Rains say the stress of not having a home, the disruption of personal relationships with fellow students and faculty, and the added pressure of trying to deal with the Federal Emergency Management Administration, insurance claims, and finding new housing has taken its toll.
Mr. Masel says he lost several faculty mentors who were laid off after the hurricane.
For Mr. Rains, not having a real home has been hard. "It's very difficult to go home to a strange place and not feel settled. That was especially difficult for me living like a vagabond back and forth and not really having somewhere that I could leave my worries at the door and have a place of refuge and a place of solace just to relax," he said.
"It's going to take a long time before I can put that aside and completely move forward. We are very much in survival mode, and we will be in survival mode until we graduate."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by e-mail at Ken Ortolon .
TMA Foundation Grant Helps Students Get Back on Their Feet
The Texas Medical Association Foundation in April awarded a grant of more than $66,000 to TMA's UTMB Medical Student Recovery Program to help students who were displaced by Hurricane Ike, which caused $24 billion in damage.
The grant was awarded April 7 during ceremonies at TMA's First Tuesdays at the Capitol event. TMA created the program at the request of its Medical Student Section to assist medical students affected by the devastation and disruption of Hurricane Ike. The money, which will be distributed to the students by UTMB, may be used for direct aid to medical students, including such items as bookstore vouchers, school supplies, gift cards for gasoline, and household items.
"After Hurricane Ike hit the Texas coast last fall, TMA's Medical Student Section responded rapidly to UTMB student needs by initiating the TMA UTMB Medical Student Relief Program," then-TMA Foundation President Susan Todd said at the presentation. "The TMA Foundation launched a fundraising campaign and today I'm proud, as president of the foundation, to present a grant to TMA's UTMB Student Relief Program in the amount of $66,400."
A recent survey of UTMB students found that average out-of-pocket expenses resulting from the storm was $8,500 per student and average appraised damage per student was $20,500. The average insurance payout was less than 50 percent of the appraised damage. Students also spent roughly $1,500 on relocation and evacuation expenses.
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