In late August of 2005, many of us watched from the relative safety of our homes and offices as Hurricane Katrina wrought havoc and devastation all along the Gulf coast. However, many otolaryngologists–head and neck surgeons found themselves in the thick of things, caring for the sick and injured and trying to keep tabs on friends and colleagues. Daniel Nuss, MD, Otolaryngology Chair at Louisiana State University School of Medicine, and Ronald Amedee, MD, Assistant Dean for Graduate Medical Education and Otolaryngology Chair at Tulane University School of Medicine, shared some of the challenges their schools and departments have faced as a result of Hurricane Katrina with ENToday.
Hurricanes are not uncommon in the New Orleans area. It was only after Hurricane Katrina had moved through the area that the degree of loss and destruction became apparent. Dr. Nuss commented, “We’re still reeling. This has been an earth-shattering and life-changing event for everyone involved. Nobody could imagine, I think, what Hurricane Katrina did to this area.”
A “War Zone” Experience
In the days following the hurricane, there was no electricity for lights or air conditioning, while temperatures soared over 100 degrees. There was a limited amount of safe drinking water, and some medical personnel resorted to giving themselves IV’s to remain hydrated enough to continue patient care. The flooding had rendered most medical facilities either inaccessible or structurally unsafe, so field hospitals were hastily erected to care for the sick and injured. The flooding also destroyed stores of medical supplies, and there were no means immediately available for replacement items. Dr. Nuss described this period as, “a war zone type experience, absolutely desperate conditions.”
Physicians and residents of all specialties were called upon during this time to provide all types of general medical and emergency care. However, there were some specific otolaryngology–head and neck emergencies. Dr. Nuss described several instances of drastic, life-threatening head and neck infections in previously healthy individuals. These were the result of minor lacerations, but because of the lack of immediate access to emergency care, and no clean water or antibiotics, they developed into major infections, which in some cases ultimately required radical surgery to address.
“I’ve never learned more in my life about what I’m capable of doing, what other people are capable of doing. We’ve proven that, collectively, we can solve anything.” – Ronald Amedee, MD
One Resident’s Story
When the evacuations began, Katie Wasylik, MD, fifth year resident (PGY-5) at Tulane, was among those who stayed behind. She elected to remain at Charity Hospital in New Orleans so the junior resident, a 49-year-old divorced mother of four, could evacuate with her children. Dr. Wasylik attached only one condition to this offer—that her dog, Puck, be evacuated with the family.
“This has been an earth-shattering and life-changing event for everyone involved. Nobody could imagine, I think, what Hurricane Katrina did to this area.” – Daniel Nuss, MD
In the days following the storm, doctors and nurses at Charity Hospital learned the true meaning of the word improvisation. Without electricity, nurses took turns aggressively fanning patients to help cool them off and bagging critical patients by hand. Dr. Wasylik described rigging a suction machine through all sorts of extensions from a generator to keep one patient with a fistula from drowning in his own saliva. There were no working elevators, so the staff was forced to trudge up and down countless numbers of dark, wet stairways many times a day.
Through the rigors of trying to continue providing medical care to the patients, personnel were also faced with trying to allay the patient’s fears. Dr. Wasylik recalled one patient saying, “Doc, tell me we are going to get out of here. Don’t leave us.” At the same time, doctors on site were being called upon to triage patients to determine who would be evacuated first.
Water up to eight feet deep surrounded the hospital. Reports of “gangs” running amok in the surrounding streets had everyone fearing for their safety. Dr. Wasylik reflected, “I realized the very flood-waters that had trapped us there were probably protecting us like a moat. Not too many looters were going to wade through eight feet of stench.”
After the stress of providing patient care with inadequate supplies and limited equipment, the fear of not getting out, the dangers of staying, and the discomfort resulting from the heat and too little drinking water and food, eventually Dr. Wasylik and her colleagues were able to make their way to the Tulane helipad, where they were air-lifted out.
Dr. Amedee described Dr. Wasylik’s caring and commitment during this time as “heroic.” Dr. Wasylik responded, “I am not sure heroic is really the appropriate word. I remember the six days in Charity as just doing what I had to do. I took care of my patients, my friends, and myself.”
Back to Business
Drs. Nuss and Amedee faced many logistical difficulties in getting back to the business of education. Because all of the hospitals in the area were either inaccessible or had suffered flooding and damage to some extent, they needed to find temporary placement for their residents, and also accommodate the personal difficulties of their students, residents, faculty, staff members, and patients, many whom lost everything to the storm.
One of the most immediate issues was communication. The contact information available for everyone was useless. Communications infrastructures were completely wiped out. Cell phones with local numbers were not working. The logistics of finding all of the people who had evacuated to parts unknown is hard to imagine, but it was important to, as Dr. Amedee said, “make sure every head was accounted for.”
The answer to reestablishing communications for both institutions turned out to be the Internet. Web sites were quickly developed by members of both programs, and that information was spread from person to person. Within a day or two, both chairmen were reestablishing contact with their residents and staff.
After locating their people, the priority became the continuity of the residency programs. Within 48 hours, school administrators were networking to try to find locations for people to resume their residencies. Offers for assistance poured in from educational institutions and hospitals across the United States. Louisiana State University has the advantage of being part of a large system of state hospitals in Louisiana, and residents from their program were shifted to these other hospitals almost immediately. Otolaryngology residents from Tulane were temporarily transferred to institutions in other areas, including Dallas, Nashville, and Atlanta. In most cases, residents were offered free housing and expenses.
However, transferring the residents was not as simple as moving them to the new facilities. There is always paperwork involved, and the records for both schools remained literally under water. Additionally, they were operating for the most part without any support staff. Secretaries, assistants, and clerical staff were not readily available to generate the documentation requested by the Accreditation Council for Graduate Medial Education (ACGME). However, once the ACGME was made aware of the desperateness of the situation, staff there worked with both institutions to ensure that the residents were placed in programs that had “all the right ingredients.” They saw to it that the residents were placed in programs that could support the additional residents without diluting the residents’ educational experiences. Dr. Nuss credits Patrick Brookhouser, MD, the Residency Review Committee Chair and Robert Miller, MD, Executive Director of the American Board of Otolaryngology as being instrumental in working toward this goal.
Some of these “temporary placements” have become permanent. Three residents chose not to return to Tulane. While understanding the reasons behind their decisions, Dr. Amedee is still saddened by the loss. He said, “It pained me to have people go away that I knew I’d never see again, because we chose them so carefully.”
On the positive side, for Louisiana State University’s program, some of the changes have evolved into wonderful educational experiences that they hope to continue over the long term.
While he wouldn’t want to live through it again, Dr. Nuss expressed a deep pride in his residents and colleagues, noting that there was an important lesson to be learned: “One of the most interesting things about this has been the degree to which these medical professionals have been able to stay focused on professional obligations even while many of them took some very serious hits in their personal lives. It was humbling to watch how well residents and faculty have been able to provide care to patients above and beyond the call of duty, and then going home to hotels or trailers or temporary living arrangements, and having to help friends and neighbors recover in the meanwhile. As awful as a lot of the things were that happened after Katrina, there was ample evidence that there are still a lot of great people in the world.”
Dr. Amedee concurs. “One of the things I’m most thankful for, since Katrina: I’ve never learned more in my life about what I’m capable of doing, what other people are capable of doing. We’ve proven that, collectively, we can solve anything.”
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