Tuesday, October 11, 2005

Forward into the breach, dear friends...

An unidentified medical team comrade outside the medical tent
(Photo Credit: Heather Blackburn)

September 27, 2005
New Waveland Café
Waveland, Mississippi

Dear Folks;
I am very sorry that I have not kept in touch, but as you can imagine, things here have been pretty crazy. As I suspected, the weather cleared after the first couple of days, and it has been brutally hot and humid, making the working conditions here that much more difficult. While I have not been completely alone in the medical tent (7Song, an herbalist from Ithaca, New York was able to lend some assistance in the medical aid station using his skills in botanical medicine), it has still been a very busy and stressful time here. Stone went on a short R & R period, and returned a little awhile ago. So, for a period of time there I was the only clinician running the med tent, and it was a responsibility I took very seriously. I did move from my deluxe accommodations at Camp Dred, and took up residence on one of the cots in the medical tent. To be honest, I felt that the Camp Dred location was in some ways superior. It was relatively dark and it was much better ventilated than the tent. But still, the army cot served rather well as a bunk, and I was able to set up my camp stove on the table outside to do my laundry and make a pot of coffee. In separate containers, of course.
Though we did not take the brunt of Rita, there was still very bad flooding locally, so much so that the mobile hospital down the street evacuated its staff on Friday night, the day after I arrived here. I had not known this at the time, and it seems a little frightening that I would not have been able to rely on them for assistance for critical patients. Fortunately, no such patient presented themselves for treatment in The New Waveland General Hospital, as Stone has recently named it.
As I said before, the choice to stay or leave was totally up to each of us to make that decision on our own. However, I do wish it to be noted that my comrades and I remained in the parking lot of Fred’s through that dark time, and for their friendship and help, I am greatly thankful to all who remained. I am reminded of King Harry’s St. Crispen’s Day speech (and one of my favorite bits of Shakespeare) from Henry V; “We few, we happy few, this band of bothers. For he who fights with me this day is my brother. And gentlemen in England now a-bed shall think themselves accursed they were not here, and hold their manhood’s cheap whiles any speaks that fought with us upon Saint Crispin’s day!” Indeed friends, I do feel a part of something very important and vital, and am very aware that I am at this place in time at this spot on the planet Earth, and for all the hardship and misery I see around me, there is no place else I would rather be.
In my Clark Kent like alter ego, I have managed to hide my secret identity as a highly trained health care professional. Specifically, I have been engaged as both an EMT-Paramedic and an ER Nurse for over a quarter of century now. And for the first time in a long while I felt like I was someplace where I was making a difference. All these years of experience, all that training, and it all comes down to this moment in history. I feel like this is what I was born to be doing, that all those sleepless nights working EMS in the big city or spent dealing with any and all manner of trauma and illness day and day out in a busy hospital ER has prepared me for this specific place in time.
Many folks who had spent the past 2 weeks cleaning up from Katrina found whatever possessions they had left completely destroyed, and this 1-2 punch from Mother Nature has caused considerable havoc here. Nevertheless, we had our kitchen and medical aid station up and operating around the clock, and things have been accelerating since. This parking lot that has been my world for the past week is a main distribution depot for the Gulf coast, and we have been feeding and supplying many, many folks from the surrounding area. For the past several days, I have been the only medical person on site, and have had to deal with organizing our medical station while seeing patients at the same time. I am pretty much functioning as I would while back in the ED, with the exception of no doctors, no lab, no x-ray or CAT scans…, in short, nothing more than my clinical experience and judgment to guide me. I am fortunate enough to have some supplies, and would truly fear having to sit on a major case for anything more than a ½ hour. Most of the things I have seen here have primarily soft tissue injuries, such as lacerations of various sizes and depth, abrasions, sprains and headaches. But this also includes a fair share of sick patients. I have several folks here with chronic lung ailments, and I see them fairly frequently for their daily neb treatments. Fortunately, anything more serious than immunizations and IV hydration can be sent over to Carolina Med Center 1, the mobile field hospital sent here last week, and the folks I did a little bartering with a few days ago. This does not mean that we don’t get serious patients. We do. In the days before I arrived, Stone, the 2nd year med student who has been here since the beginning, had to treat a patient in congestive heart failure by himself.
This would not have been such a big deal with the mobile hospital close by, but it took the ambulance almost a half hour to get here. That is representative of the level of infrastructure that was destroyed here. When Katrina hit, a wall of water 20 to 25 feet high crashed over this town, destroying almost every building in its way. This includes both the police and fire departments. The Waveland Police Department headquarters, or should I say what’s left of it, is directly across the street. The fire department now consists of 2 tents and 2 working trucks. Both the cops and firefighters are living out of tents. Whatever EMS crews are left have been brought in from outside, usually private ambulance services on contract with FEMA, and as a result, either they are not available or not familiar with the area, so getting lost is a bit of a problem. Fortunately, we have a supply of cardiac drugs, so between what Stone and I have in place here, we can pretty much take care of the initial stages of a cardiac arrest or trauma patient. But that doesn’t mean we want to.
Everyone here is focused on doing the job, taking care of the citizens of southern Mississippi and Louisiana in whatever way we can. Toward that end, when I am not rendering care in the med tent, I’m either hauling around 20 pound bags of ice, carting away debris and trash or unloading supplies. The ice I particularly like, as it is so bloody hot and humid here that the water running out of the bagged ice feels so good soaking the back of my shirt. Man, that feels so good!
As I mentioned earlier, the medical tent was closed up tight when I arrived here on Thursday evening. Stone had basically been keeping things going for the past 2 weeks, and when I arrived, he had to leave to take a long deserved break. He came back yesterday, after hanging out at his cousin’s house in Tampa, doing little more than sleeping and taking showers for the past 3 days. I didn’t realize it at the time, but he dropped out of Harvard Med School for the semester to come down here and help out. This is really a big deal, as it adds another year to his medical training, and I think this kid has real guts to do that. I am honored to be working with him, as I am with all the folks from the Rainbow family, kids who could be anywhere else but here, working hard in the hot sun and in less than stellar conditions. They are all taking care of business, and I am proud of being a part of this effort with them.
Many of the local folk are leery of going to the big mobile hospital down the road. Although it is a very impressive outfit, it is usually very crowded and busy, just like any other Emergency Room you are liable to walk into, and as a result, a lot of folks much prefer to come to us. There are no forms to fill out, no papers to sign, no money to be charged or insurance to be asked for. This is health care as it should be, given to all in need without worrying about the patient's ability to pay. There are no administrators, no bosses, no insurance company executives to worry and fret about the bottom line. I know that this is not something that is sustainable over the long term, given the way our society currently provides health care for our citizens, but it should be. Health care unfortunately has become a racket in this country, with all the hospitals and insurance companies colluding with their political operatives to keep it a money making venture, as opposed to a needed public service to protect the health and well being of our citizens. I have heard a lot of talk over the years about how the invisible hand of the marketplace will make the delivery of health care affordable and efficient. I think that the invisible hand of the market has instead delivered a slap upside the head to the poor, working and increasingly, the middle class of this country. Well, the market has decided that over 40 million of our fellow citizens are not going to have health insurance. And as long as we allow the politicians from both major parties to dance away from their responsibilities to provide the common defense (by this I mean to include access to basic health care), we will always be at the mercy of accountants and bureacrats who could care less if your mother gets the chemotherapy drugs she needs to stay alive.
In further news, I have been visited at least several times a day by engineers from the company that designed this damned tent. It would seem that every geek in the area is coming to take a look at das ubertent from USAID. They seem quite happy to jabber excitedly among themselves as they run tape measures to and fro, take a few notes and a few pictures, then leave. For the most part that is fine since I don’t have to talk to them. And of course, the number of folks I’ve been treating has increased markedly in the past few days as well. I had a team of migrant workers from Mexico, brought here clear out all the downed trees with chain saws, come in for their immunizations. There were 6 of them that needed their shots, and in short order I had six chairs set up in a row, and telling them through their interpreter to come on in, sit down and roll up your sleeves. I nodded and smile enthusiastically as I mimmicked rolling up the sleeves of my own shirt, with them following my own example, nodding and smiling and talking amongst themselves while I ran to and fro amongst them with a boat of 4x4’s drenched in Betadine, swabbing off their respective deltoids. This was followed with a heavy drenching of isopropyl alcohol. It was like an assembly line, and I believe I had those lads out of there within 8 minutes, a shot of Hep A and TD vaccines in each of their respective arms. And they all said I didn’t hurt a bit. Really.
The relief operation is set up in the parking lot of a strip mall (named “Fred’s”) and has become the focal point for the community. Waveland is representative of so many other small towns along the coast, and seeing the amount of devastation here, it is obvious that this community, and the many others like, are not ever going to be the same. These people are proud and hard working, and they don’t want charity or pity. They only want some help to put their lives back to together. These people have lost so much, and are so grateful to all of us who have come down to help out. There are many groups here, some of them church based, others community organizations, all of them originating far from here, all responding to the call of fellow citizens in need of aid. Some of the local FEMA guys have really helped us a lot, in terms of supplies and equipment, but overall, the amount of waste I see from the both the federal government and The Red Cross is enough to make my stomach turn. Case in point was the huge amount of donated clothes I saw strewn about the parking lot my first night here. Piles and piles of clothes all over the place, soaked and not very useful. I saw those same piles of clothes scooped up with bobcat’s and loaded into large dumpsters.
This is one of most incredibly draining, heartbreaking and beautiful experiences of my life, and it is truly unfortunate that a certain institution with which I am affiliated was unable to mount an effective response to this tragedy. It would not take much to make a really effective aid station out of this place. A couple of residents, an attending physician and few hardy RN’s and ER Tech’s, and I believe we could really do a lot for many of these folks. Unfortunately, I don’t think that hospital administration shares my feeling about this, so it will be forever an opportunity not taken. Or, another way to look at this is; how could a crazy ER Nurse manage to come down here and do this on his own, but a major academic teaching hospital and medical center could not? I am also well aware that this is a question that will not be a welcome one to those accountable in hospital administration. But that is a pay grade and level of bureaucracy far above my own.
Yesterday, I was passing out band aids and giving tetanus shots when a young lady from Massachusetts, down here to help in the relief effort, shows up at the door of the med tent. She looked awful, in the dehydrated, heat exhaustion kind of way that most folks do, but in her case it was particularly bad. She had just enough time to say “I’m not feeling very well” well she dropped like a sack of potatoes onto the asphalt. Naturally, I stopped handing out band aids at that point and rushed
to her aid, tossing her in a fireman’s carry over my shoulder (Oy, my back!) and tossing her rather unceremoniously onto a green army cot. To make a long story short, she came to as I was putting an IV in her arm, followed with a couple of liters of saline intravenously. After a couple of hours, her color got much better, she cooled down and was able to hold the down the Gatorade I have been passing her, so I discharged her to custody of her sister, after a stern lecture about staying hydrated in this Godawful heat.
Earlier today, we had a few more heat casualties, both given IV fluids and feeling much better for our efforts. And unfortunately one of the volunteers from Texas had a heart attack, and we were able to treat him as well. I had been hanging out with him for the past several days, and came to think of him as a friend, so it was a little difficult to treat him as a patient. It turns out he had been having chest pains for 30 minutes, and with every question I asked him (How long have you had the pain, what does it feel like, where does it travel to…) the answers were all the wrong ones. Suffice it to say, Stone and I dropped what we were doing and started treating him right there. Monitor, IV, O2, Nitro and aspirin, and by the time ambulance arrived 20 minutes later, all they had to do was transport him. He said his pain was getting better by the time he left, and he got essentially the same kind of treatment he would have gotten in any good hospital ED. We later found out that he was transferred to a hospital in Slidell, and lost track of him after that. I do hope he is OK.
I know that I have been pushing myself to the limit physically, but right now, my health and well being doesn’t seem to be all that important. I want to try to wring as much as possible out of the time I have left here, and I also feel a moral obligation to all the folks who trusted me with money to get down here to do the job. The conditions are very difficult (I’ve had one shower since I arrived, and my trousers literally ripped apart while I was giving a TD immunization, with a subsequent visit to the cops across the street who hooked me up with a pair of BDU’s. That in particular was an extremely embarrassing event. I mean, how is a man supposed to save lives and alleviate suffering with a big rip in the front of his trousers, in an area that is all too easily exposed, if you know what I mean).
That being the case, I hope I am able to make some kind of a difference here. Despite the hardships and primitive working conditions, it will be very hard to leave here tomorrow morning. I have met so many people from so many places, and from so many backgrounds, all wanting to help out as best they can. Unfortunately, the need here will continue well past the point when I arrive back in the safety and comfort of my home in Virginia. I have been here only a week, yet feel like I’ve spent a year, and this experience has affected me greatly. My time here in Waveland with my freinds and comrades from Rainbow Family, the Bastrop Church of Christ, The 7th Day Adventists and all of the rest, affilliated with a some kind of diety or not is full of memories I shall never forget, and it has been an honor to serve with them. I think about the kind of society I want to live in, and the kind of man I want to be, and I think this experience shows that those dreams are possible.

Your most humble servant,

Subkommander Dred


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Blogger Stone said...

Hey, Pete! I love the blog. Thanks for the love you sent our way. Few minor corrections:
I am at Harvard studying biology, but not yet in med school
I am an EMT-B which is where I get my medical experience, but I do say that working down here with you and the docs who have come and gone has been the MOST educational experience of my life.

10:15 AM  

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