Last week, one nurse and three physicians from Santa Fe, carrying thousands of dollars of medications and equipment donated by the St. Vincent Hospital Foundation, drove to the Houston Astrodome to assist with the Hurricane Katrina relief effort. Daniel Kovnat, one of the physicians, sent this dispatch.
We left St. Vincent Hospital later than we had hoped, tacking the boxes of insulin, asthma inhalers, antibiotics and syringes to the roof of the Nissan Pathfinder with a web of bungee cords and tarp. Eight hundred miles, one speeding ticket, several Dairy Queens, and cumulative pots and pots of gas-station coffee later, we limped into the Houston Astrodome Holiday Inn. The tarp holding our supplies had disintegrated in the Texas wind, but nothing had been lost.
The Holiday Inn had a certain lawless
Hotel Rwanda
-like urgency and chaos to it, each room overstuffed with displaced families or with out-of town doctors and nurses like us. We double-bunked, caught some grits for breakfast, then headed over to the Astrodome in our neatly pressed scrubs.
The Astrodome, we learned, wandering across the complex, is a collection of several cavernous buildings. The Dome itself, hulking and vast, had on its floor an architecture of cots, thousands in neat array: cots as beds, cots as walls of privacy, cots as play structures for the hundreds of children. The Reliant Center, across a parking lot teeming with police and makeshift basketball courts, held thousands more; the cots loosely organized into sections for families, the elderly, single women, unaccompanied children. There were video games and play areas, a food distribution corner and missing children posters, as well as desks of Red Cross volunteers assisting with placement. Both the Dome and the Center had infirmary areas for minor scrapes and medical problems, staffed by physicians and nurses who sent anyone with a more serious problem by volunteer-driven golf cart to the Reliant Arena, another gigantic hall across another limitless parking lot, where an impressive field hospital had been established.
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The Santa Fe contingent-myself, nurse Jana Kincheloe and physicians Avelina Bardwell and Dan Junck-received our emergency State of Texas licensure and our crisp Harris County Hospital District "Katrina Volunteer" identification cards, then were sent immediately to see patients. The Arena, which is usually used for events like gun and cattle shows, had the ghostly imprint of hundreds of hooves on its cement floor. This improvised hospital was impressively organized. There were areas for triage, adult medicine, pediatric medicine, minor general surgery, orthopedics, gynecology, mental health. There was ophthalmology and dentistry. There were X-ray capabilities and ultrasound, a laboratory and a well-stocked pharmacy, a central supply with crutches, clothes and equipment. All of this in a makeshift garage, filled with 18-wheelers, porta-potties and exam rooms made of scaffolding and plastic curtain. Houston, experienced from Tropical Storm Allison a few years before, had clearly done a nice job.
The whole place was being staffed by energetic and talented volunteers. There were attendings, fellows, residents and medical students form Baylor, the occasional displaced physician from Tulane University in New Orleans, as well as doctors, nurses, technicians and support staff from all over the country who had made their way to Houston to help.
The medicine we practiced there was diverse. Some people were impressively sick and required rapid ambulance transfer to a real hospital with deeper capabilities. I had two patients who refused transfer to another hospital. One had chest pain with worrisome EKG changes and another a diabetes patient who, I suspected, was developing dangerous acid levels in her bloodstream. But they didn't want to go to another facility, after the endless moving from one place to another. "Can't you just give me a shot and a pill?" pleaded the diabetes patient. And, in the end, after futile negotiations, that's exactly what I did, before writing a note giving her permission to return to the Astrodome after the 11 pm curfew.
Other people were less ill, but had rashes and wounds from days in the water. Some had run out of their medicine, needing refills of their insulin, their beta-blockers, their inhalers, their schizophrenia medicines.
In the horrific conditions in New Orleans and the subsequent crowding, an outbreak of Norwalk virus gastroenteritis had occurred. Scores of people, prostrate with vomiting and diarrhea, straggled into the clinic for rehydration and then quarantine, another spacious sports arena set up for those who no longer needed intravenous fluids but couldn't yet return to the Astrodome or Reliant Center for fear of spreading the infection. Patients in quarantine, again cut off from their families, were, for the most part, amazingly accepting of this non-negotiable order from the Health Department.
The patients we saw were united by their harrowing stories of loss and separation: from their families, their homes, their city, their livelihoods. Some had vague plans for what to do next. But others had no plans and no resources for where to go or what to do now that the immediate, life-threatening moment was over, now that they were dry, bellies were full, now that the diarrhea had stopped.
There was another group of patients we saw whose complaints initially seemed oddly minor and surprisingly chronic in this MASH hospital set up for an acute emergency. These people had concerns about suspected hypertension or chronic headaches, lumps and bumps that preceded Katrina by months or years. After seeing a few of these folks, we realized that these were not people with mundane complaints but people who had never had access to a doctor or a nurse, people who had long suspected something was wrong and now had the opportunity to seek free and accessible medical attention. In some ways, the care we gave those patients seemed the most acute and urgent of all. It was as if we had been offered a singular and fleeting opportunity to help, and we knew we had better use that moment wisely.
