The Otter Side

As part of one of my classes, earlier this month I had to write a narrative on a personal experience that relates to public health. No surprise, I wrote mine on my experience in New Orleans. Here it is uncut:

On August 29, 2005, I was a pathologist practicing in a small town in central Georgia when Hurricane Katrina hit New Orleans, Louisiana (NOLA). I watched the news intently since I had a long history with NOLA. My brother was stationed at the nearby Naval Air Station when Hurricane Camille hit in August 1969. As a Naval Reservist in the 1980’s, I did my annual two weeks’ service at the Naval Station on the West Bank. NOLA had always been a place to which I would escape when I needed good food, good music, and a devil-may-care atmosphere. I watched with increasing anger and a feeling of impotence as the Katrina tragedy developed with no response from the Federal Government.

I remember a specific pair of events—on Tuesday August 30, ABC News covered the story of Biloxi resident, Harvey Jackson. He was tearful as he told the reporter that storm surge split his house in two, and although he tried to hold on to her, his wife was swept away. The next story showed President Bush live in San Diego hamming it up on stage with a guitar given to him by a country singer. I continued to watch the news coverage, getting more and more angry until September 1 when the Louisiana Board of Medicine (BOM) put out a call for volunteer physicians. My wife and I discussed it, and I volunteered to go in five days, as soon as my business partner returned from vacation. The next day, federal disaster personnel finally arrived in NOLA.

My first day in the city was spent at the NOPD Second Precinct house. It was now nine days after Katrina’s landfall, and there had been no logistic support—no food shipments or medical care—to the precinct until that day. Their main medical problems were podiatric and psychiatric. The flood waters contained a mixture of industrial waste, waste from the inundated sewer system, gasoline, and oil. They described it as black, opaque, and “stinking like Hell.” They called it simply “The Water” in a way that you could hear the capital letters. Chemical dermatitis was common on exposed skin, most frequently the feet. Fortunately, the BOM sent us out in two-man teams, and my partner was a podiatrist that had done a podiatric dermatology fellowship. That left me to handle the psychiatric problems.

All NOPD officers are required to live inside the city, but they are not paid enough to live in the nicer areas. In NOLA, socioeconomic status and elevation are directly correlated, so the flood disproportionately harmed the less affluent. Every cop in the precinct had lost everything he owned. Most of what I did was to listen quietly and let them lament. Their stoic machismo prevented them from sharing these feelings with their fellow cops, and their families had evacuated, so in most cases, I was the first one to hear them talk of their pain and loss.

That was also the day food arrived. Up until that time, the police had relied on donations from residents (The Second Precinct was largely above the flood line.) and food from ruined markets. That day, a load of chicken breasts and ground beef arrived from Atlanta. They pulled out the massive smoker they used for Mardi Gras, and a huge cop (Think John Henry with a big spatula.) made burgers and grilled chicken for everyone. I felt guilty taking mine—I had eaten well at home less than 48 hours earlier—but they wanted us to join the fun. They temporarily looked less careworn.

I made it a point that day to have at least some time alone with every cop in the precinct. They all had the same top wish: a good, uninterrupted night’s sleep.

While shortages of some necessities were common, there were three things that were in ample supply—stories, rumors, and hearsay. Back at the Command Center in Baton Rouge that evening, I talked with someone who said he was on a body recovery team about to go into the Convention Center. He was told beforehand, "There are hundreds of dead on the second floor of the CC." He had heard that the walls were covered in blood from the carnage of a complete breakdown of social order. The next day while awaiting our ambulance crew, other ambulance teams told me much the same thing about the Superdome. They recounted stories of roving bands of murderous youth running amok in its dark, hot, humid interior with the bodies of their victims scattered about the huge building. We began to fear that the violent fatalities would outnumber the deaths due to wind and flood, but we would have to wait to find out.

My next assignment was to visit several Red Cross shelters in St. Tammany Parish on the North shore of Lake Pontchartrain. We were handicapped by a lack of medications. The BOM had faxed a request to the U.S. Public Health Service pharmacy depot, but they said they never got it. They refused to give us anything, even after we presented our credentials and told them of our assignment, so we went by a CVS in Baton Rouge and bought such over-the-counter remedies and wound care supplies as our personal cash on hand would buy. I held clinics that day in a school counselor’s office, a high school auditorium, and an elementary school cafeteria. It was embarrassing trying to render meaningful medical care with nothing but CVS generic Robitussin and Dimetapp, some Tylenol, and a few gauze pads and tape. I was lucky in that a nearby pharmacy had reopened that day, so I was able to handle my patients’ most common request, replacement of prescription drugs that had been lost or spoiled.

One woman in her thirties came in with an 18 month-old girl for a minor problem. I told her, “Your daughter is fine.” She looked at me dully and said, “She’s my daughter’s girl. Her mother was taken by The Waters.” She said it with an absolute lack of emotion, as matter-of-factly as if she had said that the child’s mother had gone outside for a smoke.

I spent the rest of my time in NOLA at an outdoor clinic under the pavilion of the Canal Street ferry terminal. For most of my time there, I was one of two physicians, two nurses, and six to eight Emergency Medical Technicians seeing 350-375 patients a day. Most were for immunizations, but we saw multiple cases of heat exhaustion and one evolving heart attack. One day, I was assigned to a National Guard tank team manned by ATF agents for “welfare checks.” When I got the assignment, I was incredulous that they were delivering welfare checks in the midst of disaster. The assignment officers rolled their eyes and explained that we were going to check on the welfare of residents whose families had called the Red Cross. “Oh,” I replied sheepishly.

We cruised into the flood zone down Canal Street. Within just a few blocks, we were in water that covered the roofs of cars. Most of the city was still too deep for wheeled vehicles, even military ones. The routine was for one tank to pull up to the front of the house while riflemen on the other tank provided cover. An ATF agent would go to the door, knock loudly, and call “Police! Do you need assistance?” At all but one address, there was no response. The agents would look in all accessible windows to see if there were bodies. Initially, they would then break down the door to check, but later in the day someone figured out that the agent could just break a window and smell carefully for decay. If none were detected, they could safely assume there were no bodies. They would spray a symbol on the front of the house that gave the date, number of living extracted, number who elected to stay, and number of dead requiring recovery. Fortunately, we found no bodies, but a heartbreakingly large number of abandoned dogs and cats. Whenever we shut down the tanks’ engines to listen for a response to the agent’s call at the door, we would hear barking in all directions.

It would have been a very depressing day but for one person. One house we visited had a jazz musician of some local renown. His daughter lived four blocks away, deeper into the flood zone, and he was not willing to leave in case she came to find him. The agent asked him if his daughter had a cell phone. The agent pulled out his cell phone, called her, and handed it to her father. She was in a shelter in Houston and had been worrying about him. He grabbed his trumpet and immediately left with us.

Even so, the ride out was somber. I spent 17 years in the Navy, many of them with Marine units, but I never served in an area of conflict. At last, I was on a tank with armed guardsmen, going through completely abandoned neighborhoods that stretched out in all directions as far as I could see. Looking up, I could see a constant flow of military helicopters criss-crossing the sky above us, freight slung beneath them. For the first time in my life, I felt like I was in a war zone. We drove down Tulane Avenue surrounded by inundated cars, flooded buildings, and the occasional floating, bloated body. This was my favorite city for R&R in the country, and we had let it be destroyed through lack of planning beforehand and inaction afterwards.

I spent three more days working at our open-air clinic. The last day we enjoyed an embarrassment of riches—the outgoing, spent volunteer physicians overlapped the incoming batch of fresh, eager volunteers by one day. I was really extra personnel, so I went into the Quarter with a three-part mission:

1. See how much damage it sustained.
2. See if my favorite places were okay.
3. Find the only bar that did not close at any time during the entire disaster, Johnny White's, at the corner of Orleans and Bourbon.

All my hangouts, as well as all the famous tourist spots, were intact. The Saint Louis hotel looked like it could have been open. The Café du Monde looked strange with no tables and the doors closed. (They are open 24/7/365.) It was really weird walking around Jackson Square—I was the only person in the entire square on a beautiful, mild, sunny day.

I found Johnny White's to indeed be open and busy. Here we were in a federal disaster zone, and a cold Bass Ale was $2.50. (I gave him a five and told him to keep the change—one should reward performance above and beyond the call of duty.) As I sat there, I realized that there were three types of patrons:

1. A fellow named Larry and I, i.e., ostensibly normal.
2. World media types (Japanese and Spanish at the time of my visit).
3. Raving loonies actively engaged in self-medication with alcohol.

I started making inquiries of the last group. One fellow had a huge boil on his arm, surrounded by angry, red swelling. He was a piercing artist, so he had lanced it himself with his largest needle, but he needed antibiotics, badly. Another fellow, who offered me a shot of Jameson's, told me that he had been without his Lexapro for 3 days "and I become homicidal without it." There were patrons on anti-psychotic meds, anti-depressants, and major tranquilizers, and they were all out or almost so. Even Larry was out of his Insulin and oral diabetes drugs. I took down everybody's name and their medications. I went to our clinic and found oral diabetic drugs for Larry, and all the others’ anti-depressants (especially the Lexapro for the potentially homicidal guy). I then returned to Johnny's and handed out meds. Unfortunately, the one woman with prescriptions indicating some serious psychopathology was out of luck. We did not have the major tranquilizers. I told her to go to Ochsner, the only open hospital in Orleans Parish. In essence, I went out for a beer and wound up running a psych clinic in a bar.

Needless to say, I have already reflected a lot on such a dramatic experience. Some of my reflections concern public health in general, while others relate directly to several of the concepts from our course.

Any discussion of anything that affects NOLA must consider race and socioeconomic status. NOLA ranked fifth among cities with more than 100,000 residents for percentage of the population that is African-American (67%) and eighth for percentage living in poverty (26%).[i],[ii] The Lower Ninth Ward is 99% African-American and 36% of its residents live in poverty.[iii] I am convinced that the reason for the Federal Governments’ inaction stems directly from this. The largely African-American poor of NOLA had no money and no influence, and were treated as being of no consequence. The lackadaisical response to Katrina was one more instance in an already shameful, long history of the U.S. government ignoring the plight of minorities and the poor.

What was the effect of the Federal government’s indolence? Four days of inaction allowed survivors to later die in their attics waiting for rescue. Four days exhausted the ability of hospital personnel to ventilate patients manually. Four days added victims of official neglect to the death toll from wind and water, and I doubt there will ever be any official accounting of their numbers.

I fear NOLA will never be the same. In my opinion, its culture, more so than any other major American city, is a product of its African-American heritage, Mayor Nagin’s so‑called “chocolate city.” With the involuntary demolition of so many flooded homes and the meager resources of their residents, I doubt that many will be able to return. My ultimate fear is that the neighborhoods I rode through with the tank crew—blocks of small, crowded, but well-kept houses—will be destroyed and supplanted by townhouses and condos far beyond any of the prior residents’ means.

Soon after my return home, several body recovery teams pulled up to the Superdome with refrigerated trailers, ready to remove the reported “hundreds of bodies.” They found six bodies—four dead of natural causes, one of a drug overdose, and one suicide. Only four bodies were found in the Convention Center, one of which was the result of a violent death. I then realized to my shame that I, too, had unknowingly shown prejudice. The stories of murder and mayhem by refugees gone feral were simply bigoted fantasies of how poor African-Americans would react to overcrowding, stress, and absence of authority; and I had believed them.

Finally, my reflecting on this experience had a major effect on me and my family. I hope I have gotten across the enormity of the events in NOLA. Witnessing them kept all of us in a state of stunned amazement, or even shock, the entire time. This was especially true during my ride with the tank team. That evening, I sat and contemplated what I had seen and what it meant. I remember thinking that this was quite literally a life-changing event, and that I could not simply go back to pathology practice. When I was in medical school, my first love was infectious disease. Being at Emory, many of our instructors were from CDC. They would come in, practically brushing harmattan dust from their khakis, and tell us about the work they were doing in Timbuktu or some other exotic place. I had often fantasized about such a career, but I played it safe and followed a conventional path. Now, I knew that I had just felt more alive and satisfied with my work than I had in years. I made a decision to discuss a career change with my wife when I got home. On my return, I told her that I wanted to leave pathology and pursue a career in International Health, and that I wanted to do whatever was necessary to return to my original dream. My wife is a former U.S. diplomat, so her reply was quick. “Sure. Let’s check the Web for jobs.” Later she told me, “I wondered when you’d decide giving money wasn’t enough and that you needed to give of yourself.”

That brings me to this course. When I decided to pursue my new career path, I left private practice naïvely thinking that my experience and skill set would allow me to find a position in communicable disease control somewhere in the developing world without further training. I have not, so I am going to remain unemployed, take a full course load every term, and focus all my time and attention the MPH program. Well, almost all—I am also going to be a stay-at-home dad to our two daughters, 3 year-old Eleanor and 16 month-old Brigid, for the next year.

Volunteering for Katrina had an effect on me beyond any I might have expected. In 11 months, I have gone from being the extremely busy, founding partner of a very successful pathology practice to being a stay-at-home dad and full time graduate student intent on eventually going to a developing country to work on communicable disease control and child survival. I’ve also never been happier.

---

[i] U.S. Census Quickfacts, http://quickfacts.census.gov/qfd/states22/2271.html.

[ii] Wagner, P, Edwards, S. “New Orleans by the Numbers” dollars & sense [sic], Mar 06, web archive, http://dollarsandsense.org/archives/2006/0306wagneredwards.html.

[iii] Ibid.

At long last, they're back! I had to share these with everyone. We just had formal pictures taken,and here are the proofs.

Brigid is now 16 months old. She is a delight.



Eleanor is now 3 years old and in Montessori school. She loves it.

I am now a stay-at-home dad, working on my MPH on the internet and in 2 week intensive courses between semesters. Mrs. O is still teaching at our local university. Life is good.

Still chilling.

Don't worry about us. The kids are brilliant. We're doing well, and our hopes are high.

Oh, Mr. Bush. Your room is ready.

I saw my cardiologist this week. My LDL cholesterol is down to 65, and HDL is up to 45. My triglycerides (previously 400-600) are only 130! I considered celebrating with a huge rack of pork ribs, but thought better of it.

Write your representative and urge him/her to co-sponsor Rep. John Conyers's proposed HR 635 (html or pdf)

Creating a select committee to investigate the Administration's intent to go to war before congressional authorization, manipulation of pre-war intelligence, encouraging and countenancing torture, retaliating against critics, and to make recommendations regarding grounds for possible impeachment.

Even if your representative is Tom Delay or John "Please Don't Pronounce It Like It's Spelled" Boehner, seeing many emails supporting the impeachment of the President may weaken their already faltering support for his agenda. Here's the text of my letter to Rep. Jim Marshall (semi-DINO, GA-5):

I strongly urge you to co-sponsor and otherwise support Rep. Conyers's proposed HR 635. When last I wrote to you expressing my opinion that the President should be impeached, you said that there was insufficient cause at the time. Here is a bill to provide an investigation to determine whether there is cause. It is designed to seek the truth and that is always worthy of passage.

As we have heard said time and again, especially by those that see "no problem" with warrantless wiretaps, "The innocent have nothing to fear." If Bush has done nothing illegal, then no harm can come of an investigation. If he has, then he should be impeached.

After my visit to the Palais de Nations and all the good feelings it engendered, today I saw on CNN International (which is much better than plain CNN) that new pictures of Abu Ghraib torture have been made public and the UN has recommended that the Guantánamo Gulag be shut down. Perhaps instead of The Pet Goat, Bush should read this children's book instead. In it, he would learn that we are signatories to the Universal Declaration of Human Rights, specifically:

Article 5.
No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

Article 6.
Everyone has the right to recognition everywhere as a person before the law.

Article 7.
All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Article 8.
Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.

Article 9.
No one shall be subjected to arbitrary arrest, detention or exile.

Article 10.
Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

How far we have fallen from this goal! There is only one course of action that can ensure justice for Bush, Cheney, and the rest of their cabal: first impeachment, then extradition to the International Court of Justice in The Hague for war crimes. Then we may be able to hold our heads high on the world stage again.

During some down time yesterday, I visted the Palais de Nations. This was the headquarters of the League of Nations and is now the HQ for the UN in Europe. It was very moving. Talking with another physician taking the tour, I compared it to a hospital—if the Headquarters in New York is the front office, Geneva is home to the wards. It is here that the real work of the UN is largely based. I sat in a gallery above a session of the UN High Commission on Human Rights regarding child labor prohibitions. We also sat in the original Council chamber of the League of Nations with its huge murals on the progress of man and cost of war. While I was there, I bought a book for Eleanor, For Every Child a Better World. It's probably a little heavy for her right now, but it contrasts what she enjoys (sufficient food, shelter, education, medical care, and peace) with what much of the world's children endure.

I was moved by the whole experience, which made the follow-up even more ruefully funny. I walked out of the Palais toward the Avenue de la Paix (Peace Avenue), and there on the back of a city bus stop was spray-painted in large, red letters:

F**k Bu$h!

Wow—these people really do love peace!

Avoir! Updates later.

Updated Feb 16: Corrected spelling of "Bu$h."

Back on the Treo--I'm sitting in a Shoney's in Franklin, NC typing away. I'm at our cabin doing some maintenance. No phone, no web, and no cell coverage.

I've decided to try to make my own luck. After spending this weekend at our cabin, I'm flying Sunday night to Geneva for a 5-day visit. I'm going to go to the WHO offices to talk about my aspirations and my determination to do international medicine. ("I happened to be in the neighborhood and thought I'd drop by.") I'm also going to seek audiences with the various medical humanitarian agencies that surround the WHO like outparcels at a mall.

I'll try to post if I get web access. Comment moderation will be off tonight if I can do it on a Treo. I'd appreciate any prayers, positive energy, or well wishes you have to spare.

Save us, Commander Codpiece, save us!!!

Seriously, what the hell was that about? Apparently the Bush Administration has run out of at least quasi-real threats to scare the electorate, so he promises to protect us from heathen scientists "meddling in God's domain."

He definitely scared me! After all, Humulin® is made by laboratory strains of E. coli into which the human gene for insulin has been inserted, creating a human-bacterial hybrid organism. Do you trust the Republicans and their radical cleric allies to compose a law that won't threaten this? How about Humatrope®, recombinant Human Growth Hormone, produced by the same ungodly melding of man and germ? It's okay, though—diabetes and pituitary dwarfism are simply punishment for sin, so it is meddling in the affairs of God to treat them, only made even more blasphemous by using chimaeric abominations.

This is moving weekend so we can close on our house sale on the 31st. Don't lose hope, but I'm still on hiatus for at least a little while longer.

From John Hlinko:

From my buddies Tawnya Dudash, Annabel Dudash, and Russell Baldon (photo by Geoff Douglass.)

Russ and Tawnya have been doing brilliant cards for over a decade now, and it's great to see that their daughter Annabel is joining in the fun.

I just got home from the hospital after my surgery. Everything went well, but more on that later--first my experiment.

I am currently typing while under considerable influence of Oxycontin, duly prescribed by my physician for the management of post-operative pain. Despite the presence of Oxycontin in my system:

1. I am not proclaiming to love America while hating 49% of Americans.
2. I am not defending a war criminal president who openly admits to flauting the Constitution when it suits his purposes after having claimed another president was the Antichrist for getting a BJ.
3. I am not dismissing Jerry Garcia as "just another dead junkie."
4. I am not composing pages-long lies while simultaneously planning to deny ever having said them if called on my mendacity.

In short, when the revolution comes and it's Rush's turn to have his back against the wall, don't buy any claims of "diminished capacity." You can take Oxycontin and not become a Brownshirted Moron.

We are visiting my mother for Christmas. Mother is 82 years old and lives in the house her father built in 1939. It sits 6 feet from the site of the original house (built mid-1800's) in which she was born. She taught school for 36 years, starting in a one-room schoolhouse. She taught grades 5-8 as her older sister taught grades 1-4.

She was telling Eleanor some stories about her life as a little girl when I got an inspiration. I lit a kerosene lamp she keeps on the mantel (in case of power outages) then turned off every light in the house. Mother read Christmas stories to Eleanor by the light of the lamp. It was magical for everyone, but you can see that it was especially so for Eleanor.

I think I may be back.

In the past 3 months, a lot has been going on. During this time, I just didn't have it in me to blog. I don't seem to have the wherewithal to stay as outraged at the Bush malAdministration as I once did. I've come up with a couple of ideas for posts that I thought about putting on line, but then I'd hear Eleanor call me to "Read it, book!" or Brigid's grin would beckon me down to the floor to watch her rock to-and-fro trying to crawl. I've dropped to just reading one blog (Eschaton), and that only irregularly. I have commented occasionally, but usually just socially because many in that community have become friends as surely as if we had met.

So where are we now?

I'm in my 3d month of unemployment. I am, perhaps unwisely, unwilling to seek a "normal" job until I know whether I've gotten a job with WHO. I don't want to go back to private practice. I enjoyed "being in the fight" in New Orleans, and I want to stay in. (Mrs. O, thank God, has wanted the same thing for herself, so we are in this together. She has agreed to teach next semester, but she has applied for positions at UNHCR, WTO, and the Global Fund for AIDS, Malaria, and TB.) As it is, I'm taking care of the kids while Mrs. O is at work. The girls are really enjoying having me around. I was never inattentive, but there were days at work when I would not get to see either of them awake. I am also giving my culinary muscles a real flexing--this is the first time I've ever had a lot of time to devote to efforts to really cook well.

We are trying to sell our house and our cabin in the mountains. Mrs. O's mother lives nearby, but she has been away 95% of the time for the past 4 months (a topic for a different post), so we can stay at her place for Spring semester, no problem. Regarding the cabin, it kills me to let it go, but there's nothing for it. If you know anyone who would like a nice cabin in the NC mountains on 45 acres with about 1/2 mile of wild trout stream down its middle, send them to this web site to check it out.

Trust me, I'm chuckling as I type this because readers are going to ask "what else can go wrong?", but stick with me to the end of the post--it gets better.

I've got a badly herniated disk in my neck that is pressing on the spinal cord causing some leg discoordination and a constant feeling of burning on both hands. I saw a neurosurgeon last week and he scheduled me for surgery on Dec 22. He was a bit displeased with me--I've had symptoms for 18 months, but I never felt I could take time off from my practice to take care of it. Well now I have time, but a cold I caught last week from Brigid developed into bronchopneumonia over the weekend, so the surgery had to be put off until December 27.

In summary, I'm still unemployed, our cash reserves are almost depleted, Christmas is coming, I'm facing surgery, and I'm coughing my fool head off, yet I have never been happier in my life. My first years in private practice, I was making insane amounts of money, yet I was miserable. I continued making the money after wooing and wedding Mrs. O, and we were fantastically happy. Now, I'm not making any money, but we are all just as happy as before. I'm getting to know my babies better than I ever would have otherwise. We have the assurance of having made an unquestionably right decision to try to go into service. Rather than bemoan the chain of events that led to this or worry about the future, I'm making good on all those times I called home from work and said, "I wish I could be there with the girls instead of here." Our lives are good, and they only look to be getting better.

Now, you tell me what's important in life.


UPDATE 12/20/05: Added UN links and the firm date for my surgery.

Permalink | Posted by Otter @ 00:15 10 comments