The Storm After the Hurricane
The first 24 hours
MONA KHANNA, M.D., M.P.H, a medical correspondent with CBS's Dallas affiliate, recounts her experiences as a member of the medical aid team that was the first to arrive at the New Orleans Louis Armstrong International Airport?to a scene of wrenching despair?
0200: The arrival
We filed off the bus, rubbing our eyes. Immediately, a police car pulled up. "Where do you want us to put her?" the officer asked. "Put who?" we asked. "Woman in labor, two previous C-sections, contractions two-minutes apart." Dr. Kelly Klein, a family practitioner and mass casualty specialist, and I looked at each other. Get ready to deliver a VBAC (Vaginal birth after C-section), I thought.
The team scrambled. Where was the best-lit place on the cement? Grab some sheets. Towels? Delivery kits? Dr. Klein and I walked over to the writhing woman, her face contorted in the agony of labor. "Ma'am," we asked, "why did you have two cesarean sections?" Grimacing, she grunted, "I don't dilate." Stunned, I looked at Dr. Klein. She stared back at me wide-eyed. We had to get this woman to a hospital with surgical capabilities fast or her baby would die.
0230: No sweet dreams
Command staff told us to sleep: more patients would arrive mid-morning. We scanned the dimly lit D concourse ticket counter. Katrina had robbed the airport of electricity; a few emergency generators provided scant power. I lay down between the Continental Airlines ticket counter and a telephone bank. Beverly Stephens-Owens, a nurse from Aubrey, lay next to me. I watched the numbers change at the time on my cell phone: my Timex Ironwoman watch was already missing. Other disaster workers and security officers were walking, watching and worrying.
0430: Preparing for the worst
I could stand it no longer. I arose. Rumors were flying: 2,500 patients were on their way. We set up three medical treatment tents in the atrium, with a triage table out front. The tents were categorized as green, yellow or red, in order of increasing severity of illness. We assembled tables and started unpacking our medical supplies and medications. Gauze, bandages, hand sanitizers, tongue depressors, cotton swabs, alcohol wipes, syringes, 22-gauge needles, 25-gauge needles, blood sugar machines, emesis trays, stethoscopes. Oxygen tanks to the yellow tent, to the red tent. IV start kits to the yellow tent, to the red tent. We worked rapidly, in sequence and silence, an ominous aura of uncertainty looming amongst us.
0830: The green tent
"Chest pain" someone called out. Our second patient. I stepped outside the tent to the triage table. An elderly man was breathing heavily. "Sir, how bad is your pain?" "It's the worst ever." "Is it 10 on a scale of 1 to 10?" "Yes." We fitted on him a nasal cannula and started oxygen while we took his blood pressure. He breathed easier. "Sir, have you ever had chest pain before?" He looked at me, a medical innocent if he ever saw one. "I've had 11 angioplasties." Another emergency hospital transport candidate.
For a fleeting moment, I wondered if the pregnant woman had successfully had a third C-section at East Jefferson Hospital. No time to muse. The ambulances were lined up outside, offloading patients, some two at a time. I was assigned to the green, non-emergency tent.
Middle-aged woman with epistaxis ? a nosebleed. "Has this happened before?" I asked. "She nodded." We took her blood pressure and instructed her to sit and apply gentle pressure. "Don't tilt your head back, you could aspirate the secretions."
A young woman with four small children needed formula. I gave her a jumbo can of powdered Similac and water. "Take what you need." She filled up bottles and started feeding her children.
Now the busloads of patients started arriving. People were streaming into the medical triage area by the dozens.
Loud screaming ensued. A young pregnant woman was escorted into my tent. She was wailing and clawing the air. "My baby, my baby." A medic was behind her, carrying a 2-year-old girl. We soothed her. She clutched her belly, "I'm going to have my baby," she screamed. We gently extracted information. She was 7-months pregnant. I looked into her eyes. Nystagmus. (Involuntary, rapid eyeball movement). "What drugs have you used recently?" I prodded. "None," she lied. She clutched her belly. "My baby, my baby." We laid her on a stretcher and started lactate ringer IV fluids. A nurse held her hand and comforted her. "Get the terbutaline ready," we murmured to each other. We didn't need it. The contractions dissipated and she slept and slept and slept.
And so it went. Patient after patient after patient. Crying, screaming, desperate, anxious, clawing patients. There was no respite. I was numb.
1800: Ambulances, buses, choppers
"Can you work the triage table?" a frantic Dr. Klein asked, poking her head in the tent. "Sure," I replied. "What's going on?"
"The choppers are coming in, we sent half our team downstairs to offload them. We need more manpower downstairs. Ambulances and buses are still dropping patients off upstairs," she replied, walking away briskly to put out the next fire. "Triage the patients into the yellow or red tents for now."
It was the first time in hours I had stepped out of the green tent. I stared, aghast. at an ocean of patients in the airport foyer. They had sprouted like mushroom fungus. Patients lay moaning in stretchers. They were stuffed in wheelchairs, on folding chairs, airport lounge chairs, sprawled on the floor. Six nervous mothers in thin pale blue hospital shifts were rocking and murmuring words of comfort to their newborns in one corner, while keeping close watch on the men who wandered into their vicinity.
Oh! My! God!
For the first time in my adult life, I wanted to turn and run as fast as I could. I turned, speechless, to Jim Owens, a nurse-paramedic and my triage partner. We headed towards the triage table with tags to label patients in order of severity of illness. We passed dozens of the infirm. Elderly men and women wearing soiled diapers cried out to us and extended their tremulous hands. The stench ? of urine and feces, blood, body odor, sweat and vomit ? would have been unbearable if we weren't beyond any sense of smell. An elderly crippled Caucasian woman in a wheelchair beckoned. "My name is Linda, Linda Mason," she said plaintively. "Can you ask my family to come and get me?"
"Doctor, doctor," they cried. "I have to go to the bathroom?"
Jim and I assigned our stack of 50 triage tags in minutes. I went back to the tents to scrounge up some more. As I was leaving, a heavyset man approached me. "I need two bottles of water," he demanded. "Sir, I can give you two cups of water, but I can't give you bottles. We don't' have enough." We were rationing our limited supply. "I don't want cups, I want bottles," he said menacingly, easing his way around the table and towards me. "Excuse me!" I waved to the cops policing the airport doors. "Sir! I need help!" An officer finally saw me. I wrestled with tears as I walked silently back to Jim; green, yellow, red and black tags in hand.
1900: Darwinism rules
"Where are you taking me?" someone cried out.
"Could I have some water?" said another.
What day was today? I didn't know. I no longer had feet, I had hot coals. When had I last sipped water? Eaten? I didn't remember. I didn't care.
An obese teenager caught my arm as I was walking. "Please, you have to help me," she said. "My baby needs formula. He hasn't eaten all day." I stared at the week-old infant nuzzling at her bosom. "Wait here." After handing over the tags to Jim, I took the woman into the green tent. "I have formula," I assured her. I walked confidently up to the table where the jumbo Similac used to be. No sign of it.
I thought frantically. The last person who handled the can was the young mother who didn't have anything to feed her four children. She was nowhere in sight. The children were gone. The Similac was gone.
Then it hit me. We had transcended into Darwinism. All of the rules of civilization and civility were gone. Survival of the fittest was the new order. I watched a fresh batch of patients being dumped into the ocean before me. God help us.
[Mona Khanna, M.D., M.P.H., Medical Correspondent, KTVT-CBS 11 News, Dallas Fort Worth. Dr. Khanna can be reached at firstname.lastname@example.org]
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