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Wednesday, August 29, 2007

Two years ago today...
Posted by Jill | 6:00 AM

Let us not forget how the Bush Administration sat by while an American city was lost.

...and that the crony appointments continue to this day. And that George W. Bush may be getting ready to promote the incompetent boob Michael Chertoff to the highest law enforcement position in the country.

And let us vow that no doctor -- and no patients -- should ever, ever have to go through anything like this ever again:

How did things change on Wednesday?
Tuesday night, we lost generator power, and that changed things a lot. ‘Til then we were on generator power so we did have some lights, and we did have some water. Water wasn’t clean, but it was running. But then we didn’t have water, we didn’t have any electricity, commodes were backing up everywhere. Conditions in the hospital started to deteriorate Tuesday night and early Wednesday. When that happens it makes care a lot more difficult. I was called to help suction a patient who had a tracheotomy but we had no suction running. We were going down to very, very basic care. You try every old-time method you can … [P]eople in charge were trying to get helicopters to come, [but] at that time we were told we were low priority. There were people on rooftops [who were going to get rescued first]. They said … there’s not going to be a lot of help coming, [so] what we decided [was] if helicopters were going to show up sporadically, we have to have patients ready and waiting to go.

How many people had died at this point?
I can’t tell you the number. The morgue was full and patients were already in the chapel, people were asking for body bags and “What do we do with bodies?"

In normal triage situations, the sickest people are treated first. But my understanding is that conditions were so bad, you and the other medical staff switched to a reverse triage or battlefield approach. Tell me about this.
The conditions were unbearable. Inside the hospital it was pitch black, with odors, smell, human waste everywhere. It was very rancid. You would take a breath in and it would burn the back of your throat. The patients were very sick. That’s when we had to go from triage to reverse triage because we came to realize if patients aren’t being evacuated, [we had to deal with what we had]. Basically it was a general consensus that we’re not going to be able to save everybody. We hope that we can, but we realize everybody may not make it out.

What were the categories?
We divided patients into groups one, two and three. Patients in category one are able to sit up and walk and are not very sick. Patients in three are critically ill, “Do Not Resuscitate.” The ones in category two were sick, but doing much [better than those in category three]. The triage system was very crude—we’d write the number 1, 2 or 3 on a sheet of paper and tape it across the patient’s chest with their hospital records. There was limited use of flashlights. There were limited batteries. [Parts of the hospital] were pitch black. I’m talking jet black. Very dangerous. It was pitch dark in inner rooms.

What is the reverse triage process like?
Let me tell you, for a patient to be triaged—typical triage isn’t that difficult. Reverse triage is heart wrenching. Absolutely heart wrenching. You place patients into categories. With boats coming and going we could evacuate patients who could sit. There were elderly couples—how do you make that decision who can go when one was sick and the spouse wasn't? Do you let elderly couples go together as husband and wife? Some of these couples had been married 50 years.

When was the first time you were on the seventh floor LifeCare acute unit? How did you come to be there?
On Monday, mid afternoon around 2 p.m. or 3 p.m, the intercom system was still working then. I was with nurses, doing things like setting up emergency operating rooms. We heard a code, a code in LifeCare. The nurse next to me said, “Anna, I think you better go. I don’t think there’s anybody up there.” So I ran up the stairs and when I got there, there was a patient who had arrested and some nurses in room. I intubated the patient, put an endotracheal tube in. The nurses had already started the code. Then another physician came up from the emergency room. The patient didn’t survive. What was interesting to me was that my friend said, “You better go there, I don’t think there’s any doctor there.” The nurses said it’s rare we get a doctor there on LifeCare.

Tell me about conditions from Wednesday night until Thursday.
By the time Wednesday evening came around, if you can imagine in our mind, there is a central area that is a sea of people. A lot of very sick patients in that central triage area. It’s grossly backed up. Few patients had been evacuated. So there was just enough space to walk between the stretchers. It is extremely dark. We’re having to care for patients by flashlight. There were patients that were moaning, patients that are crying. We’re trying to cool them off. We had some dirty water we could use, some ice. We were sponging them down, giving them sips of bottled water, those who could drink. The heat was—there is no way to describe that heat. I was in it and I can’t believe how hot it was. There are people fanning patients with cardboard, nurses everywhere, a few doctors and wall-to-wall patients. Patients are so frightened and we’re saying prayers with them. We kind of looked around at each other and said, “You know there’s not a whole lot we can really do for those people.” We’re waiting [for help]. The people in that area could have [been evacuated] by boat but no boats were coming. I would do what I could with the nurses: changing diapers, cooling patients down with fanning. It wasn’t like, “I’m a doctor, you’re a nurse.” We were all human beings trying to help another human being, whatever it took.

Were people still dying at this point?
Every now and then a nurse would say, “Dr. Pou, this patient isn’t breathing any more.” Or I would be fanning patients and watch them take their last breath. So that’s basically what it was like Wednesday night: kind of a feeling of helplessness, frustration, sadness. It’s sad. You look around and think we live in the greatest country in the world and yet the sick could basically be abandoned like this.

UPDATE: Digby and Susie Madrak were just as horrified by this article as I was.

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