A physician in New Orleans finds refuge in giving aid
By Phyllis Maguire
Living in New Orleans since 1999, Kiran G. Zaveri, FACP, has gotten used to what he calls "hurricane scares."
Every other year, as storms bear down out of the gulf, Dr. Zaveri sends his wife and children out of town for a day or two while he rides out the storm in East Jefferson General Hospital, the community hospital where Dr. Zaveri—a general internist—is chief of internal medicine. The 450-bed facility, located in the New Orleans suburb of Metairie in Jefferson Parish, sits two miles from Lake Pontchartrain and its levees.
This time, the hurricane—the third he's weathered—was different. "The wind was so strong it blew out windows," said the 37-year-old Dr. Zaveri, whose family had evacuated to Houston. The members of the medical staff who stayed with the more than 250 hospital patients slept on surgery stretchers. The sun was out the next morning, but water had risen to the hospital's first-floor entrance.
"There was no television, no electricity and food for just a couple of days," he said. "We knew from the one radio station still running that the levee had breached, so we thought the water would keep on rising."
After Hurricane Katrina, staff and patients at Metairie's East Jefferson General Hospital found themselves surrounded by water (left). Kiran G. Zaveri, FACP, and several colleagues were among the first physicians to triage thousands of evacuees brought to the Interstate 10 staging area (below).
The levee near the hospital held, although other parts of Metairie were under four feet of water. For 36 hours, the physicians, nurses and patients at East Jefferson were stranded, relying on generators to support ventilators. One patient coded from heat exhaustion, but was revived, and none of the dialysis patients could be dialyzed for five days. Some of the hospital's patients were taken home by their families, while others who could walk just left with their charts and letters detailing the medical care they needed.
When the Louisiana National Guard finally arrived two days after the storm, members helped protect a tanker that brought in diesel fuel, flew in extra generators and evacuated some acute patients. At 3 a.m. the next morning, the East Jefferson staff helped evacuate 100 bed-bound, diapered patients from an unaffiliated nursing home next door.
"We put them on buses in stretchers, but we had to make them sit—patients who hadn't sat up in months," he said. "A lot of them were screaming because they hurt just to be moved, and one patient died. That was the second night."
Venturing out to help
The third day post-Katrina, East Jefferson's census was down to about 120. Nurses were exhausted after six straight shifts, no new nurses were coming on and heated arguments broke out among the medical staff.
"One group of physicians wanted to get out and help people, or at least open up the hospital to the needy," Dr. Zaveri said. "But hospital administrators and some physicians were worried about support staff fatigue and safety."
Instead of opening up the hospital, several physicians, including Dr. Zaveri, decided to go out into the community. The National Guard first drove them to a high school in nearby Kenner, La., where 350 people had taken refuge. Writing down a list of medications the people needed, the physicians ferried samples—Dr. Zaveri's office-based practice is located next door to the hospital—and drugs from the hospital pharmacy.
That night, over the strong objections of hospital administrators who were concerned about the physicians' safety, the National Guard drove three East Jefferson physicians to the Interstate 10 overpass in Metairie a few miles from the hospital. That's where helicopters had been dropping off evacuated citizens from New Orleans.
"There were maybe 5,000 people, very angry and upset, and no federal or state agencies there except National Guard giving them food and water," Dr. Zaveri said. "We started treating some people, getting some IVs started—but with that many people, we were really working as a triage system, not a medical team."
'I've worked in missions in India, but I've never seen anything like this and I hope to never see it again.'
—Kiran G. Zaveri, FACP
Most of the crowd was dehydrated, many were out of needed medicines, others suffered from abscesses from walking miles through contaminated water. "I've worked in missions in India, but I've never seen anything like this and I hope to never see it again," Dr. Zaveri said.
Ten East Jefferson physicians returned to the overpass the next morning, bringing more supplies. After helping get wheelchair-bound evacuees onto buses, Dr. Zaveri and several other physicians asked the National Guard to drive them to the New Orleans International Airport, where they'd heard that disaster medical assistance teams were being overwhelmed by as many as 15,000 patients a day arriving from hospitals and shelters. Because they were not registered with any of the federal medical teams, however, the East Jefferson physicians were turned away.
According to the Louisiana Hospital Association, East Jefferson was one of only three hospitals in New Orleans that were able to stay open through the storm and subsequent flooding. Speaking two weeks later of those first several days, Dr. Zaveri said, "we thought we should have gone out [from the hospital] earlier, but at the same time we felt that security was a big issue." Because of reported violence, he and other physicians from East Jefferson decided not to try to get into the downtown area but to do what they could in the western part of the city.
"I'm kind of feeling guilty," Dr. Zaveri said, "about not doing enough."
Since the hurricane, both his office and hospital practice have basically shut down. The few patients who straggle in "just start telling their stories and cannot stop crying," he said. "I listen to them and try to reassure them."
His one working office phone line keeps ringing as former patients—now scattered throughout the South and Southwest--call for refills. He is particularly worried about a former patient who has already been hospitalized twice in Houston. He is also waiting to meet one evacuated patient who has terminal bladder cancer and wants to come back to Metairie to die at home.
"I'll see her in her house and do what I can," he said. "Some pharmacies are already opening up, so pain medication shouldn't be a problem."
He is, he admits, a lucky man. Other than a few shingles and a fence that blew away, his house was unscathed and is now home to two other families besides his own.
His family has returned from Houston. His wife, an ophthalmologist who no longer has any patients as a result of the storm, now handles Dr. Zaveri's clinic phone, faxing prescription refills to his patients around the country. Because their children—ages 4 and 3—are too young for school, Dr. Zaveri isn't facing the same dilemma as many of his colleagues: whether to relocate with school-age children who now must live elsewhere, or stay in New Orleans and try to salvage an uncertain professional future.
"For my kids, it's one big vacation," he said. "We take them to the office, and mommy and daddy are with them 24 hours a day."
He tries to maintain his own equilibrium by working as much as he can. "You become more philosophical or religious, whichever is closer to your own experience," he said. "You come closer to your family and your god."
At the same time, he knows he is facing an unsure future. (See "Physician accounts.") Out-of-work physicians from the area have inundated East Jefferson with job applications. The hospital, however, doesn't have the staff to process those applications, nor patients who need care.
Dr. Zaveri is scrambling himself, volunteering at a charity clinic and at emergency rooms throughout the city, with no prospects of getting paid. Like many of his colleagues, he plans to apply for a medical license in other states.
"I'm not thinking of moving out at this time, but I'll be prepared if it comes to that," he said. Many local physicians now looking for work are going to have to relocate to earn a living, he said, and his hospital—which now has a surfeit of physician applications—"is going to see a tremendous decrease in medical staff. If we get no financial help over the next three to six months, we expect half of our primary care base will go away."
Physician accounts of Hurricane Katrina
Maximo Brito, FACP, a former ACP Young Physicians Subcommittee member and assistant professor of medicine at University of Illinois in Chicago, was attending a medical conference in New Orleans when the hurricane struck. He helped set up a triage center there and has volunteered to return to the area with a provider team from the University of Illinois and Rush University. A question and answer session with Dr. Brito appears online. (free registration required).
On Sept. 13, Kiran G. Zaveri, FACP, posted abbreviated comments on a new message board created by Annals of Internal Medicine for physicians to discuss Hurricane Katrina-related experiences. The message board is online. Dr. Zaveri can be reached by e-mail at firstname.lastname@example.org.
Harold D. Brandt, FACP, a Baton Rouge internist who helped coordinate care for evacuees, was part of a rescue mission into flooded areas of New Orleans. His account of that mission is online. (free registration required).
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