| Features | winter 2007 |
The Aftermath Ten long minutes had passed. My entire body ached as I continued to brace myself over the convulsing woman. I was struggling to hold her I somehow answered it, juggled it well enough to recognize the voice of my superior in the Office of Reserve Affairs in Washington, DC, and told him respectfully that I’d call him back. Twenty minutes later, the woman now calmed with intravenous Valium and en route to the hospital, I returned the officer’s call. I had barely uttered my name when he barked, “Sachar, where the hell are you?” in for a penny The easy answer would have been, “San Antonio, Texas, sir.” But even though my insignia as a captain in the U.S. Public Health Service had barely been broken in when Hurricane Katrina swooped out of the Gulf and swept me into emergency service in Texas, I knew that any answer, short or long, would come with problems. I wasn’t exactly new to the service. I had recently reactivated my commission, one I had held since the 1960s when I served for two years at what was then known as the Cholera Research Laboratory in East Pakistan, now Bangladesh. Yet in that pair of active-duty years—and in the 38 years that followed—I had never given a salute or put on a uniform, much less learned how to wear one properly. In short, I had no sense of what it meant to be an officer in a uniformed service. So, phone to my ear, I proceeded to explain why I was where I was. “I’m in north San Antonio, helping take care of 250 special-needs evacuees who were bussed in last night.” “Who told you go there?” “The field commander.” “Where did he get his orders?” “I dunno; from the higher-ups, I guess.” “Dammit, Sachar, I’m your higher ups.” My attempt at further explanation was cut off as my superior told me I’d better talk to a captain from the Health Resources and Services Administration. He handed her the phone, and I explained things all “So,” she said, “if I understand you, the need on the ground suddenly became critical, the field commander determined that you were needed there more urgently than at your regular station, and so he moved you there to help out with an emergency.” “Exactly!” I exclaimed. There was a long pause. “Well,” she finally pronounced, “I’m comfortable with that.” I felt a rush of relief; even in a regimented environment, reason can prevail. make ready When I reflect on my brief stint as a public health physician in Texas following hurricanes Katrina and Rita, I find myself thinking most about the people I worked with and the evacuees we assisted. But those memories increasingly are being crowded by my worries over how—or whether—we are improving our preparedness for the next mischief Mother Nature may bring our way. My experience in San Antonio informed my work as a physician and provided me with a valuable perspective on emergency response procedures. It also showed me the flaws in the system—the operational barriers to the effective placement of personnel and equipment, the jumbled communication between agencies separated by geography and administration, and the weak integration of the functions of federal agencies. Although developing solutions to these problems will depend largely on decisions made by our congressional representatives, the search for solutions could also benefit from the insight of those who were in the trenches: medical personnel, civil personnel, and the evacuees. I know institutional, organizational, and administrative lessons can be learned by analyzing our responses to these disasters. I also know there are personal lessons to be found, ones I benefit from every day. My service has become a source of inspiration to me, fed by the stories and spirit of my fellow responders, and, most especially, of the evacuees themselves. those who stand and wait After the devastating tsunami of December 2004, I had decided to reactivate my U.S. Public Health Service commission and to make it meaningful. I undertook the two-week Basic Officer Training Course and became a captain in the service, the only one of the nation’s seven uniformed services with a primary mission of “protecting, promoting, and advancing the health and safety of the nation.” When Hurricane Katrina hit several weeks after my course, I knew I needed to sign up for active duty. If I didn’t, I thought, then what the heck was I doing hanging around this planet? So in a flash I signed up. In another flash I received orders. There I was, on active duty, assigned to go to an as-yet unspecified location to help with the relief effort. I packed, readied my uniform, and put my life and commitments on hold for 30 days. I stood ready. And stood ready. My active duty orders may have been issued, but my travel orders were yet to be processed. Personnel activation orders, it turns out, come from one place; duty assignments come from another; and travel arrangements from a third. When those orders finally arrived, I learned I was to travel to San Antonio, where I would join other officers as well as volunteers from around the country. For our first week, we were assigned to assist with a special-needs population. Our enormous building was a rabbit warren consisting of four common sleeping areas with nearly 500 cots each, countless tiny cubicles, and seemingly endless corridors that stretched as long as city blocks. We were supplied with a scattering of office furniture, several blood pressure cuffs, a hodgepodge of medication samples, a handful of finger-stick glucose meters, and a few vials of insulin. Notably absent were examining areas, laboratory facilities, adequate medical equipment, and pharmaceutical supplies. By the time we arrived, people with acute trauma had already been treated. The patients awaiting us had chronic conditions—diabetes, hypertension, high cholesterol, or asthma—for which they had been receiving long-term care. That care had ended, though, when they were violently uprooted from their homes, their health care providers, and their medications. Almost without exception these patients needed prescriptions refilled. Only rarely did they have the prescriptions or medication bottles in hand; often they knew only that they needed the “little white pills” or the “round pink pills.” lost and found The professional support of the Barrio Comprehensive Family Health Care Center staff represented a source of inspiration to me. Patients were in and out of the rooms in the blink of an eye, whisked seamlessly to the laboratory or the pharmacy, their charts always at hand. Even more remarkably, if a doctor stepped into the corridor and looked puzzled for an instant, a nurse or assistant immediately materialized to inquire what might be needed or how he or she could help. Similarly, the people of San Antonio were warm and friendly. Bus drivers stopped to offer directions, while passengers chimed in with additional advice. The city’s officials also were incredibly hospitable to the evacuees. Not only did they provide free food, clothing, and medical and pharmaceutical care, but they also offered free housing in unoccupied houses and apartment units for a full year. Yet despite the sterling examples of the uniformed corps and selfless volunteers and the uplifting behavior of support staff and citizenry, the evacuees proved my true wellspring of inspiration. Who were they? The New Orleans evacuees tended to be poor and African American. Some families fled together; others were scattered far and wide. Most knew where their relatives were; many did not. Yet they had one thing in common: They had lost everything. To the last man and woman, they had lost their homes, their jobs, and all their belongings. The people we saw in our clinics, of course, had also lost their health care support. The patients’ initial complaints often proved far less significant than their true medical problems. One woman showed up in the clinic bothered by a runny nose. On the way out, she quietly asked if we could refill her prescriptions. What did she need? Oh, four medicines for her high blood pressure; two sets of pills plus insulin for her diabetes; inhalers, a nebulizer, and medications for her asthma; antibiotics because of her rotting teeth; and other pills for anxiety, depression, headaches, and insomnia. A mother brought in an eight-year-old with a sore throat. Were there any other issues? Well, he was receiving treatment for attention deficit hyperactivity disorder, oppositional-defiant disorder, bipolar disease, and Asperger’s syndrome. And could he have a note for school? And then there was the elderly woman who told me, a gastroenterologist specializing in Crohn’s disease, that she had been diagnosed with that disease 40 years earlier. She had undergone one operation, had taken one Azulfidine tablet each day thereafter, and had never had any more trouble with the disease. I refrained from telling her that evidence-based medicine said she was taking the wrong approach; I’d rather tell the bumblebee that aeronautical engineers say it can’t fly. Most memorable, however, was a middle-aged man who insisted he needed attention only for his sore throat, although he had acknowledged to his wife that his legs were “feeling a little heavy.” And indeed they were, swollen to double their normal size with edema. His lungs gurgled with fluid, his neck veins bulged, and his heart rate galloped. His blood pressure, meanwhile, was 240/120 and his breath smelled uremic. With a little more prying we learned he was diabetic and that his doctors at Tulane had been treating him for three years in a valiant effort to keep him off a kidney machine a while longer. These Katrina victims with their ruined houses, broken lives, and compromised health remained stolid, stoic, and philosophical. They were alive, and they felt comforted by their faith. They would survive without complaint and without anger. They had touched bottom in the storm, but their heads were still above water. As Good as Gold At the farewell dinner for our group, a field commander stood to speak. With his crew cut, steely eyes, stern expression, and battle fatigues and boots, he looked like central casting’s idea of a Russian assassin in a James Bond movie. His words belied those looks, however. He spoke with charm and wit, concluding his comments with the thought that every life has its golden moments and that this period of service represented one of those moments for him. I realized then—as I realize now—that I, too, had experienced one of life’s golden moments in San Antonio. My fellow officers and other volunteer professionals had taught me the meaning of comradeship and pride in service. The people of San Antonio had taught me the spirit of compassion. And the evacuees—those brave “internally displaced citizens”—had taught me that tragedies come but that faith is strong and life is stubborn. David B. Sachar ’63 is a clinical professor of medicine at the Mount Sinai School of Medicine in New York, where he is also director emeritus of the gastroenterology division. Since his service in Texas, he has taken the U.S. Public Health Service’s Advanced Officer Training Course, which focused on emergency medical responses to such catastrophes as bioterrorism and chemical accidents. Photo: © istockphoto.com/Tony campbell |
airway open with several tongue blades—the only medical equipment on hand—while also trying to prevent injury to either of us as her 350-pound body worked through the grand mal seizure. Then my cell phone rang. 
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