October 3, 2005
Student Scene
A Tulane Hospital Trainee Weathers Hurricane Katrina
 Photo by Patrick Ladapo Joseph Ladapo |
Florida was hurricane Katrina’s first victim. Swirling into the south Florida coastline on the evening of Thursday, August 25, Katrina toppled trees, flooded streets and left more than a million people without power. As she advanced into the Gulf of Mexico, forecasters predicted the storm would strengthen and rumble onto the shores of Alabama, Mississippi, and Louisiana.
New Orleans, America’s magical Crescent City, was now under the spotlight for its unenviable position below sea level. By Sunday, Katrina—now a Category 5 behemoth—seemed headed straight for that city. Mayor Ray Nagin ordered a mandatory evacuation. Many residents fled and struggled through miles of grinding, bumper-to-bumper traffic on the highways leading out. Those unable or unwilling to leave by car remained in their homes or joined thousands of other mostly poor New Orleanians to ride out the storm in the Superdome.
Dr. Eliot Fagley was neither at the Superdome nor in a westbound lane of Interstate 10. A senior anesthesiology resident at Tulane University Hospital and Clinic (TUHC) in downtown New Orleans, only a few blocks from the French Quarter, Dr. Fagley was on-call that Sunday. TUHC is a brown, brick and glass, 300-bed hospital. I spoke with Dr. Fagley about his experience during Katrina.
As he described it, the scene on Sunday morning was remarkable: hospital administrators readying for the storm called a “Code Gray” and activated crisis plans, triggering the mobilization of security personnel, doctors, nurses, medical students, and hospital technicians, who had volunteered to shepherd the hospital through emergencies—if ever there was one. Administrators held briefings with staff, detailing contingency plans for the what-if scenarios of electricity loss, flooding, food and water shortages, and evacuation—an event that would almost certainly ensue if the hurricane struck with all the might forecasters predicted.
Families of patients, unwilling to leave their loved ones behind, rushed to the hospital instead of evacuating. Quarters were tight; as Dr. Fagley recalled, “By the time it was all tallied up, there were a little over 2,000 people at the hospital.”
Courtesy Eliot Fagley
Hospital staff and family members prepare to move patients from the Tulane University Hospital parking garage to a makeshift heliport.
TUHC bustled with activity: hospital personnel and families scrambled to gather extra mattresses for people to sleep on, residents and nurses identified equipment that would come in handy in the case of a complete power failure, and everyone helped lug vital items from a first-floor central supply room. “Families were helping us move equipment to higher ground…. By Sunday night, we really thought we had pretty much everything in place.”
The Brunt of Katrina
And so, early Monday morning, with nearly all the might and fury that had been
predicted, Katrina slammed ashore, battering homes along the Gulf coast and landing
almost a direct hit on New Orleans. Breathtakingly high winds, copious rainfall,
and flash flooding challenged the levee system that protected the Crescent City,
and though many news reports would say the levees were breached on Tuesday, it
is now clear they first failed early Monday. Huddled with other residents behind
hurricane-resistant windows, unable to resist the temptation of watching the
storm, Dr. Fagley recounted seeing burly trees and satellite dishes wash down
Tulane avenue in several feet of water.
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“FEMA buses never came. FEMA really never came.” |
By Monday evening, as Katrina weakened, the early signs were promising: other than a few broken windows and about four feet of flooding, the hospital was in good shape. The city, though, had lost power and plumbing, and TUHC was now operating on generators, with little or no running water. Recognizing the situation was tenable for only a few days, hospital staff and family members readied for the next task: evacuating patients, and eventually themselves, out of the complex.
As dawn broke on Tuesday, hospital personnel and able-bodied family members sprang into action. They moved patients into Louisiana Fish and Wildlife boats and large, heavy-duty Army trucks with high wheel wells, suited for traversing flood waters. All vehicles were bound for a highway overpass, where ambulances and Federal Emergency Management Agency (FEMA) buses and ambulances were supposed to meet patients and evacuate them. Dr. Fagley estimates that they hauled about 150 patients and family members to the overpass.
As would become one of the themes of that week—and fuel criticism that would eventually lead to FEMA director Michael Brown’s resignation—the FEMA buses were nowhere to be found. Dr. Fagley put it simply: “FEMA buses never came. FEMA really never came.”
Rescue by Air
Though help was illusive by land, it did arrive by air. Private helicopters
chartered by the hospital owners peppered TUHC’s parking deck, picking
up patients, and leaving behind food and water supplies. Hospital staff and patients’ families
worked together to bring patients down to the second floor, which was connected
to the parking garage by a bridge. Once inside the garage, patients were loaded
onto the backs of large trucks, driven up to the top floor of the garage to a
makeshift heliport, and evacuated out by helicopter. National Guard Troops also
arrived on the scene, joining the beleaguered Tulane police officers.
Tensions ran high in the hospital and were aggravated by the deteriorating conditions on the streets of New Orleans: looting and fires broke out, and tens of thousands of people in the Superdome grew increasingly frustrated with dwindling food and water supplies, overflowing toilets, and lack of air conditioning in the stifling 90-degree heat of a late New Orleans summer. It was no cooler in the hospital.
Early Tuesday night, the generators failed. TUHC lost power completely. Doctors and nurses scrambled to manually bag intubated patients; others hunted down small, portable generators that would eventually power the electric ventilators. With elevators already failing before the outage and evacuations just beginning, able-bodied staff and family members threw backs, arms, and legs into the task of walking, wheeling, and carrying patients down to the second floor.
In a stunning, bewildering act, someone opened fire on the helicopters, forcing pilots to halt their evacuations that evening. “There was a sniper in one of the hotel rooms [near the hospital] who was shooting into the parking garage,” Dr. Fagley recalled.
Courtesy Eliot Fagley
A Chinook helicopter approaches the hospital as a National Guardsman looks on.
Daybreak on Wednesday morning brought with it the resumption of evacuations, and Army Blackhawk helicopters joined the efforts. Dr. Fagley also noted the presence of Army soldiers in the hospital for the first time. Meanwhile, Charity Hospital—the largest public hospital in the city—ferried some of its patients by boat to TUHC, and TUHC also received critically ill patients from the Superdome.
Dr. Sanjay Gupta of CNN reported grim, harrowing stories of desperation, death, and gore at Charity, a place he described as having “primitive,” “disgusting,” and “unbelievable” conditions. The hospital was left early on without power and running water. Doctors and nurses were literally left in the dark with little food, little water, and many very sick patients. So desperate was the situation there, said Dr. Fagley, that TUHC “sent food and water on boats to Charity.”
As fatigue worsened at TUHC, hope landed in a big package: Army Chinooks—the oversized, brawny, double-rotor, heavy-lifting helicopters used to transport troops, matériel, anything to the battlefield—pitched in to help with evacuation efforts. “It was raining helicopters,” said Dr. Fagley.
By that evening, only about 200 people remained in the hospital, and by Friday afternoon, nearly everyone had been evacuated. Finally, on Friday, Dr. Fagley was one of the last few dozen people remaining to be airlifted out.
“It was the greatest feeling in the world to know that I was in the next group of 10 people and as soon as the helicopter landed, I was going.” The Blackhawk did land, and when Dr. Fagley stepped into it, the emotion and stress of a grueling week overcame him—he could not hold back the tears. The levees of human stoicism had broken.
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
Copyright 2005 by the President and Fellows of Harvard College