Eyewitness Account: Marooned At The Ritz
Eyewitness Account: Marooned At The Ritz
Stranded in New Orleans during Katrina, medical professionals set up a treatment center at the Ritz Carlton.
by Joseph Pulvirenti, M.D.
The story starts when a group of doctors and loved ones were stranded in the Ritz Carlton in New Orleans after the airlines cancelled the flights out of New Orleans. (Many of the carriers, especially Delta, cancelled their flights a full 24 hours prior to the hurricane, marooning many of us who were in New Orleans that weekend).
After the hurricane passed, a group of us explored Canal Street, the Delta and the French Quarter. There wasn't that much damage then, some exterior damage to hotels, some palm trees blown over, and only a few buildings with severe damage. However, it could have been a lot worse. There were even a couple of bars open on Bourbon Street serving beer. The feeling at that time was one that New Orleans had once again dodged a bullet and would be back in operation within a week.
However, later that day the levees broke. Since we didn't have access to TVs, and we were cut off in our hotel in a city that was without electricity, those outside New Orleans probably had a better picture of the damage to the city after the levees broke than we did. However, eventually we had about three feet of water around our hotel. Our hotel had a back-up generator which gave us some lighting and occasional phone service, but no air conditioning. It ran on diesel fuel, which we ran out of within 48 hours, and then we had no lighting or phone service. With the breaking of the levees, we also lost all plumbing and the toilets backed up. Fortunately, and with much effort, the hotel staff was able to get a couple of trucks in with fuel to restart the generator, which was used intermittently to extend resources.
Initially there were about 2,000 people in the hotel--mostly friends and relatives of hotel employees, a few New Orleans police officers and their families, and marooned guests like us.
The evening that the generator went out, I was called at 2:30 a.m. to see a hotel guest who was having severe left-sided back pain with radiation to the groin, I was concerned about a kidney stone or a urinary tract infection. I was able to find some pain medications and some antibiotics from another guest to treat her. The following morning, our group got together and decided to start an infirmary (or MASH unit) in the hotel. We spoke to hotel management, who was relieved that we decided to do this and we were placed in the hotel bar.
Our group was composed of M.D.s, physicians' assistants, nurse practitioners, a clinical pharmacist, a medical writer and loved ones. Most of the us came from the Chicago area, including Chad Zawitz (an infectious disease attending physician from Cermak Health Services at the Cook County Jail), Shane Spicer (a psychiatry resident from Northwestern University), Jim Sullivan from St. Joseph's Hospital, Kyron McAllister, Roger Trinh and Leigh Roberts from the Howard Brown Health Clinic, Max Brito from the University of Illinois, Curtis Hainds (a physician assistant) and Joshua Titus ( a clinical pharmacist). Guests of the above included Kyron McAllister, Jack Bone and Sandy markiewitz, who also chipped in to care for the patients. From Galveston, we had Marcy Salas and Kathy Smith. From Indianapolis we had two nurse practitioners (Karen West and another person). From Atlanta we had Shawne Hampton. We also had Rudolfo Arcenas and his family (wife and two small boys), and a medical writer from London named Catriona McKay who was extraordinarily helpful. Some of us (not me) had the common sense to get everyone's e-mail addresses, and a number of us hadcameras to document the events. I only had one throwaway camera. We all vowed to keep up with each other after this ordeal.
We needed to stock our infirmary and since the hotel had limited supplies, we decided to go across Canal street to a drug store. We had to get there fast, as the looting had begun. With an armed police escort, we waded across the street with large plastic containers and whatever else we could find to carry stuff back in. It was surreal walking around a darkened drug store with one to two feet of water in the aisles as a crowd of looters gathered outside. (You could say we were looters, too.) The clinical pharmacists concentrated on getting prescription medications. We concentrated on antibiotics (especially quinolones), antihypertensives, asthma meds, anxiolytics, diabetic meds, syringes, OTC meds for diarrhea and cold and flu symptoms, bandages, water, Gatorade, dried food products. Later we did second and third trips for more food supplies and meds, diapers, tampons, and even pet food. During the first excursion the looters waited--most were patient--for us to get our share of meds, and then they were let in by the police. The police had no choice and the looters were looking to survive. During our later excursions, the place was abandoned, and we were able to get the remaining our supplies unhindered. We were unable to get tetanus and hepatitis vaccine and there were no IV supplies to be had.
Back in the clinic, we developed a medical record form documenting our patients. We only had a blood pressure cuff and flashlights, but we were later able to fashion a rudimentary stethoscope (Marcy from Galveston did this) using a semi-stethoscope from a blood pressure cuff attached to a small plastic dosing cup with a hole cut in the bottom for the tubing to be threaded through. The most common issues in the beginning were medication refills; many of the guests had chronic medical conditions and had brought only limited supplies of medications. We refilled as many meds as we could and substituted when we had to. Luckily my PDA had Epocrates, which was very helpful. We also saw panic attacks and sinus and asthma complaints. These conditions were worsened by the heat and humidity and stench of a hotel without airconditioning sitting in three feet of sewer water with backed-up toilets with 90-100 degree temperatures outside. In parts of the hotel the temperatures and humidity were far higher.
We were also very concerned about skin and soft tissue infections for people walking in the sewage outside and instituted a system where people washed off their legs and affected areas with bleach water (a concentration of one tablespoon per gallon of water) and were given a dose of a quinolone to protect against development of diarrheal disease. As the days progressed we got more and more people coming in with complaints of dehydration and heat-related conditions. We also started seeing more and more diarrheal- related illnesses and respiratory complaints. We had over 250 visits in the first two days.
Other health issues included working with the hotel staff in infection control aspects of food preparation. I was able to call Bob Weinstein [Robert A. Weinstein, M.D., Professor of Medicine and Chief, Division of Infectious Diseases, Cook County Bureau of Health Sciences] for help on this and the culinary staff was well ahead of us on many issues regarding food safety and good hand hygiene. Bleach water was available for all guests for hand cleaning before meals, with signs instructing them on how to clean their hands (submerge hands in the water for at least 10 seconds), and we discussed with the kitchen and hotel staff and guests infection-control-related measures to protect themselves and the rest of us from the spread of infections. We had two to three meals per day ourselves, and many consisted of a croissant and water, with dinner consisting of cheese and crackers and water.
Outside of the hotel, looting continued and fires were set in two surrounding buildings. The looting was understandable with people getting meds, food and water. However, we saw numerous instances where people were stealing radios, TVs, jewelry, etc., which made no sense to us. Gunfire was going on around us and some of us saw a gun battle between two looters. People were aimlessly walking in the two to three feet of sewage water, and I know many of them will be ill if not dead within one to two weeks. Looters broke into our hotel on a number of occasions. Some of them were let in by friends or relatives of the hotel employees. These people and the employees were led out of the hotel by shotgun. Finally, after a day or two passed, some of the people in the city left on their own if they had cars and others were taken to the superdome, leaving a skeletal employment crew and mainly the marooned guests.
On Wednesday, we heard that four buses were to pick some of us up at the JW Marriott Hotel, located about two blocks away. This required a trek through the sewage outside the hotel. We sent some of the doctors ahead with the staff and about 200 guests. When they got to the hotel, two busloads were able to board, but then FEMA confiscated the other two buses. The people who could not go ahead were marooned at that hotel. Fortunately the doctors there were able to organize medical supplies, bleach water and other material to keep these people going.
The following day, Thursday, we were supposed to get additional buses at about 8 a.m. They did not arrive, and we didn't know if and when they would arrive, or whether FEMA would confiscate them. Meanwhile, conditions in the hotel were deteriorating and more and more people were coming into our infirmary with heat-related conditions and exhaustion. Despair was prevalent. It was my strong feeling that if we had had to stay in that hotel for another one to two days, people would start to die.
Many of us started to call the media. Jim Sullivan called MSNBC, Shawna and Katrina called the BBC, Rudolpho and Max called Spanish stations and I called NPR. Other guests in the hotel called CNN. One spoke to Wolf Blitzer and others had various high-level ties in the government and tried to exploit them. As the hours dragged on, we went through multiple periods of hope followed by despair, with news of buses first coming, then not coming. Finally, at about 4 p.m., we were told that buses were on the way and that an arrangement had been made with FEMA to allow them through without confiscating them. At about 6 p.m. the rest of the hotel guests and the doctors waded our way to the JW Marriott to await them. There, the guests were organized into bus groups, and we waited. During that time, an 89-year-old woman collapsed from heat exhaustion and we feared more serious complications. We tended to her with cold packs, aspirin, a nitro patch from a crash cart we found, small doses of pretzels and gatorade, and she slowly recovered.
Finally, at 1 a.m., the buses with security arrived and we were taken to Baton Rouge. Our trip through the streets of New Orleans was both sad and creepy at the same time.
In Retrospect In the end, I am proud to say that no one in our hotel died. I served with a great group of clinicians, hotel staff and police and security staff who battled fatigue, heat exhaustion, despair and terrible conditions to ensure the survival of everyone staying at the hotel.
As for the government. I will tell you that for the exception of the police who stayed in the hotel during the hurricane, government support was essentially non-existent for the first three days after the hurricane. We were on the main strip of Canal Street right by the French Quarter, and looters roamed this area without any restrictions by police or the National Guard. Although our conditions were terrible and were deteriorating, we had it nowhere near as bad as the poor people stuck in the Superdome and the convention center. We were blacked out from news coverage, but the stories that we heard coming from there were horrific. Helicopters hovered over our heads, and some of our group saw Air Force 1 make a low dip over the city, but that did nothing for the trapped population below. I understand that Bush stated something about the people in New Orleans having had plenty of opportunity to leave. We could not--nor could the poor and infirm. I felt his comment was extremely callous. FEMA appeared to work against and not for us. The fact that it took three to four days for adequate supplies to arrive to the people who needed them was not just slow, but criminal.
Was the lack of relief for New Orleans racist? Yes, part of it was. There is no doubt in my mind that if this had occurred in a rich, white Republican area, federal resources would have been streaming in from minute one. But there was much more. It was about poverty in a city with about 40-50% of the population living below the poverty level. It was about anger and hatred built up in this population. It is about the thin veneer of civilization that exists in many of our cities that hides a cauldron of civil mistrust and unrest. This unrest has been exacerbated by the current administration by its callous disregard for the plight of its people. This unrest can erupt in any disaster situation where people feel abandoned and must strike out on their own to survive. It took only a day for the law of the jungle, for survival of the fittest, to rule in New Orleans. Mass looting, riots, roving gangs, carjackings, murders, suicides, rapes and all of the lowest forms of human behaviors were rampant in New Orleans and dominated the news.
Yet there was another side. There was a coming together, a cooperation, a sharing and caring, a sense of commonality that brought a group of relative strangers together and allowed us and the people around us to survive. We accomplished this and saved our lives as well as those of the hotel guests and employees. We see images of disasters on TV every day and I know that I had become callous to this because I've felt that these things happened to someone else in another part of the world. But this is no longer the case. Any of us can be affected, and with the growing uncertainties in this world, the chances are increasing that we will.
So there it is. The disaster in New Orleans is about divisiveness versus working together, about survival of the fittest versus sharing and pooling resources, about the lowest human behavior versus striving for the highest that human nature can provide. In many ways our future is our choice and we must decide quickly which way we will go, as more and more disasters occur due to global warming, pollution, and wars.
What must be done? First we must aid the people in New Orleans. Second, we must band together--White, Black, Hispanic, rich, poor, Democrat, Republican, Christian, Jew, Muslim--to find commonality of purpose and save our own lives by working for governmental change, by putting in place systems that improve the chances of the less fortunate, by pooling our resources to address issues related to global warming, increasing poverty, overcrowding and other banes to the existence of the human race.
I am willing to help in any way that I can. I hope you are too.