To the list,
Last week, Dr. Christian posted an authentic-sounding letter to the list from a doc stranded in a New Orleans hotel -- but without a signature, she was unsure of its veracity. In the letter below, Dr. Joe Pulvirenti, a colleague of mine at Cook County Hospital, describes the same events, and more. Dr. Pulvirenti was in New Orleans for an HIV meeting when he was stranded with colleagues. He has given me permission to pass on this letter to the OEM list. (For those on the list who do not think politics and public health are linked topics fit for this listserve, there is a paragraph on occupational health issues for the stranded kitchen staff.)
Anne Krantz, M.D.
Stroger (Cook County) Hospital
From Dr. Pulvirenti:
"Thanks for the letter, I got a full night's sleep and am ready to help. 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 we found out we were stranded, the doctors left behind offered our services to the hotel staff who were very grateful for the offer. On the day of the hurricane (Monday), I was called by a hotel worker to care for a patient who was having a panic attack. 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 were cut off in our hotel in a city was without electricity, you probably had a better picture of the damage to the city after the levees broke then we did. However, eventually we had about 3 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 which we ran out of within 48 hours. When the generator ran out 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 2000 people in the hotel. Most of the occupants were friends and relative of hotel employees, a few New Orleans's Police officers and their families and the rest were marooned guests like us. The evening that the generator went out, I was called at 2:30 in the AM 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 UTI. I was able to find some pain meds 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 MDs, PAs, NPs, a clinical pharmacist, a medical writer and loved ones. We had people from Chicago (most of the group) which included me, Chad Zawitz (an Infectious Disease attending from Cermak jail), Jim Sullivan from St. Joseph's Hospital, Roger Trinh and Lee Roberts from Howard Brown, Joshua and Curtis and Max Brito from the University of Illinois. From Galveston we had Marcy Salas and another person whose name escapes me. From Indianapolis we had 2 NPs (Karen West and another person).
From Atlanta we had Shawn. We also had Rudolfo Arcenas and his family (wife and 2 small boys), and a medical writer from London named Katrina (I kid you not) McKay who was extraordinarily helpful. Some of us (not me) had the common sense to get everyone's Email addresses and a number of us had cameras to document the events. I only had one throwaway camera. However, we all vowed to keep up with each other.
"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 and with an armed police escort, we waded across the street with large plastic containers and whatever we could find to carry stuff back. In the group was (three of us). It was surreal walking around a darkened (drug store) with 1-2 feet of water in the aisles as a crowd of looters gathered outside (you could say we were looters also). 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 a second and third trip 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 were let in by the police (The police had no choice and the looters were looking to survive). During the second and third 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 name, hotel room number, CC, HPI, PMH, allergies and current meds. We only had a BP cuff and flash lights but were later able to fashion a rudimentary stethoscope (Marcy from Galveston did this) using a semi stethoscope from a BP cuff attached to a small plastic dosing cup and a hole was cut in the bottom with the tubing threaded through. The most common issues in the beginning were medication refills (Remember many of these guests had chronic medical conditions and brought a limited supply of medications). We refilled as many meds as we could and substituted meds when we didn't have the exact medication. 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 air conditioning sitting in 3 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 area with bleach water (concentration of
1 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. I estimate that we had about 256 visits in the first 2 days. We kept most of the records and hope to publish our experience
"Other health issues included working with the hotel staff in infection control aspects of food preparation. I was able to call Bob Weinstein (the chariman of ID at Stroger -- ak) 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
2-3 meals per day 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 2 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 2 looters.
People were aimlessly walking in the 2-3 feet of sewage water and I know many of them will be ill if not dead within 1-2 weeks. In our hotel, looters broke in on a number of occasions. Some of them were let in by friends/ relatives of the hotel employees. These people and the employees were led out of the hotel by shotgun. Finally after a day or 2 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 4 buses were to pick some of us up at the JW Marriott Hotel which was located about 2- blocks away and 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, 2 busloads were able to board but then FEMA confiscated the other 2 buses. The people who could not go ahead were marooned at that hotel. Fortunately the doctors there (including Chad) 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 8AM. They did not arrive and we didn't know if and when they would arrive and whether FEMA would confiscate them. 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 to stay in that hotel for another 1-2 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 that. 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 about 4 PM we were told that buses were on the way and that an arrangement had been made with FEMA to allow our buses through without confiscating them. At about 6PM the rest of the hotel guests and the doctors waded our way to the JW Marriott to await the buses. At the JW Marriott the guests were organized into bus groups and we waited. During the wait time, an 89 y/o women 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 1AM, the buses with security arrived. We were loaded on the buses and taken to Baton Rouge. Max and I accompanied the above 89 y/o lady in an SUV. Our trip through New Orleans back to Baton Rouge was uneventful but the trip through the streets of New Orleans was both sad and creepy at the same time. In the end, I am proud to say, no-one in the hotel died. I am proud that I served with a great group of clinicians, hotel staff and police and security staff who battled fatigued, heat exhaustion, despair and overcame 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 3 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 National Guard.
Although our condition was terrible and were deteriorating' we had it nowhere as bad as the poor people stuck in the Superdome and the convention center. We were blacked out from coverage but the stories that we heard coming from there were horrific. Helicopters hovered over our head 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 had plenty of opportunity to leave. We could not nor could the poor and infirmed. I felt his comment was extremely callous. But then again I don't expect much more from that man.
FEMA appeared to work against and not for us. The fact -that it took 3-4 days for adequate supplies to arrive to the people who needed it- 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 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, car jackings, 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 the hotel guests and employees' lives. We see images of disasters on TV every day and I know that I have become callous to this because I felt that this happened to someone else in another part of the world. But this is not the case. Any of us can be affected and with the growing uncertainties in this world, the chances are increasing that it 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 as more and more disasters occur due to global warming, pollution, and wars will occur.
"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, Jewish, Muslim etc. to find commonality of purpose and save our own lives by removing the current administration, by putting in 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."
Joseph Pulvirenti M.D.
Chairman Infectious Diseases
Associate Chairman Internal Medicine
Provident Hospital
500 East 51st Street
Chicago, Illinois 60615
office- 312-572-2762
FAX- 312-572-2733
Email- joseph.pulvirenti@hektoen.org