Dr. Goodheart

I have been encouraged to resume blogging by a major league blogger who described my efforts as "good stuff". Since I greatly admire the particular blog, I was definitely flattered.

I doubt that any of my readers has been checking the Dr. Goodheart blog daily, breathlessly waiting to hear about the next adventure. Nevertheless, adventure it shall be.

For the first time since I left my regular cardiology position--shortly before Katrina hit in 2005--I'll be heading overseas. This time I'll be going to Kiev, Ukraine, to participate in a conference called "Children at Risk". Now as a cardiologist for adults, I do not take care of kids; nor am I a social worker nor an expert in the diseases of street kids. However, I do have quite a bit of experience in working in health care reform in the former Soviet Union, and some understanding of how totally and seriously communism messed up Soviet society for over 70 years. I also understand and can apply principles of evidence-based medicine to problems in health care other than cardiology.

Our first task will be to try to understand the current situation in Ukraine, compared with my last work in the former Soviet Union over five years ago. Our group--comprised of representatives from a number of charities and Christian church groups who have been involved in the problems of Ukrainian street children--will tour a juvenile detention center, an institutional home, and other pertinent sites.

I hope to meet with physicians and other health leaders to see if there is the potential for future work along lines that are of interest, and for which I feel I could be of some help.

My daughter Sarah will be coming along on this trip, which is great. Her knowledge of Russian is, I believe, better than mine, having studied it longer and being younger and smarter to begin with. It will be fascinating to see her reaction to the situation we'll be looking at.

If I have the time and opportunity, I will try blogging during the trip to give a picture of Ukraine as it stands today. A couple of years ago, when the "Orange Revolution" was making headlines, we who have wanted to encourage deeper democracy in the former communist countries were really excited. Now the situation looks more chancy. The reformers of the Orange Revolution have fallen into squabbling among themselves, and the pro-Russian party of Viktor Yanukovich, now the Prime Minister, may well win more seats in the upcoming parliamentary elections later this month.

With luck our next post will be from Kiev.

Yes, I've been thinking about going to Pakistan to help out with disaster relief. Over the past day I've been in touch with a nurse in Seattle who also helped out with Katrina, although I didn't meet her there as she was in Louisiana. Rebecca is very eager to go, and lined up some funding from the World Economic Forum's new Disaster Resource Network.

She now has a cardiothoracic surgeon and another surgeon lined up to go--but her own job is on the line if she goes to Pakistan. A hard decision to make. I myself have just started a new job doing cardiology again part-time, and I know my boss wouldn't take kindly to my up and leaving so soon.

In any case, I feel much better having a surgeon go than a cardiologist, given the horrendous trauma I've been hearing about. Quite different from Katrina.

I'll keep in touch with medical relief agencies such as the International Medical Corps about possible future service in Pakistan.

In the meantime, here are some thoughts from Mansoor Ijaaz on how America can help. Remember that our help after the tsunami seems to have had a profound effect on Indonesians' perception of America.

From National Review Online:

America's Helping Hand

There’s a huge opportunity in this tragedy for us Americans as well. The Muslim world perceives us today, rightly or wrongly, as an arrogant nation of people adamantly opposed to Islam’s ideological and philosophical grounding, and that we are prepared to go to any military extent necessary to prove we are right. Against the terrorists, you bet we will, and we should. Rational Islam needs to understand why that is necessary and help us battle their demons from within.

But as a fiercely loyal and patriotic American of the Islamic faith, I know we are not entirely without blame in the way we are characterized. And I also know that we don’t do enough to reach out in a way that touches the hearts and minds of Muslims where it matters. Can anyone honestly say, after watching the highly intelligent faces of the young men and women who lost their children and everything they ever had telling us their stories on TV for the past 72 hours that they wouldn’t respond to us if we reached across an ocean to help make them whole again? Let’s take the game directly to the people who matter rather than letting their mullahs and fanatics define it for us.

Let us not be known as a people who offer paltry sums of money and handouts that nobody can practically use. Let’s marshal our resources in a different way to help Pakistan rebuild the lives of its Kashmiri citizens — as one people of a civilization to another, with respect and dignity that honors their sacrifices. President Bush should call on the mayors of a representative list of major cities across the United States to each adopt one small village or town in Pakistan-controlled Kashmir in order to help restore the public school systems, hospitals, and pharmacies that provide critical services to ordinary citizens.

The Salvation Army has been doing a marvelous job of feeding thousands of Katrina victims in places where there was no other food available. Out in the community of DeDeaux, a Salvation Army truck dispenses meals every day. Here (right) was the menu for the other day. If you click on the photo to enlarge it, you can see that they are thanking God for everything--'even love bugs'.

There are very few mosquitoes out here in DeDeaux, but everything outside has 'love bugs' swarming around it. Fortunately they don't bite, they just tickle. Here's a close-up.

Serving with a smile was Mrs. Julie Whiten of Annapolis, MD; her husband is also here with the Salvation Army relief effort.







That night I squeezed into a table a Chilis with a group of Southern Baptist Disaster Relief volunteers--mostly pastors--from Iowa, who are doing cooking, counseling and other tasks, in conjunction with the Salvation Army's effort here. Another Chilis customer came over to thank them for coming to help.





Next morning I went to see the Ohio volunteers' kitchen at the huge Salvation Army distribution center (where I first went when I came to Biloxi following a Salvation Army convoy from Jackson). There are a number of these kitchens in different places on the Gulf Coast.

This kitchen feeds 5,000 a day. There's more than bread and fish left over; they have trouble getting rid of the waste.

Biloxi's 'Yankie Stadium' (below) is the site of 'Compassion Central' where the Salvation Army and others feed the bellies and souls of Biloxians.

The photo below shows the SA/Southern Baptist meal tent.



Today the Kids' Kamp day-care tent was being used for an old-fashioned revival meeting, filled with spirit and the Spirit. The evangelist had driven 700 miles the night before to be in Biloxi for the meeting.









He was OK, but the ample-sized black lady who preceded him really got the crowd fired up.

She emphasized that Katrina had brought down the mighty along with the small, and that we--black and white, rich and poor--were in this together. Amen, sister!

My son John is in Kabul, Afghanistan, as a statistician for a consulting company doing public opinion surveys there. John also has the 'irrepressible urge to make things right' gene. Finding a way to do that with a mathematics Ph.D. is a little harder than with an M.D., so I congratulate him on his persistence in finding a way to help improve the world, one equation at a time.

His team was in Kabul on election day, last Sunday. Fortunately, there was little or no violence. He writes:

Do we have to change the name of the blog to Dr. Swellhead?

Thanks to links to Dr. Goodheart by Powerline, Mudville Gazette, Hugh Hewitt and others, someone in Towers Productions in Chicago, a company that makes documentaries for the National Geographic channel (they made the highly regarded “Inside 9/11”), saw my blog. They are in the process of making a 2-hour documentary covering Hurricane Katrina and the disaster relief response. I guess they liked the ground-level view of what’s going on in the Biloxi area, so they asked if I could meet with their crew.

We arranged to meet on Sunday. Sarah Huisenga, Ralph Madison and Keith Francis arrived from Mobile in Ralph’s big Ford van, loaded with videography equipment and organic food. The first thing I learned was that Keith and Ralph are now homeless, their homes in New Orleans having been flooded by Katrina. The second thing I learned is that--organic trail mix notwithstanding--these are good folks with lots of empathy for the victims of Katrina and a determination to tell their stories.

They’ve been interviewing people like General Honoré as well as getting video of the flooded areas in New Orleans, but had not yet seen the hardest hit areas of Mississippi.

Sarah, the producer, and I talked about where we might go and which of the stories I had written about might be good for the documentary. We decided to go back to the school in the rural community of DeDeaux. It’s been about a week since I was last there.

We found the school still a beehive of activity. Supplies are being delivered and distributed; the Salvation Army is distributing hot meals from their truck; and a different team of physicians had already come and gone. Medications and medical supplies were now being kept in the school building, which is now air-conditioned (hooray!). Three people are now keeping the medical aid station going: Keith Hunter, Jeremy Alford, and Alanna Edwards. They have brought in substantial new supplies, and Keith is making trips to Walgreens to fill the local folks’ prescriptions; Walgreens is charging it to FEMA. Keith and Jeremy are scouting the surrounding communities for shut-ins and others in need.

Ken Barber (in the red T-shirt, left) is the local gentleman (he married a woman from Dedeaux 30 years ago) who is now heading up the community effort. The National Geographic crew interviewed Ken; then spoke with Dennis, a man who owns a small business in Connecticut who closed up shop and brought a pickup, trailer, and tools down here
on his own. Dennis has gone from community to community, trying to identify needs and get supply distribution started. Once started, he then moves on to another community. Dennis, like many of the folks who have come down here, is a little hyper, but that seems to be what separates the people who wanted to come from the people who actually did.

We managed to scrounge up some patients who needed to see a doctor so they could video my taking care of them and pretend that I spent all my time doing this instead of traveling around with a video crew.

Left is Branlyn with her puppy.

Right: Two Sarahs.

Since we were close to two of the coastal communities that had been hardest hit, Bay St. Louis and Waveland, we drove toward the beach so they could video the damage there. On the way down, I could tell from their excited reactions--to the trees blown over and the houses that were wind-damaged—that they hadn’t yet seen the real picture of Katrina’s devastation.

As we got closer to the shore—but still several miles away—we stopped to video an area where a bunch of cars were strewn beside the road, apparently swept there by the storm surge from a used car lot.
The crew has three high-definition video cameras. The big Sony is used by Ralph for the primary video; the others are for back-up and for documenting the process—the “Making of the National Geographic Katrina Special Documentary” video. Below, right, is Ralph shooting the video, Sarah doing back-up, and Keith doing the “Making of…”video. So this is a photo of the video of the video. Whoa….







As we drive closer to the shore, the damage gets worse; but then we come to the railroad tracks, the bed of which is on a berm above ground level, so that they served as a barrier to the storm surge.

The tracks here are twisted (one is reminded of what Sherman did to the southern railroads, heating the rails and twisting them around trees to make “Sherman’s hairpins”) and the bed eroded.

Throughout the Mississippi Gulf coast, “south of the railroad tracks” is where the devastation is worst. Here in what was Waveland, barely a house is left standing for miles. We drove along the shoreline road, and our hard-bitten journalists were struck dumb by the miles of rubble that used to be Waveland.

Arriving at St. Stanislaus College in Bay St. Louis, we found a dormitory that—after Hurricane Camille—had been built to take 300 mile per hour winds; the ground floor is a parking garage, the dormitory rooms on the second floor, on concrete pylons. A man familiar with what happened at St. Stanislaus during the storm told us that about 50 students—mostly international students who had no homes to go to—and the brothers on the faculty rode out the storm right there in the dorm rooms. They could hear cars in the garage below being battered into the concrete pylons beneath them. Of all the hundreds of buildings that had been standing along miles of beach, only this one survived intact.

The video crew decided that the best way to try to convey the enormity of the devastation would be to have a single continuous Steadi-Cam shot out of the side of the van while we drove along several miles; then to show that in time-lapse mode.

I had never seen a Steadi-Cam before; it is a remarkable contraption; it has no active gyroscopic stabilization, only a counterbalance mechanism and pivoting mechanisms that keep the camera steady while the operator walks, runs, drives, etc. Think of a show like “Cops” in which a cameraman follows the police chasing a ‘perp’. Without the Steadi-Cam, we’d all get seasick watching it.


Ralph demonstrates the effectiveness of the Steadi-Cam by jumping up and down (the rig weighs 60 pounds with the camera!) while the camera remains immobile. We tie open the doors of the van; Ralph sits in the open doorway with Keith holding him; Sarah drives; and Dr. Goodheart, videographer, gets to use the HD video camera to document the whole thing.

I have high hopes for this National Geographic documentary, because I found Sarah and her crew to be immensely sympathetic to the people we talked to, and as awestruck as I at the incomprehensible scale of the devastation wrought by Katrina. Please keep an eye out for it on the National Geographic channel in about seven weeks. You still have time to run out, buy a 50-inch HD LCD TV, and get the premium cable package that includes the high-def National Geo channel.

Full disclosure: Keith wanted to make a contribution to the effort, and the next day brought back the dark chocolate I requested for myself, and three fresh pies for the nursing staff at Biloxi Regional.

I don't usually do much linkagery here, but I want to urge you to read Rev. Donald Sensing's oration of September 17 to Gold Star Marine families. Bear in mind that his son Steven is now a Marine and is being deployed to Iraq. Cardiology can be a life-and-death matter, but it's someone else's life at stake, not the cardiologist's. If you can read this homage to fallen Marines with a dry eye, the Lord needs to soften your heart. Thank you, sir!

Update: Dore' writes:
Chili's is great!!! Please be sure to eat at Chili's on September 26. Chili's is donating 100% of their profits on Sept. 26 nationwide to St. Jude Children's Research Hospital. For more info go to:
www.createapepper.com Chili's is in the midst of a national pepper coloring campaign to raise funds for St.Jude.

St. Jude is providing treatment for 80 very sick children who were being treated for cancer and other catastrophic illnesses in hospitals impacted by Katrina.

I was trying to get together with my FDNY buddies John and Chris at Chilis in d'Iberville (pronounced here "dee EYE ber vil" on Saturday night. Chilis had been closing at 5 pm, as the 8 pm curfew required them to get the restaurant cleaned up and their staff home by 8. Now they are 'closing' at 8, with an 11 pm curfew. As you can imagine, given the hours of most relief workers, we weren't getting many dinners out. John and Chris kept making plans with me, but they always ended up working too long. This time we were going to make it--I called ahead to Chilis, we were all set. Except that Chris hurt his bad shoulder, and John was not feeling well.

I was already at Chilis by myself, so I started talking with a bunch of folks wearing Southern Baptist relief T-shirts waiting outside. They were Tennessee Volunteers (natch), and their special jobs are either (1) chain-sawing fallen trees or (2) 'mudding out' houses. When they get tired of one job they switch to the other. Unlike me, this is not their first hurricane relief work. They invited me to join them, making a party of 23.

Chilis managed to find a corner in their crowded restaurant for us, and Danny (photo) served us with alacrity and humor. His own place got minor damage in the storm, but his folks' place had the roof cave in. Danny told us this about Chilis: they brought in trailers for their employees to stay in if they lost their homes; they delivered food to the families of employees; and they paid their employees during the time the restaurant was closed. Chilis is now the destination of choice of Biloxi's disaster relief workers. If you see a Salvation Army Disaster Relief truck heading north on I-110 about 7 pm, you can bet it's heading for Chilis. So I say: Eat more Chili!

From my previous posts about the plight of the Vietnamese community here, you can probably tell that I was quite moved by their stories of being refugees for the second time in their lives. Had the flood waters risen another three feet, there would have been hundreds of them drowned in their little attic shelters. And now the viability of the community, already challenged by the economics of the shrimping industry before the storm, is now very doubtful. Yet despite the desperate nature of the situation, the Buddhist and Catholic Vietnamese communities are carrying on a kind of Cold War here. It got so bad today that I walked off in a huff and a couple of choice curse words.

Here’s what I’ve learned over the last couple of days. Thursday night and Friday, Myhanh and I hung out with local Vietnamese. Myhanh spent the night with the family of one of the physicians who works in the Gulfport hospital, and was talking about setting up a better medical care clinic in a tent, rather than using the tiny area in the back of the Buddhist temple. From her and from observing the situation the next day, it is clear that there is a lot of suspicion between the Catholics and Buddhists.

From Myhanh, I heard that the church had run out of their donated supplies of rice andd fish sauce; and the temple still had a large supply. But the Catholic parishioners would not come to the temple to ask for it. Instead they considered that the supplies had been ‘misdirected’ to the temple. At the temple I met a local businesswoman, Anna. She has lived in Biloxi for twenty years; she owned a very popular new restaurant, the Pho Palace, which had been in operation only a month before the storm, and which took her life’s savings. She also owned a travel agency and several rental homes.

All of this was destroyed by the flood waters. Despite her husband’s desire to leave, she wants to stay here in Biloxi. Anna told me that a Mr. Henry Lee, an Asian businessman in San Jose, California, had donated $100,000 of oriental food supplies, and arranged to have it trucked to Biloxi to be delivered to the (entire) Vietnamese community. But depending on whether the truck unloaded at the church or at the temple (the two are next to each other), these were now “the Buddhists’”or “the Catholics’” supplies.

During this discussion yesterday, two officers from the hospital ship USN Comfort and representatives from Project Hope arrived. We told them of the small clinic set up by Dr. Wing in the Buddhist temple, and warned them of the bitter political conflict. We all walked over to the Catholic church, where Father Dong was offering the use of a large, empty warehouse. It has an intact roof and clean concrete floor, so it would be better than a tent for providing medical care; sheets could be hung for privacy in exam rooms.

We asked Father Dong about the potential problem of the clinic being shunned by the Buddhists if it were on Catholic land; we even saw that access to it could be cleared from another street so the Buddhists wouldn’t have to cross through the Catholic churchyard. It looked like it was going to work--although I still sensed from Father Dong's response that he wasn't working with the Buddhist monks at the temple.

Today, I found Navy and Project Hope physicians working at that new site, but they needed more medications. So of course we walked over to the temple, where Dr. Pham was seeing patients, and where the donated medications were located. When we proposed moving the clinic to the new site where more people could be served, Dr. Pham said we were ‘overstepping’ because the medical supplies—although intended for the entire Vietnamese community—had been delivered to the temple, and so now ‘belonged’ to the Buddhists. I pointed out that many of the supplies had been brought by Myhanh and me, donated by FEMA (Myhanh had spent the previous evening sorting the medications by category to make it easier; now they were all blended.) It was at this point that I used what my old friend and patient Brian Gallagher told me were “The two most beautiful words in the English language”, and left.

I’ll be going back to the new site, to drop off some diabetes medications which they don’t have. Then I think I’ll go to lunch with my FDNY buddies, and tomorrow perhaps over to the clinic in d’Iberville if they need me there. This is the United States of America. We are witnessing the greatest outpouring of personal, organizational, and governmental generosity in the history of the world, and some folks don’t get that we don’t worry about where the rice was dropped off. There is plenty to go around, children, don’t fight over it!

OK, let’s not leave it on such a negative point.

The morning had started out grand: Yesterday I asked building maintenance at the hospital to get Old Glory off the roof so she could hang properly again from the front of the hospital. The sight of her had been, I know, an inspiration and lifting of the heart for many. Well, they tried, but the flag was still not hanging properly. I found the stairway to the roof and went up, but a flag this size is really heavy, and I wasn’t able to move it into place.

This morning I asked my buddies to help me get her set right, and of course they set to work.

Here are John Seiler and Chris Edwards, FDNY (ret.), restoring Old Glory to her rightful place.














What is that which the breeze, o'er the towering steep,
As it fitfully blows, half conceals, half discloses?
Now it catches the gleam of the morning's first beam,
In full glory reflected, now shines on the stream:
'Tis the star-spangled banner: O, long may it wave
O'er the land of the free and the home of the brave!

On Thursday, September 15, Myhanh and I met Kim at the relocated Red Cross health care headquarters in Gulfport. As you can see from the photo, the air conditioning is now more natural, with breezes coming off the Gulf. We then set out to assess the health care facilities in Bay St. Louis, where the local hospital, Hancock Memorial, had been flooded and was closed.

The drive down to Bay St. Louis showed more scenes of the awesome power of the storm; cars overturned, strewn around the side of the road.

Here’s what we found at Hancock Memorial: a beautiful campus and facility from the outside—washed clean, I guess.

In front, a bunch of containers; to the side, a tent city of military folks; and under the front portico, nurses enjoying a lunch of tuna salad.

Angie Gambino is the Chief Nursing Officer of Hancock, and she gave us a tour—probably very experienced at this by now. On the night of the hurricane, the staff transported all the patients to the first floor because of fear of hurricane winds. Then as word came of the flooding, they transported the patients back upstairs—all except one 600-pound man who had had to be carried downstairs by the National Guard and who was evacuated rather than carry him back upstairs.

They then watched through the second-story windows as the parking lot filled with waters from the Gulf of Mexico, usually 5 miles away. Angie saw her Dodge Durango SUV disappear under the water, then saw the parking lot filled with whitecaps (‘nurses’). They must have been terrified.

Angie praises God that they did not lose any patients or staff; but 70% of their staff had their homes destroyed. Their two outlying clinics were also destroyed. Now here is her staff having a leisurely picnic under the portico, enjoying the Gulf breeze, cheerful as can be. “We can make it”, said one nurse with a lovely smile.

Angie shows the level that the water reached inside the hospital’s first floor; the hospital is on a small rise so it wasn’t as bad as it could have been. The hospital has steel studs and a concrete slab floor; so once the wet wallboard is removed it should be sound again soon. Here's the way the corridor looks now.










The medical equipment did not fare as well. The photo to the lower left shows a pile of it out in the patio, ruined.



Angie shows us part of the floor where they were testing a new woodgrain vinyl tile. Other than the dirt tracked in, it is pristine. A great ad for the tile.

Back in front of the hospital (after the nurses shared their lunch with us), Angie told us that the containers are loaded with equipment and supplies to restock the hospital and their outlying clinics in Kiln and Waveland. Mobile homes will be used as facilities for the clinics. Angie gives us what seems like a wildly optimistic re-start date for the hospital of October.

We leave Hancock humbled and awed by the spirit of the nurses despite their own terrible losses. The local physicians, by the way, all lost their office buildings. If the community wants them to stay, they'll clearly need some help rebuilding. I have no doubt the community is going to work together and rebuild it better than before.

We drove a few miles east on Pass Road to see a little of Bay St. Louis. Here is a photo of their Bay Bridge, with only the pylons standing, the deck entirely swept away. This must be a popular site to take pictures for us disaster tourists; there were four porta-pottis so no need to wait.Back down Pass Road, we find the hand-drawn sign that says “Field Hospital”. Frankly, we didn’t look when we came by before because the signage was so crude. It turns out that’s the only crude thing about an enormously impressive operation. Here in the K-Mart parking lot (9 bodies were found on the K-Mart roof, such was the flood level here) is the world’s first complete mobile trailer-based hospital, Med-1 from North Carolina. Surrounding it is a Barnum and Bailey tent town of supplies, clothes (“I’d like something in blue,” whispers Kim) and representatives from FEMA and the Small Business Administration. An aid station is giving out tetanus shots; another tent is for triage.




We come to the Men in Black—a SWAT team from North Carolina intent on not letting any questionable characters into their priceless facility. Well, actually it’s not priceless, it cost FEMA $1.5 million, and it’s doubtful they’ve ever spent any money as wisely. After a radio call, we are met by the public affairs officer, Alan Taylor, who gives us the official tour. The mobile rig—a trailer much like a NASCAR support trailer—has side wings that triple its size when expanded. It is accompanied by a support trailer—a two-level job, again modeled after NASCAR—that carries the equipment and supplies when Med-1 is on the road. Surrounding us is a circus-sized tent, air-conditioned, with power supplied by the generator in the tractor that pulls the hospital. On one side, the urgent care area (photo on the right); on the other, an area that can serve as a ward for hospitalized patients. The hospital itself is completely self-contained: it has its own lab, ultrasound, digital radiography, a 4-bed CCU/ICU, an integrated medical information system, and a 1-bed OR.

How did this marvel come to be? Dr. Tom Blackwell of Carolinas Medical Center had it already designed after prolonged research and analysis, when FEMA expressed an interest. According to Mr. Taylor, FEMA was expecting a very long process to acquire such capability, when Dr. Blackwell offered to fax the complete proposal. This during a conference call; and apparently Dr. Blackwell’s offer was met first with stunned silence, then with an astonished “What did you say?” Dr. Blackwell got his grant of $1.5 million from FEMA to build it. Mind you, we’d been told by one of our Humvee acquaintances that the support coach that accompanies them—a real luxury RV—would cost about a million on its own.

Speaking of luxury: here's the most recent modification of the system. Dr. Blackwell is a guy, so the support trailer has a big TV and a comfortable lounge. What he did not count on was the needs of the female nurses. Here's how they provided the needed equipment: yes, that is a vanity, complete with Hollywood lights for the mirror. Go, nurses!

I think FEMA got a great bargain. FEMA, the military, and some of the states such as Florida have looked at this prototype, so more may be built. Working with the military, the North Carolina folks were able to cut two inches off the dimensions, and that made the whole facility transportable by C-17 or C-5A. You like it? I may be able to get you a good deal on one. Have your governor call me.

This time, its first deployment, was a little more problematic. The Med-1 team was ready to go just after the storm; an agreement between the governor of North Carolina and Governor Blanco of Louisiana was prepared and faxed to Governor Blanco. 24 hours elapsed and the agreement was not signed. The team was ready to leave on Friday, September 2, and the agreement was not signed. The team was then federalized by FEMA and ordered to deploy. They made it as far as Mississippi—still no agreement. So instead of heading for Louisiana, Med-1 came to Bay St. Louis, where it serves as a temporary replacement for Hancock Memorial while the latter is out of commission. Although they have a mobile CT scanner as well (arranged by the Director of Hancock Memorial), Med-1 does not try to be a full-service hospital. They can do emergency surgery, but more sophisticated specialty surgery and large-scale hospital care is beyond their capability. What they can do is treat the more common things, stabilize critically-ill patients, and evacuate those they cannot handle. One can imagine that several of these rigs would be a Godsend to a devastated state in a natural disaster—provided the governor asks for it.

Here is Myhanh in front of the New--and Improved--Waveland Cafe, where Christian Life feeds thousands every day. I don't know how many loaves and fishes they have left over, but they and other Chrsitian groups are doing a wonderful job of serving here. If you sent your donation to one of the Christian church denominations doing relief work, you did well. The Southern Baptist effort is particularly visible, but I've lost track of the names of the church-based or other Christian groups I've seen at work here. God has blessed you to be a blessing.

I won’t soon forget the look on Marty Mulcahey’s face when I told him that there was a group of Humvee’s (Hummer H1’s) in Mississippi, looking for a way to link up with the Red Cross on the coast. Marty seems to be something of a regional director of the Red Cross’ Katrina effort, and Myhanh and I met with him a few days ago; the meeting was facilitated by Biloxi’s fire chief, and another example of something happening just because we were there and wouldn’t take no for an answer.

We had gotten that ‘no’ from someone at the local level, who didn’t quite understand what we were proposing. Marty was much more responsive, and we hoped he would be able to make it happen. Well, to tell the truth, we didn’t quite know ourselves what we were proposing. We had been involved in a lot of phone calls between David in Atlanta with HOPE (Hummer Owners Prepared for Emergency), Chip Mewell of the Atlanta fire department, and several Red Cross folks. Marty finally did what it took to make things happen, and the next morning Myhanh and I had ‘our own’ Humvee, owned and driven by Kim Stebbens, a Robert Redford look-alike.

Kim is a self-described refugee from a high-tech company who lives most of the year on a boat in the Caribbean, the rest in Seattle. He drove his H1 from Seattle to meet up with other HOPE vehicles in Picayune, Mississippi. They finished up their work of distributing supplies there a week early, and were freed up for another assignment. The drawback of being associated with a very large organization is, of course, bureaucracy.

In relative terms, the approval for getting the HOPE Hummers linked up with the Red Cross in this area came in record time. For us, it meant a day of waiting around the Red Cross command center in Gulfport. The advantage is that once the bureaucracy does move, it has lots of resources to make available.

I never knew this before about the Red Cross shelters and aid stations in disaster areas: they readily provide food, water, and first aid. But physicians cannot practice medicine in a Red Cross facility; and nurses cannot do anything beyond giving out bandages. Liability is the problem, of course. In this emergency, however, it would appear that the governor’s declaration of emergency and state Good Samaritan laws ought to allow us to provide good faith emergency care if we are licensed in another state. So I was told that I could provide medical care ‘adjacent to’ a Red Cross facility, but not as part of that facility.
Is Red Cross rethinking this? Maybe. The next morning when Myhanh and I returned to the Red Cross command post (left), the ‘medical lead’, Gary Iley, seemed to be singing a different tune. He had lost many of his volunteer nurses. Now he and Caryn Abbott, the lead nurse, were talking about using the newly-acquired Humvees (by now I think seven or eight of them) to take nurses door to door to give tetanus shots, do assessments, and get people to medical care facilities as needed. He was talking about ‘taking the Red Cross response to a new level’. Caryn was now asking me to go out to assess the situation in Waveland, one of the hardest hit communities. Gary is trying to find nurses who can come for a week or so over the next couple of months.

Biloxi Regional has a glut of RN volunteers from out of state who are eager to get out in the field to be more useful. We called them in response to Gary’s request, and they also came to the Gulfport Red Cross facility to help out. They went out as requested into a community in their Ford Explorer. But I heard later they had been kicked out by the Sheriff’s office because they didn’t have the proper credentials. It seems like we’re still getting some wires crossed.

Meanwhile, in Kim Stebbens’ Humvee with a Red Cross on the side, we were going anywhere we wanted. We did take advantage of this to see some of the devastated areas of Long Beach and Bay St. Louis.

In Long Beach, several miles of that long beach are strewn with the wreckage of beautiful homes, mixed with container trailers thrown about like matchsticks; sometimes a trailer frame wrapped around a lamppost or in some other grotesque position.









We later saw the barge that was probably carrying all those containers; like the casino barges in Biloxi, it had been cast up on shore, smashing homes in the way.

It may seem if you’ve seen one picture of the hurricane you’ve seen them all—but you have to imagine putting those pictures together one after the other, block after block, mile after mile, town after town. Here's another huge casino barge at the west end of Long Beach, cast up on shore. Now it's being cut apart.

It really is a force beyond our comprehension. Next post I’ll show you what happened to the hospital in this town of Bay St. Louis, and what is taking its place now.
Here's Myhanh checking in with hubby from the comfort of our air-conditioned Humvee. Thank God for cell phones!
Link: Mudville Gazette

Myhanh has been wanting to know more about the local Vietnamese community. We had assumed that they would be getting left out of the distribution of food, water, clothes, etc. The photo on the right shows that we were wrong. After a couple of tries of bringing food that was rejected (macaroni and cheese? lasagne? these folks are all lactose intolerant) they are now brought free hot meals each evening by a Christian group, Operation Compassion.

A Vietnamese doctor new to the community, Dr. Han, is seeing patients in the back of the Buddhist temple. He's being helped by several nurses from the hospital.

We just heard this evening that Dr. Han has a family emergency and has to leave for Tennessee. I'll be covering his clinic in the morning, and another Vietnamese doctor will take over in the afternoon.

There is a national Vietnamese-language TV network--this is their truck, come from California to do video news on the plight of the Vietnamese in the Gulf. Myhanh gave an interview. She tells me that they wanted to do the 'if it bleeds it leads' game, but she kept coming back to the great spirit of the community--and to the relevance of these immigrants' previous refugee experience to this one.

You remember the story of Billy? I've now heard versions of it a number of times, from middle-aged men who were imprisoned in Vietnam after the war, and managed to escape from Vietnam. Katrina was a pretty minor experience in comparison, except that they are now middle-aged, and have families and businesses. It's going to be very hard to start over. Perhaps 90% of the Gulf coast shrimp fishermen are now Vietnamese. Many of the boats were destroyed by Katrina. Even before Katrina, the shrimpers were being underpriced by Asian shrimp industries with huge aquafarms and shrimp boats with no regulations. 'Little Saigon' with its restaurants and shops is now in ruins; will it rise again from the rubble? Will there be an economic basis for the Vietnamese to stay in this area?

This evening we met a young Vietnamese doctor who is part of a small Vietnamese evangelical church across the street from the Buddhist temple and the Catholic church. Doctor Do and his wife (who speaks with a very strong Southern accent, which Myhanh can't get used to) want to set up a larger medical clinic under a canopy in the parking lot of one of the Protestant churches. He has some potential volunteer physicians and nurses from Gulfport Memorial Hospital, where he works. They have taken in two families into their house, and there was a lot of heated discussion over whether one of the extended families would accept being evacuated to South Carolina. Mom clearly is concerned for her kids, but in this culture it's Dad who makes the decision. We'll see.

Another story we've heard repeated many times: the families who climbed into the attics of their one-story homes while the flood rose, and thought they might die. I haven't heard of another baby being set in a cooler to survive the flood; but there were about 50 visiting people from California who took shelter in the attic of the Buddhist temple, hours after celebrating the opening of a new part of the building.

I'll try to blog tomorrow about our trips yesterday and today to the west of Biloxi, in Long Beach and Bay St. Louis; and more on our cooperation with the Red Cross effort.

I just got this e-mail from the lovely Mrs. Goodheart:

YOU ARE NOT RETIRED!@!!!!!!

Ain't she great? But what do I call myself? Unemployed? Having a late-mid-life crisis? I'm clearly not sitting in the hammock drinking mint juleps (hmmmmm...I've never actually had a mint julep. But now the bars aren't open, and the restaurants close about 7 pm. Let me know if you come up with a better description that will keep Mrs. Goodheart happy.

Many thanks to Grehawk of Mudville Gazette, and John H. of Powerline for the links, and many thanks to those of you who have sent very kind comments. I just feel really fortunate that I was able to come down here now.

I want to pass on a link from LT Smash's blog of a letter from the Chief of Naval Operations to all his admirals. I agree completely--the Navy has been very visible here in its relief efforts, and now rebuilding efforts. In my usual practice I don't get a chance to rub shoulders much with men and women in uniform, or men and women of the shield. That's been one of the real delights of the past week. God bless you all! You're doing a wonderful job.

Remember: we WILL provide medical/nursing care for a helicopter (or LCAC) ride.

We did give a teenager in devastated Long Beach, MS his first humvee ride today. He's sold!
More later.

This post has nothing to do with medical care, but a lot to do with the kind of resources being put into the relief effort by our military. This photo shows an LCAC (landing craft, air cushion) on the beach in Biloxi, right along the shoreline drive. I took video of this one heading out to sea, and Myhanh (especially, all 89 pounds of her) and I were almost blown over by the sandblast created by its propellers as it rose off the beach, turned in its own length (next photo), and headed out to sea with about 130 personnel on board. Fortunately Midshipman Moore had warned us to get farther away than the front-row seat we had been occupying. Here's the next one landing on the beach, throwing up a mighty spray and roar. Myhanh and I put up a sign "will do medical/nursing work for helicopter ride", and now have added "or LCAC". Myhanh could flag down any passing Blackhawk, then I could step out of the bushes and she'd say "But my Dad is going too."

3:30 p.m. Central: d'Iberville's new family practice clinic, where we went this morning and planned to work today, is not yet ready for business. It looks like they will be well staffed up tomorrow. The National Guard is running a tetanus vaccine clinic, so they're pretty much taken care of.

Our FDNY friends, however, have located a group called HOPE that's affiliated with the Red Cross. They have a bunch of Humvee's (privately owned) and--provided someone high up in the Red Cross here in Biloxi/Gulfport requests them--will be made available to take medical teams and supplies into hard-hit, hard-to-reach areas. Sounds like just the ticket for our medical team, right?

Except--as I learned a full battery charge of my cell phone later--the Red Cross doesn't do medical work. Huh? Yupp. They give first aid at Red Cross stations, but are NOT ALLOWED to provide 'medical' or 'nursing' care because of liability issues. So after umpteen phone calls to and from Red Cross folks, we seemed to have arrived at a dead end.

EXCEPT that we managed to find a sympathetic ear, in the form of Marty Mulcahey, a Red Cross leader here who is actually out of Illinois. He promised us he is going to try to get this going. If it works, we'll be out tomorrow. This process is frustrating, but educational.

The government is not the only big organization with red tape.

By the way: I heard from a doctor at the d'Iberville clinic (above) that his group of volunteer physicians from Georgia is now doing nothing, because they were told the previous order by Governor Barbour which protected licensed physicians working on hurricane relief from liability has been rescinded--apparently at the behest of the MS Dept of Public Health. They now want MD's to have to register with them and go where they are told. Well, I can tell them where they can put that idea.

Linked to Mudville Gazette.

Today I'll be going out to a brand new clinic in d'Iberville (pronounced de Eye-berville), across the river from Biloxi. This area was very hard hit, the local clinic with two family practice docs was washed away. Sunday night I got word that a Dr. Charles was looking desperately for a doctor and a nurse to help out there. I got hold of Charles Runnels the next day: by then the situation had changed: instead of a picnic table, they had gone to a school, and now a double-wide mobile home which is going to be completely stocked with equipment and supplies by FEMA and the MS Health Dept. FEMA wouldn't do anything until the PH Dept gave its OK, but once the spigot was open, it was wide open.

Yesterday I spoke with Dr. Joe Dawcy at the clinic, offered to go out then, but he told us to wait until today. A nurse from California, Myhanh Nguyen, is going with me. She eagerly volunteered to go of the group of 19 nurses from Orange County whose way was paid by radio station KFI. Here I am with them: 'East coast girls are hip...' but these are California girls. KFI's Angels. Sorry, son, Myhanh's married. Durn.

We got another pile of meds from the FEMA pharmacy, now we're waiting on some tetanus vaccine. All of a sudden we got four more volunteers and a van. Hope they can make use of all of us.

Once again, the eagerness of folks to help is overwhelming. And the spirit of the local folks is terrific. Here's an example. Here's a local Vietnamese family bakery, a young fellow from the family who is cleaning up the mess, and Myhanh.

Having Mihanh along is great, as she speaks Vietnamese and there's a Little Saigon here. I drove her around the ruined part of downtown Biloxi, and we came to a Catholic church and went in. Below is a picture of Myhanh with the priest, Father Dong. Other churches had come to help clean up the mud and mess--the waterline can still be seen at about 8 feet above the floor.

I've already mentioned meeting up with two retired FDNY firefighters, John Seiler and Chris Edwards. Today, September 11, the Catholic church next to the hospital is holding a special memorial mass. This mass, as the bishop said during the service, had been planned many months before, never dreaming that they would have their own tragedy on this day as another occasion to celebrate mass. It was a moving, patriotic ceremony, opening with the Star-Spangled Banner and America the Beautiful, with a color guard of firefighters. John and Chris went down to the front pew. I went with them, feeling very sheepish because I didn't belong there, but they seemed to want me with them. Here they are talking to the Biloxi Fire Chief.

John and Chris became the objects of a lot of media attention after the mass. They ended up being on the front page of the local paper, and I think on the local TV channel as well.

This was a terribly hard day for them; I won't try to tell their story here because I can't do it justice.

They later went out and delivered 1500 bags of ice from the Red Cross to distribution centers, and came back at 11 pm. These are the guys with bad hearts, backs, and knees, all suffered in service. They're discouraged by some of the bureaucratic stuff, but still soldier on.


To the right is a Biloxi family I talked to after Mass, together with a friend, Dennis, far left. The folks I first spoke with had not had severe damage to their home during the hurricane. Dennis had lost everything--except the family photos and art work that had been removed prior to Katrina's arrival. Dennis' reaction: well, in some ways he's better off because he doesn't have anything to fix! It's all gone--including the piano. he can't figure out where a piano could have gone. Attitude is everything, and these folks have a loving, Christian attitude that is deeply humbling.

This will probably be my last day at DeDeaux school. Things seem to be slowing down and getting under control. Next week Mark, the nurse who lives out here, will see patients here when he's not working. He works nights, so helping here the next day is not so easy. Once again, people chipping in to do what needs to be done for their neighbors. I'm humbled. The Connecticut nurses, Shery and Lee, left to go home. This time when I go to the ED looking for a nurse, the wheel of fortune turns up LeeAnn Salazar. LeeAnn claims to be the mother of five kids; I think she uses that story to keep the guys from hitting on her. She also manages a team of 100 nurses, owns a business on the side with her husband, and they're building a new house with seven bedrooms. I tell her America was built by hypomanics like her; for some reason she doesn't take it as a compliment. LeeAnn is originally from Connecticut, and she talks fast too. Here we are at the sign in front of the school:LeeAnn is one of a group of nurses from Florida who work in sister hospitals of BRMC, owned by HMA. HMA seems to be doing an incredible job of providing logistical needs for BRMD. Capitalism at its very best, I would say.
We give out about 50 tetanus shots today, and I dispense and/or prescribe another passle of meds. This time no real medical problems came along, such as the lady with the angina or the one whose generator burned her arms.
There's not a lot for teenagers to do out here. ATV's are a popular way to get around, especially now. LeeAnn and I returned to Biloxi. I found the Ohio MDAT (Medical Disaster Assistance Team) shipping their tent. The Ohio MDAT will be replaced by another MDAT group from Pennsylvania. The help just keeps on coming.

OK, let’s move along, or I'll never get caught up. You’ve got the picture of what I’m doing. It's not cardiology, mostly it's pretty basic but much needed primary care. Now I’ve mostly moved out of the hospital ED and its tent annex, and I’m doing more work out in the field. Lots of people have neither the ability nor the inclination to see a doctor unless their arm is falling off, so we have to do OUTREACH. People have been warned to get a tetanus shot, and they all know that lockjaw is one nasty disease they don’t want.

Today, September 9, I went back out to Old DeDeaux School, to the medical aid station set up by Mark Irby, RN, and neighbor Tammy. The photo above shows Tammy with her extremely loquacious daughter.

Here’s an example of the kind of cooperation we’re seeing all the time here: I need meds: I go to the FEMA pharmacy in the hospital. I tell them what I want; if they’ve got it, it’s mine. I go to the BRMC (Biloxi Regional Medical Center) ED, tell the nursing supervisor I want a nurse to go with me. I get two. They are volunteer nurses from Connecticut, Lee and Shery.

These nurses are part of a group of go-getters, disaster junkies, who live for this stuff. They run a clinic in Jamaica. Both Lee and Shery talk so fast I can’t understand them half the time, and I’m not from the South. They’re smart, cute, and hyperactive. Stimulants? I didn’t ask. Here they are at the hospital.

Oh, and to get out there we need gas, which is not yet available here in Biloxi, but the hospital has a special tank truck. Hospital workers get 5 gallons. Shery gets me a tankful--no questions asked. Here's the guy filling our SUV.

Here are some photos from our day in DeDeaux.
Say, this reminds me of an old joke my brother told me years ago. Seems a mutt meets two French poodles. One poodle says: “My name is Mimi, spelled M-I-M-I. The other poodle says “My name is Fifi, spelled F-I-F-I. The mutt says “And my name is Fido, spelled P-H-Y-D-E-A-U-X.”



Here I am filling out a medication prescription. Lots of folks lost all their pill bottles; others are here because they can't get to the pharmacy yet. Others have heard we're giving out free drugs. Surprisingly (I'm told), we get few requests for narcotics.

Below: Here I am with Shery. This is supposed to be a disaster. Is it right we should be having this good a time?















Right: we get lots of supplies from visiting firemen: paramedics from Laramie, Wyoming.

My main interest in medicine these days is what I call ‘medical systems transformation’—improving the various subsystems that make up a health care system. I started thinking about this 10 years ago when I went to Russia as medical director for a USAID-funded health care reform program. The individual physicians were usually much more capable than the obsolete, often Stalinist systems they worked in. A natural disaster is a real test for a health care system, and I was curious to see how an American physicians, hospitals and public health systems would respond to Katrina. So I sought out the medical director of the most visible crew helping out: the Medical Disaster Assistance Team (DMAT) from Dayton, Ohio.

Kim Kwiatec, MD is the medical director, and Brian Kurtz, RN is the manager. We talked for a while about the training they had done, including the drills at the NYC GOP convention and the Atlanta Olympics at which they had medical aid stations. Most important, I heard that they had been called up by FEMA and prepositioned in Memphis, Tennessee prior to Katrina’s landfall. They arrived in Biloxi on Wednesday, two days after the storm. For this team, that volunteers and prepares precisely for this kind of event, things went quite smoothly. They have a large team of doctors, nurses, and paramedics, complete with all the supplies they need plus supplies to provide to others. Very professional.

Another team from Ohio also came down. These folks were from the Ohio Military Reserve, a state guard unit (as opposed to the National Guard, the state guard can’t be federalized). I first met Halita Holmes, a sweet, gentle massage therapist--she serves by giving massages to disaster relief workers, keeping their bodies and spirits going. My ears perked up when she told me she had joined this guard unit, and was working on qualifying on the M-16! This unit has regular military basic training, command structure, and ranks. Most of the members are retired military. Private Halita told me a story of having been ‘out in the field’ with their trucks, serving people not coming in to the hospital. I asked her if there was a chance of my going out with them. It sounded slightly more interesting than looking at rashes and refilling medications. She called the team commander, Major Fred Miller on their radio. They had already left, but came back to get me. They had trucks (Chevy Suburbans) loaded with MRE’s, water, other essentials, and tetanus vaccine. Their nurse was Capt. Karen Thomas, and they were very happy to have a ‘doc’ coming along.

We first drove west on I-10 from Biloxi, going north of I-10 about 14 miles west of Biloxi; out to a small rural community called Vidalia, which they described by asking me: “Have you seen the movie ‘Deliverance’?” There’s a fellow there, Kenny, who needs some medications. He has congestive heart failure, but is pretty healthy—he does all the work, a couple of young sons seem to be layabouts. Dental care in rural Mississippi is not all it could be; my team told me the whole family’s tooth count might amount to one whole set of teeth. OK, so it’s an exaggeration. Whatever the team was thinking, they provided for Kenny’s needs very professionally.

We also met a neighbor—well, she met us, driving up in her truck when we came on Kenny’s property, to make sure we weren’t there to loot. She was retired USAF, so got along well with our paramilitary team.

We next went back toward the interstate, to a mobile home community where we were told some people had medical needs. Most folks were OK, we delivered a few medications and some water. One woman with ‘medical needs’ is a retired RN with CHF (congestive heart failure)—but she fixes meals for 25 people in her neighborhood where the power is out and regular stoves not working. Their biggest problem is inadequate sleep, due to looters who come at night to siphon gas out of cars and try to break in to houses.

They have a neighborhood armed patrol, and the requisite “You loot, we shoot” sign in the front gate. Here you see one of the mobile homes with some new accessories: a fallen tree limb, and a tarp to cover the new common cooking area.

Next stop: Old DeDeaux (pronounced here DEE-doe) School, where the DeDeaux community had set up a distribution point and medical aid station in the old school.

This was quite impressive. They had massive piles of water, food, and clothes, mostly brought by the army or FEMA trucks, with some ice brought in by helicopter to get it out before it melted. They have so much stuff, they’ll need a relief effort to help them recover from the relief effort.

A local RN, Mark Irby, who works in the BRMC ED (Emergency Department), together with Tammy, a CNA (Certified Nurse Assistant) had—with the Sheriff’s permission—raided a pharmacy and commandeered various medications and medical supplies for their aid station. Mark was bringing tetanus vaccine from the hospital for the local folks. They had a very good assortment of common medications. We surveyed what they had, and I made a list of some other drugs they might need. We stayed a few hours, with our nurse, Karen, giving tetanus shots and dressing wounds, while I dispensed drugs if we had them, wrote prescription refills, and saw patients.

Impressed by the DeDeaux folks’ initiative in serving their community, I agreed to return the next day.

After finishing at DeDeaux School, we drove back to Biloxi, where the Ohio team took me to a neighborhood that had been hit directly by the 32 foot flood surge that hit central Biloxi. Here virtually all the buildings are either totally demolished, damaged irreparably, or uninhabitable.

Driving through these streets and seeing the wreckage of this ‘proud old lady’, I was struck that I was unable to respond with as strong an emotion as I felt was appropriate. Perhaps my brain protecting me from the psychological shock if I were to really comprehend it all. I remember seeing on our California TV news before leaving a diagram showing that if this had happened along the California coast, everything from San Francisco to Santa Barbara would be devastated. Truly, truly unbelievable.

We first stopped at Ellie’s house. Ellie is a retired nurse, I think 71, in good health. Her home, however, as all her neighbors’ homes, is nothing but a shell. Inside, mud has been cleared from the floor, but the sheetrock on the walls is mush, the bathroom fixtures a wreck.

She now still lives there, but sleeps in one little area on a cot, walled in by plastic sheeting. And get this—she considers herself blessed, and is worried more about the neighbors. This is not unusual—we heard this over and over. Ellie thanked ME for looking at her house and sharing her story.

Next was Billy’s. Billy is a Vietnamese immigrant, and this is his story, in brief. His father was a general in the South Vietnamese army. At the end of that war, he was therefore put in prison. He escaped; was recaptured and imprisoned again. He escaped yet again, and put to sea in a small boat; the boat was overrun by pirates who raped a woman with him, beat the men, and left them all for dead.

Billy managed to end up at a refugee camp in Thailand where he was asked where he wanted to go. Without hesitation, he said America, because he had known American GIs who were good to his family. One little problem: he spoke no English at all. When he started out, he was paid $5 a week while training to be a welder; he paid $2 for rent, $2 for food, and saved $1. After six months he had saved $20. That $20 was then stolen. Eventually he did well as a welder (you don’t need much English, mainly point to what you want done), and had a nice house, a good car, and a family: a wife, and two children: a six-year old girl and a three-month old baby. The six-year old translates for them, including reading Mom’s medical reports!

The night Katrina came, Billy took his family into the attic of this one-story home. As the flood waters rose (they eventually reached to 9 feet, just below the ceiling of the first floor), Billy was afraid the whole family would die. So he smashed a hole through the sheetrock, dove down into the water and somehow came up with an ice cooler. He and his wife put blankets in the cooler and set the baby inside. They thought that they would die, but there might be a chance that the baby’s cooler would float and that—like Moses in the bulrushes—the baby would be found and saved.

The family didn’t die, but everything they had was destroyed; even the car, which looks pristine but is ruined by the water. Our Ohio military reserve team ‘adopted’ Billy and his family. Instead of just dropping off food and disappearing, they kept coming back to talk, and to attend to the family’s needs.

On this, their last trip, Billy had gifts for them. These were beautiful framed bas-relief sculptures of the Great Wall of China, made of mother-of-pearl. They must be the most valuable thing he has left in the world beside his family. He managed to get the photos of his mother and father, but they were damaged by the water—we suggested getting them scanned and restored. These gruff ex-military, ex-marine guys were of course getting close to breaking down with the emotion of the moment, and with Billy’s joy at life despite having yet once more almost lost everything.

As the sun was setting (the irony of a gorgeous sunset in this once-beautiful, now devastated city is not lost), the team took me down to the waterfront, where we gaped at the huge, hotel-size casino barges that had been thrown up on shore by the raging waters. One collided with the old Tivoli Hotel (which was just being restored after years of neglect), and knocked off a front corner of the Tivoli. Sad to say, this blow was fatal for the old gal.

Only later did I get more of a feeling of the terrible sense of loss suffered, even by those Biloxians who had not lost their homes in the storm. As Anita Tootle (yes, that IS her name, and don’t you dare laugh!) explained to me that night in the hospital: all the landmarks of their memories were gone. The Ring Oak with the trunk grown in a ring, and the legends of the lovers associated with that; the skating rink where she might have had her first kiss; all the sites of her youth were gone. Beauvoir, Jefferson Davis’ home—gone. All the beautiful old Victorian homes here in downtown Biloxi’s historic district (in which the hospital is located)—gone. And, whatever rebuilding is done, these are gone forever.

I walked through Billy’s house and Ellie’s house. Floors are spongy under your feet, so the sub-floors are soaked with water. These homes will have to be demolished. This is the hard part: Ellie’s family had lived in that house, perhaps for generations. The need to hang on to that beautiful past—what Anita called ‘that proud old Southern lady’ wrestles with the urgent need to sweep out the debris and build from scratch, so people can get back to their lives and jobs. Will it ever be the same? Certainly not—not for Anita, not for Ellie, not even for Billy.

But that's not really the story of Biloxi, or the story of this disaster. The real story--one you're almost certainly not seeing on TV, is one of love, community, and defiance.

Now for the end of the day: my new friends from the Ohio Military Reserve Unit took me to the school where the police and firefighters have been eating. I had heard stories of filet mignon and lobster, as they ate the contents of the destroyed casinos' freezers. Well, that was gone: tonight was beans and pork. The team was leaving tomorrow, so I wouldn't get a chance to go out with them again. Halita, networking as ever, came up with a terrific replacement: two firefighters from FDNY, John Seiler and Chris Edwards.

Both are great guys, both retired, and both permanently affected by the loss of their comrades in 9/11. Although John was retired and Chris on medical disability, they both helped with the recovery of their comrades from the wreckage. Here's a photo of John (on the left) and Chris. We'll see more of them soon.

There's that beautiful big flag in the background. Here are two heroes, coming to 'pay back' for the help the rest of the country sent New York after 9/11. What a country!

Sunday, September 11:
I'll be going to a memorial mass with two new buddies from FDNY. You'll hear more about them later.

Saturday, September 3: Davis

Wife Peggy and I were watching Fox News, when she began urging me to go help with the Katrina disaster relief effort: I’ve never done it before; it’s the biggest effort ever; it will be good experience; etc. I encouraged her to think that this idea is hers, as I wasn't sure how she would take it if I proposed going.

Sunday, September 4: Davis

Used my Delta Skymiles to get a ticket to Jackson, Mississippi, and priceline.com to get a hotel and rental car. Peggy had second thoughts, as usual; as usual, I didn't. Slight complication: our son John was leaving Sept. 7 for Afghanistan, and I knew that Peggy was more worried than she was letting on.

Monday, September 5: Delta to Atlanta, then to Jackson.

I fell into bad company immediately: a nurse, Kathleen Leatherbarrow, from Modesto on her way with her husband and six other nurses to Jackson, MS, under the auspices of the Red Cross. She was very excited—‘just had to come’. Their plan is to travel to Baton Rouge, presumable to work in one of the three large refugee centers set up there. It was not clear to Kathleen that she would actually be able to do nursing work, but she was willing to go anyway. In Atlanta we changed planes for Jackson. This time I sat next to a quiet middle-aged man who thanked me for coming to help. I noticed that he was doing a Bible study but didn’t ask about it. After we picked up our baggage Bob Smith, my seatmate, gave me his card and told me I should feel free to call him if I needed anything while in Jackson. Very friendly—and as it has turned out, very typical.

I went to the Alamo rental desk. There were only five cars left; the only mid-size a Sebring convertible. I commented that it seemed a little strange to be coming to help with disaster relief and be driving around in a convertible. The agent rented me a Chevy Equinox quasi-SUV instead; a little more but worth avoiding the grief of explaining.

One little problem—I had heard that there was no gasoline in Jackson. The SUV came with 1/8 tank of gas. Another friendly lady at baggage claim told me where to look for gas on the way into town from the airport. I tried her way, which did indeed have lots of gas stations; unfortunately, not one had gas. Instead, there were bags over the pump nozzles, or yellow ‘caution’ tape around the pumps. No luck tonight. Slept well at thee Marriott Downtown Jackson, assuming it would be my last comfortable bed for a while. Wrong. The tub, however, was the last I would see for a while. Hot water was goooooood!

Tuesday, September 6: Jackson to Biloxi

Between Monday afternoon and Tuesday morning I contacted by fax, phone, or e-mail about 10-12 places listed on the internet as places seeking physician volunteers in Louisiana or Mississippi. As of noon on Tuesday I hadn’t heard from any of them. So I went out to get gas—this time, available with only a short wait. Surprisingly, given the severe shortage of gas, prices were only about $2.50 a gallon. A little ‘price-gouging’ would have shortened the lines considerably!

Out shopping for some things to keep my cell phone working, I saw a convoy of Salvation Army disaster relief trucks heading south on Highway 49—probably toward Biloxi, I thought. I missed following them then, but decided to head that way anyway—they seemed to know where the action was. With my new gadgets from Radio Shack, I grabbed a Subway sandwich and started down Highway 49 where the Salvation Army trucks had gone. I had no real idea where I was going to end up.

North of Hattiesburg, I started seeing trees blown over in the median. Like Virginia and perhaps elsewhere in the South, highways such as this are built with a wide median planted with trees. The trees, quite large hardwoods, were all blown down in the same direction, with the trunks pointed southeast by south. Katrina, her leading winds traveling counterclockwise, had hit from northwest to southeast, knocking all the trees down in the same direction.

Just before Hattiesburg—there was one of those Salvation Army trucks. I passed it, doubled back, and stopped behind it. No problem, just waiting for the other truck. This was the last of the convoy I had seen earlier, I guess. They were from—of all places—New York City! ‘If you don’t mind’ I said, ‘how about if I follow you?’
‘Fine,’ was the reply. So now I had a new destination; Biloxi (pronounced here ‘Biluxi’), east of Gulfport.

So I followed the two trucks on southeast to Gulfport, then east on I-10 to Biloxi. Arriving in Biloxi, we passed over a bridge with a sign warning that only residents and disaster relief employees were allowed in the area. As I followed the Salvation Army trucks through this part of town, two things were obvious: (1) this section was not in great shape to begin with; and (2) it was really hard hit by the hurricane. Stores and offices—all closed.

Many, many buildings knocked down in heaps; no electric power; debris strewn everywhere. And here and there a rather large boat that was sitting where no boat was supposed to be sitting—at the side of a road, next to a house.

Now we arrived at the Salvation Army distribution center, with three or four big trailers. I was directed to the fire department, back beyond where we had turned to come into this part of town. I went back, but passed Division Road where I was supposed to turn and instead continued down two more blocks, arriving at the water. This was the Gulf. I turned and drove along the shoreline road.

Passing a large, modern building, it seemed to have suffered severe damage, whereas other modern buildings near it had not. As I passed by it, I realized why: this was a floating casino, essentially a gigantic houseboat. It had been lifted up on the flood surge of the hurricane and carried across the road! A little farther on, I found yet another beached (previously)-floating casino. This one had apparently collided with a hotel building, and the front corner of the hotel (I later learned this was the old Tivoli) was sheared off.



I managed to make my way back to the fire department, but no one there knew anything about any health services, except for a tent put up behind the fire department for minor urgent care. I asked, ‘Is there a hospital operating around here?’
‘There’s the Regional Medical Center down the road’ said a policeman. ‘You might try there’.

I did. This was just down the road, near a remaining (non-floating) casino which showed little damage, called the Beau Rivage. I had to laugh; earlier I passed and photographed a run-down place with a hand-written sign: “No Rivage” and below that “Heartbreak Hotel”.

The hospital, Biloxi Regional Medical Center, looked completely intact. I pulled into the parking lot; on the other side of the street from the ED entrance were two tents, apparently for emergency purposes. Walking into the ED, I asked the first person I saw if they could use a volunteer physician. This first person just happened to be a nurse responsible for ‘staff development’. She dropped what she was doing, and took me to the administration office. There I met Tim. Now Tim today was well tanned, a little scruffy, wearing a baseball cap, T-shirt and jeans. Tim, however, is the hospital CEO. I learned later from a nurse that until Katrina, he was seen ONLY in a suit. Interviewed on TV, he had been asked about the ‘rather casual’ appearance of the nursing staff, who were wearing cut-off scrubs and flip-flops when the air conditioning was off. His reply: ‘Tomorrow, the nurses are wearing bathing suits, and I’m going to be buck naked.” This, needless to say, endeared him to the nursing staff.

Back to my meeting with Tim: I told him my name and that I was a cardiologist from California and would like to be helpful. I handed him my envelope with my CV and copies of my diplomas, certificates, and license; then my driver’s license (photo ID) and physician license wallet card. Tim told me that because there had been an emergency declaration, this was all I needed—‘Welcome aboard!’ Wow, that was fast!!

Tim took me to the ED where Cindy, a hospital administrator, got me a room in the hospital and Paul Medina, an ED physician just coming back to work for the night shift, gave me a quick tour. The tour was mostly of the two tents I had seen across from the ED entrance: these were in fact triage and treatment areas. They had lots of supplies: bandages, pain relievers, and most of the most likely medications anyone would need. These were given without charge to patients seen in the tent. Many had lost their medications, or could not find an open pharmacy. Others had new problems needing treatment. Private physician offices and other clinics were closed, so this was the only medical care available for the local community; this community, by the way, appears quite low income, and mixed race.

This ‘ED Annex’ tent treated several hundred patients a day, with minimal paperwork, no charge for drugs, and vastly more efficient than the usual ED—because we don’t have to worry about the usual defensive medicine/liability issue.

Wednesday, September 7: Biloxi Regional Medical Center

It's just after midnight. I started this a.m. at 7, working in the tent outside the hospital, doing small urgent care stuff: refilling lost medications, treating rashes mostly. In the afternoon it got up to 92, and felt pretty hot in the tent (actually a canopy; when a breeze came up we could feel it). Every patient expressed gratitude for help from the hospital staff and the volunteers who had come from as far away as Davis/Redwood City, California.

Lots of people having big anxiety and grieving problems. Even if their own houses were spared, their neighbor's, or close family members' houses were destroyed. One poor fellow with chronic back pain from a ruptured disk was tortured that his re-injuring it would keep him from helping clean up and provide for his family. I did well enough at the stuff in the 'tent' that they want me back tomorrow, and as long as I choose to stay on and there’s still business.

I left work at 7 pm, spent the next couple of hours chatting with people. Most memorable: the nurses sharing with me their own feelings of loss for the Biloxi they had known since childhood: the special oak tree with a ring in the trunk; the Tivoli hotel that was just being remodeled after years of neglect when it was hit by a floating casino and the corner knocked off. Now it's coming down. Beauvoir, Jefferson Davis' home, is gone. So many memories of childhood, gone. I was about to turn in about 11:00 when I went downstairs for a midnight snack of crackers and peanut butter (I'm NOT going to lose weight here!). Stepped outside: the growing odor of decaying flesh—of some sort –is becoming more prominent. We imagine that it’s the unburied bodies of some unfortunate souls, but it may just be some shrimp piled up somewhere, or somebody’s powerless freezer filled with previously frozen meat. Inside the hospital, air filters are working to keep the odor down.

An ambulance pulled up; an ER physician went to the ambulance, and said something like "Aha! sounds cardiac to me!"--a patient with an implanted defibrillator that had shocked him 15 or 20 times for ventricular tachycardia. The device was working fine, he wasn't. Another storm victim who hadn't been eating or drinking normally. We brought him insid; I took care of him (Yeah! a cardiac case! anything but another rash!) by giving him intravenous magnesium and amiodarone. After this treatment he seems to be settling down, and is being admitted. Tomorrow he will probably need to be shipped out to Mobile, which has more facilities than this small (but critically situated) community hospital.

By the way: I made the mistake of telling the patient, in response to his 'silly question'--"Where am I"--he was in BiLOXi Regional Medical Center. Seeing the horrified looks, I immediately apologized: "Sorry, "BiLUXi Regional Medical Center". The only benefit so far of Katrina is that the rest of the country knows how Mississippians pronounce Biloxi. I'm having a great time. Feel really blessed to be here. I'm turning in now. 'Night.