August 21, 2005- here we go again, yet another storm heading our way. It is less than a week away. Preparations begin, concern with feelings of doubt take over the people of New Orleans and its surrounding areas. Many questions come into my head. Is this another false alarm? Will all the preparations be for nothing, again? Is this going to be the big one I’ve always heard about since I was a young child? New Orleans, the giant soup bowl that will fill up with water when a hurricane goes up the mouth of the Mississippi River and everyone will drown. Will this one make a crucial turn at the last minute and spare us yet again? I am not one to get excited or worked up easily. This to me is more of an annoyance and aggravation. The relentless news reports and talks of the storm take over life as I know it. Within 3 days, there are endless lines at Home Depot, batteries and water are impossible to buy at the grocery stores, gas stations have waits for hours to fuel up, evacuations are ordered, windows are being boarded up and traffic to get out of the city is unbelievable. Most people afraid of this one and are taking it serious, packing up and heading out.\r\n\r\nI am a registered nurse at Kenner Regional Medical Center. I am not scheduled to work the day of the storm, but the day after. Being a nurse in New Orleans for the past thirteen years, I know the drill and the “Disaster Essential Personnel Rules”. Basically, show up for your scheduled shifts or be fired. No one has ever been fired, because we have never had a true disaster. My family, friends and boyfriend are all heading out of town in different directions. I still have many feelings of uncertainty, questions and options. I have to make decisions based on my well being and safety, obligations to my employer and patients. I have to consider moral and ethical issues related to my career choice and of course there is financial considerations. Decisions have to be made quickly, based on the uncertainty of a hurricane spinning wildly out in the Gulf of Mexico named Katrina.\r\n\r\nI decide to stay, work and ride out this storm at the hospital. Before reporting to work, I need to prepare my house. I need to get important papers, secure my valuables, and I am not sure what all of that means. I am a single female who does not own a truck so boarding up the windows even if I could get ply wood, is out of the question. If my house was to flood, I should bring as much as I can to the second floor in my house. While carrying things up the stairs, I think what if a tree comes through the roof and water gets in and ruins everything upstairs? I stop catch my breath and realize this is way out of my control and decide to leave everything where it is. What will be, will be. I grab a few sets of clothes, some important documents, and my three pound Chihuahua, Lola. Off the hospital we go.\r\n\r\nLola and I arrive at the hospital only to be turned away. I am told by hospital personnel that in order for Lola to enter, I must have her shot records. Records that are in my file cabinet back at the house. I put Lola back in the car and go to the intensive care unit where I work, to relieve the off going shift and try to figure out what to do with my dog. I quickly get report on my patients, who are both in stable condition and ask another nurse to watch them while I hurry home. It is forty minute, white knuckle round trip drive. Upon returning to the hospital, Lola is checked in with the other employee pets, without anyone ever asking to see her shot records. Confusion and chaos from the beginning is not a good sign of things to come.\r\n\r\nWork as far as patient care, is routine and nothing out of the ordinary. It is unfortunately being overshadowed with what is happening outside and our impending disaster. There is a constant buzzing and sense of potential impending doom. People are running in every direction, talking to their loved ones on the phones, televisions in every room are giving constant storm updates and advise to prepare. Nervousness fills the air and lays across my shoulders, like a wet blanket. I am always the optimist and know that no matter what happens we will be fine and it will all work out. All of this running around, confusion and nervousness is unnecessary and annoying. No one has any idea what we are about to go through and there is nothing else we can do to prepare. We are here and will ride it out together, giving our patients the best care we can. I feel as if I am being overdosed on talks of Hurricane Katrina so I try to keep my focus on my patients and the job at hand. \r\n\r\nI have an assigned two bed hospital room, that I will share with three other nurses. Two of the nurse work the night shift and myself and another nurse work the day shift. The hospital has termed it “hot cotting”, meaning the beds never get cold because someone is always sleeping in it. The two night nurses that share the room are both eight months pregnant. I am guessing that they thought the hospital would be the best place for them in their condition. Lola sleeps in her kennel on the loading dock with the other pets. Several employee family members are designated to watch, water and walk the dogs, but I still check on her frequently. She has never slept anywhere other than with me and never in a kennel for that matter. I know she is terrified because I can hear her cries over all of the other dogs that are ten times her size. It breaks my heart.\r\n\r\nAfter a restless night of little sleep, it is August 28 and Hurricane Katrina is rapidly approaching. My day starts off routine with change of shift report. I know my two patients quite well because I have taken care of them both for four days prior. My first patient, I will call Mr. Smith. He is a forty eight year old with a ten year history of bleeding stomach ulcers. His case is so bad that when the doctors try to cauterize a section of his stomach that is bleeding, the section next to it begins to bleed. He is in the hospital currently for the same problem of gastric bleeding, but what makes him a difficult patient is his numerous antibodies to blood products that he requires to replace what he has lost. For the past week we have had special cross matched blood brought in from out of town for him. He has six units of blood on hold for him in the blood bank.\r\n\r\nMy second patient, I will call Mrs. Jones. She is a sixty eight year old women, blind since birth, who came in with pneumonia and temporarily put on a ventilator to assist her breathing. She is still not strong enough to breath on her own. \r\n\r\nBy noon the wind is pounding so hard on the windows, I thought they were going to break. The patients were moved away from them and the shades were pulled down. The power goes out and the hospital switches to emergency generator power. No more air conditioning, no television reports, just the noise of the storm. Mrs. Jones is a large woman and having a tube in her throat makes her extremely uncomfortable, but add the heat factor and she was miserable. I decide to keep her heavily sedated so that she doesn’t have any unnecessary stress until the storm blows over. Mr. Smith, is a very pleasant man who is alert, oriented and mobile. He never asks for anything and is calm without any complaints. He does however have a tube that comes from his stomach, hanging out of his nose that is connected to a suction container. It begins to put out more blood. This means his stomach is bleeding again. There is no cause for alarm, we have plenty of blood on hold for him.\r\n\r\nMy shift is over and so is the storm. We seemed to have weathered it with only minimal damage. I went downstairs to visit with Lola and eat some food the hospital was giving out. My cell phone was still working intermittently so updates were exchanged with friends and family. That night, sleeping was almost impossible because of the heat. It was still raining outside so we could not open the windows. I make it through the night thinking that this will all be over soon.\r\n\r\nOn Tuesday morning, August 29th, I start my day with report from the night nurse as usual. No change with Mrs. Jones, the plan keep her sedated. Mr. Smith however, continues to bleed. He required two units of packed red blood cells during the night and will more than likely require two more during my shift. That leaves him with only two left.\r\n\r\nAs midday approaches we can see water rising around the hospital like a moat. I thought the storm spun around so hard in Lake Ponchartrain that it pushed out the water, causing flooding. I had no idea that the levees had broken and areas all around the city were being destroyed. We still do not have any current news because there were no reporters left in the city and the stations were down, not to mention no televisions. We did have a radio and our computers were still connected to the internet and we were able to get spotty updates from those. I remember emailing one of my friends who live in Australia and telling her “we are ok, it is hot but we can handle it. I am sure that we will see trucks and helicopters any time now to come and rescue us.” By the end of my shift, I still could not believe that no one had come. No calls, nothing. Tomorrow will be a better day, there were probably people who needed help more than we did. It would take just a little more time, but I know that they are coming. Hospitals are always on the top of the list of places to rescue first. Right?\r\n\r\nBy day three, Wednesday August 30th, food has started being rationed, we no longer have running water, the patients have starting having seizures because of the extreme heat, our dialysis patients are in need of dialysis treatments (which requires clean running water) and Mr. Smith who continues to bleed, has just had his last unit of blood. Where is the cavalry? We are told they will be here any minute, but the truth we later find out is that no one has even been in contact with us. There are no helicopters, no rescue trucks, no food or water drops, nothing. We are like sitting ducks. Our country has failed us. I am no longer able to keep Mrs. Jones sedated, the heat is taking a toll on her. I now have her stripped of all clothing and blankets (just a dignity towel) and am wiping her down with cool water. It helps for about a minute and she is hot again. I let most of the sedation wear off and explained to her as gently as possible, the current situation. She nods to indicate that she understands. She had brought a small battery operated radio with her and she indicates she would like to listen to the news. \r\n\r\nLate in the afternoon, a small bit of relief was delivered. Six men carrying two box fans each came on the unit, unwrapped them and put one in each of the patients rooms. I asked one of the men, “Where did you get these from?” He replied, “We are not supposed to say… Walmart, we called it operation box fan”. We had started looting for survival. This is America, not some third world country, what are we being reduced to? I knew in my heart, Mr. Walmart would not have minded. It was a huge relief from the heat, but within hours a patient had died because he could not get dialysis and another was going bad as well.\r\nBy the end of the shift on the third day after the storm, it was apparent to everyone that we were on our own. It would be up to us to evacuate the hospital. A plan was developed and to be implemented at the first sign of light in the morning, four days after the storm.\r\n\r\nOn day four, August 31st, the water around the hospital had gone down enough to drive out of the city. We had a hospital van that had some windows busted out during the storm, but it was functional after the glass was swept out and the window covered with tape. People were using the computers to communicate with other outlying facilities to accept our patients. The first patients to go were from the psych ward and the medical patients able to sit upright in a vehicle. I am not exactly sure of where everyone was taken to, but I know they were brought to safety. I had other problems to worry about. Mr. Smith was taken by his doctor to be scoped again in attempts to stop his bleeding, it was unsuccessful. We did not have any more blood for him. He was going to die if we did not get him out of there. I was giving him multiple doses of a medication used to coat and form a protective coating in his stomach, without any change in his condition. I was watching this man die in front of my eyes. This is against everything I have ever known or learned about in my thirteen years of nursing. He never said anything about his situation, he just calmly laid in his bed and waited. It was truely a blessing when his wife who had evacuated to Houston, managed to get a call through to his cell phone. I cried as I listened to him tell her he loved her. I think they both believed this would be their last conversation. I could not believe I was expected to sit here and watch my patient die. He is a viable human with a condition that can be easily treated with proper medical care. His death is preventable and not inevitable, if the situation were different. I called down to his doctor who was running the evacuation of the hospital and explained to her that his condition was worsening. She replied to me that there was nothing else we could do for this man. He is going to die. If I wanted I could give him morphine to make his death easier for him. Up until that point, I had maintained my composure and dealt with everything in a calm, controlled manner. I began to cry as I told her that I will put Mr. Smith in my car and drive him out of here myself before I would ever consider doing such a thing. She told me that she did not know what else to do and that I could what ever I felt I could for this man. Basically, she relinquished his care to me. I called the blood bank even though I knew they did not have anymore blood from him, but I thought maybe they might have a suggestion. They informed me that while they did not have anymore blood without antibodies for him, they did have his specific type and it would be worth trying if he is monitored closely for any transfusion reactions. I quickly called Mr. Smith’s doctor again and she agreed that it would be worth a try. I explained the situation to Mr. Smith and he was all for it. The first unit of blood was hung and I held my breath, not taking my eyes off of him as it infused. He did not have any adverse reactions and I had bought him a little more time. The second unit went in as easily as the first and my shift was over for the night. \r\n\r\nI went downstairs to take Lola for a walk and see the one doctor left and hospital administration evacuating patients as fast as possible. Patients were being taken away in vans, cars and in the back of pick up trucks. It was unbelievable to see. I would have never believed that we would ever be having to do this in my lifetime. Those remaining at this point, were not able to sit upright and still had life sustaining medication infusing through their veins. When the doctor saw me, she was excited to report that she had chartered a jet to take both my patients to a hospital in Pedimont, North Carolina, first thing in the morning. I was comforted to know that while I thought she had given up, she was really doing the best she could and truly cared. I went back to the intensive care unit to tell my patients the good news and this time I was able to sneak Lola up with me. No more loading dock for her.\r\n\r\nPost Katrina day five, my patients are each put in the back of a pick up truck. I ride with Mrs. Jones because she requires that I breath for her while disconnected from the ventilator. I make sure to keep her well informed of everything we are doing, where we are going and what our plans for her are. She mouths to me around her tube that she is afraid to fly! I reassure her that she has nothing to worry about because I have a syringe full of a sedative medication to give her before she gets on the plane. It was the first time I saw her smile in five days. \r\n\r\nThe ride to the airport was jaw dropping. It was the first time I saw the devastation and destruction that Katrina had left behind. We had to take many back roads and turn around several times just to get there. Nothing could have prepared me for what I was seeing, better yet going through. When I look back on it now, I still cannot believe what happened and l have trouble comprehending it all. Both of my patients were flown to a facility that was able to give them the care they needed. I have since heard reports that they were eventually reunited with their families and both recovered from their illnesses.\r\n\r\nWhen I returned from the airport, all but a few of the patients had been evacuated and the few remaining would be transferred out shortly. I was told by my administrators that I could leave. No one was dependant on me anymore and now I had to take care of myself. I gathered my things and Lola and I headed toward Baton Rouge, to be reunited with my family. Before I left the city, I decided try and drive to my house in Metairie to see what Katrina had left for me. It was another white knuckle drive, requiring dodging downed trees, power lines and other debris. I was elated to see that my home had been spared for the most part. I quickly emptied my refrigerator and headed for the interstate to Baton Rouge. \r\n\r\nI got on the interstate at I-10 and Causeway and was shocked to see hundreds of people stranded. There were busses, helicopters and emergency vehicles all around, but not nearly enough to accommodate the masses of people. Since I had not heard any recent news updates, I was clueless as to what was going on. I knew I would not be able to help and as I continued to drive, people are waving their hands asking me to stop. After a few seconds consideration, I stop and pick up a guy who needs a ride to his parents house in Baton Rouge. He said I was the first car to drive by in over two hours. He explained that the buses were taking people to Houston and not letting anyone off in Baton Rouge. I am a little nervous, never picked up a stranger before but being in this extenuating circumstance I was not threatened by him. \r\n\r\nOnce safely in Baton Rouge, my passenger thanked me and left to call his family to come get him from the gas station. I realized that it had been six days since I had a shower and was still wearing my surgical scrub uniform that had the arms and legs cut off because of the intense heat in the hospital. When I walked through the door of my cousin’s apartment to see my evacuated family members, I expected to be greeted with hugs and tears of joy. To my surprise, I see my family laying around, bored and obviously sick of each other. There are no hugs or tears, just “oh, hey”. I didn’t realize that they had been there for about a week and for the most part unaffected by the storm. Their battle had been mental, they were tired of being there, tired of laying around with nothing to do and ready to go home. I tried to explain to them what I had just been through, but it was fruitless. After I showered, my cousin asked me to go to Starbucks with her. It was there that for the second time, I was unable to hold back my emotions. People in Starbucks were ordering Lattes and croissants and less than two hours away back in New Orleans, there was massive human suffering taking place. It was more than my mind was able comprehend. How in this world we live in, in the richest country, are we able to have such massive human suffering and seventy five miles away, order a Latte and life goes on a usual? Where was our government when we needed them?