Saturday, February 03, 2007

The Mission

The Departure:
There was an air of excitement, akin to a trip to Disneyland, meeting other team-mates at the airport. Familiar faces though names unknown, people one recognizes after working at the hospital for 5 years. Each giving a smile of acknowledgement or a nod, knowing our common goal.
This felt like going on a camping trip, almost clouding the scope, the depth and seriousness of our mission. But this will change soon after we arrive.
At the New Orleans airport, the welcoming team waits for us with signs, Operation Blessing, MC Team. As we gather, people walking past us in that busy airport lobby clap, or give us the thumbs up, recognizing our medical center's name and expressing their gratitude. I imagine the astronauts on Armageddon must have felt something similar as they prepared to leave for their mission. We left the airport chattering excitedly.
However, miles out, things became more solemn. More real.

Despite being a year and half out from Katrina and Rita, it's apparent that this city has not yet recovered. We passed miles and miles of neighbourhoods in utter ruins. Though an unfair comparison, I imagine this is how a warzone resembles. Demolished houses on one street, intact ones another. Homes vacant, windows nailed shut with plywood. Collapsed roofs. Condemned homes.
Spray paints on the walls, a scar from the search effort, seemingly in some alien language, with a large X and other symbols. We passed some homes that were being rebuilt. Many however, lived out of trailers and campers parked in front of their homes. I noticed a familiar yet alien landmark. A Toys-R-Us store, it's windows shattered, walls brown, carpark ruined and totally empty but for trash. Similar curse befell hotels, stores, car dealerships.
We are here for a reason, I realize. Fate put me here for a reason. From a small town in Malaysia to Canada to the USA and now to here.

The Mission:
We began seeing patients from Sunday, January 28th, and did so till our departure on Saturday Feb 3rd. Our exam 'rooms' were nothing more than 8' x 10' rooms with curtain walls in a large tent, with a table and 3 chairs, no bed. I averaged about 20 patients daily, from the first one at 6 am till about 4 pm. Though they had specifically wanted some of us there for subspecialty support, I saw everything from sore throats to gonorrhea to bad backs and of course, diabetes.
After several days, exhaustion creeps in. Probably more psychologically than mentally. Our days begin at 4 am daily, leaving by bus to the medical camp at 5 am. The extent of our duties became apparent when our bus nears the medical campsite. There, the 530 am darkness is illuminated by the lights of hundreds of cars, lined up waiting to enter the triage are. We have the New Orleans police department, the Army National Guard and our own security force watching our perimeter, complete with two army humvees parked out front. Many patients began waiting from 3 am, knowing that there will be masses of patients should they arrive late. Our camp caps at 500 (unofficially we've been taking 750, I've been told), and the numbers are filled by noon, with excess patients having to return the next day.
It was heartbreaking.
There was no other way to describe it. My soul feels both so fulfilled, yet so tired, so bitter, at what these fellow human beings have to go through. Most of them had not seen a physician in a year or more. Most with active medical problems, hypertension, diabetes. Blood pressures over 200s. Hemoglobin A1c 23% (I never even knew you could measure something that high. It was probably a sensitive machine).
This one patient had renal failure from diabetic nephropathy. After having undergone dialysis for a few years, he had a transplant. The allograft worked wonderfully, allowing him to live a more normal life of not having to spend the 4 hours 3 times a week hooked to a dialysis machine. But when the hurricane hit, he lost access to all his medications including his antirejection meds. Knowing full well what the consequence of that would be. And so he lost his kidney. He's back on dialysis now.

Most of my patients stopped all their medications at least 6 months ago. Systolic BP's of 180 were the norm, some up to 220. A1c mean was 11%, amongst the diabetics I saw. Who can blame them, when a vial of Lantus insulin means several meals for the entire family? Which father or mother would let their family starve at their expense?

Many patients came just because they had not seen a doctor in months, and wanted someone to check them out. Some, it was clear, needed to talk to someone, to feel that someone cared. I had many patients, when prodded, just started sobbing uncontrollably. They thought that no one outside of New Orleans cared. They just needed to feel like they're not forgotten.
It was heartbreaking.

I also had one of the most surreal experiences in my life the other day:

This volunteer peeks through the curtain separating my room from the hall and says in a heavily accented speech, "Doctor, please come, emergency."
I admit, my first thought was she was exaggerating. After all, she wasn't a medical professional, but a layperson volunteer (bless her heart).
I step out of my room and see a body on the floor. Right in the middle of the waiting room, which
was a 15 by 10 foot area at the front of the tent. My consultant was checking his airway while someone else was trying to start chest compressions. He is a middle aged, obese male patient. And he is pulseless.
"He was just sitting there, when he suddenly slumped over." Someone said.
I could not feel a femoral pulse despite the compressions, and took over chest compressions.
"Call 911, and get Dave (the critical care fellow on the team. After all, the last time I did a code was 3 years ago)."
I start chest compressions, thankful that I work out frequently in the gym- it's not easy trying to perform a perfusing massage of the heart of a 150 kg patient.
"Check pulses, and get a pulse ox. Get labs." I tell someone. Aside from the synchronous femoral pulses with the chest compression, she feels nothing.
What made it unreal, was that the waiting room was full of patients, sitting on the chairs waiting for their turns. 10 people, the closest was just 1 meter to my right. As I push down onto the patient's chest and feel it give under my weight, I hear another patient, a lady, pray loudly. "O Lord, please have mercy. Please have mercy. Please have mercy...". It was unreal.
My consultant administers mouth-to-mouth (we were unable to find the dang face mask).
The AED (Automated External Defibrillator) arrives. We slap it on, and cease resuscitation momentarily. He remains breathless and pulseless.
"No Shock Advised. Continue CPR if pulses" the monotonous electronic voice says.
We restart. "Epinephrine?" I hear someone ask. "Yes, 1 mg stat" I yell back in sync with someone else. but before that was given, but after what seemed like an eternity (really just 3 or 4 minutes into CPR), we see spontaneous chest movement. He is back. By then, EMS arrives. The patient opens his eyes, and unbelievable, actually responds verbally.
"Is there someone you want us to call?" my colleague Tanya asks him. His answer belies what he had just gone through (he probably didn't realize it yet)- "No, I'll call her from the hospital", he says drowsily.
He'll be alright, we think to ourselves. Needless to say, I was no longer sleepy when I went back to my room.
It was surreal, really. How I was there to see endo patients but ended up helping with a code.

"O lord, please have mercy....." Simply surreal.

But through this all, the people endured. In every possible way. And the biggest surprise? The people of New Orleans remain ever so warm, so friendly. This was purely a voluntary effort. The patients did not have to pay financially. But, pay us they did, with their graciousness, warmth, touching stories, handshakes, hugs and even kisses. When they thank me with tears in their eyes, how can I tell them that I feel guilty that I seem to be getting more from them than they are from me? I learnt so much from them.
While I felt that I was helping some, there was some bitter frustration and feeling of hopelessness as well. You provide patients with care and medications for a month. They get better. But you know they'll probably stop once they run out, unable to pay. Or, the patients with poorly controlled diabetes on NPH insulin to whom you're trying to teach dose adjustment and they get that glazed-over look. It's clear they're confused, or don't understand. And many of them can't read, so you can't write the instructions down. The "Oh honey, I left my reading glasses at home and can't read that" probably is their way of saying they're illiterate. So you take a leap of faith and come up with a guess of what their insulin doses are, and send them out. Knowing you'll never be able to follow up with them for adjustments. You pray that they'll fly, but deep down worried that it may be shortlived.
Despite all that hopelessness, it was encouraging to see how big institutions pool their resources together. We gave out $27,000 worth of medications one day alone. By day 3, the whole operation had given out over $300,000 of services and equipment. And when we mentioned to our hospital at home that the patient tents were dark, the supervisors here went out and bought dozens of lamps within minutes. And how they urgently shipped down hundreds of glucometers when we ran out, to be given to patients. The hospital provided us with numerous cellphones for us to use when we needed a language interpreter. We were able to call our hospitals interpreters from New Orleans who translated for us over the speakerphone. I truly feel blessed to be working for this institution. There was also a group of chinese doctors, 20 strong, who took leave and paid to fly here to help. On their own time.

When darkness befalls fellow men, it's heartwarming to see how people reach out.

There was a media frenzy as well. Reporters from TV stations, newspapers. Two interviewed me, though I'm not sure if that will ever see the light of day (doctor with braces= not very sexy. There was a reason they didn't pick a pimply-faced kid with braces to play Dr. McDreamy). My colleague who was standing right beside me during her interview appeared on prime time national news. And I thought this would have been my big break into some medical reality show (Dr. Sugarboy, 55905).

Though the week is over, and the job is far from done. Hopefully, we can help patch up some wounds. And more than that, hopefully the country becomes aware that this city is far from healed. This is truly a national tragedy, and more aid is needed.
The people who organized this are simply amazing. It's not that difficult working your ass off, volunteering for a week. But when you do that all the time, it takes real dedication. The day before we left, after the tornadoes hit Florida, some of the Operation Blessings people left us for the disaster area, ready to set up camp there. The trucks with the emergency equipment were being packed as we left, and are probably on the way there now.
This has been a truly amazing week for me, for us. At the predeparture briefing, they had said this would be a life-changing experience. It certainly has been. And on top of it, I've met and worked with some wonderful, selfless colleagues, new friends: doctors, nurses, pharmacists, lab techs and other allied health members. In a way, like camping; we slept in groups, on bunkbeds, ate in mess-tents; except it was a camping trip with a purpose.
It has reminded me of what being a doctor is about. Something we take for granted and forget in an extremely academic and competitive place. It's not about publishing papers, presenting at meetings, writing grants. It's about helping fellow human beings.

More information on this website, with a short video essay.


Blogger Xiao_zhai said...

Whoah......this entry is probably the best thing that I have read in a while.

I am at loss for words at the moment. Very heart-warming? Touching? Adrenaline pumping? Respect and admiration? Motivating?

Anyhow, thank you for sharing your experiences here. This just made my day.

5:59 PM  
Blogger VioletKatlin said...

wow, ur job is so surreal...
hope u get more rest soon ^_^

1:09 AM  
Anonymous ront said...

made me wanna change profession....

1:20 AM  
Blogger 4nOcean said...

sugarboy, that was an amazing entry. i'm so glad you shared your blog with me, i'll be checking it regularly. that picture of "the physicians" reminds me of something off the marvel comics.

5:00 PM  
Blogger Bernard said...

I thought that with all the resources in the US of A, they'd have rebuilt the place and set services back to normal already.

Thanks for sharing this.

7:09 PM  

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