05-SEP-A-16
A COLD MORNING SHOWER STARTS OFF THE
“AUSTERE CIRCUMSTANCES” OF OUR DAY—
HARDLY TO BE COMPARED WITH MANY OF THOSE
WE WILL BE SEEING TODAY, BUT MOST NOW HAVE POWER AND PLUMBING AND NO LONGER NEED THE ICE
CLINIC DRAMA: “THE MASS OF MEN LEAD LIVES OF QUIET DESPERATION”—AND THAT WAS BEFORE THE STORM!
September 14, 2005
It begins with a cold shower. Now, there is good news—we have running water. The bad news is that it is not hot water. We had hot water, the kind of thing that once you experience it it is very easy to take for granted. But that was only the first day. The Anne Arundel Maintenance Engineer from the big MCCU (“Mobile Command and Communications Unit”—if you would like to see someone go ballistic, call it the “RV!”) was detailed to work on the hot water recirculator for the hospital. This was added to a large list of the community resources he was supposed to get into and fix during the first hectic week. He was working on it when he developed chest pain, was seen and diagnosed as a “cardiac event in progress” and was transferred over to West Jefferson Hospital where he is still in the CCU. So, we have had only cold water showers since then. We are reminded of that when we step into one of the diesel powered emergency vehicles and get the second shower of the day—a blast of cold air showering from the overworked A/C units.
The majority of the community around us has plumbing. The bad news there is known of the water is potable. We are telling them continuously to drink only the bottled water we furnish them and also telling them to brush their teeth with the bottled water. The electricity came on for most of them also, so now the smelly mess in the refrigerators and freezers which we had taped shut at the school just as I had in Derwood, can now be re-frozen in order to be disposed of as I had hoped to do. It is ironic that I have a lot in common with these folk who have a refrigerator or two pushed out to the curb with tape around the doors. I know whereof they speak. I can identify with the stench of the long-decayed meat and dairy products.
I have a series of “hair of the dog” stories. When we arrived at the Lincoln School there was a very large and very dead dog lying on the sidewalk where the people have to line up to get their water ice and MRE’s. That “body count” was the only one identified for the school and was hauled away—but the malodorous memory lingers on. In fact, I have gone out to the street and scrubbed with a mob, since disposed of, with bleach and every cleaner we could commandeer, and still the smell lingers on. It is only now that I realize that there were more than one or two bodies in the area, and the smell persists probably from some rodents we have not identified and other small creatures which had sought refuge in the front and entry areas of the school, and the pickup of debris has not changed that death stench in each place. That was the way the hospital smelled when first we opened it, and both school and hospital have been “policed” by details of our brigade to the point that the smell is down and we could almost welcome in the following permanence residents to start the long takeover process whereby they could start functioning as a school and hospital again, with the unpaid conscripts for the cleanup brigade turning attention to other problems that need fixing.
THE LEXICON OF OUR “AUSTERE CIRCUMSTANCES”
AND “HARDSHIP CRUISE” OF WHICH MEMORABLE STORIES
ARE MADE AND SWAPPED AMONG US NOW-“VETERANS”
We veterans of the Katrina wars are used to the “austere circumstances” and reacting with “flexibility to a fluid situation” answering all questions with “that is not known at this time, but we will get back to you on it.” The endless “roll calls” and “musters” are military mindlessness that leads to the comfortable feeling that the outside world is somehow changed because of the compulsive ordering of the inside system which may not be linked at all to any outcome objective. We have become experts at a whole list of the cliché’s which are the responses to any question regardless of how unreal they might be in terms of any genuine human problem, and they all make sense if couched in the lexicon of militarisms, now mimicked by the toy soldiers all around—the newly minted MD Defense Force and EMS “troops alike.
A WHOLE SERIES OF PATIENT PROBLEMS THAT DESCRIBE TRAGIC LIVES—BEFORE, DURING AND SINCE “KATRINA”:
THE “LOUISIANA COCKTAIL” AND BARELY COPING THROUGH DESPERATE CIRCUMSTANCES
I have noticed a pattern. People keep coming to me for low back pain prescription refills, and they are all on an unusual hardly rational group of prescription nostrums administered in chronic refillable doses of seriously abused drugs. After the tenth patient comes in with “Soma 350 mg po tid, Xanax 1 mg po q4-6h anxiety and Hydrocodone 5/ 500 mg q 4—6 h.” Why on earth are you taking this and for how long?” I ask. “I don’t know; he put me on it 12 years ago when I had my low back pain and I have been coming back to the pain clinic for refills ever since. Are you sure you are not going to give me my Oxycontin?” “Absolutely. Count on it; I have never written for the most addictive drug on the street and never will. I will give IV morphine before any of the agents you seem to be hooked on and I am not here to cultivate further drug-seeking behavior.”
Let me tell you about a couple of patients. One is a thin fifty year old woman who has a lot of troubles. She came to get her Louisiana Cocktail of pain meds refilled and told me she had tried to make an appointment to have her teeth fixed (she has only one upper and two lower teeth in a sea of putrid periodontal disease. When I took her out to get the free food we have stacked up next to the gate, she went with me instead to get the baby food and pureed canned goods.) She was worried, she said, about a lot of things in her life just now and had no time to go through the elective things, like a spot on her leg she had been putting cream on for the last four years but has not gone away and is spreading. I agree, this seems to have been a postponable lesion for her, but now I was going to move it up to number one on her priority list, and we would see that she got it taken care of today. I took only a quick look and said “This is a nodular melanoma, and it has spread through the dermal lymphatics but also into the nodes in your groin, and you will need to have an operation to remove this. That operation must be done within the week and if they will not do so over at the West Jefferson Hospital to which I am sending you with this note, I will do the excision here in Lincoln Elementary to be sure you get started on the treatment and can guarantee that the lesion is in the hands of the pathologists.” “They won’t pay me no never mind. I got no insurance and tried to get Medicaid but they refused me, and it don’t matter anyway.”
What is the reason she would not get to a hospital and pay attention to this life-limiting risk? “It’s my son, my only child, and they don’t seem to know what is going to happen to him.” How so? “Well see, he is in jail and he is a multiple offender and is up for another violent crime and when the Hurricane came they took him at night for security and moved him to a place north in Louisiana and they only let him call this morning. He did not even know there was a Hurricane and what damage it done, and that the small house is flattened and I am living in an abandoned car. I asked him if he had heard from a court appointed attorney, but I have no way they can get in touch with me nor I him and if he had not called my sister when I was over there talking about how we get the other people out of the wreckage of our house, I never would have known that he has been forgotten about up there.” I got the social service number started on the business of her son, and wrote a tough letter to West Jefferson with my credentials on it, assuring them that if they did not address this woman’s metastatic melanoma today, I would do so in Lincoln Elementary School and let the media know that a Maryland team was doing what had been neglected in Louisiana until the disease had spread and added my phone number. It got the job done, since she came back saying they had taken her into a big DMAT tent and everyone came to read my note and poke her in the groin and tell here to her complete surprise that it was a malignancy that had spread and “Why did you wait so long?” Because she had a dozen social problems that were bigger than a trivial hickey on her leg that did not go away, is why. At least her admission for the operation will “medicalize” the four dozen other social problems which can now draw attention only to make her disposition at discharge.
And you think that is an unusual atypical case? No, let me give you another: a pretty young black girl named Brianna. She is mincing around in pain with a knot under her arm. She is hurting bad and with two questions I have her rather classic diagnosis. She has an abscess in her right axilla form Hidradenitis Suppurativa, and needs it drained—and does not need a temporizing futile repeat course of antibiotics. I asked if she had female family members who also have this problem, and sure enough, she has a sister and her mother also affected. I tell her we will do an “I & D” here and now, and that she will feel the hurt only of a small local anesthetic injection and after that will have a great deal of relief with the pus let out. After the usual squeamishness about a small girl and needles, etc and whining and retreating as I go about the rather quick and smooth I & D, she does eventually smile and allow as how she has not felt so much better in two weeks. I ask her if she is on any meds, and she says –of course—yes. Besides the Louisiana Cocktail, she has had “Depo.” “What?” I ask, “Depo Provera injection? Whatever for?” “For birth control, of course, and the oral contraceptives I had been on for six years were not working and giving me a lot of trouble so they decided to give me the injection.” “Well, is there a reason you want to tell me why you might need this?” “Well, if you look like me”—and she give a seductive shake of here topside—“You certainly don’t want to get pregnant since I have not even been able to graduate form school and there won’t be any chance now, and I can’t help what happens to me otherwise.” Her mother nodded in agreement. She is a very attractive live bait in a bayou filled with raptors and scavengers. OK, Brianna, I will see you on Friday to take the drain out and redress this and talk with you again.
And, now “Popeye.” He is built a little a bit like the “Sailor Man.” He and I bantered about how much he must like spinach, and he gave and took with a good humor. But, when he squinted at me through his broken taped up eyeglasses, he told me what was really bothering him besides the need he had for refills on his Louisiana Cocktail. He had two policemen come to the ruins of his house this morning, the house he had shared with his “Momma who had OldTimers Disease and died in my arms last November and I miss her so,” and they asked him through the boarded up door at 5:00 AM “Are you ______ (real name)?” “Yes.” “Do you have a brother _____(real name)?” “Yes.” And did he live with his common law wife _____(real name)?” “Yes and I never did like her, since she was an alcoholic and was abusive of my brother.” And did they live with your friend ------(real name) and some other persons unknown in Wave Mississippi? “Yes, I believe so but it has been some time since I contacted my kid brother since there is no way for me to reach him or he to reach me.”
“Well the Mississippi State Police have notified us to tell you that they went into a ruined abandoned house under the trees knocked down by the Hurricane and found five bodies two of which are identified as your brother and the woman he has lived with and it could possible be your friend as one of the others, and it seems that they have been there since the storm so the bodies are too decomposed for visual identification and they wanted us to confirm the circumstances of who might have lived there. Thank you. That will be all.”
“First my Momma, and now my kid brother and my friend I had hoped would one day bring him back to me and Momma, and now I am alone, except for the woman I have found over the last seventeen years who rides with me on my three wheeler cycle down to pick up my ICI check at the Batu Post Office, the only one open and only for Social Security checks on the far side of Jefferson Parish.” (I don't suppose that Popeye might have a direct deposit bank account for government check deposit, would you?)
“While I am away, getting the money you see right here that I just picked up, someone broke in to my poor house and stole my TV set and I don’t even have electricity back yet—and I was the ones my neighbors were trusting to look after the homes they abandoned in running off to Georgia. Just when I thought I had things going right with this woman and all (I was married three times and none of them worked out but now this one, and we ain’t married, seemed to be working and we were making it on my disability and her food stamps, and I am an honest man since I ain’t been in no jail for twenty three years—and now all this.” And Popeye broke down and cried with me holding him. I thought he might have rehearsed this line for a prior audience, so I wanted to see him in the social service net and was going to suggest that. I asked if he had children.
“That’s the problem Doc! If only I knew where they is! They came and took them away before the Hurricane and said they were going to bus them to Texas and I don’t know where they are or if they made it, since I had to stay and protect the neighborhood until this morning when I was the one broken into. But I don’t know where they might be!”
Well, I thought, this one is easy. We got out the sheet that has the missing persons tracking information and the emergency number to trace out the dependents. I gave him the sheet and he gave it back. I then underlined the numbers and he confessed “Doc, I would be a preacher if I could and want to tell the world that this storm is a warning of the second coming. But the church tells me that to be a preacher I have to be able to read, and I have been praying everyday that some day I might be able to read—but nothing has worked so far!”
I got Popeye on Food Stamps, and made the call myself to the tracing agents and when asked to name the father of the missing children I told them “Popeye” and for the phone number “Negative” but gave them the same address the Louisiana State Police had used to find him this morning to give him bad news. Thy found him once, so they can find him again for better purposes. He said he would ride his tricycle over to see me if he heard from anyone about any good news and appreciated his chance to talk with me about the problems and a few ways he might be helped. “I would appreciate knowing your name.” I thought it would be a non-starter to write it, so I wrote 240/401-0247 and told him if an agent stops by they can call me to follow up. At the same time he said “Before I get started once again on trying to read, I sure could use some glasses.” He is Popeye since he has an opaque glass in one lens and a crack through the other held together by Scotch tape. I remembered that I had seen in the box dropped by the Islamic charity a pair of women’s glasses and ran outside and “procured it.” Rhinestones or not, Popeye was pleased as punch that he could see with them and folded them carefully in his three wheeler saddle bag since he had to save them “for special purposes” and use his “regular glasses” for the ride back home.
Popeye is one of several colorful and desperate patients who have been less affected by the storm than the heavy waves of everyday life and they either felt that it was almost irrelevant to have Katrina flatten the little that they had “You can’t fall of f the floor!” or it may have been the straw that broke the back, and they have decompensated. Seeing all of us coming down as a new resource at one extreme, or a source of new hope at the other, some have tried to con us, and some abuse us to get enough of the candy store of free drugs that they can have some “traders” and use the pills as currency to swap up to some good stuff, like Jack Daniels. But, the two patients I have described at length are real devastated people who have lived lives of desperation barely getting by----and all this was way before the storm. It has not helped them that there have been predatory people with fly by night licensed operation to be mining money for their ADC and SSA checks to be converted into cash under the table and off the books, making some charlatans richer (I have been gathering recurrent names off their empty prescription ill bottles to turn in the drug-control agencies) before they move off to prey on other illiterates and supply them with addictive stuff that will have them return for the magic “oil rig” ball-point pen to mint more money. Scavengers are out preying for more than just the tasty pickings here in the Bayou like Brianna.
WEDDING BELLS FOR THE NEWLY WED COUPLE—
WELL, TWO MORE THAN A COUPLE, ACTUALLY,
BUT A HASTY BUT FORMAL WEDDING TODAY IN AMES SCHOOL CLINIC
The last two days we have had a school bus with a second team (alpha) ride with us as they go out to another school/clinic at Ames Elementary School. A few days ago a “young couple” came in with a daughter who had a cleft palate with an earlier poorly repaired cleft lip. As Momma held the infant the Daddy held a new born baby, so it seems this couple is off to a fast start on a couple of kids a year apart. And it further t urns out that “couple” they may be, but they aren’t married. But, when asked why they were not married in order to give the kids a proper name, they replied, “We have never had any money or a job and could not do it right, so we would want to wait until it could be done right and then along came the daughter’s problem and then Katrina and now the newborn, so it looks like it just never might happen as problems multiply.” As the group is getting together to get the daughter's cleft palate repaired, they took up a collection within team alpha and they gathered $350. With that “nest egg” the women of the team went into a sentimental overdrive and the preparations were done up proud. They rummaged through the donations boxes of clothes and found a long pink dress that fit the toddler daughter with the palate problem, and the neighbor got flowers for her to bear as flower girl. The other neighbor had a fake flower corsage to carry as a bride’s bouquet, and the women nurses of the clinic plaited her hair in a French twist and gussied her up with all the clothes they could muster (the new “bridal gown being the second set of clothes she has now in addition to her tee shirt and cutoffs which were her ONLY clothes before.)
They mobilized ADC and social services at least as far as child support, and then the chaplain who had led the invocation at the 9/11 Sunday morning memorial service came to do the honors in a ceremony at the Ames Elementary School in mid-clinic today!
When the chaplain asked “Who gives this woman to this man?” the chorus of alpha team was “Her friends do!” With tears and hugs and flashing disposable cameras the knot was tied in solemn ceremony (I am unsure of Louisiana licensure) with witnesses, so the happily married “couple” or should I say “quartet” two of them little nudniks—came out of the clinic as we stopped to pick them up so I was able to take a picture of the “recessional.” So, if you are into happy endings, I am unable to give you a follow-up of a union undertaken in somewhat shaky circumstances, but at least this “windfall” [sic] has got them off to a quasi-official start and better funded than the whole of their lives together—two, three and four together, that is—have been so far. Are you already flush with at least three good cries for the day on the patient problems described (above?)
DON’T CRY FOR ME---
I HAVE BETTER DAYS ACOMIN’ !
RUMOR HAS IT THAT THER WILL BE A HOT SHOWER TOMORROW, AND THAT I AND TWO OTHERS MAY BE ABLE TO RUN WITHIN THE ARMED GUARD PERIMETER!
Now, with rumors of a hot shower tantalizingly coming closer to reality, there is a psych nurse and another biking fanatic and I who may be given permissions to go out at 5:15 PM on return from our respective clinics and RUN, so long as we are within the guard perimeter, and take an armed escort with us (I would prefer to run with a side arm than an M-16—but that is what the troops in Mindanao had to carry along with RPG’s on a shuffling waddle alongside and then far behind me in their clumsy boots!)
If that isn’t just peachy keen enough, let’s have you salivate over this one! We are getting hot dinners catered by a LOCAL dining establishment. Whose? Emeril Gassaud’s of New Orleans, that’s whose! Glenn, Eddy (the head chef), and Dave will be planning the menu (cream of crab and corn soup tonight for only the starters followed by fillet of fish and “Katrina Pot Roast”. Eat your heart out! Better yet, withy all this sedentary eating and snacking, I had better run to my heart’s content, and soon!
And, now, the bad news. This morning at around the fourth roll call, they asked who had intend to leave by the C-130 coming down with the new contingent on Friday and who had planned to go home on Sunday. For the purposes of a transition between team leadership, I figured a new team leader would be here Friday and I would go home on the C-130 on Sunday and start the new week where I had left off on Labor Day ever so abruptly. Now, the next news, as in the military ever, subject to change without notice. There will be a plane coming in on Friday with 82 new people, but, sorry, no plane out. So, those who had planned to go by air on Friday will be packed into a bus and drive to Maryland on Saturday—and however long after that it takes (estimates vary from 24 to 48 hours.)
For those planning to fly out on Sunday—well, you are not. “Sunday’s plane” if it goes at all, will be going on Monday or Tuesday, maybe. If you are wiling to extend a longer interval and take that chance, let us know, otherwise you had better take the more sure option of the “Friday flight” which is the “Saturday bus.” If this is quite clear to you, you are getting the hang of the military mindset—you know—“flexible response to a fluid situation in austere circumstances!”
For the contrast in life style between those of us who are trying to eat wisely and avoid the snack foods but relishing Emeril’s occasional cuisine, and hoping to make a regular exercise run to balance it off, consider the alternative. Popeye went back to his “home” which I hope the Louisiana State Police can re-find with the bonanza of a case of self cooking highly salted and fatty MRE’s and a bit of hope in his life since he had me listen to him for one of the first time in his life when someone with more than a high school equivalency diploma has looked at him seriously. A near frantic woman had had an expert diagnose and kick start the delayed treatment of her neglected and advancing melanoma. And Brianna—to cite only three of today’s 158 patients—went back to her Louisiana jungle protected and with an abscess drained—and none of the three were given a yard long series of scripts for prescription pain pills requiring their addicted return to spend two thirds of their public assistance funds on charlatan “pain clinic” prescriptions (I am collecting names from their empty prescription pill bottle labels to turn over to the drug enforcement authorities at the end of my stay.)
So, I will return to hot water showers, and Emeril-catered occasional diners and will finally get refuge from salty fatty snacks without any exercise through regular running. I may even be able to fly out of here to start working on household problems of my own. For a temporary reprieve, I have been brought together with a few people who have been overwhelmed by unusual circumstances to address some of their problems which would otherwise have been unanswered like an advancing melanoma, or a recurrent hidradenitis supporativa, or a serious problem in multiple medical systems for an illiterate, while they are still embedded in a social morass for which there seems to be little hope of ameliorating through any self-help on their own. But today they have experienced a “windfall” [sic] that has brought them together with someone “outside” who listened to their lives of desperation in which they had been barely coping. And into those devastated lives blew an ill wind that may have made for some good. That means that Katrina has brought a difference into their lives—and mine.