05-SEP-A-19
LAST CLINIC DAY, SPORTING THE NEW “UNIFORM”
TEE-SHIRT MADE UP OVERNIGHT BY THE PARISH PRESIDENT
AND PACKING UP,, WITH A TOUR OF THE DEVASTATION OF THE SURROUNDING AREA OF NEW ORLEANS PROMISED, BUT THEN CANCELLED BECAUSE OF GUNFIRE FROM THE PROJECTS SURROUNDING OUR MEADOWCREST HOSPITAL
September 17, 2005
There was a start at making my final clinic day a short one followed by a chance for the “tour of the area” everyone had been agitating for—and disposable cameras were bought for the occasion by our local resident medical student Ryan Hebert to bring in for our “tourism” use. But, after we had packed up the clinic at 2:00 PM in the after non after a shortened day in which we had still seen 84 patients (not bad for a Saturday down from our peak patient flow a few days back with 181 patients treated) we came back to the Meadowcrest Hospital for our “sightseeing. There are now big signs all around saying “Hospital Closed” and a tarp is thrown over the sign that this is Meadowcrest Hospital, the sign itself damaged by the Hurricane winds. As the eager pack drew up to the entrance, the bad news came back that “the guard has nixed the tour, since there has been resumption of gunfire from the slums behind the hospital and in the area of our Lincoln Elementary School.” It was a very hot and sultry day and many people have come back to their homes in whatever condition they are, to be both shocked and some irate at the plunder, and there have been armed confrontations with expression of that ire in open firefights. So, there will be no tourism or picture snapping other than the kind we have been doing regularly on the way to and from our clinic site with the ambulance and its siren and flashers in front of us as we run red lights and a Humvee full of guards locked and loaded behind us. No Kodak instant memories are going to be made on the disposable cameras purchased for the purpose. And that will leave me with some time to get packed up and perhaps do a good long run upon return.
CALL FROM DONALD AFTER THE VOICE MAIL MESSAGE
HE HAD LEFT TO DISCUSS HIS OPTIONS AND THE
DECISION HE WILL MAKE SOON:
TWO ARE NOW MADE: HIS CARDIAC AORTIC VALVE
REPLACEMENT WILL BE DONE AT SHANDS UNIVERSITY
OF FLORIDA HOSPITAL BY DR. MARTIN;
NOW AWAITING DECISION ON WHAT KIND OF VALVE
Donald called to leave a voice mail message on my phone and now called as I was coming in to get to hope to run today after my last clinic as mountains of baggage accumulated out front form the teams of newcomers flooding in. He had wanted to talk with me and left a message stating he had leaned toward Dr. Martin of the Shands Hospital of the University of Florida and that he was still intensively looking up details about the kind of cardiac valve he would have since each made big differences in his lifestyle. He said his wife had already made up her mind as to what he would be having since she had said that he would have a mechanical valve and just stay near home, since they never traveled anywhere anyway, and she would look after him and his clotting times and Coumadin. Donald had said to me that he was worried about the question he had opposed to each of them: yes, a mechanical valve is the state of the art with the longest time course for implantation, but what would you have done? Each of them said they would have a biologic valve, since they travel all over the world and would not want to worry about anticoagulation. He rather thought that what they would want for their kind of active lifestyle would be what he would want as well, but Kathy had determined that the mechanical valve and anticoagulation had fit the style she would have recommended for him.
Donald chuckled over the fact that he was working overtime today, going to the University of Florida Tennessee game so that he could collect the overtime, see the game, and also get his mind off the other things he has been thinking of. He wanted to go to see (or actually “hear”) a fellow who had a mechanical valve to see how noisy it is and whether he wanted to live with that. I told him that the older Bjork Shiley valves made for very poor poker players after implants since they would always telegraph the quality of their hand by the rapid rate of their audibly clicking pulse. He says for his own peace of mind, he does not want to wait through the whole year that they had advised he would have before the need to undergo the operation since it is regurgitation rather than symptoms of aortic stenosis that is the troublesome part and the symptoms of “Stokes-Adams” syncope that I had first asked about are not his kind of problems, but a gradual overwork of the heart in the amount of blood that goes back and forth in the regurgitation of aortic insufficiency is likely to result in cardiac hypertrophy over time. But Donald is talking about seeing Martin again to talk about October as a time to have the operation, since he does not want to put it off once he has his mind made up. He wants to talk with me on Thursday before he return to see Dr. martin to talk with him about the timing and the valve, and says the last decision he has to make is also now changing—and that he is leaning toward a biologic valve despite the pressures he was hearing form both mother Sally and wife Kathy in the same room getting together and making the decisions for him that he was sure he would come to better without such predetermination,
He was feeling much better now about the talking with me saying cardiac surgery had come a long way since its starting points and that he was sure that there would be newer improvements and that he would hear more about them. I will also speak with people about the newer creations of bovine fibroblasts and semi-synthetic struts and biologic coverings over the structural valve components. He is going to enjoy a couple of the football games of the season and is looking foreyard to my being down in Gainesville when he needs me, not so much for advice as for the support of his father in whatever decision he comes to.
AND, NOW, THE BAD NEWS:
THE PLACE FLOODS WITH ARMED TROOPS JUST AFTER I GET MY RUNNING SHORTS ON, AND THE “INCIDENT”
CANCELS OUT ANY POSSIBILITY OF A RUN
Abruptly, I am out of action. I have changed into my running shorts and the new shirt that the Parish President had made up overnight. It says “Maryland Task
Force Operation Lifeline” on the front with the state flag, and on the back “Proud Volunteer Medical Relief Team for Hurricane Katrina Victims in Louisiana” on the back. I may be stuffing more things into my bag going out than coming in, since I had the big boots and other items like that to think I might need on the front end of this “flexible situation” which is going to have a lot of flexibility going out the back side.
“No running!” That is the message that comes along with a bunch of Humvees and a big squad of armed troops in full armor and helmets and weapons at the ready as they spread out over the neighborhood behind the hospital form which the gunshots had been reported that had canceled our “tour”. So, the perimeter guarded running route we had established just two days ago is now off limits since it is presumably in the free fire zone. So, I am going to go back to Maryland with any number of over caloried meals in me and only one run, and a shorter one at that than the hour and a half planned for today because of the longer time we would have form the early close of clinics and the cancellation of the tour. No run—no dice.
“BODY COUNTS:”
TOTAL NUMBER OF PATIENTS SEEN TO DATE IN OPERATION LIFELINE EXCEEDS 5,000;
TEAMMATES SHIPPED OUT TODAY: 30;
REPLACEMENT VOLUNTEERS ARRIVING: 92;
EXCESS BODIES TO STACK IN FLOORSPACE: 62
For the team that has been here since the inception of our mission –that means me and about a dozen others, all leaving at some undetermined time tomorrow on a plane that is likely to have to dome from Alabama to carry us back to Martin State Air Base in Sparrows Point Maryland,--it is a time to go through the “accountability and safety “drill once again. The distinction is lost on the brass between the terms accountability and counting, so we repeat the counts dozens of times daily to see that we are all “accounted for.” If we “count” then we are safe. That there may be some underlying themes of unruly characters doing end-runs around the system to be gamed, is made apparent by a conversation I overheard while I was at the MCCU last night trying to email photos. I heard two EMT’s saying they were going to be trying to smuggle a dog in transport through the EMS system but not let anyone know about it. I do not have to have a picture drawn for me to understand just what is happening here.
Our numbers have been pulled together. I has seen quite a number of patients today with a reduced staff and a few of them were serious such as a fellow who was 60 whose neighbor whom he had helped go get her glaucoma eye drops had found him with slurred speech and dragging his feet and checked his BP with her own sphygmomanometer since she has high BP under treatment, and could not determine it since it was too high. He had been admitted to Charity Hospital over a year ago with uncontrolled high blood pressure, but had been kept over night and discharge in the morning when his pressure was regulated with IV drugs. He was sent out with t script for medications he never got since he has neither money nor a Medicare card which he was denied as being too young. So, here he sat with a BP of 240 128 and not fully alert. So, rather than just getting him down with some oral meds and an IV dose of Hydralazine (he also had a heart block with a pulse of 40) we plugged him in to an IV and loaded him on a stretcher and shipped him to West Jefferson in our ambulance—which would make a bit more impression on him and on the hospital and this time he would not fall out in the cracks for his continuous high BP treatment program which he will need for life. He is a stroke waiting to happen, and we may have done more social good than medical benefit through the emergency transfer. He is another patient that a “system” should be treating where none seems to have been in place.
Apparently our Operation Lifeline has totaled over 5,000 patients treatments which has been a good community resource---with or without the storm! The system in place is a system to the advantage of some unscrupulous patient providers. The patients have virtually no preventive care services and if the Hurricane that blew through has done nothing else, it has turned over this rock to show that the “health services for all are created equal” missed this are of Louisiana—not unlike the Sudan or parts of Malawi, with the exception that there are no pots of gold to be mined by meddlesome private practitioners or clinics in providing addictive nostrums to milk these patients of their welfare checks. If the devastation of the disaster is added to the misery of these peoples’ lives, it is to show that the Hurricane had flattened most; the floods had destroyed others, but that the majority of the people here have been plundered by predators and a failed system of health care. This is not, as the media seem to have carried on in their malpractice lawyerly way “for any problem there is someone at fault and our job is to fix the blame, not the problem”, but to say that these people have lived tragic lives—before Katrina blew through. The response to the storm is either “Well, you can’t fall off the floor—I didn’t have much before and I have less now, but we will just keep trying to muddle along with a little help from our friends and neighbors” or “That was the last straw: why doesn’t someone somewhere DO something.” One of the things we can do is bust the chops of those who are quasi-legally milking these patients for whatever they can write that will keep them coming back for more. But another is to alert these people that the “standard of care” is not being met, and we will do what we can to being them up to some standard, but they will have to participate in their own health care in limiting their overindulgence in excess calories, too much liquor and ANY cigarettes, and that is it time to get off their excessively expansive backsides and get active! The good part of this experience is to see the neighbors helping each other—essentially the only social safety net I saw. It did not do well enough to save “Pineapple” but it brought the fellow in today BEFORE he had a stroke form his neighbor who had tried to take his BP and could not measure it since it was so high—so she gave him one of her pills—a nice gesture, but a woefully inadequate 25 mg of hydrochlorthiaziade when what he needed was big time combination treatment to being his BP down from critically dangerous to simply “high”. And some system besides his neighbor will have to follow him up to see that it comes down form “high” to safe, and that won’t come from a 25 mg hydrochlorthiazide shared from his well-intentioned neighbor who just happens to have some since she does have a Medicare card.
Not everyone can launch their own Internet search for the best kind of valve to be placed in the aorta for one that is regurgitating, nor had two physician parents and a lot of ancillary supporting folk as Donald does. But some “health aware” person ought to be able to guide someone like today’s patient into some preventive program before he simply drops over from a preventable stroke. The Hurricane Katrina has blown the cover off that part of the secrets of the Big Easy.
Now, we will go down to Emeril’s streak dinner to welcome and orient our replacements, for the three days of clinic takedown they will have to leave these patients in much the same non-system as before the storm.