Excerpts from the notes of Dr. Glen Geelhoed who went to work to help the victims of Hurricane Katrina:
September 16, 2005 //
Dr. Geelhoed usually travels to developing countries and works in dangerous and miserable situations.
"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."
"A WHOLE SERIES OF PATIENT PROBLEMS THAT DESCRIBE TRAGIC LIVES—BEFORE, DURING AND SINCE “KATRINA”:
The Lousiana 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 patient. 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.
Glenn Geelhoed MD is Professor of Surgery and International Medicine
at George Washington University and Board member of the International
Society for Panetics
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