Winter 2013

Drowned Medicine

Part of the challenge of treating patients displaced by Hurricane Sandy was figuring out who they were

By David Watson Sobel, ’14

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Sun gleams on the Hudson River in the distance, with the darkened Manhattan skyline visible at center, two days after Hurricane Sandy made landfall, on October 31, 2012. Photo: Narui Tama/Getty Images

Imagine a humid gymnasium stinking of body odor and excrement. The space is large enough to hold a full-size running track, basketball courts and bleachers under an enormous iron canopy and bright fluorescent lights casting an eerie greenish hue below. Now imagine this space filled with 600 cots, and nearly that many frail and dehydrated elderly people, either bedridden or milling about aimlessly in the enormous room.

These people had all been displaced when their nursing homes and assisted living facilities got submerged by Hurricane Sandy’s terrible wind and surging waters in late October. As ground floors, basements and sub-basements were lost to the flood tides, residents were evacuated in droves from their homes and facilities and brought here to the Park Slope Armory, an imposing 19th-century brick castle located in a dry neighborhood of Brooklyn, N.Y. For some, it would be their temporary source of basic human needs for more than three weeks; for us, it was our mission and our home for seven days.

One of my first patients was Alice. Alice was a rarity among the denizens of the armory due to her relatively young age. She was a short and portly 50-year-old with thick coke-bottle glasses heavy enough to give her nose a chronic scrunch. She walked around combating the effects of gravity with her nose high but her attitude humble.

Like so many of the shelter residents, Alice had been swept onto a bus and driven through the storm to the armory without any notice. At least 29 facilities in Queens and Brooklyn that had been filled with elderly, disabled and mentally ill residents were “severely flooded” by the storm, according to the New York Times. Everything had been left behind in the evacuation, including medical records and medications.

For some, the loss included their identities. A number of patients with advanced dementia entered the armory not knowing their names and were quickly lost in the crowd. Long-term medical problems such as seizures, diabetes, chronic lung disease, high blood pressure and incontinence were suddenly unregulated and untreated. People accustomed to living in a lockdown dementia ward were now roaming about freely in the disarray.

A nurse brought Alice over to the field hospital complaining of a sore throat, but what I noticed first was that she was shaking on the medical cot. She struggled to even bring the tissue to her nose without tearing it between her quivering hands, and when I checked her pulse it threatened to race out of her wrist. A ring of sweat pooled under her glasses and on her forehead. One of the aides from the home came through the part in the wrestling mats that made up the walls of the “hospital” and stated simply, “She has anxiety. She hasn’t slept for days.”

Patients were now two days out from getting their last medications and thoughts of withdrawal and accompanying seizures jumped into my mind. Alice was used to being on high-dose sedatives three times a day. Can we contact the pharmacy? There was no way. Like her apartment, the pharmacy was underwater.

I checked on Alice again. She had been moved to the far corner of our field hospital, separated from the chaos by a couple of wrestling mats stood on end, finally asleep. We restarted her on her medications that we had on hand and let her rest. Released back to the milieu hours later, I wondered how she would do. Luckily, I continued to see her drifting about with her head held high throughout our stay. Every time, she smiled at me and said “thank you.”

NYPD officers patrol the Park Slope Armory shelter during the aftermath of Hurricane Sandy. Photo: David Watson Sobel, '14

NYPD officers patrol the Park Slope Armory shelter during the aftermath of Hurricane Sandy. Photo: David Watson Sobel, ’14

Scattered and Lost

Fortunately, I was not alone in the middle of all this chaos. Rhode Island One was one of 17 federal Disaster Medical Assistance Teams under the Department of Health and Human Services to deploy to Hurricane Sandy. Although this was my first federal deployment, I had trained with the Rhode Island One team for more than four years during college as an EMT and throughout medical school. Thirty members had been on the roster for October, and two days before we were to rotate off, we got the call. Our team, made up of paramedics, nurses, physicians, pharmacists and logistics support staff all left our day jobs the moment our phones and pagers went off.

Our deployment was nothing if not by the book. First, the government sends the teams. I was warned that NDMS, the National Disaster Medical System, really stood for “Night Drive, Morning Surprise,” and this was no exception. Packed to the gills with medical equipment and supplies to be self-sufficient under any conditions for 72 hours, we convoyed south through the night in rented Suburbans and minivans from Rhode Island into a blacked-out Queens. There we received mission orders to proceed to the Park Slope Armory.

Once a team has secured the location, the government sends the federal caches. Two 18-wheelers filled with medical supplies and enough equipment to build a critical-care field hospital and pharmacy showed up within hours of our arrival at the armory. Hundreds of gunmetal grey Rubbermaid containers on pallets were cracked open—here, I learned that NDMS also stands for “Never Done Moving Stuff”—and the acute-care area that had seen the shelter through the first 12 hours was transformed into a well-oiled MASH unit. Massachusetts Two showed up to augment our numbers. We staffed the field hospital and treatment areas 24 hours a day, day in and day out.

Disaster medicine attracts those who constantly think about “worst-case scenarios.” Despite all our training, walking the perimeter of the gymnasium for the first time was like stepping off a plane in a foreign land with harsh smells and sounds. Yells of disorientation echoed off the walls. A forlorn man who looked far older than his age was slumped in his cot crying “help” over and over. The bathrooms overflowed. Whole communities had been lost to the storm and had washed up here like flotsam and jetsam. Two days ago these people were lying on crisp sheets with hospital corners and attended by nurses in their familiar rooms and apartments; now they were scattered around a gym, helpless and wearing donated clothes.

Bobby was another of my patients. He was a short pudgy man with an awkward bowl cut and chubby cheeks who lived at the nursing home considered worst off. He was identified by the shelter staff as a psychiatric flight risk. Originally combative, he ended up checking himself into in the “VIP Lounge,” the code name given to the mental health unit that we had set up.

The author, making notes at right, first got involved with medical relief work when he was an undergraduate at Brown University.

The author, making notes at right, first got involved with medical relief work when he was an undergraduate at Brown University.

Pleased with his new status as a VIP, Bobby became a benevolent ruler within the walls of the unit and gained the support of the care providers and his comrades. After a few days, he was well enough to graduate back to the larger crowd and collected his food-stained clothes and minor items in his arms. It was not to last. Later that afternoon, I heard that Bobby was back in the VIP Lounge, crying inconsolably. The owner of the nursing home had come through and told everyone that the facility had to throw out all of the residents’ possessions, that all of their earthly belongings were gone. There was nothing left.

Bobby’s fragile world had shattered. His only source of comfort now was his VIP status and his knowledge that the “people in the tan uniforms” cared about him. The VIP Lounge was his shelter within the shelter, and he moved back into the mental health unit with his few remaining belongings.

Celeste was another medical disaster waiting to happen. One morning, Celeste would not budge from her cot. An unforeseen consequence of the outpouring of food donations was diabetic patients gorging themselves throughout the night. A volunteer nurse came to us and said Celeste was drinking a lot of water and eating with reckless abandon. She was sitting up with a dazed look, crumbs scattered over her orblike belly. She had poorly controlled diabetes at baseline and now was feeling the effects of a blood sugar of 400, on the brink of acidosis. An insulin drip, started in the critical-care area, brought her sugar level under control.

She was afraid that if she got help, we would send her to the outside hospital and she would not be able to come back to the shelter. Like Bobby, she had few comforts: Her cot, some shelter blankets and a tarnished silver necklace was all she had left.

Life in the shelter was a constant battle against chaos. We awoke one day for shift change to frigid air: Not used to round-the-clock occupancy, the heat in the armory had automatically shut off overnight, and six patients were sent to the hospital with hypothermia. A handful of shelterees suffered an acute reversal of their constipation when a stomach virus that plagued other shelters infiltrated ours.

And yet, even with the unpredictability of the shelter and its residents, an odd sense of peace and structure developed; the days began to coalesce into a timeline of patients and problems that we fixed. Creature comforts for the team returned in the form of showering in the basement of the shelter for battered women next door. Food donations meant the remaining government-provided MREs (Meals Ready to Eat), or “Meals Rarely Edible,” as we called them, sat in our jump bags. In precious downtime we pondered the merits of a tour of duty in the VIP Lounge versus “The Thunderdome,” our name for the field hospital, over New York bagels donated from the local deli. A volunteer orchestra set up and played an impromptu concert within the walls of the armory. The anguished yells that greeted our arrival were replaced by classical music coming from the string quartet in the bleachers. Somehow, we had reached equilibrium.

After seven days, the situation at the armory was declared stable, and we were ordered to rotate out: “Convoy to Times Square, await further orders.” The Massachusetts Two team took command of the field hospital, and we packed our jump bags. Our exit from Park Slope Armory was just as surreal as our entrance had been. Bedraggled but smiling residents lined up and applauded as we passed over the threshold and back into the world.

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