A hurricane threatened to pummel the author's community and practice. Here's how he and his patients got through it.
A hurricane threatened to pummel the authors community and practice. Heres how he and his patients got through it.
Every fall here in Florida, the hurricane season arrives with its attendant squalls, flooding, falling trees, and traffic jams. As this years season creeps closer, I cant help but reflect on the storm that threatened my community and practice three years ago.
The hype, fear, and preparations for Hurricane Georges began several days before it was due to hit our Tampa Bay area in September 1998. Everywhere I went, people were talking about the approaching monster. Newscasters and weathermen charted its course through the Caribbean. "The situation is serious," one anchorman announced grimly. "You can expect 120 mile-an-hour winds, 15 foot storm surges, and 7 to 14 inches of rain."
As soon as news of Georges impending arrival spread, people began arming themselves with video rentals, indoor games, library books, and emergency food supplies. The shelves in our local supermarkets were nearly empty well before the big event.
I remembered when tropical storm Alberto hit Brooksville in 1994, causing considerable flooding and damage to homes and other buildings. That time, the paramedics had called me from the shelters to admit patients to local hospitals.
Georges was scheduled to reach Tampa Bay late Saturday evening. On Thursday, I overheard my secretary Julie canceling my Friday appointments. When I asked her why, she said, "Its not safe to keep the office open during the storm. If we wait till were sure well be hit before we cancel, it could be too late."
"But Julie," I said, "its only Thursday, and the hurricane is still near Cuba. Thats more than 300 miles away. Dont press the panic button yet. Maybe all well get is a tropical storm."
"Okay," said Julie. "Ive canceled only 10 so far. Ill leave the other 12."
I knew she was concerned about our older patients, many of whom live in mobile homes along the exposed beach, and almost certainly would be evacuated to shelters. But I also knew what troubles wed face if we canceled all the appointments. Wed have to reschedule everyone, putting a strain on the following week.
Besides, I felt people were overreacting, though I was in the minority. But their reaction was hardly surprising given the nonstop television coverage showing the devastation Georges had caused in Cuba and Puerto Rico. TV screens were filled with images of flooded houses, roofless buildings, and people standing knee-deep in water. The news reports described it as "one of the deadliest storms in 200 years."
The weathermen gave instructions on how to cope. They talked about stockpiling necessary supplies like food, fresh water, andin case of power failureflashlights, batteries, and candles. But we still didnt know whether the storm would actually hit our area, or if such preparations would really be necessary.
A few patients called our office and asked whether they should go to shelters, what medicines to bring, and how to handle particular medical emergencies. I assured them that everything would be fine as long as they followed the orders of the emergency planning officials. "Dont take any chances," I told them. "And dont wait till the last moment. If theres a medical emergency, well come to the shelter to see you."
Meanwhile, a patient Ill call Fred was quite sick in the hospital with recurrent pulmonary embolism while on full anticoagulant therapy. A transesophageal echo showed a large clot in his right ventricle, and another small one in the right atrium. If either one broke loose, he could die instantly. Because our small community hospital doesnt have a cardiac surgical facility, I had already discussed Freds case with a surgeon at a nearby cardiac center, and had proposed transferring him there.
The surgeon called back that Friday evening while I was making rounds. "Sorry, Ravi," he said, "we cant accept the case. Because of the hurricane, were not accepting any new patients. The OR is closed except for in-hospital emergencies, and the cath lab is closed till Monday."
"What about Tampa General?" I asked. Thats a big hospital with lots of beds.
"Oh, no," he replied. "Theyre even closer to the path of the hurricane. Theyve also stopped accepting patients till Monday."
By then I was getting angry at Hurricane Georges. Although it still hadnt moved much from Cuba, it had already started to control my life. What were we supposed to do with our sick patients, I wondered? Just wait it out and hope for the best?
I looked out the window, and saw a little drizzle, but no sign yet of any wind. I decided to renew my efforts to transfer Fred by early morning, and finally located a hospital in Gainesvillemore than 100 miles inlandthat agreed to admit him.
The next patient on my rounds was Vernon, who had recovered from chest pains, and whom Id been planning to discharge in the morning. His wife had just arrived for the evening visit. "Youre doing well," I told Vernon. "You can go home in the morning." I knew hed be happy at that news because his elderly wife was living there alone.
"I cant, Doc," he said. "Theyve closed our park."
Vernon lived in a mobile home park whose residents are routinely evacuated because their trailers are very vulnerable in hurricanes. "So my wife is moving in with me here till the park reopens."
Hoping his HMO wouldnt give me any trouble, I made notes in his chart explaining why hed be staying at the hospital for two more days. It was 9:00 that evening before I got home and sat down for supper.
On Friday morning, I called the hospital in Gainesville to arrange Freds transfer. The senior resident I talked to called me back after consulting with her attending, and agreed to accept him. A few minutes later, however, a hospital coordinator called and said that shed been unable to get approval for the transfer from Freds HMO, which had closed down because of the storm.
"What am I supposed to do?" I demanded to know.
"Well," she said, "if you can document that this is an emergency, maybe theyll eventually approve the transfer. But in case they dont, you should tell the patient and his family that they could be liable for all the expenses."
I protested that Fred was an elderly man with limited savings, and he couldnt afford to pay those bills. If the HMO was closed on a working dayhurricane or notits their problem, not mine, and not Freds. I then called Freds family physician, who approved the transfer, even without authorization from the HMO.
Later that day, I told my wife Id probably be making my rounds of the shelters the next day, knowing many of my patients would be staying in them during the storm. Still, by midday on Friday, Georges had only reached Key West, and we still didnt know whether it would hit us. But at least I knew my preparations were complete.
On Friday night, Georges suddenly turned northwest into the Gulf of Mexico. It ended up causing about $1 billion in damage along the northern Gulf Coast.
Thankfully, our area was spared. On Saturday morning there was no rain or wind, and the sky was bright blue. There was no flooding, and no traffic jams along the coastal roads. I didnt get a single call from the shelters.
Most of my patients tolerated the evacuation and the shelters without a problem. When they showed up at the office, I reminded them that even though their preparations and evacuation had ultimately proven unnecessary, the experience had provided valuable training for themand for mein case the next hurricane doesnt miss.
M.P. Ravindra Nathan. How we got ready for a monster storm.