By TOM POUTON, Special to the Courier & Press
September 18, 2005

Editor's Note: Tom Poulton, a pediatric intensive care doctor and pediatric anesthesiologist for Deaconess Health System and Riley Children's Hospital in Indianapolis, was part of a medical team from Indiana that assisted Hurricane Katrina victims in Louisiana. This is the journal he wrote about that experience. 

I never enjoyed taking photographs. A personal disaster in which my family lost all our possessions several years ago convinced me that acquiring pictures instead of memories isn't wise. But here I was at 3:15 a.m., scouring the aisles at Wal-Mart for disposable cameras. 

I had just received a middle-of-the-night call from Kevin Cox, CEO and founder of Hope Crisis Response Network in Elkhart, Ind. His group is organizing much of the Hoosier response to Hurricane Katrina. "Tom, would you be able to leave for New Orleans in just a few hours?" he asked. I would fly with other volunteers on a donated commercial airliner. 

He said medical help was urgently needed. The federal air marshals, accompanying supply flights and refugee return flights from New Orleans airport, had witnessed two refugees die on the tarmac outside Terminal D of the Louis Armstrong Airport in New Orleans. They saw dozens of bodies lined up outside. 

"I'm already packed - I can be on the road in 10 minutes." 

I lied, knowing I still needed to pick up a few items on my way to the Indianapolis airport. Co-workers had already gathered some last-minute pediatric supplies from the storerooms at Deaconess Hospital. 

Like many Evansville citizens, I wanted to help. Unlike some, I had a boss who said "Sure, go for it. We'll cover for you." 

I work as a pediatric intensive care doctor. Until a month ago, I worked with St. Mary's Medical Center, but the powerful new partnership of Deaconess Health System with Riley Children's Hospital inspired me to move my practice. I cannot work as a pediatric intensivist in our hometown until next summer. Meanwhile, I work in the pediatric ICU at Riley Children's Hospital in Indianapolis and also hope to fill in some time helping out my former employer - the U.S. Navy. 

I was a Navy Medical Corps reservist until a few years ago. I had a variety of immunizations that would be helpful in entering a flood zone, and I knew how to live out of a backpack. Cox liked that part. "Uh, Tom, this is likely to be pretty primitive living for a few days. You'll be safe and guarded by military and security people, but it's going to be bad. You're OK with that?" Cox said. I know much about seriously ill and dying children. I know what their illnesses and deaths do to their families and how they never really recover. But all my previous "disaster" experience has been lived one child and one family at a time. I had no idea what to expect in the aftermath of Hurricane Katrina. I was relieved to learn I would serve with 25 other Indiana doctors, nurses, and other medical personnel, many of whom had prior disaster experience. We arrived in early-morning darkness at a private aviation hangar in Indianapolis. Our "tour guides" - four armed federal air marshals - painted a grim picture. I recognized the names of fellow Evansville residents Dr. Ken Combs, a Deaconess internal medicine specialist, and Barbara Duncan, a registered nurse I knew from St. Mary's, and "telephone friends" Drs. Gwenda Breckler and Diane Crowley. 

The time of year and the atmosphere took me back to the first day of school in the seventh grade. There we were, excited to see old friends, cautiously making new acquaintances, and anticipating this adventure. 

The cabin was full of chatter and ad hoc committee meetings as we tried to plan for the unknown. When we approached Armstrong Airport from the east, flying just north of the center of the city, we saw the Mississippi River clogged with about 60 disorganized barges that had torn loose from their moorings. Only one tugboat was working to create order. 

We saw the Louisiana Superdome and several small smoke plumes from neighborhood fires. It struck me: This is too raw, too personal for my cameras. I pulled the cameras out of my carry-on bag and stuffed them in the seatback pocket before me. Maybe a person on the return flight would choose to use them to record their odyssey north to safety. Instead I would record word "snapshots" on the file cards I had stuffed in a pocket to record patient information.

The New Orleans Airport
The New Orleans airport was filthy and smelled foul. Several hundred refugees crammed several waiting areas and the hallways of the C concourse. Mud and feces from the survivors' feet and shoes smeared the floor. The airport had regained electrical power and water service overnight. Housekeepers were hard at work mopping and trying to re-establish order . The refugees were dirty and subdued. Many made eye contact with us; few had the energy to return our greetings. A politician has cautioned not to call these citizens "refugees." I looked up the definition - "a person who flees in search of safety and protection." I was sure I was looking at refugees and didn't feel it demeaning to recognize fellow citizens in need. 

Many had come from the Superdome. Others had been flown from rooftops to the airport triage center by a steady stream of helicopters. We saw few children. 

Our security escort reminded us that some groups may not have been screened yet for weapons and that we might be dealing with anger, frustration, and extreme fatigue. Not once during my several days in the disaster area did any person raise a voice at me. All seemed too overwhelmed to invest energy in anger. 

I used to fly frequently, sometimes daily, in helicopters. Yet I saw more helicopters in one hour on the tarmac than I have seen in all the rest of my life - ranging from delicate two-seat Hughes to Army Blackhawks, Air National Guard UH-1 "Hueys" of Vietnam vintage, bright orange Coast Guard Dauphins, Sea Kings and Sea Stallions, twin-rotor Chinooks and Navy Super Stallions, all queued for miles. 

Property ownership
Our own sense of personal property melted away quickly in shelters and field hospitals. Food, shelter, blankets and cots, expensive medical equipment - all became community property in the disaster zone. I saw rescuers hand over a $5,000 defibrillator to a group that needed one. They just handed it over. The recipients asked how they'd ever get it back to the donors. "Uh, not sure you will, but if you need it, you take it. It's got our name on it. Maybe we'll see it again. Good luck!" My small group needed cots to sleep on. We found a pallet of cots and simply picked up six and walked off. "You suppose this is like taking food from a convenience store?" one asked. We all knew it was, and we all knew we wouldn't hesitate to "loot" a food store as others had. 

Patients arrive
My first "disaster patient" was a Ross, a 13-year-old boy with "persistent developmental delay," a syndrome of severe emotional and intellectual incapacity. He and his mother, brother and father had been plucked from a roof two hours earlier. I saw him at the field hospital at Baton Rouge's Louisiana State University campus, a 300-bed, fully functioning hospital on the floor of a sports arena. They had been on the roof for 30 hours, the boys' mother said. Many refugees had no idea what day it was. I suspected they had been there for many days, but didn't press her. "My son needs four medicines to control his behavior and he hasn't had any of them for days and days. He needs routine and calm and quiet. "We had to walk through water chest deep about half a mile to get to where we could get on that roof. Then the helicopter trip - he's never been close to one, so he got really agitated and started hitting everyone. They were afraid he'd get hurt or jump out or something, so they gave him a shot to make him settle down."  She paused. 

I knew she was exhausted and paused with her. Finally, I prompted, "is there something else we should know to help your family right now?" Tears streamed down her face as she explained, almost apologetically. 

"There were bodies," she said. "We had to walk through the water and there were bodies. We just didn't know what to do." Hugs, prayers for a better tomorrow, a meal, and medicines from the pharmacy helped get the boy's behavior back to usual. The whole family slept with us in the unit that night, but moved out to a more remote shelter the next morning. The social worker tried to assure them they'd get mental health support at the next stop. Our psychiatrists were dealing with more pressing problems. At one shelter, a local caregiver of a chronic patient had walked through the foul waters to avoid a worse fate. She and her charge made it out, but she felt so filthy from the exposure to the water - again with bodies in it - that she repeatedly scrubbed her legs and treated them with bleach, producing a raging inflammation. Our team included a plastic surgeon who cared for her. 

Student volunteers
Three days earlier this sports arena had basketballs and exercise mats on the floor. Now as a medical and pediatric ICU it was marked by a portable X-ray machines, a minor operating room, a pharmacy, sterile supplies, a bank of copying and fax machines, a chemotherapy operation for displaced cancer patients, and an obstetrical facility. And 50 renal failure patients daily were receiving dialysis there. 

Fittingly, there were still college students everywhere we looked. Bright, upbeat, energetic college students who brought us food and drinks, tracked down supplies, carried requisitions to the pharmacy and shuttled blood and urine specimens to the laboratory. Many were displaced from New Orleans and followed the trail of victims to help, doubling up in dorm rooms. Their smiles and their energy and ingenuity were a godsend. 

Local physicians
We arrived as the local medical community was regaining its legs and starting to function shoulder to shoulder with relief workers. They were quickly integrated into our field hospital. We asked gently about their personal situations. All said family members were safe. 

Most "lost everything." 

As the caseload quickly dwindled in the pediatrics area, we tried to talk our local colleagues into taking time off. I left a message for Irina, a 45-year-old Russian pediatrician who had been working in New Orleans for 16 years, to sleep through her shift that night. But she showed up to work. 

Tears welled up in her sleepy eyes. "Well I didn't get (the) message. My cell phone charger is ... I don't know where. My batteries are dead. But even if I know you are here, I come," she said. "I come to see my patients. These are my patients from New Orleans and I never want them to think their doctor forgets about them or would not care." 

Tears poured down her cheeks as we hugged her. "We understand. Your patients are lucky to have you." 

Another displaced local pediatrician was a man named Richard. "Please go hug your wife and get some sleep," I told him. 

His face was tired and deeply lined. To no one in particular, he explained "these are my neighbors. They have so many stories to tell." 

Later in the night, I saw him sitting at the bedside of an elderly woman in the cancer ward, holding her hand and nodding. These wonderful people were far from having lost everything.

More patients
My final patient late one evening was a 3-year-old with asthma and pneumonia. 

Like so many times before, the parents sat largely mute, requiring encouragement to answer even basic questions. They didn't know how long they were trapped before they had to try to escape. 

Leiona's father carried her out on his shoulders through water that came up to his clavicles and to the neck of his shorter wife. Their daughter screamed for most of the mile-long trial, writhing so much they feared she would fall into the bad water. 

As I listened to her chest, she started to awaken. The parents warned that she would be frightened. She opened her eyes, looked about, and smiled at me. "Who are you?" she demanded. I smiled back and pointed at the SpongeBob SquarePants sticker on my stethoscope. 

She laughed out loud. "You're silly - you are not SpongeBob," she scolded, passing my quick mental status exam. "You are somebody else!" 

The resilience of youth! Her parents smiled for the first time, as well. 

The unaccompanied
"Any other kids who should be seen right now?" I asked a severely starched Army nurse. She was a lieutenant colonel, large and quite in charge. She stared at me, then very quietly leaned toward me and quietly asked, "You been topside yet?" She turned and looked up at what looked like a press box with windows extending along one side of the huge gymnasium. "(Those are) the unaccompanied kids." 

It took me a moment to process what she had said. "Kids who are alone - no parents, no families?" "That's it," she replied. "Go see if they're OK." 

I had to pass two checkpoints with armed sentries. I introduced myself to the nurse in charge, who reported on each of nine kids, ranging from 4 to 15 years old. Community volunteers, all young women, chatted quietly and played board games with the kids. They were all doing as well as one could hope. The Red Cross was working on a huge registry of the missing and a few kids had already been placed with aunts and uncles. 

Night shift
Later that night, pediatrics was quiet. I walked over to the adult intensive care to introduce myself to the night shift there and offer help if they needed it. Adult medicine was busy around the clock. 

The adult intensive care specialists were gracious. I was sure I sensed a hint of wariness - "A baby ICU doctor working in this setting?" Point taken. We were interrupted with an announcement: "We have 24 ambulances en route." The scale was intimidating. Not just an ambulance on the way or three or four as we occasionally face at home, but 24. The staff was up to it. EMS teams were in place to greet each new arrival and escort patients to the appropriate unit. The landing zone for helicopters was a track-and-field stadium immediately adjacent to "the field hospital." The helicopters were scraping the surface. 

Thoughts of the seventh grade intruded once again. I remembered Mr. Mastri, who came unhinged if anyone walked on the gym floor in street shoes. Is there a Mr. Mastri here, worried about the damage to the field? The landings and departures continued. 

At 3 a.m. one day I was awakened by the obstetrician I was assigned to back up. 

A woman 30 weeks pregnant had just arrived in labor. Because this was her fifth pregnancy, we knew this premature infant could be delivered in 10 minutes. I was on standby to help stabilize the infant. I grabbed a displaced pediatrics resident from New Orleans 

He asked if we should try to deliver the baby "under these circumstances." I reassured him that our obstetrician was committed to stopping the labor with drugs if possible. The labor stopped and she flew out 15 minutes later. We heard she was doing well, with labor still stopped, later the next day. 

Wrapping up
The field hospital population dwindled rapidly. There were soon many more caregivers than patients. The hospital would close this afternoon and become a shelter for the displaced. As quickly as it was created, it would be removed. As we were preparing to send the last patients to local hospitals, one had a heart attack and couldn't be resuscitated. The last admission was an elderly woman accompanied by a child about 7 years old. The woman was on a wheeled stretcher. The brave little girl couldn't reach over the cart's railing to hold the woman's hand so she clutched the cart's railing instead. She kept pace with adults pushing the stretcher through the cavernous arena, never relaxing her grip. 

One student volunteer gently and quietly approached, took the little girl's hand and sat down with her beside the old woman. They were quickly lost in conversation and giggles while another volunteer ran to get a bowl of Cheerios. 

Angels truly do walk among us.
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Tom Poulton is also a medical adviser for the Ohio Valley Search and Rescue.  He works with a pediatrics hospice and works one week a month in the U.S. Navy Medical Center Pediatric ICU in San Diego while its staff is serving in Iraq.