My longtime friend is a Director of ER Pscyh at at local SF Bay Area Hospital. He flew down to Houston on his own dime, when his Houston colleague got him a temporary certification to practice in Texas. He sent this email:
I arrived too late to see Bill and Hillary Clinton and George Bush Senior but just in time for the dysentery.
My early afternoon arrival to the Astrodome, just a little jet-lagged from getting up at four am and a long flight from Oakland, helped provide a much-needed eye opener. The evacuees are all wearing wrist bands, so they can come in and out of the Astrodome interior. As soon as you are a mile away from the stadium you start to see groups of teens and young adults walking everywhere -- in the middle of busy traffic, sitting and talking on highway medians, cowering in parking lots. Apparently many of the area drug dealers have arrived as well, given the captive audience of easy sales. Some of the purchasers we would see in the medical building later.
More below the fold.
We pulled up to Reliant Arena, part of a huge plaza complex that includes the Astrodome and Reliant Stadium (NFL's Houston Texans). The arena was where the makeshift clinic and hospital are housed.
It's actually a pretty impressive de novo medical center. There are metal dividers everywhere with canvas curtains separating the general medicine clinic, surgery, infectious disease, OB, pediatrics and psychiatry. There is even a dental clinic and a dialysis area.
One problem is that the only restrooms for medical staff are porta-potties about a block away. As the day drags on and you keep slugging coffee the relieving distance seems longer each time.
But otherwise, everything is relatively concise. If you lift up the curtains for the psych ER you are in the dialysis clinic. Pediatrics shares drapes with surgery.
There is also a more disturbing area, which just got developed today. A large room identified merely as "quarantine". There are already at least fifty occupied cots in there.
People have started getting dysentery, marked by diarrhea and vomiting, which leads to dehydration. They don't know what the infection is yet. Until they do, everyone stays in isolation.
There is a center area of makeshift handwashing sinks but no water inside the individual clinic areas. Thus there are myriad bottles of "dry" alcohol-based handwashing bottles and everyone is encouraged to wash hands every few minutes, hoping to prevent any further spread.
In my section of the ER, the psych ER, there are two other MDs working as we arrive. Others come in and go during the day, seeing if they might be of help, but they are of limited assistance in the true Psych ER work. The reason is they are regular psychiatrists, not that familiar with emergency, medically-based psychiatry (what my home job does -- more similar to a medical ER than a counseling center, to describe as briefly as possible -- medical treatment of brain disorders.) We assign them to patients who need grief counseling, of which there are many. There are at least a dozen non-physician grief counselors here as well, for folks who don't need a physician but just want someone to try to
help them figure this all out. They have their own separate tent to bring people into for counseling.
Our Psych ER area is a large main area surrounded by curtains. Patients arrive at the opening to be evaluated by a nurse. If they seek counseling, they are sent to the grief counselors. If they need a doc, they get their vital signs taken, some basic information, and are placed into one of nine curtained "rooms" to wait for one of us. A greasepaint board shows the names of those waiting, and we sign our names next to theirs to take responsibility.
Most need medications today. They haven't had their meds in over a week, and in some of them that is really starting to make life difficult. A lot of pharmaceutical companies have donated piles and piles of free samples of the meds we need. We have a curtained room that looks like King Tut's tomb full of free psychiatric meds.
We meet the people and we ask about their symptoms, figure out what meds they need. They tell us their stories of the past week. They are as bad, or worse, than what you have been seeing on TV. Already I have had two patients who had to break a hole through the roof out of their attic, climb out of their house, and try to swim to safety. One guy said he just kept swimming and swimming, not sure which way to go, letting the current take him sometimes, other times grabbing a street sign and hanging on so he could rest. He finally made it to the Convention Center and sprawled himself out on the sidewalk. An old man was sitting in a chair next to him. An hour later, somebody threw a blanket over the man in the chair, because he was dead.
The guy who had been swimming had a painful look in his eyes as he breathed, "They didn't move him for three days."
Another lady got separated from her husband in the melee around the Superdome and they ended up on different buses. He came here to the
Astrodome, she somehow went to Dallas. In Dallas they cleared out the county jail and used that to shelter her and the others. She is psychiatrically fragile, had lost her home, is separated from her husband, and they kindly provided her shelter behind bars. She was doing
surprisingly OK. A relative had picked her up and brought her here. She needed some meds to get herself stable again so she could go into the
Dome and look for her husband.
Later I was asked to see a patient who was in the Dome itself. Some police gave me a lift over to the buidling, about three blocks from us.
When you walk in you see some cops and security wearing face masks, worrying about infections and TB. The Astrodome is huge and packed, cots are everywhere, people are everywhere. There will be many more soon as there is an 11PM curfew and everyone must be back inside or else.
Every politician in the world was here today touring. As I said, the Clintons and Bush Senior. The head of Health and Human Services. The Surgeon General. Last night, Dr. Phil did a live support session with evacuees in the parking lot, televised by Larry King. Greta Van Susteren from Fox News is live inside the Dome.
One psychiatrist from Maryland waltzed into our ER today, saying she had just flown in to help and demanded to be put to work. The director informed her she couldn't without a temporary Texas Medical license, which he could get for her but it would take awhile (he had done mine for me before I arrived, as you can do when you know someone is coming.)
There is always someone wanting to come in and be in charge, luckily the director is very strong willed and pretty much tells them where to go. He is very humble and doesn't like TV or radio so he won't do any interviews. He tells the people that want to be in charge that they can go talk to the media for him, and this makes them happy, since they get what they really wanted, instead of having to actually work.
He has asked if I will work all night tonight. I have agreed. I got to take a few minutes to find this internet connection to send this out to
you, but soon it will be back to patients. Hopefully some sleep in the morning.
Will write again next time I have a chance.