On the Front Lines of Hurricane Katrina

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

Comments

[Bob Graetz]

This material by Glenn Geelhoed on the front lines of hurricane Katrina, as he tells about encountering the death stench at the Lincoln School has a strange impact. I immediately visualize the picture of someone valiantly sweeping back the tide with a broom: a window into a scene of heroic responses to a chaotic, dimly sensed process that is emerging into our awareness. This picture is reinforced by the account of the history of repressive medications given to troubled people, masking and exacerbating their impoverished state: longstanding before the hurricane disaster and only now being forced on our consciousness.

[Glenn W. Geelhoed]

Bob is "spot on" in his analysis. My summary statement was that these are devastated people leading tragic lives--and that was before the storm.

Rmember I had just returned the week before New Orleans from Eritrea which one could predict might be suffering, following four wars in fourteen years with its bigger neighbor Ethiopia from which it had broken away--and they are a bit ahead of some of the patients I had seen along the Gulf Coast--American refugees. The exception among the latter is that they have the additional acquired morbid plague of obesity, hypertension, diabetes, alcoholism, asthma--and one other big factor I alluded to in the patients' stories---predation.

The "Louisiana cocktail" they came seeking does not spring up over the counter at patient demand, but is PRESCRIBED. Each of these short-term prescriptions is costly ("two thirds of my ADC check, which I can only give in cash to the office nurse who hands me the pre-filled prescription" said one woman to me.)

There are predators out there in that hidden jungle lurking to pounce on the vulnerable--and not just the pretty young Brianna, who is on Depo-Provera after six years on birth control pills--now age 16. Even the poorest are a "market" that can be mined. One of my contributions, if any, beyond talking with the patients in trying to protect them (I shall forward a series of pictures of my visits with Brianna and her mother, as she now says she would like to get into a school and try to become a nurse)is through another form of prevention. I asked that the former prescription pill bottles be brought to me, and collected the recurrent names of the ghost prescribers for me to report to the local, state, DEA, BNDD, and National Clearinghouse so that unscrupulous prescribers cannot jump across arbitrary lines to find another pool of poverty--another easy market to "mine."

In a prior Panetics article, I had written of the "Restoration of Pain." Perhaps that is my job. Especially here--in America.

Here, in a counter-intuitive move "reduction of inflicted suffering" would require a lot fewer, rather than an ever-increasing number of addictive drugs and behaviors.

I am toiling away in mulitple "Panetics Laboratories" in the "Third Worlds"---whether in, or across any geographic or political boundaries. The great differences among people in this "new millennium" seems not to be in the nationality they claim, religion they follow, language they speak, or certainly nothing as trivial as the color of their skin, but the brutally simple divide between the haves and have-nots. This is the "Panetics of Poverty."

GWG

[Robert Daoust]

Excerpts of Glenn's article "The Restoration of Pain" in Panetics, October 2000, vol. 9, no. 4, pp. 4-8 :
(...)
"Around dense population there is usually a rim of marginalized people living with discomfort, decay, injury, disability and death. There is also the vitality of youth, birth, art and ingenuity with the tragedy that much of it is wasted and a good deal of potential is lost for lack of some simple enabling element." (...)
"Recognition of such potential for enhancement requires one to become sensitized to pain and come to terms with it. This, itself, is a painful experience that most of us would not choose (...)."
(...)
It is a big and a wonderful world. (...) We are participants in this process of life and not observers only. The bigger part of the real world lives in circumstances far less luxurious than those that have coddled us. To be unaware of that is not only cruel, fatuous and spoiled behavior, it is willful ignorance of the 'head-in-the-sand' variety. It is not that we might become them given a few less privilege. We ARE they, given enormous excess privileges (...)."
There is one more big benefit of being a participant, and not just an observer; one can find out, first hand, that it hurts! This kind of participation breaks detachment immediately. Now, not only does one know, but one genuinely appreciates what life like this can be like, and that sensitization is a very important first step. But the next that should follow is 'what are you going to do about it?' (...)"
(...)
Participation in pain sounds like an invitation most people would rather give a miss. They would be missing more than just the pain. Sensitization to the human condition requires restoration of the ability to experience that pain and help mitigate it in others." (...)

[Bob Graetz]

The further comments by Glenn on the "Louisiana cocktail" invite our attention to what is wrong in the practice of medicine and the economic system in contemporary America. The "predators out there in the hidden jungle lurking to pounce on the vulnerable" is a problem that goes beyond the destructive effects of a culture of poverty. It is also a symptom of the broader problem of how our lives have become entangled in an economy and style of goverment driven by political forces that seriously degrade our environment and imperil the sustainability of life itself.

A transformational shift in consciousness that enables us to see deeply into the nature of ourselves and humanity has become imperative in order to develop a sustainable future. A promising sign of transformation is seen in the growing number of health profesionals who have shifted their focus from emphasis on treating symptoms to that of promoting healthy living through holistic and integral modes of practice. This enables the symbiotic healing of persons and society, reminiscent of the vision of Ralph Siu when he spoke of a coming age of humane renaissance.

[Robert Daoust]

I often noticed that three kinds of people are the targets of action about suffering : an action may be directly for people who suffer (a natural role for Dr. Geelhoed or Dr. Graetz), or for people who help those who suffer (like when we send money to support the Red Cross), or against people who inflict suffering (apparently that would be panetics natural niche).

I proposed somewhere else here that the ISP approach "governments, institutions, professions, and social groups" and offer for a few dollars an assessment of their pratices concerning the (non)infliction of suffering. Perhaps we could begin by doing this for free, on our own, and send the results to newspapers when useful...