A pathologist on the frontlines
  in New Orleans

November 2005

Feature Story

Anne Ford

“I am now a temporary resident of the Ritz-Carlton Hotel in New Orleans,” the exhausted pathologist typed on Aug. 30, the day after Hurricane Katrina struck the Central Gulf Coast. “The city now has no clean water, no sewerage system, no electricity, and no real communications.... We hear gunshots frequently.... We are anticipating dealing with multiple medical problems, medications and acute injuries.” He concluded with what would prove to be the understatement of the week: “It has been challenging to me to learn how to be a primary care physician.”

Just as Gregory S. Henderson, MD, PhD, section head of ana tom ic pathology in the Department of Pathology and Laboratory Medicine at Ochsner Clinic Foundation, New Orleans, finished the e-mail to his family and friends and hit “send,” the hotel power went out. He wouldn’t know for days whether anyone had received his message and its plea for medical supplies. And he had no way of knowing that it would eventually end up on the BBC News Web site, or that it would lead to interviews with Time magazine and CNN.

Instead, all Dr. Henderson knew was that within days of sending the e-mail, he found himself serving as the only physician for the thousands of people huddled in the city’s convention center. Though he had some drugs (appropriated from abandoned pharmacies under police escort), “it was 15 years since I had any pharmacologic training,” he says. “I was praying to God that some knowledge of primary care medicine would infect me. But I was surprised how much I remembered.” As he told one of the police officers he befriended during the crisis: “I’m a pathologist, but I’ll do the best I can.”

Dr. Henderson had attended a strategic planning retreat for Ochsner medical staff at the Ritz-Carlton the weekend before the storm hit. When the retreat was cut short by news of the impending hurricane, he sent his wife and two daughters to stay with his parents in Jackson, Miss., but stayed behind himself “on the outside possibility that if they needed help at Ochsner, I’d be available to do it.” After boarding up his house in uptown New Orleans, he went back to the Ritz-Carlton to ride out the storm.

Once Katrina had passed, the destruction it left behind didn’t seem alarming at first. “There was minor damage here and there, but nothing real astounding,” Dr. Henderson says. “But Tuesday morning when we woke up and looked out the window, it was pretty obvious that we had a different deal altogether.” That was after the levees had broken, and the hotel was surrounded by water.

Shortly thereafter, infectious disease specialists who had been staying in the Ritz-Carlton for a conference organized a clinic in the hotel bar. Dr. Henderson offered his services and soon found himself across the street in a flooded Walgreens with another physician and a pharmacist, stuffing prescription medication into plastic bags while police officers held off looters at gunpoint. “As we were leaving, the crowd just poured in,” he says. Back at the hotel, after swallowing precautionary Cipro, he wrote the e-mail asking for help and then aided the other physicians in the improvised clinic.

On Aug. 31, the residents of the Ritz-Carlton—including the other doctors—were evacuated. Dr. Henderson stayed behind with a group of police officers, who set up a makeshift precinct in the Sheraton Hotel across the street. For the rest of the day and into the night, he did his best to treat the officers’ diabetes, hypertension, rashes and diarrhea from the filthy water in the streets, and minor wounds.

“I found addressing the pharmacologic needs of the police officers, essentially all of whom had none of their prescription medications, quite a task,” he says. He had only the medications that he had gathered from the Walgreens to work with, and many of the officers and the police support staff had only a vague recollection of all the medications they were taking.

“I had to do a brief history and physicals, try to decide what medicines they were likely taking, which ones were important to continue, compare that with what I had collected, and if I didn't have what they were on, make some decision as to a reasonable replacement—as you can imagine, a huge mental challenge for someone who hasn’t managed meds in 12 years,” Dr. Henderson says.

At about 4AM on Sept.1, he managed to get a few minutes of sleep before being awakened by a giant explosion. Afraid it was a toxic gas explosion, he called his wife: “I told her I loved her, and I was trying my best to stay alive.” And what did he do after finding out 30 minutes later it had been a train car filled with gasoline that had exploded, and not a toxic gas incident? “I took a deep breath. I knew I was going to live through the day, or at least I hoped I was.”

Dr. Henderson knew he wasn’t equipped to handle serious trauma, such as a gunshot wound, so he asked the police officers to drive him to Ochsner, where staff gave him trauma packs, scrubs, a stethoscope, and other supplies. “Most fortunately, I was not presented with a case of gunshot wound, deep penetrating wounds, or major trauma,” he says. On his way back to the Sheraton, he passed the convention center. “I had never seen anything like it in my life,” he says. “I never thought I would see it happen in the United States. It was infants, grown-ups, handicapped people, this incredible mass of people that had been thrown up on the banks of the convention center. As I was driving through with the police officers, they saw I had scrubs on and started banging on the window.”

For the next 48 hours, Dr. Henderson and a police officer named Mark Mornay did their best to tend the desperate crowd. “It was every primary care problem you could ever want,” Dr. Henderson says, from kidney transplant patients who’d run out of their anti-rejection medication to recovering heroin addicts looking for methadone. One elderly woman told him she thought something was wrong with her legs. “I lifted up her housecoat and saw a bunch of deep leg ulcerations and several gangrenous toes. I said, ‘Ma’am, there’s nothing I can do for you right now.’ She said, ‘That’s okay, baby, it doesn’t hurt too bad.’”

The first glimmer of hope arrived on the evening of Sept. 1, when Dr. Henderson started getting calls on his cell phone from colleagues who had received his note by e-mail. Colleagues of his from Wilmington, NC, told him they were having medical supplies flown to Baton Rouge; the humanitarian aid organization Northwest Medical Teams called and said, “We got your e-mail, and we’re halfway to you. Just hang on.”

“It was the first indication I had that somebody knew what was going on and were sending help our way,” Dr. Henderson says.

The next day brought hope, too, when a MASH unit landed at the convention center: “I went out and hugged them.” On Sept.3, two school buses from Wilmington—along with an 18-wheeler truck from Texas—arrived, filled with medical supplies. “It was just like the cavalry coming in,” Dr. Henderson says. He had the supplies taken to the MASH unit at the convention center, where people were waiting to be evacuated in helicopters and buses.

The next day, Northwest Medical Teams personnel arrived and began treating patients. Dr. Henderson stayed with them for two days, until “it was clear that there were enough teams there to take care of the people,” he says. A reporter from the New Yorker gave him his rental car so he could drive to Jackson to be reunited with his family. He’s now working at Ochsner—the only New Orleans hospital that remained operational during the storm—and living in his house, which survived the hurricane, while his wife and children stay in Jackson until the New Orleans schools reopen.

Remaining unruffled was one of Dr. Henderson’s biggest challenges. “Remaining calm and focused and maintaining at least the appearance of being in charge” was difficult, he says, when “I was very uncertain at times as to our fate, and the fate of the city, and as I became increasingly sleep-deprived over the course of a week of very high stress.”

What are the lessons of Katrina for hospitals and laboratories?

“What you learn is what it is really like to go from First World to Third World in the matter of a day,” Dr. Henderson says. “You can plan and plan and plan, but plans don’t often take into consideration the fact that all these things you rely on just don’t exist anymore. Okay, so you’ve got backup generators for your hospital, but those generally don’t take care of the air conditioning. One of the great challenges Ochsner dealt with was, there was no air conditioning and it was 100 degrees and a lot of lab equipment had to shut down.

“Also, we learned the hard way that as sad as it is to say, you really cannot rely on the federal agencies or the state agencies to come to medical rescue.”

At Ochsner, “for the past six weeks, we’ve been wrestling on a daily basis with the challenges of the complete destruction of a medical infrastructure in an American city. I think what stuns us all is there’s really no template for this.”

Still, he says, there’s a guarded optimism among the city’s medical community about the chance to redress the health care delivery problems that existed in New Orleans before Katrina. “One thing that keeps me going day to day,” he concludes, “is: What other chance in your life will you ever get to start anew in every way and say, ‘Now, how can we do this right?’”