Sep 22, 2008

Voices of Ike - Back at work

4:29 pm, Monday, Sept. 22, 2008 Beaumont neurosurgeon Mark Kubala, MD
Back at work. Lot of elective case done today. Water is fine. Still about 75,000 without electricity. Lot of stores reopening. Saint Marys in Port Arthur is open and running also. Biggest hit was Bridge City and south Orange where flooding was up to 10 feet in places.

Sep 21, 2008

Voices of Ike - Help: Missing Person

4:32 pm, Sunday, Sept. 21, 2008
Houston trauma surgeon Ken Mattox, MD
I am appealing to our trauma network to attempt to find a missing person. A Mr. FRANK KEMERY was picked up one week ago on Monday in Galveston by an "out of town" ambulance and apparently taken either to the Ball High School or somewhere out of the area. He might have been transferred to the George R. Brown Convention Center in Houston, but I am so far unable to find out any information. His employer and family are looking for him and do not know where to start, thinking he would have surfaced by now. He was not registered at the Ben Taub General Hospital. This is a missing persons search, and not a clinical matter, so it is not a HIPPA violation. HELP if you can.

Sep 20, 2008

Voices of Ike - Full recovery is just around the corner

3:12, pm, Friday, Sept. 19, 2008 Galveston pediatrician, Ben Raimer, MD

Good day mates, We are drying out great and moving into our recovery mode. We have been blessed by NO RAIN and cool weather (low 70s) for the past five days. Otherwise, the heat and humidity would have been unbearable. We have power generators or REAL electricity from the grid to ALL of our campus buildings at this point, so we can really start moving on clean up faster. Water (not for drinking) is on at a low pressure. There are Port-a-Toilets, hand washing stations, military-style showers for staff, a dining hall on the parking garage top by Waverley Smith, and a good attitude. Dr. Callender is an absolute FANTASTIC LEADER. That guy goes from before sunrise to long after sunset. He must have a photographic memory. He knows every single detail of the whole operation, and in addition can call the names of almost everyone on campus. It really makes for a committed team of people to see him in charge. And countless others in the trenches are assuring that the campus returns to stability and moves us into the best possible position for the future. Photo 1 (above): OLD RED got a basement (ground level) full of water, but should be back on line. Dr. Lurlee Thomas is busy at home writing dean's letters, telling students to "STUDY now; it isn't over!" Dr. Lieberman has found placements for all the 3rd and 4th year students, and the 1st and 2nd year students should be back on line in a week. No, this will NOT interfere with your graduate or match dates. The only thing that might be an undesirable outcome would be for students to see this as a holiday and get distracted from their studies. Access your study guides and HIT THE BOOKS. Medicine is life-long learning; get used to it. Residents are successfully being placed and should immediately find out from Dr. Backwell their new assignments. Many clinical services will be conducted through St .Joseph Hospital in Houston, as well as through mainland area hospitals. The hospitals that have returned to operation in the area have enthusiastically welcomed UTMB physicians and patients into their facilities. Three community-based clinics opened yesterday and will also see patients on Saturday; more will open Monday morning. Information systems are becoming more stable and the patient systems (Envision and Signature) should be on line tomorrow, followed quickly by the student information systems. Updates are more timely now on the site, so please long on and check it our. Remember to register with FEMA, look for updates regarding payroll services and the like, and if you need to check in with EAP, do so. Phone and computer alerts will continue for employees and students. Photo 2: A crane setting a generator in place for the west end sewage treatment facility. If you were here (which you should be glad you are not) then you would really be happy about that crane and the forthcoming ability to FLUSH! I think it is VERY important for people to get back into a regular routine as soon as possible even if you are not in your home or on campus. Continue to study your normal time each day. Use the time to write a paper or prepare a lecture. Volunteer where you are to help others. Please do not just sit around and feel sorry for yourself. That is unproductive. We can never change the past; that is behind us. We can focus on our future and be sure that we put as much attention as we can into doing something about the things that we do control. Write, read, exercise, visit with friends, play some games with your kids. TURN OFF the TV coverage of the storm. Memorize the Red Cross Survival Guide for returning home (it's on their Web site - really). What will it be like when I return? Prepare yourself for some changes. Much of the debris that blocked I-45 has been removed, or at least shoved to the side. But you MAY still see some boats sitting on the side of the road. Along with jet skis, roofs, cars, houses, and just about anything that you can imagine. Buildings have a lot of structural damage along Broadway, the East End, and the like. There was a lot of water (and mud) damage on Harborview, and in areas west of 53rd Street. Rather than broken windows, you will likely see MUD on the floor and water lines. Cars are immobilized around the neighborhoods. Lots of downed trees all over town. Lots of burned out houses around Harve Lafitte! Looks like a battle ground. URBAN MYTHS

  • Were there really a lion and tiger loose on the west end? Yes there was! Police had to shoot one; I hear the other one is pretty hungry!
  • Were there cows on the heli-pad? Yes there were! Three! Dead from the storm.
  • Was there great loss of life on the island due to the storm? No, thank the Lord! There were a couple of tragedies and the dead of a couple of folks in hospice care.
  • How about Boliver? Don't know! Still awaiting some information.
  • Is there widespread looting and shootin'? Definitely NOT. Good coverage by the militia and local police. This is Texas! Guns galore. City officials are working night and day still!
Is it safe to return? I would not suggest that you come on the island with the idea of staying here very long -- if at all. Sanitation is not good; mosquitos have returned. Electricity is not dependable. If you have small children or fraile older parents, it would be a really bad idea to subject them to the climate and conditions. If I come down, what should I expect? Watch where you drive (nails). STOP at intersections and look all around. Bring some bleach to kill the mold if you got water. Bring your own drinking water, a flash light or lamp to look around inside. Bring mosquito repellant. If you want to tear out carpet, bring gloves (thick ones) and boots. Have you had a tetanus shot lately? If not, get one. Bring your own food. Bring trash bags. Bring any meds you are taking. Have a good day and a good weekend. Full recovery is just around the corner. Remember, UTMB stops for no storm. Ben

Sep 19, 2008

Voices of Ike - Almost endless need

Friday, September 19, 2008 11:24 AM San Antonio pediatrician Rebecca L. Huston, MD, MPH

I have had a very small role in the hurricane volunteer effort so far. I volunteered on Wednesday night at the Kelly shelter. It’s a pretty overwhelming atmosphere. They are set up in a huge warehouse, with the medical station at one end. There were many wonderful nurses and doctors volunteering under trying circumstances. I wish I had brought many things with me. Two of the most useful were hand sanitizer and books from my clinic’s Reach Out and Read program.

Most of the problems I saw were pretty routine: colds, earaches, tummy aches, and headaches. I did what I could, but at least I sent out each child holding a brand new book. The situation felt very similar to Katrina.

For many of the families in the shelter, I sensed almost endless need. Clearly Ike was only one of their many problems. My main hope was to offer a kind word and a listening ear.

Obama vs. McCain on Health System Reform: Podcast TMA

U.S. Rep. Michael Burgess, MD (R-Lewisville) told physicians attending Texas Medical Association’s 2008 Fall Conference that this year’s presidential election will be a referendum on health system reform. But where do the two presidential candidates stand on the issue of expanding health coverage to the uninsured? The cover story in the October issue of Texas Medicine takes a look at the health system reform proposals of both Democratic nominee Barack Obama and Republican nominee John McCain, who take far different approaches to helping the uninsured. In this installment of Podcast TMA, American Medical Association President-elect Jim Rohack, MD, and Roland Goertz, MD, a member of the American Academy of Family Physicians Board of Trustees, discuss how the candidate’s reform plans contrast and the prospects for major reform in the next congressional sessions. Download the show now. This installment covers:
  • The differences between the Obama and McCain health care proposals.
  • How the two plans stack up against reform proposals of the AMA, AAFP, and other national specialty societies.
  • Whether Congress is likely to enact major health system reform next year regardless of who wins the presidential race.

If you missed the great debate at Fall Conference, you can still read our detailed analysis of the John McCain and Barack Obama health care platforms and how they compare to TMA policy. While you’re at it, take the TMA 2008 Presidential Poll.

Want to Subscribe to Podcast TMA through iTunes? Here's the link. It takes you to the iTunes store. Subscription is free. Catch up on all the old Podcast TMA episodes on the TMA Web site. What's a Podcast, how do I get it, and what do I with it once I have it? (See the short tutorial on the iTunes Web site.)

Voices of Ike - A wonderful community of physicians

1:05 am, Friday, Sept. 19, 2008 Austin internist Frierson-Stroud, MD

The care of the coastal evacuees is evolving in both subtle and dramatic ways. I had a front row seat again today. I went by the Convention Center first. The Exhibit Hall was no longer subdivided into pods. A sea of cots coated the now essentially wide-open room. Another room was similarly set up. The hospital beds were essentially gone. This is due to the fact that the patients with medical needs had been moved to the U.T. J.J.Jake Pickle Research Center. When I walked in, at the Research Center's Common building, I found the now about 44 patients (down from greater than 90) in what is normally the basketball court. The nurses' stations were on center-court. The pods, A-G still, were placed in a circle around the center. Cardboard boxes held the charts. Again, the nurses, part of the City's Health Department, brought the patients to my attention. Most had already been initially assessed but one gentleman had just arrived. We had to convert his insulin in the same manner as on my previous day. Most of the problems were pretty routine. Meds were refilled (some have been there the week and others are running out of their meds).

Patients were also referred to vscular and orthopedic surgeons, neurologists and internists. Having seen before/after pictures of Galveston, patients from the island were referred to the clinics for longer-term care. I was later joined by a pediatrician who felt a bit like a fish out of water. However, she did a wonderful job providing primary care. She bonded with the DON, usually involved with pediatric immunizations, over vaccines. The saddest patient to minister to was a young woman who had a C-section about 3 weeks ago. Her incision had dehisced. She was getting home health to care for it, but she needed a VAC. She had a stony demeanor that was daunting. She didn't have a family according to her. This made me wonder where the baby was. I was, frankly, afraid to ask her if it had survived. Fortunately, the pediatrician was able to tactfully ask her. With relief I found the baby was with a friend. I looked for Mrs. K but she wasn't there. I hope she's gone home or to a nursing home. The 400+ pound woman was also not to be found. I recognized a few of the patients, including my old psychiatric patient. He's still a handful. The gentleman with the staph infection was still there although he spent a lot of time in the TV area. The cots for the most part were higher off the ground thanks to pads including air pads. The narrow cots were occasionally taped together to make the bed a more comfortable width. Hospital beds were mainly along the edges. One of the patients required a transfer to the hospital to rule out a DVT. Another was taken to a nursing home. The attrition will continue as the days go on. They are requesting volunteers thru September 25th. I'm hoping to drag a medical student with me the next time I come. I recognized the handwriting of one of my colleagues. He'd been there a few days before. I always thought he was a nice guy. Now I know. As my shift drew to a close, I was happy to be relieved by a former hospitalist. I knew the patients would be in capable hands. I took him on rounds as I showed him the ropes especially pointing out the problem patients. This crisis continues to bring out the best in the medical community. A radiologist who is a med school classmate (the second one I've seen since this started) was dropping off donations at the Convention Center. The pediatrician who left her comfort zone and family to come help those in need. The unknown number of physicians who have selflessly volunteered to care for their fellow man. Many, including the two I worked with today, are novices to this type of medical care. People like this reinforce what a wonderful community of physicians we have here in Central Texas.

Sep 18, 2008

Voices of Ike - On the road to being normal

12:12 pm, Thursday, Sept. 18, 2008 Houston cardiologist A. Tomas Garcia, MD

Well things are starting to look normal. Traffic lights are working, no lines at gas stations, ice boxes are full, and Whataburger has an Ike menu: burger, chips and drink. Keep it simple.

The hospital is full; but back to normal. The ER is busy but handling it well. The ICU has beds available, and the floors are sending patients home.

Power is coming back through out the city, water is okay, so what about less than a week to recover from a major cat 2 storm?

Boliver is sand and sea. Perhaps, the state should condemn the place and make a state park? How about galveston? thankfully we don't have to carry the mail on that one.

Guillermo and Carlos are helping out at the house with the limbs and trash. The house is okay. We're on the road to being normal. What is normal with a hurricane? Oh well, see you at the next TMA meeting.


Voices of Ike - East Texas hospitality

11:20 am, Thursday, Sept. 18, 2008 Crockett surgeon J. Patrick Walker, MD

Out of power and water for a few days. Now back up.

Stayed at the hospital and an evacuation clinic most of the time. Still have a few patients from the coast.

There are a number of second homes in and around Crockett that are open, if you know of any physicians from the Galveston area that need a place for a month or two.

Hope all is well with you.

Pat Walker

Sep 17, 2008

Voices of Ike - It can only get better, right?

9:43 pm, Wednesday, Sept. 17, 2008 Sugar Land internist Elizabeth Torres, MD

Hi, thank you for your concern.

We only lost electricity for 36 hours and had damage to fence and trees, which are trivial compared to what others have experienced. Also have my Dad staying with us until his lights are back.

Now trying to care for our patients under trying circumstances of limited communications and large surrounding areas of no electricity that persist. It can only get better, right?

Thanks again.

E. Torres,MD

Voices of Ike - We will reopen tomorrow

5:28 pm, Wednesday, Sept. 27, 2008 Texas City pulmononlogist Joseph Prince, MD

I am a physician at Mainland Medical Center in Texas City. I believe we were the only short term acute care hospital along the Gulf Freeway not to close our doors in advance of Hurricane Ike. I stayed on duty in house the night of the hurricane, but once the storm came we were forced to close our doors--but did take patients up until about 8:00 p.m. Power went out during the overnight hours but the backup generators were fully functional and overall the staff morale was excellent. Unfortunately, due to power loss in Texas City we lost running water and sewage in the early morning hours, resulting in the need to evacuate our facility. Fortunately I know of no patient deaths in our facility resulting from the storm. Although the OR was flooded, the hospital will reopen tomorrow and will have limited ER triage, minor surgical, and medical ICU capabilities. I am informed patients with igher level of illness will require transfer to another facility. It is our hope we will be able to decompress some of the medical needs of Galveston and the coastal areas during the closure of UTMB.

Voices of Ike - Hospitals filling up quickly

1:36 pm, Wednesday, Sept. 17, 2008 Houston cardiologist A. Tomas Garcia

Here is a picture taken during Ike with Carlos, graduate of the Royal College of Art/London, my youngest son who volunteered throughout Ike; Guillermo just arrived minutes from the airport from Afghanistan and helped out; Todd Great, ceo and leader of our hospital; me, and Dr. Carl Vartian physician liasion for the hospital.

All our suburban hospitals are filling up rather quickly. The medical center is having problems with power, water and/or telephone systems; so all the patients appear to be coming to local hospitals. As they fill, FEMA with their ambulances are taking the sick to San Antonio. It appears that there is a paradigm change, where in the past, patients would automatically go to the TMC; now it appears they are going to the local hospitals which really makes sense. For example, I have a patient just involved in a MVA and has a pulmonary contusion. She's quickly admitted and under my care with a pulmonary specialist to help out. all done in less than an hour. This can only help our patients.


Voices of Ike - Pizza by candlelight

11:48 am, Wednesday, Sept. 17, 2008 Houston cardiologist A. Tomas Garcia, MD

The problem is power. Many of the trees hit power lines, transformers, and poles at many key points. So they say. So the ramp-up has been great in some areas and slow in others depending on what the storm did. The hospital is now functioning normally. They figured out what the problem was with the generator and why it failed. Subsidence, it had actually drifted 2 inches since its installation, which was enough for the rainwater to shut it down. So when the hospital lost power on Saturday morning, the main back-up failed; we then went to emergency power which is minimal and will not run the AC, only the fan.

Currently the emergency room is seeing the car accidents, cuts, bruises, broken bones, and chain-saw accidents as predicited. This will probably continued for a while. Our doctors are opening our offices, but the patients aren't coming in. They're working at home cleaning up the mess and getting their accidents as predicted. Some businesses are starting to open and the lines at many of the gas stations are smaller now. It seems that the generators that everyone is using are taking a lot more of the gas. Everyone is trying to save their freezer and refrigerator food; as well as run AC units in one room and their television and/or fan. Reports are that this should improve as well.

The key is patience at this time. I lost everything in the freezer and refrig; my sons pitched it all. They found a pizza place open for business and so we enjoyed it with candlelight. The temp dropped with the windows open. I had my first night of rest at home after my first shower since Friday. Needless to say, a 12-hour sleep was just what the doctor needed.

Nuff for now.


Voices of Ike -- This is no place for people

[Editor's note: Thankfully, we are beginning to hear from physicians in Galveston, helping to put that great medical city back together. Here is a long post from UTMB Senior Vice President Ben Raimer, MD.] 10 am, Wednesday, Sept. 17, 2008 Galveston pediatrician Ben Raimer, MD

I have been on the island since Monday. Sharon, David and I weathered the brunt of the storm in Austin. The 400 UTMB employees who remained at the university transferred all remaining patients (including the prison) prior to the storm, shut down the Galveston National Lab (by the book), transitioned students, residents, and other personnel to safety, and then weathered a full day of battering wind, rain and water. The first floors of several buildings did flood, along with several parking garages. Overall, UTMB is located on one of the higher points of the island. Some of you will remember that University Blvd. actually sits on top of one of the early seawall extensions. There is, nevertheless, a significant amount of damage to equipment due to water and also due to the currently lack of power and dehumidification equipment. MRI's and other technology do not do well in the corrosive environment. Structures are intact and with a bit of cleaning (which is ongoing), will rapidly return to use. The entire island seems to have been submerged, except for a small area that was spared north of Avenue P. The Strand had over 8 feet of water in the street, and Shearn Moody Plaza which houses many of our UTMB services on 25th and Strand had about 6 to 7 feet in its first floor. 23rd Street had water all the way up to P, with the First Baptist Church across from Rosenberg Library as well as Trinity Episcopal Church both receiving water (FBC had a foot in its sanctuary). Sharon and I have an old building on 23rd and Strand that has apartments upstairs; many of our medical student friends as well as our son David (a UTMB resident) live there. There was 5 feet of water in the first floor, and one of student (Adam) had his car totally submerged in the garage to the building. There is mud, silt, debris (and a few dead fish) in the streets and buildings along 23rd. The East End Historical District lost a lot of its vintage trees to the water and wind. Major structural damage to the historical homes is evident as one drives by. I am told that our favorite restaurant, Rudy and Paco's, at 21st and Postoffice took on 6 feet of water at the peak of the storm. I am sure Paco will shop vac the place and be serving that great meatloaf sandwich in a few weeks. UTMB staff under the direction of Dr. David Callender are the real HEROS. Dr. Callender's calm leadership style and his ability to deal with a myriad of issues in an organized and orderly fashion certainly make him the perfect individual to guide the institution in this challenging period. His concern for people, their welfare, and their future mold his decisions. He seems to always be able to evaluate the situation, no matter how complex or difficult, solicit input from his talented staff, and make just the right decision for the moment --- ever mindful of the future that we plan to create. Today he has focused on the systemic issues of getting the campus back in operation as well as relief for a very tired staff. And, hats off to City Manager Steve LeBlanc and that wonderful "school-marm" Mayor Lyda Ann Thomas. Those two leaders have worked tirelessly day and night to assure the safety of the city, the assistance of those in need, and the recovery efforts. The mayor's calm and planful manner certainly gives the city's citizens hope for the future. Recovery would be easier if people heeded the mayor's words and realized that this is no place for people to be living at the moment. I cannot muster up much sympathy for those complaining of the lack of water, food or other amenities at the moment. All were ordered to leave, and transportation was provided. Not to chose that option and gripe later about one's own choice --- well, you know how I must feel about that. They need to get to safer circumstances as soon as possible; I hope that will occur within the next 24 hours. The public health issues without potable water are enormous. We must remember the health issues that make it an unsafe place to be. The city is trying to focus on restoring utility services, so the distraction of having to be a bed-and-breakfast for so many people is not good. And, if one adds in the distraction of having to direct police and fire personnel to chasing individuals with criminal intent around the island --- then that too is not good. Recovery resources are providing food, water, ice, and other services at designated locations (mainly Ball High School). First responders have been great. The outpooring of resources and people to step in and start the recovery is one of the best things about America. Volunteers! Tractors are moving trees, sea debris, and clearing roads. Day by day there are visible changes for the good. At UTMB: The research enterprise is stable. The National Lab was safely shut down without a problem. The structure was built for weather like we had (and more) so it is just fine --- nothing that a bit of soap and water on the first floor cannot correct. Dry ice and emergency generators continue to preserve specimens of value to future research, and the entire research enterprise team have done an extraordinary job in maintaining all systems. A federal team of HASMAT-type vets are also assisting with animal health (so far they are happy campers). It is too early to determine the status of machinery and technology; we can only hope for the best. Damage assessments are being performed by outside consultants. The clinical enterprise is shut down in Galveston, but our patients can call 409-772-2222 for assistance, and tomorrow three Community Based Clinics will be open to see their usual patients. Our Transplant Program is shifting its outpatient services to a mainland site, and will relocate surgical services temporarily to St Joseph's Hospital. Dr. John Bertini, a UTMB Alum and practicing urologist and head of the board of directors of St Joseph, has offered space for UTMB training programs. Other area hospitals, and programs in other states have also expressed their desire to assist in the recovery efforts. General surgery and anesthesiology will likely do some shifting to St Joseph in Houston. Other specialist will be deployed off the island into the community clinics as soon as that team can assure that utilities and support staff are in place. It is likely that hours will be extended to accommodate all of the UTMB doctors (they are eager to get back to their patients ASAP). For our patients, this means that clinical services will be back up and available on the mainland before weeks' end. Thank God for the amazing resilience of our health professional staffs! The educational enterprise has also moved into its disaster recovery mode, and students will be getting notices regarding resumption of their studies, locations for electives, and other instructions. Residents will also be deployed to nearby locations until services are operation that permits continuation of their programs on campus. Residency director Dr. Tom Backwell and Associate Dean Dr. Steve Lieberman have been working around the clock to confirm student and resident placements. Hats off to them and to their staffs for their efforts. Communication systems should improve today; FEMA is reportedly putting up some cell towers in the area. UTMB web is up and being updated regularly. Unless you have really important business in Galveston ... you should stay where you are are in a safe place until you hear otherwise. Exploring for yourself will not accomplish anything other than a long wait in lines, and you will be most likely turned away at this point. For those of you who have a pressing question about something, please email me and/or call me and I will try to help. Also, for students and residents (and faculty), you can call the UTMB general number and receive assistance. The dean's office numbers work, as do those in other areas. Remember 409.772-2222 for patient questions and/or general information. Patient records (EMR) should be back in operation by tomorrow or Friday so that mainland outpatient clinics can operate normally. The ER is open and staffed by federal HASMAT teams. All UTMB clinical personnel have been relieved of duty and asked to focus on recovery activities. The major jobs right now on the island are the restoration of power to the whole island, the restoration of potable water to the island and campus (there is no water at all ... not a drip from a faucet) --- so you can only imagine the sanitation issues that we face. There is no natural gas so one cannot boil water (hot showers and flushing toilets left the island with Ike's arrival). We stink --- what can I say. No amount of deodorant or aftershave will hide that fact. The UTMB campus has been secured so we feel reasonably safe. Yesterday after the "Look and Leave" policy was implemented, a lot of folks were allowed onto the island. 40% stayed in spite of the curfew and the orders. Last night also turned into a scary situation as intruders attempted to get into buildings around the island --- for purposes that only you can imagine. I was greeted today when I arrived on campus at 0630 from my home with police officers with machine guns! That's right --- machine guns! Our major priorities here now are security for our personnel and for the contract personnel who are doing the campus clean up. I am rethinking my plan to stay at home at night; I may camp out in my office from this point forward ... or until the "bad guys" go away. I understand that our city officials have "re-thought" their "L/L" policy and are now focusing on getting intruders out of two. We understand (cannot verify) that there were gunshots and the like around town last night. There is not a lot of stuff left to take; we only have 60,000 residents in this town and it is not like the island is home to incredible wealth. The Moody Mansion is about the only "mansion" in town, and it is filled with Sears furniture from 1890 Catalog (Mr. Moody was thrifty). They can have my 20 year old Sony TV; I may go home and put it into the drive way with a sign on it. I would also appreciate it if they would take the large garbage can filled with rotting meats, cousin Ann's delicious black-eyed peas, and the okra from cousin Lavelle's garden. Oh, and yes, they are welcome to the soon-to-be rotting carpets that Dave and I pulled from the house that filled with 16 inches of water. I would like them to get it out of the yard before the mold gets to the point that I'll need a lawn mower to deal with it. Overall, Galvestonian's are an optimistic group of people. They are the real survivors ... the people who will make their way into the future, step by step, with a successful plan. Islanders are resourceful, they work well collaboratively, and they work for the greater good of the community. Islanders understand that we are here because we choose to be here. The Rabbi and Pastor at First Baptist have already had a conversation about what worship places are usable, and how they can share --- not unlike the conversation between Rabbi Cohen and Dr. Harris some 108 years ago after that un-named storm claimed 8000 lives. We understand the risks, and we also understand our responsibility. And our faith keeps us focused on why we are here. After the 1900 Storm, the dean of the UTMB Medical School suggested to the UT System Chancellor that the school should close. The Chancellor's response, "The University of Texas stops for no storm." After 108 years, the message is the same. We have not stopped, and we do not intend to do so. This recent testing of our meddle has only reaffirmed our vision to create the future of health care for our people. It will be better; it will be relevant; it will be innovative; it will be strong. It will last through any of life's calamities. Ben

Voices of Ike - We're blessed

Tuesday, Sept. 16, 2008

National Public Radio carried an excellent report on "All Things Considered" about how the University of Texas Medical Branch at Galveston was able to evacuate ALL of its patients from John Sealy Hospital before Hurricane Ike struck.

Listen to the story.

Here are some great excerpts:

(Joan Richardson, MD, Chief of Emergency Preparedness, UTMB): "The evacuation went great. We evacuated well over 300 people, and it just so happened that about 51 of them were newborns, neonates from the Neonatal Intensive Care Unit, and these are little bitty babies who were sick and had all kinds of life support systems to keep them going." Dr. Richardson: "You know, when you're transporting a 150 pound adult, you don't need the kind of specialized equipment that we need when we had these little babies. Many of those babies were on respirators. Many of those babies were on oxygen. They're all little bitty and so they need incubators to keep them warm, and so the transport of a neonate is a very specialized operation. And we're blessed that all kinds of people showed up to help us move those babies." (UTMB President David Callendar, MD): "No matter how well you prepare your facilities and your people are at risk, you do need to be prepared to evacuate all your patients. You need to be prepared to make that decision well in advance of the arrival of the storm. If you can't for some reason evacuate patients or you take patients during the storm, you're going to be operating under the most difficult circumstances. Some people might call it battlefield medicine conditions."

Voices of Ike - Looking after each other

1:41 pm, Wednesday, Sept. 17, 2008 Austin internist Lee Frierson-Stroud, MD

I forgot one more observation Patients were looking after their fellow strangers. One lady, while being assessed for a cough, whispered to me that the smiling, elderly Oriental lady, wrapped like a sore toe, in the next cot was by herself. The patient couldn't understand how such a nice lady was being neglected by her family. I referred her to a social worker to decrease the risk of slipping through the tracks.

Voices of Ike - The Blue Olive

12:47 am, Wednesday, Sept. 17, 2008 Austin internist Lee Frierson-Stroud, MD

I'm beginning to feel like a veteran. Ike is my third Hurricane. I triaged at the foot of the bus door steps when bewildered, lost souls from New Orleans arrived at the Convention Center loading dock. I rounded on group home evacuees from Rita. Now I'm getting ready to return for my second tour of duty as part of the Travis County Medical Society's response to Hurricane Ike. Perhaps because I was there the night that Ike slammed ashore this hurricane felt like Katrina. The big screen TV was blaring as "Weather on the 8's" intermingled with reports of Austin's response to the Hurricane. Concerned evacuees sat in front of the screen taking in the information. When I arrived I was greeted by well-organized staff who gave me a necklace with a plastic circle, a.k.a. "the blue olive," which served to identify me as a volunteer. I made my way past a police contingent to where the patients were being housed. The organization was impressive. There was a row of computers ready as patients walked or were wheeled or rolled in from the loading docks. After being checked in, they were triaged by the nurses and assigned a cot. The exhibit hall had been separated into essentially six areas. The first was the walk-way. Then there were five rows called "pods" each divided by curtains. Each "pod" was then subdivided into 7 nurses' stations (A-G). There were about 12-16 beds per station. The numbers were taped to the floor. Patients were being assigned primarily to Pod 1 and 2 with a smattering in Pod 4A. Pod 5 was for caregivers and their families. Each very low cot had been made with even a pillow and blanket in place (one colorfully decorated Little Mermaid blanket topped one cot). At the foot of each cot was a blanket and towel. Row upon row of cots waited silently for inhabitants. I was introduced to Dr. Ann Messer , a wonderful physician who proceeded to give me a tour. The tour was detailed and yet very informative. The problem patients--ones that needed to be checked on to be sure they had gotten up during the day, the psych patient who had just been placed on his meds, the gentleman who had just had an abscess lanced by a local ER MD, the 3-year-old boy with a feeding tube and oxygen who desaturated when he cried were all pointed out. This came in handy later when the psych patient ended up back in the triage line. I was able to connect him with his bed. We were later joined by Dr. Mark Levy. We would assess each patient as they came in. A week's worth of meds, if needed, would be prescribed. I had to call my office manager to get my DPS number--something about a new law. These prescriptions then were filled at the pharmacy located in the concession stand. Orders were written including getting oxygen concentrators and nebulizers for some. These would magically appear. A gentleman in his 40s who was to have a brain tumor removed was set up for possible clinic referral depending on the Galveston situation. Patients who were more appropriately placed in nursing homes were triaged away making room for others who would arrive later. I got my first request for a med refill today in my fax machine at the office. I'm going to have to figure out what to do about these requests . Our tour guide's advise had been to just make the rounds. The volunteer nurses would call us over. The nurses were marvelous taking care of these newcomers. They set up their MAR's and carried out the orders as best they were able. One confused soul, who would later be taken to a nursing home, was patiently taken care of even to the point of one gentleman giving her a foot wash. When she was changed from her soiled undergarments, her dignity was protected as best they could with shields. One gentleman had three shields strategically placed around his bed. This sharp 80-plus-year-old black gentleman had asked for the shields due to his need for a foley. As a result, he had a nice peaceful little room in the middle of the controlled bedlam. He related how he had left his home in Baytown but had to leave his stubborn 50-year-old wife behind. He was worried because she'd not picked up her phone when he'd called. Where needed, patients with psychiatric needs were given one-on-one support. This was embodied by one woman who ended up with a very patient volunteer caregiver for most of the night. One woman, wife of the gentleman with the brain tumor, just needed a hug and a hymn to let her know she was going to be okay. Twice my experience with diabetes came in handy. Due to limitations in what was available in the form of insulin, I needed to convert patients to Lantus plus Novolog. The hardest decision of the night came when I was called over to help decide what to do about a 400-plus pound patient. She had just arrived in a very narrow stretcher with her sister. She had spent some hours in the ER as they managed out-of-control sugars. She was better so she was sent back to the shelter. She had apparently been promised a hospital bed upon her arrival. A few hospital beds began to appear but were in short supply. In fact, they were all in use at this point. The sister was getting madder by the moment. The ambulance attendants whose stretcher was in use were in limbo. AND Mrs. K., a sweet 90-plus-year-old black female had finally been able to get situated in her hospital bed. This sweet little old lady had been sitting in some vehicle on its way to Austin then in a wheelchair at the shelter as they assigned a cot that she couldn't get into. Someone had taken pity on her and assigned her a hospital bed next to which she sat for a while until someone helped her to get into it. But, she didn't absolutely need it. I went to her bedside and explained the situation. This little hero said it was okay for me to give someone else the bed. She just needed a thicker pad for the cot. A cot,with extra padding held Mrs. K. with the help of some EMS gentlemen. And, the other patient was able to be placed. Before we left that night, I made sure Mrs. K. had been placed in a hospital bed. After all, she had taken one for the team. By the time my shift was over, I was a old-hand at this. People were still trickling in at midnight. The next shift of EMS had shown up (hopefully to be stationed where they could help the elderly up from the cots for the patients' potty breaks). The nurses were looking for their replacements. The young Director of Nursing was working on placing yet another patient. CPAP's were plugged in. The children, who had been remarkably well-behaved, were through playing videos on the computers in the food service area and heading for bed. And my replacement, Terri Albright, MD, had arrived. We looked at each other and realized we were med. school classmates. We'd not seen each other at least since our 10 year class reunion if not since graduation. We caught up as I became the tour guide, pointing out the patients who needed special attention. As I left I reflected on what a wonderful expression of love and concern for others this massive undertaking has been. And yet, it is so matter-of-factly presented. I am proud to have been a tiny part of it. Now I'm looking forward to going back on Thursday. Maybe I'll be able to say "Hi" to Mrs. K. in her comfy hospital bed.

Sep 16, 2008

Voices of Ike - Ready to go back to work

1:58 pm, Tuesday, Sept. 16, 2008 Galveston endocrinologist Kevin McKinney, MD

My house is okay, and I had no flooding. My power came on today.

I'm ready to go back to work when able.


Voices of Ike - Injuries coming in

1:14 pm, Tuesday, Sept. 16 Houston cardiologist A. Tomas Garcia, MD

We continue to have power issues and lack of gas problems. Corporate HCA has secured a tanker that will park in our hospital parking lot with armed guards to help physicians and support staff with 10 gallons of gas per car if it's less than half full and this will be checked; and we will be charged @ $5.25/gallon. oh well; it beats being in line for hours and still not get gas. they will bill us later as they don't have the logistics to collect the money, cash or otherwise.

The hospital is still in disaster mode, and there are armed guards to secure the place so we can work without having to be armed or worry that someone will enter and try something. The ER is now really busy with the injuries coming in, including the chain-saw alley type.

The city still isn't confident of the water supply even though it's now coming in and with good pressure. The rule of thumb is bottled water until otherwise instructed. I still don't have power at the house, so my office is my residence for now. Anyway, I need to be close to my patients in case they need me or in case the emergency room needs me for a code stemi/acute myocardial infarction.

Overall the hospital is responding great and the morale is high. I'm keeping my office open as long as patients continue to call and want to been seen. Better they be seen here in my office where I have their charts and can care for them quickly and efficently. Again, to try to keep our emergency room open for the injuries and car accidents. (The traffic lights are still not working.)

Patient just came in; gotta go.


Voices of Ike - Stay away from Beaumont

1:02 pm, Tuesday, Sept. 16, 2008 Beaumont neurologist Mark Kubala, MD

Reporting from Austin today. I have my cell phone with me.

Mayor is urging everyone to stay away from Beaumont. Sewage at 95-percent capacity. They’re concerned about back-up and resultant health problems. Water not drinkable for several days. Hospitals and downtown have power.

I think the power will come back much quicker. Main problem is flooding. Power lines aren’t down like they were from Rita. Don’t think we’ll being doing anything elective until next week, at best. Hospitals are open for emergencies and the sick.

Voices of Ike - "Ikeitis"

12:30 AM, Tuesday, Sept. 16, 2008 Houston cardiologist A. Tomas Garcia, MD

The hospital is now feeling the brunt of all the injuries and health issues of people doing the clean-up; cuts, broken bones, back sprain and other sprains, stuff falling on them, and them falling all over the place. Ibuprofen will be a staple in their diets during this time, along with the aspirin and tylenol. Instead of "boomeritis," we ought to call it "ikeitis." Every joint is going to be injured or sprained.

Everyone is feeling the relief of having survived the storm and perhaps a little bit of the survivor guilt when comparing what happened to Bolivar, Crystal Beach, High Island and Chambers County. The images we are now seeing are almost too much. Alma and I had an opportunity to drive through there recently and it was just beautiful with houses, trees, vegetation, plants of all sizes, colors and shapes, sand, beach and people walking, biking, having cook-outs and enjoying the beach. The picture in the Chronicle captures the devastation; one house and the rest is just sand all the way out till all you see is the sea. Unbelievable, really.

The patients in the hospital are feeling very fortunate to have been in the hospital during this time; hey, dry, warm food, doctors tending to them and staff honoring all their requests wile they watch the images and reporters observation of the storm's damage.

It took Guillermo almost 10 days to finally get here from Afghanistan; he's going to take every thing out of the freezer that's defrosted and barbeque it up and bring it to the staff here at the hospital. It'll be alot of work; but better that then throwing it away. They're in for some good food; I know I killed or caught it. Oh well.

Hey, I'm beat and to bed. Big day tomorrow; I'll bet the office will be topping.


Sep 15, 2008

Voices of Ike - "I'm really proud of the team"

5:39 pm, Monday, Sept. 15, 2008 Houston cardiologist A. Tomas Garcia, MD

So far so good. The ER has been hit pretty hard since so many physicians did not open their offices. It's all been the "I ran out of medicines," dialysis, insulin ran out, and COPD issues. Those are being triaged out ASAP to care for the very injured and very sick.

After hospital rounds by our doctors we opened more beds to be ready for the injuried and sick patients that we expect in the coming week. We were told that the next 5 to 7 days, maybe more, there will be about 2 million people returning to this area, which means the pressure on the ER will go up significantly.

I'm really proud of the the team of doctors, nurses, anxilary staff, and administration that worked as a team to achieve this degree of success to date. We have more challenges in the coming days, but the city is recovering, water and power are coming on, and this is really helping speed the recovery.

I had a consult at the Bellaire hospital and drove over there. Bellaire looks like a war zone; trees, limbs, fences, debris of all descriptions all over the place. You see people helping their neighbors cleaning up and clearing the area; especially streets. The lines at all gas stations are very long.

My son guillermo got in safely from Afghanistan.

Gotta go, paged to the ER.


TMLT Reduces Rates Again

The Texas Medical Liability Trust (TMLT) Board of Governors has approved an average 4.7-percent cut in liability insurance rates for its policyholders and a 22.5-percent dividend for physicians renewing their policies, effective Jan. 1.

TMLT Reduces Rates Again

9/11/2008 7:00 PM

CMS Clarifies Medicaid Prescription Rule

The Centers for Medicare and Medicaid Services (CMS) previously said prescriptions printed from electronic medical records (EMRs) or e-Prescribing applications would need special copy-resistant paper to comply with the tamper-resistant prescription pad …

CMS Clarifies Medicaid Prescription Rule

9/11/2008 7:00 PM

TMA Sues Family Therapists Board

Marriage and family therapists are not physicians and thus cannot practice medicine in Texas, the Texas Medical Association says in a lawsuit against the Texas State Board of Examiners of Marriage and Family Therapists.

TMA Sues Family Therapists Board

9/11/2008 7:00 PM

Medicaid Seeks Opinion on Manual

The Texas Health and Human Services Commission (HHS) is revamping the 2010 Texas Medicaid Provider Procedures Manual and wants physicians' opinions.

Medicaid Seeks Opinion on Manual

9/11/2008 7:00 PM

Medicare Providers OK with New MACs

The Centers for Medicare & Medicaid Services (CMS) says the annual satisfaction survey of physicians and other health care professionals in the Medicare system shows they are satisfied with services provided by Medicare fee-for-service contractors.

Medicare Providers OK with New MACs

9/11/2008 7:00 PM

United Schedules Training on Rating Program

UnitedHealthcare will conduct three online/teleconference training programs this month to educate physicians and practice administrators about its Premium physician designation program that will expand into the Beaumont, Corpus Christi, El Paso East …

United Schedules Training on Rating Program

9/11/2008 7:00 PM

Did the Mental Health Services Redesign Work?

The Texas Legislature last year appropriated $82 million for public mental health authorities to restructure local crisis service delivery systems. Texas A&M University researchers want to hear from TMA members – particularly emergency room physicians and …

Did the Mental Health Services Redesign Work?

9/11/2008 7:00 PM

TDI Amends Ambulatory Surgical Center Fees

The Texas Department of Insurance (TDI) Workers Compensation Division has published

TDI Amends Ambulatory Surgical Center Fees

9/11/2008 7:00 PM

Wanted: Your Online Classified Ad

TMA’s Web site experiences nearly 320,000 visitor sessions each month. With this kind of activity, can you afford not to advertise in TMA’s classified section?

Wanted: Your Online Classified Ad

9/11/2008 7:00 PM

Blue Cross Compliance Process Announced

Physicians can file a Compliance Dispute Form if they believe Blue Cross and Blue Shield is not complying with the terms of its settlement of organized medicine's lawsuit against it and other for-profit HMOs. Any physician who did not opt out of the …

Blue Cross Compliance Process Announced

9/11/2008 7:00 PM

Stop Embezzlement Before It Starts

Embezzlers can be the nicest people. When you work closely with a person every day, it’s hard to imagine that person stealing from you. But embezzlement occurs in medical practices more often than you might think.

Stop Embezzlement Before It Starts

9/11/2008 7:00 PM

CME Transcripts Made Easy

Have you ever needed a continuing medical education (CME) transcript at 3 am on Christmas morning? If you ever do, just go the TMA Web site.

CME Transcripts Made Easy

9/11/2008 7:00 PM

Voices of Ike - Health heroes

1:10 pm, Monday, Sept. 15, 2008 Houston trauma surgeon Ken Mattox, MD

Houston is the 4th largest city in the US. The Houston/Galveston greater area has upwards of 4.5 million people, depending on just where you draw the line. It is safe to say that NO ONE in this area is untouched by this storm. NO ONE. Galveston was totally under water from both the gulf and the bay. UTMB and its famous burn center was evacuated. Bolivar Island is still "off limits" to anyone visiting it. West Galveston Island, with its beach housesm was under water and many destroyed. The famous Balinese Room of Galveston is GONE. The Galveston Sea Wall is 17 feet above sea level and the sea ran over it. This was a wind and SEA SURGE storm, not particularly a wet storm. Balinese - ZZ Top From Galveston to Houston one travels Interstate 45, and that is the route that IKE took. The areas of NASA, Kemah, Seabrook, are yet to be fully assessed. Over 95% of the area lost electrical power in the entire greater Houston area, and most are still without electricity. NO HOME or yard is without some sort of damage, either shingles, an entire roof, glass broken, fences down, or trees fallen and limbs broken. I do not mean just any tree. Many huge oak trees over 100 years old are broken like match sticks or up rooted. The many faithful health workers were at work despite their homes being blown apart. First, I must give tremendous credit and recognition to thousands of individual health heroes who were here at the Ben Taub General Hospital and many other hospitals for many hours straight. They gave and gave and then gave more of themselves so that others would have a place to receive health-related attention. Second, I was impressed by the leadership of the state government both during Gustav and Ike in the days before the storms hit, in creating a 5,000-plus person 2-3 times a day conference call to address known course of storm, local needs, evacuation, gas, search & rescue (SAR), and recovery. Both state, county, local governments were on this conference call as well as other assets such as hospitals, EMS agencies, etc. It appeared that most items were covered and addressed. It was obvious that jurisdictional turfs existed. At the LOCAL area, different jurisdictions set up in different locations: Galveston, Transtar (Harris County), HEC (City of Houston) and assets of the state, such as Texas Task Force 1 set up in several different locations. Ownership of various assets was under different, but communicating agencies. What we did not have during Ike, but did have during Katrina was a region wide JOINT UNIFIED COMMAND. We really needed that during and for the first 2 days after Ike hit. At the hospital and emergency room level, every hospital in the area did their part, but all entered the hours of the storm with full ICUs. We (and everyone else) had patients ready to be dismissed from the hospital, but we would have sent them to an area of high risk of flooding. That would not have been good, but we did need their bed for new ER patients. No local "medical" home health care type shelters were set up in the Greater Houston area. We must address this next time. In my view, this would be an excellent role for DMAT teams, to be both up front for some few minor problems and to establish an up to 500 bed "medical" observation shelter as opposed to a "clinic" or hospital. We really do not need mobile hospitals, what we need is the intermediate "medical" shelter to unload the existing local hospitals. By 12 hours after the storm had cleared the area the mass property destruction was noted and people began to clear their property, including using chain saws they had never read the instructions on, and climbing ladders. We had lots of falls. Also many hospitals wanted to "evacuate" merely because their rooms were warm and humid as they were only on emergency generators. The water for the entire community was feared to be contaminated due to low water pressure. Therefore, we were requested to receive patients with relatively minor conditions, such as a need for a lower temperatured room and nasal oxygen in an elderly patient. Some such patients came by outside the area contracted private ambulances who knew nothing about the working of the local EOCs, although those were multiple. We really needed the DMAT type run medical holding area shelter for these type of patients, who never needed to come to the hospital to use the hospital as a shelter. One of more DMATs were set up in the Greater Houston area, but initially coordination with existing Trauma Center facilities was sparse. If there was coordination, it was with one of the many supervisory silos. It became interesting to me that within 24 hours after the storm cleared, many of the persons in each of the silos, including representatives, and including press people, who by now were very tired; began to point fingers and to try to get credit for what was done right and dodge when there was a criticism for what went wrong. I could write a book on this subject. In the five-state area around Texas there is a fantastic trauma network among the trauma centers and trauma surgeons, headed up by Dr. Ron Stewart in San Antonio. This excellent integrated disaster network is as sophisticated as ANYTHING I have seen from the well funded federal programs, and it costs NOTHING. The doctors and nurses on this network and the network itself are well known to each of the federal, state, regional, county, and city EOS silos in the five-state region. However, neither for planning, implementation, evacuation, or recovery do these silos utilize this very mature sophisticated trauma network. It is almost as if the hands on trauma personnel who in at least six of the cities of the network (Houston, Galveston, San Antonio, New Orleans, Oklahoma City) have a composite experience of active involvement in more disasters than any group that I know about in the country; are purposefully omitted from the government run silos. In my humble opinion, this disconnect between the governmental mandated EOS silos and the JCAHO mandated trauma center communications led by the American College of Surgeons and their trauma center and disaster committee MUST somehow get together as has happened in the state of Connecticut. We are approaching 48 hours since it has been able to move around after the storm. There is lots of frustration and depression. Criticism that the government did not move fast enough to clear the roads, turn back on the power, "bring me water," etc. is distressing. Even by FEMA rules, such response is not required until 72 hours. If there is gas available, and if the electricity is back on, many complaints will disappear.

I have tried to write concurrently with my frank feelings and observations of the real time. Sometimes I was more frustrated than others. On the whole I have been very proud of my local community, proud of the citizens, and so very proud of the FANTASTIC TEAM OF MEDICAL PROFESSIONALS AT THE BEN TAUB GENERAL HOSPITAL. This team could put a man on Mars in a week. This team seeks to be a resource to take care of the sickest of the sick, that no one else wants, especially during a crisis. This team could reach the illusive peace in the Middle East in five days. Congratulations to the many many unsung heroes at every unit level of this team.

Voices of Ike - Back in the office, for a bit

11:30 am, Monday, Sept. 15, 2008 Houston cardiologist A. Tomas Garcia, MD

Finished rounds early today. The ER was cleared out by FEMA and transferred the patients to San Antonio last night. Good job guys. Our ER is now ready for more sick patients. In addition, we are getting the patients on the medical floors discharged if they are well enough to go home so as to have those beds available for any other sick patients that will most assuredly arrive later today.

More physicians are showing up and rounding in the hospital; so I'm now in the office available for those patients who really feel like they need to be seen in an attempt to not have them in our ER if at all possible. My staff came in and we saw a few patients. The phones are now quiet so we closed and transferred the phone to the answering service.

Guillermo made it in and Carlos is picking him up; leave the front lines of Afghanistan to the situation here with post-Ike issues. Still no power or water at home; but no damage.

Got another call to the ER.

Gotta go.


Voices of Ike - An offer to help

7:59 am, Monday, Sept. 15 From Dallas medical transcriptionist Michelle Lloyd [Editor's note: I cannot vouch at all for this person or the work that she does, but I was so impressed with the sincerity of this unsolicited e-mail that I just had to post it. stl]

I am a medical transcriptionist with about 10 years experience, and I currently work for a large pediatric hospital in Dallas. I am writing because I realize that paperwork for the patients still needs to get done, and doctors, nurses, and residents need to have their time to devote to patient care. I am offering to help out with any transcription needs. No strings. If you can get it dictated on any type of recorder and mail it, e-mail it, send it by carrier pigeon or pony express, I'm pretty sure I can get it back to you so that you can at least cut and paste it from Word and get it to the chart. I have worked for and with some of the doctors that came out of the Galveston area and feel very comfortable with your local "resident speak." I do a lot of general dictation from neurosurgery and radiology, cardiology, pulmonology, ER stats, letters, requests to the FDA, even protocols for cancer clinics, some work on technical labs and genetics; and I work with many kinds of accents. Anyways, my point is that I am decent enough at it to help you guys out or provide some back up relief for your current voice system and/or transcriptionists. I can get you references from my doctors, should you want them. You can pass this message to any local Galveston doctor, nurse, or resident doctor, whomever. I am willing to back you up on a volunteer basis until you get back to status quo. I'm well versed in HIPPA (I got it, I got it) and reliable. If you are wondering, I grew up in Galveston and went to Ball High for a couple of years; my parents owned a business where O'Malley's sits on Post Office. Mom uncovered the Opera House arch and helped with some of the original restoration. My old apartment building fell into the bayou after a major hurricane a few years ago. I have friends with businesses along the Strand and just across the street from the hospital some friends of mine own the Italian restaurant, Bossi's. I also have friends who run the port and some major businesses down there, but I can't get in to help them cleanup. So until I can get there to help them fixup and rebuild, I would love to be able to contribute in the only way I know how, medical transcription. (Plus, nobody would let me cook in their's a fine way to populate the ER.) Again, feel free to offer my volunteer service to the local medical staff. Agencies can be pretty expensive and I'm not big on sending work out of or across the country. At least I'm close by, I have the time, and you really can't argue with the price. Thank you for your time and attention. Sincerely, Michelle Lloyd

Sep 14, 2008

Voices of Ike - Still on generator

11:37 pm, Sunday, Sept. 14, 2008 Beaumont neurosurgeon, Mark Kubala, MD

Since my E Mail to you this AM things are about the same. Christus St E (and Baptist Herman Memorial) have moved the dialysis patients. Christus St E is still on generator. Hopefully they will be up on power in the next 2 days. Both hospitals are open for trauma ( fortunately there has been very little). Once power is up they will be fully open, but I doubt much will happen for several days as most patients are out ot town.

Since the water is not drinkable, and concern is about the sewage backing up (I spoke with a friend of mine who a had some back up), I will probably take Betty to Austin tomorrow and then decide when to came back.

Will give you a call in a couple of days.



Voices of Ike - "Like the Cavalry Coming to Help"

10:10 pm, Sunday, Sept. 14, 2008 Houston cardiologist A. Tomas Garcia, MD

Well, the ER got busy as predicted. Boy did it. We went through the hospital and sent the well patients home to create space for the critical coming in. Cardiac arrests, hemo dialysis, chf patients, and the injured. We culled twice and now have just super sick folks in the hospital. The ER is packed. I mean packed. The kind that need admission and waiting for an ICU bed for treatment and care.

We called FEMA and next news you know, we had about 11 ambulances with appropriate staff to transfer the sick, ready for admission, to San Antonio. And they will be back to get some more if we have them. I'm sure this is happening in the other hospitals across the city. This really greatly helps and allows us to care for the ones coming in tomorrow. We have city water now with good pressure so all the toilets are clear, and the hospital is looking clean and sharp. We're still on generator power. The staff is holding up well and the docs are all helping in the usual way by caring for our patients. We're having the usual Code Blues.

We all saw through the ICU window the 11 ambulances coming down Richmond Ave with red lights flashing and all in convoy; wow, what a sight. With the city without power and lights it was very, very impressive. It was like the cavalry coming to help and boy, did we need them. They came from Riverside California; drove first to Dallas, then to San Antonio, then here to the command station here in Houston and then to our hospital ER with the assignment to clear out our sick to the San Antonio hospitals. Thank you, San Antonio and your hospitals, nurses, and of course you doctors. God love you. By clearing out our ER; we're able to care for more patients bright and early tomorrow.

The city is slowly coming to life and the people are starting to move around as the power and water are coming on. Business, stores, eating places are beginning to open. Hopefully, by the end of the week, we'll start to have things closer to normal. According to the reports we're receiving; some parts may take longer unfortunately. Some areas were severely damaged and flooded. Several of our staff have homes partly or fully destroyed or flooded. Yet, they still are commited to our patients and remain here.

Got another call, gotta go.


Voices of Ike - The hospital is full

2:54 pm, Sunday, Sept. 14, 2008 Houston cardiologist Tom Garcia, MD

Okay, the latest. Our hospital is full, the ER is full. We have requested FEMA to move all patients in the ER to San Antonio; we are waiting for instructions from them.

Water just got going but we are uncertain of the safety so only bottle water for drinking at this time. Dalysis patients are a real concern with out the water pressure and sanity; the hospital can't accommodate the number that might need dialysis. Many of the outpatient facilities can't care for them without water, water pressure, and safe water. Another challenge, we'll figure something out.

With the pressure for beds, we are reviewing all patients/charts to see if they are well enough to go home to make room for the high demand we are experiencing currently. Still no power to vast areas of the city. Some physicians are being held up at other hospitals with other patients of theirs and having their patients in other hospitals needing their attention; again the docs are stepping in to cover them.

The flooding is incredible; fortunately it has not affected us here on the west side too much; unless it rains again like this morning. If so, build an ark. The administration here at West Houston is doing an outstanding job; good leadership, good planning, and good execution. It also helps to have an M&M peanut dispenser close at hand. (We all have a weakness!)

The physicians have done an outstanding job of caring and treating all the patients here. The problems we have encounted are very similar to (New Orleans physician) Mike Ellis' comments after the Katrina storm; e.g. people who stayed on the island now are in trouble and want help. Fortunately some did learn and left: and the process so far appears to be going as smoothly as could be expected for such a bad storm for the ones that didn't listen or prepare.

Got called back, gotta go.


Voices of Ike - In case the Generators go out

12:31 pm, Sunday, Sept. 14, 2008 Beaumont neurosurgeon Mark Kubala, MD

We are OK Major problem is power outages. Entergy says this is worse than Rita. Water is not drinkable. Still major flooding in areas. Rain this AM so water draining slowly. Christus St Elizabeth is still on generator. All the dialysis patients moved out. Currently moving the critical patients to other Christus hospitals (Texarkana, Lake Charles) in case the generators go out. Cheers Mark

Voices of Ike - Internal Disaster Mode

9:50 am, Sunday, Sept. 14, 2008 Houston cardiologist A. Tomas Garcia, MD

I just finished rounds and the situation at this moment is the following: Some physicians and support staff can't get to the hospital. With the cold front and rains that it brought, flooding is now a real problem. With a saturated ground, the water has to go somewhere and causes its usual problems, i.e. into home and cars and hospitals.

Mainland Hospital is out; it lost its roof and the roof over the OR rooms. All have been transferred. BayShore Hospital s out; flooding with sewage. St. Luke's is surrounded with water as is the TMC, so getting into and out is a real problem. So patients are left with our suburban hospitals like ours.

We are now on strict water conservation. The entire county and surrounding area has this common problem. Basically all our hospitals are now on Internal Disaster Mode and addressing their unique and individual problems as they see fit. So far, we had no employee injury or patient event.

Our ERs are starting to have the usual injury and "trying to clean-up the mess" accidents. We are also starting to have the acute sob and chest pains that usually occur in the aftermath. Our hospital staff is staying in areas of the professional bldg to rotate with the hospital staff working their shifts; again trying to have "fresh" folks for our patients.

The docs are hanging in there; I think I'm running on adrenaline now. Had 2-3 hours sleep; got called back to the ER for acs (acute coronary syndrome). One MD was told there were no generators to be had and if they were available they are expensive. I've just crossed out my freezer; there go those ducks. Oh well. Also, the salmon and halibut. Oh well.

My son, Guillermo just got into Dallas from Afghanistan and can't get into Houston. Needless to say, "a little pissed off" is a mild statement for the military just coming from the front line. Oh well. Carlos, my other, just collapses and sleeps when he can.

Lots of work to do and patients to see.

Just got another call, gotta go.


Voices of Ike -- Day 2 of the great adventure

Sunday, September 14, 2008 8:33 AM
Beaumont orthopedic surgeon David Teuscher, MD

Massive debris fields and downed timber. Power outage expected for weeks. Rita took out half of our trees and Ike got half of what was left. This is the day you either empty your fridge and freezer or face the horrible stench later and buy a new one. Lots of hazards out there, and without power there won't personnel or patients to run an office. There will be an army of woodsmen and bubbas in the ER with chainsaw, falls, and crush injuries. Righties bag the left thigh and southpaws the right one. With limited communications we are not sure what happened elsewhere. Caught a break when the levy in Pt. Arthur did not get breached and flood all those refineries and homes. Send news. More to follow.


Sep 13, 2008

Voices of Ike - the ER is crazy tonight

11:02 pm, Saturday, Sept. 13, 2008 Houston trauma surgeon Ken Mattox, MD

Brutal is to placid a word to describe summer humid heat in Houston. Miserable, mosquitoes, mad, are good "m" words to describe the environment. What a difference 24 hours make. Last night the EC was a tomb, and tonight it is crazy with many real very sick trauma patients, auto-pedistrian victims, etc. etc. We also have far too many nursing home special needs patients that are just dropped off by an ambulance transporting geriatric nursing patient home patients to a shelter, whose director thinks the person might benefit from some oxygen and sends them to the hospital. Not a good use of resources. I drove around the city this afternoon and tonight. Lots of uprooted trees and broken limbs. Nests of lights exist, but there are NO places to eat, NO grocery stores open, and I saw only ONE open pharmacy. ONLY ONE. Long lines for the gas pumps existed. We are pretty much FULL. A few beds here and there. Rumors exist that up to 14 hospitals of various sizes are running on total or partial emergency generator. At least two hospitals have asked that the BTGH receive their patients in transfer with 170 and 87 patients in the hospitals respectfully. The latter is a subsidiary of major hospital chain that has MANY multiples of this number in their system, but they still want BTGH to take the patients for a variety of reasons. We are reviewing their lists, while at the same time, the EC is now OVERCROWDED by political transfers, political acceptances, nursing home dumps, SAR dumps, and private ambulances bringing patients to us totally outside they system because they know that we will take care of them and no other hospital in the region will accept some such patients. The staff is getting TIRED and will be relieved by noon tomorrow by the E-2 group. Half of the E-1 group are asleep right now. We have had ten times more trauma patients in the first 10 hours after land fall than we had the 24 hours previous to the impact.

Voices of Ike - Caring

11:01 pm, Saturday, Sept. 13, 2008
Houston cardiologist A. Tomas Garcia, MD

Right now, things are pretty bad in the city. No power in vast parts. The hospital (West Houston Medical Center) has maintained power with emergency generators; but no AC, which has been tough on the patients and staff.

Water is now a problem. We are being careful to drink only bottled water for now. We are labeling cups and bottles to conserve water for drinking. Water for the toilets is another problem. We just went through 6,000 gallons to clean out the lines at 7 pm and have another truck on the way.

Last night was tough. The whole hospital building was moving, and we had some leaks; but no windows broke. Many patients were scared, but the staff really came through. We had the usual deliveries and c-sections, and the usual admissions. Unfortunately, many physicians didn't anticipate the tree damage to home, vehicles, and roads, and couldn't make it in.

We had a meeting early this morning and with cooperation of all 14 or so doctors divided the 170 patients among ourselves. Our concern was that there might be a sick patient that needed attention, and with docs unable to round we might have a critical situation get worse. It happened to me. One of the patients i was rounding on had taken a turn for the worse, he had sickle cell crisis with a hemoglobin of 4.0, with fever, tachypnea and tachycardia. We were able to transfer him immediately to telemetry and with a full court pressure turned the corner.

I labeled all my notes as "Hurricane Ike Physician On-Call" for the rounding on other physicians' patients. For the patients that were transferred from the east side, BayShore, (they had raw sewage flood their hospital as I understand), I wrote a full H&P. Everyone pitched in; there were physicians helping with simple things such as moving patients, passing on communication from administration to the staff, to encouraging everyone to use the stairs whenever possible.

Things went rather smoothly compared to "Rita." With "Rita," we had about 1,000 people, family, extended family, friends in the hospital and professional building. Only added to the confusion and work efforts for our doctors and nurses. This time the requirements were more strict; staff and "immediate" family only. I think the total was about 600 or so. Serving food was a bit of a challenge; with these numbers and limited seating in the cafeteria, the staff, docs and family members lined up and waited for the folks ahead to decide to sit and eat or move to another area of the hospital to eat. It really worked out well; and the food was hot and good. with so much to do it was a relief to not have to worry with feeding yourself.

Todd Caliva was excellent as our CEO of our hospital; I can't say enough of how important it is to maintain a certain calm with such a challenge. With his leadership, our doctors were able to perform optimally and efficiently.

I checked the house(I live across the street): no physical damage, one tree down; my son and i were able to get it back up and secure it. Still no power or water there; so I'm back at the hospital. There are still a group of us available for any emergencies that will most certainly start coming in.

The last 3 days have been very challenging and I'm quite certain that the rest of the week will offer its future obstacles. But the preparation we did for the week before led to our success here in the hospital. By taking the common sense steps to prepare for such an incredible storm led to our success.

This is my first entry after the storm because I couldn't get on line.

I'm really beat. To bed. More later.


Voices of Ike - Surveying the damage

10:12 AM, Saturday, Sept. 13, 2008 Beaumont neurosurgeon Mark Kubala, MD

Steady winds decreasing to 40 mph. Tornadic wind 60 mph over Vidor going north. Still getting rain. Orange County Judge Thibodeaux says a lot of flooding in Bridge City. People stranded in attics and on roofs. Orange county getting boat out to rescue. My son's brother in law has a big tree through his kitchen. Cheers Mark

Voices of Ike - Learn from This

9:03 AM, Saturday, Sept. 13, 2008 Houston trauma surgeon Ken Mattox, MD

Have just left morning incident command briefing. Hospital still on LOCK DOWN. NO VISITORS. Hospital staff on two or more sleep shifts. Anticipate that staff that came in yesterday at noon - 6 PM will be in hospital until 12 noon tomorrow - Sunday. Operating Room for stat cases only. Yes we did some stat cases. Building leaked water on side of major wind assault. EMS calls to 911 are 65% more than for comparable time. EMS does not make runs when the wind is >65 MPH. As soon as the streets are safely passable, we anticipate a huge number of patients who have lost their medicines, scraps, diabetes out of control. etc. We anticipate that we will have referals from other hospitals to take complex injuries. Which we will do. We deeply appreciate the many e-mails and comments of support. Your support, prayers, e-mails give us added and renewed strength to do what it is that all of us were created for: Serve our fellow man during their time of need. And that we will do to the best of our ability. One word of advice to each and every one of you. At some time in the future, YOU will be looked to by your associates to assume leadership at a time of unexpected challenges. Most of the time there will not have been a blue print. Take good records and keep your memory sharp in regard to what you learn from watching this natural disaster. These lessons will aid you in your leadership during that future time.

Voices of Ike - the Levees Held

7:32 am, Saturday, Sept. 13
Beaumont neurosurgeon Mark Kubala, MD

The levees have held Major power outages, but we do have water My generator is working as is my DSL. Only one major trauma last night at Christus St Elizabeth (not related to Ike). Cheers


Voices of Ike - Houston braces for the storm

2:51 am, Saturday, Sept. 13, 2008 Houston trauma surgeon Ken Mattox, MD

Eye of storm is now passing over Galveston. Huge Oak Tree down on McGreggor St - the access to the Ben Taub Hospital. Any traffic has to come in a back way. Restaurant in downtown Houston burned to the ground. Three employees were sheltering there. wo with near 100% body burns and one with hand burns and inhalation burns. The latter with us and the two former at Memorial Hermann Hospital. Over 1 million people without electricity and therefore air conditioning. NO FLOODING in Houston YET. Winds up to 100 MPH in gusts, steady at about 65 mph. We have lots of employees who are here to weather the storm, Nurses, doctors, etc. Will be up to two weeks (or more) to get electricity restored. Not much more news right now.

Voices of Ike - Waiting for the Worst

11:23 pm, Friday, Sept. 12
From Beaumont neurosurgeon Mark Kubala, MD

Things are going well so far. We have 180 patients at Christus St Elizabeth (some from Port Arthur) The ER has been fairly quiet. Usual problems but nothing major.We expect to find out about the surge around 2 or 3 pm. So far the levees are holding, but once Ike hits Galveston, the wind will change to southeast and that"s when the surge willhit. Right now the surge is up to 10 feet in Sabine Pass. (The levees are 16 feet)

The winds are around 60 now but most of Beaumont has electric power. A lot of power outages in Port Arthur and mid county. We expect a lot more power outages when the wind changes.

May or may not get back to you later.



Sep 12, 2008

Voices of Ike - Spending the Night

9:46 pm, Friday, Sept. 12, 2008
Houston cardiologist A. Tomas Garcia, MD
(Editor's note: I'm transcribing this just as the eye of the hurricane has crossed the coast line at Galveston.)

We've had all the transfers from bayshore (east side of houston, the hospital was flooding from the surge) to our hospital. the usual, respiratory insuff with chf, recent left leg amputation with severe diabetes, atrial fibrillation with rapid ventricular response, etc.,

We had our first meeting at 7 pm to plan the reminder of the night. We have over 600 people sleeping in the hospital to care for the 160 patient's in the hospital all of them a very sick. We anticipate a pretty bad day tomorrow depending on the amount of damage the city suffers. We have about 15 physicians including myself who are sleeping in the hospital. I'll stay on line for as long as possible.

My son, Carlos, just came in; he's been helping with security and with all the air mattress inflation for the dependents that are in the professional bldg. there are about 200 to 250 on there. the hospital fed everyone at 8 pm. We are to meet at 9 am to access the situation; we are predicting that the physicians here will have to care for the 160 patients that are currently here. As saturday goes it's predicted that the emergency room will get real busy.

Gotta go; I'm being paged.


Voices of Ike - the Calm Before the Storm

6:30 pm, Friday, Sept. 12, 2008 From Beaumont orthopedic surgeon David Teuscher, MD

Southeast Texas (Jefferson, Orange, and Hardin Counties) is suffering from "Hurricane Fatigue Syndrome." We are in our third mandatory evacuation in a month (Eduardo, Gustav, and Ike). The previous two "missed us" but found folks returning with orthopaedic injuries, lost wages, and gas, food, and lodging bills. Hopefully this has not let them become complacent should Ike be the real deal. The mandatory evacuation was called here yesterday at 6 am, throwing every patient and health care provider into another parking lot on our highways north and west. No chance to evacuate east as Gustav left widespread power outages in Baton Rouge and all of southwest Louisiana. Greatest danger being surge on this bad boy, wind and rain will likely pale in comparison. The surge up Galveston Bay will be catostrophic in my amateur meteorologist opinion, and may do same up Sabine Lake. Right on time at 5 pm the major outer bands of wind and rain arrived in Beaumont while I was cooking ribs on the grill and laughing at the dogs play without any idea of what was about to happen. Now the long wait begins. Rita trimmed the heavy timber of Beaumont in 2005, but there is plenty of coniferous and deciduous forest surrounding our homes and offices. More importantly, these coastal areas may have the levees of south Jefferson County breeched with the predicted 20+ foot surge over the 15 foot levees in Port Arthur. Connie and me are sheltered in place at home with five dogs, two birds, and two octogenarian guests. A lawsuit is alot like a hurricane. If you practice medicine on the Texas Gulf Coast, you can count on both. More to follow if able. May God grant safety for all who are in harm's way.