KATRINA AN. Striving to make the most of a disastrous situation.

Transcription

1 KATRINA AN Striving to make the mot of a diatrou ituation.

2 D ME BY D. BRIAN KIM, MD magine that you jut finihed your econd year of reidency. You ve tudied the AAO Baic and Clinical Science Coure religiouly and tried to aborb a much information from your attending a poible. You ve learned how to run a reident clinic and tayed up late on many night managing patient on call. But by thi point, you ve performed only a limited number of procedure and you eagerly await the chance to raie your urgical experience to the next level. Suddenly, a literal deluge hit you like a tidal wave. Mot of the population of your city flee overnight, and, when all i aid and done, more than half of the roughly 500,000 people who fled till haven t returned. Many lot all of their worldly poeion including their home and ome even lot their live. Hurricane Katrina truck in Augut 2005 and devatated the live of many people (Figure 1 3). When I think about it, my own lo wa minicule in comparion, and I m ure my colleague at that time, the other reident at the LSU Eye Center and Tulane Univerity, have torie of their own harrowing experience perhap far wore than mine. But thi i my tory. SOOTHSAYER When I wa in medical chool at Albany Medical College, I hared my interet in the LSU ophthalmology program with my mentor, the chair of pediatric, David Clark, MD. He told me in graphic detail how New Orlean i itting inide a bowl, below ea level. If a catatrophic flood ever truck New Orlean, he aid, the whole city would be under water. Hi word were, It a ticking time bomb. At the time, I thought to myelf, What are the chance? istockphoto.com SUDDENLY, A LITERAL DELUGE HITS YOU LIKE A TIDAL WAVE. MOST OF THE POPULATION OF YOUR CITY FLEES OVERNIGHT, AND, WHEN ALL IS SAID AND DONE, MORE THAN HALF OF THE ROUGHLY 500,000 PEOPLE WHO FLED STILL HAVEN T RETURNED. MANY LOST ALL OF THEIR WORLDLY POSSESSIONS INCLUDING THEIR HOMES AND SOME EVEN LOST THEIR LIVES. MARCH 2018 CATARACT & REFRACTIVE SURGERY TODAY 51

3 Figure 1. The New Orlean Veteran Adminitration Hopital (top); a local dive frequented by LSU and Tulane reident (econd from top); Tulane Medical Center (third from top); LSU Eye Center and Reearch building (bottom). Recalling hi word today end chill up my pine. I never imagined that, in thoe 5 hort year I pent in New Orlean, I would be a witne to one of the wort natural diater ever to hit the city. EVERYTHING WILL BE FINE RIGHT? When Katrina truck the Louiiana Gulf Coat, I wa rotating through the Leonard J. Chabert Medical Center in Houma, which i outhwet of New Orlean. Even though Houma i cloer to the Gulf of Mexico than the Crecent City, we lot power only for 2 day and didn t experience major flooding in the area around the medical center. Other were not o fortunate. In the city, the New Orlean Veteran Adminitration and Charity Hopital rotation were hut down due to major flooding. I received word that my fellow reident, Henry Alexander Leder, MD; Pedro Rivera, MD; and Wendy Donahue, MD, who covered Charity Hopital, were tuck there. They had no electricity and limited reource, yet they valiantly kept caring for patient and helping them to evacuate by helicopter and boat. I can only imagine how traumatic thi experience mut have been. Total chao ran amok in the city. With the breakdown of infratructure, it wa martial law: Every man for himelf; urvival of the fittet. A week after the torm, New Orlean wa till hut down, and the military wa trying to ecure the city. Civilian were not allowed back in. One day, the econd-year reident rotating with me in Houma, Adham al Hariri, MD, approached me with a look of deperation on hi face. He didn t have a car, and he aked me if he could borrow mine to go into New Orlean to retrieve hi paport and other peronal document at hi home in the Garden Ditrict. I told him that the city wa hut down, but he inited. I finally acquieced, but I told him that I wan t comfortable letting him go alone; I would go with him. Unarmed, we packed a few thing, and I gave my wife and 1-year-old daughter a ki. I prayed to God for afety a we ventured toward the city. When we got to the outkirt, we encountered armed military peronnel at multiple checkpoint. Luckily (or maybe unluckily), we had our crub and LSU badge on, o they let u pa, thinking we were authorized medical peronnel. Driving through, it wa like a cene out of a potapocalyptic movie et: The road were covered in mud mixed with garbage and debri. For all intent and purpoe, there were no dicernable road or interection. Power line and broken treet light were trewn like obtacle in a maze; it wa diorienting. With no power and no treet ign, it wa difficult to navigate, but when a caravan of military Humvee drove pat u, we followed them to Adham houe, with many of the urrounding neighborhood treet and home till underwater. When we approached hi houe, he got out, tripped down, and tied a large garbage bag over each of hi leg, covering up to hi thigh. Adham began wading through the tagnant, fecal water toward hi houe, which wa at the end of a long treet. I lot ight of Adham a he chlepped away. He i a uave and refined-looking guy, but, that day, I learned that he alo a pretty tough dude. I, on the other hand, am a chicken. A I waited, I looked around and aw an empty chool acro the treet with broken window. There wa nothing, nobody only complete ilence, ave for the ound of my car engine idling. In that moment, I realized that anyone could neak up on me, hoot me, take my car, and no one would know. Watching TV how now like The Walking Dead vividly remind me of that moment and the eerie and unettling feeling I will never forget. Finally, Adham made it back with hi 52 CATARACT & REFRACTIVE SURGERY TODAY MARCH 2018

4 WITH MORE THAN HALF OF THE POPULATION GONE, AND WITH THE NEW AND UNPRODUCTIVE ROTATIONS, I WONDERED HOW ANY OF US WOULD REACH THE SURGICAL MINIMUMS REQUIRED FOR US TO GRADUATE. paper, and we hightailed it back to Houma afely. NOW WHAT? Eventually, New Orlean wa reopened to the public, and I and the other reident were able to get together for our weekly didactic lecture. We traded note on the different rotation: which one were good and which were not. The New Orlean baed rotation were till hut down, o new rotation were created in Lafayette, 1.5 hour wet, and Bogalua, 1 hour north. Right after the torm, ome diplaced reident even went a far a Shreveport and Alexandria to maintain ome emblance of a rotation, but much of the experience wa limited, and urgery wa nonexitent. Collectively, we bemoaned our plight. Surgery wa pare, and undertandably o. More than half the population had fled, which meant there were fewer patient for u to treat. It wa a treful and anxiety-provoking time. Some reident tried to leave the program, but thi wa dicouraged. My wife wa in an allergy, athma, and immunology fellowhip at Tulane. She wa diplaced to the Ochner Clinic Foundation in nearby Metairie, and her program wa eentially unaffected. I didn t want to leave my family to go to another program, and I probably would not have left even if I had the choice. So we were tuck with ome of thee new, improvied rotation, ome of which were eentially oberverhip without any urgery. A a riing thirdyear reident, I felt I wa jut getting warmed up. With more than half of the population gone, and with the new and unproductive rotation, I wondered how any of u would reach the urgical minimum required for u to graduate. The reident currently on the Lafayette and Bogalua rotation worked tirelely to make the rotation better, but there till wa no urgery. I mut have picked the hort traw becaue our reidency program director, Ira B. Fuller, MD, choe me to go to Lafayette. I wa determined to do everything I could to make the mot of the rotation. Dr. Fuller allowed me to recruit an excellent co-reident and good friend, Viet N. Bui, MD, to join me in Lafayette. It had been decade ince any ophthalmology reident did a cae at the Univerity Medical Center (UMC) in Lafayette, and at that time, no one wa doing eye cae there. We tayed at an apartment provided by LSU and worked feverihly to make the rotation worth omething. Viet and I met with the hopital adminitrator, including the CEO of the hopital, and explained to them our need. With their upport, and with aitance from LSU, Viet and I were allowed to buy equipment. We picked urgical intrument out of a catalog and met with a local urgical ale repreentative to buy a new phacoemulification machine. Although the UMC did not have an eye clinic, the center wa an early adopter of telemedicine. We took full advantage of thi reource and probably analyzed everal hundred diabetic retinal can to try to identify any patient who might need care. We Figure 2. Charity Hopital (top); the rear of the New Orlean Veteran Adminitration Hopital (econd from top); another nearby building (third from top); a banner hanging from Charity Hopital. MARCH 2018 CATARACT & REFRACTIVE SURGERY TODAY 53

5 Figure 3. Evaculation and relief effort in New Orlean. The aying, What doen t kill you make you tronger, reonate with u. I believe the experience helped u to grow a human being. It made u tougher and more reilient. We had to work together to reurrect our program. looked for diabetic retinopathy, and, if the view to the fundu wa limited, we brought thoe patient in to be evaluated for poible cataract. We alo picked up the Yellow Page and cold-called every eye clinic in the area, informing them that we had a free eye clinic where they could end their indigent patient. So, after we pent the firt 3 of the 6 week of our rotation building an infratructure with our blood, weat, and tear, Viet and I proudly (and anxiouly) performed the firt eye urgerie in decade at the UMC. At that time, flip phone were the norm, and YouTube wa a figment of omeone imagination, o we depended on watching DVD to tudy and hone our kill. We devoured the brand-new book by David F. Chang, MD, Phaco Chop: Matering Technique, Optimizing Technology, and Avoiding Complication, like divinity cholar diecting the Bible. In our barren apartment, we had nothing but our duffel bag, air mattree, and a laptop to watch urgical DVD. We tayed up night watching video and haring note, urgical technique, and pearl we picked up along the way. We were fortunate to avoid any major urgical complication, and together we performed more than 30 phaco cataract urgerie in thoe lat 3 week. When I look back, it wa a time of tremendou growth for both of u a urgeon. We uccefully converted from block to topical anetheia and from divide-and-conquer to chopping technique. We had to balance caution with boldne becaue we knew time and opportunitie were carce to advance our kill and help our patient. Thee became ome of my mot preciou memorie a a reident, and I m till amazed that we were able to accomplih what we did. To thi day, UMC i a olid urgical rotation. I need to give a hout out to the reident who came before u in Lafayette. They buted their butt to et up clinic pace and helped tranfer equipment from Charity Hopital in order to get thing tarted. We wouldn t have gotten far without their effort. And I would be remi not to acknowledge and thank Paul J. Azar Jr, MD, for being the impetu for the Lafayette rotation. He and the doctor in hi private practice group in Lafayette took u in and taffed our cae. Without him, none of what I jut decribed would have been poible. A common thread throughout my pot-katrina experience wa the upport of many people like Dr. Azar and local private practice ophthalmologit and LSU alumnu Stephen Capp, MD, who acrificed their time and energy to help ave our program. I am forever grateful to them. HEALING In November 2017, I returned to New Orlean for the AAO Annual Meeting. I wa amazed and happy to ee how the city ha recovered. I love the city, the people, the culture, and the unique and delectable cuiine. It i a one-of-a-kind place, and I am glad to have trained there. I attended an LSU alumni reception at Mother Retaurant and had the chance to catch up with old friend, including ome who are now LSU attending themelve. During the reception, the Katrina reident gathered together in a circle and talked about our time back then. The aying, What doen t kill you make you tronger, reonate with u. I believe the experience helped u to grow a human being. It made u tougher and more reilient. We had to work together to reurrect our program. It wa the collective effort of attending, reident, and community ophthalmologit that made it poible. When our little circle dibanded, I looked around the room and aw that it wa full of revelry, mile, laughter, and warm hug. What a contrat thi wa to what we went through in the aftermath of Katrina. It warm my heart to ee the program and it reident thriving today. I uppoe time truly doe heal wound. n D. BRIAN KIM, MD n Private practice, Profeional Eye Aociate, Dalton, Georgia n Member, CRST Editorial Board n kim@profeionaleye.com n Financial dicloure: None 54 CATARACT & REFRACTIVE SURGERY TODAY MARCH 2018