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A Sense Of Duty
W. Richard Boyte (wboyte{at}ped.umsmed.edu) is an associate professor of pediatrics in the Department of Pediatrics at the University of Mississippi Medical Center in Jackson. A NEWS REPORT on my battery-operated television told of a group of elderly patients evacuated from their Louisiana nursing home to a rural church-owned camp near where I live in central Mississippi. The camp, like most of the surrounding area, had been without electric power since Katrina released her fury two days earlier. The patients were stranded there and suffering from the relentlessly brutal heat. The television announcer reported there had been a death at the camp, then pleaded for medical volunteers. In my mind I developed a list of excuses against volunteering: As a pediatrician, I would be unhelpful to geriatric patients; the one-hour round trip would drain some of the suddenly hard-to-locate gasoline from my car; I was already sharing duty at our hospital’s pediatric intensive care unit that week; certainly there would already be enough help. But something inside—what I think of as duty—dictated that I go. After arriving, I parked and quickly approached a large metal structure where I could see workers and police. Ambulances were lined up alongside. My medical scrubs seemed to be the only credential I needed to gain access to the building. Indoors, the temperature was well over 100 degrees. As my eyes adjusted to the dim interior, lit only by sunlight spilling in through a few open doors and windows, I struggled to make sense of the scene. Loud fans, powered by generators, were useless against the oppressive heat. The air was thick, wet, and difficult to inhale. About half of the floor in the cavernous room was set up with metal folding chairs; the remaining floor space was covered by mattresses. And the mattresses were occupied by human misery. On nearly every one lay a gray-haired, panting person. Some were writhing, others moaning. A few wandered about aimlessly. Workers dressed in scrubs, uniforms, or street clothes scurried back and forth among the mattresses. I began to search for anyone remotely in charge. I was directed to a man organizing ambulance transport. Each patient was to be taken to an evacuation facility with air conditioning or, if critically ill, to a nearby hospital emergency room. As a physician, I was asked to do triage, designating which option was appropriate for each patient. Among the busy volunteers, I found several off-duty paramedics, emergency medical technicians, and nurses. I did not find another physician. During the next few hours, I moved from one elderly patient to another. Each, thank goodness, had a thick medical chart from the nursing home at the foot of his or her mattress. I would scan the lengthy list of health problems and search for diagnoses and medications. Then I would try to do a brief physical exam. All were obviously dehydrated. Confusion and disorientation were common. Several were significantly hypertensive. Some were vomiting. Others were unresponsive. One sweet-natured woman had a urinary catheter in place with dark blood clearly visible in the reservoir bag. Another woman’s pursed-lipped slow breathing and distant stare made me fear that she was slipping into coma. I marveled at the ability of emergency personnel to place intravenous catheters in fragile and barely visible veins. I admired compassionate nurses as they fanned out to distribute aid and comfort. I was distressed by the decisions I had to make and the potential consequences of rendering wrong judgments. All along, I waited for additional help from another physician that would never come. I felt a mixture of emotions: satisfaction that I had answered an internal call to duty; anger that others had not; fear for the futures of these traumatized men and women. I would later learn that after power was lost, a camp official had vainly sought help. His requests reportedly were rebuffed because the camp was not an officially designated evacuation shelter. When an eighty-year-old woman died, he turned to law enforcement and the media, which finally brought help. Eventually, I felt I could leave. That night, I slept the deep slumber of the exhausted. I know little of the fate of the men and women whom I triaged. For their sake, wherever they are, I pray that they continue to find the generosity of volunteers.
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