Perspective
Hurricane Katrina
Lethal Levels
N Engl J Med 2005; 353:1549October 13, 2005
- Article
On Tuesday, August 31, in the wake of Hurricane Katrina, Sylvester Donaldson (not his real name) landed at the emergency room of the Ochsner Clinic Foundation in New Orleans, desperately ill, having missed more than a week of dialysis treatments. He arrived by pirogue, a shallow-draft Cajun boat that has been used for hundreds of years by Louisiana trappers and fishermen to negotiate narrow marsh inlets and bayous.
After Katrina, the flood waters came to within a block of Ochsner. Boats were now traveling a route usually traversed by car or ambulance. Donaldson's journey began in the lower Ninth Ward district on the east side of New Orleans. A rhythm-and-blues singer with a local group, he had returned from California only days earlier to take part in a recording session. He had weathered the storm at his mother's New Orleans home, but when the two-story house became totally submerged by the rising waters, he paid the pirogue's owner $40 to help him escape.
Donaldson paddled approximately five miles from downtown New Orleans, westbound along Claiborne Avenue, until the pirogue ran aground. On his way, he witnessed the drowning of a friend who was trapped with his German shepherd in a nearby home and the brutal hijacking of a boat containing two elderly neighbors. Climbing out of the boat, he walked another few hundred yards, severely weakened by an accumulation of fluid in his lungs – the consequence of his missed dialysis treatments.
But he had made it to dry land. Although tentative preparations had been made to evacuate upward from the lower floors at Ochsner, and dialysis equipment had been moved from the first floor to the sixth-floor ICU, the flood had stopped just short of the institution, and the exterior damage consisted of only a few leaks and broken windows.
In the emergency room, it was quickly established that Donaldson's serum potassium had reached potentially lethal levels, and he was admitted to the ICU. Although power had been lost within moments after the storm, Ochsner had three backup generators that were situated high enough to avoid flooding. So Donaldson was able to receive a dialysis treatment.
During the next few days, about two thirds of Ochsner's patients were discharged or transferred by helicopter and fixed-wing aircraft to hospitals in Baton Rouge, Houston, and Memphis. Critically ill patients who could not travel, including a dozen who required dialysis, remained at Ochsner. After three days of dialysis therapy and antibiotic treatment for the pneumonia he had contracted, Donaldson was ready to be discharged, and he returned to California.
About 10 days after Katrina, some reports suggested that 50 percent or more of the patients who had been receiving dialysis in the New Orleans area had not yet been located. A tracking program to find the rest of these patients has been launched by the Centers for Medicare and Medicaid Services.
Source Information
Ochsner Clinic Foundation, New Orleans
