What it's like to be on call during a hurricane

As an attending and educator, I give a lecture to the residents each year about stroke syndromes. In the lecture, I use mnemonics, pictures, and associations, so that the trainees can retain the information in non-traditional ways and have fun learning what could be otherwise dull material. When I talk about the internal carotid artery stroke syndromes, I bring up the possibility of “the good, the bad and the ugly” when it comes to the outcomes of this type of occlusion. While millennial learners may not know this movie that stars Clint Eastwood, it gets the point across.

Such is the outcome of being part of the on-call team during a hurricane in a hospital. I was one of two on-call attendings the weekend of August 26-27, 2017. The same weekend the worse hurricane to make landfall in the past decade two-stepped its way to the doorsteps of Southeast Texas, the Texas Medical Center, and specifically where I work: TIRR Memorial Hermann. This inpatient rehabilitation hospital was recently named the #2 rehabilitation hospital in the prestigious U.S. News & World Report rankings. If there was a ranking for support and heart, this 134-bed rehabilitation facility would be #1.

So here it is: The good, the bad and the ugly of being in a Houston rehabilitation hospital during an epic storm.

The good

The efforts put forth by the physiatry residents. They had planned teams of residents to sleep in the hospital. Team A consisted of 3 residents, Drs. Azariah, Mollett, and Dr. Cao, who stayed in the hospital over 50 hours when the storm was at its worse. They divided work and responsibilities. They rested in shifts. They checked on patients incessantly. They worked way beyond work-hour restrictions, and two slept on couches. But they didn’t complain. They were happy to be there. They were doctors on a mission. While the water level rose outside the hospital, they worked, they comforted, they prevented emergent transfers, and they made my job easier.

The therapists who stayed in the hospital as well. The hospital was short staffed given the timing of the flooding and the fact that the storm caused Brays Bayou to become a moat around the hospital. Morning shift workers could not get in on Sunday. That’s where the therapists expanded their job description beyond physical or occupational or speech therapy. They put on hair nets and delivered food, they answered phones, they turned patients every 2 hours to prevent pressure sores, they changed diapers, and they did it with a smile.

I never thought I would be thanking HBO, but Game of Thrones did provide respite to the resident physicians on Sunday night. My colleague, Dr. Galloza, was able to connect his computer to the TV in the resident’s lounge. There they watched the season finale and got to have a semblance of normalcy for one hour in an otherwise stressful situation.

The bad

No one likes to dwell on the bad, but this was a storm that crippled our city. The five days of rain led to a new U.S. continental rainfall record for a tropical system. The news was deafening and heart-wrenching. When an aphasic stroke patient can’t keep their eyes off the TV, this is bad, too.

It was unfortunate to learn what “code gray” means. Code anything in a hospital is a bad thing. In our hospital system, code gray is an external disaster. Staff could not come in. And current staff could not get out. But nurses, therapists, doctors, staff, administrators worked together and did whatever it took to keep everything running smoothly in the hospital.

After my weekend call, it wasn’t over. Some water receded, and I could travel to and from home, but others were not so lucky. Our hospital system has 259 rehab beds across the Memorial Hermann network. And two of our community physiatrists were evacuated and could not come in. We coordinated our own University of Texas Health faculty to get emergency privileges and reach those hospitals and treat those rehabilitation patients.

The ugly

Hurricane Harvey just wasn’t bad; it was ugly. The aftermath has been devastating. Two of my fellow physiatrists lost their homes and cars. One co-worker was evacuated on national television and taken to a shelter. The next day he moved to a cousin’s house and expeditiously showed up to round on his rehabilitation patients.

I also saw ugly tears while on-call. They were cried by a patient’s spouse. There she was, dotingly at her husband’s side, hoping his recovery from severe brain injury would rebound, all while fielding calls telling her their home was being inundated with water. At that point, she felt she was truly losing everything.

There was also the sobbing and angst of a mother who could not get to her infant who was with an extended family member at a hotel and running out of milk. She was with her husband who was rehabilitating from a stroke, but then it became obvious there was no safe way out, and she was worried beyond measure. In the end, our in-house social worker helped the situation; and baby and mom were reunited soon enough.

The nice thing about a hurricane — if you can say there is a nice thing — is that you know it is coming. While we knew Harvey was coming and had a contingency plan in place; it was still a shock to us. Personally, I had to walk through standing, dirty bayou water, and climb over gates with my bags to make it into the hospital. Despite those disgusting conditions on the outside, the conditions on the inside could not have warmed my heart more. Despite the bad and the ugly, in the end, I only saw the good. Pure Texas goodness in the Texas Medical Center and in TIRR Memorial Hermann.