Code Gray at LSU's University Hospital in New Orleans

ABSTRACT: On the weekend before Hurricane Katrina struck, Gabriela Ballester, MD, was the hematology/oncology fellow on call for LSU patients at University Hospital (part of the Medical Center of Louisiana at New Orleans, along with Charity Hospital). She shared her story in a telephone interview with ONI.

SHREVEPORT—With a category 5 Hurricane on the way, Dr. Gabriela Ballester, a first-year resident in hematology/oncology at LSU, did rounds at University Hospital with her attending on Saturday. She wondered why her patients weren't being evacuated and went to sleep that evening worried about what was to come.

Early Sunday morning, hospital administration called a "Code Gray," activating hurricane procedures. Dr. Ballester said that in a previous meeting, Dr. Oliver Sartor, director of LSU's Stanley S. Scott Cancer Center, had set the policy that the attending and fellow on call would stay and cover the hematology/oncology service in case of a code gray. According to Dr. Ballester, her attending told her they could evacuate after covering rounds Sunday, since the LSU medicine service would look after the four patients on the hem/onc service.

Dr. Ballester's husband, Dr. Oscar Ballester, a hematology/oncology attending at LSU, went with her to the hospital early Sunday morning. "He had made hotel reservations so that we could leave the city as soon as I finished my rounds," she said. But then Dr. Vincent Cataldo, chief resident for the LSU medicine service, told her that medicine had too many patients of its own and could not care for LSU's hem/onc patients. Dr. Cataldo discussed the situation over the telephone with the hem/onc attending, who had already left town.

"It was clear that I had to stay," Dr. Ballester said. "I was new to the service and didn't know anyone in the hospital. My husband insisted on staying with me. We hurried back to our house and packed a suitcase. The most important item in the suitcase was my husband's medicine for his diabetes." She also casually tossed in a bag of cookies and a change of clothes.

That evening at the hospital, the Ballesters discovered that no room had been set aside for them and they had no place to sleep. "We were given air mattresses and sent to a part of the hospital that was under reconstruction—it was dirty and unfinished with no working restrooms," she said. "My husband and I, along with a few others also seeking a place to sleep, decided to cross the pedestrian bridge over to the Seton Building where my husband had his office."

Monday morning, the hurricane struck full force; the winds caused the Seton Building to move and shake. Worried about their patients, Dr. Ballester and her husband crossed the bridge back to the hospital. They moved their patients into the hallway to avoid the breaking windows. "Our four patients were frightened but okay," she said, "so when the nurses said they needed help with a patient on the medical service who was bleeding, I offered Dr. Cataldo my help."

Shortly after the hurricane hit, phone and computer services were lost, but the hospital had running water and electricity from the hospital generators. It was crowded, Dr. Ballester said, not only with necessary staff, but with family members of the hospital employees, family members of the patients, and people who walked in from the street.

The Ballesters were not allowed to return to the Seton Building because of the damage and so could not retrieve the suitcase with the medicine. "The nurses, who were supportive and caring throughout the ordeal, were able to locate some insulin. They also found a mattress and an empty conference room where we could spend the night. Later that night, we were able to make a quick run to the Seton Building to retrieve the suitcase," she said.

No Power

When the levees broke flooding parts of the city, a bad situation became even worse, Dr. Ballester said. On Tuesday, there was no power as the generators were now underwater. The ER and cafeteria were moved to higher floors.

"I did my rounds early at 6 am as soon as there was light enough to see by. We thought that rescue teams would arrive soon. When they did not come, we tried to contact the outside and sometimes were able to get through on our cell phones by standing close to the windows and maneuvering different ways to find a signal," she said.

At last, a boat arrived, but only to evacuate the most critical patients from the ICU. Dr. Cataldo and some other medical residents left with the patients, but Dr. Cataldo returned later.

"We had a working radio and yet the newscasts we were hearing said little or nothing about our situation," she said. "We knew of the desperate problems in the Superdome, which we could see from the hospital. I saw part of the Superdome roof peel off, which only made me more concerned about our own safety."

They learned that Tulane's hem/onc patients, some of whom were critical, were being covered by a Tulane first-year medical resident. During Dr. Cataldo's temporary absence, the LSU medicine service included three first-year residents and a pediatric medicine attending. One of the Tulane patients had received high-dose methotrexate but had not received his leucovorin rescue. The nurses knew this patient would die without the medicine. The residents did not have the medicine (the pharmacy was under water) and did not know the correct dosage.

"My husband was able to instruct the residents on how to proceed, and somehow the nurses came up with the medicine. Again, the nurses, who seemed to be working day and night, showed their professionalism and regard for their patients," she said.

On Wednesday and Thursday, things became even worse. Other people came into the hospital seeking shelter. The hallways and stairwells were dark. It was very hot, and each person was rationed only two bottles of water a day—first 750 mL, then 500 mL bottles. "Worried about hydration, I kept my patients on IVs," she said. With no running water, sanitation was very difficult. "We used hand sanitizers to clean ourselves and our patients," she said. Trash cans and bed pans served as toilets. Food was limited (the cookies from home were long gone).

The hospital was an island surrounded by water. Outside, the roads were full of people trudging through the water, seeking help. "As bad as conditions were in the hospital, we did not want to venture out," she said.

They heard that patients were being evacuated by helicopter from Tulane University Hospital and Clinic (TUHC), but the roof at University Hospital was not suitable for a helicopter landing. The military could only drop food and supplies (including additional insulin for Dr. Oscar Ballester). "We saw people being evacuated from the Superdome, but still no one came for us," she said.

Dr. Dwayne Thomas, CEO of the medical center, who was at University Hospital, managed to arrange for private boats to take the dialysis patients and the newborn babies (two to a nurse) to TUHC for helicopter evacuation, but Tulane sent them back, Dr. Ballester said.

It was not until late Friday morning that the military came in swamp boats and helicopters to evacuate the hospital. "I think they were from the National Guard," Dr. Ballester said. They set up lights in the stairwells and began the evacuation: patients first, then visitors, then staff. "I told our patients to keep their charts with them, since I didn't know where they would be going," Dr. Ballester said.

Because the hem/onc service was on the 7th floor, their group was the last to leave. "The military arrived and said 'go,' and we did. They were well organized and managed to evacuate 1,200 people in about 3 hours," she said.

A Bus to Dallas

The Ballesters, who left the hospital by boat, were eventually put on a bus to Dallas where they stayed in a hotel for 2 days and were able to purchase some badly needed new clothing. "In Dallas that weekend, I was overcome with emotion. I could not grasp that people could smile and laugh and eat dinner as if nothing had happened. The sight of ordinary things such as flowers and grass made me cry. I had nightmares about the ordeal for more than a month," she said.

Next, they rented a car and drove 16 hours to stay with Dr. Oscar Ballester's daughter in Tallahassee. "After a couple of nights there, we returned to New Orleans to retrieve our passports and other documents from our house, which had suffered roof damage but was intact. Then we flew to Argentina, where we had family who pampered and comforted us, and tried to help us forget," she said.

One minor casualty of the hurricane was Dr. Ballester's long hair. "It had become so hopelessly knotted during the week without shampooing that I had it cut," she said.

The Ballesters have returned to LSU and are currently based in Shreveport. Dr. Ballester said she regretted that her husband had to suffer the ordeal with her, but as it turned out, his expertise proved valuable in helping other patients. "The patients were very thankful we were there for them," she said.