Friday, September 2, 2005 \r\nIn the morning, we got a call from Ruth Bertucci, the wife of one of my partners. After many despairing hours she had gotten in touch with her husband and my partner, Bryan Bertucci, who had made it through the storm alive. He told her what had happened in St. Bernard. John Thien, our other partner, had originally planned to ride out the storm, bur changed his mind at the last minute and evacuated to Dallas. That left Bryan behind and in charge of our hospital service. \r\n\r\n\r\nThe storm blew over St. Bernard late Sunday night and lasted until early Monday morning. By 7am the wind and rain were beginning to subside. At dawn St. Bernard looked to be in fairly good shape — some wind damage, maybe a foot of water in the street gutters — but nothing all that serious. The dodged bullet. Then, sometime shortly after that, the water in the street inexplicably rose. \r\n\r\n\r\nSince this conversation with Ms. Bertucci, I have talked to at least a dozen people who weathered Katrina in St. Bernard, so I feel confident about the accuracy of what she said happened next. The water rose, fast. So fast everyone in Chalmette Medical Center (CMC) had to scramble to get out of its way. At 7 am the streets were empty, by 7:45 there was twelve feet of water. CMC was a two-story building and almost all of the patients had been moved to the second floor. If that had not been the case, most of them would have drowned. There was no way the personnel remaining could have moved all the patients in the thirty or so minutes they had before the water reached the first floor ceiling.\r\n\r\n\r\n(Just down the road at the single-story St. Rita\'s nursing home in Violet was the story of what would have happened if CMC had been without a second floor. The water rose to 15 feet in minutes. Thirty-three residents died as the staff desperately tried to move patients on to the roof.)\r\n\r\n\r\nThe lights had gone out hours earlier, and the medical staff was trying to save the patients in the dark. CMC had a modern design, meaning the windows did not open, and so in a very short time the heat was unbearable. (Yet another reason the place should have been evacuated. How was a building without ventilation going to function in August with the power out? The generators, by the way, were on the first floor and rapidly flooded out.) Finally, the patients and staff moved up to the roof, where they remained for about a day. \r\n\r\n\r\nEventually they were rescued by boat. Since there were no rescuers from the federal or state to get them out, St. Bernard was rescuing itself. The boats, most of which were either privately owned or operated by the parish police, took everyone to the only unflooded building in the entire parish, which was, ironically enough, the jailhouse.\r\n\r\n\r\nThere they waited. And waited. Nobody came. The St. Bernard Parish President, Junior Rodriguez, was fond of saying afterward that the first people to arrive were the Canadian Mounties. This was probably not technically true — the Coast Guard and the Louisiana Department of Wildlife and Fisheries were known to have begun operations in western St. Bernard by at least Wednesday — but it was true that a Canadian group of first responders arrived in the Parish long before FEMA did.\r\n\r\n\r\nI also learned from Ruth Bertucci that Universal Health Services, the owners of Chalmette Hospital, had twice attempted rescue missions but were stopped both times by FEMA agents. FEMA confiscated their rescue equipment and sent them away, claiming that the conditions in the city were too dangerous for independent rescues. Never mind that St. Bernard was well east of the areas of concern and that no looting or lawless behavior had been reported from there at any time. It was just one more example of FEMA not understanding the geography of New Orleans. From my comfy chair in Baton Rouge I could had told them that St. Bernard, given its geographic and cultural isolation from the city proper, was probably safe and could be approached from the north and east by boat without going near populated areas of New Orleans, even if gang violence was a concern.\r\n\r\n\r\nI listened to Ruth with a little skepticism. Federal bureaucracy can always incompetent within certain limits, but this was absurd. Given the dire conditions, it was beyond belief that FEMA would prevent people who wanted to help from getting in. Especially if that the target of the rescue mission was a hospital. Sadly enough, though, I have since come across more than enough corroborating information to convince me that this did in fact happen. In his book The Great Deluge, David Brinkley would report that on Wednesday of Katrina Week FEMA director Michael Brown had issued an order that there were to be no rescue attempts without FEMA approval. FEMA officials were enforcing this to the letter, and the UHS mission was not the only rescue attempt so thwarted.\r\n\r\n\r\nAfter I hung up the phone my wife and I went out to take care of a bit of personal business. We had a claim to file with our insurance company. On that day I realized that I had done a very serendipitous thing in taking out fire and flood insurance with the same company, State Farm. There were already reports coming out of Mississippi that insurance companies were playing a shell game with Katrina: Accident insurers were claiming house damage was mostly flood; flood insurers were claiming most of the damage was from wind. Homeowners were caught in the middle, and until the percentages could be worked out not a red cent would be forthcoming. People who only had accident insurance were in even worse shape — since most of the property damage from Katrina was caused by water, they might get nothing.\r\n\r\n\r\nLuckily, we had both with the same company, and the maximums on both policies covered 100% of the value of our house. In other words, we were getting our money from them one way or another. There was no reason for our carrier to contest our claim. They didn\'t — we were paid in full by November. This was very, very lucky. There are many people even a year after Katrina who are still trying to collect insurance money.\r\n\r\n\r\nWe took our kids with us, not wanting to burden my aunt or parents with them. Once in the car, my daughter immediately demanded to listen to her new favorite CD, a collection of songs from the cartoon The Backyardigans. The Backyardigans CD was one of the few we had taken with us when we left, and the punishment for this sin was that we got to listen to it over and over wherever we went. To make things worse, one of the songs had the following chorus: \r\n\r\n\r\nCastaways, we are castaways\r\nAhoy there, ahoy, we are castaways\r\nWe\'re stuck where we are\r\nNo house, no car\r\nCastaways, ahoy, we are castaways. \r\n\r\nThe words were backed by a lazy Caribbean beat, and while the kids were having a fine time listening to it, I could have stood for something else on the way to the insurance office.\r\n\r\n\r\nIn all fairness, though, The Backyardigans is a pretty good children\'s album.\r\n\r\n\r\nThe State Farm office in Baton Rouge was bracing for an onslaught. All the necessary forms were in stacks next to the doors, and folding chairs lined every wall and cubicle. Signs pointed patrons to the appropriate queue and notices at every turn told them what papers to have ready and when. The only thing not in abundance was people. I guess most folks were still in too much of a state of shock to think about filing insurance claims.\r\n\r\n\r\nThe process was quite easy, and only took about 15 minutes. The employees at State Farm were ready for us, and knew exactly what they had to do. Our insurance company was far better prepared for Katrina than our government had been.\r\nThe process was easier, and I say this without irony, because we knew that we had probably lost everything. All we had to do was put in a claim for the maximum amount and walk out the door. We did not have to estimate partial damages or itemize. In the 70075 zip code, everything was presumed a total loss. I do not think a State Farm agent ever inspected our home. St. Bernard was condemned by satellite photos, probably by folks cruising the National Geologic Survey website at the corporate office.\r\n\r\n\r\nIn the many conversations I have had with people affected by Hurricane Katrina, I have concluded that complete loss is in some ways easier to deal with than partial loss. An old friend of my wife\'s, for example, had one inch of flooding in her house and wind damage that tore off a section of her roof. This allowed the rainwater to rush in, ruining furniture, carpeting, sheetrock and paint jobs, clothing, electronics. She had to haggle with contractors and insurance agents for months over every item, every expense. People who only had 40% damage, for instance, had too much value left in their homes to walk away; they had no choice but to tear everything out and renovate, renovate, renovate. It is often easier to build from scratch than to reconstruct. \r\n\r\n\r\nWe would eventually just take our check and buy a new house with it. It could have been worse. Unfortunately, it would also mean we would have an abandoned house to deal with.\r\n\r\n\r\nWhen we got back to my aunt\'s house, we saw the news media were reporting the first encouraging information in a week — the Superdome was being evacuated, people were starting to move out of the Convention Center, and the U.S. Army was moving in. Although the Army would not be there in real force until Saturday, just the fact that something was happening was a major change.\r\n\r\n\r\nHere I want to break the flow of this narrative and make an editorial comment about the U.S. Army. It has been widely assumed and reported that the 5-day delay before the Army showed up was the result the dithering of Governor Kathleen Blanco and Mayor Ray Nagin. This is a vicious lie propagated by the Bush administration. Gov. Blanco and Mayor Nagin made many mistakes during Katrina week, but delaying the U.S. Army was not one of them. The U.S. Army answers to the President of the United States alone, and the President did not issue the order to move troops in until Thursday. Period. According the U.S. law the President has the right to deploy the Army to any area declared a disaster area. The Governor asked for disaster status prior to the storm and the President declared Louisiana a disaster area on Saturday, August 27.\r\n\r\n\r\nIf George Bush had wanted the U.S. Army in New Orleans on Tuesday, he could have had it there. All he had to do was issue the order. If it was illegal for him to deploy the Army on Tuesday, why was it suddenly legal to do so on Friday? Only one thing had changed in the intervening days: public opinion polls.\r\n\r\n\r\nAs I said before, Blanco and Nagin were guilty of numerous oversights, but their shortcomings in no way lets the President off the hook. The Convention Center crisis never would have happened if the President had ordered the Army in four days earlier. There was nothing that legally stopped him from doing this.\r\n\r\n\r\nEveryone knows about the huge crowds at the Superdome and at the Convention Center. Many people do not realize, however, that there were equal crises elsewhere. The Isle of Orleans is a peninsula that stretches eastward into the Gulf of Mexico; Interstate 10 runs east-west across its entire length. Much of the New Orleans I-10 is an elevated expressway, and thus, as a local high point, an obvious drop-off point for boaters rescuing people from rooftops. This left thousands stranded on the expressway. A major destination was under the overpass at I-10 and Causeway Boulevard. There were about 10,000 people stranded there, including 4 patients of mine, who spent 2 nights under that bridge without food. They got out of town about the same time the Superdome was evacuated.\r\n\r\n\r\nDespite the continuing suffering, Friday was the turning day. The water stopped rising on Thursday, and finally the Army Corps of Engineers was making progress closing the levee breaches. My city had been devastated, devastated worse than any American city in my lifetime, and though I wanted to be an optimist I understood there was a real possibility that New Orleans could fail. It might not survive this. A city that a month ago had 1.3 million people living in it now had an estimated 50,000 remaining and these few were racing for the exits. Officials were saying the city would not be livable for over a month. How does a city overcome a setback like that? How do all the jobs come back, the schools get up and running, the electricity get turned on, the homes all get fixed? Why would businesses stay?\r\n\r\n\r\nNew Orleans had passed its lowest point, but the greatest challenge remained. New Orleans had lurched to its lowest point like an alcoholic reaching the end of his final binge; but like the situation of the alcoholic, the knowledge of hitting bottom in no way illuminated the way out. Friday was inevitable. At some point things would stop getting worse — they had to, just by law of statistics. The recovery was the greater problem. There were already rumblings among politicians in Washington and pundits on the internet that there may not be sufficient value in saving a city that is below sea level. (I apologize, but I cannot restrain myself from observing that it is easier to maintain an American city that is six feet below sea level than it is to create a democracy in an Islamic nation that has not been democratic in its 4000 year history.)\r\n\r\n\r\nI also had to consider the question of whether I would come back. It was apparent by now that the hospital I worked at was gone. Our clinic was certainly gone too. And most importantly, my patients were scattered across the nation, and I had no way of knowing if enough of them would return to sustain a rebuilt practice. It was another ironic stroke of luck that my partners had not responded to my proposal to buy into the practice. I did not own any equity in my medical practice, so I was free to leave without financial constraints. \r\n\r\n\r\nThen there were my student loans. I had paid almost a third of what I owed during my four years in Chalmette, but I still had a long way to go. With the loans, I could not afford to spend 6 months waiting for St. Bernard to recover. Medical practices are peculiar things. When a doctor sees a patient, he bills the insurance company and gets a check two months later if he is lucky, maybe a year later if the carrier wants to be cantankerous. There was no telling how long we might have to live on credit before we could establish a steady reimbursement stream. That would be acceptable without student loans, but with them, it wasn\'t. I had to consider leaving.\r\n\r\n\r\nIf I had to credit one factor as the key to my eventual decision to move from the New Orleans metro area to McComb, Mississippi, 100 miles away, it was my student loan debt. There were certainly many others. But it is much easier to take a risk and stay when there isn\'t a huge monthly note to worry about. The Federal Direct Loans Program did offer me a holiday on my loan payments — an option I took advantage of — but I was still charged interest during this period. Giving me the option of \"forbearing\" payments while the interest continued to mount was not enough.\r\n\r\n\r\nToday, New Orleans faces a shortage of physicians. In retrospect, the government might have averted what may evolve into a real crisis if it had cancelled the student loans of affected doctors provided they stay. It could have also offered financial incentives to medical personnel, including tax cuts or even outright grants. There is a saying in business: It is easier and cheaper to keep an old employee than to recruit and train a new one. The same is true for doctors. If the local and federal governments had made a concerted effort from the very beginning to keep doctors in town, it would have saved the considerable expense New Orleans now faces in recruiting new ones. It is hard to say what the eventual cost of this massive loss of medical professionals will be; but in the end, the expense will be more than a few forgiven loans, I am willing to wager.\r\n\r\n\r\nThat Friday night, Turnaround Friday, I got on the internet after everyone had gone to bed. I looked in vain for new information about our house, and then started looking at doctor\'s job sites. I had left New Orleans once before, to go to college and medical school in Virginia. I was gone for thirteen years, but eventually something had pulled me back. I would have to consider leaving again, this time under circumstances quite unexpected.\r\n\r\n