A Word from President Helen Heslop, MD

I have lived in Houston for 10 years, but until this past month I had experienced only one hurricane in my life. Would you believe that was more than 20 years ago, in London?

That was an unnamed Category 1 storm that the BBC weatherman famously failed to predict. I slept through it. There was severe damage to trees, but no major power outages because power lines in England are underground.

Here in Houston we monitor and track named storms when they reach the Gulf days ahead of landfall. In 2001, tropical storm Allison caused major flooding, and three years ago Category 5 Rita was forecast to hit Galveston. We activated our emergency plans, with the fresh memory of Katrina-devastated New Orleans, and more than 2 million people evacuated the city. But at the last minute, Rita weakened to Category 3 and turned east. We escaped with only tropical storm-force winds. A great relief, to be sure, although I felt guilty when one of my patients from Beaumont showed me photos of his flattened house.

This year we had more narrow misses: All of the Texas Medical Center institutions closed for Eduardo in August, but that storm took the same path as Rita and landed to the east. Gustav ended up hitting Louisiana. Hanna went to the East Coast.

But then came Ike.

The predicted landfall oscillated between Florida and the Mexican border, but by Wednesday, Sept. 10, Ike veered back toward Galveston. The next morning the state ordered evacuations from Galveston and South Houston, and the National Hurricane Center and President Bush both warned of near-certain death for those who failed to comply. I was supposed to travel to Stanford, but canceled the trip to implement our hurricane disaster plan.

Houston hospitals have comprehensive plans, and our BMT program superimposes our own FACT-required plan upon these. Although we have implemented it frequently over the past few years, the details differ each time. Immediately before Rita we had four NMDP donor collections scheduled and our NMDP coordinator, Marsha, in a tour-de-force performance with the NMDP, rescheduled them all to get the products out before the airport closed.

This time we had no NMDP donors scheduled, but we had to decide whether to postpone transplant admissions and plan how to complete our Friday infusions before the hospitals closed down at midday. We made sure there was additional liquid nitrogen for the GMP facility, rescheduled outpatient clinics and updated our emergency contact lists.

There is a specific hurricane vocabulary with terms such as “rideout teams,” “relief teams” and “recovery teams.” We assigned these and then, in Texas vocabulary, “hunkered down” for the winds to begin. I was on the recovery team, so I stayed with local friends.

We lost power early on Friday night when the winds were only tropical-storm force and before we had finished cooking dinner. To avoid spoilage by loss of refrigeration, we ate smoked salmon and partially roasted potatoes, washing the lumps down with a couple bottles of Bollinger. We spent 10 hours in an internal room with no windows, following the storm’s progress on wind-up radios. Ike, by then a Category 2 hurricane, was extremely loud and exponentially stronger than my long-ago London Category 1.

The next morning, when the winds had decreased, we navigated flooded streets, fallen and precarious trees, downed power lines and non-functional traffic signals to get to the hospitals. More than 2 million households had lost power, but the Texas Medical Center has an underground supply and never had to switch to generators. The water pressure was low for 24 hours but, in general, the hospitals all did very well.

A major challenge was communications. Telephone landlines were working, but few people still rely on line-powered phones. Most cell phone towers were without power, so the most reliable communication was via Blackberry. (Our always-prescient nurse practitioners had successfully lobbied for Blackberries a few months ago and were able to use them to keep in contact with patients.)

Now, two weeks later, about 60 percent of staff and patients have power at home, but schools are still closed, so many staff have childcare issues and many have damaged homes to repair.

On a trip to the NIH, I exchanged hurricane stories with some M.D. Anderson faculty. My three days without electricity paled compared with Steve Kornblau’s account of his flooded house and finding his boat in the backyard, and Laurence Cooper’s description of having to get out his chain saw to clear fallen trees from his street and fuelling his generator every eight hours.

Every disaster offers lessons for next time. Among my lessons from Ike are:

1. Transplant unit-specific disaster plans are not just a FACT requirement, but actually help when emergency strikes.

2. Other subspecialties should also develop unit-specific disaster plans.

3. Hurricane recovery is not an event but a process. Expect continued staff shortages caused by evacuation, childcare and housing issues long after the official emergency ends.

4. It is good to have a fridge in your office at work.

5. Keep an old fashioned phone to substitute for your cordless one when there is no power.

6. There are good reasons to join the Blackberry Brigade. I may have to sign up for a users group.

7. The transplant community is very good about offering help. Thanks to all of you who contacted us.

– Helen