Waiting for Irma

I waited during the first day of my neurology clerkship, having just simulated the brain death protocol and told a standardized patient their simulation mother was brain dead. The atmosphere was already gloomy and charged with tension. All that morning we had been hearing of an approaching storm, practically the size of Florida. We’d heard of other medical schools closing and wondered if we’d be next at FIU. Having gone through a few rotations already, the abstraction of patients was not as abstract as it had been in the first two years of medical school. So with the dire warnings from our governor, I thought about how there would be patients impacted, people impacted. I hadn’t gone to my neurology rotation site yet but I knew there would be patients there in need of care.

A native Miamian, I was not sure if Irma would really be as bad as the projections. Sure, NOAA made it look like it was heading right toward us, and it was pretty big. It had been years since a bad storm, though. A few hours later, all school activity, including clerkships, were canceled for the time being. Some classmates who had never seen a real hurricane before tried to flee on flights that began canceling. Others opened their homes and the homes of their loved ones to one another further north in Tampa and Orlando or out of state. This would later prove a mistake for some when the storm changed path.

I went to be with my family in Miami, whose home had been, for the first time we remembered, part of a projected flood zone.  We prepared our home, gathered what dwindling resources we could find in the ensuing panic, and waited. The storm seemed to take forever to come, and the warnings from every conceivable media outlet seemed dire.  While I worried about the hospitals, I also worried about my fellow medical students, my family and myself – we might become victims of the storm.

As expected, when the storm came, my family home lost power almost immediately. It would turn out that they wouldn’t get it back for almost two weeks. We watched through peep holes as water lapped up to our taped up doors. The storm passed. In its wake what we immediately saw were downed trees, power lines, and fences. Perhaps, like the set of some dinosaur movie.

About two weeks after my first day of neurology clerkship, things were normal enough to return to rotations, though not really normal. In the buzz of the hospital, I learned my neurology ICU attending and his pregnant wife, an ICU Advanced Registered Nurse Practitioner (ARNP), still didn’t have their power back. Another ARNP told me about how nurses slept overnight at the hospital hoping the hospital would shelter them. While the hospital seemed to be all back to normal on the surface, while I pre-rounded each morning, the only topic worth discussing was the storm: from how people and their homes had fared, to their relatives, to the destruction in Puerto Rico. The storm had passed, but it wouldn’t be gone for a while.

My first patient coming back was Mr. S, who had fallen putting up hurricane shutters, hit his head, and suffered a subarachnoid hemorrhage. As I looked at his MRI, there it was, shining in his basal cisterns, that star of a subarachnoid hemorrhage–as bright as a star at night after a hurricane when all the lights in the city are out. During my clerkship, I would learn that of those who survive an initial subarachnoid hemorrhage, many patients go on to have a further complication of cerebral vasospasm (narrowing arteries), which could lead to delayed cerebral ischemia (limited oxygen supply) that leads to death of brain tissue. Mr. S had survived his initial affront, but now, he would have to wait, and hope. Every day, I would perform my neuro exam on Mr. S, look over his transcranial Dopplers (a type of ultrasound that measures blood flow), and learn more about him and his family.

Mr. S faced struggles in that dark room of the neuro ICU that I could not imagine. However, I could not help seeing how some of his feelings mirrored so many of my own those days before and after the hurricane. Unsure of what was to come, frightened, hopeful. Eventually, he was out of the dangerous window period of vasospasm, and graduated to the neuro step down unit, with a less guarded prognosis and less frequent checks. The neuro step down unit was full however, so Mr. S would stay in that dark, cramped ICU, awaiting the day he could move to a floor with more luxury of space, windows, and light. I left the ICU before Mr. S did because my rotation had ended. Unfortunately, with rotations of only a few weeks, I often find myself wondering what happened to my patients after I left. Everywhere I go there are reminders of Mr. S. I see him in still shuttered windows. I saw him weeks later in a retired man coming in from the Keys where the heat had helped trigger his myasthenia gravis as he tried to clean up after the storm. I saw Mr. S in the ubiquitous detritus of shrubbery taking up van-sized areas beside the street. There are still trees knocked over as I drive home from clerkships, months later. There are still lives that are torn apart and lost. There are still people waiting in the dark that need our help.