Oncology Fellows
March 2018

Our Patients' Care Comes First, Even During Natural Disasters

Simon Abi Aad, MD, discusses caring for patients during Hurricane Irma.

Simon Abi Aad, MD

As a senior fellow, one is blessed to have a light call schedule compared with that of our younger peers. Having paid our dues during residency and fellowship, we get the privilege of picking our call schedules and are required to cover just 4 weekends for the whole year.

With 3 call weekends left on my schedule, it was smooth sailing. I was scheduled for the weekend of September 8, 2017, which looked to be a warm but unremarkable Miami weekend. I would be rounding on the patients, taking in new consults, and covering for colleagues who were taking the weekend of. There was some talk and background noise that Hurricane Irma, brewing in the Atlantic Ocean, might make its way to Miami in the coming days. After all, it was hurricane season, and that’s a weekly story, nothing to worry about—or so I thought.

I have had my share of calamities during my medical training. I spent a month at a military hospital during wartime in Lebanon, was stuck at Memorial Sloan Kettering Cancer Center in New York City throughout Hurricane Sandy, and was the weekend on-call fellow during the blizzard of 2015, also in New York City. I figured I had enough “when I was your age” stories to tell younger physicians 20 years from now.

Irma had other plans. As the week progressed and the e-mail frequency increased, I soon found out that the hurricane would be making landfall during my call weekend. The emergency plan was basically for the house staff and attending physicians to pack and head to the hospital on Saturday morning, with no expectations of leaving before getting the green light from the hospital leadership. Every patient who didn’t need to be hospitalized over the weekend had to be discharged as soon as possible. All noncurative chemotherapy was put on hold until further notice. This was obviously not the first rodeo for our hospital.

After my fair share of lamenting my fate (a little dramatic here), I was on my way for my 3-day lockdown. When I arrived at the hospital, I found it barricaded as though ready for the apocalypse. No door or window was left uncovered. Only a few entrances were open; they would be locked down at noon that day.

Despite the warnings, it was sunny and beautiful outside— the calm before the storm. I walked in, expecting chaos, but it was business as usual for the nursing staff and hospital operations. Everyone was in a good mood and ready to go. I found a place to sleep and created my own area, which I split with my attending physician. I had enough snacks for 3 days. They were gone in 3 hours—stress eating, I guess. Soon after, the hospital was on lockdown. No one could get in or out, wind speeds started picking up, and the only way to know what was happening outside was by watching the TV screens in the hallways and patient rooms. It began.

Cabin fever hit hard. I was isolated from the outside world, with no natural light and no cell phone reception. Going for a walk meant pacing the hallways and visiting patients on the other side of the hospital. No one—neither us nor the patients— could really sleep or eat well. We were more concerned with the goings on outside, and then for ourselves inside. Patients asked me more about what I thought would happen to their loved ones than about what was happening with their treatment and disease. That’s not uncommon with people who have cancer; despite having to fight the hardest fight of their life, they always feel that they have to take care of those around them. I never get used to their show of strength, and even though I cannot know where or how they get it, I admire it and accept it.

I spent more time than usual with patients, because time was the only thing I had plenty of at that point. We briefly discussed their treatment and complaints for the day, and then they always moved on to telling me stories about their last hurricane and how bravely they prepared for it and got through it—how they rebuilt what was lost better than ever. We would end the conversation by comparing their cancer with the hurricane and how they would get through that, too.

In my downtime, I tried without success to study. I just had to follow the path of that big spiral in the sky. On TV, online, on my phone…I never knew there were so many weather apps out there!

After 3 days and 2 sleepless nights with no sunlight to go by, no window to peak through, my body and mind started losing track of time. It’s hard to explain, but I soon became disoriented: 3 PM felt like 3 AM and vice versa—not a good feeling.

And then, at the nurses’ station, we received an email saying that it was safe to go outside—the worst of the storm had passed. We were advised that some roads would not be accessible because of broken trees and downed power lines, but I didn’t read that part. All I wanted was to get out. As I walked through the exit, I could see the first signs of the aftermath— massive trees ripped by their roots lying in the middle of the street, which would require lots of manpower and machinery to budge. Nature’s wrath is scary.

After I walked around a bit, watching as people started to clean and fix what was broken or lost, I went back to check on patients before my relief coverage took over. One of my patients with leukemia asked me when I was going home. “In an hour or 2, I hope,” I replied. She said she was happy that I finally would get some rest in my own bed. “You deserve it. And go shave—you look better without a beard!” she said.

My drive home was a slow one, although the streets of Miami were eerily calm. Not too many people were outside or even around, because most of the city had been evacuated. Some streets were either flooded or so strewn with debris that I had to change routes. Electricity was out in some areas and phone reception was spotty at best, but all in all, I thought, we dodged a bullet. All I cared about was a warm shower and few good hours of sleep. I made it home.

The next morning, I woke up to a phone call from the hospital— I had overslept. I dressed hastily and headed back to work. Just another day on the job. No glory or fame. Life of a doctor, I guess… As doctors, we are committed to certain things that most people do not even consider. We work at night, we work during holidays, we work on weekends, we work after hours, we work before hours, we work when everyone else evacuates to safety. We also leave behind our families, our loved ones, and our children to fulfll our duty to strangers, hoping that those we love will take care of themselves. It’s unfair, one might say, and it raises a lot of questions about the work that we do—questions such as “Why shouldn’t I be able to evacuate with my family?” and “Why should I be separated from my loved ones when it matters the most, to go take care of others?” It’s exhausting and makes you age quicker, plagued by guilt trips every time you think about it.

At the end of the day, that’s what makes our lives as doctors unique and, dare I say, brave. We fght for our patients and for their well-being every single day, rain or shine, hurricane or war. We do it not because we are forced to; we do it without questioning. We never ask if we should do it, for that’s a fait accompli; we ask what the best way to do it is.

I had so many questions leaving home the day of the hurricane, not knowing what I would return to, but I never questioned whether or not I should be at the hospital. It was my duty. I could say that doctors have a military-level commitment to their duty toward their patients. That makes us proud! At the end of the day, I made a diference for the fathers, mothers, brothers, sisters, cousins...everyone I took care of during the hurricane. Who knows, maybe I had a role in saving a life or two.

I hope that I don’t keep attracting disaster situations on my weekend call days. I am happy to pass the torch, but if I end up in another hurricane, I can say that I’ve seen enough to be ready!

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