Friday, April 21, 2006

New Orleans Matters

Yesterday I had an afternoon off, and as is my vice & habit, found a bookstore. A book caught my eye called “Why New Orleans Matters” by Tom Piazza, a long-time resident. I inhaled the book when I got home. For I once lived in the area . . . a brief glorious time immediately after residency. Metarie, Slidell, Covington, Mandeville, and that miraculous eighth-wonder-of-the-world bridge across Pontchartrain – I trolled every nook and cranny. On my weekly excursions downtown, I did what many would consider to be some very stupid things as a female all by myself. But that was kind of the point. If it is possible for a city to heal a broken heart, this one did. Forgive the clichés, but darkness visible was banished by the incredible lightness of being I found and embraced in and around the City of New Orleans.

As Katrina approached New Orleans last year, e-mails were flying back and forth between my friends and I, speculating about what would happen to the city. I had just gotten back from THE trip to Great Britain with Mom. Exhausted, I had still contemplated hopping a plane to catch the LSU Pediatric Board Review course that is held at the Hyatt (adjacent to the Superdome) every year. It’s a great way to get monster credits in continuing medical education and slurp down your “Hurricane” too. But I was wiped out, my ankles were already swollen to three times their normal size (from scrunching my American frame on the buses & planes on our trip “over the pond”), and I HATE to fly . . . so I decided not to go. I had also been watching Katrina’s storm track in the Gulf. I did not think it would hit the city, but did not want to be anywhere near “the bowl” if it did. One of the e-mails I sent out (as the storm bore down, but before we knew the extent of the disaster) was to a good pal in Memphis who did not understand my attachment to the Big Easy. Here’s my explanation:

“I lived there for six months - a Locums assignment right out of residency. I experienced Thanksgiving (fried turkeys), Christmas (gorgeous), and Mardi Gras (like Times Square, I can say I did it once), St. Patrick’s Day and JazzFest in all of their unique Louisiana glory. I loved the people (not the drunk & boisterous tourists) but the characters who inhabited the city - and MAN were there some CHARACTERS! There was a class system to be sure, but people showed one another a respect - no matter what their circumstances - that I have not seen or experienced since. I've heard it likened to San Francisco (although I've never been there). The place was ALIVE . . . full of architecture and folklore and accents and ghosts and history and art and music and the best food in the world. I was happier there than I have ever been. But I left, in large part, because I knew something like this was coming. They were talking about it years ago. In fact, the week after I pulled out for good (except for the occasional visit), my apartment complex parking lot was under water from a nasty tropical storm.

Also, some of my fondest memories of Daddy involve the Big Easy - when he & Mama came down to visit me for Christmas (the year I was there) - or when they accompanied me to the Board Review for CME. He loved the trolleys and steamboats and would have hopped the damned things all day had it not been for Mama's carefully planned itineraries. On one occasion, he bought a dapper black cape and walked down the street in the French Quarter swishing his cane - he was quite dashing and I had never seen him behave like that. People mistook him for some kind of foreign lord. It was hilarious. And I have a favorite restaurant on the other side of Pontchartrain - where I took & treated my parents - and we had one of the best dinners of my life on the front porch of an antebellum mansion as the sun set - right in front of the lake. Sometimes when I close my eyes . . .

My beloved city is not some &^*% "bowl". It is a state of mind. I hope my old friends will be okay."
For a brief period, the next day, it appeared that the breath of God had blown down from the heartland, and - in a twist of irony - nudged the storm’s eye away from a city that many regard as a modern Sodom and Gomorrah. I breathed a sign of relief. But then word came that the levees had failed. Good times rolled no more.

It’s easy to play the blame game where New Orleans and Katrina are concerned. People want to blame it all on Bush & FEMA . . . or that idiot Mayor Nagin . . . or Governor What’s-Her-Name of the Very Important Louisiana What’s-Their-Names. But the truth is, that this is one game where everyone has a little piece of the action . . . from the people who lived there forever (of all races and classes) and ignored the risk . . . to the tourists who took much for granted (especially the faces that populated the service industries) when they visited. In this case, Al Gore was right, for the short-sighted “needs” and greed of the modern world have literally re-shaped the mouth of the Mississippi . . . and decimated the barrier islands that protected the mainland. Louisiana politics has always been corrupt, everybody knew it and chuckled over it and shrugged off the sleaze as part of the “charm” of the place. And like San Francisco, everybody knew “the big one” was coming . . . but it just wasn’t going to happen anytime soon . . . so it was okay to divert levee funds to new casinos.

I will never forget Daddy pulling me aside, after he & Mama got back from taking one of the Bayou tours, and admonishing me, “Daughter, you have your fun and you do what you need to do. But don’t you stay down here. Someday a big storm is going to hit this place . . . it won’t even take a big one . . . and when it does, these levees will not hold . . . it will be the biggest mess you’ve ever seen . . . and you do not want to be here when it happens. Mary, I am serious, these levees WILL NOT hold.”

My Father was a wise man.

I held a Louisiana medical license until early 2004. I always liked to say I had a license to practice medicine and voodoo. I finally and reluctantly let it go as I did not expect to ever return there to practice After the storm hit, like everybody else (and with a couple of weeks off before I started another assignment), I wanted to hop in my car and drive down and help. But I knew that, practically speaking, unless there was an actual plan to that kind of action, I would be more of a hindrance than a help . . . another mouth to feed and house . . . when there was no food and the houses were flooded or gone. Besides, in order to practice medicine in any state, one must be licensed in that state . . . and even if you are a “Samaritan”, you’d better damned well be insured. I e-mailed the NCMS and the AMA and DHHS, and made some phone inquiries about offering my medical services. But it all came to naught. The government programs were not flexible enough to accomodate short-timers with good intentions – nor were they prepared to mobilize and use all of the offers they received.

In this era of terrorist threats and regular unnatural disasters, the aftermath of Katrina is the best argument anyone could make for a national system of medical licensure (not to mention medical discipline). But the state medical boards will never give up their little fiefdoms. And so it goes.

I have a beautiful print of the French Quarter . . . a “period” piece that depicts St. Louis’ Cathedral and the Café DuMonde . . . that hung in my office during my entire tenure at RMA. After I was fired, it was stored in Mama’s attic, for it reminded me too much of the happier times in Asheboro, and what I had lost. I pulled it out after the storm, and dusted it off, and propped it up against the wall in my bedroom. I’m told the French Quarter escaped a lot of the damage – as the Quarter abuts the River and is actually the highest part of the city. In the right light, my print looks like you could walk right into the scene, scarf down a beignet, and stroll down St. Anne’s to the shops on the Rue Royale. I wondered what remained.

I got my answer. A dear friend of mine from residency has family in the New Orleans area. For a time, after the storm, she actually brought her young nephew up to stay with her (faux-motherhood became her). A few weeks ago, she went down to visit – for the first time after the storm. I asked her to bring me back some trinket – some remembrance of the place – a symbol that my beloved city was still there. We had dinner a week or so ago. She apologized for not bringing anything back, but told me that her family had taken her on a “tour” of the destruction . . . the sights and the smells . . . and the silence . . . and afterwards she had not felt like buying anything. Her eyes told me a story that words could not. And she sadly told me that she did not think I should go back down for the foreseeable future – as she knew what New Orleans meant to me, and that she did not think I would be able to bear it. It’s a good theory and I’m not going to test it anytime soon.

Anderson Cooper, of CNN, made a name for himself reporting on Katrina and its aftermath. His blog featured a post last week entitled “Big Easy healthcare Falls on Hard Times”. Healthcare in New Orleans was never “easy” . . . even before 40 percent of the doctors left . . . even when Charity was open and the state & federal money flowed. The politics and impracticalities and hard realities of medicine – especially for the poor - made New Orleans a great place to train (because you saw everything), but not a place where everyone wanted to stay once they were done. The Big Easy was big on “burn-out” . . . as its excesses eventually caught up with you.

If Katrina proved anything, it proved that, where healthcare is concerned, we are all vulnerable, and there is no net.

Reality bites. A sinking bowl on all sides, I am skeptical that New Orleans can or should ever be rebuilt exactly as it was. Rebuilding a decimated neighborhood that is 16 feet below sea level simply makes no common sense. But Tom Piazza argues (convincingly I think) against the “top-down” approach to “re-building” the city . . . the “Las Vegas South” model that many, including Nagin, have proposed. “The top-down approach is relatively straightforward and quick and it will ruin something that can never be replaced. The bottom-up approach will take more thought and maybe more time, but it will build a New Orleans that feels like New Orleans, and that can last. Put in the leg-work to bring in investment to rebuild what is already there . . . the aquarium and City Park, the stores and restaurants and universities and neighborhoods that have been damaged, the hotels that have contributed to the city’s economy for years. There will be plenty of money to go around. Use a Habitat for Humanity model to construct durable and livable and affordable housing for the people who want to come back to the city they love and will work for. Give people a sense that they have a stake in rebuilding their own lives – a collective project that can make everyone feel proud instead of cheap. That will be in the spirit of New Orleans, and it will pay back dividends for the entire country. It is not too late.

And then maybe next year, or the year after that, we will pass on another on Mardi Gras Day with the sound of a parade in the distance, or a gang of Indians coming down the street, and we can stop and share a drink and a laugh under the oak tree and give thanks once again for this beautiful day, this life, this beautiful city, New Orleans.”

People like Tom Piazza give me hope that we, as a nation, will ask the right questions and get the right answers and figure it all out . . . because New Orleans matters.

1 comment:

The Sewing Machine Doc said...

Dr. J,

Just a brief 'Hi". Not sure how I found your blog (actually searching for the word physician but I digress). I read a few of your posts with interest, will read more as I get time. I am an Emergency Room Physician in a rural hospital in Eastern NC. I chose to return there after a hiatus in Virginia as that is where I trained. The hospital is also closer to "home" and not too far from where I taught high school and coached in my younger days. On my return I found the county hospital was purchased by a for profit company. There is tremendous pressure to admit everyone who walks through the door. Calling a sty periorbital cellulitis or a rash cellulitis is supposed to allow us to legitimately admit these people. At least there is the suggestion that we should stretch the truth. I have chosen not to play that game which makes me a target of the administration. Fortunately for me, being that this is my backyard and the other ER physicians are from much further away and the fact that I have known the other attendings for a long time gives me some protection (at present). They certainly have totally screwed up the medical profession in the past generation haven't they.

About Katrina. In the week after the hurricane as the pictures came across the TV screen, I tried very hard to join a group and volunteer my medical services in Louisiana or Mississippi. Health and Human Services, Red Cross, etc... Was told there was no longer a need, then told they were only accepting applications from groups. I finally got to go and serve last month. Not as a physician but as a house stripper (down to the bare studs) with a church group. It was a wonderful experience which I shall not forget in this lifetime. Despite the government's best efforts to destroy the city, the people of New Orleans move forward, so full of optimism and faith it was overwhelming. I'd like to go again this summer or fall.

I tend to stay away from blogging my medical experience, instead opting to journal my non-medical events. I repair sewing machines in my spare time which I am almost ashamed to admit I get more satisfaction from than working the ER.

Again, I'll read some more as I get time. Blog on.