Education and Training
Caring Despite Chaos
Psychiatric News
Volume 40 Number 23 page 5-5

As one of two psychiatry residents who stayed at New Orleans' Charity Hospital during Hurricane Katrina, James Brad McConville, M.D., can look back on an educational experience few other psychiatrists can claim.

He provided the following account to Psychiatric News and to the alumni magazine of the University of Iowa Carver College of Medicine, where he went to medical school:

"On Sunday [August 28], we saw a massive influx of psychiatric patients in the psychiatric emergency room as family members started dropping off the sick before the storm. At the same time, we were trying to discharge as many people as possible. It was a losing battle, because ethically we couldn't refuse anyone admission and send them out in the storm.... At the same time I was unable to open more than 4-6 beds. We admitted maybe 35-40 people that day and discharged about five....It was an extremely frantic, busy day, but I did follow the storm's progress on CNN, and we knew it was going to be bad.

"We lost power at 5 a.m. [on Monday, August 29]... .The basement flooded, and we lost our generators at maybe 9 a.m. After the storm, I went outside and walked around. There was massive devastation beyond anything I had personally ever seen, but it was nothing compared to what happened in the flood....There were tons of rats, everywhere. Apparently they had fled to the land around the hospital....

"Caring for psychiatric patients during the hurricane was very stressful and challenging. For starters, many of them didn't want to be in the hospital at all. Even in the face of an obvious disaster, they wanted out. I found myself doing a great deal of reality testing and had to run group therapy sessions dealing with the hurricane. Even when surrounded by six feet of water, patients were demanding discharge and wanted to swim back to their homes.

"[S]everal of the severely psychotic patients refused to take medications altogether. Normally we have a policy for instituting forced meds, but it involves a thorough psychiatric evaluation by two independent staff psychiatrists followed by thorough documentation for legal reasons. At that point, we would give forced injections until they improved. Obviously with no staff, we couldn't do any of that so it broke down. The nursing staff didn't feel comfortable giving forced injections of Haldol every few hours—it was always pitch dark in the hallways, we were understaffed, and it just wasn't safe. I respected and agreed with that, and in some cases we simply let some of the patients remain grossly psychotic, and we focused on keeping them safe.

"In another case, I had a suicidal patient with diabetes and other medical problems who decided not to eat in hopes of killing herself.... In the end, the nurses and I spent hours a day just talking to her. I suspended all insulin in fear she would become hypoglycemic. After 3-4 days, the wonderful caring nurses on that unit talked her into eating something...."

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