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AAOS Now

Published 11/1/2017

Inside the Shelter

'Luckily for me, a priest walked up and helped'
Camden Tissue, MD, is a recently minted orthopaedic trauma surgeon practicing at Memorial Hermann Southwest in Houston. As a lifelong Houstonian, he returned to the area after completing his training in New York. "My wife and I looked at each other as Hurricane Harvey was bearing down the coast and said, 'Why did we leave New York again?'" he said.

Dr. Tissue noted that as a wind event, Harvey was underwhelming. "A lot of times when you watch the news, it feels like fear mongering to keep you tuned in. I thought that was going to happen with this one. However, two days later, you could definitely see that it was not stopping and the hurricane was not moving. It was dragging band after band of rain right over the Houston area and after the first day and night, the flooding was already awful."

As it became apparent on Sunday that the flooding was going to be on a colossal scale and vast numbers of people were going to be displaced, Dr. Tissue's thoughts turned to what he could do to help. He conferred with a close friend, Marc Robinson, MD, an internal medicine physician who had served in relief situations, including Haiti.

"When something like this happens, we all want to rush to help. I thought, 'Oh, I'm a doctor. I should be helping.' But Marc kept telling me that you have to pay attention to what relief workers and victims are requesting. Just because you have a skill set doesn't mean it is needed."

At about 10:30 p.m. Sunday night, word came from the George R. Brown Convention Center, which served as a temporary shelter in downtown Houston for nearly 10,000 evacuees, that the facility desperately needed physicians. Without the complication of a flood, the trip to the convention center should have taken Dr. Tissue about 12 minutes. However, it took him and his friend more than an hour as they kept running into high water. When they arrived, they found a rather chaotic scene, with the 10,000 people crowding a space that had been designated to accommodate about half that number.

According to Dr. Tissue, the most glaring need was for drugs. Salvation came in the form of a pharmacist who lived two blocks from the convention center and who owned a pharmacy in Sugar Land.

"He took it upon himself to drive to Sugar Land, which is on the west side of town where the flooding was the worst, and emptied his pharmacy into his car and brought the supplies back to the shelter. Without him, we would have had nothing," Dr. Tissue said.

The volunteers onsite—Dr. Tissue, Dr. Robinson, an emergency room physician, the medical director of the Houston fire department, and a few others—set up a triage desk along with a critical care area for people with urgent ailments such as breathing problems. Dr. Tissue's orthopaedic skills were not in high demand among the hundred or so people he and his colleagues treated.

"It was mostly people who had chronic medical problems like diabetes, hypertension, seizure disorders, and these sort of things," he said. "Their medications had washed away in the flood. I was basically an intern for the medicine doctor. I would make my medical plan, not that I have any sort of expertise in that area, just what I could remember from medical school, run it by him real quick to make sure it was OK, and then I'd go and dispense medication to the patients."

While a couple of people in the shelter had broken bones, they were not acute. Mainly, people needed splints after they had discarded their wet casts. Dr. Tissue and the other doctors were able to handle the overt medical problems. However, the biggest unmet need was for social workers and psychiatric medicines.

"People's psychiatric medicines got washed away, and we did not have those available. So, we were getting called in to diffuse situations in which people were struggling with their psychiatric illnesses. At one point, I was standing between two people who were having a heated argument about whether God was a man or a woman. Luckily for me, a priest walked up and helped me as I was feeling very overmatched at that point. I was thinking, 'There are no bones to fix here; what do I do?'"

Dr. Tissue and others have observed that it is during the recovery period of a natural disaster that orthopaedic injuries may be seen in larger numbers, as amateurs endeavor to repair their homes and the professional contractors take on taxing workloads. Furthermore, the recovery from this slow-motion disaster will be painfully long.

"There will be new needs in the near and distant future. We need to save some of our collective goodwill to continue taking care of our neighbors now and months from now," Dr. Tissue said two weeks post-Harvey. "For those of us who were spared from the flood waters, our lives are back to normal, but that's not the case for many of our neighbors. That is the most important thing to keep in mind as we go forward."