Hurricane Response Efforts

On October 28, 2012 an unprecedented storm hit the New York City area. Hurricane Sandy tested the strength and resilience of the NYU psychiatry residency program. Over the next week, with the assistance of our amazing residents, we successfully evacuated our three main hospitals and over three hundred of our hospitalized patients. Included here are a series of photographs from this storm and its aftermath. In addition, one of our senior residents also documented his experience of these events. The courage, endurance, and dedication to patients displayed by our residents during this disaster reflects the spirit of the NYU psychiatry residency program. We look forward to meeting all of our interviewees and to sharing our experiences with them.

Senior residents arrive to help with the crisis.

Residents gathering in the psychiatric emergency room.

"Neither rain... nor hurricane, nor flooding, nor pregnancy stays these residents from the swift completion of their appointed rounds." We asked her to stay home, really!

Camaraderie during some downtime.

PGY2s have each others' backs during a crisis.

Residents, attendings, and social workers enjoy a rare sight together - an empty CPEP!

We made plenty of friends in the National Guard for our next adventure. They were amazed at how swiftly and effortlessly we trekked up and down 20 flights of stairs.

EMS personnel lined up in the Bellevue lobby to evacuate.

Everyone together after a long night of work.

The scene in Bellevue's atrium after evacuation was complete.

Dr. Marmar takes us out to celebrate a job well done. From disaster area to fine dining, just another typical day for an NYU resident prepared to handle any setting!

The calm after the storm: NYU Psychiatry leadership expertly plans the next steps to continue our mission of compassionate patient care and academic excellence from our central One Park Avenue offices.

Resident Account of the Storm

As the storm raged outside, I sat in my relatively unscathed apartment and neighborhood in Williamsburg, Brooklyn watching and reading in horror as one catastrophe after another fell upon the medical center where I had spent the past three-plus years working and learning. First, prior to the storm, the Manhattan VA Hospital was emptied out. Then, NYU-Tisch Hospital was evacuated emergently as the storm surge flooded the basement and the backup generators failed. Next, I learned that Bellevue was running on backup generators and was initiating a partial evacuation. Bellevue is the heart and soul of the NYU Psychiatry Residency Program. A public hospital with over three hundred psychiatric beds and one of the busiest psychiatric emergency rooms, it provides care for some of the sickest, most disadvantaged people in the city, country, and world. Many, if not most NYU psychiatry residents largely choose the program because of Bellevue, and through our training, grow to love it and the service it provides in a deep and complex way. When I heard that this fortress of care for the underserved was seriously compromised for the first time in its storied history, I was deeply saddened.

So, when I received an email from one of our Chief Residents on Tuesday morning asking for residents to come in and help out, I barely left time to brush my teeth before I was calling a car service to take me over the Williamsburg bridge. The scene that I encountered when I arrived was surreal. The hallways were dark and eerily quiet. The National Guard was everywhere, and the smell of the generator diesel hung pungently in the air. It was one of those moments when life imitates fiction, and it felt like I was living out some sort of post-apocalyptic television series.

One might imagine that helping in a hospital after a disaster might be full of busy, frantic work. However, with the emergency room closed to new patients and none of the usual non-urgent hospital work getting done, it was actually significantly less busy from the resident perspective than any routine shift. Rather, it quickly became clear that the main "task" was to let the administrators and physician leadership figure out what needed to get done, while trying to keep the hospital functioning at a safe level for patients and get as many patients out as possible. For the heroic staff present during the hurricane, this meant creating a human chain from the ground to the thirteenth floor to pass fuel up to the generators before the National Guard arrived to take over the task. For residents, this often meant waiting for long periods of time for instructions to carry out any non-clinical tasks necessary.  This ranged from escorting discharged patients safely down twenty flights of stairs to walking discharge medications or food from the ground floor to the eighteenth or twentieth floors. Notice a theme?  My legs and knees will be sore for weeks! We often ran into numerous administration snags and communication disruptions. For instance, the pharmacy computer system at one point went down, and an overwhelmed pharmacy staff had to fill and label discharge prescriptions by hand. There were often mistakes in the process, which initiated a correction process that took hours, involving a flurry of phone calls and then a series of on-foot trips: back to the inpatient unit for a new prescription, then to the inpatient pharmacy on the fourteenth floor for approval, then to the ground floor pharmacy for filling, and then back up to the unit for verification and dispensing. While such a process would have infuriated us on a normal workday, we were able to take it in stride. It seemed our Bellevue training had prepared us to work under the most difficult conditions, as long as we knew we were doing our best for our patients.

As Tuesday turned into Wednesday (many of us lost track), the conditions became both worse and more eerie. I have vivid memories of walking past a darkened, empty ICU with many of the machines still crazily beeping (the intensive care units were evacuated first), the National Guard carrying extremely ill-appearing patients down many flights in stretchers, and watching body bags leave the hospital as the morgue was evacuated.  At one point, the hospital's plumbing failed, and the various smells grew vile as the toilets filled with un-flushed excrement. I remember thinking how inhumane it was to have even a single psychiatric patient locked on an inpatient unit in such conditions.  Because of this, the psychiatric administrators and staff worked furiously and tirelessly to get patients discharged or transferred, even before an official evacuation order came from the Mayor's Office. I remember seeing the head nurse of the psychiatric emergency room show up in a bright red dress, bright red lipstick, and a determined look on her face. Everyone knew (more than even usual) to stay out of her way unless she had something for you to do. I swear I saw Bellevue's director of psychiatry every time I turned around, her demeanor somehow as sweet and openly caring as ever.  I worry that the pregnant director of consultation-liaison psychiatry did not leave, or even rest for days as she helped to coordinate the safe transfer of hundreds of patients who could not be safely discharged.

After the official evacuation order was announced on Wednesday afternoon, the pace of the work picked up (at least for the residents). We had to get everyone transferred by Thursday at noon. Finally, they needed the residents clinically. We dispersed to the units to frantically prepare legal forms and discharge paperwork. Of course, seeing doctors working at nursing stations attracted a great amount of patient interest, and the more psychotic patients began to pepper us with questions about why they weren't being discharged, whether we could give them their birth certificate that we surely had right in front of us (we didn't), where exactly the belt that they came into the hospital with was, and why we weren't giving it to them, etc. It was fun in a strange way to watch my co-residents verbally re-direct these patients using each their own unique clinical style in between legal documents and transfer forms. At one point, the National Guard showed up to mass-evacuate a unit just as we were signing the very last piece of paperwork. As they showed up, we noticed that a particularly paranoid patient was becoming suspicious and agitated. In a moment of snap clinical judgment that Bellevue training prepares us so well for, we decided that he would make the trip down twenty flights and to another hospital much more safely with some medication on board. We quickly ordered an oral dose of medication, which the patient took in the last few seconds before being whisked into the staircase by the Guard.

As the evening progressed and it became clear that the mid-morning evacuation deadline was miraculously on track, some of us decided that it was time to go home (our chiefs heroically remained behind). We were asked to help escort several patients who were ready for transport down to the psychiatric emergency room on our way out. When we arrived on the unit, we quickly learned that one of the patients, an obese and very psychotic woman, was unwilling to leave. She was understandably confused and afraid by the events of the past several days, and was terrified of being transferred to another hospital by strangers in the wee hours of the morning. We would normally delay any non-urgent procedure or activity for such a patient, to allow time for staff that she knew and trusted to speak with her about it the next morning. However, these times were anything but normal. Every patient had to be evacuated when their transport was ready. Therefore, we had to do the kind of thing that makes psychiatry more difficult than any other field in certain ways. We had to enter the dark room where the patient was staying with flashlights, and after an unsuccessful attempt to convince her to take oral medications and reconsider her refusal of transfer we had to give her medications over objection via injection.

As it should, this type of intervention always gives me a deep, gut-wrenching feeling of sadness. To have to temporarily override any individual's autonomy, especially when they are at their most vulnerable - even when you know it's necessary for their safety--is possibly the most difficult thing that a psychiatrist or a physician can do.  As I left the unit with the other patients, her screaming rang in my ears.

Numerous complex and interweaving impressions and lessons are swirling through my mind, and I'm sure time will help me to consolidate many of them. However, a few crystallize immediately. I have come to respect my supervisors and colleagues more than I could ever imagine. Other than the patients, it’s the most important aspect of this work that makes it both possible and enjoyable. I have also been reminded once again of the vital importance and value of rigorous, intensive clinical training - training that prepares you for anything in clinical work and to a certain extent, in life. Finally, this disaster and response reminded me that how we choose to value each other and work together as a society matters in a profound way; in fact, it often carries life or death implications. Bellevue is a public hospital with a mission to take care of all comers, regardless of class, insurance, race, gender, sexual orientation, or immigration status. If Bellevue didn't exist, far fewer patients in New York City (particularly psychiatric patients) would have access to the skills, dedication, and passion of so many talented health care workers. And Bellevue would not have been able to safely evacuate all of its patients over a series of a few days without the coordinated effort of the local, state, and federal governments, including the National Guard. I am prouder than ever to be affiliated with an institution that represents and actualizes the sense of community and mutual support that exists in New York City.