Inside the psych ward for Katrina survivors

HOUSTON--I arrived too late to see Bill and Hillary Clinton, and George Bush, but just in time for the dysentery.

After getting up at 4 a.m. and taking a long flight from Oakland, Calif., my early-afternoon arrival at the Astrodome left me just a little jet-lagged.

As soon as you are a mile away from the stadium, you start to see groups of teens and young adults walking everywhere in the middle of busy traffic, sitting and talking on highway medians. Some are cowering in parking lots. Apparently, many area drug dealers have also arrived, lured by the possibility of making a quick sale. We would later be treating some of the purchasers in the medical building.

We pulled up to Reliant Arena, which is part of a huge plaza complex that includes the Astrodome and Reliant Stadium (home of the NFL's Houston Texans). The arena is where the makeshift clinic and hospital are housed. It's actually a pretty impressive de novo medical center. There are metal dividers everywhere, with canvas curtains separating the general-medicine clinic, surgery, infectious disease, obstetrics, pediatrics and psychiatry areas. There is even a dental clinic and a dialysis area. Everything is relatively cheek by jowl. If you lift up the curtains for the psych emergency room, you are in the dialysis clinic. Pediatrics shares drapes with surgery.

One problem is that the only restrooms for medical staff are portable toilets about a block away. As the day drags on and you keep slugging down coffee, the relieving distance seems longer and longer.

A large room is identified merely as "quarantine." It already hosts at least 50 occupied cots. People have started getting dysentery, marked by diarrhea and vomiting, which leads to dehydration. They don't know what the infection is yet. Until they do, everyone stays in isolation.

The evacuees are all wearing wristbands so that they can enter and leave the Astrodome. There is a center area of makeshift hand-washing sinks but no water inside the individual clinic areas. Thus, there are many bottles of "dry" alcohol-based hand-washing bottles, and everyone is encouraged to wash their hands every few minutes to prevent any further spread of disease.

I work in the Psych ER with two other doctors. Others come in and go during the day, seeing if they might be of help. But they are of limited assistance. They are regular psychiatrists and not very familiar with emergency, medically based psychiatry. We assign them to the many patients who need grief counseling. There also are at least a dozen nonphysician grief counselors for folks who don't need a physician but just want someone to help them cope. They have their own, separate tent for counseling.

Patients arriving at the Psych ER area are evaluated by a nurse. If they seek counseling, they are sent to grief counselors. If they need a doctor, someone takes their vital signs and some basic information, and then places them in one of nine curtained areas to wait for one of us. A whiteboard shows the names of those waiting, and we sign our names next to theirs to take responsibility.

Most need medications today. They haven't had their meds in more than a week. In some cases, that is really starting to make life difficult. A lot of pharmaceutical companies have donated piles and piles of free samples. We have one curtained room that looks like King Tut's tomb, full of free psychiatric meds.

We meet the people, and we ask about their symptoms, figure out what they need. They tell us their stories of the past week. It is as bad--or worse--than what you have been seeing on TV. Already, I have had two patients who say they had to break holes through their attic roofs, then climb out of their houses and swim to safety. One guy said he just kept swimming and swimming, not sure which way to go. Sometimes he let the current take him, other times he grabbed a street sign, hanging on for a moment's precious rest. He finally made it to the Convention Center and sprawled out on the sidewalk. An old man was sitting in a chair next to him. An hour later, somebody threw a blanket over the man in the chair, because he was dead. The dead body remained in place for three days.

Another lady said she had been separated from her husband in the confusion around the Superdome and that they ended up on different buses. He came here to the Astrodome, and she somehow wound up being sent to Dallas. In Dallas, they cleared out the county jail. After losing her home and being separated from her husband, the woman is now being provided shelter behind bars. A relative had picked her up and brought her here. She needed some meds to get herself stable again so she could go into the Dome and look for her husband.

Later, I was asked to see a patient who was in the Astrodome itself. Some police gave me a lift over to the building, which is about three blocks away. The cops and security personnel wear face masks. They say they worry about contracting tuberculosis. The Dome is packed with cots and people. There will be many more soon, as there is an 11 p.m. curfew, and everyone must be back inside or else.

This is a media fishbowl for politicians and media personalities. Last night, Dr. Phil did a live support session with evacuees in the parking lot. Greta Van Susteren of Fox News is live inside the Dome.

There is always someone wanting to come in and take command. Luckily, the director is very strong-willed and pretty much tells them where to go. He is very humble and doesn't like TV or radio so he won't do any interviews. He tells the people who want to be in charge that they can go talk to the media for him. This makes them happy, since they get what they really wanted.

He has asked if I will work all night tonight. I have agreed. I was able to take a few minutes to find this Internet connection. But soon, the line will be will be given over to taking care of patients. Hopefully I'll get some sleep in the morning.