Last week, Tropical Storm Isaac started tracking toward the Gulf of Mexico. As usual, the prediction models offered varying forecasts. Nonetheless, by this weekend a consensus emerged that the tempestuous weather system would, most likely, affect the City of New Orleans.
National Hurricane Center image
The Mayor, Mitch Landrieu, didn’t panic. I watched him on TV on Sunday evening in an interview with CNN’s Wolf Blitzer and Erin Burnett. Isaac wasn’t a hurricane yet, although a Category I or II storm was predicted by then. He didn’t order an evacuation. Rather, he emphasized the unpredictable nature of storms. There’d be business as usual the next day, on Monday morning August 27. Mind the weather reports, and do what you need to do, he suggested to the citizens. He did mention there’d be buses for people who registered.
“Don’t worry,” was the gist of his message to the citizens of New Orleans. The levees should hold. He exuded confidence. Too much, perhaps.
Some people are drawn to leaders – or doctors – who blow off signs of a serious problem. “It’s nothing,” they might say to a woman who fell after skiing and hit her head, or to a man with a history of lymphoma who develops swollen glands and fever. It’s trendy, now, and sensible, to be cost-conscious in medical care. This is a terrific approach except when it misses a treatable and life-threatening condition or one that’s much less expensive to fix earlier than later.
“Every storm is different,” meteorologist Chad Myers informs us.
Like tumors. Sometimes you see one that should have a favorable course, like a node-negative, estrogen-receptor breast tumor in a 65 year old woman, but it spreads to a woman’s bones within a year. Or a lymphoma in a 40 year old man that looks to be aggressive under the light microscope but regresses before the patient has gone for a third opinion. But these are both exceptions. Cancer can be hard to predict; each case is a little different. Still, there are patterns and trends, and insights learned from experience with similar cases and common ways of spreading. Sometimes it’s hard to know when to treat aggressively. Other times, the pathology is clear. Sometimes you’re wrong. Sometimes you’re lucky….
In New Orleans, the Mayor’s inclination was to let nature take its course. He’s confident in the new levees, tested now by Isaac’s slow pace and prolonged rains. I do hope they hold.
Elaine,
Comparing a hurricane’s path to patient care is a great analogy. Isn’t it crazy how we can tie everything back to cancer? And it’s so true, sometimes it all does come down to luck doesn’t it?
Interesting perspective here, Dr. S. – although it seems more the composure of Mayor Landrieu that reminds you of medicine (the hurricane just happened to be the scary possibility of chaos and trauma lurking in the background like some dreaded diagnosis!)
I’m also reminded of the ongoing concerns here of hospital administrators to free up beds. Computer monitoring of each death, transfer or discharge home means that some clerk working in Bed Control knows instantly when a human has vacated Bed 1 in Room 320, meaning one more patient just admitted through Emergency gets a place to stay. The traffic pressure on Emergency to admit (or rather, the pressure on Emergency to NOT admit) might actually mean that patients who should be admitted are patted on the head and sent home because of the triage backlog in Emerg.
The E.R. staff are thus rewarded for becoming calm and reassuring traffic cops – like New Orleans’ confident mayor.
I suspect that this pressure was likely a factor for the E.R. doc who sent me home with an acid reflux misdiagnosis despite textbook heart attack signs. Within five hours (far shorter than the recommended practice guidelines for testing troponin levels, by the way), he had successfully freed up an E.R. bed for incoming traffic while not increasing the burden “upstairs” on the inpatient wards.