Seeing in the Dark

By Eric Manheimer, MD

The tropical storm Sandy that hit the greater metropolitan area of New York caused enormous damage in vulnerable flood-prone communities; and shut down several hospitals in Zone A, resulting in emergency evacuations without power. Front line hospital staff throughout the metropolitan area were locked in place for days. During this time, they performed at an exemplary professional level. First responders including police officers, fire fighters, and EMTs to subway workers and everyone in between, did what they had to do and what was expected of them, with first-class performance and outcomes.

The storm surge was higher than expected and exceeded the fragile, aging city power and transportation infrastructure at critical junctures. Hospital backup power and IT functionality were incapable of withstanding the saltwater deluge. A year earlier, Hurricane Irene had come through with lots of wind and rain, leaving little damage (and perhaps a false sense of security). Hospitals had been mandated to preemptively evacuate “just in case.” However, with Sandy approaching the greater New York area, decisions were made by multiple agencies responsible for emergency management not to require evacuations. Leaders at two hospitals chose to voluntarily move their patients to higher ground over the few days of false calm before the storm hit.

Sandy touched down on New York City just as the presidential election season was mercifully ending. The endless television commercials, talking heads on steroids, and shameless shamanic forecasting were thrust aside for a full week before Election Day. As my wife and I watched, the 14th Street transmitter blew and southern Manhattan blinked its way into darkness.

The professionals at the front lines had done their jobs and continued to do so, until relieved when power and transportation was gradually restored in fits and starts, all limited by a gasoline shortage that had many of us revisiting the OPEC oil embargo of the 1970s.

The “lessons” from the storm will be parsed for some time. There will be many public statements, writing and rewriting history as FEMA totals up the damages and the political process goes into high gear for compensation.

A few lessons from an observer blacked out and without phone service during the storm:

Regulatory bodies governing hospitals provide minimal standards. Those standards are not a reliable yardstick to make judgments about what needs to be done in all situations. Given the experience with Hurricane Katrina and other complex “accidents,” we know what can go wrong. We frequently do not make the tough calls to provide the resiliency in our systems or opt for the safest situation for our patients and staff, relying on heroism to save the day.

Agencies responsible for the care and support of communities do not always make the right decisions. Their vision is imperfect and frequently clouded by the weight of political forces or faulty judgment. The question is not whether the plane landed 99 percent of the time.

The absence of climate change discussions on a national level, although discussed in great detail on multiple levels from the Discovery Channel to Science and Nature, has created a cognitive dissonance for leaders. On the one hand, the oceans are rising and temperatures reveal a warming planet. On the other hand, climate perturbations aren’t felt on a local level as putting a city, its institutions, and its people at risk right now.

The politics of the past decade have meant trillions of dollars spent on wars without limit; the US infrastructure is in decline and needs investment. The same was said in the 1970s when the Vietnam War ended and social programs suffered. Investments were delayed and we entered a prolonged recession with severe social consequences, including a war on drugs, mass incarceration, civil unrest, and the beginning of the economic decline of the middle class.

There are no easy solutions to the storm surge and depredations of Hurricane Sandy. We will have to face our own issues, encounter problems of our own making, and find the correct solutions by first identifying the right problems. Technological fixes are only partial solutions, even if these solutions are affordable and doable, such as creating mechanical barriers around New York City’s harbors and inlets.

Will leadership emerge equipped to discuss the underlying complexities and change the debates from denial and fear— manifested by building bigger barriers — to more fundamental solutions? Can the focus move from short-term patches to longer-term thinking on an entirely different level? As the lights came back on, did we lose the ability to see?

—Eric Manheimer, MD, is a clinical professor of medicine and medical director of NYU’s Langone Medical Center. He is the author of Twelve Patients: Life and Death at Bellevue Hospital and can be reached at eric.manheimer@myumc.org.

Editorial Note: Dr. Manheimer additionally lends his leadership perspective on the events surrounding Hurricane Sandy in a longer edition of this article now published in the latest edition of the New England Journal of Medicine (NEJM). It can be accessed through the NEJM’s website.

0 thoughts on “Seeing in the Dark

  1. i very happy after reading “While hospitals are managing Medicare patients with rising rates of chronic disease, the federal government “doesn’t want to pay more for the rising severity that has been uncovered by their new, more accurate payment system,” says an analyst with the American Hospital Association.

Leave a Reply

Your email address will not be published. Required fields are marked *