Reframing “Normal”
Post-disaster, it’s natural to long for a return to normal. “Normal” is relative, however, particularly in the context of an ongoing emergency like COVID-19, said Dr. Walvekar. “We can gauge progress by focusing on how we are meeting the basic goals of our academic practice in patient care, resident training, and medical student education,” he suggested. “Progress toward normal is also affected by available hospital resources and the fact that we must ration those resources carefully—for example, limited operative time. Consequently, in these challenging times, we have to manage our expectations and those of our patients by helping them understand the limitations and challenges we face as a medical community.”
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November 2020
What I see as most relevant in dealing with the aftermath of a disaster—and which also set the stage for facing other challenges, including COVID-19—was to find the true strength of a collective team and mind. —Rohan R. Walvekar, MD
Returning to normal happens in stages, said Dr. Carter. “You first have to define a safe environment in which to bring back workers and patients. During Katrina, this was when the water was clear and the utilities had returned. During COVID, it was when we had the safety protocols in place to keep patients and staff safe and compliant with department of health rules.”
Disasters tend to bring irreversible changes that challenge the very idea of normalcy. Some changes are immediate and apparent. “The challenges following a hurricane can include closed schools and, therefore, unexpected childcare issues,” said Dr. Kluka. “There are fallen trees, continuing flood water, damage to property, loss of electricity and drinkable water, and possibly missing or lost loved ones. Traffic issues increase with loss of usable roads, and there’s an influx of workers and insurance adjusters.”
Other changes are less obvious, although they can be just as damaging, if not more so. Dr. Nuss remembered the psychologically destabilizing aspects of life in New Orleans post-Katrina. “All the things that used to be familiar to you are no longer familiar at all, and you have to piece together in your own mind what things used to look like to orient yourself,” he said. “Just the stench, which lasted for weeks and weeks, was one of the most difficult parts of reestablishing a connection with the city.”
During a public health emergency, physicians and other medical personnel may be called to work under intolerable circumstances. “After Katrina, there was no getting in or out of hospitals, so there were employees who were forced to be on duty continuously, and yet, without resources, could only stand by while people suffered. There was no running water or air conditioning—and this was September, which is always one of the hottest months here, with 100% humidity and no open-window ventilation,” said Dr. Nuss. “I know a lot of people who had to get professional counseling to deal with the helplessness and misery that followed in the immediate wake. It was a little bit like wartime. There was a lot of long-lasting psychological damage.”