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Doctors Without Quarters

August 28, 2006

Fran Simon
fsimon@tulane.edu
Photography By John Everett

"I used to have a life. Now, I just have a mission."
- Aeon Flux, 2005


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At the end of June, Marc Kahn is the last man out of the Houston campus.


That's how pharmacology professor Craig Clarkson ends his e-mails since Hurricane Katrina swiped past New Orleans. Indeed, Clarkson, along with other faculty, administrators and students of the Tulane University School of Medicine, might have felt they were caught in a surreal drama at times during this past academic year.

After the storm, Clarkson drove five days with his cat to his mother's home in Seattle. Then he got a message from the medical school saying, "Come to Houston." So he left the cat and drove four days to join a small group of Tulanians. Their mission: to set up the Tulane School of Medicine in temporary quarters at the Baylor College of Medicine in three weeks, so that Tulane medical education could resume.

The goal: none of the medical students would lose time and the fourth-year students would graduate on schedule. Woven amidst the year's memories is a bewildering panoply of emotions and concerns that are now coming into focus.

"In my 33-year career in medical education, I've been involved in the start-up of three medical schools, and one time we had four years to do it," says Ronald Markert, professor of medicine and director of the Office of Medical Education. "I've never attempted to set up a medical school in three weeks."

The Tulane team received critical life support from four Texas institutions that formed the South Texas Alliance of Academic Health Centers nine days after the storm: Baylor College of Medicine, The University of Texas Medical School at Houston, Texas A&M University System Health Science Center College of Medicine and the University of Texas Medical Branch at Galveston. Shortly after the New Orleans diaspora, Peter Traber, president and chief executive officer of Baylor College of Medicine, invited senior leadership of the Tulane University School of Medicine and Health Sciences Center to meet at Baylor with senior officers of the alliance schools.

Even before Katrina struck, Tulane School of Medicine dean Ian Taylor, vice dean Kevin Krane, Marc Kahn, associate dean for admissions and student affairs, and Ron Amadee, associate dean for graduate medical education, had been in serious discussions about contingency plans for the school. The meeting at Baylor helped everything fall into place. Alliance members agreed to provide all necessary resources until the Tulane School of Medicine could return to its home campus in downtown New Orleans.

The consensus was that the displaced students should continue to study with Tulane's own curriculum, taught by Tulane faculty. Further embracing the students, the four institutions agreed to accept them for clinical rotations.

Faced with a self-imposed target date of Sept. 26 to resume classes and training for the 620 Tulane medical students and 580 residents who were scattered to the winds across the United States, the small group of deans, faculty, staff and students who had gathered in Houston worked around the clock to accomplish their mission.

Housed in an office the size of a broom closet, Krane and Kahn started with the basics: locating the students, communicating with them, organizing the curriculum, helping faculty develop the courses, hunting down handouts, finding textbooks, salvaging the students' exams and calculating their scores. Initially, the group sat on the floor of Krane's apartment, using a cardboard box as a table. Soon, Baylor gave them not only space in the building and keys, but also desks, phones, computers, long-distance access codes and whatever nuts and bolts it would take to hold together the medical school in exile.

"I was holding three cell phones and a land line, answering hundreds of e-mails a day with no secretarial support," Krane says. "The esprit de corps was palpable and infectious."

The medical students set up temporary websites with blogs, encouraging each student to sign in and provide contact information. The group organizing the medical school in absentia posted daily updates about the progress to the student body. Under the leadership of then-dean Ian Taylor, the team feverishly worked 12- and 14-hour days to plan the medical school curriculum, with course directors planning in two-week blocks.

At the end of each day, Taylor gathered the organizing group in a "war room" briefing to review what had been accomplished and what still needed to be done. The students who participated say they felt a spirit of democracy and common cause. Regardless of title or rank, all participants had a say in the mission, suggesting courses of action and volunteering for assignments.

Third-year medical student Justin Lafreniere, unofficially dubbed "dean of housing," worked 12 hours a day or more to match each medical student with housing donated or subsidized by people in the Houston medical center community. It was a task that came naturally to Lafreniere, who aspires to become a dean of students for a medical school one day.

"It was a fluid process," Lafreniere says. "Day to day, people called in to offer a couch, bedroom or apartment. I took care of the special circumstances, the students who have spouses and kids. I played matchmaker." Within four days, all medical students had found homes away from home.

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Recreational space created for them by the Baylor College of Medicine gave Tulane medical students a sense of home in Houston.


The Baylor College of Medicine designated two large rooms for Tulane in the basement and a suite of offices on the first floor, coincidentally in the "T" corridor.
 
Baylor stenciled "Tulane Univeristy School of Medicine" and the Tulane emblem on the glass doors and painted one of the rooms a bright green for a student lounge, which was outfitted with a 42-inch plasma TV, sofas, a pool table and hanging file folders for "mailboxes."

The other large room became the office space for faculty and staff, with a conference table in the center and a white countertop around the periphery lined with laptop and desktop computers.

"Welcome to my office," says educational technologist Tripp Frasch, as he stretches his arms wide across a three-foot space of counter, above which hangs a piece of white paper with his name printed on it. Around the periphery of the room, the names of other faculty and staff members hang above their workstations along the counter.

The Baylor registrar pitched in, working overtime to help get the medical students registered for their courses, and Rondel Frank, who served in the Tulane medicine department before the storm, became the registrar even though he had never done that job before.

Byron Crawford, course director for the mechanisms of disease course, the core of the second year of medical school, had his work cut out for him. Typically, the yearlong course involves about 70 faculty members and residents participating in the teaching. Faculty taught each other's courses and Baylor faculty pinch-hit when Tulane faculty couldn't travel to Baylor. In the end, the experience may strengthen the teaching at the Tulane School of Medicine.

"We realized areas where we might integrate our courses better," Crawford says. "In some cases, we used Baylor case studies, which I'd like to do in the future if they'll give permission."

The Tulane medical school in the outpost was ready to resume classes on the target date. But then Hurricane Rita approached Houston and the students, faculty and staff scattered again. After the threat passed, Tulane medical school finally held orientation at Baylor on Oct. 1. The atmosphere in the room was electric, with Tulane medical alumnus Michael DeBakey (A&S '30, M '32, G '35), the noted Baylor heart surgeon, among those welcoming the students.

"We've worked hard together," says Kahn. "Those of us working here in Houston have really developed a camaraderie that we wouldn't necessarily have developed in New Orleans. We've gone through a lot together and solved big problems together, and so far come out of it intact. Kevin (Krane) and I worked extremely closely together. I saw more of Kevin than I did of my wife."

While Kahn's personal and professional families settled into a routine, with his two children attending Houston schools and the medical students beginning their coursework, Kahn had to scramble to rewrite more than 100 dean's letters for the fourth-year students applying for their residency training upon graduation. With the letters due Nov. 1 and Kahn's office in New Orleans soaked in floodwater for weeks, it was a challenge to get all of the letters submitted on time.

At the same time, it was the beginning of the admission cycle, with all of the files for prospective medical students destroyed. In an innovative and collaborative move, the Tulane and Baylor admission offices worked in tandem to interview candidates who applied to both schools.

"We've all become better, stronger, more capable people," says Markert. "As a life event, we've had the chance to do something very powerful. We'll always remember 2005-06."


LIFE GOES ON

Construction sites with steel girders rising, rather than demolition zones and gutted houses. Pinto beans instead of red beans and rice. The sleek, silver Metro bullet shooting past the medical center in place of the rumbling, stately streetcar on St. Charles Avenue. For the medical students, faculty and staff members relocated from New Orleans to Houston, there were many adjustments to make.

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Tripp Frasch and colleagues provided support from temporary headquarters located in the basement of Baylor medical school.


Since October, staff member Tripp Frasch and his wife, Sanela, have lived in a garage apartment donated by a couple of Baylor-affiliated physicians who live in the main house.

They delight in going to Central Market, marveling at the array of fresh produce, fish and meat -- including rattlesnake. They choose a piece of salmon to poach or a steak to saute in the copper pan they brought from their French Quarter apartment, cooking on a two-burner hot plate. On the weekend, they enjoy eating dim sum in Chinatown. Though Houston has been interesting and the Baylor contingent has been more than kind, Frasch is anxious to return to New Orleans, a city that for him is like no other.

"I so wish I were home!" Frasch says. "I'm frustrated because I feel like much has passed me by, and I feel like I've been out of touch. Things that happened over a course of months and normally I would have heard about gradually, I heard all at once. A friend is getting divorced. Another friend has non- Hodgkin's lymphoma."

Palak Turakhia, president of the Medical Student Government, believes it has been particularly hard for fourth-year students who had to continue their clinical rotations while finding time to travel around the country for interviews with medical schools for their residency training.

Turakhia, who interviewed with 14 medical schools including Tulane, will pursue her postgraduate training in anesthesiology and critical care medicine at Emory, where her brother is in medical school. Tulane was her second choice.

"I love the city and I would have liked to stay in New Orleans, but it requires more patience staying in New Orleans after Hurricane Katrina," Turakhia says with a sigh. "This has been difficult on so many levels, but everyone has done amazingly well. We've demonstrated our flexibility and resilience."

Second-year student Philip Dorsey, a native New Orleanian, says he likes to think of this experience as a semester or year abroad.

"We never thought we'd be here, but we are," says Dorsey, whose entire extended family resides in the New Orleans area. Following the storm, 28 members of his family lived in his cousin's apartment for three weeks. Initially, he felt guilty about being away from the Crescent City, but he believes the time he has spent in medical school in Houston will enable him to come back to New Orleans better prepared to help out.

"We've had to work doubly hard to continue medical school. It's tested all of us and our commitment," says Dorsey, who may pursue an MD/MBA degree and set his career path on cardiology. "Being shaken up and put in an alien environment challenges me and encourages me to work harder. This has been like the ultimate test and I work best under pressure. The hurricane drama hasn't held me back or hurt my education. If anything, I'll be a better physician."

The second year of medical school is notoriously difficult, with students taking courses in mechanisms of disease, medical pharmacology, clinical diagnosis, pathology, microbiology and foundations in medicine in preparation for the first of their board examinations and the clinical rotations in their third and fourth years. Britt Themann found Katrina added an extra measure of difficulty to her second-year experience: stress caused heart palpitations and other physical symptoms that, while ultimately not serious, caused anxiety for this young woman who had open-heart surgery as a teen.

"This year would have been life-changing, even without the hurricane," Themann says. Moving to Houston was a shock for this small-town kid from Washington who was a Green Wave basketball player as an undergraduate. "I've been looking at what it means to be alive, what it means to have illness. My whole life changed in 48 hours. This year I've been seeing things from the perspective of a patient, a doctor, a student and a public health professional. Not a day goes by that I don't consider: What is the big picture? Why am I in medicine? It's been grounding in a not-grounded way."

Themann, along with 181 other medical students, is pursuing both a medical degree and a master of public health degree concurrently in Tulane's combined program. After the storm, only a handful of students have decided not to pursue the combined MD/MPH degree. Themann and her boyfriend, second-year MD/MPH student John Gonsoulin, joined a group of medical volunteers at the Lafayette Cajundome for two weeks to help coordinate relief efforts at a Red Cross shelter and clinic.

Once they settled in Houston, Themann and Gonsoulin began a practice of mindful meditation that they found helpful in dealing with the stress. Now, they are teaching a meditation class for about 10 of their fellow med students.

Second-year students Scott Simpson and Jeff DellaVolpe still sport their "hurricane hair-dos" -- buzz cuts they adopted in the hot days after the storm when they worked as medical volunteers at the Pete Maravich Center in Baton Rouge.

"The greatest experience we wish we had never had," says Simpson, who is the second-year class president. "It reconfirmed for me the power of a caring physician to effect positive change."

Once they arrived in Houston, Simpson led a textbook drive that netted more than a thousand textbooks donated by about 15 medical schools and healthcare organizations. Many of the medical students felt a strong pull to return to Louisiana to help with relief efforts, but only a handful decided to transfer.

"When you look at it, we could have floundered or floated," DellaVolpe says. "We could have used this as an excuse." Instead, DellaVolpe says he and most of his classmates have embraced the experience, going to the rodeo, listening to music in Austin, and participating in the Baylor annual talent show.

As the second-year students look toward resuming their studies in New Orleans, some are concerned about the future of Charity Hospital (the Medical Center of Louisiana at New Orleans), closed since floodwaters devastated the old behemoth on Tulane Avenue. Tulane has a longstanding reputation of providing medical students with a diversity of patients and diseases for their training, but the shifting demographics of the population raise questions about the richness of their clinical experience in the coming year.

Perhaps the first-year students had the toughest time acclimating to life in Houston. They had only attended medical school for two weeks in New Orleans before Hurricane Katrina struck.

Edward Pankey, a 31-year-old former actor and first-year medical student whose father is noted infectious disease physician George Pankey (A & S '54, M '57), says the bizarre year has confirmed his desire to become a doctor who will be an advocate for his patients -- putting the patient first, above all.

"It is difficult to say how our experiences of the first year are different from the first years of other classes as we do not have a previous year to compare it to," he says. "This is our medical school experience, and I am certainly proud of it."

More than the hard work, perseverance and commitment to Tulane shown by the classmates and faculty, Pankey points to the genuine care and support seen between faculty, staff and students as the thing that has most affected him.

"We now know, unequivocally, the vulnerability that comes after being stripped of all things familiar," he says. "We have lost our homes, possessions and, in many cases, the very lives of our loved ones. It is this same vulnerability that many patients carry with them every time they walk into an examination room, and it is our charge to protect it."

Clarkson, the pharmacology professor, says December was the hardest period of time for him. On Dec. 8, the university's Renewal Plan was announced and more than 100 medical school faculty members were separated from the university.

"The psychological impact was heartbreaking, with the loss of colleagues I had worked with for 20 years gone in the blink of an eye and their lives changed," Clarkson says. "I actually felt like I was going to have a heart attack."

Cassie Cusick, who coordinates the neuroscience course and teaches head and neck anatomy, finds it difficult to be living the academic year away from her husband and daughter, Maggie, who is a senior in high school and will attend Tulane next fall. She stays active in her daughter's life by chatting over the phone.

"Yes, I have too many roles," says Cusick, whose husband is working to repair their Mid-City home in New Orleans that suffered damage from two feet of floodwater. "But this role is essential. We've done something here that's amazing and important -- continuing medical school in a way that's true to the Tulane spirit, with its authentic curriculum."



BACK IN THE NOT-SO-BIG EASY

In July, Tulane welcomes a full medical school back to its downtown New Orleans facilities. The incoming first-year class of 150 to 160 students was selected from about 7,000 applicants, with the same high standards as previous years. Third- and fourth-year students resume their studies in July, and first- and second-year classes will resume in August.

To assure adequate clinical opportunities, the medical school has developed a stronger relationship with Ochsner Foundation Hospital for required clinical training. Students also have begun training at Tulane-Lakeside Hospital in Metairie and Lakeview Regional Medical Center in Covington, and other opportunities are possible. 

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The sleek, silver Metro bullet shooting past the medical center contrasts with the rumbling, stately streetcar of St. Charles Avenue.


Tulane medical students scored above the national average in this year's Step 1 examination, with a pass rate that was the best ever in the history of the school, says Paul K. Whelton, dean of the medical school and senior vice president for health sciences.

"Our students have received many awards and recognition," Whelton says. "Their list of accomplishments is too extensive to detail, but a good example is the award of a very competitive Doris Duke Fellowship in Geriatrics. The accomplishments of our student body have always been impressive but are even more remarkable in a year when we have had to contend with the aftermath of Hurricane Katrina."

As Lafreniere, the ad hoc "dean of housing," enters his final year of medical school, he and his fiance, Amy Vinturella, a faculty member in the Tulane School of Public Health and Tropical Medicine, plan a big wedding in the Audubon Zoo's Tea Room. The only glitch has been the loss of the bakery that was to deliver the cake, whose roof blew off thanks to Hurricane Katrina.

Fourth-year student Chris Hasney, a New Orleans area native, got just what he wanted on his birthday, March 16, which occurred on Match Day, when graduating medical students found out where they will continue their medical training over the next three to seven years. Hasney will enter ear, nose and throat training at Tulane -- his first choice.

"I could have gone elsewhere with guarantees of a stable situation," Hasney says. "I feel personally obligated to contribute to rebuilding the Charity system here in New Orleans. Lots of people in this city can't afford medical care so they come to the academic health centers. That's where I come in -- I can get my education and at the same time contribute to rebuilding New Orleans. I've got faith in the people who've stuck around to put it back together."

Faith -- what you believe in, what you are committed to, what you need when there's little else. Without it, the unlikely becomes the impossible.

Who knows what Kahn, the associate dean assigned to be the last person out of the Tulane encampment, ponders as he turns off the lights along the "T" corridor at Baylor. Faith, fate, the possible and impossible? The statistical chance of another storm? What if one again targets New Orleans? What if one targets Houston? If one targets Baylor? Will such a catastrophic event ever again befall an American city, an American medical school?

Sometimes you just have to shrug it off. Turn off the lights. Hand over the keys. Take the long ride back home.



 

Tulanian

Tulane University, New Orleans, LA 70118 504-865-5000 website@tulane.edu