Maurice A. Ramirez, DO, CNS, CMRO

Bridge Collapse!

Last night’s tragic collapse of 500 feet of road deck crossing the Mississippi river in Minneapolis, Minnesota at rush hour is yet another example of the fact that “All Hazards” includes more than just the natural disasters of hurricanes, earthquakes, floods, and tornadoes and it goes far beyond the manmade disaster of terrorism.  With night falling and bumper-to-bumper rush hour traffic, the bridge gave only a momentary creak as warning before suffering structural failure and sending more than 50 cars into the murky waters of the muddy Mississippi.

But Hennepin County, Minnesota, the metropolitan area that encompasses Minneapolis, is unlike most in the nation.  Hennepin County has a multihospital compact for dealing with “All Hazards” disasters.  While reports and even the governor of the state have used the word “catastrophe” which in disaster par lets means “loss of the ability to respond.” Hennepin County led by Hennepin County Medical Center and joined by the other hospitals of the compact however dealt with this tragedy handily.

Unfortunately, a setting sun and the speed of the water added to the submerged hazards created by the bridge structure itself did cause the needs (rescue and body recovery) to exceed the resources available (daylight).  So, despite the fact that there were more than enough rescuers and equipment, despite the fact that healthcare in Hennepin County was truly “All Hazards” prepared, unlike 95% of the nation, the tragedy did finally rise to the level of disaster (needs exceeded resources).

As daylight now breaks on Minneapolis the rescuers are returning to help survivors and reclaim the dead from the river, returning them to their families.  The nation should look to Minneapolis and Hennepin County, Minnesota, not only with a soft shoulder of sympathy for those lost and those who have lost their loved ones, but with a mind to learn how they dealt so well, so heroically with this instantaneous tragedy and maybe even a green eye of jealousy for the fact that they are “All Hazards” prepared even beyond their imagining.

In the words of a native Minnesotan and internationally acclaimed disaster preparedness guru, James G. Schultz, PhD.:

“Kudos to you Hennepin County and Thank You for all you do!”

London Got Lucky - The World is Still Not a Safe Place

This morning’s announcement by London Police that their “ordinance division” (bomb squad) had defused a “viable device” near Piccadilly Circus demonstrates yet again that the world is not yet a safe place.  While, no organization has claimed responsibility for this bomb, reports indicate that the device was of sufficient sophistication as to include vehicle fuel tanks, propane gas cylinders as part of the incendiary charge as well as nails for shrapnel. All this only 7 days short of the second anniversary of the bombing of the London Underground and two days after a new Prime Minster tooks office.

Multiple studies, including a June, 2006 report by the Institute of Medicine, have decried the fact that terrorism and national preparedness in general have fallen from the main public debate despite response catastrophes such as Katrina and the recent tornadoes, wildfires, and floods that have plagued various regions of the United States.

Even as the candidates line up in droves for potential presidential consideration, that the public debate centers more on the issue of keeping out individuals on whom our economy relies rather than excluding those who would seek to do us harm.

In the long history of disaster response in the United States, we have been fortunate to have enjoyed great success with a rather haphazard approach to our preparedness and security.  Individual portions of the system have worked extremely well, including planning by the Federal Emergency Management Agency (FEMA) and its sister departments at the various state and local levels. 

Rescue has been well represented by local EMS, Fire Rescue, Urban Search and Rescue, and Coast Guard Units.  Medical response for the last two decades has been the purview of the National Disaster Medical System and its various medical venture, veterinary and mortuary response teams.  These have been in the recent year been augmented by State Medical Response Teams and the all volunteer Medical Reserve Core.  These medical assets served with success and distinction in virtually every declared national disaster since their inception in 1986, providing medical care to survivors and rescuers alike. 

Response activities have been augmented by various volunteer and charitable organizations including pay based organization, the American Red Cross we have shelter, clothes and beds for those who have been displaced as well as for those who have come to serve, to assist the survivors.  Recovery has been a mutual effort involving various aspects of Federal Government, charitable organizations, local communities, corporations and even individuals. The ad hoc group has clustered around the only organized recovery system that our nation has had for the last 20 years, FEMA. Through it all rescue response and recovery had been augmented by our national guard and in our greatest of tragedies, the men and women of our armed services.

In an era of terrorism, law enforcement has played a critical role in both interdiction and at times capture of those who would attack innocent civilians. Despite the injustice of these acts our society has insisted that our judicial system mete out our just retribution.

Despite the tremendous assets brought to bear, it has only been since 2003 that there has been a National Response Plan and that plan has only had form and framework since 2004.  Both healthcare and non-healthcare corporations in this country have failed to take up their mantle of responsibility and even some communities have preferred to believe it could not happen to them… that it could not happened again. 

Today’s “near miss” in London, a car bomb left on a busy thorough fare, in front of a popular nightclub, just down the street from 10 Downing street and Buckingham Palace demonstrates how vulnerable we all are.  Today Londoners are lucky, how long will the United States rely on luck alone.   

Another Season, Another Storm

We’ve all heard the predictions. Despite a restful 2006 hurricane season, nobody yet has forgotten the unpresidented 2004/2005 hurricane double whammy that battered Florida and the Gulf Coast. But before we look ahead to this coming season, let’s stop and take stock of the lessons we’ve learned from our most recent experiences and prepare our children for this year.

In 2004 and 2005, we pulled together as a community and did all the things good friends and neighbors do when the chips are down. We shared food, water, tarps, and cell phones, and we took time to connect with the strangers across the street. We reached out to those in need and made some great new friends in the process. We hunkered down, we weathered the storm, and together we cleared the deadwood.

We became accustomed to the blue tarps, and fortunately, “tarp city” is almost gone. So what can we do to prepare for this year? Certainly we cannot change Mother Nature. After all, few “mothers” allow her “children” to change her. However, we have now learned how to live with her. And that is the first step towards a safe season.

The good news is that most of the things hurricanes can damage have already been damaged and replaced. New roofs, stronger windows, and better structures mean less damage. The old trees are gone and the new trees are firmly rooted in their place. Our communities are now ready to come through the storm with minimal or no damage.

Yes, we’re ready. We all know what we have to gather, and for the most part, we all have our storm supplies ready. Sure, there are some things we can still do. For example, we can still have our plan of where to go when the phones are out. We still need to know where the closest shelter is.

Those of us with kids should consider going to visit friends or relatives when the next storm comes. After all, what better time is there to go on vacation than when a hurricane is in town?

We’ve all discovered that cell phones work during the storm, and we’ve all learned that if you can’t call directly to a family member, then we need somebody else to call—a central friend or message board—somebody out of town who can let everyone else know we’re okay. Don’t forget text messaging, email and SMS. Teens and even young kids with cell phones are expert at these technologies. Chaos is the only constant in natural disasters such as hurricanes. The answer to coping with the sense helplessness chaos brings is to take control of some aspect of the disaster. Even if you know how to text message, ask your kids to help you or even teach you to use these technologies.

The key to feeling safe and not worrying about this year’s storms is to be prepared and to have a plan. Make sure your children know the plan, have practiced the plan and can implement the plan without you. That’s right, the key to security is knowledge. After 2004, we have the knowledge and we have the experience. And as a result, we’ll get through this year’s storms far easier than we got through last year’s.

So when the wind blows and the rain falls this season, we’ll be warm, dry, and hunkered down. We’ll play games with our kids, talk with our kids and maybe even learn something about them as people.  We’ll hold your children close until the sun shines in Central Florida again. After all, they don’t call us the Sunshine State for nothing.

Hunker Down Again

It is 2007.  It is summer.  The sky is blue.  The sun is shining again over central Florida and you are enjoying one of Orlando’s beautiful spa and resorts.  The kids have met Mickey and Minnie, Pluto and Donald, Shamus and every character in Universal Studios.  You know because you have had to walk every inch of every park.  As you nestle in for a much deserved evenings rest you turn on the Weather Channel and there before you are the two red flags with those ominous black squares. 

Hurricane!

Your mind races.  What do you do? 

You are miles from home.  All your worldly possessions are safe but your most precious possession, your family, is here. 

Are you prepared?  I have a disaster plan for home.  You followed the D.I.S.A.S.T.E.R. acronym. 
* You know how to Detect. 
* You know how to find out who is In charge. 
* You know how to be Safe. 
* You know how to Assess the situation
* You know how to get Support. 
* You understand the concepts of Triage and Treatment, how to decide what is most important and how to get help if I need it.
But…
* You do not know how to Evacuate.
* And you are not part of any Recovery plan here. 

You are just a tourist. 

At home you are R.E.A.D.Y. 
* You know what you Rely on. 
* You have Educated yourself and your family. 
* You have learned to Appreciate those around you and those who will help you. 
* You have Drilled, Drilled and Drilled again.
* But in the end any disaster plan comes down to You and here you are in a strange place far from everything that you need; everything that you rely on; everything that is familiar. 

The P.L.A.N. acronym is all you have left. You have to start all over again. You need a new plan.
* Take inventory of the People participating, your family. Prepare each person for the disaster. If you have small children, you may need to talk to them about what is happening, and reassure them that everything will be all right.
* If instructed to Leave, when and how will you leave (evacuate)? Where will you go and how will you get there? Will your family or fellow evacuees meet before you leave or when you arrive at your destination? The decision to leave makes communication and your contacts outside the disaster zone critically important. How will you communicate while you evacuate and after you arrive at your destination? What are you going to do if you get separated? Operate on a buddy system; no one should be left alone. When you and your family or business associates become mobile, make sure everyone knows the plan.
* Anticipate plan failures and plan for the “what ifs.” This is a chance to brainstorm. Make a list of all the possible failures. What if the phone lines go down? What if your basement floods? What if you get caught in traffic? No “what if” is too extreme to consider. The only possibility that you can’t plan for is the one you didn’t think of. Once you’ve brainstormed possible failures, you need to Adapt to each one with an alternate plan. If the phone lines go down, can you use your cell phone? If your basement floods, can you seek shelter with a neighbor or in some other nearby location?
* Make sure you account for all your Needs for seventy-two hours. Be prepared to be self-sufficient during this time. Each one of your family members must have personal identification and photos of all others in your plan, one quart (liter) of drinking water, seventy-two hours of food, seventy-two hours of clothes, two weeks of medications, two weeks of toiletries, a supply of cash (credit/debit cards can’t be verified if phone lines go down), a flashlight, a portable radio, batteries, a signal whistle, white/silver duct tape, a first aid kit, prepaid calling card, and a list of emergency phone numbers.

Take heart my traveling friend.  As a professional speaker as well as a disaster responder, I travel every week. I can tell you that you are better prepared on the road than you are at home. 

First, you are already packed.  All those worldly possessions that you could not bring with you are waiting safely at home and all the things that you need to get through a trip whether for pleasure or disaster are already in conveniently packaged in suitcases, backpacks, duffle bags and we hope not a steamer trunk.  What you need is right there. 

Second, everything else you will need is conveniently located in one place, the nearest pharmacy. Flashlights and radios are easily obtained at any of the local drugstores and even at the local attractions.  Stay away from candles.  While they are safe at home where you know the environment and you control the environment, in a hotel you might get wet and not from the hurricane but from a sprinkler system. An inexpensive first aid kit is also a quick and easy item to obtain while on the road.  Again a simply trip to the pharmacy and you have what you need. 

Don’t forget water. You might be on your own for as much as 72 hours.  Most hotels have water in the room at an obscene price but while you are at the pharmacy or drug store picking up your handcranked radio and flashlight, your toiletries and filling any medications that you may need to have transferred in from back home, do not forget to pick up a liter of water per day per person and then you are ready to go. 

Pack it all in your suitcase and give up the items that may not be so important.  Leave them for the hotel to take care of. 

Third, make contact with the hotel.  Find out what their disaster plan in.  I assure you they have one.  They are responsible for you.  They no more want the bad press or the liability of someone getting hurt than you want to be that someone who is hurt. Ask them if their staff is trained in Disaster Life Support, the “CPR” of disaster response. This training is available throughout the United States. It is offered nationally by High Alert, LLC and several major universities. Here in Florida, this training is offered by National Disaster Life Support of Florida and several state universities.

Rely on your hotel.  They will provide for you.  Our central Florida hotels provided their guests extraordinary service and comfort during the last two seasons of hurricanes.  There is no reason to believe it will be any less so now.  In fact every facility is more prepared now than they were two years ago.  There was even a major medical convention last year during Hurricane Wilma and the convention went off without a hitch.  So will your vacation. 

Finally, resist the urge to try to go home.  Do not jam the airport full.  The airport is the last place you want to try to hunker down through a hurricane.  If you can get out and get on, do so.  Check out by phone after you get home.  This way you have a hotel room to come back to.  If your hotel checkout is already preplanned and the storm is some distance away, consider leaving for home early, before the travel rush.  Whatever you do, don’t rent a car and try and drive out of the state of Florida.  Unfortunately there are only a few major highway exits from our state.  We have been credited with the largest traffic jams in world history during the last several years’ hurricane seasons.  Only Hurricane Rita misplaced us from that number one position as Houston evacuated 1.2 million people over 48 hours on the highway.  If the airport is a bad place to weather a storm, a rental car is worse. 

So enjoy your vacation.  Stay.  See the sites.  When the weather turns bad listen to what the officials tell you to do. 

We are good at this.  Trust in the people that have made the pleasurable part of your trip so great and remember in Central Florida the sun always shines again.  The sky is always blue again and we are

And the Greatest of These is Love

“We love our customers.”

“We love our employees.”

“We love the boss.”

“We love your problems.”

It seems that American business loves everyone and everything.  Perhaps it is the fact that most of today’s business leaders were born or grew up in the 1960’s and 1970’s, the decade of love.  But more likely it is a semantic error, or a marketer’s ploy.

The problem comes from the fact that in English we have only one word for many meanings “love.”  In ancient Greece there were five words to describe the various forms of love that we attempt to communicate in business today. Each of these types of “love” have their correlation in English and in American business.

But why is this distinction important?

Love is one of those wellsprings of emotional resilience.  If a business truly “loves” its employees those employees can draw strength both from the relationship (relationship resilience) as well as the sense of being “loved” (emotional resilience).  Providing this type of workplace support not only enables employees to work longer and stronger in the face of business adversity, but it helps make those employees happier about helping a company that faces adversity.

The problem is that we often use the word “love” when we mean “like”.  Love is a choice.  Like is a feeling.  We have all experienced the situation where we have met somebody that we truly like.  They have some quality about them that engages us, connects with us and spurs us to seek their company and their friendship.  Similarly we have met individuals who explicably we just do not like.  We do not make the active decision to not like them.  They simply “turn us off.”  These are emotional responses, however in the confusing language that is English we often utilize love as the word to describe that unplanned and controlled response, we even have a phrase “fall in love”.

Love is actually an act of choice.  We frequently state that we love somebody “because” of a particular action or personality trait or other attribute.  There are even times that we hear a husband or wife state, “I do not like him/her, but I love him/her.”  In this circumstance the description is quite correct.  The immediate and uncontrolled response that is to say the emotional response is dislike.  However for some reason known only to that individual, they choose to love despite the fact that they do not like their partner.

When we say that we love our customers or love our employees it is therefore an active choice.  We reach out to them in a way that the Greeks would call philos brotherly love and by so doing make ourselves and our businesses stronger and more resilient.

Suicide Bombers and the “Microbe Mule”

By Paul Purcell

Given the fact that numerous terrorist organizations have indicated an interest in biological warfare, and given the fact that many have also made attempts to gather radioactive material for the creation of a “dirty bomb,” it stands to reason that one threat we may face might be a combination of the two concepts.

One such scenario is that of a terrorist who is intentionally infected overseas with a virulent disease and brought over here before becoming symptomatic, in order to smuggle in a disease in much the same way a “drug mule” smuggles drugs.  Before becoming non-ambulatory, and after acting as a "Petri dish on the hoof," providing infectious bodily fluids for bioweapons (via other methods of dispersal), we may see such an individual perpetrate a suicide bombing.

No terrorist would want to die in a sick-bed, and a suicide bombing in a crowd where survivors would be exposed to infectious bodily fluids and remains would unfortunately be a perfect bio attack since authorities would most likely pay attention only to the bombing itself.

In such a bombing, the perpetrator’s bodily fluids would be turned into a fine mist and inhaled by the panicked and hyperventilating crowd of survivors, or droplets would fly into open mouths or open eyes.  Add to this the bone and other bodily fragments of the bomber acting as human shrapnel that will imbed itself into victims and it’s easy to see that the risk of disease transmission is high.

There is little to no prevention for this type of scenario other than vigilance on the part of security personnel at venues and locations where crowds gather, which may prevent a bomber from gaining access.  However, the purpose of this short article isn’t prevention, but to discuss the follow-up steps that should be taken by first responders, law enforcement, medical personnel, and coroners or medical examiners in the wake of a suicide bombing.

Indicators the bombing might involve a biological element:

A. Witnesses who saw the bomber before detonation describe him as “looking ill.”
B. No shrapnel in the bomb (to leave survivors).
C. A lesser explosive charge than expected (big enough to obliterate the bomber, but small enough to leave infected survivors).
D. The bomber chooses an open area with a crowd instead of a confined area such as a bus.
E. The bomber chooses a slightly elevated position over a crowd rather than in the crowd.

Whether or not the above indicators were present, we should perform the following steps:

1. Treat the scene as an extreme biohazard.
2. All remaining bits of the bomber should be gathered and screened for infectious disease.
3. Collect contact information from uninjured witnesses for the purpose of later medical treatment and/or ring vaccination, as they may have been infected by airborne droplets.
4. Follow up with all injured survivors for the same reason.

These simple steps might be all that is necessary to prevent a biological sneak-attack from succeeding.  The one missing step though, is to make these first four steps SOP among all involved parties. 

# # #

Paul Purcell is a security analyst and preparedness consultant with over twenty years risk management experience.  He’s also the author of “Disaster Prep 101.”  More information can be found at http://www.disasterprep101.com.

The Greatest Show on Earth

Today something common happened.  Something that happens two or three times each weekend day in two or three cities around the United States each week. 

Today something common happened.  Something that I had never thought of before, never really noticed before. 

Today something common happened and I finally noticed.

Today I took my family to the Ringling Brothers and Barnum Bailey Circus in Orlando, Florida.  We strolled among the animal enclosures admiring Asian elephants and several variety of tigers.  We stood in awe of beautifully groomed horses and somewhat obstinate zebras.  As the animals were prepared for their part in the show the humans were herded towards the arena.  There circus performers of every type mingled with the audience giving autographs, posing for photographs, smiling and waving.  This was every day Americana. 

When the lights were dimmed and everybody found their seats was when that something happened. One of the top ringmasters in the world, Tom McFarland, officiated. Tom McFarland is a ringmaster extraordinaire.  He has the presence of the most highly paid motivational speakers in the world.  When he enters the arena, you can almost see P. T. Barnum himself standing before crowds ushering them into the greatest show on Earth.  Mr. McFarland's singing voice is a rich baritone, but when he walked out he was not singing.  He walked out humbly despite his grand and sequenced ringmaster's uniform.  Like the General he is (at least at the circus) Tom McFarland strode out in a single white spotlight.  On the huge television screen appeared, the Ringling Brothers “We Support Our Troops” ribbon. 

The audience was hushed as a humble ringmaster stood and announced that he would like to thank the troops, those serving in foreign lands, those serving here at home and those in the Orlando audience.  Mr. McFarland stated that he had served his country proudly for 12 years in the United States Army and wanted to invite one of his co-performers, a former Air Force Reservist to come forth.

Without fanfare the curtains parted and hoof beats could be heard.  Like the Calvary of old, the single rider, galloped into the arena carrying our nation's flag.  She stood erect in the stirrups as her steed halted and Mr. McFarland extended a hand. He invited the audience to rise and join him in the National Anthem. This is a scene not uncommon in American sports; a lone singer invites an audience to stand and for a moment we are all joined in support of our nation, our neighbors and our troops. 

But today was somehow different.  As the words began to ring across the arena, small children began to sing at the top of their lungs. Heard even above the amplified voice of Mr. McFarland and the brass of the band who accompanied him, little children sang: 

"Oh say can you see by the dawn's early light.  What so proudly we hail at the
twilight's last gleaming…"

In all my various professional roles, I have learned to avoid emotional displays, but tears streamed down my face as my voice joined the voices of hundreds of people saluting our nation and those 3,000 plus who have given their life for it in just the recent years. 

Today, something beautiful happened and in words of the ending song to the Ringling Brothers and Barnum Bailey’s Greatest Show on Earth, "Anything is possible."

Another Inconvenient Truth

The National Oceanographic and Atmospheric Administration (NOAA) has made several determinations of late confirming what most of us already knew, 2006 was the hottest year on record and 2007 is expected to be hotter yet. Global Warming activists and environmental groups have latched onto the sudden climate change since 2004 as proof that global warming is accelerating and that human generated greenhouse gases are the cause.

The evidence for global warming is irrefutable, the planet is warmer. The increase in carbon dioxide and other greenhouse gases is also well established. What is not in evidence is that the greenhouse effect is responsible for the sudden change in global temperatures over the past 2 years. The greenhouse effect ignores several important factors, planetary axis shift and oceanic carbon dioxide sequestration.

Planet earth has undergone several axis shifts over human history. The best documented are the axis shift following the eruption/explosion of Krakatoa and the 2004 axis shift following the Indonesian earthquake and tsunami. The most recent of these shifts is responsible for changing the latitude of the Northern hemisphere by 1/2 to 1 degree relative tot he incident angle of the sun's rays. In plain English, everyone in the Northern Hemisphere moved south 200 miles that day. I live in the Orlando area, now I have Miami weather.

Oceanic carbon dioxide sequestration is more difficult to explain. Imagine that the deep ocean floor is a "carbon dioxide battery." Under the right water temperature and salinity, the ocean water "charges" the "battery" by pulling massive amounts of carbon dioxide out of the air. As a result, greenhouse gases are reduced and global temperatures drop. Under different ocean conditions, the "battery" releases carbon dioxide which bubble or even boils to the ocean's surface.

This sudden and explosive release of carbon dioxide has been documented on film as early as the 1930's when a US Navy freighter sank suddenly as the ocean around it foamed and lost buoyancy. It has been estimated that in the time it took for the ocean to engulf the freighter and the release to end that the equivalent of 1 year worth of human and domestic animal carbon dioxide production was released.

What does all this mean to global warming?

It means that the problem is far more complex than simply decreasing fossil fuel use. There are global factors that move in cycles set in geological time. Events that we can no more predict than we can control have a far greater impact than all human endeavor and domestic animal cultivation combined.

On the other hand, the entire global climate system is like a household budget. In my home, I am the long range planner, infrequently spending large sums of money on large family purchases. My wife is the short range budgeter, spending smaller amounts daily to keep the household going. We both negatively impact cash flow. I have big effects, but they are rare, just like planetary axis shifts and oceanic sequestration. My wife has a constant effect, but it is sustained and if just slightly over budget, will have a large negative impact.

Our human effect on global climate change is incrementally small, but if excessive, will yield a global catastrophe equal to the 2004 axis shift or Krakatoa.
 

New Orleans’ Ninth Ward: Rehabilitation or Recovery

The press has recently focused attention yet again on New Orleans and the process of rebuilding.  But this debate now entering its second year is more monologue than dialogue.  The emphasis has been on rebuilding and rehabilitating and not on true recovery.

A mere question of semantics?  Not really. 

The dictionary defines “rehabilitation” as to restore to original condition.  “Rebuild” is defined as to build again. 

I for one do not wish to see the Ninth Ward put back in the vulnerable condition which led to the catastrophe that was Katrina.  My observation of the political commentaries and emotional pleas that have surrounded the reclaiming of New Orleans convinces me that the residents of New Orleans also expect far more from those charged with its recovery. 

The job of Disaster Recovery more than rebuilding, more than making whole again. The job of Disaster Recovery is to make better and create those situations and systems that prevent the next catastrophe.  Disaster Recovery in the Ninth Wade will require a novel and innovative approach.  Let me suggest one such solution.

Here in Florida we have a unique device, an odd machine called a Dirt Building Plant.  This natural gas fired device is used to literally burn contaminated dirt until it is clean.  The machine is basically a large incinerator which safely burns off hazardous materials, petroleum contaminants, organic contaminants and other items found in the soil.

I propose that several of these devices be moved into the areas of Ninth Ward where the homes can no longer be repaired or reclaimed.  The entire area be cleared and placed through the dirt burning plants.  Additional fill soil would be brought from the various “hazmat” landfills, placed through the dirt burn process and added to the Ninth Ward elevating it until finally the surface of the Ninth Ward is level with the top of the levies.  This will effectively reinforce the earthen levies changing them from levies to new river banks.  The Ninth Ward would become valuble riverfront property. 

The land would then be returned to the people of the Ninth Ward.  They would have the option of rebuilding their homes on new high ground, above the level of future flooding.  They could set strong foundations deep into the earth and in compliance with the newest building codes.  Alternatively residents choosing not to move back to the Ninth Ward could sell their land now far more valuable because it is both high ground and riverfront property.  The development would revitalize the New Orleans economy and the new homes would revitalize the Ninth Ward.

Certainly there would be obstacles, the emotional impact of burning and burying the old Ninth Ward will be hard for many to swallow.  But like a phoenix rising from its own ashes the Ninth Ward would be resurrected not as an example of society failing its most vulnerable members, but as an example of serving those in need.

The Gift of Resilience

December 29, was an amazing, exhausting 45 hour day.  In the aftermath I had the opportunity first to take stock of everything that had happened, of how the corporations, companies, people and professionals and the resources of a nation come together to save one life.  After the euphoria had dimmed the fatigue set in.

The holiday season is stressful for all of us, this year for me, especially so.  My physical resilience had already been stressed by an unexpected encounter with influenza (H1:N1).  When I got the news a few days before Christmas that I had the Spanish flu, I actually had to chuckle.  Imagine an expert on pandemic preparedness that I had H5:N1. 

As with any influenza, the body aches and fever ensued. Laryngitis made it difficult to dictate my daily magazine column.  Patients would chuckle in the emergency department and then nervously after ask me if I was contagious.  I assured them that because of Tamiflu and the fact that I was beyond the infectious period, they had nothing to worry about. 

Christmas preparations had been hectic, but Christmas Day had been a joy.  The day after Christmas, my wife and children went onto my in-laws home for a visit while I stayed behind, both to work and to insure that I did not inadvertently carry an illness to my already sick father in-law.  This is the first time since we married that my wife and I did not spend the entire holiday season together and I found myself sipping from my canteens of relationship and emotional resilience. 

The laryngitis had also excluded me from four religious concerts for which I had prepared diligently.  Although I had enjoyed the beauty of the religious services, there was a twinge of disappointment in not lending my voice in praise and expression of my spiritual beliefs.

When “Glen” arrived in the emergency room all focus shifted to him.  As we worked first to stabilize him, then to find a place that could care for him and finally a way to get him to that place I transitioned from drawing on resilience for my personal needs to drawing on resilience to complete the mission. Taking “Glen's” wife on the transport meant that my own emotional resilience and even spiritual resilience would be sustaining not only myself, but “Glen” and her as well. 

Without realizing it, I was now drinking deeply, gulping, from my canteens.

Exhaustion taxed my physical resilience as I crossed first 24 then 36 hours awake and on duty. My relationship resilience was drained by separation from family and my inability to meet them at the airport as they returned home while I was on Coast Guard Rescue Flight 2114. Watching this couple hold hands for what may have been “Glen's” last day sapped my emotional resilience.  My only remaining reserve was my spiritual resilience.

My canteen of spiritual resilience was constantly refilled by the knowledge that it was only true Providence that “Glen” had come to the emergency department at all.  That it was only through the hand of Providence that there was a physical sign of his illness that could not be explained by any other possibility.  When a 49 year-old man comes to the emergency department with chest pain, the first thought is heart attack and the first treatment is one that would have killed “Glen”, but he had one physical sign, one thing, that could not be explained by heart attack and in fact could only be explained by the condition that he had.  Yet when his CT scan was reviewed, he should not have had that sign.  It was the knowledge of this Providence and the renewal of emotional resilience drawn from the waves of people who surged to save “Glen's” life that made it possible for me to complete the mission.

I had been awake for 36 straight hours by the time I arrived home.  My family was all at there, having arrived back earlier in the day.  They had sketchy information on where I had been and I was more interested in hearing about their trip then talking about mine.

My daughter Tiffany asked, “How do you do it? How do you work for 36 hours straight like that?” I told her that you pay a price. You trade a small piece of your life and health for a much bigger piece of theirs.

After a four hour nap, I awoke to find that the medical students, who had no way of knowing of what had transpired, had left me a present.

In the gift bag I found a snow globe, a miniature recreation of the place where they had volunteered their time.  There was also a pin, one like those that each of them had worn as a volunteer and a small leather bookmark embossed with the mission of the Give Kids the World volunteers.

“What Matters…
One hundred years from now,
It will not matter what kind of car I drive,
What kind of house I live in,
How much I have in my bank account,
Nor what my clothes look like.
But the world maybe a little better because I was important in the life of one child.”

The card enclosed read:

“Dr. Ramirez,
You are a real sunshine maker!
Thanks so much for your hospitality and kindness!  Gathering at your lovely home was a great way to start our unity project.  We look forward to seeing you in D.C.
Best wishes, Sally Murad & SOMA”

Sally and her leadership team had asked if I would be willing to address them in April, 2007 in Washington, D.C.  It was at the moment that I read the card and opened the snow globe that I knew what story I would tell. 

I would tell them the story of a group of young medical students who had given up their Christmas and inspired an old doctor. 

I would tell them the story of “Glen” a 49 year old man whose birthday present to himself was the manifestation of almost absolutely fatal condition and how a nation had come together to save this his life. 

I would tell them the story of being tired, of trading a small piece of your life and health for a bigger piece given to a stranger.

I would tell them the story of being close to drawing the last drop of resilience and how a card, a bookmark, a pin, and a snow globe refilled my 40,000 gallons of resilience.

As 2006 draws to a close and we all prepare to celebrate the renewal that 2007 represents,
I take stock in the things that I have (my physical resilience),
the people whom I share my life (my relationship resilience),
the joys, sorrows, triumphs and dreams of my life (my emotional resilience)
and the Providence that guides me (my spiritual resilience).

Happy New Year!