“When This Disaster Happened, We Were There…”

The Story of Hurricane Florence Through the Eyes of The Providers Who Worked Through It

Wednesday, September 12th

The week leading up to landfall for Hurricane Florence had been difficult from a planning perspective. The storm had weakened, then strengthened again. It had shifted course and slowed. Governors from Maryland down to Georgia had all declared a state of emergency. The hurricane was clearly a serious threat, but where precisely it would hit, and with how much intensity, had been difficult to predict.

By Wednesday, the day before landfall, three things at least were clear: wind speed had dropped, leading forecasters to downgrade Florence from its peak of Category 4 down to Category 1. On the other hand, the storm was moving so slowly, just two to three miles per hour, that catastrophic flooding, not wind, was now the primary concern. And third: the wall of the storm, where winds are strongest, was going to hit two US Acute Care Solutions communities, New Bern and Morehead City, head on.

The night before, Dr. Chad Albaugh, the Medical Director for Carteret Health Care in Morehead City, had given the go-ahead for any provider who wasn’t needed during the storm to evacuate west. Providers from CarolinaEast Medical Center, just 35 miles north in New Bern, did the same.

The trick, said Jayne Kendall, the vice president in charge of the region, was to get the staffing levels just right to keep providers safe but to also ensure USACS had enough providers available to serve the community. Fortunately, USACS had experience successfully staffing sites through previous Florida hurricanes. Volume would drop during the height, but then it would increase as the storm passed and those who needed help were able to travel again.

“We wanted to make sure we had just the exact amount of people we needed. No more, no less,” Kendall said. Then, those who were not needed could get out of harm’s way.

One of the providers advised to evacuate was Sara Bishop, the lead APP at Carteret. She wasn’t scheduled to be on shift during the height of the storm, so she took her three dogs – a lab, a Rhodesian ridgeback, and a German shepherd, to her mother-in-law’s house in Kinston, roughly an hour and a half inland to the northwest. Her husband, a police officer on nearby Atlantic Beach, stayed behind to work, planning to seek shelter at the station.

“I was just so uncomfortable,” Bishop recalled. She was concerned that flooding would prevent her from being able to return to help if help were needed. “The only people staying were two docs, and I was like, what if I can’t come back?”

Within eight hours of getting to Kinston, Bishop turned around and drove back to Morehead City. She dropped the three dogs at a friend’s house in Havelock, which had never flooded in previous storms, and continued onto the hospital. The fear in these kinds of circumstances was of a mass casualty event, like a building collapse, which could suddenly flood the emergency department with patients just when it was anticipating lower volume. Bishop didn’t have kids to evacuate, so she decided she would rather ride out the storm in the hospital.

One of the doctors working at Carteret Wednesday night was Victoria Selley, and she was thinking something similar. Her husband, also an emergency physician, worked 30 miles north at the USACS site in New Bern. Together they have two kids, a 1-year-old and a 7-year-old. As the storm bore down on the coast that night, Selley felt like she had a choice: stay there, keep her kids close, and be available in case she was needed, or stay, be available if she was needed, but send her kids away.

“If I had sent the kids with their nanny far away to a hotel, that would have been more stressful for me,” Selley said of the decision. “In past storms, we’ve had flooding, and it would have been difficult for them to get back. I knew I could give 100 percent if I knew my kids were with me safe.”

Selley was also concerned about the ED suddenly being consumed by a mass casualty event. If that happened, she figured, she could always bring her kids into the hospital with her. In her driveway, she positioned her Ford Expedition facing out toward the road in case she needed to make a quick escape.

Thursday, September 13th

The Team at CarolinaEast

On Thursday morning, Dr. Michael Somers arrived at CarolinaEast Medical Center in New Bern. Somers, the medical director there, had spent the past week, like Albaugh, planning staffing levels, coordinating with leadership, and preparing his team to work through the storm.

The plan was for two teams (team A and team B) to work alternating shifts from Thursday through at least Saturday. Both teams would live and sleep at the hospital. It was expected that travel back and forth from homes would be too dangerous. CarolinaEast itself was built to withstand a Category 5 hurricane.

The hospital made patient rooms that weren’t currently occupied available for the staff and providers who would be staying there. The cafeteria stayed open and served hot food to patients and staff. Somers was assigned a room with the other USACS physician working through the storm, Dr. Troy Myers.

Meanwhile at Carteret, USACS providers crowded into the hospital’s psychiatric unit, a five-bed area locked off from the rest of the ED. “It was kind of like sleeping at a hotel,” Albaugh said, except the beds weren’t as comfortable. Albaugh himself slept on an air mattress. For the next three days he would wake up and get ready for work using the shower in the psychiatric unit.

Jayne Kendall and Dr. Linda Lawrence, USACS president for the Southeast & West regions, were in constant touch with Albaugh, Somers, and all the other providers who they knew were staying through the storm. “I didn’t want to bother them because I knew they were busy,” Kendall said. “But I also wanted to check on them because I wanted to let them know we were thinking about them.”

By Thursday evening, Hurricane Florence had slowed considerably. A huge swath of high pressure over North America stalled the storm’s forward motion just as it was about to make landfall. As it approached the coast, it was now lumbering along at between two or three miles an hour. Though it had been downgraded to a Category 1 storm – winds approximately 110 miles per hour – the slow speed meant the primary danger was now flooding. New Bern itself sits at the confluence of two rivers, the Neuse and the Trent. In the coming days, storm surge from the coast would combine with spillover from the rivers to cause unprecedented – and catastrophic – flooding.

Friday, September 14th

Hurricane Florence made landfall early Friday morning. The eye of the storm hit Wrightsville Beach, North Carolina, approximately 90 miles down the coast from Morehead City. The storm itself was approximately 375 miles in diameter. It was roughly as wide as the state of Florida is tall.

USACS leaders, drawing on their experience staffing sites in Florida during past hurricanes, had predicted a large drop in volume, somewhere around 80 percent. In fact, volume at USACS sites in North Carolina only dropped about 30 percent. Kendall speculates that since North Carolina had experienced fewer hurricanes, fewer people evacuated, and therefore more people were injured.

But the main challenge turned out not to be storm injuries. By Friday, both Carteret and CarolinaEast were inundated by residents in search of reliable electricity for patients on oxygen and dialysis.

These people, most of them too old or too immobile to evacuate, nevertheless needed a place to ride out the storm. It was up to the hospital to provide a place where they could be comfortable and ensure that the equipment they relied on could keep running.

At Carteret, Bishop helped organize an area for them in the waiting bay on the way from triage to the ED. At Car- olinaEast, many patients spent the storm in recliners in the physical therapy area where USACS providers brought them food and blankets and made sure they were OK.

Perhaps the greatest challenge of all, however, was what Somers described as a “lack of situational awareness.” The fact was, the Emergency Departments didn’t have any windows. Much of the region’s electricity was out. People who they were used to keeping in touch with couldn’t be reached because their cell phones had died. No one working at the hospital knew if their homes were still intact. For much of the time, the only way to know what was going on outside was to watch television. And what they saw wasn’t reassuring.

“I think it was emotionally very trying,” Somers recalled. “Everything was going on outdoors. I figured my home was being clobbered, and I didn’t know if it would be there when I got back.”

Somers would walk outside from time to time. “You try to go outside and all you can see is the rain coming down outside so hard that you can’t see, so you just live in the hospital, and that’s what it was like for three days,” he said. “The disorientation was really challenging.”

By then, the storm had cut power to 500,000 people in North and South Carolina. First responders had already performed hundreds of rescues up and down the coast. The storm surge in New Bern was up to six feet, while rain continued to flood the Neuse River.

Bishop, who had gone to sleep at 4 or 5 a.m. on Friday morning, woke up later that day to a phone call from her husband. The friend’s house where she had left her three dogs was flooding. The friend, whose name was JP, had texted her husband, Cory, that water at the house was up to the dogs’ bellies, and JP wasn’t sure what to do with them. After that, Cory had lost contact.

Bishop started crying. Her instinct was to rush back toward Havelock, a nearly half-hour drive in good weather. “My husband forbade me to go out,” Bishop said.

Meanwhile, Cory didn’t have a vehicle with him. He was holed up at a police station in Pine Knoll Shores, which is across Bogue Sound, a long, exposed causeway from the mainland of Morehead City. According to Bishop, what happened next has made it all the way up and around to the top leadership at USACS, and there are two versions of the story. In one telling, what Bishop calls “the male version,” one friend goes to pick up another friend and give him a ride in a storm – simple as that.

But there’s another telling, what Bishop calls “the female” version. Here’s how she told it: Without a vehicle, Co- ry’s boss requisitioned a heavy-duty Ford pickup truck to drive Cory as far as the other side of the causeway, which is known as the Atlantic Beach Bridge. After that, however, he’d be on his own. Cory called Albaugh at the hospital and told him the situation. Albaugh, without a second’s thought, put on his rain coat and drove out into the torrential hurricane in his Ford pickup to go meet Cory and the officer driving him on the Morehead City side of the bridge. The streets were strewn with downed branches and trees, even telephone and utility poles, and the wind was only getting stronger. Albaugh took Cory to their house to get their truck – the third Ford pickup in this story – and Cory drove to Havelock and back to rescue the dogs. When he got back to Morehead City, the wind was blowing 110 across the exposed causeway, which is nearly a mile long. Cory would later tell Bishop that it was the scariest drive of his entire life back across that bridge. The wind blew the truck clear across its four-lane width as he drove. Once over, he returned to the station, where the three dogs rode out the rest of the storm with him.

“When Chad got back to the hospital, I just hugged him. His rain jacket was soaked. But it was like nothing for him. He would’ve done it any day, for any of us,” Bishop said.

By Friday night, the full brunt the storm was upon them. Bishop and a group of colleagues went to look outside from within the front bay’s expansive windows. They were built to withstand 150 mile-per-hour winds, but they were shaking heavily. “We have this massive front, it’s all glass, and it was just rocking,” Bishop remembered. “It was like, oh lord. We’re just all watching it and thinking, what’s going to happen?”

They went outside and stood under the ambulance bay. Across the street, power lines had come down across the parking lot of a post office. Bishop could see broken lights and downed stop signs whipping across the street. She could hear the sirens of the police and fire department vehicles blaring across town. Over the radio, she kept hearing warnings counseling everyone to stay inside and off the streets.

Saturday, September 15th

Picking up Cory at the bridge wasn’t the only time Albaugh ventured out. After the worst had passed, he started driving around town checking on the homes of providers, both those who had stayed and those who had evacuated. Dr. Bryan Carney, who had evacuated days earlier with his wife and 4-year- old daughter, said Albaugh sent him a picture of his home that showed the wind had ripped the siding off. In fact, nearly every home that sustained heavy damage during the storm seemed to have a similar story. The roofs were still intact, but with siding missing and wind and driving rain that went on for days, the entire insides of homes were still getting soaked through.

After the storm, Carney’s home still had walls and a roof – but other than that, it was a near total loss. The same went for Bishop’s home. The water seal and siding were ripped off, and the floors, the furniture, and all their possessions were destroyed. “Our entire neighborhood, all of them had the same problem,” Bishop said.

By Saturday morning, Hurricane Florence had been downgraded to a tropical storm. It was essentially stalled out a few miles inland from where it had come ashore near Wilmington. It was still dropping heavy rain on every town for hundreds of miles up and down the coast. Major interstates were impassable. Wilmington itself was completely cut off for a time from the rest of the mainland by floodwaters.

Thankfully, there had not been any mass casualty events. Most of the deaths directly-attributed to Hurricane Florence – 30 in all – were from drowning, flooding, or somehow being swept away in floodwaters (another 25 deaths were indirectly attributed to the storm). At Carteret and CarolinaEast, the USACS teams continued to care for patients transferred in by first responders, as well as the groups of patients who were there for oxygen or dialysis.

Albaugh and Dr. Sean Rowe, who was also working at Carteret through the storm, did workouts when they weren’t on shift to keep active, running up and down flights of hospital stairs. They had a Spartan Run coming up. Dr. Stephanie Roberson was also working through the storm. Selley, at home with her two kids, was in frequent touch with them, and she knew they were all getting tired. But, she said, “They were in good spirits. They had hunkered down together.” Albaugh joked that it was like being at overnight camp, except this was overnight camp with his work family. “We work in a pretty close-knit team. It was kind of like hanging out with your friends after work. It took our minds off of [what was going on outside],” Albaugh said.

Sunday, September 16th

On Sunday, the staffing plan called for team C to come relieve the A and B teams which had been alternating shifts throughout the storm. Selley, who had ridden out the storm with her two kids in town, came in to work. Her house had escaped serious damage, though a large tree had fallen down in the back yard.

But Bishop, Carney, and many other USACS providers sustained devastating losses. Following the storm, Bishop and her husband and their three dogs stayed for three days on an air mattress on the floor of a 50-square-foot locker room at the police station. Carney and his family stayed with Roberson for a few days before settling in at the home of USACS PA Justin Packer.

Across the company, USACS providers have shared stories of the incredible support they’ve received from their partners and colleagues. Bishop said it has been overwhelming to feel so taken care of. “I have a boss out of Charlotte. She calls me the day before, tells me her whole house is available and that I can come if needed. In the middle of the storm, we have our VP, Jayne, and Linda reaching out to us every day, saying ‘please tell us what’s going on,’ sending us emails, asking how they can help.”

Bishop said the support came from every direction, in every way possible – emotionally, physically, and financially. In the aftermath of the hurricane, USACS support staff and providers combined to raise more than $110,000 to support those who had been affected. Bishop, Carney, and others said the help was welcomed, and much needed. Insurance checks did eventually come, but often not for months, and meanwhile families had to pay for everything out of their own pockets. Furthermore, insurance deductibles go up for named storms, as Bishop discovered, and there was no possible way the insurance money would cover every expense. “You have help, you have insurance, you have money that comes to you,” she said. “You work hard, you put money aside. But nothing prepared us for this.”

For Selley, support from people like Albaugh made all the difference: “Chad spent four to five days in the hospital as a way to care for our team … to let some evacuate, to take dogs to owners, to take team members to check on their homes and to check on other team members’ homes that were gone. And we as team members can easily always give 110 per- cent because we know we are cared for.”

Selley said she was incredibly gratified to work for a group which had so many “people full of integrity.”

Somers too returned to his house in New Bern to find it had sustained heavy damage. Like the others, Somers spent much of the following months co- ordinating various contractors to begin the long work of repair.

“It was a unique experience,” he said of working through the storm. “I think the combination of living in a hospital for several days separated from your family in austere conditions, having situational disorientation and realizing that all the news media are talking about your town … I don’t think I’ll ever experience anything like that again.”

More than a month after the storm, North Carolina released a report estimating damages from Hurricane Florence to homes, businesses, farms and local governments at nearly $17 billion, with private insurance estimated to cover only $4.8 billion of that total.

“Our mission is to care for patients, and when this disaster happened, we were there. It was a great moment for our company. And that felt really good,” Somers concluded.