Bernard M. Jaffe, MD Professor of Surgery Department of Surgery Tulane University School of Medicine New Orleans, LA

Hurricane Katrina flooded Tulane University Hospital on August 29, 2005. The hospital was so severely damaged by water intrusion through small breaches in its outer brick shell that extensive mold resulted from the combination of heat and humidity. Tulane was closed from the day of our evacuation, September 1, 2005, until February 14, 2006. The re­pairs were extensive, very costly, and difficult. The staff was informed that there were 500 people working on the reconstruction every day for several months, and based on what has been done, that is easy to believe. In anticipation of the hospital's reopening, Columbia HCA (the majority owner of Tulane University Hospital) retained its employees, redistributing some employees among other corporate facilities and paying salaries to those whose temporary living situations precluded their redistribution. There was no question Tulane would be back.

During the 6-month interval, Tulane augmented the resources of Tulane-Lakeside Hospital. Originally purchased in July 2005 to become a women's and children's hospital, it served as a major all-specialty institution, far exceeding its original expectations. Lakeside's bed and operating rooms (ORs) were overcrowded, and parking during daylight hours was virtually impossible. Yet, with the investment of significant monetary resources, the hospital flourished and maintained a clinical presence for Tulane University physicians during a critical period.

During the fall and early winter, I worked at both Lakeside and Huey P. Long Hospitals. Both institutions had medical students and residents, and faculty members were able to carry on. Each institution had advantages and disadvantages. Huey P. Long, located in Pineville, Louisiana, was very efficient and physician-friendly but was almost 4 hours away from home. Lakeside, located in the inner New Orleans suburbs, was close to home. It was also largely staffed by familiar Tulane colleagues. However, Lakeside was very inefficient and everything took an inordinately long time. I couldn't wait to get back "downtown" to Tulane Uni­versity Hospital.

I never realized the importance of institutional stability until I was displaced. Before Katrina, I had my share of concerns about how Tulane Uni­versity Hospital was run. It's easy to be critical when you are clinically overrun and barely have a chance to breathe, let alone think. From a distance, however, it's much easier to be realistic. To surgeons like us, our hospitals are our second homes.

Two weeks before Tulane reopened, I returned to the OR to book some future cases. It was very reassuring to return to work with old friends in the scheduling office. After a warm reunion, I went to OR 14, my second home, the room where I have worked all day and evening for almost 14 years. It looked as if I had left it the night before. Everything was in its place, including my suture box. I was overwhelmed and broke down. I never expected to be so emotional about a workplace.

I discussed my reaction to OR 14 with a number of colleagues, fully expecting them to think I had lost it. To my amazement, they not only understood but agreed.

Tulane University Hospital reopened with a flourish. It started on the roof of the parking garage from which we evacuated patients and were ourselves evacuated. The reunion of the staff was emotional with numerous hugs and shared stories. At 8:30 am, one of the relief helicopters landed and delivered the huge flag that had been draped over several floors of the hospital after the storm. The sound of the whirlybird evoked an immediate anamnestic response. Both of the pilots had been involved in the post-Katrina evacuation. There wasn't a dry eye on the roof when the flag was unfurled, flying again for all to see. It symbolized strength, union, and rebirth.

The next phase of the ceremonial reopening took place in front of the newly rebuilt emergency department, which had been under water. The re­assembled medical and nursing staffs sat in temporary stands created for the event. There was incredible excitement and energy, including several periods when the group erupted in the "wave," the sequential stadium cheer. Lots of notables attended. The speeches by the chief operating officer of Columbia HCA, the chief executive officer of Tulane University Hospital, the dean of the Medical School, and the president of the New Orleans City Council focused on the heroes of the evacuation and the promising future of our city. There were as many standing ovations as for a State of the Union address. Finally, it was Mayor Nagin's turn. He promised to follow the written script of his speech, noting that he tended to say bad things when he wandered from the prepared text. With no words about our "chocolate city," he then cut the ribbon and Tulane University Hospital was formally opened. Although the administration was concerned that the reduced New Orleans population might not be adequate to support the hospital, the open beds were full within 48 hours and have remained so.

I deliberately waited 1 week after the reopening for the OR to work out the kinks, but I have been operating regularly since. The majority of the nurses, techs, anesthesiologists, and nurse anesthetists have returned, and it has felt like home. There are some problems, but under the circumstances, it's very difficult to be fussy. The feeling among the staff is very positive and optimistic.

Tulane University Hospital is physically far from normal. There are no usable public entrances or exits on the ground floor, and entry is via one of the parking garages. Large sections of the facility are not yet repaired, and they are sealed off. There is no kitchen, and food for patients is delivered by Lakeside Hospital. The local area is relatively un­occupied, and most of the local shops and restaurants are closed. Only two critical care units, one large nursing station, and five ORs are open. Despite that, there is palpable progress. Be it ever so humble, there is no place like home.