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On a Sunday, August 28, 2011, Hurricane Irene pushed the saltwater from Long Island Sound over two city blocks and into the Milford, Connecticut, home of one of our home health aides (HHAs), Mary Ann. By nightfall, 6 feet of seawater filled her home's basement, wiping out the electrical circuits, the furnace, the water heater, appliances, and lifelong memories. The next day, Monday, Mary Ann stayed home from work to arrange for repairmen. But-looking back-like the sea, Mary Ann is a force to be reckoned with.


On Tuesday, Mary Ann decided her patients must have care. She managed to drive through streets with downed trees and wires to care for her most ill patient, J. M. This older adult patient was terminally ill, following a devastating cerebrovacsular accident that left him incontinent and oxygen-dependent. On arrival, Mary Ann noted a large tree lying on his roof. The house was dark and had no power or water. Mary Ann quickly created her plan. She found 5-gallon jugs of bottled water and dragged them out into the sun, which allowed them to warm slightly. Next, she found a neighbor who had water available from a garden hose. She filled gallon jugs and toted them back across the road to J. M.'s home.


When the water was warmed sufficiently so that the chill was off, Mary Ann bathed her patient, leaving him clean and refreshed. Because there was no power, the hospital bed had to be cranked manually. J. M.'s oxygen was connected to tanks instead of to the oxygen concentrator. For safety's sake, the patient remained in his bed, propped up with pillows, instead of being transferred by a Hoyer Lift. That afternoon, contractors came and reported that there was structural damage to the roof and house from the tree. The patient was then evacuated to an assisted living facility, where Mary Ann continued to provide care for several days.


Mary Ann left J. M.'s home and visited two more patients that day, both of whom fortunately had power and water.


On that Tuesday evening when Mary Ann returned to her home, the workers were gone, and her house was dark and seemed in shambles. Mary Ann phoned me at work the next day to tell her story. She also spoke about the wonderful primary care nurse who brought her hot coffee each morning to her home and the generosity and support of many team members.


Giving care under special circumstances requires planning and imagination that includes:


* Observe for personal/environmental safety. Determine what equipment is available. In this case, the observations included:


* Live wires were down nearby,


* An absence of running water, power, and telephone, and


* Tree on roof.


* Triage patient's needs:


* Incontinence care/bathing positioning/comfort/personal care/meal preparation, and


* Confirm medication(s) (and/or oxygen) are available.


* Creativity: Make do with what is available.


* Obtaining "warm" jugs of water for bathing,


* Obtaining safe drinking water,


* Observing the family change the oxygen connections to the tank (scope of practice limitations),


* Teaching family safety (i.e., no Hoyer Lift transfers, get help in an emergency), and


* Teaching family to use the manual bed cranks.


* Reassess situation:


* Report to supervisor.



Mary Ann has worked without missing a beat since that flood and its waters invaded her home of 13 years. In spite of that unwelcome guest, Mary Ann loves her home, where she lives with her two sons. In fact, she walks her American Bulldog, Sydney, on the beach daily. Sydney is named after a pediatric patient that Mary Ann cared for until her death.


Mary Ann decided to become a home health aide after caring for a friend's elderly mother. As a young mother, home care suited her need for flexible hours. Currently, Mary Ann carries a full load of patients. Not surprisingly to me, in 2008, Mary Ann was named the "Home Health Aide of the Year" by our hospice. The hospice is proud to serve patients with such skilled, caring, and creative aides. Even a hurricane could not stop this extraordinary woman!