The storm and the aftermath.

n engl j med 367;24 nejm.org december 13, 2012 2265 Mississippi . . . .” We’d been told that if the electricity came back on before we hit “ten-Mississippi,” then the backup generators were working fine. A communal sigh was heaved when the count stopped short of double digits. Ventilators and intravenous (IV) pumps hummed on without a hitch. Downstairs, however, water was pouring into the basement, inundating the elevator shafts and disabling all 32 elevators. At 10 p.m., it was realized that the basement fuel pumps were submerged and could not bring fuel to the emergency generator on the 13th floor. If that generator tank was not replenished by midnight, all power to the hospital would be lost. Oxygen tanks and interns were stationed at the bedside of every patient on a ventilator, just in case. Nonessential electricity was turned off. Any IV drip that could be converted to subcutaneous injection was changed. The collective pulse of the staff notched up toward tachycardic, though externally everyone remained focused and calm. Within the hour, a fuel truck from the New York Police Department showed up at the entrance to the emergency department. An impromptu bucket brigade was formed: 5-gallon jugs were filled from the truck and then passed, hand to hand, from maintenance workers to facilities managers to doctors, technicians, and clerical staff who lined the darkened stairwell. Within 2 hours, 500 gallons of fuel had been lugged up to the 13th floor until the generator tank was full. Electrical power never faltered again for the duration of the crisis. There was another ticking clock, however — the water supply. Rooftop tanks feed the hospital by means of gravity. But the pumps that haul the water 200 feet up to those tanks had been damaged by the flooding. The tanks held about a day’s worth of water — enough to last until Tuesday evening. There was still hope that the pumps could be repaired soon, enabling the water system to function, so a full-scale evacuation was not yet initiated. Nevertheless, the bulk of the day on Tuesday was devoted to transferring patients who were at high risk to other New York City hospitals in case the situation did not improve. One by one, all the patients in the intensive care unit, those on ventilators, and those receiving hemodialysis were carried down the stairs by emergency medical technicians and taken to local hospitals. Late on Tuesday, however, the water pressure beThe Storm and the Aftermath