In 2005, gunfire nearly ended Dr. Holger Salazar’s American dream.

 

The place was Tulane University Hospital, a few days after hurricane Katrina famously broke the New Orleans levees. With no power, the hospital’s pharmacy was an attractive target for looters, who began a days-long gun battle with hospital police. Inside, Salazar tried to ignore the gunfire, maintain his sanity, keep his wife and young son safe and keep his patients alive.“We could hear the gunshots all the time;” Salazar remembers. “And I couldn’t just stay with [my family] all the time, I had patients to take care of, so I just told them to stay away from the windows and stay in one place.”

 

Fortunately, life isn’t always so stressful for the 47-year-old cardiologist. Salazar now works at the swanky Stern Cardiovascular Center in Germantown, a place traditionally devoid of looters and gunfire. The Ecuadorian-born doctor is lean but not lanky, rigid but not stiff. His collected demeanor, professorial attention to detail and South American accent give his speech the rhythmic regularity of a healthy heartbeat.The consistent rhythm belies the severity of his situation as he describes the incidents surrounding the devastation of Hurricane Katrina.“I remember it clearly,” he says. “I was on call so I had to go into the hospital and, of course, stay in the hospital. I had my son and my wife, already had tickets for them so they could leave but she didn’t want to leave.” He repeats the last sentence. “She… didn’t WANT to leave.”

 

Salazar’s wife and son went to the grocery store for supplies, and then came to the hospital to hunker down until the hurricane arrived the next morning. When that did happen, the early results looked promising. “Nothing really seemed to be happening,” he remembers of the storm itself. “There were some winds but they were not bad winds; there were some windows that appeared to be broken in some buildings in the surrounding areas, but nothing else than that. Then all of a sudden, everything was gone and everybody was happy and no problems.”

 

On the day of Katrina, at least for Tulane, there were no problems. That changed quickly though.“Monday night, and I was awoken around probably three in the morning by another physician saying that we have to meet,” Salazar says.“At that point, we were told that the levees broke and it was a matter of time before the city was going to be flooded. So we have to organize our patients for evacuation at that point.” For nearly 48 hours, the hospital retained most of its functionality. Every one of the more than 300 patients and family members, along with 50-plus staff and family members, were eating three meals a day. Tests could be run; patients’ progress, input and output checked; and temperatures controlled.

 

However, the tone quickly shifted when flooding drowned the power.Indoor temperatures spiked to more than 100 degrees. Hydrating patients of varying needs became a guessing game — that is, when potable water could be found. IVs, EKGs, X-rays, lab work and pretty much every mechanical test were now unavailable. The doctors and nurses were left with only the bare essentials — their physical exam skills — to evaluate and treat patients. And for this, Salazar was uniquely qualified.

 

In Ecuador, Salazar’s medical programs stressed physical evaluations because the medical schools and hospitals in that county did not have the same “infrastructure” as modern facilities. The fourth year of Ecuadorian medical school is almost entirely devoted to physical examinations, and it was during this year that Salazar was taught by one Dr. Guarderas, who he calls “probably the best teacher I have ever had.”Guarderas was known to be tough. Students who made academic mistakes were punished with weekend shifts supervising interns. At least, that’s what Salazar thinks — he says he was never punished. Guarderas taught Salazar the importance of knowledge, observation and communication in a physical exam. He also inspired Salazar to become a cardiologist.“Ever since I was six, I knew I wanted to be a doctor or a soccer player,” Salazar says. “But I didn’t know which kind of doctor.”His fourth year fixed that. Every week, Guarderas would assign a part of the body to a student;that student would give a detailed presentation on the subject, including anatomy, embryology and biochemistry, to the class before the professor would speak. Salazar was assigned the heart and that presentation inspired a career.

 

In New Orleans, with no power, no instruments and a battle raging outside, the lessons of fourth-year medical school became more prominent than ever.Without powered IVs or labs to monitor the patients’ blood, a keen eye and feel for physical examination was required. For patients with potassium issues, Salazar and the nurses would monitor the amount of sweat coming from a patient, on both the skin and the bed, and use that to make an estimate for a dose. As long as the pharmacy stayed protected, most stable patients were kept that way.It was a tough situation but Salazar is no stranger to difficult odds.. Early in his training in Ecuador, Salazar decided he would study in the United States.“Everyone told me I was crazy,” he says. “Not many people had done it before, and no one around me really knew how to do it, but I knew the United States had the best training. Everyone around the world, if you ask them about the best medical training, will say the United States. I had to train here.”The road was not easy. Salazar used a top-class placement in Ecuador to earn himself a five-year cardiology residency in Madrid. While in Spain, he used his nights and weekends to study for the appropriate boards and exams required for acceptance in the US. And accepted he was. He completed a three-year internship and residency at New York Medical College and was recognized as the top resident in his third year. From there, he worked through a cardiology fellowship at Tulane and an advanced cardiac imaging fellowship at the Cleveland Clinic Foundation.He then returned to Tulane in 2003, this time as a professor. And that led into Katrina.

 

The storm had come on Monday morning. The power went out Tuesday night. While adaptive physical evaluations were sufficient for most patients, some, particularly those with ventricular assist devices — a type of artificial heart —  would need a more creative solution.The heart pumps needed power or the patients would die. One was just two years old. Using a barely-alive cell phone and some American ingenuity, Salazar and his team were able to keep the devices functional using diesel generators. It would hold for a few days, and that proved to be enough. On Thursday, the helicopters finally came. After the patients from Tulane and nearby Charity hospital were evacuated, Salazar, his wife and his young son boarded a helicopter and escaped the city.Describing the moment, Salazar remained characteristically level.“That was probably the best time of the last two or three days,” he says. “While there were a lot of shots being fired outside and people making a lot of comments that hospital police may not be able to hold out for much longer. So it was a relief. It was one of the best moments of the four days that I was there.”After escaping, Salazar landed in Memphis.

 

Within a week, he had interviewed at Stern, and after a few months of going back and forth between Memphis and New Orleans, Stern is where he settled. Now, he specialized in patients rather than research, in lifestyle and diet rather than danger. And it suits him just fine.“I’m happy with what I did,” he says. “Will I do it again? The answer is ‘yes I think I will.’ But would I like to go back to an academic setting right now? The answer is ‘no, I’m happy right here.’”