A Crescent City Rock Label's Tale

DATE May 10, 2006 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. Katrina Firlik describes her life as a
neurosurgeon and her new book "Another Day in the Frontal Lobe"

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

As a brain surgeon, my guest Katrina Firlik describes herself as part
scientist, part mechanic. She writes, "Many of the brains I encounter have
been pushed around by tumors, blood clots, infections, or strokes that have
swollen out of control. Some have been invaded by bullets, nails, or even
maggots. I see brains at their most vulnerable."

Dr. Firlik has written a new memoir about her work called "Another Day in the
Frontal Lobe." She was the first woman admitted to the neurosurgery residency
program at the University of Pittsburgh Medical Center. She now has a private
practice and is a clinical assistant professor at Yale University School of
Medicine.

And a heads up to listeners who get a little queasy hearing about medical
procedures: our conversation about her work sometimes gets a little graphic.

When I read the story in your book about the patient with a nail lodged two
inches into his brain, I thought, `You have to tell this story on FRESH AIR.'
So let's start at the beginning.

Dr. KATRINA FIRLIK: Sure.

GROSS: So this guy comes into the emergency room. What do you see?

Dr. FIRLIK: Well, I see, basically, a normal-appearing carpenter wearing his
construction boots, sitting up on the hospital guerney in the emergency room.
And he pretty much looks like a normal guy. Arms crossed, you know, waiting
for me there in the ER. And he looks normal. That's the first thing I see.

GROSS: Except for the nail sticking out of his head.

Dr. FIRLIK: Well, that you can't see at first glance, and the interesting
thing is this was put in his head accidentally by his friend because they were
putting up siding of a house, and so this was an automatic nail gun, pretty
high-powered nail gun, and it basically lodged itself through the skull into
the left frontal lobe with pretty good force, such that all you could see, if
you got up close to him, was the flat silver head of the nail, kind of flush
with the scalp. So you couldn't see the nail just looking at him head on, you
really had to get close to him.

GROSS: Wow. OK. So, now obviously, you can't just like pull it out of his
head.

Dr. FIRLIK: Exactly. The first thing that I had to do was to examine him,
do a very brief neurological examination. I could see obviously that he was
awake and talking and acting normally. Did a brief examination of his pupils,
you know, shine a light in his eyes and check his strength in all of his limbs
and check reflexes, that sort of standard examination. But the next step, the
more critical step,actually, was getting the CAT scan to see what this nail
had done, where had it gone, and whether or not it caused any bleeding.

GROSS: So what did you find?

Dr. FIRLIK: So that was the next step.

GROSS: So what did you find with the CAT Scan?

Dr. FIRLIK: Basically, luckily he was lucky enough that the nail went in,
but really didn't seem to have done any damage to the surrounding brain, in
other words, it didn't snag any blood vessels on the way in, didn't snag any
veins or arteries, and it looked like it was just sitting here.

GROSS: It's just amazing, and he got through the test that you gave him OK.

He didn't seem to be impaired.

Dr. FIRLIK: Exactly. Did not seem impaired.

GROSS: How is that possible?

Dr. FIRLIK: Well, first of all, the thing I have to say is that the
examination that we do in the emergency room is about a five-minute or less
examination. We're trying to work through things quickly, and so I didn't
test any sort of very esoteric frontal lobe functions, you know, in terms of
higher level thinking and decision making and the things that the frontal
lobes really mediate, and so I kind of expected him to be normal. And the
frontal lobes, they're also very forgiving, so you can actually do a lot more
damage to the frontal lobe and still be pretty much the same person who you've
always been.

GROSS: OK, so let's get back to this nail that's hammered into his head.

Dr. FIRLIK: Sure. Yes.

GROSS: What did you do to get it out?

Dr. FIRLIK: Well, first, I called the appropriate team, had to call
anesthesia and call the supervising neurosurgeon. At the time I was a
resident, which means that I was in training in my neurosurgery residency
program, and took him to the OR. And we basically shaved a small patch of
hair, made an incision in the scalp, and then we took a drill and drilled a
circle around the nail, so the nail was actually at the center of the circle.
And after having done that, we gently, carefully, lifted that disc of skull up
with the nail in it and were very lucky to find that there was no bleeding
coming forth from the hole that it had created in the surface of the brain.
And a common slogan among surgeons is "better lucky than good," and at that
point we were feeling pretty lucky.

GROSS: OK. So you get the piece of skull out with the nail hammered into it,
and then how do you get the nail out of the skull?

Dr. FIRLIK: Well, this particular nail had a couple of barbs, kind of
copper-colored barbs that were sticking out at various angles, and so we had
to take those barbs out and then we used whatever hammering device we could
find to hammer the nail back out of the skill backwards, and left with a nice,
neat little hole in the center of the disc of bone, cleaned everything up with
an antibiotic solution, and put it back.

GROSS: How?

Dr. FIRLIK: Well, we used these small titanium, very thin, slick little
titanium plates that we screw in, and these are very small. We're talking,
you know, a couple of millimeters thick, that we used to plate the piece of
bone back in. And so when we're done, pretty much, you know, can't see that
we had taken this bone out in the first place, once we closed the scalp back
up. You're not left with any sort of divot or hole in the head; in other
words, it's cosmetically a nice result.

GROSS: How did he come out of it?

Dr. FIRLIK: He came out fine. This was, you know, luckily the nail did not
do any damage on the way in. And even more lucky, did not do any damage on
the way out, and watched him in the hospital overnight. The next morning, we
got another scan just to make sure that there was nothing we had missed in
terms of any other bleeding or bruising of the brain. That looked great. He
was up walking around, eating breakfast and begging us to leave.

GROSS: Now you point out in your book that being a neurosurgeon means that
part of you is always thinking about larger things like consciousness...

Dr. FIRLIK: Yes. Yes.

GROSS: ...and part of you is just a mechanic.

Dr. FIRLIK: Exactly.

GROSS: So in terms of the mechanical part of brain surgery, is brain surgery
more delicate and more risky than most other surgeries? You know the
expression, 'It's not brain surgery.' Well, what you do is brain surgery.

Dr. FIRLIK: Sure. Sure. It depends on, you know, there's a huge range of
different types of brain operations. Some of them are very coarse and
simplistic in terms of, say, taking a blood clot out of the brain. There's
not that much to it technically. You make a hole in the skull and you find
the blood clot and you, for lack of a better word, suck the blood clot out.
It sounds kind of crude but it's mechanistically fairly straightforward. But
then there are other types that are incredibly delicate. We're working around
very difficult structures, say, at the base of the brain, the nerves and the
brain stem and that sort of thing. And that's where we bring the microscope
in and it may take several hours, and that's on the other extreme. So brain
surgery really spans a huge spectrum of different types of cases.

GROSS: Can you tell us about a surgery that you performed where you felt like
the surgery enabled you to almost like help with a miracle of bringing
somebody back...

Dr. FIRLIK: Sure. Sure.

GROSS: ...or saving the neurological function when it seemed like that would
be impossible?

Dr. FIRLIK: Yes, yes. That happens, actually, luckily, more and more these
days. There's a diagnosis called NPH, or normal pressure hydrocephalus. It's
one of the few reversible forms of dementia. So obviously the most common
form of dementia is Alzheimer's. NPH is one in which you can actually reverse
the dementia that's taken place, and it's done with a fairly straightforward
procedure. It takes about an hour to perform in the operating room. But you
can take a person who, for example, one of my patients recently had been in a
nursing home for months, wheelchair bound, in a diaper, couldn't really read
anything, was apathetic. Turns out a very shrewed, smart neurologist
realized, you know what, I think this guy may have had NPH, or may have NPH in
the late stages. Did the appropriate testing. Turns out that he did. I put
a shunt in him and within--a shunt--I should back up. A shunt is a device
that takes off extra spinal fluid in the brain and that diverts it into the
abdomen. So basically the underlying problem here is that there's too much
fluid in the brain, and the shunt ables us to treat the disorder. But fast
forward a few months, and he is now back at home, reading The New York Times,
walking, and had regained his driver's license.

So you take a person who, you know, everyone thinks is basically in a nursing
home for life, and you reverse it and you make them a fully functional
individual, and that's just miraculous. Not so much because of me putting the
shunt in, but more for the neurologist in figuring out that that's the
diagnosis. The shunt is the easy part. It's more making the correct
diagnosis of the person and luckily there's more awareness about this
diagnosis these days so more and more people are being treated.

GROSS: My guest is Dr. Katrina Firlik. She writes about her work as a
neurosurgeon in her new memoir "Another Day in the Front Lobe." We'll talk
more after a break. This is FRESH AIR.

(Announcements)

GROSS: If you're just joining us, my guest is Dr. Katrina Firlik. She's a
neurosurgeon and her new memoir is called "Another Day in the Frontal Lobe."

Now you tell a story about something you learned the hard way, that if
somebody has, you know, a head wound or a gunshot wound, even if they're going
to die pretty soon as a result of that wound, you still have to stitch the
wound up. Tell us your story.

Dr. FIRLIK: Well, this is--it's a bit disturbing but it was a valuable
lesson for me. And, you know, we saw the whole gamut of brain trauma, you
know. The most common would be, say, car accidents, but on occasion we would
get patients who were either the subject of a homicide or a suicide attempt,
and we'd have to figure out how aggressive to be. Now luckily, when it comes
to gunshot wounds, we would kind of think of a dumbbell approach, and that
some people come in and they're clearly going to live or they're clearly not
going to make it. And there's not a huge middle ground, there so the decision
making in the beginning, when they hit the ER, is fairly straightforward.

But I remember a case in particular where it was on the more pessimistic end
of that dumbbell. He was a man who had tried to commit suicide and had come
in to the ER still breathing and still with some very rudimentary neurological
function, but at that point we realized there's really nothing we can do for
him. So in my interest to really treat the family, more so that treating the
patient, I really just helped the nurse clean everything up. I, you know,
took some nice sterile white gauze and wrapped his head as best I could and
just really wanted them to be able to come into the room, knowing that he
probably wouldn't make it for even more than a few hours. So got everything
ready for him. I went home that evening, you know, knowing that in the
morning he would no longer be there.

Now it turns out, in the morning I was horrified to find out that he was still
alive and was still breathing away normally. And his family had been in there
all night, holding vigil at the bedside. I felt absolutely terrible for the
family that they had been through this, this torture. And I talked to my
attending--my supervising neurosurgeon on the phone. I gave him the update
because this is about 6 AM. And I said, `You know, it turns out this guy is
still alive. What, you know, what do I do here? This is unexpected.'

He said, `Well, you sutured up the bullet holes, right?' There are two holes,
you know, the exit wound and the entry wound. And I said, `Well no, no. He
was going to expire within hours. I didn't do anything. I just wrapped his
head.'

He said, `Well, you know, you should have known better. You have to suture up
the holes here.' Because what happens is in a serious injury like this, the
brain swells. When it swells, it will exit through the path of least
resistance, which are those pre-existing holes, and that in a sense
decompresses the brain and decompresses the skull so that what would otherwise
be a rapid death is then prolonged because the pressure inside the head is
released.

So I had to basically have the family leave the room, finish the job that I
should have done in the emergency room, and he then promptly expired a few
hours after that. But it was one of those lessons that really, really, really
struck me, and in the end, it wasn't so much that I was worried about the
patient, of course, because I wasn't treating the patient, but I felt I had
failed the family in not treating the situation appropriately.

GROSS: It must be so emotionally difficult to treat a patient who clearly was
committed to killing themselves.

Dr. FIRLIK: Yes.

GROSS: I mean, when you shoot yourself in the head with a gun, you're pretty
serious about killing yourself.

Dr. FIRLIK: Yes. Exactly.

GROSS: It's not a cry for help like...

Dr. FIRLIK: Right. Right.

GROSS: ...like taking pills might be.

Dr. FIRLIK: Right. And I have to say, in some ways, even worse than this
scenario that I just described, even worse when somebody does make it. And
you always, it's like this catch-22. You're doing everything you can to save
their life, and in the end, they come out not only neurologically impaired,
but alive, and they don't--exactly what they didn't want. So it's a real
catch-22. It's in some ways an ethical dilemma. But when they hit the ER,
the spur of the moment, you really have to do what you have to do, without
necessarily thinking of the ethical consequences at the end.

GROSS: Now, are you often in, or at least consulted on difficult decisions
about when or if to pull the plug on somebody who's been diagnosed as being
brain dead?

Dr. FIRLIK: Yes. That is part of our role. And it happens, you know,
fairly frequently in a big academic center, for example, where I did my
training where we saw a lot of severe head injuries, a lot of severe cases of
bleeding into the brain. And it's a very tricky decision to make. Frequently
the surgeon will have a very strong view one way or the other. And it's just
a question of making sure that the family is all on the same page. But there
are certain cases where it's a no-brainer, so to speak. Where it's
just--there's really nothing that can be done, and you don't want to prolong a
life only because there's no chance of neurological recovery, and those sort
of cases are fairly easy decisions. But then there are other ones that are
more on the fence that take, you know, some back and forth, especially when
you're dealing with, say, a younger person. It gets trickier.

GROSS: What did the Terri Schiavo case make you think about? You know, as a
neurosurgeon?

Dr. FIRLIK: Mm-hmm. Well, I watched that case very closely. I was very,
very interested in that case, as you might expect. And I guess I was a bit
disappointed in the fact that I was on the side of letting her peacefully pass
away, only having seen patients like that myself, knowing the torture that can
ensue when you prolong things. The other thing is that when patients are in
that state, they do have some primitive neurological reflexes left, and those
are easily mistaken for conscious interaction. So for example, it's--I was
horrified to find out that people thought that they were actually interacting
with her visually, that she would follow them across the room. And then it
turns out on autopsy, her entire visual cortex, which controls vision, was
nonexistent based on her injuries, so all those years, family thinking that
she was following them and tracking them was completely impossible. So it's
that sort of thing where, you know, you see subtle neurological function and
you misinterpret it that really gets kind of complicated.

GROSS: Now you studied at the University of Pittsburgh, where you were the
first woman neurosurgeon.

Dr. FIRLIK: Yes.

GROSS: And University of Pittsburgh apparently has the biggest neurosurgery
department in the country.

Dr. FIRLIK: It does.

GROSS: So why do you think there are so few neurosurgeons--women
neurosurgeons?

Dr. FIRLIK: Well, I think, you know, a couple of things. One, is that
there's just a reputation for the training program being very harsh, very male
dominated, and that's just kind of the prevailing, you know, culture.
However, I have to say that there weren't serious, you know, egregious
incidences where I felt like I was being discriminated against, or, you know,
where I thought sexism was at play, and I think it's slowly coming around,
that there's no problem with women entering the field, and there are more and
more residents who are women in the training program. So even though only
about 5 percent of practicing neurosurgeons out in the community are women,
there are a greater number of people going through the training program who
are women. So that's slowly changing.

GROSS: When patients see that you're a woman...

Dr. FIRLIK: Mm-hm.

GROSS: I guess, you have a private practice...

Dr. FIRLIK: I do. Yes.

GROSS: ...so a lot of patients you see...

Dr. FIRLIK: Yes.

GROSS: ...just come to you knowing who you are. They've chosen you.

Dr. FIRLIK: Yes.

GROSS: But back when you were working in the emergency room, when a patient
saw you and saw that you were a woman, would they...

Dr. FIRLIK: Mm-hm. .

GROSS: ...try to find a way to tell somebody else in charge, `I don't want
her.'

Dr. FIRLIK: Interesting. Well, it's funny because actually you might think
that was more of a problem. It's actually--I guess not a problem, but more of
a challenge--actually being out in practice as opposed to being a resident.
As a resident, the patients know that you're not the end of the line. You're
not the boss. Whereas out in practice, I am the boss. There is no one ahead
of me, there's no one superior to me who's making decisions, for example. So
it's actually come more to the forefront in my private practice than it has
during my training and, you know, it's not an insurmountable problem by any
means, but I think I tend to get certain questions that I know that male
neurosurgeons don't get quite as often. So it's a little bit of a challenge
when I first meet a patient, just to kind of get over that little hurdle, and
you know, it may take a few minutes to get them comfortable but--you know.

Just as an example, I may see a patient for the first time in the office. I
may spend a good half hour, 45 minutes with them explaining the pros and the
cons of a particular operation. I may go through an anatomical model and go
through all the details and that sort of thing. And at the end of this long
conversation, where they've answered questions--they've asked questions, I've
answered them, they'll say, `So who actually does the surgery?' And I'm always
amazed because I introduce myself as the neurosurgeon, but they still somehow
don't get the picture that I'm the one doing all the things that I'm
describing. So it's kind of a funny impasse that we came to and I have to
kind of recalibrate, `OK, no, no, I'm the surgeon here. Everything we've been
talking about here is, you know, is based on what I do.' So I don't think men
get that quite as often but I do find it funny.

GROSS: Well, Dr. Firlik, thanks for telling us some really fascinating
things about the brain and neurosurgery. Thank you.

Dr. FIRLIK: Well, thank you so much. I enjoyed it.

GROSS: Dr. Katrina Firlik is the author of "Another Day in the Frontal
Lobe." She's a clinical assistant professor at Yale University School of

Medicine.

I'm Terry Gross and this is FRESH AIR.

(Announcements)

GROSS: Coming up, historian Douglas Brinkley. His new book "After the
Deluge" is about Hurricane Katrina, a subject that hits closer to home than
most of his books. He lives and teaches in New Orleans and helped in
hurricane rescue efforts.

Also rock historian Ed Ward tells us about the New Orleans label AFO Records
that produced the classic "She Put the Hurt on Me."

(Announcements)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Author Douglas Brinkley discusses the week after
Hurricane Katrina in New Orleans and his new book "The Great
Deluge"
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Historian Douglas Brinkley watched history being made as his city was
destroyed. He lives in New Orleans, where he directs the Roosevelt Center at
Tulane University. He was in the city for Hurricane Katrina and took part in
boat rescue efforts. Then he created a Tulane University task face to
document the catastrophe through oral history. Now he's written a new book
called "The Great Deluge," documenting the week the hurricane struck.
Brinkley is the author of several best-selling books, including "Tour of Duty:
John Kerry and the Vietnam War" and "The Boys of Pointe du Hoc: Ronald
Reagan, D-Day and the US Army Second Ranger Battalion." About his new book, he
writes, he hopes "that this history, fast out of the gates may serve as an
opening effort in Katrina scholarship."

Your book was excerpted in Vanity Fair, and what's really made news from that
excerpt is your reporting on Mayor Ray Nagin, and you write, "To some
observers, the naive politician was turning into a pathetic figure, the city's
skipper who didn't know what a boom was." How would you describe Mayor Nagin's
performance based on the interviews and reporting you've done for your book?

Mr. DOUGLAS BRINKLEY: I interviewed Mayor Nagin for the book. I've also
interviewed people that were holed up with him at the Hyatt Hotel. What
I--what's making a little bit of news and what was in the Vanity Fair excerpt
and what's making Mayor Nagin very uncomfortable, to put it mildly, is the
reality that when the storm hit, he was supposed to be at the emergency
operations center at City Hall. The New Orleans City Hall is across the
street from the Superdome and the Hyatt, and it is a sturdy building. It's
almost a--it's one of the sturdiest buildings in New Orleans. And the EOC was
set up there, emergency operations center. He didn't go there. He, instead,
and he told me the reason why is he had security guards that wanted him to
stay at the Hyatt, yet Terry Ebert of Homeland Security, and one of the great
heroes of my book, he stayed and ran the city while the mayor went to the
Hyatt, checked in to the 27th floor, and that entire week that I write about,
when we watched on television all these people at the Superdome trying to
figure out what's happening, all these people at the convention center, he
never once had the courage to leave his bunker and to go over and address the
people, to talk to them, to inspire them, to lead. So I'm questioning in the
book the leadership, you know, and because I love my city so much, I thought I
had to tell everything that I knew, not hold back on my critique and
criticism, which is something that historians usually don't do. But, you
know, I'm a person who witnessed people being treated like garbage and debris,
and the mayor was partially responsible for that pathetic response we had to
helping those people in need.

GROSS: Do you think that the mayor was rightfully concerned about his
security and that prevented him from being more visible? I mean, for example,
there's one part in the book where an aide tells him that a mob from the
Superdome is approaching the hotel where the mayor is staying, and the aide
urges the mayor to go up to a higher floor.

Mr. BRINKLEY: Well, the higher floor is the 27th floor of the Hyatt, that's
the top of the building and that's where he spent most of the week. And the
anecdote you're mentioning is about Jackie Clarkson, whose daughter
incidentally is the actress Patricia Clarkson, who's been a longtime city
councilwoman. And she was working the phones, she was at the EOC at city hall
for a long time. Everybody at the city hall I talked to wondered where the
mayor was. They felt abandoned at city hall by the mayor because he had his
Hyatt hideout strategy. And she tells us the story, they're on the fourth
floor. Somebody whispers, `A mob's coming,' and he immediately leaps up and
runs up to the 27th floor. There was no mob. These were people at the
Superdome looking for food and water.

GROSS: You sound a little angry when you describe what Mayor Nagin did and
didn't do during the week of the hurricane. Now I know you're a New Orleans
resident and you care deeply about the city, but I'm wondering if that kind of
anger and passion ever got in the way at all with your work as a historian
trying to write this first history of the hurricane.

Mr. BRINKLEY: It certainly got in the way. I'm a human and I watched other
humans, people of authority that we count on in time of crisis, turn their
back on the poor, largely African-American population of my city. And you
know, I did not, you know, I have tools I use as a historian, but I will not
deny that there's a passion in my book, that there's an anger at government
officials. I'm angry at the Army Corp of Engineers for building shoddy
levees. I'm angry that the sense of coastal restoration cannot be made a
national issue, we're losing our wetlands, that every day the Gulf of Mexico
is getting closer to New Orleans. I'm angry that the gas revenues from oil
from the state of Louisiana are always taken. We are a state where we're
abused by companies, we're a place where people extract but don't put money
back in. That New Orleans has been losing population. Garbage is everywhere
right now. We're heading into a hurricane season without a sensible
evacuation plan. All of our buses that should have been put on high ground,
when you have a Category 3 or 4 or 5 brewing in the gulf, were left to drown
in the city of New Orleans. It's just common sense. The Louisiana National
Guard left their assets below sea level at Jackson Barracks. I mean, it's one
debacle after another, after another and it's hard...

GROSS: Is it worse than you thought? I mean you were obviously upset before
you started this book. But having done all the research and written this up,
are you even angrier than you were before? Or more upset, more discouraged?

Mr. BRINKLEY: Absolutely. More--both. On the one hand, I'm uplifted by the
human stories I've encountered, when I write about the so-called "NOLA
Homeboys," New Orleans Homeboys, this group of people that jumped in the water
and were saving everybody on little boats. I've interviewed, you know, a
hundred of these first responders. Dr. Ruth Berggren, I write about, who
stayed at Charity and wouldn't leave without her AIDS patients and the bond
that they formed. I've been uplifted by the human response, what real people
did, how Louisianians saved Louisianians, how Mississipians saved
Mississipians. So that part has been heartening and it gives me a kind of
faith in our country, a renewed faith in an unbelievable way in our people.

But the government attitude towards it has infuriated me. I praise to holy
heaven in this book the private sector, companies that did great. But, you
know, you would have Wal-Mart trucks coming to try to quickly bring in
supplies and be stopped by FEMA officials with clipboards who said they're not
on their computer punch-out. They're not allowed to bring in supplies. You
have the Gretna bridge incident, where largely African Americans from the
convention center, dehydrated without water, without food, was trying to walk
over the Mississippi River--great symbol of our country, the Mississippi--walk
over the Mississippi River bridge who were met by the Gretna police force with
guns pointed at them, turned back, not allowing them to escape the
deprivations of the city.

GROSS: You really are very critical of the government response to Katrina,
but somebody who you single out for praise is Terry Ebert of Homeland
Security. In what sense do you think he did well?

Mr. BRINKLEY: Well, Terry Ebert is an ex-lieutenant colonel, a Marine, with
service in Vietnam. He was in a lot of combat. He had a lot of his lung shot
out. He, for a while, was the head of our Pacific theater nuclear security,
so he's a very important person, and he was assigned to New Orleans for
Homeland Security. When Katrina started, he never left his post at the
emergency operations center. And while everything was crumbling from a
leadership standpoint around him, I think the fact that he had been through
combat in Vietnam helped him, at least, that was--he told me it did and I
believe that, because he stayed cool and collected. He essentially ran the
city the best that he could, without a police force that was there to help in
any real sense. But he was able to use the fire department people that he
could get to effectively and he became the vortex.

GROSS: We're nearing hurricane season. Are you confident living in New
Orleans with the city in such a fragile state. Do you have any faith in the
levees or the evacuation plan?

Mr. BRINKLEY: No. I have no faith in the evacuation plan as it now is.
It's been very slow out of the gate. They're trying to get one forward.
Hurricane season is upon us. This happens time and again in New Orleans, you
know. New Orleans is the best city in America for food, in my opinion, food
and music and cultural life and ambiance. It's my favorite city in America.

We don't do politics well. We don't know how to do it. And you know, it was
bad before Katrina. Now everything is kind of in disarray. My wife is
pregnant and we're going to, hopefully, God willing, have a baby girl this
summer, and I would never think of having it in a hospital in New Orleans
right now. We're going out to where my mother and father live in California
to have the child. My other two children were born at Touro Hospital in New
Orleans. I would have liked to all three of them to be. I don't trust the
hospitals there.

And I have to tell you, the electrical grid in the city--a strong wind's going
to black out the city. Not a hurricane. Not even a tropical storm. Just a
really bad storm and the city's going to be in danger. The sewer system is
cracking; it's leaking over places. People getting allergies and illnesses
from mold in their houses. We're still in crisis mode in New Orleans.

The dilemma, the paradox, is when I say things like that, I also am suppose to
be a city booster. `Come back to New Orleans. Come party down there. We
need the tourist revenue.' And so it's a city conflicted. And until we get
our politics right, it's going to be hard to convince people and
conventions--Philadelphia, where you're at--a company in Philly, are they
going to want to come? They're booking their conventions two years out now,
are they really going to come to New Orleans when they have other options? So
we've got to get a new message out of our city that we're really taking our
politics seriously and our public policy seriously. We have a reputation
nationally for not doing that, and unfortunately, since Katrina, things--that
same sliding into failure are occurring.

GROSS: My guest is historian Douglas Brinkley. His new book is called "The
Great Deluge." We'll talk more after a break. This is FRESH AIR.

(Announcements)

GROSS: If you're just joining us, my guest is Douglas Brinkley He's a
historian who has written a new book about Katrina. It's called "The Great
Deluge." He lives in New Orleans and teaches at Tulane University.

You describe New Orleans politics as historically dysfunctional. Do you feel
like you have any sense of why that's true?

Mr. BRINKLEY: Well, it's, first off, it's a port city, and a lot of the
world's port cities tend to be politically dysfunctional because money comes
and goes through import and exports, and it's easy to turn a blind eye to
thing. And cultures of corruption can get started. That's certainly the case
there. It used to be, you know, people talk about Jean Lafitte, the pirate, I
mean, he was a slave stealer. He wasn't just trading in slaves; he'd rob
ships and then sell them for cheaper prices, and yet he's kind of a cultural
hero in town. Governor Edwards of Louisiana is kind of beloved. He might be
able to win the governorship if he ran again, yet he's in prison right now for
corruption. A police department is wildly corrupt to the point that I don't
think people in the rest of the country understand how corrupt. Its, you
know, its payoffs, and turning your back and allowing drug dealers to run
rampant. And it's all with the kind of laissez-faire attitude, you know, `let
the good times roll.'

We're about celebrating our culture, which is the genius and beauty. It's one
of the great literary art capitals and the home of jazz. I mean, we all know
all that, but when it comes to politics, people laugh about it. It's no
longer funny to tell the story about the politician with cash in a brown paper
bag. Katrina doesn't make those stories, you know, kind of quirky and
interesting. It makes it reprehensible, because you see that bad politics and
corrupt politics causes great damage to people's lives and even cost them
their lives. So the people in the community that care have to rally against
the wrong kind of politics and we're doing that.

There is a wonderful man who's the district attorney of New Orleans named
Eddie Jordan, and he's a great leader. And, you know, there are people coming
up that are going to make a difference. The Warren Rileys and Eddie Jordans
and the--so there's hope on the way. It's just, it's hard to weed it out.

And the FBI is embedded really with the New Orleans Police Department.
They're doing an extraordinary job, the FBI, of trying to train the police
department to get away from that culture of corruption and turn more towards
public integrity.

GROSS: Before you decided to write this history of this first week of
Hurricane Katrina and its aftermath, you were writing a book on Teddy
Roosevelt and conservation. And I'm wondering if there's any intersection
between those two books.

Mr. BRINKLEY: Only to the extent that I quote in this book about, you know,
100 years ago, Theodore Roosevelt, our great conservationist, went down to the
Breton Island. There's a whole group, if listeners look on a map and they
don't know the region, you'll see these beautiful islands that are in the Gulf
of Mexico. And T.R. went down in, you know, 100 years ago, to try to save
the bird rookeries there.

And he warned people that hurricanes coming up, if these islands aren't kept
as barrier islands, New Orleans would get devastated by a hurricane, that
barrier islands weren't just for, you know, birds. They were important as a
speed bump for hurricanes in the Gulf of Mexico. He was an extraordinarily
sophisticated naturalist, T.R. His thinking is 100 years ago is relevant
today.

Unfortunately, these islands are disappearing. Coastal erosion. The barrier
islands are shrunken. Louisiana is just losing its incredible wetlands every
day, and so, in that regard, you know, one of the big issues in the early part
of my book is how the Gulf South wasn't prepared for this hurricane. And by
not taking these barrier islands seriously and having the federal government
not take them seriously enough, by being seen as a green issue instead of a
security issue as well as a green issue, we're losing Louisiana. These
barrier islands need to be rebuilt. They are the first bump, as I said, speed
bump to stop these hurricanes before they make landfall.

GROSS: You say in your book that it was books and music that sustained you
while you were writing your new book "The Great Deluge." What did you read and
listen to?

Mr. BRINKLEY: A lot of Bob Dylan. The Martin Scorsese, you know, "No
Direction Home" CD, which went with the PBS documentary that came out right at
the time of Katrina. And songs like, you know, "When the Ship Comes In" with
lines about hurricanes, and "Chimes of Freedom" by Bob Dylan I would play over
and over again on my iPod, and the Neville brothers. I was listening to
Willie Nelson, who sings a song by Daniel Lanois called "The Maker." And if
everybody listening to this, I just urge him to listen to the beauty of this
song, "The Maker," which is very fitting for what happened in Katrina, and the
Willie Nelson version of singing in it is beautiful.

And bookwise, you know, I turned immediately when this happened to John
Steinbeck, and I reread "Grapes of Wrath" because I thought the exodus from
New Orleans--I can't--I don't have the skills. I'm not a good enough writer
to ever try to do what Steinbeck did with the Okies and the Dust Bowl. But I
saw how he gave dignity to the Joad family, and I then went back and looked at
"Cannery Row" and some of Steinbeck's works when I was writing this, and he
kind of set a tone for me. There's a Nobel prize-winning writer from Iceland.
His name's Halldor Laxness, and he wrote a book called "Under the Glacier."
And it's about bureaucratic ineptitude in part, and he does it so brilliantly.
And that novel "Under the Glacier" by, as I said, a Nobel prize-winning author
from Iceland had a profound effect on me. I hadn't read it, and when I read
it it made me realize that this happens in life, this sort of political
indifference to the plight of the poor, and politicians worrying about their
image more than truly helping people is not unique to Katrina. That has many
antecedents in past history.

GROSS: Well, Doug Brinkley, thank you very much for talking with us.

Mr. BRINKLEY: Thank you. I really appreciate it.

GROSS: Doug Brinkley's new book is called "The Great Deluge." You can find an

excerpt on our Web site freshair.npr.org.

Coming up, rock historian Ed Ward tells us about a New Orleans record label
that was created in 1960. This is FRESH AIR.

(Announcements)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Ed Ward describes the history of AFO Records

TERRY GROSS, host:

There have been several waves of pop music in New Orleans since World War II,
with each one subsiding as its celebrated musicians realized they can't make a
living in the city they grew up in. In 1960, another of those waves crested
and with it came a pioneering effort for racial equality. Ed Ward has the
story of AFO Records, All For One.

(Soundbite of music)

Mr. ED WARD: In 1960 Harold Battiste was a disgruntled saxophone player.
He'd come up through the ranks of the New Orleans studio musicians and played
on and produced a number of hits, but all his experience had showed him one
thing, the artist never made any money. He'd observed the system at work and
he didn't like it. He'd also been listening to the Black Muslims, and the
idea of black people working for their own enrichment had become something of
an obsession with him. He began talking to his fellow studio musicians and
one by one converted them to his idea: a label which would produce the hits
for which New Orleans had become famous, but where everyone got paid fairly.

Along with trumpeter Melvin Lastie, drummer John Boudreaux, saxophonist Alvin
"Red" Tyler, and bassist Peter Badie, he set up AFO Records, All For One. His
partners were the AFO executives, both in fact and as a band name. Now all
they needed was a hit. Along came Melvin Lastie's uncle Jessie Hill, who
showed up in the studio with a young woman named Barbara George and a guitar
player named Lawrence Nelson, better known around town as "Prince LaLa."
Barbara opened her mouth and there was the hit.

(Soundbite of "I Know")

Ms. BARBARA GEORGE: (Singing) I know...

Unidentified Singers: (Singing) I know...

Ms. GEORGE: (Singing) ...you don't love me no more. No more.

Singers: (Singing) No more.

Ms. GEORGE: (Singing) No, no more. And I don't want to be hurt anymore.

Singers: (Singing) Now more.

Ms. GEORGE: (Singing) Anymore.

Singers: (Singing) No more.

Ms. GEORGE: (Singing) Yeah, yeah, I have loved so hard, everything I did was
no dard. If I can't love you right baby, I don't have to love you at all.

I know...

Singers: (Singing) I know.

(End of soundbite)

Mr. WARD: "I Know" shot to the top slot on the rhythm and blues charts, and
number three on the pop charts. Of course, for a small label like AFO, this
wouldn't have been possible without some help, which they got from Juggy
Murray, the New York-based owner of Sue Records, which made Battiste very
happy. Murray was black himself, and having Sue distribute AFO Records made
it possible to complete nationally.

But "I Know" wasn't the only song on the agenda that day. There was another
one that Barbara George couldn't nail. In exasperation, Prince LaLa started
singing it to show her how, and an AFO executive decision was made: roll the
tape.

(Soundbite of "She Put the Hurt on Me")

Mr. LAWRENCE "PRINCE LALA" NELSON: I met a girl two years ago. She
understood that I love her so. She took my heart and she left for me, I swear
she put the hurt on me.

She put the hurt on me.

Unidentified Singers: (Singing) Hurt on me.

Mr. NELSON: (Singing) Oh, hurt on me, now.

Singers: (Singing) Hurt on me.

Mr. NELSON: (Singing) She put the hurt on me.

Singers: (Singing) Hurt on me. Hurt on me.

Mr. NELSON: (Singing) Oh, tell her, if Daddy tell me what can it be

I looked for her all alone...

(End of soundbite)

Mr. WARD: "She Put the Hurt on Me" didn't do as well, but it remains a New
Orleans classic. It would be a while before these records made it, and studio
time cost money. So one day the AFO executives were called by another black
New York record label owner, Bobby Robinson, to cut a track by a singer he'd
discovered. Again, a smash was born.

(Soundbite of "Ya Ya")

Mr. LEE DORSEY: (Singing) Oh well I'm uh, sitting here la la. Waiting for
my Ya Ya a hm, ahm. Oh sitting here la la, waiting for my Ya Ya. Uh, ahm.

It may sound funny, but I don't believe she's coming' home. Oh, baby, hurry,
don't make me worry, uh. Oh yah, baby, hurry don't make me worry...

(End of soundbite)

Mr. WARD: The executives had copied Allen Toussaint's style perfectly, and
that was a winning formula. Lee Dorsey and "Ya Ya" got to number seven on the
pop charts and the top of the rhythm and blues charts, but it was the
beginning of the end for AFO. To start with, Robinson never paid for the
session. When Juggy Murray heard that his hated rival had hired his New
Orleans band to produce, arrange and play a hit, he announced that he wasn't
going to distribute AFO anymore. And after Barbara George made her fair share
of money from "I Know," Juggy convinced her to buy out her contract and sign
with him.

Battiste forged on, producing records by Willie Tee, Eddie Bo, and a couple of
characters who called themselves Pistol and Nookie Boy. He also recorded a
couple of white boys, one of whom was an honorary executive.

(Soundbite of song)

Unidentified Man #1 and Unidentified Man #2: (Singing) He don't know rockin'
rockin' talkin', river dig slime a road...(unintelligible)

Man #1: (Singing) Baby talk that talk.

Man #2: (Singing) You gotta talk that talk.

Man #1: (Singing) You gotta talk that talk. You gotta walk that walk.

Man #2: (Singing) You gotta walk that walk.

Man #1: (Singing) You make a hound dog bark...

Man #2: (Singing) You make a hound dog bark...

Man #1: (Singing)...when you walk that walk.

Man #2: (Singing)...when you walk that walk. And when you talk that talk.

Man #1: (Singing) I know I'm talking to you, yeah. Baby talk that talk.

(End of soundbite)

Mr. WARD: Mac Rebennack was calling himself Dr. John even back then, and
Ronnie Barron later called himself Reverend Ether. Mac played piano, organ
and guitar on AFO sessions, and Battiste was grooming Barron as a teen idol.
But a record label without national distribution isn't going to go anywhere,
and eventually the AFO executives packed up and moved to Los Angeles, where
practically before he could unpack, Battiste found himself producing yet
another yet, Sonny and Cher's "I Got You, Babe." Clearly New Orleans was a
long ways away.

Rock historian Ed Ward lives in Berlin.

(Soundbite of song)

Unidentified Man #3: (Singing) I'm on my way to see my baby, Lucindy...

(Credits)

GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.