I'M HOME. Got in about 8:30 pm. I see Mark Goodacre has already fulsomely blogged the entire conference. You won't get as much or as soon from me, but I do have a few photos. I'll get to it as soon as I can, but I expect to be pretty busy this weekend. Meanwhile, here's an important e-mail I've only just opened. It's a firsthand account of the situation in New Orleans as of 31 August, forwarded by reader Dr. Risa Levitt Kohn of San Diego State University. It's from a colleague of hers who was and perhaps still is stranded in New Orleans. Sorry for not getting it to you sooner.

Thanks to all of you who have sent your notes of concern and your prayers. I am writing this note on Tuesday at 2 p.m.. I wanted to update all of you as to the situation here. I don't know how much information you are getting but I am certain it is more than we are getting. Be advised that almost everything I am telling you is from direct observation or rumor from reasonable sources. They are allowing limited internet access, so I hope to send this dispatch today.

Personally, my family and I are fine. My family is safe in Jackson, Miss., and I am now a temporary resident of the Ritz Carleton Hotel in New Orleans. I figured if it was my time to go, I wanted to go in a place with a good wine list. In addition, this hotel is in a very old building on Canal Street that could and did sustain little damage. Many of the other hotels sustained significant loss of windows, and we expect that many of the guests may be evacuated here.

Things were obviously bad yesterday, but they are much worse today. Overnight the water arrived. Now Canal Street (true to its origins) is indeed a canal. The first floor of all downtown buildings is underwater. I have heard that Charity Hospital and Tulane are limited in their ability to care for patients because of water. Ochsner is the only hospital that remains fully functional. However, I spoke with them today and they too are on generator and losing food and water fast.

The city now has no clean water, no sewerage system, no electricity, and no real communications. Bodies are still being recovered floating in the floods. We are worried about a cholera epidemic. Even the police are without effective communications. We have a group of armed police here with us at the hotel that is admirably trying to exert some local law enforcement. This is tough because looting is now rampant. Most of it is not malicious looting. These are poor and desperate people with no housing and no medical care and no food or water trying to take care of themselves and their families. Unfortunately, the people are armed and dangerous. We hear gunshots frequently. Most of Canal street is occupied by armed looters who have a low threshold for discharging their weapons. We hear gunshots frequently. The looters are using makeshift boats made of pieces of styrofoam to access. We are still waiting for a significant national guard presence.

The health care situation here has dramatically worsened overnight. Many people in the hotel are elderly and small children. Many other guests have unusual diseases. ... There are (Infectious Disease) physicians in at this hotel attending an HIV confection. We have commandeered the world famous French Quarter Bar to turn into a makeshift clinic. There is a team of about seven doctors and PAs and pharmacists. We anticipate that this will be the major medical facility in the central business district and French Quarter.

Our biggest adventure today was raiding the Walgreen's on Canal under police escort. The pharmacy was dark and full of water. We basically scooped the entire drug sets into garbage bags and removed them. All under police escort. The looters had to be held back at gunpoint. After a dose of prophylactic Cipro I hope to be fine.

In all we are faring well. We have set up a hospital in the the French Quarter bar in the hotel, and will start admitting patients today. Many will be from the hotel, but many will not. We are anticipating dealing with multiple medical problems, medications and and acute injuries. Infection and perhaps even cholera are anticipated major problems. Food and water shortages are imminent.

The biggest question to all of us is where is the National Guard? We hear jet fighters and helicopters, but no real armed presence, and hence the rampant looting. There is no Red Cross and no Salvation Army.

In a sort of cliche way, this is an edifying experience. One is rapidly focused away from the transient and material to the bare necessities of life. It has been challenging to me to learn how to be a primary care physician. We are under martial law so return to our homes is impossible. I don't know how long it will be and this is my greatest fear. Despite it all, this is a soul-edifying experience. The greatest pain is to think about the loss. And how long the rebuild will take. And the horror of so many dead people .

PLEASE SEND THIS DISPATCH TO ALL YOU THING MAY BE INTERESTED IN A DISPATCH from the front. I will send more according to your interest. Hopefully their collective prayers will be answered. By the way, suture packs, sterile gloves and stethoscopes will be needed as the Ritz turns into a MASH.

UPDATE (4 September): On reading more closely, I see that this is actually from Tuesday the 29th, so it's fairly ancient history now. But it's an illuminating insider report from the immediate aftermath of Katrina.

On another note, I'm having a great deal of difficulty with Blogger. For some reason the toolbar above the "create" a new post page now takes many minutes to appear with when I use dial-up access. I'm also having other troubles getting the photograph facility to work. So I'll probably wait until tomorrow to post on the conference, so I can use my office computer.