“Let’s Handle This:” An Interview with Mary Showstark, M.S., PA-C

In 1992, when Mary Showstark was 12 years old, Hurricane Andrew nearly ripped the roof off her family’s house in Miami. Today, Showstark specializes in disaster response, serving with the National Disaster Medical System and other medical relief organizations. She’s been deployed all over the world to provide medical care after earthquakes and hurricanes.

Showstark, M.S., PA-C, still lives in Miami—right on the beach. We spoke to her 48 hours before Hurricane Irma was expected to slam into the Yale PA Online faculty member’s native city. Because Showstark and her family were “in the line of fire,” as she put it, the U.S. Department of Health and Human Services took her off the list of PAs scheduled to deploy.

Hurricane Andrew “was terrible,” she said. “It lasted 12 hours. You sit and you hide. That’s what I’m doing right now. You set up for camping, really.”

The same holds true when Showstark deploys. Her “go bag,” at the constant ready in her front closet, contains anything and everything she might need to survive the aftermath of a disaster in which she’s providing medical assistance—in Nepal after the April 2015 earthquake, for instance, or in Haiti after that country’s January 2010 earthquake.

“It’s to make yourself sustainable,” she said. “In Nepal I was in a very small, eight-to-nine-person team that got dropped in the mountains. We were helicoptered in and then hiked village to village to provide medical care. So you bring what you can carry, for the most part, and you bring what’s going to sustain you and allow you to survive.”

Before Irma hit, Showstark was talking to her neighbors, urging them to be smart after the hurricane passed.

“A lot of deaths happen after the storm because people are trying to fix things; they’re walking through the flood waters,” she said. “Miami Beach’s slogan is ‘Rising Above’ on a normal day because we flood. One of the biggest things that I’m warning my neighbors about is that we have all these manholes here. In [hurricanes], the manhole covers [fly off or] float up, and people trying to walk the streets can sink into a manhole. And you’re not swimming out of a manhole.”

In celebration of National PA Week (October 6–12), we asked Showstark about being a physician assistant (PA) who specializes in disaster response.

My friend backfills for one of the teams, and he’s sitting in a hotel in Atlanta right now with 36 members of the team. They stage there, so basically you sit, and wait, and wait, and wait. It’s a government call from [Human and Health Services]. They had my friend check out of his hotel yesterday, and they had all 36 members of the team sitting on the floor of the hotel, waiting. And then they checked them back into the hotel because they didn’t have a place to send them yet. It’s a lot of hurry up and wait because of the uncertainty. It’s Mother Nature, and you don’t control Mother Nature.

It’s making sure you’re able to take care of yourself first. That was one of the biggest things I saw in Haiti. Many medical providers couldn’t take care of themselves. It means you have to be fully sustainable. You have to make sure you have your rehydration salts. You make sure you have your packets of Gatorade. Make sure you have your N95 mask, or pollution mask, because in some of these locations there are chemicals, dead bodies and debris. Some people can’t handle the heat or the smell. You have to make sure you’re up for something like this before you try to be a hero. And you’re not a hero. You’re giving back with the skills you have. It’s not about the ego. It’s about providing help, and if you feel like you can take care of yourself, you can take care of others.

It’s more recognized to have mid-level providers on the team now. They realize the importance of having a PA or a nurse practitioner on the team because they can provide—and they’re used to providing—for a lot of patients at one time. I think the number one thing is that we’re recognized as critical members of the team.

It depends whether it’s international or national. On the national federal team, we’re a member of the [Disaster Medical Assistance Team]. So, we all have to listen to our commander, our chief officer, and our administrative officer. We get orders and we follow those orders. Once you’re on the ground, you can lead. You can lead your own area and section. You can set up your own mini clinic where patients are triaged to see you.

So, in Nepal I would have one of the paramedics see a patient and do his or her vital signs. Then the patients would come back to me, and I would work with translators to try and diagnose what was going on with the patient.

After I was in Haiti, I came back and I continued to work with the team on the ground there because I knew the hospital systems and was trying to facilitate getting certain patients transferred out. We’d work with people with private planes to get patients out of the affected area into different hospital systems where we would relay the medical diagnosis and the transfer information and try to get hospitals to accept them. So, it was more of a facilitation role.

Good Samaritan laws protect us as PAs. So, if you see a car accident on the side of the road and you’re a medical provider, you can stop and take care of those people without the fear of getting sued. Is it still possible [to get sued]? Sure, but the Good Samaritan law is supposed to protect us.

When I was in Tahiti, I was working with the pro surf tour. [Weather models and] the government told us about a 60-foot swell coming in, so we began planning for a disaster. The night before, the waves were crashing up against the shore and the houses, so we knew it was going to happen. We also knew that all of these big-name surfers were flying in from all over the world for these waves. We had to legally cancel the contest, per the Tahitian government. The police chained up the Jet Skis and arrested some of the boat drivers who were trying to go out. Some surfers still went out. 

We had to call in some Australian lawyers to see if we could still function off the Good Samaritan law because the government was telling us that we would be arrested if we treated patients. We said we wouldn’t operate our clinic if we could still treat people hurt by the storm. They agreed to that, which allowed us to treat a lot of people. But you have to find out what’s recognized in other countries.

There’s a whole specialty of mass gathering medicine that falls under the World Health Organization and that has modules on mass gathering protocols. Disaster ends up being kind of a mass gathering. I worked the New York City Marathon, in operations and medical command, and that’s one of the nation’s largest planned disasters. You don’t think of a marathon as a planned disaster, but look at what happened in Boston. There are people behind the scenes at concert venues and cruise ships, for instance, who are trained in mass gathering emergency preparedness.  

Some of it is learning while you go. It’s hard to know what’s going to happen. It’s hard to predict, and emergency medical providers—whether they’re police or fire rescue or paramedics or PAs—really work on intuition and instinct, and I think that’s the best. There aren’t a lot of people who are going to walk into a disaster and think, “OK, let’s handle this.”

This interview was edited for clarity and brevity.

When Showstark deployed to Haiti in 2010 after an earthquake that killed between 200,000 and 300,000 people and displaced 1.5 million, she noticed that “nobody could prove who they were.”

“They didn’t have a birth certificate on them, they didn’t have their passports, and they didn’t have their IDs,” she said. “So, making sure you really waterproof and seal those is one of the biggest things that people don’t really think about.”

Before deploying into a disaster zone, Showstark makes sure critical information and documents are saved to the cloud or sent to friends or family members out of harm’s way. She takes pictures of her credit cards and makes copies of her IDs, insurance, bank accounts, and in-case-of-emergency contact information. Then, she double bags it in sealable plastic. Here are other things you’d find in Showstark’s “go bag.”