by Sheri Fink
Mulderick slammed her office door shut behind them to protect passersby from flying glass in case the windows shattered completely. The sturdy building shook violently. The sounds of the wind stealing through invisible crevices added to the aura of terror, a moaning, like a ghost, up and down the musical scale.
In the corridor, a panicked crew from plant operations ran toward Mulderick. “Glass is shattering all over the building!” they yelled. She was in charge. What did she want them to do?
It had fallen to Mulderick, the rotating hospital manager on call, to lead the hurricane response at Memorial as “incident commander.” She felt responsible for every patient, staff member, and visitor. Her job was to oversee all emergency operations, lead meetings, and make decisions with the hospital’s top executives. The fifty-four-year-old nursing director appeared well qualified for this job, with the authority of her thirty-two years of employment at the hospital—decades more than CEO L. René Goux, also present, who had been sent by Tenet to run Memorial only in 2003. Mulderick directed sixteen nursing departments and had more than fifteen years of experience on the hospital emergency committee, which she now led. When Hurricane Ivan had menaced and missed New Orleans a year earlier, she had also been at the helm, although Memorial’s emergency management plan called for the CEO, typically, to assume the role of incident commander.
Mulderick had another sort of crisis-management experience—the family kind. Like Pou, she belonged to a large, Catholic school–raised New Orleans brood. But as she grew up, despite the outings to City Park in perfect, matching Easter dresses and bonnets, beyond the swingset and white shingles, beneath the high ceilings and crystal chandeliers, a certain chaos reigned. The third of seven children, the care of her younger siblings had often fallen to her, and she emerged from childhood remarkably strong and calm, a manager, an emergency responder.
Mulderick began her nursing career in the ICU at Baptist in 1973 and never left. She raised her own children and painted as a hobby, but for more than three decades, she had given almost everything else of herself to the hospital. She rarely took a break and once, when she did, a deadly storm nearly ended her life. In 1982, after spending five years planning a trip to Las Vegas with friends from Southern Baptist and another local hospital, she and they were bumped off an overbooked flight at the last minute, leaving their suitcases behind on Pan Am 759. The 145 people on board that airplane plus eight more on the ground were lost when a violent form of wind shear, a microburst, blew the Boeing 727-200 back down to the ground soon after takeoff. Mulderick saw smoke billowing out of the trees from a window of the plane her group had boarded fifteen minutes later. True to her coolheaded nature, Mulderick did not tell her friends what she saw so as not to make them worry.
Hospital life and family life intertwined. One of Mulderick’s brothers died at Memorial after back surgery. A sister, with help from Dr. Horace Baltz, had been saved there from a bleeding brain aneurysm. Another sister worked at the hospital as an executive assistant, and Mulderick’s housemate, as a nursing coordinator. Mulderick held on to her position as a nursing director for more than a decade, through significant changes. Under financial pressure, Southern Baptist Hospital merged with a New Orleans Catholic hospital, Mercy, in the early 1990s and then both were sold to giant, for-profit Tenet Healthcare Corporation in 1995. Mercy-Baptist’s president didn’t hide his lack of enthusiasm for the sale when he announced it in prophetic terms: “Due to market-driven health-care reform, the days of stand-alone community hospitals are limited.”
Christmas decorating contests and the decades-old motto “Healing Humanity’s Hurt” disappeared. Gone, on paper, was the Baptist name; calling it that became a satisfying, if minor, form of rebellion. Now press releases extolled Memorial Medical Center’s “fiscally sound partnerships,” and “stronger financial performance.” Patient-care managers were given monthly budgets and productivity goals and took a beating if they failed to meet them. Success was rewarded with progressively tighter budgets. Mulderick adapted and survived.
Tall and fair-skinned, with straight red hair cut short in a pageboy, she had a tough, no-nonsense manner that intimidated some employees. She was known as calm and cool, even cold, under pressure.
After the maintenance crew came running to announce the breaking windows, Mulderick got on the phone with Cheri Landry. The senior intensive care nurse was camping in the new surgery building across Magnolia Street where Pou and her group were. Mulderick told Landry to get everyone out of there before the bridge linking the two buildings collapsed or its windows shattered. The staff members and their families would have to make a terrifying dash across its swaying, rattling expanse.
Anna Pou called one of her sisters before making the trip. “The walkway’s about to collapse. I have to run across it,” she said. “Just checking to make sure you all got out.” She learned that one sister, a dialysis nurse, had not left the city, staying instead in the flood-prone Lakeview neighborhood near Lake Pontchartrain. Pou knew she was tough, but she prayed for her anyway.
Mulderick went with the maintenance men to survey the hospital. They roped off the danger zones and moved patients out of exposed areas into interior hallways. In the ICU on the top floor, where Jannie Burgess and around twenty other patients were staying, the small patient rooms were arrayed along the building’s outer walls. Most patients were attached to oxygen tubing, IV pumps, and EKG monitors plugged into outlets and would be difficult to move away from windows. Instead, for the first time anyone could remember, maintenance crews had boarded up the windows with plywood from the inside.
The exposed sides of the windows shattered under a hail of rocks launched from nearby rooftops. The ICU filled with screams. Plywood grew wet and buckled. Water slipped inside to pool on the floors, creating another hazard. The father of one of the nurses on duty, who had taken shelter in the hospital with her, tried to stop his daughter from entering the area to do her work. The metal window frames strained and creaked like the Titanic, it seemed to one doctor, who finished up his work and headed to a lower floor. Several policemen were camping at the hospital, and a patient’s son brought one upstairs to insist his mother be moved into the corridor for safety. “If I had someplace else to move her, I would,” the nurse manager of the ICU, Karen Wynn, said, exasperated. “This is a clinical decision. This is not a decision he can make. We have to keep the patient safe, but also do what’s clinically appropriate.” The policeman understood, but the son didn’t. His rage threatened to ripple chaos into the calamity. “If you’re going to continue to be a problem, we will have you removed by the same cops you got,” Wynn told him. There was enough going on without this.
At 4:55 a.m., the supply of city power to the hospital failed. Televisions in patient rooms flicked off. Memorial’s auxiliary generators had already thumped to life and were playing counterpoint to the shrieks of the storm. The system was designed to supply only emergency lights, certain critical equipment, and a handful of outlets on each floor; the air-conditioning system shut down. Nurses trained box fans on their patients. There weren’t enough to go around.
On the sixth floor in the newly renovated family waiting room outside of Labor and Delivery, the windows shimmy shook so hard they blew themselves out with a sound like a sonic boom. Rain sheeted onto the carpeting. Elsewhere, winds funneled through broken windows and scrambled narrow aluminum blinds. In their offices, doctors drew drapes across picture windows and stanched leaks with hospital gowns and bed sheets, the scene outside black and thundery.
At just after six in the morning, Katrina’s eye slid over land as a Category Three hurricane, glancing at New Orleans from Buras, Louisiana, about sixty miles southeast of the city. The storm raged after daybreak. The view outside Memorial, for those who dared to get close enough to a window to look, was an impenetrable white blanket. Gusts of 135 miles per hour were expected by nine thirty.
Between squalls it was possible to stand outside on the emergency room ramp and peek
out from behind a heavy post. The US and Louisiana flags flapped madly on their flagpoles against a gray sky. Water raced like a river down Clara Street. A red car and a red van were bathed to the middle of their wheel wells. The wind kicked up whitecaps and spray.
The basement began taking water. It was, as it had been in 1926, full of food—three to five days’ worth, five to seven if it was rationed. Incident commander Mulderick helped pack the supplies onto rolling dollies and move them upstairs, an arduous process that took hours because of the limited number of hand trucks.
The possibility that the floodwaters could reach the first floor raised fears for the ten patients in the emergency room and the Noah’s ark of pets in the medical records department. For now, the emergency patients stayed put. Surgeon Anna Pou joined a chain of hospital volunteers and National Guard soldiers to help pass kennels up a staircase to the eighth floor and place them in the old, unused surgical suites behind the ICU. The area filled up with cages and the earsplitting barking and the stench of frightened animals.
Mulderick’s first-floor command center was relocated to a fourth-floor nurse training room. Another concern was drug reserves. Memorial, like many modern hospitals, did not maintain a large supply of medications on hand, opting instead for a “just in time delivery” system. The head pharmacist had requested an emergency cache of medicines from supplier McKesson on Saturday, but the company’s workers seemed to have already left their local warehouse ahead of the storm. They never delivered the drugs. Now, Monday morning, only about a day’s worth of certain medicines remained. Memorial would need more supplies by Tuesday morning.
Memorial CEO René Goux was on-site and asked his community relations manager, Sandra Cordray, to share these issues with corporate executives at Tenet Healthcare in Dallas. “Rene’s major concern is patient care after storm and high flood waters and continued loss of power,” she wrote in an e-mail to Tenet’s chief operating officer and other officials. “We will consider options for patient evacuation—that we may not have to use.”
Some patients were not being seen because their doctors were off-site and unreachable by phone. The medical staff president, Reuben L. Chrestman III, was on vacation. In his absence, Dr. Richard E. Deichmann, chairman of medical services, one of Memorial’s three clinical departments, took the lead in organizing the physicians. Most of them were, like Anna Pou, university doctors or private contractors credentialed to admit patients, but not employed by the hospital. Memorial didn’t specifically require most medical specialists to be present for hurricanes. These doctors had stayed either because they were on call for the weekend like Pou or had, like Dr. John Thiele, grown accustomed over years of hurricane warnings and near misses to spending storms in their offices.
More doctors seemed to be on hand than in any previous hurricane, perhaps because the storm had fallen on a weekend and those on call had simply stayed. Several, Deichmann and Baltz among them, were internists. Thiele was one of three lung specialists present who treated critically ill patients in the ICU. Others included a kidney specialist, an infectious diseases doctor, emergency medicine doctors, and neonatologists who took care of the youngest, sickest babies. There were several surgeons, including Pou, and three anesthesiologists. Deichmann assigned these clinical doctors to different nursing stations so that someone would be in charge of each of the fifteen patient units.
Katrina rapidly lost strength after moving onto land. The rain lessened and the winds began to ease by late morning. The water level outside Memorial stabilized at about three feet. Maintenance crews began to survey roof damage and broken windows, downed ceiling tiles, and sodden carpets that, in the growing heat, invited mold.
By midafternoon, the waters outside began to recede. Pets and food were carried back downstairs. Nurses mopped floors for hours until the rain and the ceiling leaks stopped completely. Patients tried to call loved ones to check on them and let them know they had come through all right. Emmett Everett, the 380-pound patient up in LifeCare who had been moved from Chalmette in St. Bernard Parish, was unable to reach his wife on her cell phone and told his nurse he was worried about her.
By evening, the flooding was gone, and it was possible to walk dogs outside. Some doctors who lived nearby navigated the debris-filled streets to check on their property and even stay the night at home. Other staff crossed back to their campsites in the new surgery building. Katrina had weakened before arrival, buffeting the city with only Category One or Two winds, not the Category Five tempests envisioned by the doom-prophesying weathermen. “We dodged a bullet,” people said to one another with weary relief. Memorial had sustained damage but remained functional on backup power. The hospital seemed to have weathered one more storm.
CHAPTER 4
DAY THREE
TUESDAY, AUGUST 30, 2005
“CODE BLUE, ER.”
Karen Wynn’s eyes opened in the dark room. She felt around for her shoes and socks, but could only find her teenage daughter’s flip-flops. She shoved them on her feet and ran the length of two city blocks from the new surgery building over the footbridge into the main hospital and down to the first-floor emergency room, struggling not to trip or cut her feet on broken glass.
Along the way, the ICU nurse manager tried to sort through her confusion. It had to be four or five in the morning. Why were they summoning her to a Code Blue in the emergency room? The ER staff members could resuscitate patients by themselves. Besides, who would be coming into the hospital when most of the city had been evacuated?
She arrived, panting. Blood was everywhere. A woman was lying on a gurney. She looked to be in her late sixties. The story came from her grandson, who had carried her up the ER ramp. There had been drinking. A fight. The woman’s daughter stabbed her in the chest with a kitchen knife. The grandson ran for help and found policemen, but they told him there were no ambulances running and he would have to find some other way to get her to the hospital.
The knife-and-gun club hadn’t taken a break, even within hours of a major hurricane.
The page operator called overhead for all doctors to come to the emergency room. Internist Horace Baltz appeared in a white coat, with bare legs. In an effort to get there quickly, the senior doctor had thrown the coat on over his shorts, then tied on his black Oxford shoes and run downstairs.
The patient, at first conscious and communicative, began struggling to breathe. Wynn knew air might have followed the knife’s path into her chest and collapsed her lungs. The woman’s blood-pressure measurements were falling.
Blood could be collecting in the sac around her heart, constricting it and limiting its ability to fill and pump. Someone called for an ultrasound machine technician to check this, but for now there was no time to await answers. A doctor made a cut in the skin between two of the woman’s ribs, spread the tissues with a blunt instrument, and pushed a tube into her chest cavity to release any built-up air. Another tube went into her throat and was attached to a mechanical ventilator to help her breathe.
Fortunately, the ultrasound exam showed that the knife had not penetrated the membrane around the woman’s heart. Open-chest surgery wouldn’t be necessary. The team hadn’t liked the thought of attempting it on backup generator power. Wynn’s ICU had one available bed. The woman was taken by elevator to the eighth floor.
The ICU nurses on the overnight shift received their new patient at about six a.m. and began positioning the tangle of equipment that had taken over for many of her bodily systems. The machines breathed for her, checked her blood pressure at regular intervals, measured her pulse, pumped fluid into her veins, and monitored the oxygen level in her capillaries—all just as if a hurricane had never happened.
A nurse rolled a cart with a computer up to the woman’s bedside and began documenting her progress. Some of the ICU nurses had radios on their carts. They tuned them to WWL, a popular 50,000-watt talk radio station that was broadcasting on generator power.
On the radio, the president of neighboring Je
fferson Parish announced that martial law had been declared. The hosts aired his message repeatedly, but martial law—an extremely rare assumption of police powers by the military typically requiring an act of Congress—had not, in fact, been declared in the disaster zone.
A caller complained that looters were ravaging New Orleans. She didn’t say how she knew this, but the radio host took her at her word and amplified her outrage to thousands of listeners. “If someone is breaking into businesses and looting merchandise, these people should be shot,” he said. “We’re under martial law here.”
Throughout the early morning, callers began describing something even more ominous. Water from the storm was still sitting in the streets. One resident was mystified because he could hear the city’s drainage pumps running. “My question is,” he said to the host, “if you live a block away from the pumping station, and the pumping station is working, why would you have water in your house?” The host had no answer.
“We’re very frightened,” a man named Freddy said calmly, and described his situation. He was sitting in the attic of his home in the Gentilly neighborhood near Lake Pontchartrain, surrounded by about nine feet of water. The area, one of those that had flooded badly in the 1927 storm, was several miles northeast of Memorial. With him were four other people, including a baby. They had punched a hole through the roof and, using candles, a lantern, and a flashlight, had tried for four hours to signal a helicopter.
“And is the water rising anymore?” the host asked him.
“Yes, it’s steady rising, yes.”
“The water’s rising?” one nurse asked aloud in the medical ICU at Memorial. It made no sense. The street flooding around the hospital had gone away. Anyone who had taken a break and ventured outside during the night knew it was clear and still. The news was confusing and worrisome, but there was work to do.