by Sheri Fink
This time heat exhaustion had caused his symptoms. Cook rested, drank fluids, and recovered.
A RUSTING HELIPAD sat atop the hospital’s Magnolia Street parking garage on the southwest side of the campus, 114 feet above sea level. Memories of its use had faded like the blue letters painted on its tarmac: SBH, for Southern Baptist Hospital—the name the hospital hadn’t officially carried in more than a decade.
The helipad, known as a Helistop, had been opened with fanfare in 1985. In what only a hospital marketing newsletter would proclaim as a “time-saving, potentially life-saving feat of logistics,” the building project had involved extending the garage elevator two floors higher to allow direct helipad access from the hospital’s emergency room and sixth-floor maternity unit.
The Helistop had special features. Pilots could illuminate the landing lights remotely by setting their VHF radios to a particular frequency and pulsing the switch on their microphones. The lights alerted hospital staff to prepare for an arrival. Landings could take place day or night in most types of weather.
The elevators and the landing lights relied on electricity. From that standpoint, the helipad design no longer represented a time-saving or lifesaving feat. The garage elevators had not been wired to the backup electrical system, rendering them useless without utility power. It was now impossible to take a patient directly from within the hospital to the helipad.
Several hospital administrators and others trudged up the seemingly endless garage staircase to assess the situation. The picture of decrepitude that met them raised a more serious question about the Helistop. Would it buckle under the weight of a helicopter? The engineers in the group were unsure. Whereas the platform once could accommodate an aircraft weight of 20,000 pounds, the hospital had recently spent upward of $100,000 in repairs merely to keep it from collapsing onto the eight-story parking garage below.
One doctor lingered on the helipad after everyone else departed. Paul Primeaux, an anesthesiologist in a hospital where surgery was no longer being performed, was one of several physicians who had no clinical responsibilities because of the situation. (Others included two radiologists and a pathologist, doctors who didn’t normally see patients but provided critical services to them.) Primeaux had never been up to the helipad before and had joined the group out of curiosity.
Standing atop the thin platform was dizzying. Its flat edges dropped away to nothingness as breezes whooshed across it, unhindered by almost any other structure as tall as it for miles. Before him, to the west, the flooded streets of the Freret neighborhood stretched out like long mirrors, reflecting treetops and the top halves of double-shotgun homes. Southward, the land sloped up to the banks of the Mississippi River. Church steeples rose above debris-strewn rooftops. To the northeast, beyond the upper stories of the main hospital, he could see the skyscrapers of downtown a mile or so away and the Superdome, the city’s shelter of last resort. The storm had ripped away most of the gleaming white outer layers of its roof. The north side of the helipad led to the elevator tower through a tunnel full of glass from broken windows.
Primeaux heard the thrum of helicopter rotors and looked up at the sky. He saw a massive, dark-olive military helicopter with the numbers “585” painted in white across its nose. It looked like a Black Hawk. Primeaux gave it a casual, friendly wave. He did not mean to signal it, but the pilot began lowering his aircraft toward the spindly-legged helipad.
The Black Hawk, weighing more than 11,000 pounds empty, touched down. It sat, rotors spinning, framed by blue sky and wispy clouds. The helipad held.
The pilot asked Primeaux if there were people who needed to be evacuated. Primeaux said yes and suggested a sick newborn. The pilot checked with his commander and received permission to take one. Primeaux ran down the parking garage stairway and into the hospital to alert the incident command team. Then he went up to the neonatal ICU, where critically ill babies were being tucked into portable incubators, cradles, and cribs in preparation for transport.
The lack of functioning garage elevators turned the journey between the maternity unit and the Helistop from “immediate access” to long and circuitous. When the first baby finally reached the helipad, the waiting pilot was unhappy. “That took too long,” he said. Thousands of people needed help across the city. He had spoken with his commander and wouldn’t be returning. “You’ve got to figure out a better system.”
“OUR HELIPORT IS operational. We can receive air,” Memorial emergency communications leader Sandra Cordray wrote just after noon to Tenet’s regional business development director Michael Arvin at Tenet headquarters. The panicked calls and e-mails to make transport plans began to produce results. A hospital in Baton Rouge agreed to take all of Memorial’s babies; sixteen were critically ill. Coast Guard helicopters were expected to arrive in the afternoon to transport them and several adult ICU patients. The plan was coordinated with the help of a nurse’s husband who happened to be a junior grade lieutenant and medic working at the Coast Guard’s emergency command center in Alexandria, Louisiana. The National Guard promised to move thirty-five medical and surgical patients to a Tenet hospital in Texas via high-water troop hauler trucks with big tires and high platforms.
That would still leave well over one hundred Memorial patients and hundreds of other people in the hospital, and there were signs that government assistance might not be sustained. In the midafternoon, Arvin and his boss, Bob Smith—Tenet’s senior vice president for operations in the Texas–Gulf Coast region, a top official who reported to the company’s chief operations officer—received an e-mail with a desperate plea for help from the Federation of American Hospitals. “Senator Landrieu’s office called and is begging us to help them fill in emergency rescue gaps in Louisiana,” it said. “Apparently the state’s emergency response capability is falling woefully short.” Louisiana senator Mary Landrieu was asking hospitals in surrounding areas to lend their Medevac helicopters to help evacuate patients in the coming day. The author of the e-mail asked hospitals to respond “asap.”
Despite the request, and the fact that executives from some Tenet hospitals, like Atlanta, had already expressed a willingness to provide evacuation support, Tenet officials continued to rely on governmental resources to respond to the emergency.
BY MIDAFTERNOON, the waters around Memorial had climbed partway up the sloping emergency room ramp, where a camouflage-green National Guard troop hauler stood. Patients emerged from the ER, some pushed in wheelchairs, others using walkers, and were guided to the truck by hospital staff with sweat-soaked shirts and hair wet with perspiration. Anna Pou worked among them.
Pou and her colleagues loaded about a dozen people onto the open truck bed. They sat squeezed together along its sides on simple metal benches beneath a green metal frame. Hospital security personnel wearing blue bulletproof vests joined the effort to lift patients onto the chest-high platform. Several nurses climbed aboard to accompany the patients out of the city. One still wore her neat white tights despite the heat.
Beyond the truck, a man in a striped shirt waded along Napoleon Avenue in water up to his chest. One of the Memorial security guards walked atop the raised brick siding to the submerged end of the ramp. Gripping a traffic sign for balance, he leaned out over the water in the direction of the wading man and gestured away from the hospital. Even if the man didn’t hear what was said, the message seemed clear: he was being warned away from the hospital, not welcomed there.
The platform of the truck wasn’t much higher than the water level. A limited time remained to rescue patients by road.
At about four p.m., the truck’s large wheels churned through the water, rolled past downed crepe myrtle trees at the front of the old hospital building, and then headed west. Hospital leaders had arranged for the patients to be accepted at a hospital in Nacogdoches, Texas. They planned to send twenty-seven more patients there when a second truck arrived.
“IT’S TIME TO GO!” In the neonatal ICU, portable plastic bassinets, norma
lly used to carry babies to their mothers’ rooms, were lined up on the ground with two babies each and their recent medical records. To the relief of the nurses, the NICU had not yet switched to computerized charts, which would have taken a long time to print and compile. A nurse’s husband sat in a chair cradling a skinny, diapered neonate against his chest to comfort it; one of its tiny brown feet stretched down to balance atop the man’s beer gut as someone snapped a picture. The man was one of many family members who were now volunteering with important nonmedical tasks.
The sickest babies were placed in transport isolettes—large, self-contained incubators on wheels complete with oxygen tanks, warming pads, and battery-powered pumps that administered IV fluids. The staff rolled one of them carrying two very sick babies to the single elevator working on backup power in the medical center’s newer Clara Wing. The incubator was too tall to travel through the garage on the back of a pickup truck, so staff pushed the wheeled machine up the parking garage’s down ramp, circling to the ninth story. Then five men in sweat-soaked T-shirts squeezed around the incubator and began to heave it up three sets of fire-escape stairs to the helipad. The machine that provided oxygen to one of the babies wasn’t working, so a nurse climbed the staircase beside the men, pushing oxygen from a small tank into the baby’s airways by repeatedly compressing a self-inflating bag the size and shape of a large lemon. She worked with a worried expression, her hand inserted in a round opening in the incubator.
When they reached the top, none of the expected Coast Guard helicopters awaited the babies. In the late afternoon someone at Memorial forwarded approach maps and geographic coordinates to a Coast Guard representative. Pilots from out of town were having trouble locating Memorial Medical Center. The helipad hadn’t been certified for use in years, and the markings indicating the old name of the hospital, Southern Baptist, could be confusing.
The babies waited for the Coast Guard helicopters in the covered tunnel, their incubators plugged into a power outlet supplied by a hospital generator. A neonatal specialist wearing green scrubs paced from the holding area to the helipad, growing increasingly worried as time passed. The babies were hot; one was having complications that might require urgent surgery. The neonatologist, Dr. Juan Jorge Gershanik, looked down at the water surrounding Memorial and imagined what it would be like if all power went out. The children would be goners. It would be a death sentence. He felt like he was in a movie.
He went to speak with internal medicine department chairman Richard Deichmann, who was outfitted with a two-way radio to communicate with other hospital employees as he directed movements on the helipad. Small private helicopters were landing, including one that dropped off the long-awaited drug supplies. Other pilots were willing to take sick elderly patients but not sick neonates, who typically required more specialized care.
Could Deichmann convince the pilots to transport babies instead? “We can’t wait any longer,” Gershanik said. “Please, Richard, see if any of them can take us.”
“I’m at their mercy,” Deichmann replied, but when another helicopter landed, he turned and gave Gershanik a pointed look. The neonatologist didn’t know what the look meant, but he rushed toward the helicopter, pushing the incubator ahead of him.
“No way,” the pilot said. The giant incubator couldn’t fit in his three-seat helicopter. The babies would have to wait.
“They can’t wait,” Gershanik said. More than an hour had passed on the helipad. It was getting close to sunset. “I really think they’re running out of time,” Gershanik said.
They were also running out of backup oxygen tanks on the helipad, and the nursery staff had to trek back into the hospital several times to get more. Some of the tanks went to elderly ICU patients also arriving on the helipad.
On the eighth floor in the ICU, nurse manager Karen Wynn, a blur of motion in wrinkled blue scrubs, was helping get them there. With the air-conditioning off for more than a full day and the ICU equipment producing heat, it was getting unbearable. The windows that hadn’t broken were sealed shut, some were still covered in plywood, and it was moist inside, humid. People were sweating. She told her staff they could change from their scrubs to shorts if they had them.
White box fans were moved back and forth between patients. Some in the unit weren’t terribly sick, but others were fragile and lacked resilience. The tiniest change in their environment threatened their homeostasis. The heat menaced them.
Wynn helped pry boards off of the inside of the windows, hoping to uncover cracked and broken panes that would let in some air. Male nurses and the housekeeping director took turns battering the windows Katrina had left intact with a tall metal pole normally used for hanging bags of intravenous fluid, finally shattering them.
When Karen Wynn put a patient on the elevator she heard a sound like Niagara Falls. The shaft was filling. A security guard stayed in the elevator to ensure that nobody pressed the button for the basement. Wynn wanted to get her patients off the eighth floor. Time was of the essence. Even if the generator power didn’t go out, they were going to have to shut down the elevator soon for safety.
The ICU had received a call for more patients on the helipad: “We need some more! Helicopters are waiting!” It was taking about forty-five minutes to get each patient to the helipad. Veteran surgical ICU nurse Cheri Landry, entrusted with the radio on the eighth floor, passed the word to her colleagues. “We’re losing helicopters, we have to move faster.”
Wynn’s staff, helped by some of their accompanying relatives, worked furiously. It was taking so long for the single elevator to arrive that they started carrying some patients down the stairwells. They rolled patients onto their sides, pushed a blanket up against their sweaty backs, then rolled them the other way and pulled the blanket out so it was lying underneath them. Volunteers grabbed onto the sides of the blankets, gathered up the slack, and lifted the patients from their beds.
Another surgical ICU nurse, Lori Budo, gripped a flashlight under her chin as she navigated the dark stairwell alongside a patient. When she came back up, she collected flashlights and tape and directed a volunteer to fix them to the railings.
One of the sickest patients in the ICU was seventy-seven-year-old Helen Breckenridge, a former drapery maker and interior decorator who had been a patient at Memorial for about a week. Breckenridge had developed complications of lung and heart disease and diabetes, and had been in hospice care at another hospital. That meant that the treatments she was receiving had been focused on affording her comfort rather than extending her life. She was receiving morphine and powerful sedatives and, when she stopped eating, perhaps as a result of the sedation or her worsening disease, the hospice had not provided nutrition or fluids. Her brother, a physician at another New Orleans hospital, couldn’t stand to watch her wither away. He believed she had been forced to sign paperwork that led to her hospice admittance and that she didn’t really want to be there. He went to court to have her removed from hospice and transferred to Memorial for aggressive treatment in the ICU.
Now, a team of medical workers labored to move Breckenridge. One squeezed air into her lungs by hand and others kept an eye on the multiple battery-powered pumps that delivered drugs into her veins to regulate her fragile circulatory system. They traveled downstairs from the eighth floor.
“Bring her back up,” a doctor said when she arrived downstairs. “She can’t go in the first sweep.”
Memorial’s doctors, meeting earlier, had established an exception to the protocol of prioritizing the sickest patients and those whose lives relied on machines. They had decided that all patients with Do Not Resuscitate orders would be prioritized last for evacuation. There were four DNR patients in the ICU, including Breckenridge and Jannie Burgess, the African American nurse who had once cared for patients at hospitals where she herself could not be treated.
A DNR order was signed by a doctor, almost always with the informed consent of a patient or health-care proxy. Informed consent was a legal co
ncept established beginning in the 1950s in the United States. It was designed to protect patient autonomy in medical decision making, in the context of historical abuses. Doctors were required to disclose the nature, risks, benefits, and alternatives of the medical interventions they proposed. A DNR order meant one thing: a patient whose heartbeat or breathing had stopped should not be revived. A DNR order was different from a living will, which under Louisiana law allowed patients with a “terminal and irreversible condition” to request in advance that “life-sustaining procedures” be withheld or withdrawn.
But the doctor who suggested at the meeting that DNR patients go last had a different understanding, he later explained. Medical chairman Richard Deichmann said that he thought the law required patients with DNR orders to have a certified terminal or irreversible condition, and at Memorial he believed they should go last because they would have had the “least to lose” compared with other patients if calamity struck.
Other doctors at the meeting had agreed with Deichmann’s plan. Bill Armington, a neuroradiologist, later said he thought that patients who did not wish their lives to be prolonged by extraordinary measures wouldn’t want to be saved at the expense of others—though there was nothing in the orders or in Memorial’s disaster plans that stated this. This decision about evacuation priorities would perhaps not be a momentous one—as long as the hospital was emptied quickly.
Nurse manager Karen Wynn learned of the doctors’ decision from two doctors, Ewing Cook and Roy Culotta, and shared the information with Susan Mulderick. The plan was also made clear to a nurse helping transport Breckenridge: first “the most salvageable had to go.”