Five Days at Memorial

by Sheri Fink

  By the time Breckenridge was returned to the ICU, she was barely alive. They plugged her pumps and drips back into the emergency wall outlets and restored her mechanical ventilator, but she soon died, a death perhaps imminent but nonetheless seemingly the first in the hospital to be hastened by Katrina. A staff member summoned Dr. Horace Baltz to pronounce her death, and the white-haired doctor came panting up the staircase.

  Rodney Scott, a sixty-three-year-old licensed practical nurse who’d once worked at Baptist, was brought down from the ICU, where he was recovering from a heart attack and multiple surgeries. But he weighed well over three hundred pounds, and a doctor feared he might get stuck in the narrow passageway being used to funnel patients into the garage. Worried this would back up the evacuation line, the doctor decided Scott should be the last patient to leave the hospital. Scott was taken to a patient unit on the fourth floor to wait.

  UP ON THE HELIPAD, neonatologist Gershanik was deciding what to do about the two sick babies whose incubator didn’t fit on the small helicopter. Gershanik depended heavily on technology to keep his critically ill newborns alive. Transporting babies this sick without an incubator was unthinkable.

  And then it wasn’t. Gershanik decided to take the risk. He climbed into the seat next to the pilot and cradled a six-week-old preemie wrapped in blankets in his arms. “Baby Boy S” had been born at twenty-four weeks with severely underdeveloped lungs and still weighed less than a kilogram. Gershanik dispensed rapid puffs of oxygen with squeezes of the reinflating bag, attempting to replicate the work of a sophisticated machine that sent oscillating waves of oxygen into the baby’s lungs. Someone placed the other tiny baby from the incubator into the arms of a nurse, who folded herself into the backseat of the helicopter. She slid the baby under her scrub shirt, decorated with pink and blue baby footprints.

  As soon as they lifted off, Gershanik grew afraid. A cold draft circulated through the helicopter, and he tried to shield the baby with his body. It was getting dark. He could easily, without knowing it, dislodge the tiny tube in the baby’s windpipe. He had brought no machine to check the level of oxygen in the baby’s blood. The cacophony of the helicopter blades rendered his stethoscope useless. It would be impossible to listen to the baby’s chest for breath sounds. What did I do? he wondered. Did I make the right decision? Practically the only way to know whether the baby was still alive was to use his free hand to pinch the baby’s foot and feel whether he withdrew it. Gershanik’s other hand was getting cramped from rapidly squeezing the oxygen bag. He made a silent promise: If this baby lives, I’ll never complain about anything again.

  The pilot announced that he had to stop for fuel. Gershanik couldn’t believe it. They landed at a refueling site for petroleum-industry helicopters. A planned five-minute stop stretched into ten, then fifteen, then twenty-five minutes. Gershanik pulled out his penlight and shined it on the baby. Still alive. He swung the light to the baby’s oxygen tank. Nearly empty. Two US Army helicopters had landed after them, but were getting served first. Gershanik protested to the pilot. “Sir, the babies are not going to make it.” The pilot told him the Army helicopters were rescuing people from rooftops. “Otherwise they’ll die as well.”

  For a moment, Gershanik considered the larger reality, the competing priorities that had emerged as waters suffocated an entire city. He was only doing what is ingrained in a doctor—advocating for his own patients—but now he saw that the struggle to save lives extended far beyond the two critically ill neonates in the helicopter, or Memorial’s entire population of sick babies, or even the whole hospital, much as it had seemed like the universe when he was back there. He used the delay to switch oxygen tanks with some difficulty. He apologized for his impatience.

  Back on the helipad at Memorial, some of the remaining neonatal ICU nurses had taken to waving down passing helicopters like hitchhikers putting out a thumb. The activity on the helipad drew the attention of a mass of hospital onlookers, who had climbed upstairs to watch. They were hot and had only time on their hands. The air of chaos surprised a newly arrived coordinator for Acadian, who was moving from hospital to hospital with several small medical helicopters to evacuate critical patients. Other hospitals had been more organized. On the northeast edge of Memorial’s helipad, he put down a cooler filled with sandwiches for his hardworking flight crews. It was promptly ransacked and emptied by Memorial staff and strangers loitering on the tarmac.

  The doctors on the helipad had gone from practicing medicine to, at least in one case, arguing with a Coast Guard pilot about how many patients could fit in his helicopter. The pilot flew away to rescue people elsewhere. A nurse who was also an Air Force captain witnessed the scene and was upset at losing a helicopter. She knew that these pilots ruled the air and, having logged thousands of search-and-rescue flight hours, could be trusted to know their capacity. She approached Dr. Richard Deichmann, the chairman of medical services managing the helipad, and told him the Air Force had trained her to run a flight line in an emergency. He put her in charge, and she cleared the helipad of doctors and patients, sending them to wait in the wind-protection tunnel. She shooed people off the hospital rooftops so that the pilots could keep landing.

  Memorial staff members began loading the last group of critically ill babies onto a helicopter. Its pilot had a flight plan for a hospital west of Baton Rouge instead of the hospital that had agreed to accept Memorial’s neonates.

  The neonatal ICU nurses resisted. They had no idea whether the other hospital was prepared to support the lives of their fragile charges. Richard Deichmann said the babies could leave. “The babies will be taken to wherever the pilot is going,” he told the nurses and, via walkie-talkie, their director in the hospital. “This is a disaster.”

  “Then we will remove the babies from the helicopter,” the nursing director in charge of the neonates radioed back, contradicting him in spite of the unwritten hospital hierarchy that put doctors on top. She told Deichmann that the pilot had to find a way to fly to Baton Rouge or she would not allow him to take the neonates. Within minutes the pilot received approval for a flight plan to Baton Rouge.

  A text message arrived a few hours later from Baton Rouge. All the babies had made it, including Gershanik’s. Baby Boy S’s oxygen level on arrival matched what it had been on the high-tech machines, thanks to the doctor’s life-support improvisations. The babies were more resilient than the doctor had imagined.

  AS SOON AS Anna Pou walked back into the hospital after helping load patients onto the National Guard trucks, a nurse came to tell her that a Code Blue medical emergency had been called on LifeCare, the long-term acute care hospital that leased the seventh floor. “I think you better go, because I don’t think they have doctors up there,” the nurse said.

  The stairs were slippery with condensation, but Pou ran up six flights in the heat rather than wait for the one working elevator. A seventy-three-year-old man had developed a very slow heartbeat just before three p.m. and had stopped breathing. A team of nurses had surrounded his bed and pulled up a crash cart filled with the supplies needed to try to resuscitate him. As the only doctor present, Pou took charge.

  She stepped behind the man’s bed and, with the help of a LifeCare respiratory therapist, tipped his head back with some difficulty. The man was extremely thin, and his neck was stiff and bent. Using the metal blade of a laryngoscope, she scooped his tongue and pulled his jaw up. Then, with a battery-powered light on the scope to guide her, she carefully inserted a tube between his vocal cords and into his airway. The tube was connected to a ventilator plugged into a red emergency outlet. It pumped oxygen into the man’s lungs from a supply that ran through pipes in the hospital’s walls, fed by a giant tank of pressurized gas that did not depend on electricity.

  The electrocardiograph showed that the lower chambers of the man’s heart had stopped beating effectively and begun quivering—fibrillation—which could result in death in minutes. The team that gathered had initiated a code, a pre
scribed sequence of drugs and electric shocks, interspersed with CPR, to attempt to restore a more normal heart rhythm. An ER doctor arrived and took over for Pou. Resuscitating patients was not a typical job for a head and neck surgeon. Despite all their attempts to save the man, he did not survive. He was Dr. John Thiele’s patient, and with no doctors specifically assigned to LifeCare, Thiele had come upstairs and examined him late that morning, finding his condition stable.

  After they called off the code, Pou introduced herself to the respiratory therapist who had assisted her. “How y’all doing?” she asked. “Making out OK up here?” They were, albeit feeling somewhat forgotten. While LifeCare’s medical director and the doctors who admitted the most patients to LifeCare were absent for the storm, none of the physicians who were present had been eager to take responsibility for the seventh floor when dividing up the wards, even though one, Roy Culotta, had pressed LifeCare staff into finding extra room for his grandmother for safety before the storm because her nursing home did not evacuate. “What about us?” a senior LifeCare manager, nurse executive Therese Mendez, had asked at one doctors’ meeting. A female doctor had given Mendez her phone number and location. “Don’t call me for a runny nose,” she said. A male doctor told the woman, “You don’t have to do that. You’re not under any obligation at all.”

  That the doctors would feel more of a duty to care for Memorial patients versus LifeCare patients during the disaster surprised some LifeCare employees. Many of the available doctors were on staff at both hospitals. Some had patients on LifeCare, as Thiele did, and also Pou, who had checked on a man with a jaw tumor over the weekend.

  LifeCare’s leaders were grateful for the Code Blue efforts. “Great response from team and MD’s,” one typed on a notepad computer in LifeCare’s pharmacy. Since midday, LifeCare staff had “talked” to corporate colleagues in Shreveport in real time via a software program, pcAnywhere, normally employed by help-desk specialists to access computers remotely. As the day progressed, confusion had deepened over LifeCare’s evacuation prospects.

  Diane Robichaux, an assistant administrator who was seven months pregnant, had shouldered the role of incident commander for LifeCare’s New Orleans hospitals to allow the senior administrator to leave the city before the storm with his family, which included a child with special needs. Now, on backup power with limited phone and Internet connectivity, Robichaux was attempting to manage evacuations for LifeCare’s patients not only at Memorial, where she was, but also at another LifeCare campus near the New Orleans airport.

  In the late morning, she had gone downstairs to Memorial’s incident command leaders, provided a list of LifeCare’s most critical patients, and told them that LifeCare was trying to do whatever was possible to move its own patients. An Acadian ambulance paramedic on-site at Memorial registered surprise that LifeCare was awaiting direction from corporate officials, as he believed Acadian had a transportation contract with LifeCare, and he wanted to help them.

  In the command center, Memorial’s leaders informed Robichaux that the helipad was operational and LifeCare could land helicopters on it. Robichaux came back upstairs and shared the news via the chat connection with a corporate contact in Shreveport, Robbye Dubois, LifeCare’s senior vice president for clinical services. Robichaux sent Dubois a list of fifty-three LifeCare patients who needed to leave Memorial (two of the original fifty-five had died). Most critically, seven relied on ventilators, one on an assisted-breathing device, and five needed dialysis.

  The reply from Shreveport appeared letter by letter on the screen, tracking backward, excruciatingly, whenever a typed mistake was corrected. Shreveport employees were in contact with a man named Knox Andress, who, they believed, worked with FEMA in Baton Rouge. He’d said FEMA and the Louisiana Department of Health and Hospitals were aware of LifeCare’s situation and planned to evacuate patients on ventilators first. Because all of the hospitals needed help, he could not tell them when, exactly, the cavalry would arrive.

  They waited. An employee in Shreveport offered to make calls for LifeCare staff members in New Orleans who wanted to let their families know they were OK. Some had been unable to contact loved ones for almost two days. Phone numbers and messages were passed on the chat connection: “Yvette is alive, love you guys”; “I’m alright cant reach you, tell Marvin that I love him.”

  Then, in the midafternoon, came an urgent offer from Memorial, followed by confusion. LifeCare patients could go out on the Coast Guard helicopters heading for Baton Rouge. LifeCare had twenty minutes to decide whether to send patients this way.

  Before they could answer, the offer was withdrawn. The Memorial representative had assumed that LifeCare’s patients were included in the patient count sent to the Coast Guard, but it wasn’t true. When Memorial incident commander Susan Mulderick had reached an air evacuation coordinator at the Coast Guard’s emergency command center in Alexandria, Louisiana, by phone in the early afternoon, he had logged her request to transport two hundred people—just slightly more than the number of Memorial patients. “LifeCare patients were not included. Repeat NOT included,” Robichaux typed to her Shreveport colleagues.

  Memorial, Robichaux wrote, had worked on the assumption that FEMA was coordinating LifeCare’s transport, an understanding that seemed to have stemmed, like in a game of telephone, from the conversation between LifeCare’s Shreveport representatives and Andress, the man they believed worked with FEMA. Only, as they would find out much later, Knox Andress was a nurse at a Catholic hospital in Shreveport who had volunteered as a hospital disaster-preparedness coordinator for his region of northwest Louisiana after 9/11. His volunteer title, “HRSA District Regional Coordinator,” was based on the federal hospital bioterrorism preparedness grant to the state. He displayed it proudly on his CV, and he took his role very seriously, participating in local and national training programs as a student and speaker. He did not, however, work for FEMA.

  The most important message was this: “MMC told us that they are going first. First the critical then the other patients.” That meant even Memorial’s less sick patients were being prioritized over LifeCare’s generally very sick ones.

  Robbye Dubois, in Shreveport, said that she thought the helicopters heading to Memorial were coming for both Memorial and LifeCare patients. “We have spoken to the folks at FEMA and we were supposed to be included in the move.” It was hard to imagine that FEMA and the Coast Guard wouldn’t be coordinating with each other. Besides, these were federal resources. How could Memorial monopolize them? If the goal was to get the critically ill patients out first, then why should Memorial’s noncritical patients go out before LifeCare’s critical ones?

  At around five p.m., Robichaux spoke with the LifeCare New Orleans administrator who had evacuated with his family. She told him Tenet’s patients were being lined up for evacuation, which was a little depressing for the LifeCare staff. From the pharmacy computer on the hospital’s seventh floor, Robichaux also pressed her colleagues in Shreveport for specifics. Had FEMA actually said that the Coast Guard airlift at Memorial could include LifeCare?

  A LifeCare staff member in Shreveport called Knox Andress again to check. “All he is telling me is that they have our information and will get back to us,” she wrote to Robichaux. “I specifically asked several times if we were to be included with MMC and all I got is they have our information and will be evacuating all hospitals.” The hospitals were, Andress had told her, going to be evacuated in a certain order, though it was unclear what that order would be.

  Corporate Senior Vice President Robbye Dubois would keep making calls from Shreveport, trying to reach whomever she could who might help. “Please keep pushing from your end,” she wrote to Robichaux, urging her to go to the helipad and explain to the Coast Guard that LifeCare was a hospital within Memorial and also needed to be evacuated.

  Dubois was working at a disadvantage. LifeCare had employed her for many years, and she commuted between its corporate headquarters in Plano, Te
xas, and her home two hundred miles away in Shreveport, where she was now, working out of a hospital. But her superiors were new, part of a management team appointed by the investment firm The Carlyle Group, which had acquired LifeCare earlier in the month. Most of them, including her new boss, LifeCare’s corporate COO, happened to be traveling and out of the office that day.

  Dubois was not inclined to turn to her new boss for help in any case. The morning before Katrina struck, he had questioned whether evacuating the Chalmette campus of LifeCare alone was doing enough given the strength of the coming storm. He wanted suggestions on what might be done to help the other two New Orleans–area campuses after the hurricane hit, such as bringing in additional staff from Shreveport or Dallas to help. Dubois had sent him a terse reply. Hospital evacuations weren’t being recommended, the campuses were well staffed and supplied, and she had compiled a list of staff who could go to New Orleans from Shreveport.

  Now, as conditions deteriorated, there was no way she was going to bring more LifeCare staff into danger to relieve the exhausted staff, which was what she believed her superiors wanted. When she floated the idea of hiring buses to aid in the evacuation, they did not seem enthusiastic. She decided to head up the corporate disaster response alone, assisted mainly by a LifeCare quality management director and an information technology specialist with her at the hospital in Shreveport. She would do whatever it took to aid these hospitals, to the best of her abilities, and ask permission later. She did not turn to higher-ups at the multibillion-dollar firm, who might have had more influence or resources at their disposal, because she felt she wouldn’t get help from them.

  Back in New Orleans, Diane Robichaux went downstairs to Memorial’s command center. When she returned, she seemed to have accepted the status quo out of a sense that LifeCare was covered by at least one of the federal agencies. “OK got clarification again,” she wrote. A Memorial representative said the hospital was not using FEMA to evacuate its patients. It was using the Coast Guard to get patients to Baton Rouge on the way to other Tenet facilities.