by Sheri Fink
“Wait a minute, nobody’s moving anywhere,” Wynn said. She felt responsible for the staff members she had called in to work. She felt responsible for their families, too. With most of the intensive care patients on the eighth floor gone, she wasn’t inclined to send her staff out to transport patients from other units. “Nobody on the eighth floor is moving anywhere,” she said. She quickly toweled off. “We’re not doing this willy-nilly, we need direction.” The one person she trusted to give that was Susan Mulderick. “I’m going to find Susan,” she said.
In other parts of the hospital, the sound of a man shouting stirred groggy adults and children from mattresses, sofas, and the odd examination table. “Everybody up! Everybody, get up!” The noise pierced the slumber of Dr. Ewing Cook, lying in his office with his wife and colleagues. They clicked on their flashlights and caught sight of a white man in fatigues yelling as he moved through the dimly lit respiratory care department at around one a.m.: The boats are here! Get down there! You can take one bag! No animals! Go to the first floor! Boats are here and leaving in thirty minutes!
People screamed back at the man—how could he expect them to leave their pets behind? An Indian-born respiratory therapist and his wife had secreted a pair of golden retrievers in the hospital where they weren’t allowed. At home, the cossetted pets slept like children in their own room on individual recliner beds and were never permitted to trot outside without a quartet of boots placed over their paws. What was to become of them now?
Staff members scrambled to consolidate insurance certificates, needed medicines, important papers they had with them for safekeeping. Who had a single bag packed? They had brought enough to sustain themselves for days.
The Cooks and a group of other employees and family members tromped down the stairs by flashlight. They came to a halt at the sight of Susan Mulderick. She faced them, tall and authoritative, on a staircase landing. “What are y’all doing here?” she asked. They said they had been told to come downstairs. The boats that people had been expecting were ready to take them away. “What boats?” Mulderick asked. “There aren’t any boats.” Others told her they’d heard helicopters were waiting. Mulderick left to investigate.
The groups wound back upstairs to their mattresses in a sleepy fog. What little peace the night might have brought had been shattered. Word spread that some people couldn’t find belongings they had stowed and left behind. Had the man stolen from them? Was it all a hoax built on their hopes of rescue?
The night was wasted. Now even the most exhausted found it impossible to sleep. After the futile jaunt downstairs, Ewing Cook felt a new level of anxiety, not good for his damaged heart. He lay awake in his office near the hospital’s engineering plant and listened to the roar of its diesel generators, the ticking of Memorial’s own weakening heart.
A BATTLE WAS under way to keep the generators running. Each of the three teal-colored generators was taller than a typical adult and pumped electricity into a complex circulatory system of feed lines, riser circuits, and transfer switches. Normally an outside company serviced the 750 kW generators, each producing the power of about six engines from one of the year’s most popular cars, a Toyota Camry. The hospital’s maintenance staff did little more than change the oil and run tests once a month in the middle of the night. The tests were brief, in keeping with national codes that treated hospital generators like heart-lung bypass machines used during surgeries, meant to support vital functions for a period of only minutes to hours. Despite the fact that the generators were not built for prolonged work, Memorial’s disaster plans called for them to shore up the hospital for at least three days. They had already been running for two.
None of the Memorial electricians or engineers on-site was a generator mechanic. Earlier, when one of the generator engines had shut down, casting part of the hospital into darkness and sending staff scrambling to move patients, maintenance workers concluded it was overheated. Laboring by flashlight, they added water to the radiator and were able to restart it.
Hours later, the problems multiplied. Low oil pressure appeared to be the cause; the men brought barrels of diesel to try to prime the motors with fresh fuel and restart them. Maintenance men crossed the bridge to the surgery building to retrieve more diesel from a generator there. Some sections of the hospital were losing power. In parts where there was light, it seemed to be dimming, strangling.
Over the years, the original 1926 hospital had received additions, and the electrical system now resembled the blood supply of conjoined twins, separate but overlapping and, as a whole, unique to itself and mysterious.
One generator failed. Unable to restart it, the engineers tried to tie some of the lines it supplied to another generator. They pulled on rubber boots and ran down to the basement, splashing into knee-deep water, then climbed up a few steps to the mezzanine of the core electrical building.
They tried to determine the reason for the partial outages throughout the hospital. The depth of the water offered a clue. About a third of the automatic transfer switches, which allowed the generators to power the hospital when normal utility power was lost, were on a low level of the building, and it looked like they and their associated distribution panels might be submerged, much as plant operations director Eric Yancovich had predicted several months earlier.
Like in a scene from The Poseidon Adventure, the men waded through a narrow hallway bordered by electrical panels and a sign with two lightning bolts that read CAUTION: HAZARDOUS VOLTAGE INSIDE. Using a flashlight, they located a metal lever with a yellow rubber–coated handle above their heads marked “bypass handle.” Praying not to get electrocuted, one flipped it, grafting the load of the nonworking generator to a working one.
Soon a gauge showed that the working engine was drawing too much current, a sign of a short circuit. The men tried to back off and untie the two loads to avoid a fire, a terrifying possibility given that the sprinkler system’s pumps were now underwater and city fire trucks were presumably out of commission. To further adjust the load, they went around the hospital shutting off scattered branch circuits serving unused fixtures and devices.
Another generator failed. This time, the workers had an idea of what caused the problem, but no spare parts to fix it. They tried to scavenge from the failed generator, but the attempted repair was unsuccessful.
The battle for the generators raged for two hours. At about two a.m. on Wednesday, August 31, 2005—nearly forty-eight hours after Katrina made landfall near New Orleans—the last backup generator surged and then died.
The sudden silence struck Dr. Ewing Cook, lying in his office on the second floor, trying to rest, as the sickest sound of his life.
ALARMS HERALDED the power loss. They flashed and wailed on the eighth floor, where the ICU nurses had settled for the night in the rooms of their rescued patients. Nurse manager Karen Wynn stepped up on a chair and clobbered an alarm panel with her shoe to quiet it. She told her nurses to try to get some sleep.
On the seventh floor below them, the LifeCare notepad computer lost its text-messaging connection. The special mattress supporting Emmett Everett’s massive body deflated. Mechanical breaths still hissed rhythmically in the rooms of patients on life support. They would cease when the battery backupus on the ventilators were exhausted.
MEMORIAL’S FIFTH FLOOR was bathed only in the dim, bluish light from Toshiba Satellite laptop monitors. A night shift nurse, Michelle Pitre-Ryals, quickly typed notes into her patients’ electronic charts before the computer batteries died, despite the fact that once that happened, the electronic medical records system would be useless. Paper was high technology in a disaster. The electronic medication dispensing cart, new to Pitre-Ryals’s unit, would also shut down, its stock of medicines locked securely inside it.
Pitre-Ryals was carrying a cell phone belonging to the nurse whose husband was at the Coast Guard station. It rang. “We have sent three helicopters and someone is waving them away,” a Coast Guard auxiliary member said. Pitre-
Ryals took the phone downstairs in the dark to the command team. “Is that that guy again from the Coast Guard?” a nursing director asked, and she disappeared with the phone to speak with him. On return she instructed Pitre-Ryals not to bring it down again. The man, she said, was “not part of our evacuation plan.”
Pitre-Ryals made her way back upstairs, but then a Louisiana health department official and a Coast Guard lieutenant called. The latter commanded her to disregard her instructions and bring the phone immediately to someone in charge. Pitre-Ryals descended the unlit staircase again, and the nursing director berated her before taking the phone. A male doctor said no more patients were being evacuated because it was too hard to see. Pitre-Ryals suggested waking people up and putting flashlights in the stairwell, but she was ignored. After she returned to the fifth floor, the phone rang again. A more senior Coast Guard lieutenant insisted on speaking with a hospital leader. Pitre-Ryals gave the phone to a nurse’s husband to carry back downstairs while she went to care for her patients. She couldn’t believe hospital leaders were yelling at the Coast Guard for trying to send rescuers. “With these people in charge,” she told a fellow nurse, “we may very well die here.”
UP ON THE eighth floor in the ICU, it wasn’t easy to sleep. Battery-powered fans agitating the hot air lost their will and sighed into silence.
Nurse Manager Karen Wynn lay awake on an air mattress that her ICU staff had prepared for her. Her daughter, lying beside her, seemed to be the only one asleep.
After a time, Wynn stood up in the darkened room.
“Where are you going?” one of the nurses from the medical ICU, Thao Lam, asked.
“I’m just gonna go see what’s going on,” Wynn told her. “I’m not asleep, might as well get up and do something, be productive.”
“Can I come with you?”
“Sure. Come join the party.”
Wynn shined her flashlight, and the two nurses walked to a staircase near the elevator lobby on the eighth floor. They didn’t have to descend more than one story to find action. On the seventh floor, LifeCare staff members were carrying ventilator-dependent patients into the stairwell as nurses dispensed huffs of oxygen from football-shaped Ambu-bags compressed like bellows between their fingers. Word had come that the Coast Guard was on the pad again and could evacuate patients if they were brought there immediately.
Wynn and Lam offered their help. They and the other workers helped roll patients onto their sides in bed and then roll them back atop stiff spine boards. They slid the spine boards onto waiting stretchers and wheeled the patients down the corridors toward the staircase by the elevator bank. They lifted the spine boards off the stretchers and began carrying the patients downstairs.
Lam held on to the front end of a spine board and lit the way with a flashlight. Wynn carried the back end and managed to shine hers. Two or three other volunteers stood at each side. Every few steps, they reached a landing that marked a turn in the narrow staircase. They lifted the patient above the handrails and rotated the board into position to continue down to the next flight. All the while someone continued to pump oxygen into the patient’s lungs and tried to ensure that the breathing tube didn’t get dislodged from the airway. Down five stories they went, to the second-floor lobby and through a hallway to the power plant, with its now silenced generators.
No doorway existed between the hospital and the parking garage beneath the helipad. Without the elevators working, Wynn assumed they would have had to go outside to access the garage—clearly impossible now with the flooding. Plant operations director Eric Yancovich had talked about busting a hole in a hospital wall to create a direct conduit. In fact, they could have carried the patients down to the first floor, through two doorways into a separate stairwell and up to its second-floor landing, which opened into the garage, a taxing journey. But one of Yancovich’s workers recalled a hidden passage. Inside the machine room, halfway up the wall to the right of the entrance beneath a large water pipe, stood a rectangular three-by-three-and-a-quarter-foot opening lined by rough concrete. It was normally covered by a piece of hinged metal. Yancovich thought the opening might have been created to allow equipment to be serviced directly from the garage.
Wynn and Lam passed the patient through the opening and into the hands of other volunteers stationed in the parking garage. A welcome breeze tunneled through the passageway. Wynn had no idea why it existed. Perhaps God had said there needed to be a hole there.
Each time Wynn returned to LifeCare to roll a patient onto a backboard, she was surprised at how hot the patient felt to her touch. My God, she thought, someone could fry an egg on them. She knew elderly bodies had trouble regulating heat. Certain medical conditions, such as a stroke or a head injury, as well as some commonly used drugs, interfered with the process. Dehydration, heart disease, a little extra weight—all could impair the body’s ability to rid itself of heat through sweating and other mechanisms. The extra heat, in turn, could complicate other critical illnesses.
It was likely that over the two days since the air-conditioning cut out, these patients’ core temperatures had risen. Their bodies would have failed to buffer the heat as sweat production paradoxically ceased. This was heat stroke, widespread inflammation in the body and dysfunction of multiple organs, particularly the brain, causing a range of effects from confusion to coma. Ice baths could reverse it, or wetting the skin and fanning the patient, along with giving oxygen and sometimes fluids. Nine times out of ten the person would survive. But Karen Wynn worried about the potentially irreversible damage the heat might be causing in the cells and organs of the patients she carried. We’re going to have fried brains here, she thought.
Even those without medical training worried about the effect of the heat on the LifeCare patients. A woman who had been hired to sit at the bedside of patient Elvira “Vera” LeBlanc reached her charge’s daughter-in-law by cell phone at around four on Wednesday morning. The sitter described how hot it was. “The nurses are starting to freak out,” she said. “People are dying. There’s no place to put them.” LeBlanc’s daughter-in-law Sandra was a paramedic. She said she was trying to get into New Orleans and back to the hospital. “When are you coming?” the sitter asked, sounding desperate.
AT THE COAST GUARD emergency command center in Alexandria, LTJG Shelley Decker, a former Army pilot who had recently joined the Guard, had been fighting to get helicopters to Memorial for LifeCare’s ventilator patients. She learned that at least three had gone to Memorial and were waved away. “No, they want them to land,” she said to a contact at the air station. “You have to go back.” The auxiliary member beside her, Michael Richard, spoke by cell phone with a nurse leader atop the helipad. She seemed to be panicking, waving her arms over her head, believing she was signaling the pilots, not turning them off. “When those helicopters come,” he told her, “stand clear!”
Each air rescue crew had only eight hours to fly within any twenty-four-hour period; thousands of people in the city needed help. Every minute was precious. The same was true for the fragile LifeCare patients on life support. Decker kept trying to reach Susan Mulderick on the nurse’s cell phone to give a play-by-play of the helicopters’ arrivals. The rescue effort needed to proceed. She’d been told that one ventilator patient had already died waiting. Yet the pilots weren’t seeing patients on the pad. How can we keep missing these people? Decker wondered. She and two colleagues engaged in a complicated chain of communications, maintaining contact with three cell phones at Memorial, while talking to the air stations, and, via HF radio patch, to the crew of the C-130 flying over New Orleans, which then tasked the helicopter pilots.
The Jayhawk that had flown away from Memorial to Tulane Hospital hours earlier with the Acadian Ambulance coordinator was diverted again by the C-130 and directed back to Memorial to rescue the critically ill LifeCare patients. In the intervening hours, crew members had hoisted several people from the rooftops of flooded homes, depositing them at the cloverleaf highway interchang
e west of New Orleans. One elderly woman couldn’t walk, and the rescue swimmer on board had carried her across a field of grass to emergency workers. What he saw concerned him: thousands of people camped out on the south side of the highway, surrounded by refuse, no buses in sight.
The pilots flew to Memorial as instructed and executed a challenging maneuver at night, using a slight tailwind to position the helicopter properly on the helipad. Crew members were again told that there were no critical patients to rescue but that non-patients and staff were anxious to leave and were becoming unmanageable. One member of the flight team took to the radio again to ask what to do next. Back came the word that, according to contacts inside the hospital, the patients were indeed still there awaiting rescue.
Incident commander Susan Mulderick had climbed up to the helipad in the dark to see what was really happening with the Coast Guard. She passed people who were clearly non-patients, perhaps extended families and community members who had taken shelter at Memorial before the storm. They snaked up the stairwell and into the covered, enclosed walkway she had purchased years earlier when the helipad was still in use. The tunnel was designed to protect against the hurricane-force winds unleashed by helicopter rotors. Dozens and dozens of people were up here clamoring to leave, no doubt roused and alarmed by the man who had run through the hospital.
The pilot kept his rotors going to avoid stressing the pad with the full weight of the aircraft, and it was loud. Mulderick stood to the side of the helipad and discussed the situation with the Coast Guard flight mechanic, who shouted questions at her over the din. Was there food and water? Was it dry inside the hospital? Mulderick shouted back, yes. “Listen, you’ve got food, you’ve got to stay here, because where I’m going to take you, it’s not good!” the flight mechanic screamed. “We’re going to dump you off in a field!” There was no infrastructure set up at the cloverleaf. It was basically a point in the highway. It looked to him like Woodstock after the concert. The civilians were better off staying at Memorial.