by Sheri Fink
An aluminum flatboat, its motor singing a gentler vibrato, took five newborn babies cradled in slings against their mothers. A World War II veteran with leukemia, who had once seen an American ship explode at sea, put on his Merchant Marine cap for the journey. A young man warned him to take it off so the wind wouldn’t steal it as they shoved off from shipwreck Memorial.
Nurse manager Karen Wynn didn’t like to pull rank or beg favors, but she was determined not to let all the first boats leave without her other pregnant ICU nurses. One, less than a month from her due date, had started having contractions the previous day, but she resisted getting on a boat without her grandmother. Her colleagues told her she had to go. Wynn said she couldn’t put her unborn child at risk for the sake of the elderly woman. Wynn and nurse Cheri Landry would look after the nurse’s grandmother and an elderly aunt who had also accompanied her. The nurse climbed aboard.
The giant fan at the back of one of the airboats roared. Its pilot, high above his passengers on a metal chair, steered through the murky water on Clara Street, leaving a small wake. The boat floated past the domes of several vehicles in the parking lot of Memorial’s Cancer Institute and a trunk door that had popped open in the water. Where the hell her nurses were heading, Wynn had no idea. Somewhere, she thought, somebody out there has this organized, has this under control. She was sure.
At the drop site, the airboat pilots transferred these first evacuees into waiting ambulances and began the more than three-mile journey back to Memorial. They glided slowly to avoid hitting debris. The round-trip took more than an hour.
Sandra LeBlanc scouted out a closer dry-drop location near a Rite Aid and a Copeland’s Restaurant nine blocks south of Memorial. Along the city’s southwest border, the “sliver by the river” was dry, and it connected to roads out of town. The airboat pilots, whose efforts were soon bolstered by the arrival of a much larger vessel, began ferrying people to the new site, but they found no ambulances there. Perhaps nobody had tried to get a call through and redirect them. Also, disembarking there required wading through dirty shallow water to dry ground.
The evacuation strategy underwent another subtle shift. Now only the relatively few patients who were well enough to be discharged were put onto the boats. Several doctors had taken over loading the boats, trading the hot hospital and its very sick patients for the open-air emergency room ramp, where they oversaw the process. They began allowing hospital employees to leave along with their own and the patients’ family members, hundreds of whom still remained at Memorial. The evacuation line wound from the ramp back through the emergency room and into the hospital’s reception area.
As they neared the boats, many people asked questions of Karen Wynn. “Where we goin’? Where we goin’?” She didn’t know where. It frustrated her when people on the cusp of freedom suddenly hesitated to leave the hospital. They seemed more comfortable with the hell they knew than with the unknown journey that awaited them. One woman refused to get on a boat when told she couldn’t bring her purse for space reasons. Her and her husband’s “whole life” was in that purse, she said, and she was willing to be separated from him, a discharged patient, to hold on to it. Give me the fricking purse! Wynn wanted to tell her. Wynn offered to take responsibility for it, as she had taken responsibility for the pregnant nurse’s grandmother, if that would convince the woman to go. But it didn’t. The woman wasn’t having it. She would not give up the purse, and so she wouldn’t leave.
The stress of the disaster narrowed people’s fields of vision, as if they wore blinders to anyone’s experience but their own. Again and again, Wynn saw signs that others were not appreciating the gravity of the situation inside Memorial. Early in the morning, an outpatient somehow made it through the floodwaters to the hospital for a regularly scheduled chemotherapy appointment. The water had stabilized at about five to six feet around the sloping hospital grounds; the feared additional fifteen feet had not come. “Sweetheart, we’re not giving chemo today,” Wynn told her.
A representative of the Women’s Hospital in Baton Rouge called Wynn to complain that a male psychiatric patient from Memorial had been transported there along with the neonates on Tuesday. Just what do you want me to do? Wynn wanted to ask. The staff at Women’s could simply put him in an ambulance and send him to a hospital that accepted men. At least she assumed they could. She wasn’t thinking about how many patients from New Orleans might have been dropped in the capital. She couldn’t imagine the situation outside the walls of Memorial was anywhere near as bad as it was inside them.
While the boats made runs to dry ground with hospital staff and family members, Wynn helped care for the patients categorized as 1’s from LifeCare and Memorial who had been carried down to the first floor in anticipation of rescue. They waited on the down-sloping sides of the ambulance ramp, the brakes of their wheelchairs locked. Throughout the hot afternoon, Wynn memorized the faces of her “little bodies” so as not to lose a soul, and then an unfamiliar one appeared. Where’d he come from? she wondered. He’s not one of mine. The man was wet, and she noticed a dialysis catheter hanging from his chest just below one shoulder. It dangled from him, lacking the protection of a sterile dressing. The man told Wynn he lived in the neighborhood, had stayed for the storm, and was overdue for a dialysis treatment. As it was a matter of life and death, he had waded to Memorial in the foul, chest- or neck-high brew; Wynn could only imagine what little trolls had trekked into the catheter, which opened into a major vein, putting him at risk of a deadly blood infection.
Wynn called out to one of the doctors manning the boat launch. “Dr. Casey?” She pointed to the man. “Dialysis. He’s gotta go. He’s gotta go on the next boat.” She had no idea what awaited the man at the other end of his boat ride, but she prayed she was giving him a chance to survive.
SOMETIME ON WEDNESDAY, people on the ER ramp noticed the strange sight of a mattress floating up Napoleon Avenue. The mattress made a turn onto Clara Street and neared the hospital. On it lay an ill-appearing black woman, with several men swimming through the fetid water, propelling her. “The hospital is closed!” someone shouted. “We’re not accepting anybody.”
René Goux, the hospital’s chief executive, had decided for reasons of safety that people approaching Memorial should generally be directed to the dry ground at Napoleon Avenue and St. Charles Avenue nine blocks away, the same place Sandra LeBlanc had identified for discharging boat passengers from Memorial. Even the previous day, the Coast Guard auxiliary member in Alexandria had instructed Memorial staff by phone to secure the premises, station men at the doors and windows, and bar entry to anyone not in uniform. Nonetheless, after a heated exchange, a sympathetic doctor convinced administrators to take in the woman and her husband, but the men who’d swum in the toxic soup to deliver her were told to leave. The woman was lifted onto a stretcher and moved indoors into the emergency room hallway. Whadda we have here? Karen Wynn wondered. It was all well and good of the doctors to insist on accepting this patient, but now somebody had to care for her. Wynn had more than enough work with her charges on the ambulance ramp. Still, she couldn’t leave the situation alone. She had to go inside and see about this lady.
The gaunt-faced woman, wrapped in covers on a stretcher against the wall, looked dead. Wynn pulled back her covers to assess her. The elderly lady was still breathing, but barely. She was emaciated. Her husband, who had arrived with her, told a confused story that suggested his wife had been in hospice care, suffering from some condition from which she was expected to die soon.
Wynn reached a hand beneath the woman’s tiny frame and felt wetness. A tube had been placed into her bladder to drain her urine, but it had detached from its sterile collection bag. Wynn reattached the bag, even though it was no longer sterile and could eventually cause an infection. “So much for aseptic technique,” she said to herself. She gathered up the wet bed linens. At least the woman would be dry.
“Have you all eaten today?” she asked the woman’s hus
band. When he said no, Wynn went outside to rummage through her small cache of food. She returned, popped open a can of nutritional supplement, drew some into a straw, and dripped it into the woman’s mouth. The woman swallowed. At least she could do that. Wynn turned the can and straw over to her husband, who coaxed his wife to drink.
Wynn found food for the man, too, and after he finished eating, he told her he was worried about looters. “I gotta go back and lock my house,” he said. Wynn spent about twenty minutes trying to convince him that returning home wasn’t possible. “Sweetheart, you can’t go back home,” she told him. “It’s too dangerous. There’s water and it’s just too dangerous.”
One couple with small children rowed up to Memorial, and the family was told to “go away.” Dr. Bryant King, the young hospital-based physician who had recently come to work at Memorial, lost his temper. “You can’t do this!” he shouted at CEO Goux. “You gotta help people!”
Karen Wynn saw that the hospital had all the people it could handle. She did not detect a note of racism in the refusals, even as the people being turned away were nearly all African American, as was she. King, by contrast, was offended largely because the people they were turning away had dark skin. As the only African American doctor on duty and one of very few who worked at the hospital, race had not been an issue for him until now. He believed introducing color into his argument would only make everyone touchy, and so he did not. This was a universal issue: the hospital was harboring dogs and cats while babies floated over polluted water on unsteady skiffs.
The family was refused in spite of King’s advocacy.
To Dr. Ewing Cook, watching from the ambulance ramp, the episode reinforced the impression of King he’d developed the previous day when King resisted discontinuing treatments that weren’t absolutely necessary. King was, Cook thought, out of touch with reality. Memorial wasn’t so much a hospital anymore but a shelter that was running out of supplies and needed to be emptied. Cook also worried that intruders from the neighborhood might ransack the hospital for drugs and valuables. He’d had his semiautomatic Beretta in a pocket of his scrub pants since he’d heard rumors that a nurse was assaulted while walking her dog near the hospital on Monday. The CEO had told him to take the damn thing out of his briefcase and wear it.
Now, Wednesday afternoon, a day after his heat-exhaustion episode, Cook was physically and mentally drained, filthy, and forlorn. A painful boil was growing under his wristwatch, and bladder spasms drove him repeatedly into a ghastly-smelling bathroom with a nonflushing toilet.
Cook had also been contending with the illnesses of various family pets. His adult daughter’s massive, ursine Newfoundland had at first frolicked in the floodwater and later began panting heavily in the heat. His daughter, ICU nurse Stephanie Meibaum, wanted to try giving Rolfie oxygen from the wall supply in the empty surgical building across the pedestrian bridge from the main hospital. The dog lumbered there obediently on shaking legs. As he stepped inside, he collapsed on the floor and convulsed.
Cook wrote a prescription for “Rolfe Meibaum” for five 100 mg tablets of the antiseizure medicine phenobarbital from the hospital pharmacy. On the same prescription form, Cook ordered eight syringes of the powerful anesthetic drug Pentothal, a half gram each. In Louisiana, only licensed veterinarians typically could prescribe medicine for animals. In the context of the disaster, the pharmacist let this go, but he insisted on the prescription as documentation in order to give Cook the controlled substances.
Cook began injecting Rolfie with Pentothal. It took multiple doses before he died. Cook also euthanized one of his daughter’s three cats, which was suffering from a tooth abscess.
Pets weren’t being allowed on the boats and helicopters, leading people to fear they would not be rescued. The owners of the two coddled golden retrievers had departed by boat, leaving them in Cook’s office with instructions not to abandon them to suffer alone. Cook euthanized them, too.
After Rolfie’s death, Dr. Horace Baltz noticed Cook’s wife and daughter weeping and asked what was wrong. Ewing Cook described what had occurred with characteristic bluster, hiding any sadness behind what struck Baltz as a devilish laugh.
At around two p.m., Cook climbed slowly upstairs to check what was happening on the eighth floor in the ICU, where he had worked for many years. Most of the ICU patients had been airlifted on Tuesday, but the four with DNR orders who had been kept behind had not.
“What’s going on here?” he asked the four nurses he found in the unit. “Whaddya have left?” The nurses were down to one patient with advanced uterine cancer, the seventy-nine-year-old woman who had worked as a nurse in segregation-era New Orleans.
The disaster had interrupted plans to move Jannie Burgess into a general medical ward for comfort care. Instead, the ICU nurses were giving her small doses of morphine every few hours as needed for pain. Cook opened Burgess’s medical chart. According to the notes, on Monday night after the storm she had cried and was agitated. Her surgeon had visited on Tuesday and wrote that Burgess had stable vital signs and responded when he spoke to her. At one fifteen on this morning, her electronic monitors had stopped working when the emergency power failed in their section of the hospital. Intravenous pumps continued to drip fluids, sugar, electrolytes, and medicines into her veins for another two hours until they drained their batteries. Nurses then ran the fluids by gravity through Burgess’s IV tubing, controlling the flow with a slide clamp.
After daylight, her eyes had remained closed. The rhythm of her shallow breaths was irregular, like the tick of a slowing clock with a dying battery. Sometimes ten to fifteen seconds would go by without an inspiration.
Cook examined Burgess. She was so weighted down by fluid from her diseases that he sized her up at more than three hundred pounds, much more than her normal weight. He arrived at certain conclusions: (1) Given how difficult it had been for him to climb the steps in the heat, there was no way he could make it back to the ICU again. (2) Given how exhausted everyone was and how much this woman weighed, it would be “impossible to drag her down six flights of stairs.” (3) Even in the best of circumstances, the patient probably had a day or so to live. And frankly, the four nurses he found upstairs with her were needed elsewhere, although it was not up to him to tell them where to go.
To Cook, a drug that had been on Burgess’s medication list for several days provided an answer. Morphine, a strong narcotic, was frequently used to control severe pain or discomfort. But the drug could also slow breathing, and suddenly introducing much higher doses could lead to death.
Doctors, nurses, and clinical researchers who specialized in treating patients near the end of their lives would say that this “double effect” posed little danger when the drug was administered properly. To Cook, it was not that clear. Any doctor who thought that giving a person a lot of morphine was not prematurely sending that patient to the grave was a very naïve doctor. “We kill ’em” was, in all bluntness, how he described it.
In fact the distinction between murder and medical care often came down to the intent of the person administering the drug. Cook walked this line often as a pulmonologist, and he prided himself as the go-to man for difficult end-of-life situations. When a very sick patient or the patient’s family made the decision to disconnect a ventilator, for example, Cook would prescribe morphine to make sure the patient wasn’t gasping for breath as mechanical assistance was withdrawn.
Achieving this level of comfort often required enough morphine that the drug markedly suppressed the patient’s breathing. The intent was to provide comfort, but the result was to hasten death, and Cook knew it. The difference between something ethical and something illegal was, as Cook would put it, “so fine as to be imperceivable.”
Burgess’s situation was a little different, Cook had to admit. Being comatose and on occasional doses of painkillers, she appeared comfortable. But the worst thing he could imagine would be for the drugs to wear off and for Burgess to wake up and find herself in
her ravaged condition as she was being moved. Cook turned to Burgess’s nurse. “Do you mind just increasing the morphine and giving her enough until she goes?”
Cook returned to Burgess’s patient chart. A sticker on its front cover listed allergies to “egg/poultry” and a sticker on its back cover said “DNR.” Cook turned to an empty lined page of her progress record and scribbled “No respirations or cardiac activity.” He added, “Pronounced dead @,” left the time blank, and signed the note “ECook” in a large squiggle. Then he walked back down the stairs, believing that he had done the right thing for Burgess. He would later call that choice “a no-brainer” and reflect on it. “I gave her medicine so I could get rid of her faster, get the nurses off the floor,” he would say, perhaps to cover up the deeper emotions of a man who had devoted his career to the sickest of patients and was loath to let them suffer. “There’s no question I hastened her demise.”
The question of what to do with the hospital’s sickest patients was also being raised by others. By the afternoon, with few helicopters landing, these patients were languishing. Incident commander Susan Mulderick, who had worked with Cook for decades, shared her own concerns with him. He would later remember her telling him, “We gotta do something about this. We’re never going to get these people out.”
Cook sat on the emergency room ramp smoking cigars with another doctor, John Kokemor. The patients were lined up in wheelchairs or sitting behind their walkers on mismatched chairs. In their similar blue-patterned hospital gowns, they reminded Cook of a church choir. Help was coming too slowly. There were too many people who needed to leave and weren’t going to make it. It was a desperate situation and Cook saw only two choices: quicken their deaths or abandon them. It had gotten to that point. You couldn’t just leave them. The humane thing seemed to be to put ’em out.