by Sheri Fink
Cook went to the staging area on the second floor, where Anna Pou and two other doctors were directing care. The area was broiling. Only some older wings of the hospital, built to be “productive of coolness” in the age before ubiquitous air-conditioning, had windows that opened. At first, some staff members had been warned they could be charged with destroying hospital property if they broke windows. Now, patients were moved back, and uniformed men and other eager volunteers crashed chairs, two-by-fours, and an oxygen tank through the tall glass panes into the surrounding moat, punishing the building that had failed to protect them.
Cots and stretchers appeared to cover every inch of floor space. An immense patient lay motionless on a stretcher, covered in sweat and almost nothing else. Cook thought the man was dead, and he touched him to make sure, but the man turned over and looked at him.
“I’m OK, Doc,” Rodney Scott said. “Go take care of somebody else.” He was the licensed practical nurse who had once worked at the hospital and who had been designated, because of his size, to leave the hospital last.
Despite how miserable the patients looked, Cook would later say he felt there was no way, in this crowded room, to do what he and Kokemor had discussed over cigars. “We didn’t do it because we had too many witnesses. That’s the honest-to-God truth.” A different memory of their interactions would be held by Kokemor, who would say he never talked about euthanasia, and, regardless, was not involved in hospital decision making.
The scene in the second-floor lobby also rattled registered nurse Cathy Green. Like many of the other ICU nurses who no longer had their own patients to treat, she had volunteered to help care for others.
Green stood between the rows of recumbent patients and waved a bit of cardboard over them, agitating the dankness. “Help me,” patients said. She offered sips of water.
Separated from their medications and treatments, and the nurses who knew them, they looked so sick. For all her experience with critical care medicine, this scene broke her heart. She couldn’t bear it. She had to leave.
Green went up to the parking garage. Patients were arrayed on the asphalt awaiting helicopter rescue. An elderly lady lying on the ground was wheezing and looked distressed. Her lungs sounded as if they were choked with fluid. The oxygen tank beside her was empty. Green found a partially used tank. She recruited a few other people to help prop up the lady to a partial sitting position, making it easier for her to breathe. Green set up an inhalation treatment to help clear the woman’s lungs. She talked to the woman softly, trying to reassure her.
A doctor came and peered at the lady’s chart. “She has lung cancer,” he said quietly. He turned to Green and closed the woman’s chart. “She’s not going anywhere.” He looked at the oxygen tank and shook his head no. “That’s it,” he said, and chopped the air with his hand. There would be no more respiratory treatments. This oxygen cylinder, its gauge indicating a quarter tank left, would be the last.
Green felt numb. She took the lady’s hand and held it. The decision not to move her to safety or support her with oxygen felt personal. Two dozen or so of Green’s relatives were in St. Bernard Parish, an area she’d heard on the radio was the worst and first hit by the flooding. Several times, Green’s young adult daughter, who lived in a different state, had reached her on a cell phone. “Mommy,” she cried, “I really think something happened to Granny. I just have this horrible feeling.”
Green saw the sick lady before her as somebody’s mother, somebody’s grandmother. Many people probably loved this lady. Green felt love for her and she didn’t even know her. The woman was precious, whether she had six months to live, or a year to live, whatever it was.
Green stood up and walked to another patient. She couldn’t stand to watch this lady die on the ground, in a parking garage, in an American city, because nobody came to get her. She didn’t want to know this lady’s name.
WEDNESDAY, AUGUST 31, 2005—LATE AFTERNOON
THE UPTURNED BOWS of the airboats cast longer shadows on the water as they bobbed alongside the emergency room ramp. Sandra LeBlanc had spent hours helping to load them. Hospital visitors, technicians, nurses, even doctors had left throughout the day. LeBlanc’s yellow-billed Louisiana State University baseball cap was stuck to her head, and sweat darkened her blue T-shirt.
LeBlanc looked for her husband, Mark. She found him caring for his mother, LifeCare patient Vera LeBlanc, in the second-floor lobby. “We got to get Mom out,” she told him, surprised her mother-in-law had not already been rescued. With helicopters landing only rarely and ambulances failing to arrive at the boat drop-off, only a few patients had left Memorial all day. Vera had been placed far from the head of the line.
Vera’s hospital gown was covered with the family names and phone numbers Mark and Sandra had scrawled on it after they had been told she would leave Memorial by helicopter. Instead, she was lying near the ATM and the planter full of green-striped leaves. The patients around her had DNR orders, as did she. Vera’s Do Not Resuscitate status was not the recent wish of a dying woman, but rather the result of a request she had made more than a decade earlier so that her heart would not be restarted if it stopped. Her heart was still beating.
Earlier a staff member had tried to block Mark and Sandra from entering this patient-care area. It took a threat to gain admittance. We brought the boats, Mark warned, and we can take them away.
The patients lying cot to cot, partially uncovered, looked terrible to the LeBlancs. Most were deathly quiet, but not Vera. “Give me water,” she demanded in a voice fit for a stage. The volunteers fanning other patients turned to stare. Mark found a five-gallon plastic jug of Kentwood water he figured belonged to the hospital staff. He filled a cup, deciding that the need to keep his mother hydrated trumped the risk that she might choke on the water because she had difficulty swallowing. “Oh, the water tastes so good, Mark,” Vera crooned. “More water! More water!” A female doctor yelled for a nurse to give Vera a medicine to quiet her, but no nurse came.
Mark and Sandra discussed what to do with Vera. The boats were running low on fuel, and their pilots had heard that people were shooting at rescuers. These volunteers from the Louisiana swamplands had no plans to return with their vessels on Thursday, despite the fact that hundreds of people remained at Memorial.
No hoofbeats had been heard from the cavalry promised by the imposing man with the handheld radio. He seemed to have accomplished nothing. He told Sandra LeBlanc that no more helicopters would be coming for the day.
The LeBlancs didn’t know where they might take Vera, but anywhere else seemed better than another night here. They decided to carry her down to the first floor and put her on one of the airboats they had directed to Memorial.
They picked up the ends of her cot. Instead of holding firm, it bent in the middle and began to sandwich Vera. They tried to readjust. Several doctors came to tell the LeBlancs they couldn’t take Vera. “The hell we can’t,” Sandra said. “You can either help or get out of the way.”
At first Sandra thought that the doctors were just being protective of their patient, but it seemed ironic that they didn’t want to let Vera go when they had clearly decided there was nothing they could do to help her. Or were the doctors upset that a patient they had designated to leave last was cutting the line?
The LeBlancs readjusted their grip on Vera’s cot and, with the help of two volunteers, carried her down to the ambulance ramp. Looking as pleased as a queen held aloft on a litter, she chattered away as they made their procession. They lifted her over the edge of the ramp where hospital workers had removed a pane of Plexiglas. “I’m on a boat!” she said, stentorian, and they fitted her with a set of earmuffs.
There was one more thing Sandra LeBlanc had promised to do before they left. She turned back to guide a burly hospital security guard onto the boat. They had worked together that day on the emergency ramp. He was desperate to leave Memorial. She’d offered to help him, too, escape.
AS THE ABLE-BO
DIED left Memorial, two dozen or so of the category 1 patients, “the choir,” remained grouped in their wheelchairs on the ER ramp, watching and waiting for their turn at rescue.
Nutrition. Hydration. Elimination. Memorial’s Karen Wynn and LifeCare’s Gina Isbell worked with other staff to meet the patients’ basic needs. Medical care, for the most part, was not provided.
One partially paralyzed stroke patient had diarrhea. Wynn repeatedly rolled her wheelchair into the privacy of the darkened emergency room, went with a flashlight to search the supply room for bottles of sterile water and saline, returned, put down the flashlight, and helped hoist the heavy woman to a standing position to be cleaned.
Wynn and Isbell rummaged for bedpans and changed adult diapers. Outside, they held up sheets around the patients to provide a semblance of privacy. At times, nature’s urgency outpaced the nurses’ alacrity. Wynn covered one accident on the emergency room ramp with a piece of cardboard.
The bathrooms in the hospital were offensive. People had continued to use the backed-up toilets, spreading feces onto the floor. No cleanup appeared to be happening. The spirit of volunteerism seemed to have retreated at the bathroom door.
The prospect of having to use a toilet took away Gina Isbell’s hunger and thirst. Once, she brought a patient’s elderly sister inside the hospital to a bathroom. When she returned for her, the woman was gone. Isbell lumbered as fast as she could down a dim, crowded corridor searching for her. She found the lady being led by the arm away from a door she had tried to exit. “She’s mine,” Isbell said. “I got her. I’ll take her.”
Some nurses said she was a Holocaust survivor, and as the day progressed, she grew more confused about where she was. “I need to get my sister out of here,” she said, and unlocked the brakes of her sister’s wheelchair, sending it rolling down the sloping pavement toward the floodwater. Isbell ran to catch the patient, but her sister kept repeating the trick. “You’re killing me!” Isbell told her. Karen Wynn caught the woman trying to wander off with her sister’s medical chart.
When evening came and the boats left, Isbell and Wynn wheeled the patients back inside the hospital’s first-floor lobby for safety and settled them down on cots and stretchers to rest for the night. Father John Marse came to offer prayers, and the elderly sister swung her cane at him, asking “Why are you in such a place like this?” He answered: “ ’Cause God sent me here.” She swung her cane at a nurse. She seemed to think she needed to protect her sister. A security guard took away her cane.
One male patient refused to get out of his wheelchair for the night; he wanted to be first in line to leave in the morning and thought being ready to move would give him an advantage.
Patients weren’t the only fearful ones. National Guardsmen and local policemen had left for the night. Many in the hospital sensed danger in the coming darkness. Some employees from St. Bernard Parish, expecting that their houses might be flooded, had brought along their entire gun collections for safekeeping. Memorial CEO René Goux distributed the firearms to security and maintenance staff, who cordoned off the hospital’s entrances.
Karen Wynn went to find her ICU nurses to tell them there would need to be a night shift to care for the estimated 115 remaining Memorial and LifeCare patients. Her nurses, anticipating this, had already volunteered to cover patients in the second-floor lobby, despite the fact that most of them had worked all day fanning and carrying. Wynn broke down in tears when she told her staff she had been watching them and was so proud of them.
She slipped back outside to decompress. The heavy air, though it couldn’t be described as fresh, seemed to shift against itself in the barest of muggy breezes.
Wynn stared out at Clara Street as the darkness deepened. Her gaze lifted above the flooded parking lot across the street to fix on the outpatient cancer center beyond it. What she saw momentarily perplexed her: a light was on inside the building.
Just a light, she told herself. It was a newer building, and it must have a different generator that supplied the lights. She thought no more of it.
The emergency room manager was resting on the ambulance ramp nearby. A call came in on his cell phone at about eight p.m. It was a Tenet executive in Dallas trying to reach Memorial’s CEO to say that the company was sending rescuers. Everyone should be ready to leave the hospital at seven a.m. on Thursday. Wynn had trouble believing it.
IN DALLAS, dozens of Tenet employees had spent the day scrambling to support the company’s six hurricane-affected Gulf Coast hospitals. The ground floor of corporate headquarters had been given over to banks of phones and computers manned by dozens of employees from various departments. They had little experience in disaster management.
Early that Wednesday morning, business development director Michael Arvin and his colleagues had been unable to make contact with staff at Memorial and another New Orleans hospital in the flood zone. They began calling authorities in search of information.
The one who leveled with them was Cynthia Matherne, a seasoned hospital emergency manager with military experience who sat in a warren of desks at New Orleans City Hall. The municipal building had been transformed into an emergency operations center, but it, too, was surrounded by several feet of floodwater. Phones trilled and people in uniforms and mufti shuffled together and apart for meetings.
Matherne was responsible for learning what was happening at the region’s hospitals and nursing homes and relaying that to emergency officials. Her usual job was as a bioterrorism preparedness coordinator for the local hospital association. That position had been created after the 9/11 terrorist attacks and anthrax mailings in September and October 2001, when federal appropriations flowed from the crisis. The program’s mandate had only recently been expanded to allow the funds to be used to prepare for natural disasters—a belated acknowledgment that these occurred far more frequently and inevitably than bioterrorism attacks.
Matherne had attended the mock “Hurricane Pam” workshop. It was hard to believe it was just the previous week; in a follow-up meeting two days later, she had jotted “Katrina” in the margin of a handout as the storm approached Florida, noting that its track was moving westward along the Gulf Coast. Still, when she’d been asked to consider what to do when “each hospital in the affected area has become an island,” she’d had no idea she was in a dress rehearsal for that precise calamity. “Which patients should be extracted first? Second? Will you focus on those that could make the trip?” Those questions on paper were now a reality.
Matherne knew there were no plans setting out how New Orleans hospitals would be evacuated after hurricanes. What agency, if any, was now in charge of that was unclear to her. The Pam scenario had assumed that flight resources would be limited and, for at least the first five days, applied “to save life and limb of those clinging to rooftops and trees. Hospitals should be prepared for 7 days.” That number of days had surprised Matherne, as it had previously been three, but hospitals had indeed long been instructed to prepare to be on their own.
When Matherne discovered that at least two hospitals had lost power on Tuesday, she made her best guess about who could help. She searched out liaisons from the Coast Guard and National Guard and asked them to rescue the hospitals’ trapped occupants.
One serviceman told her they were in a safe building. They had supplies. Matherne hadn’t expected to have to do any convincing. “They don’t have electricity!” she said. “You can’t take care of patients without electricity.”
She noticed the people in uniforms at the command center avoiding her after that. She knew her outburst had violated the emergency officials’ code of cool. It occurred to her that the Guardsmen had resigned themselves to the idea that some flood victims were going to die. These officials, too, felt helpless. They were performing an awful triage of their own.
The local Coast Guard air station where the helicopters were staging had been damaged by Katrina. Its radio antenna was down. Its generators undulated through states of failure and
temporary repair. Fixed telephone lines were out, and the station’s commanders had only intermittent contact with superiors via satellite and cell phones. Their old Nextels worked. The new Treos didn’t.
A rigid command protocol was therefore impracticable. Commanders sent down few tasks and had not yet divided the city into a grid to execute a systematic rescue plan. With so many people waving rags on rooftops, the Coast Guard air-response units, which could talk to one another when flying, worked freelance, setting their own priorities, often rescuing people as they saw them.
By Wednesday morning, when Tenet regional senior vice president Bob Smith reached Matherne, she had concluded that the best hope for the rapid evacuation of private hospitals was to use “private assets.”
Smith was incredulous. His company had no experience mounting rescue operations. The corporate jet couldn’t land on a hospital rooftop, and the company had no corporate helicopters. It had no pre-storm disaster plan. He and his colleagues were still setting up the command center in the ground-floor conference room with phoned-in advice from Tenet’s regional chief medical officer, the executive with National Guard experience who was on vacation in Oregon talking on speakerphone while his wife went down to the beach without him.
Smith jotted down notes as he spoke with Matherne. “Boats,” he wrote. “Wildlife and fish,” for the state’s Department of Wildlife and Fisheries, which had a fleet of swamp boats that, Matherne supposed, might be able to help. “Staging and pontoon boats.”
From Matherne, Smith learned that Tulane University Hospital’s parent company, Hospital Corporation of America, a corporate competitor, had started hiring helicopters to assist in that hospital’s evacuation on Tuesday morning as soon as it became clear the city was flooding. When Smith finished speaking with Matherne, he contacted HCA for advice. The HCA executives wished him luck. Contracting with privately owned helicopters and bringing them into the disaster zone had taken time, and communications problems in New Orleans had made the process more difficult.