by Sheri Fink
Smith wondered how to begin arranging an airlift. Michael Arvin told him about a phone message he had received late Tuesday from the representative of an air logistics company in a Dallas suburb. It was an offer of assistance.
“Call them,” Smith said.
Meanwhile, other Tenet executives attempted to convince government officials to prioritize the evacuation of Memorial and the company’s other marooned hospitals. Staff at every agency seemed happy to nudge another agency. Someone from a senator’s office offered to appeal to Gov. Kathleen Blanco and the Centers for Medicare & Medicaid Services. But people at the Centers for Medicare & Medicaid Services directed Tenet to contact the head of the appropriate hospital association. That association, the Federation of American Hospitals, appealed to the US Department of Health and Human Services, which appealed back, on behalf of patients in general, to the Federation, the American Hospital Association, the nation’s hospitals, and the Federal Emergency Management Agency. Billionaire Ross Perot, whose son was a Tenet contractor, appealed to the Coast Guard and the Navy. There was no locus of responsibility. Fingers pointed every which way, much as they had when New Orleans flooded in the 1920s.
To make matters more confusing, the federal, state, and local communications systems were not interoperable, much as the city’s electrical systems had not been interoperable in the 1927 flood, when the utility NOPSI couldn’t supply emergency power to the city’s drainage pumping plant because it ran on a different frequency. Also, the software that authorities were attempting to use to manage the current disaster didn’t sort information in a shareable way. Multiple agencies and officials appeared to be maintaining separate priority lists for hospital evacuations, which perhaps explained why Memorial was variously first, second, or last on “the list.” The bureaucratic complexities were incomprehensible to key Tenet officials and bred panic in them. “We are in dire need of help from the Navy!!!!” Michael Arvin wrote in an e-mail to a woman in California, asking her to seek assistance from a particular admiral she knew. “We are getting runaround from local USCG and US Navy.”
“Admiral Mike retired…” came the woman’s reply.
On Tuesday evening, EMS officials in the state capital had supposedly made the evacuation of Memorial a top priority. However, by Wednesday morning, Matherne, at the emergency operations center in New Orleans, told Tenet’s Bob Smith that Memorial was among the lowest on her list of eight local hospitals that needed help evacuating. Tenet officials later discovered yet another prioritization list was being managed by state public health officials. On it Memorial ranked sixth out of seven.
“Evacuation is going SLOWLY,” a state official explained in an e-mail sent to staff of Louisiana’s US Senators and congressional Representatives, who had been hearing from constituents trapped at hospitals. “Please ask your folks to be patient.”
According to the e-mail, critical care patients were “going out first.” Memorial’s critical care patients had been airlifted out on Tuesday evening.
The message also said: “The hospitals that are flooded and without generators are being evacuated FIRST.” Presumably news of Memorial’s power loss over a dozen hours earlier hadn’t reached this particular set of officials, despite the daylong presence at Memorial of the tall man who introduced himself as a state health officer.
Tenet executives, generally out of touch with the hospital since the previous evening, hadn’t mentioned in their missives for help that the hospital had lost power. They could have inferred that from the sudden loss of electronic communications and Sandra Cordray’s warnings about an impending power loss the previous evening.
One Tenet official wrote to Tenet’s general counsel:
Our number one priority for the last two days is getting our hospital’s evacuated…. For some reason no one seems to want to help us with this. We have 2000 people at Memeorial (150 patients) but we do not seem to be a priority. We need help on this one from any angle.
The lead agency coordinating the federal public health and medical response was among the most hamstrung. The US Department of Health and Human Services (HHS) had an official emergency coordinator assigned to a five-state region that included Louisiana. However, in her four months on the job, she had not visited the state, communicated with its emergency health officials, or participated in the recent Hurricane Pam exercises. Still, the state of Louisiana requested that the federal officials take charge.
When a Tenet employee contacted the HHS coordinator to ask how to enter the disaster area, she directed him to the Louisiana Hospital Association. A Tenet official’s appeal to the HHS deputy secretary resulted only in a promise to pass word to FEMA.
Rather than providing assistance to Tenet, HHS officials were requesting it. Tenet officials, along with hospital CEOs around the country, participated in a call with the head of the agency, HHS secretary Michael O. Leavitt, early in the afternoon. Leavitt asked the nation’s hospitals for medicines and staff to establish federal emergency field hospitals in the disaster region.
The conference call left one Tenet official angry. “Field hospitals are great, but we can’t get people out,” he wrote to the head of the Federation of American Hospitals, Charles N. Kahn III, asking for an immediate conference call with HHS. “Today has been a complete wreck. I don’t know how much clearer it can be said.”
“HHS is only a side player here,” Kahn responded. “We have to get them to push FEMA and the locals. I am working on that.”
LifeCare’s corporate chief financial officer was also on the conference call with HHS. The company was making as poor progress as Tenet was in getting its patients to safety. Senior vice president Dubois had spent much of Wednesday trying to locate the four LifeCare patients flown out of Memorial by the Coast Guard early that morning, and to move them to other LifeCare locations.
Dubois had engaged a fleet of ambulances from Lone Star Ambulance in Texas, where LifeCare had a contract, to pick up patients being flown or boated out of Memorial and a LifeCare hospital near the New Orleans airport, which was not flooded but was having power issues. She sought permission for the ambulances to go to the city but did not get it. Dubois advised the LifeCare staff at Memorial to send the patients with whatever transport officials arranged for them. Dubois was upset to learn, late in the day, that four LifeCare patients and seven LifeCare staff members from Memorial were stranded on the corner of Napoleon and St. Charles Streets. She worked the phones in the evening to seek help for them from the Coast Guard and Knox Andress—the disaster preparedness coordinator she still thought worked for FEMA.
The Federation of American Hospitals’s Charles Kahn sent an appeal to an HHS official in the early evening. “I cannot over emphasize the urgency of these situations,” Kahn wrote. He included a list of the immediate needs of area hospitals, but left out several hospitals, including New Orleans’s biggest medical center, the public Charity Hospital, which was not a Federation member. Kahn’s message also failed to mention the power situation at any of the hospitals. The status update for Memorial that appeared in his appeal had been written nearly twenty-four hours earlier.
At Tenet headquarters in Dallas, Michael Arvin’s contact with the private air logistics company proved fruitful, and the company began lining up helicopters to arrive in New Orleans on Thursday morning. Though these were regular helicopters normally used for firefighting and other purposes, Tenet executives began referring to them as “air ambulances.”
As Tenet planners sought flight clearances, they told officials they would be rescuing their own patients. What they really needed help with, they said, was moving out “800 community members” who had sought refuge at Memorial. “Our real need is to get the local residents out of the hospital by boat,” a Tenet vice president wrote to Sen. Mary Landrieu’s staff. Landrieu offered to intervene with the governor on behalf of the hospitals—another pivot in the circular game of telephone.
Corporate officials seemed fixed on safety concerns at Memorial. �
�Our last communication with them indicated they were also having security problems with the local citizens,” Tenet’s Bob Smith wrote to a Navy captain. “This situation is getting to a critical point with no security.”
Tenet distributed an update for communications managers to upload to each affected hospital’s website. It said: “Martial law is in place in New Orleans.” It was as untrue as it had been when the radio announcers had said it.
By the time a Tenet official reached Memorial’s emergency room manager on Wednesday evening as Karen Wynn stood watching, there was better news to share. Though the details were vague, Tenet had received word that Louisiana’s Department of Wildlife and Fisheries would send boats to Memorial.
Just before ten p.m. the private aviation services company confirmed that it had received Tenet’s signed contracts for a half dozen helicopters of various sizes. They would converge from around the country to begin arriving at Memorial early Thursday morning, one as early as six a.m.
But the news from Memorial to Tenet was grave. Tenet vice president Bob Smith summarized in an e-mail to Tenet leaders what he said he learned via HF radio communications. “They have 115 pts. in-house, 30 bed bound and 40+ wheelchair bound. Expect up to 60 are fragile and may die within the next 24 hours.”
Smith’s business development director, Michael Arvin, the other main point of contact with the hospital, shared similar conclusions with company employees who had offered assistance with the evacuation.
Conditions in Memorial are deteriating fast. We may lose 30-45 patients overnight. There is rampant looting in the streets and the hospitals do not have security to protect. It has become our priority to get all patients and employees/families out of Memorial.
CHAPTER 7
WEDNESDAY, AUGUST 31, 2005—NIGHT
NURSE MANAGER KAREN WYNN lay awake beside her sleeping teenage daughter in an operating-room hallway on the eighth floor. It was so hot, it hurt to breathe. The air stirred only with the complaints of an older woman, the girlfriend of an ICU nurse’s father. “We never gonna get out of here,” she moaned. “We gonna die in here.”
The woman’s cries threatened to wake Wynn’s daughter. Wynn worried the panic would spread to the other people resting in the room. Maybe, she thought, there’s just that little seed in the back of their brain, and I don’t want this to grow into an acorn and an oak tree. Wynn stood up and steered the woman to a stairwell to sit, breathe, and quiet down.
The floor was full of glass, and Wynn had gone barefoot in her haste. Exhaustion played on her perceptions and emotions. Through the open windows, Wynn could hear amplified movement and conversations outside the building over the water, eerie in the dark.
When she returned to her pallet, Wynn had the sense the fearful woman was right. They were never going to get out of Memorial. Thoughts of her sleeping daughter uprooted the feeling. They would get out. They had to.
One story below Wynn, in LifeCare, shattered windows also opened onto the stage of the shattered city, echoing with gunshots, shouts, and blaring car alarms. Staff members, convinced the hospital had been broken into, blockaded the stairwells for the night.
Just before midnight, a nurse pushed a dose of the sedative drug Ativan through a syringe into LifeCare patient Wilda McManus’s IV line. It wasn’t a drug McManus normally took. Her daughter Angela had made sure of that because Wilda had once had a bad reaction to the drug, growing more agitated instead of calmer.
McManus was lying on a bed by a doorway near the nurse’s station, uncharacteristically alone. Late Wednesday morning, she’d been “en route,” according to a note in her medical chart, “to the heliport.” She had never even made it off the floor. All day she had waited, Angela by her side, asking in vain for a doctor to rescind her mother’s DNR order.
Angela served as the voice and advocate for her mother. Wilda had been the longtime patient information manager at Charity Hospital, the first person visitors would see when they walked beneath an ornate metallic screen through that hospital’s Art Deco entranceway. Wilda could still smile sweetly but couldn’t always make herself understood due to a stroke and the brain-muddying effects of certain medicines. A note in her hospital admission paperwork said “daughter stays with patient at all times.” Angela had quit her job and spent more than a year as her caregiver. She had not put limits on her sacrifices. Tending to her mother and ensuring her dignity was her life’s current purpose.
Living on a cot or reclining chair for days under unremitting fluorescent hospital lights, frequently being awakened at night, making life-and-death decisions, watching mistakes being made, and being buffeted again and again by new test results was stressful, even unhinging. Hospital life was so different from normal life that it could be jarring to step outside and see people smiling and laughing, apparently carefree.
Though it was difficult for Angela McManus to accept that death might come soon for seventy-year-old Wilda, she was not unreasonable about this. Carefully counseled by the infectious diseases specialist on duty the day Katrina hit and Wilda’s infection worsened, Angela had opted against surgical intervention in an operating room on backup power. She also agreed that if her mother’s heart or lungs shut down there was no sense in trying to revive her with breathing tubes, electric shocks, or chest compressions—interventions that would have no effect on chronic, underlying health problems. But the role Angela McManus had chosen was not to preside over her mother’s dying process. She found value even in Wilda’s less active life. Angela’s role was to ensure that for every last moment her mother would be well cared for, and, until this latest setback, that she would be given every chance modern American medicine could afford her to survive.
All day Wednesday, the McManuses had watched dozens of other LifeCare patients bundled into cocoons of sheets and carried into the stairwells ahead of Wilda. More than once, nurses returned crying after patients had died in transit.
The day brought Wilda no closer to the heliport, but helicopter rotors washed wind and the smell of fuel into the unit. Although reaching the helipad involved an arduous journey—down five flights of stairs, through the hole in the machine-room wall, up the parking garage ramp and three stories’ worth of metal steps—from the windows across the hallway, the helipad looked almost touchable, framed like a picture in the windows.
A radio played in the corridor, transmitting tales that alarmed the LifeCare staff: hostage situations, prison breaks, someone shooting at police. Looters had used AK-47 assault rifles to commandeer postal vehicles, filling them with stolen goods, according to a councilman from Jefferson Parish, which shared a border with the city. A deputy sheriff said on air that he saw a shark swimming around a hotel—or perhaps it was just debris that looked like a shark fin; he wasn’t sure.
“The hunger, the anger, the rage is growing among people who have nothing, and if they have nothing they get violent and they get angry,” Jefferson Parish president Aaron Broussard said, appealing to the governor for more armed military police: “Basic jungle human instincts are beginning to creep in because they lack food, they lack a decent environment, a shelter.”
WWL announcer Dave Cohen denounced the looting on the station’s marathon ad-free, call-in broadcast, being fed out to AM and FM stations all over southeast Louisiana. “It’s such a big problem that state police have sent in a tactical team—two task forces […] The governor is making it so clear,” Cohen said. “It’s time for a full evacuation of the city of New Orleans.”
Officials and civilians called into the station and stopped by its makeshift studio in the basement of an emergency operations center near New Orleans. Two guests referred to the people remaining in the city as zombies. Cohen described them as “a mass of humanity, slowly wandering.”
“It’s like Night of the Living Dead,” Oliver Thomas, the city council president of New Orleans, said. “And you look at the look in their eyes; they’re stressed, they’re hungry, they’re thirsty. The governor has asked for armed reinforcem
ents.”
An organized group of criminals, “hordes of ’em,” Thomas said, seemed to have waited out the storm in order to start breaking and entering. “I heard one lady say maybe this is Sodom and Gomorrah.”
Some of the staff on the seventh floor at LifeCare seemed to be taking the stories to heart, freaking out, Angela McManus thought as she listened to them cry out what amounted to, Oh Lord, the world’s coming to an end! Nurses worried aloud about their children and roamed the halls for a spot where their cell phones would work to try to locate their families. Employees who had visitors were beset by requests for water and other necessities. A poodle owned by Wilda McManus’s nurse barked and barked from a nearby room. “Shut that dog up!” Wilda said to her daughter. Angela’s own eyes and throat were scratchy from pet allergies. A cat escaped its quarters in a shower stall and the nurse’s dog pinned it behind a cage. The nurse, frantic with worry about leaving her dog behind to be euthanized, spent more time feeding and doting on it in the room next door than she did caring for Wilda, Angela thought. She overheard nursing assistants argue over whose turn it was to do the unenviable work of cleaning and toileting patients in the awful heat.
Angela, exhausted, dizzy, and anxious about a sibling who lived close to the levees, nonetheless found the strength to nurse her mother herself. She nourished Wilda through her feeding tube, removed and replaced the colostomy bag that collected her feces, and ran her hand under her mother’s backside after her fever broke to find it slick with sweat and wound discharge. There was no running water to bathe her. It took hours for Angela to recruit a nurse to help her wipe Wilda down with alcohol, dry her, and change her wound dressing. All the while Angela talked, sang, and prayed with her mother. Wilda had been fond of reciting the Lord’s Prayer and the Twenty-Third and Ninety-First Psalms. Before the storm, LifeCare staff members would bow their heads as she prayed in sessions the staff had come to call “church.”