by Sheri Fink
Mulderick hadn’t known Fournier before the storm, but after the cat incident she was coming to share the opinion some nurses had of her. They found her aggravating. Fournier didn’t shy away from letting nurses know when she was upset about something, often in a loud voice with colorful curses and comments that struck some as inappropriate. She didn’t filter.
Fournier didn’t have her own medical practice. Dr. Richard Deichmann paid her a flat fee to cover his group’s internal medicine practice, including Memorial and LifeCare inpatients, whenever his turn came up to take call on weekends. Fatefully, while it was not her turn, Fournier had agreed to work because the doctor on the schedule had wanted to throw a birthday party for her daughter. Deichmann had suggested she leave the hospital after Katrina passed. He would later recall that even her physical appearance was concerning. A large patch over an irritated left eye was fixed with a piece of ragged tape whose grip, in the terrarium-like humidity, grew progressively more tenuous.
Fournier had decided to stay and had worked harder than most, often alongside Anna Pou. That morning, Fournier had sprawled on the second-floor lobby carpet amid the patients in front of a box fan with blades, powered by the overloaded generator, that moved in slow motion. The long extension cords and high loads kept tripping the generator’s breaker, and someone had to run to the parking garage repeatedly to reset it. The doctors who met in the radiology room had decided to try to convince Fournier to leave the hospital as soon as transportation arrived. One was dispatched to encourage her to do so, but he thought she seemed fine and hadn’t pressed the issue.
Fournier grappled with the implications of Mulderick’s request as she interpreted it. She did what she typically did when she had concerns—shared them freely. Fournier asked a nurse manager, Fran Butler, what she thought of the talk going around about putting people to sleep or out of their misery. “That is not an option,” Butler said. She’d held that view for a quarter century—personally, professionally, and spiritually—since becoming a nurse. She didn’t turn up the morphine unless a patient looked uncomfortable. She’d trained at Charity, knew how to work in the trenches, and while Memorial “wasn’t the Taj Mahal,” she’d say, she didn’t think the conditions were unbearable. Back upstairs there had been a breeze through the broken-out windows, she’d cut her uniform pants into shorts, put on her flip-flops, slung a tied-together pair of ice-filled gloves around her neck—and worked; she was heavyset, sweat-slicked, flushed, and not the youngest of nurses, but she thought everyone should have stayed on their wards and “maintained” until the water went down around them.
Kathleen Fournier solicited another opinion later, as she and pulmonologist John Thiele struggled to euthanize two Siamese cats around a corner from where the patients lay on the second floor. The cats belonged to a pharmacist who lived alone and considered them her children. She had asked Fournier to euthanize them, convinced she would have to abandon them.
Fournier held one of the cats as Thiele trained a needle toward its heart. While they worked, Fournier told Thiele she did not want to participate in putting patients out of their misery. Thiele told her he understood, and that he and others would handle it. She wasn’t sure what that meant.
Before Thiele could inject the heart-stopping medicine, potassium chloride, the cat struggled out of Fournier’s hands. It clawed at Thiele, ripping his sweaty scrub shirt. Someone else injected another cat and threw it out a broken window into the floodwaters.
Fournier polled another of the doctors, Bryant King, whom she knew from Tulane Medical School. She pulled him aside on the second floor. “This is between me, you, and the fence post,” she told him.
The words tumbled out. Her concerns about her cat. Her concerns about the patients. The patients were suffering miserably, she said, and she asked King what he thought about helping to end their suffering.
He said if they could find some way to turn on the air-conditioning or more fans, that might help.
“No,” Fournier said. That wasn’t what she meant. She told him about her conversation with Susan Mulderick and Anna Pou.
“I can’t be a part of anything like that,” King said. “I disagree one hundred percent.” The idea was stupidity itself. They had only been there two days since the floodwaters rose, and they were dry and had food and water.
He told her that hastening death was not a doctor’s job. He knew the situation was grave. He’d carried the man’s body to the chapel before sunrise. But he, unlike Pou, Fournier, and Mulderick, had gone upstairs and visited every patient on the seventh floor to assign a triage category. The remaining patients were hot and uncomfortable, and a few might be terminally ill, but he didn’t think they were in the kind of pain that called for sedation, let alone mercy killing.
In normal times, doctors occasionally sedated very sick patients to unconsciousness in cases of intractable anxiety, breathlessness, and pain, and sometimes even to make caring for certain patients less taxing on nurses who would otherwise constantly need to monitor patients’ suffering or guard against the possibility that their movements would disrupt a spaghetti-like mass of tubes and lines. But taking away patients’ ability to monitor their own well-being and express themselves could render them even more helpless than a baby or an animal to communicate when something was wrong. And they might seem less alive, less worth saving.
“I’m a Catholic,” Fournier said, “but not a great Catholic.”
“Well that’s between you and your God,” King replied.
The conversation deepened King’s desperation to escape Memorial. He was nearly ready to swim out, despite having watched nurses foul the murky water with the contents of bedpans. He sent text messages to his sister and his best friend telling them that “evil entities” were discussing euthanizing patients. He begged them to send someone to get him out of there. Contact CNN, the National Guard, anyone, he wrote.
Handwritten note by Aviation Services, Inc., on-site flight manager, Memorial helipad
Pilot’s log book with leatherette cover
Please pass to Aviation Services in Dallas
1) AVS 3 lifts so far 2 Slidell & 1 to Kenner
2) Coast Guard shuttling 3 HH65 aircraft. 5 lifts so far moving amb, children, women to (about 5-6 per lift) ambulance ground site near Superdome
3) Per Admin-total population as of 1000 CT/1 Sep is at 450. Repeat 450
4) Total pop includes ~120 patients from this hospital (Memorial) & associated hospital
5) Population was ~1500 but surface water craft moved many yesterday
6) Criticals were moved Mon & Tue […]
7) CG shuttling about every 15 minutes w/ 5-6 pax per lift.
AFTER A DAY and night working downstairs, LifeCare nursing director Gina Isbell returned to the seventh floor and was surprised to see “Miss Alice” Hutzler and her roommate Rose Savoie still in their shared room instead of in an evacuation line. Hutzler looked dehydrated and barely responded to her. Isbell felt guilty. She remembered she had promised Hutzler’s daughter she’d take good care of her.
Isbell took a short break in an empty room, peeling off the thick white T-shirt, blue scrub pants, and tennis shoes she had worn for days. She washed herself down as best as she could with baby wipes and put on a clean pair of jean shorts and a light gray T-shirt she had picked up from her car, where she had enjoyed another burst of air-conditioning. She sat down to have a Ding Dong and make some instant iced tea. A doctor passed the room. Isbell didn’t know her name, but she recognized the short woman with the fluffy hair, having seen her on the floor earlier in the week.
Isbell offered Anna Pou a packet of powdered iced tea for her water. “I think I will have a tea,” Pou said softly. She wore a scrub shirt with the arms ripped off and little shoes. She looked sad as she walked away.
One of Isbell’s favorite nurses, a friend from school, Andre Gremillion, approached her looking upset. He had been down to the second floor. The other workers, he said, didn’t seem to realize th
ere were still patients on the seventh floor. One told him they were under martial law, that “Baptist” was evacuating its employees, and anyone who could walk needed to go. “From what they telling me downstairs,” he said, “everybody’s leaving.” He was afraid LifeCare staff members would soon be the only ones there, with nine patients still to transport from the seventh floor. “If everybody leaves, who’s gonna move the patients?”
Several LifeCare leaders went down to find Susan Mulderick.
“IF YOU WANT your suitcase that badly, you’ll have to swim out with it!”
Mulderick lost her temper with a hospital employee’s family member who insisted on the right to carry a very large suitcase onto an evacuation boat. The rule was at the most one small bag, sometimes just a wallet, no suitcase, no pets.
Mulderick couldn’t take two steps without running into someone having a conniption and who felt the need to share it with her. She had walked the floors for two days, shouldering people’s tension, anxiety, and panic. Two nurses who had brought teenage children to Memorial had come to her in tears saying they had to get out. When she told them there were still patients to be cared for, they had yelled at her. Other nurses had been allowed to leave. Why not them? Mulderick defended the departed nurses—they had gone to help people at the boat drop-off point—even though she had asked them, too, to stay at the hospital.
When Mulderick passed through the second floor, people sitting with their animals and their packed bags asked her when they could leave. A therapist erupted when she told him he had to stay; there were still many patients to move. He yelled at her. He had a bad back. Carrying patients was a job for younger men. Mulderick walked away. There was too much happening to argue with every person who was upset.
After the fight over the suitcase, three senior staff members from LifeCare approached her. They said they were getting low on rubbing alcohol and a few other supplies and wanted to know what the plan was for nine patients who remained on the seventh floor—as if they expected her to tell them what to do! They said they weren’t sure they could move the patients on their own, including a large paraplegic patient. One of the LifeCare staff members had told Mulderick earlier that two of their patients were in grave condition, running extremely high temperatures of 104 and 105 degrees.
Mulderick told the LifeCare team the plan was not to leave any living patients behind. She asked them to talk to Dr. Pou. After all, the doctors working on the second floor were the ones who had stopped LifeCare’s DNR patients from being brought down to the staging areas on Wednesday, saying it was too crowded. Were the patients dying, would they not attempt to move them; or would they proceed with getting them in the staging area for evacuation? Whatever the LifeCare leaders were going to do, Mulderick told them, they needed to decide and get it done.
During their conversation, a uniformed man began yelling, “All women and children!” More boats had arrived, and people streamed toward the ER ambulance ramp as if the man had announced the last one was leaving.
One of the LifeCare staff members, physical medicine director Kristy Johnson, excused herself to fight through the crowds. She wanted to bring the news of the family evacuations to the seventh floor, where two daughters of LifeCare patients remained.
CEO René Goux came to the ramp and asked the doctors why the hell they were loading family members onto boats. The doctors who had gone out that morning to the drop-off point had marshaled resources, including ambulances. “We’re trying to get the patients out!” he said.
“Everybody’s a patient, including us,” Dr. John Kokemor said. He, like many others, had been concerned for his life. He kept a credit card on him to use if he made it out of the hospital and a driver’s license for others to identify him in case he did not. Patients were slow getting onto the ramp. If the boats quit at five thirty as he expected, they would all be there another night. Kokemor’s goal was to get as many people on board each boat as quickly as possible; that included two of Memorial’s oldest doctors, one of whom was Horace Baltz. Kokemor wanted to get Baltz’s older sister out too, and her daughter, an ICU nurse. They had medical problems, and Kokemor didn’t think they were doing well. “I’ll move you to the front of the line,” Kokemor told them, “and you guys get out of here.”
Baltz accepted the offer even though he had not asked to leave. His longtime colleagues Dr. Ewing Cook and Susan Mulderick both hugged him and told him tearfully that they loved him. Their uncharacteristic emotion surprised the elder doctor. This wasn’t a normal good-bye.
Two men in camouflage caps who appeared to be National Guard soldiers helped Baltz step down into the unstable boat. Baltz, in shorts with white socks, held one young man’s rifle for him while the man helped others aboard. Baltz looked back at his beloved hospital. He was sure he was watching it die.
ANGELA McMANUS couldn’t believe that three men who looked like police, holding sawed-off shotguns, could be demanding that she leave her mother’s bedside near the nursing station on the LifeCare floor. They told her they were evacuating the hospital and she had to go.
“You’re going to stand over my mom’s bed with a gun pointed at me? Have you lost your mind? Shoot me!”
After staff had said her mother was being evacuated on Wednesday, McManus had waited in the boat line and had spent the night downstairs. This morning she had run into her mother’s nursing aide, whom she’d befriended.
“Angela, Mama’s doing good,” the aide said. “She’s a strong woman.”
“What do you mean?” McManus asked. “She’s still here?”
She climbed back up to the seventh floor and found her mother in the hallway near the nursing station where her bed had been rolled after Angela left her. Her mother was being given a cooling alcohol rubdown. “What’s going on here?” Angela McManus asked. “Why’s she so lethargic?” Angela was told patients had been given Ativan. “She can’t take Ativan!” she said, even while noticing that this time the drug seemed to have achieved its intended effect of calming rather than exciting Wilda.
Wilda was a little too calm for Angela’s liking. She kept dozing off, and Angela repeatedly woke her to make sure she was OK.
Now, as the policemen told Angela she had to go, she refused.
“I’m not leaving my mom,” she said. “I’m not leaving until they get her out of here.”
“Oh no, you’re leaving,” one of the policemen said. He lowered his gun, which had been pointed up at the ceiling, and Angela screamed. She noticed her mama didn’t awaken. Something seemed very wrong. Was it the Ativan?
“I need to talk to my mom,” Angela told the police. “Y’all move so she can’t see you.” The men moved behind the head of Wilda’s bed.
Angela roused her mother. “Mom,” she said, “the police are making me leave the hospital. They’re evacuating.”
Wilda McManus asked what was happening.
“They want us to get out of the hospital,” Angela said. “I can’t go with you.”
Angela tried to soothe her mother with words she used frequently. “It’s OK for you to go and be with Jesus. Daddy’s waiting for you, Grandma and Grandpa, Auntie Elois, waiting for you.” She had a sense that she was not only leaving her mother, her mother was about to leave her.
Wilda McManus couldn’t sit up, but she raised herself a little, looked intently at Angela, and screamed.
Angela kept calming her. “Mama, do you understand what I just told you?”
“I’m going home.”
“Yes, you’re going home.”
Wilda McManus asked her daughter to sing. Angela sang again like she always did, like it was church. She sang the gospel song “Near the Cross,” about the soul finding rest, and Wilda shut her eyes.
Angela asked her mother’s nursing aide to make sure her mother continued to receive nutrition through her feeding tube. “I’m going to be with her,” the nursing assistant said, “no matter what happens.”
Angela cried so hard during the walk downstairs tha
t she had trouble seeing. In the heat, carrying her belongings, she quickly grew winded. LifeCare physical medicine director Kristy Johnson, who had come up to get her, guided her down the dim staircase with a flashlight and helped carry her bags. They walked slowly, taking rests between floors. When they reached the first floor, Johnson bulldozed Angela through the crowds to the front of the boat line. Because Angela was traveling alone, a spot on a boat was quickly found for her.
KATHRYN NELSON also didn’t want to leave her mother. LifeCare nurse executive Therese Mendez was trying to convince her to go now or she’d never get out of the hospital. Nelson had inscribed Mendez in the “Especially Nice to Mother” list she had maintained throughout her mother’s hospital stay. Mendez was listed twice, meaning the smart, take-charge executive had been especially nice to Mother on at least two occasions. When Nelson told Mendez she didn’t care about missing the boats, Mendez responded so sharply Nelson felt that she had undergone a Jekyll-and-Hyde switch. “Your mother is dying!” Mendez said, after days without sleep, having worked overnight on what she called “First Floor Beirut.” She was worried it was Nelson’s last chance to leave.
“I’m dying too!” Nelson said, and told Mendez she had cancer. She didn’t, and later she would wonder how she had come up with something so ridiculous. She would say or do anything to protect her mother.
If her mother really was dying, then why would Nelson want to leave her now after she had been with her every day in the hospital for more than a month and a half? When she had first been told to leave, on Tuesday, she had asked if she could be admitted as a patient so they could travel together. Nelson looked the part of a patient. She had taken to wearing hospital gowns during her mother’s stay.
The last time she had been made to go downstairs, she hadn’t stayed away long. She couldn’t bear to be separated from her mother. Though she had been told on Wednesday her mother would soon be evacuated, she’d had a sense that her mother and the other bed-bound LifeCare patients would be staying for a while. She had peered at the helipad through a window and watched people, including a male nurse she recognized, boarding helicopters. The able-bodied were leaving, not the sick.