by Sheri Fink
Ewale had been resuscitated once several days earlier when he was at the point of dying. He had since come off of the ventilator and stabilized with the use of a special oxygen mask, but he still had grave medical problems and his doctors, including Roy Culotta, had felt strongly that resuscitating again someone as sick as he, with such a poor prognosis, would be futile. After the power went out and the vacuum lines failed, medical workers had not figured out how to suction his airways effectively. Ewale had been given, at Culotta’s direction, injections of the sedative Ativan and morphine for comfort. He had been pronounced dead shortly before two p.m. on Wednesday after having choked on his secretions for hours.
Ewale had been comatose and unresponsive during those hours, but Karen Wynn believed that even when patients weren’t conscious, they could still feel things. As a young staff nurse, she’d had a patient with liver failure who was unresponsive for weeks. One day he awoke and asked for pizza and a Pepsi. He said that the whole time he was unconscious he had heard everything the nurses were saying to him. If he could hear, Wynn had concluded, he could probably feel as well, and this inference had informed her practice ever after.
The patients lying before Wynn on the second floor looked bad. They appeared to be struggling and working for each breath, when breathing should be effortless. In the incredible heat, even if they were not conscious, in Wynn’s mind they were suffering.
Wynn believed giving morphine and Versed would probably speed up these patients’ deaths, a process of dying she felt was already under way. Although she didn’t examine all the patients, her sense from seeing and hearing them, after decades of experience, was that they weren’t going to survive. She believed the outcome would be the same with or without the drugs even if the time frame would likely be different.
Besides, if the patients were working this hard to breathe when lying still, how would they fare if the staff attempted to move them? Shoving them through the hole in the machine-room wall, putting them on the back of a pickup truck, and bumping them up to the eighth floor of the garage seemed to her a more active means of precipitating their demise. Even then, it would be appropriate to sedate them for the journey.
All she and her colleagues had were means to provide comfort, peace, and what little dignity remained possible. Wynn turned to the elderly white woman with labored breathing. She diluted what she later remembered was a 10 mg vial of morphine and a small amount of midazolam in 10 ml of saline. She drew it up in a syringe and pushed it slowly into the woman’s IV catheter, then flushed the line with saline. The woman seemed to stop struggling so hard to breathe. She died within about half an hour.
Wynn saw one of her ICU nurses with Anna Pou attending to patients near the supply table. Another group comprising Dr. Thiele and several nurses had gathered near the broken windows. Wynn joined them beside a heavyset African American patient whose mouth was open in an O. Everyone could hear his awful death rattle.
The man had already received morphine, but to Wynn he looked and sounded dreadful, his breathing raggedy, like he was obviously suffering. “I’ve done everything I can do to make him comfortable,” Thiele said.
Thiele tried more morphine. He tried prayer. He put his hand on the man’s forehead; Wynn and another nurse manager took the man’s hands in theirs. Together they chanted: “Hail Mary, full of grace. The Lord is with thee.” They recited the Lord’s Prayer. They prayed for the man to die.
The man kept breathing.
“It’s hot! I wanna drink!” the young male amputee groused from the opposite side of the lobby. Thiele stood up from the heavyset man he’d been praying over and strode furiously toward the grumping and griping man. “He’s gotta get out of here!” Thiele said. Another staff member intervened to prevent the situation from escalating. The complaining patient was moved toward the head of the evacuation line.
A nurse approached to ask if anyone working in the lobby needed a break. She saw a group of colleagues gathered around a patient she knew well. “Oh good, you’re giving her some fluids,” she told another nurse. It was starting to hit her that what was really causing the patients to decline was dehydration. How easy it had been to lose presence of mind in an emergency, addled from nights without sleep. Of course you could run an IV without an electric pump. You could hang a bag of fluids above the patient and, with the right kind of tubing, allow gravity to do the work of dripping it into a vein.
As the hours had passed with patients sweating out their vital fluids, dehydration posed the most lethal threat to those who could not drink on their own. The initial goal had been to discontinue all treatments that could interfere with marshaling the patients up to the helipad as quickly as possible. But now that a day or two had passed, depriving these patients of liquids was undermining their chance of surviving.
From the shake of her colleague’s head, “No,” the nurse perceived that it was not IV fluids that her former patient, Ms. Essie Cavalier, was being given. The seventy-nine-year-old lady had been unable to walk or speak more than a few words since a stroke in her sixties. However, she’d had no acute health issues that would mean she could not survive. In fact, as the storm approached she was being discharged back to her nursing home after treatment for a urinary infection, but the nursing home was evacuating and could not accommodate her.
She had been a frequent patient at Memorial. A tall lady who had once played semi-professional basketball, Cavalier had grown up picking cotton and sweet potatoes, and had met her husband while working as a Rosie Riveter on the Higgins amphibious boats that originated in the Louisiana swamps and had helped win World War II. Recently, during her hospital admissions, some staff members would get annoyed with her because of her difficulty communicating. She could do little for herself but was well aware of her own needs and did what she had to do to draw attention to them, including scream. She would repeat the few words she could still form, including “Mama, Mama” and “my, my, my,” at a loud volume and nod and shake her head to indicate when she was uncomfortable and needed to be shifted in bed.
Here in the open lobby, these outbursts had disquieted those around her. After she was first carried downstairs, Dr. Pou ordered a dose of medicine to relax her, which a nurse gave her. Dr. Bryant King had done the same for her twice, most recently early this morning. He had been concerned that people like her were getting a little delirious, starting to yell out—some staff members were, too. King, like Karen Wynn, believed that fear was contagious. Now Ms. Cavalier’s eyes were open, looking around, but she appeared calm and was silent.
The nurse tried to find out what was happening. She noticed another patient, surrounded by caregivers trying to comfort him, who was struggling to breathe after receiving an injection. The nurse panicked and searched in vain for someone to do something, write an order to reverse the drugs, inject an antidote. Later her recollection of it would all be a blur that left her with the discomfiting sense that, at least in some people’s minds, the medicines were being given “for the greater good,” to get the exhausted, frightened employees out more quickly because there were too many patients who were immobile. “This is what needs to be done,” one colleague told her when she asked what could be done to stop it. Several staff members said that Dr. Pou had ordered the drugs, though the nurse had no idea if that was true or what her intentions might have been.
As the patients on the second floor died, and word spread about what was happening, the nurse wasn’t the only one who felt the way she did. Several nurses familiar with the patients who were injected believed that after they had survived everything so far, there was no reason they couldn’t still make it to safety. One employee acted like those who objected to patients being given the medicines weren’t being realistic and needed to grow up; most of the other employees milling around the second floor seemed to think what was happening was horrible but necessary.
Because no one was willing to try to reverse the drugs, a group of nurses carried the man who was still struggling to breath
e toward the parking garage, hoping that getting him quickly up to the helipad might give him a chance to survive.
The very young nurse who had been told to go pack her things returned to the second-floor lobby about an hour later. She noticed one of the patients she had been caring for looked weirdly whitish. A nurse who accompanied her placed a sensor on the patient’s finger to measure her blood-oxygen level with a battery-powered pulse oximeter. The reading was extremely low, around 65 percent. The young nurse, Julie Couvillon, scanned the lobby and noticed that a few of the patients definitely didn’t look right. The female doctor with the brown hair who had told her to leave now came to tell her and her fellow nurses to stop what they were doing and cease all care for the patients. The young nurse saw other staff drawing sheets over the patients. She was frightened. She was only twenty-two years old and three months out of nursing school, and she had never seen a patient die. The previous evening she had broken down in fear for her own life. Now the doctor asked her to help carry the dead patients and line them up inside the chapel. The young nurse began assisting.
From: Ben Russo [Tenet Healthcare business development and managed care director]
Sent: Thursday, September 1, 2005 1:25 PM
To: Michael Arvin [Tenet Healthcare regional business development director]
Cc: Steven Campanini [Tenet Healthcare media relations director]
Subject: Fw: Fw: New Orleans Bound
Mike or Steve, can you call Mitch or me regarding having fox news and john hammerly follow our clinical team to evacuate personal. This would be a huge pr play for Tenet. Mr. Hammerly is near Baton Rouge and would like to do a story on evacuation efforts.
AS THE PATIENTS who had been injected died, Wynn and her colleagues helped cover them with sheets and move them into the chapel. They tried to move discreetly to avoid attracting the notice of more cognizant patients still waiting in the evacuation line. Someone unlocked the chapel for them to enter and relocked it when they left.
Throughout the day, boats and helicopters drained the hospital of nearly all of its patients and visitors. Wynn and a group of other female nurses helped lift the last few patients through the hole in the machine-room wall.
From: Denise Beltran on Behalf of Earl Reed [LifeCare CEO]
Sent: Thursday, September 1, 2005 4:02 PM
To: All LifeCare Locations’ Employees
Subject: New Orleans Update – Sept 1
[…] Our patients in the Tenet hospital are still being evacuated. We are exploring private means of evacuating those patients. […]
AS THE LAST patients were brought to the top of the garage in the waning daylight, Merle Lagasse continued to await rescue there. A day had passed since the wrenching separation from her daughter as Lagasse was conveyed through the machine-room hole. Lying for days in the heat, suffering from advanced cancer and emphysema, Lagasse was far from the glamorous lady she had once been. A nurse noticed her gasping for air, breathing in a pattern that often heralds death. The nurse asked Lagasse’s physician, Roy Culotta, to give her something to ease her respirations.
Culotta saw Lagasse was in respiratory distress and believed she was actively dying. He took her out of the evacuation line. He asked an ICU nurse to retrieve painkillers and sedatives from the hospital.
A shortcut led from the garage back into the seventh floor of the main hospital over the rooftop of an intervening building. A wooden pallet bridged the gap between the garage and rooftop, with a hose to grip for balance, allowing those staffing the helipad to go back and forth easily to retrieve supplies. The ICU nurse returned with a mix of painkillers and sedatives Culotta assumed came from a lockbox in the ICU; they included morphine, Versed, and Ativan.
Culotta had been treating Lagasse with narcotics for weeks because she had pain and anxiety from her spreading cancer, so he knew her tolerance was high. It would take a large amount of morphine, he felt, to relieve her gasping and suffering. It would also, he believed, undoubtedly hasten her death. While she and her daughter had not agreed to a DNR order, he, as her doctor, had felt during her hospitalization that her therapeutic options were limited, and a central goal of his care was keeping her pain and anxiety in check.
The nurse gave the drugs Culotta ordered. They put Lagasse in the back of the truck, and Culotta drove back down with her and brought her into the hospital. He was with her when she died.
SUSAN MULDERICK surveyed the emergency room. She had been told hours earlier that the two patients lying in its waiting room—one of them the elderly lady who had arrived with her husband and was cared for by Karen Wynn—were not being moved because they were dying. The two were still present and alive. “What are we doing with these people?” she asked the ER doctor. Mulderick told him they needed to make a decision about the two. Were they expected to die soon, or was it time to move them upstairs? The doctor said, “OK,” that he’d take care of it.
IT HAD BEEN a long day on the helipad. Some helicopter pilots refused to take bed-bound patients. To get around this, doctors lifted some of these patients into wheelchairs and tied sheets around their midsection and chest to convert them to “sitting patients.”
At around nine p.m., the obese ICU patient Rodney Scott was hoisted up the open metal steps to the helipad. He was apprehensive about being carried up a narrow passageway by inexperienced volunteers but relieved to be outside of the dark, airless hospital. Sudeep Reddy, a reporter from Tenet’s hometown newspaper, the Dallas Morning News, tracked Scott’s progress toward rescue. Reddy had begged a ride from the aviation services company supplying leased helicopters to Tenet and flown in with a photographer, Brad Loper, late that afternoon. Reddy had counted eighteen people, many of them women, helping slide Scott through the machine-room wall on a count of three. Six others received him on the garage side, discussed how much oxygen he needed, and loaded him onto the back of a Ford F-150 pickup truck for a ride to the top. As Reddy ascended to the upper level of the parking garage, he was surprised to see patients in obviously terrible condition still lying in the heat on the ground. Some looked so bad that Reddy took doctors and nurses aside and asked in a low voice whether the patients were alive. The medical staff said they were, but that others had died on the ground in the horrific conditions. Reddy could not piece together why these very sickest patients had not yet been airlifted.
Reddy watched clusters of volunteers hoist stretchers on their shoulders and carry patients up the narrow metal steps to the helipad. He scribbled in his notepad. “Urine and feces rolled off the beds and onto the workers, forcing them all to wipe down with sanitizing liquid every time,” his story would say.
Now four men surrounding Rodney Scott shouted, “Push! Push!” and rolled his heavy wheelchair into a Coast Guard helicopter. When this was done, one of the male ICU nurses collapsed to the ground. He’d been pinned against the helicopter by the wheelchair and his colleagues hadn’t heard him yell for them to stop.
The ICU nurse seemed to be having trouble breathing and it looked like he would need to be evacuated, too, perhaps in place of Scott. Dr. Roy Culotta bent to examine his chest and other workers screamed for ICU nurse manager Karen Wynn, who had helped lift Scott through the machine-room wall and then grabbed her purse and hiked to the top of the eight-story garage. What can I do? she wondered. She was like a mother to her nurses, even as they scattered from Baptist and New Orleans, perhaps forever.
Another helicopter hovered overhead. It could take the injured nurse and Culotta, who would accompany him, ready to insert a chest tube in midair if necessary to help him breathe.
As they devised this plan, the helicopter carrying Rodney Scott lifted away. Weighing more than three hundred pounds, recovering from surgery and heart trouble, and unable to walk, Scott had been designated the last to go through the hole in the wall because of his weight. Ewing Cook had mistaken him for dead the previous day. And yet he had been successfully airlifted, alive. Scott was the last living patient to leave Memorial.
PART 2
RECKONING
Yesterday we could see, today we can’t, tomorrow we shall see again….
—José Saramago, Blindness
CHAPTER 8
THE CAMERA WENT LIVE, showing some of the thousands of people trapped on the stinking, trash-filled Interstate 10 cloverleaf on Thursday night. The reporter estimated that 90 percent of them came from inner-city housing projects. “But then there are the others,” she said. She introduced two Memorial Medical Center employees, describing them as very scared.
“You could have gotten out. You could be in a nice, warm bed tonight, but instead, you’re out here,” the reporter said. Her made-up face looked, to the tattered survivors, out of place in the disaster.
Memorial’s director of maternal-child nursing, Marirose Bernard, had agreed to go on camera in exchange for what she thought was a promise from the news crew to help rescue her children, husband, and mother, who had left Memorial on Wednesday only to end up hungry, thirsty, and terrified at the New Orleans Convention Center.
Bernard described the five days at Memorial. She said doctors and nurses had worked with, at most, an hour of sleep a night. She spoke of learning to triage and explained how employees and visitors carried each patient down the stairwell in the dark.