Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (14 page)

Tenet did not have preexisting contracts with medical transport companies. The corporate headquarters did not have an incident command system in place for emergencies. One of its executives had served in the National Guard and knew something about crisis management, but he was on vacation and offered tips by cell phone from a secluded beach retreat in Oregon.

Arvin let Cordray know that the company was working on securing
medicines and blood for Memorial, but he was not sure how to get anything to her. Again he mentioned the National Guard, explaining that Memorial’s sister hospital, Tenet’s Lindy Boggs Medical Center, the former Catholic hospital Mercy, was waiting for troops to arrive.

We suggest you do the same. If you are beginning your plans to evacuate it is our understanding the National Guard is coordinating. Good luck.

Cordray wrote back, incredulous:

Are you telling us we are on our own and you cannot help?

AT 12:28 P.M., Memorial’s director of case management took matters into her own hands. She typed “HELP!!!!” in the subject line of an e-mail and sent it to colleagues at other Tenet hospitals outside New Orleans. She told them the hospital was expecting fifteen feet of water and it needed to find places for its current census of 187 patients. Hospitals that might accept them should contact Arvin at Tenet headquarters.

Arvin was quickly inundated with responses. Many hospitals offered space and at least one offered to send relief staff. But Arvin, too, had been busy trying to line up assistance, contacting Tenet hospitals in Houston and Nacogdoches. His message back to the Memorial administrator who sounded the alarm was brusque:

please route any requests through to me and Bob Smith. We are getting overwhelmed with your MAY DAY to the entire company!!

Among the hospitals that responded was Atlanta Medical Center. Like Memorial,
Atlanta was a former Baptist hospital founded in the
early 1900s and now owned by Tenet. By e-mail and phone, its hospital executives offered support, including aeromedical helicopters to help evacuate Memorial’s patients.

Michael Arvin reined them in, saying that the National Guard was coordinating all relief efforts. The Atlanta CEO understood.

Michael, per our conversation, we will “sit tight” unless we hear from you or someone at the Dallas office regarding the need for assistance in the evacuation of patients.

AT MEMORIAL, word spread that all available doctors and nurse managers should report to the ER ambulance ramp, which overlooked Clara Street. Anna Pou walked out of the hot hospital into a bright, slightly breezy day. In a small parking lot across the street, water was rising up the wheel wells of the cars.

Dr. Richard Deichmann, the head of the internal medicine department, told the doctors that the hospital was going to be evacuated. They needed to work on getting patients transferred, the sickest first.

Deichmann took stock of who was present and reassigned two physicians to cover each of the fifteen patient wards. At the suggestion of Dr. Horace Baltz, to avoid duplicating work, doctors would no longer visit their own private patients unless they were on the designated ward. The doctors were to categorize every patient and to prepare a count by four p.m. Patients would be marked down for transfer to one of several types of care settings: an ICU, a general hospital ward, a rehabilitation facility, or a nursing home. Patients ready to be discharged could be given a week’s worth of medications and sent on to an evacuation center. The medical staff should get the patients packed up and work on transfer orders.

Pou paired up with a thirty-five-year-old internist, Kathleen Fournier, and went to the fourth floor, where Pou had several surgical patients. She knew the nurses well, and one confided in her that many of the staff and patients were frightened and worried about their homes and their loved ones outside the hospital. Pou met with the nurses and offered what reassurance she could.

Pou and Fournier walked from patient to patient, evaluating and classifying them. There were around two dozen, a full complement. Many had been put in wheelchairs and pushed to a central nursing station to sit with fans blowing on them.

Nurses began photocopying charts and readying a few of the sicker patients to go out first. Throughout the day, Pou shuttled back and forth to the fourth floor, bringing the nurses whatever news she heard.

One of Memorial’s veteran critical care doctors was Ewing Cook, a pulmonologist who was Dr. John Thiele’s former partner. Cook took responsibility for another section of the fourth floor, replacing his son, also a doctor, who had gone home the previous night and was prevented from returning by the flooding. To ease the load on nurses, Cook decided all but the most essential treatments and care should be discontinued. Bryant King, a thirty-five-year-old internist who had recently joined Memorial as part of its
new inpatient hospitalist program, which offered care for other doctors’ patients during their hospital stays, came to check on one of his patients there. Bucking the directive to see only patients in assigned wards, he still planned to submit billing claims on his existing patients as usual. He canceled the senior doctor’s order to turn off his patient’s heart monitor. Cook found out and was furious. He thought that the junior doctor did not understand the circumstances, and he directed the nurse to reinstate his instructions.
“I’m in charge of this floor,” he told the nurse in front of King. “I told you what to do; I don’t care what any other doctor says. Do it.”

Outside on the ER ramp, maintenance workers watched a fuel truck approach to top off the generator tanks. The shiny chrome truck inched
toward the hospital along the wrong side of Napoleon Avenue in the lane where the water was shallower. As the tanker turned the corner onto Magnolia Street a hundred yards away from the hospital it stopped, backed up, and left. “Oh jeez,” an electrician said, disheartened. The driver seemed to have judged he couldn’t make it the rest of the way without flooding his vehicle.

Workers paddled one of the small, flat-bottomed boats kept for minor street flooding to the ER and carried it to the top of the ambulance ramp, which was dry. With dark humor, Susan Mulderick jumped in with chief financial officer Curtis Dosch and hammed for the maintenance chief’s camera, pretending to row. Behind them, Clara Street was a rising lake, calm enough to bear an image of the dappled blue sky, to double the stature of twisty-limbed oaks along Napoleon and add two reflected floors to the cancer institute across the street while now engulfing the cars in its parking lot to their door handles.

Downstairs in the basement, puddles expanded on the floor. Maintenance staff shut off some lighting and electrical panels to try to prevent a fire. An electrician heard the sound of a waterfall pouring through the breached seals of a ground-level window. Two carpenters raced to buttress the loading dock against flooding with custom-built plywood walls. They layered duct tape around a vulnerable set of doors, but water sought its level, spurting through cracks ten feet into the hospital shop.

The supplies that Mulderick and the maintenance crew had moved out of the basement during the storm had been restored shortly after it. Now teams of volunteers rushed to remove them again as water flowed up the drains, a reprise of 1926.

The pets, too, had been moved back down and were now being taken up to the parking garage facing Magnolia Street. Dr. Ewing Cook and his wife, Minnie, joined a procession bearing creatures and cages. The Cooks and their children and pets always stayed for hurricanes. Recently, not long after his son graduated from medical school, Ewing had
retired from clinical practice. He now served as chief medical officer after working at the hospital for a quarter century. Minnie was one of several Baptist nurses who gave birth to daughters who grew up, studied nursing, and replaced them. Her daughter now worked in one of the ICUs with another second-generation RN, Lori Budo, whose mother had once been nursing director there.

The Cook entourage included their daughter’s three cats and Rolfie, her giant, furry Newfoundland. Minnie walked ahead with one of the cats and Rolfie on the leash, while Ewing followed dragging the dog’s four-foot-long, folded metal cage.

At the top of the staircase, Minnie turned and waited for Ewing, but he and the cage didn’t appear. “Dr. Cook’s down in the security office,” someone came up and told her. “You might want to go see about him.”

The sixty-one-year-old doctor had nearly passed out in the heat on his way upstairs lugging the forty-pound cage. A security guard had grabbed him and brought him to his office by the stairwell.

Minnie thought Ewing was having another heart attack. He’d had two, the most recent one only months earlier when he’d borne the pain like a stoic, continuing to load floor tiles into his car at Home Depot until she noticed he was gray and insisted he go to the hospital.

This time heat exhaustion had caused his symptoms. Cook rested, drank fluids, and recovered.

A RUSTING HELIPAD sat atop the hospital’s Magnolia Street parking garage on the southwest side of the campus, 114 feet above sea level. Memories of its use had faded like the blue letters painted on its tarmac: SBH, for Southern Baptist Hospital—the name the hospital hadn’t officially carried in more than a decade.

The helipad, known as a Helistop, had been opened with fanfare in
1985. In what only a hospital marketing newsletter would proclaim as a “time-saving, potentially life-saving feat of logistics,” the building project had involved extending the garage elevator two floors higher to allow direct helipad access from the hospital’s emergency room and sixth-floor maternity unit.

The Helistop had special features. Pilots could illuminate the landing lights remotely by setting their VHF radios to a particular frequency and pulsing the switch on their microphones. The lights alerted hospital staff to prepare for an arrival. Landings could take place day or night in most types of weather.

The elevators and the landing lights relied on electricity. From that standpoint, the helipad design no longer represented a time-saving or lifesaving feat. The garage elevators had not been wired to the backup electrical system, rendering them useless without utility power. It was now impossible to take a patient directly from within the hospital to the helipad.

Several hospital administrators and others trudged up the seemingly endless garage staircase to assess the situation. The picture of decrepitude that met them raised a more serious question about the Helistop. Would it buckle under the weight of a helicopter? The engineers in the group were unsure. Whereas the platform once could accommodate an aircraft weight of 20,000 pounds, the hospital had recently spent upward of $100,000 in repairs merely to keep it from collapsing onto the eight-story parking garage below.

One doctor lingered on the helipad after everyone else departed. Paul Primeaux, an anesthesiologist in a hospital where surgery was no longer being performed, was one of several physicians who had no clinical responsibilities because of the situation. (Others included two radiologists and a pathologist, doctors who didn’t normally see patients but provided critical services to them.) Primeaux had never been up to the helipad before and had joined the group out of curiosity.