Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (16 page)

Wynn’s staff, helped by some of their accompanying relatives, worked furiously. It was taking so long for the single elevator to arrive that they started carrying some patients down the stairwells. They rolled patients onto their sides, pushed a blanket up against their sweaty backs, then rolled them the other way and pulled the blanket out so it was lying underneath them. Volunteers grabbed onto the sides of the blankets, gathered up the slack, and lifted the patients from their beds.

Another surgical ICU nurse, Lori Budo, gripped a flashlight under her chin as she navigated the dark stairwell alongside a patient. When she came back up, she collected flashlights and tape and directed a volunteer to fix them to the railings.

One of the sickest patients in the ICU was seventy-seven-year-old
Helen Breckenridge, a former drapery maker and interior decorator who had been a patient at Memorial for about a week. Breckenridge had developed complications of lung and heart disease and diabetes, and had been in hospice care at another hospital. That meant that the treatments she was receiving had been focused on affording her comfort rather than extending her life. She was receiving morphine and powerful sedatives and, when she stopped eating, perhaps as a result of the sedation or her worsening disease, the hospice had not provided nutrition or fluids. Her brother, a physician at another New Orleans hospital, couldn’t stand to watch her wither away. He believed she had been forced to sign paperwork that led to her hospice admittance and that she didn’t really want to be there. He went to court to have her removed from hospice and transferred to Memorial for aggressive treatment in the ICU.

Now, a team of medical workers labored to move Breckenridge. One squeezed air into her lungs by hand and others kept an eye on the multiple battery-powered pumps that delivered drugs into her veins to regulate her fragile circulatory system. They traveled downstairs from the eighth floor.

“Bring her back up,” a doctor said when she arrived downstairs. “She can’t go in the first sweep.”

Memorial’s doctors, meeting earlier, had established an exception to the protocol of prioritizing the sickest patients and those whose lives relied on machines. They had decided that all patients with Do Not Resuscitate orders would be prioritized last for evacuation. There were four DNR patients in the ICU, including Breckenridge and Jannie Burgess, the African American nurse who had once cared for patients at hospitals where she herself could not be treated.

A DNR order was signed by a doctor, almost always with the informed consent of a patient or health-care proxy. Informed consent was a legal concept established beginning in the 1950s in the United States. It was designed to protect patient autonomy in medical decision making, in the context of historical abuses. Doctors were required to disclose the nature, risks, benefits, and alternatives of the medical interventions they proposed. A DNR order meant one thing: a patient whose heartbeat or breathing had stopped should not be revived.
A DNR order was different from a living will, which under Louisiana law allowed patients with a “terminal and irreversible condition” to request in advance that “life-sustaining procedures” be withheld or withdrawn.

But the doctor who suggested at the meeting that DNR patients go last had a different understanding, he later explained. Medical chairman Richard Deichmann said that he thought the law required patients with DNR orders to have a certified terminal or irreversible condition, and at Memorial he believed they should go last because they would have had the “least to lose” compared with other patients if calamity struck.

Other doctors at the meeting had agreed with Deichmann’s plan. Bill Armington, a neuroradiologist, later said he thought that patients who did not wish their lives to be prolonged by extraordinary measures wouldn’t want to be saved at the expense of others—though there was nothing in the orders or in Memorial’s disaster plans that stated this. This
decision about evacuation priorities would perhaps not be a momentous one—as long as the hospital was emptied quickly.

Nurse manager Karen Wynn learned of the doctors’ decision from two doctors, Ewing Cook and Roy Culotta, and shared the information with Susan Mulderick. The plan was also made clear to a nurse helping transport Breckenridge: first “the most salvageable had to go.”

By the time Breckenridge was returned to the ICU, she was barely alive. They plugged her pumps and drips back into the emergency wall outlets and restored her mechanical ventilator, but she soon died, a death perhaps imminent but nonetheless seemingly the first in the hospital to be hastened by Katrina. A staff member summoned Dr. Horace Baltz to pronounce her death, and the white-haired doctor came panting up the staircase.

Rodney Scott, a sixty-three-year-old licensed practical nurse who’d once worked at Baptist, was brought down from the ICU, where he was recovering from a heart attack and multiple surgeries. But he weighed well over three hundred pounds, and a doctor feared he might get stuck in the narrow passageway being used to funnel patients into the garage. Worried this would back up the evacuation line, the doctor decided Scott should be the last patient to leave the hospital. Scott was taken to a patient unit on the fourth floor to wait.

UP ON THE HELIPAD, neonatologist Gershanik was deciding what to do about the two sick babies whose incubator didn’t fit on the small helicopter. Gershanik depended heavily on technology to keep his critically ill newborns alive. Transporting babies this sick without an incubator was unthinkable.

And then it wasn’t. Gershanik decided to take the risk. He climbed into the seat next to the pilot and cradled a six-week-old preemie wrapped
in blankets in his arms. “Baby Boy S” had been born at twenty-four weeks with severely underdeveloped lungs and still weighed less than a kilogram. Gershanik dispensed rapid puffs of oxygen with squeezes of the reinflating bag, attempting to replicate the work of a sophisticated machine that sent oscillating waves of oxygen into the baby’s lungs. Someone placed the other tiny baby from the incubator into the arms of a nurse, who folded herself into the backseat of the helicopter. She slid the baby under her scrub shirt, decorated with pink and blue baby footprints.

As soon as they lifted off, Gershanik grew afraid. A cold draft circulated through the helicopter, and he tried to shield the baby with his body. It was getting dark. He could easily, without knowing it, dislodge the tiny tube in the baby’s windpipe. He had brought no machine to check the level of oxygen in the baby’s blood. The cacophony of the helicopter blades rendered his stethoscope useless. It would be impossible to listen to the baby’s chest for breath sounds. What did I do? he wondered. Did I make the right decision? Practically the only way to know whether the baby was still alive was to use his free hand to pinch the baby’s foot and feel whether he withdrew it. Gershanik’s other hand was getting cramped from rapidly squeezing the oxygen bag. He made a silent promise: If this baby lives, I’ll never complain about anything again.

The pilot announced that he had to stop for fuel. Gershanik couldn’t believe it. They landed at a refueling site for petroleum-industry helicopters. A planned five-minute stop stretched into ten, then fifteen, then twenty-five minutes. Gershanik pulled out his penlight and shined it on the baby. Still alive. He swung the light to the baby’s oxygen tank. Nearly empty. Two US Army helicopters had landed after them, but were getting served first. Gershanik protested to the pilot. “Sir, the babies are not going to make it.” The pilot told him the Army helicopters were rescuing people from rooftops. “Otherwise they’ll die as well.”

For a moment, Gershanik considered the larger reality, the competing priorities that had emerged as waters suffocated an entire city. He
was only doing what is ingrained in a doctor—advocating for his own patients—but now he saw that the struggle to save lives extended far beyond the two critically ill neonates in the helicopter, or Memorial’s entire population of sick babies, or even the whole hospital, much as it had seemed like the universe when he was back there. He used the delay to switch oxygen tanks with some difficulty. He apologized for his impatience.

Back on the helipad at Memorial, some of the remaining neonatal ICU nurses had taken to waving down passing helicopters like hitchhikers putting out a thumb. The activity on the helipad drew the attention of a mass of hospital onlookers, who had climbed upstairs to watch. They were hot and had only time on their hands. The air of chaos surprised a newly arrived coordinator for Acadian, who was moving from hospital to hospital with several small medical helicopters to evacuate critical patients. Other hospitals had been more organized. On the northeast edge of Memorial’s helipad, he put down a cooler filled with sandwiches for his hardworking flight crews. It was promptly ransacked and emptied by Memorial staff and strangers loitering on the tarmac.

The doctors on the helipad had gone from practicing medicine to, at least in one case, arguing with a Coast Guard pilot about how many patients could fit in his helicopter. The pilot flew away to rescue people elsewhere. A
nurse who was also an Air Force captain witnessed the scene and was upset at losing a helicopter. She knew that these pilots ruled the air and, having logged thousands of search-and-rescue flight hours, could be trusted to know their capacity. She approached Dr. Richard Deichmann, the chairman of medical services managing the helipad, and told him the Air Force had trained her to run a flight line in an emergency. He put her in charge, and she cleared the helipad of doctors and patients, sending them to wait in the wind-protection tunnel. She shooed people off the hospital rooftops so that the pilots could keep landing.

Memorial staff members began loading the last group of critically ill babies onto a helicopter. Its pilot had a flight plan for a hospital west of
Baton Rouge instead of the hospital that had agreed to accept Memorial’s neonates.

The neonatal ICU nurses resisted. They had no idea whether the other hospital was prepared to support the lives of their fragile charges. Richard Deichmann said the babies could leave.
“The babies will be taken to wherever the pilot is going,” he told the nurses and, via walkie-talkie, their director in the hospital. “This is a disaster.”

“Then we will remove the babies from the helicopter,” the nursing director in charge of the neonates radioed back, contradicting him in spite of the unwritten hospital hierarchy that put doctors on top. She told Deichmann that the pilot had to find a way to fly to Baton Rouge or she would not allow him to take the neonates. Within minutes the pilot received approval for a flight plan to Baton Rouge.

A text message arrived a few hours later from Baton Rouge. All the babies had made it, including Gershanik’s. Baby Boy S’s oxygen level on arrival matched what it had been on the high-tech machines, thanks to the doctor’s life-support improvisations. The babies were more resilient than the doctor had imagined.

AS SOON AS Anna Pou walked back into the hospital after helping load patients onto the National Guard trucks, a nurse came to tell her that a Code Blue medical emergency had been called on LifeCare, the long-term acute care hospital that leased the seventh floor. “I think you better go, because I don’t think they have doctors up there,” the nurse said.

The stairs were slippery with condensation, but Pou ran up six flights in the heat rather than wait for the one working elevator. A seventy-three-year-old man had developed a very slow heartbeat just before three p.m. and had stopped breathing. A team of nurses had surrounded his bed and pulled up a crash cart filled with the supplies needed to try to resuscitate him. As the only doctor present, Pou took charge.

She stepped behind the man’s bed and, with the help of a LifeCare respiratory therapist, tipped his head back with some difficulty. The man was extremely thin, and his neck was stiff and bent. Using the metal blade of a laryngoscope, she scooped his tongue and pulled his jaw up. Then, with a battery-powered light on the scope to guide her, she carefully inserted a tube between his vocal cords and into his airway. The tube was connected to a ventilator plugged into a red emergency outlet. It pumped oxygen into the man’s lungs from a supply that ran through pipes in the hospital’s walls, fed by a giant tank of pressurized gas that did not depend on electricity.