Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (21 page)

Over the side of the helipad, Mulderick and the flight mechanic could see a patient being carried up the metal steps. There was barely any lighting. It struck Mulderick as extremely dangerous to have untrained staff performing this work. She told the flight crew to take the patient but not return again to Memorial.

A group of workers approached with the patient, manually ventilating her. They’d had to run a Code Blue resuscitation on the way to the helipad, and the patient needed to go directly to a hospital in Baton Rouge. After spending a long time spinning on Memorial’s helipad, the Jayhawk was approaching bingo—it didn’t have enough fuel to make it all the way to Baton Rouge. The crew, too, was running out of flight time.

In desperation, a doctor threatened to leave the patient unattended on the helipad if the patient wasn’t allowed aboard the Jayhawk. A plan was hatched—they would fly the woman to the hurricane-battered Coast
Guard New Orleans air station and transfer her to another aircraft. They loaded her and a LifeCare nurse and left Memorial at five fifteen in the morning.

Inside the roaring, shaking military helicopter, the accompanying nurse looked terrified to the point of inaction. The Coast Guard rescue swimmer, along with a young freelance cameraman accompanying the crew, took over the care of the patient. Somehow they made it.

Mulderick’s decision to end the airlift hadn’t yet reached everyone. A fresh Jayhawk crew that had taken flight from a Coast Guard air training station in Mobile at three thirty a.m. had also received a call for assistance over the radio. Power has been lost at Baptist Memorial. Patients need help. Could the aircraft transport two ventilator patients at once? “Hell yeah,” the crew’s rescue swimmer told the pilot. “Let’s go get it, man.”

The pilot kept the helicopter aloft, concerned the helipad might not hold his Jayhawk’s weight, as the swimmer lowered himself onto Memorial’s helipad, where he was swarmed by frantic hospital personnel. This time the LifeCare patients were ready to go. He saw they were so fragile and required so much medical equipment, it would be dangerous to “package” them in the litter used for rooftop rescues and hoist them. He radioed the pilot, orbiting overhead, who set up for an approach, his flight mechanic lying on the deck with his head to the ground to help them land light on the wheels, holding power to the rotors to maintain some lift. They landed safely. The staff rushed the two patients to the helicopter, and the swimmer put up troop seats to make room on deck. He unloaded bottled water and ready-to-eat meals for the hospital staff. “You need to nourish yourselves,” he, a seasoned emergency responder, advised, “or you’re not going to do anybody any good.” He handed the doctor something perhaps even more needed—a portable Coast Guard drop radio around the size of a cell phone that he could use to communicate on emergency channel sixteen.

The helicopter lifted off with the two patients. The pilot headed
directly for a hospital in Lafayette, more than an hour’s flight. To the rescue swimmer, every moment felt like forever. He kept bagging and monitoring the patients’ vital signs and praying.

Back inside the hospital, more ventilator patients from LifeCare had been brought downstairs and were lined up waiting to be carried through the hole in the machine-room wall.

One of those patients, wrapped in sheets, was passed through the hole with the help of
a LifeCare respiratory therapist. On the garage side, a team maneuvered the patient onto a mattress on the bed of a truck that would drive to the helipad. “We need more viable patients,” the therapist heard a voice say in the dark. “Y’all can’t keep bringing patients like this to us.” The comment struck the therapist as snide and offended him. The patients he cared for on LifeCare were “like this.”

Susan Mulderick’s decision to stop the airlift reached LTJG Shelley Decker at the Coast Guard command center in Alexandria before six in the morning. By that time, three sorties had occured, and only three of the LifeCare ventilator patients and one patient on a special oxygen device had been rescued. The Memorial nurses explained to Decker that it was dark; they were moving patients by hand up and down the stairs, with a nurse standing by them and bagging them constantly. “We’re tired,” they said. Decker had assumed there was emergency lighting. She tried to picture what they were seeing, but found it difficult. She sat in a well-lit room with running water, electricity, and working phone lines. It was surreal; she imagined a weird B movie, the dystopian, post-disaster world depicted in the film
Escape from L.A
.

The Memorial nurses told her that the remaining vent patients “were DNR”—although that was not true of all of them—and that operations had to stop for now and could resume at nine in the morning. A Memorial nurse assured Decker that the patients would continue to be bagged, ventilated by hand. Decker understood, but it was hard for her to swallow. She could get rescue assets to Memorial if only its staff could get the patients to the helipad.

The Coast Guard auxiliary volunteer working beside her, Michael Richard, had an even harder time accepting the decision. As Memorial’s generators failed one by one, he had spent hours finding hospitals to take the patients and laboring to convince hospital leaders to allow the rescues to proceed. It had shocked him when one told him that the hospital’s priority was to evacuate first its own patients—her responsibility was to them, not to these sickest patients belonging to another company who were going to die anyway. Holy crap, he thought. She wants to walk away and let them die. Was it all a question of money? “Hold on,” he’d told her. He put the phone down and pretended to consult a superior about this decision. He didn’t feel he had to speak with anyone. He knew exactly what was right. He picked the phone up again. “Absolutely not,” he said. “You’re going to take the most critical out first.” She insisted it was her choice to make. He told her it wasn’t. Maybe it wasn’t his, either, but he didn’t care. He couldn’t imagine her making this call and living with it later. He thought the decision would scar her conscience. He was raised Christian; he was raised to take care of those most in need.

Back at Memorial, the number of LifeCare patients being ventilated by hand grew by one: eighty-year-old
John Russell, a Korean War veteran who liked to joke with his caregivers. Russell, who was being treated for a bad skin infection on his leg, had a history of cardiac disease. He was found not breathing, with no heartbeat, at about five thirty in the morning, within hours of the backup power failing. The staff called a Code Blue, intubated him, and injected him with drugs that restored a livable heart rhythm. Then they carried him downstairs.

LifeCare director of nursing Gina Isbell stood beside him now on the second floor, pulsing air through a one-way valve into his breathing tube with squeezes of a reinflatable Ambu-bag. In previous disasters, hospital workers had ventilated patients this way for hours, just as Gershanik had done with the neonate on the helicopter. However breaths given by hand were not as precise in volume or pressure as those that would have been dispensed by a machine, likely making them less effective.

Isbell’s hands grew tired and her white scrub shirt stuck to her generous frame. Russell was twitching and largely unresponsive, signs that he wasn’t getting enough oxygen to his brain in spite of her efforts. The wait in the hot corridor went on for nearly an hour before Russell was advanced into the machine room on the way to the heliport. A physician stopped by the stretcher and shined a flashlight into Russell’s eyes, a crude check of his neurological function. “You do know that he needs oxygen,” he said to Isbell.

“Yes, sir.”

The doctor said the hospital didn’t have any more oxygen, and couldn’t get any. “You have to let him go.”

It was not true that there was no oxygen in the hospital, but Isbell was not in a position to know this. She did not know that the ICU nurses had passed around an oxygen mask like a marijuana bong just hours earlier (oxygen from the wall supply was not available in the machine room). She did not know where the stores of portable oxygen tanks were at the hospital. Did the doctor? Perhaps he felt that searching for tanks wasn’t practical. Perhaps he’d heard there weren’t any. Or perhaps he felt the man was too far gone, or that oxygen needed to be saved for other patients, or that the airlift wouldn’t start again in time to save the man.

The oxygen problem was also recorded in the state’s emergency medical services logs a few hours later: “Baptist Hospital has now run out of O2—Priority has been given to moving their vent patients.”

Isbell believed the doctor when he said there was no more oxygen. She stood for a moment by her patient and wondered, How do I just let him go? Then she stopped pumping the Ambu-bag. She hugged the elderly man and stroked his hair as he died.

Isbell pulled a sheet over Russell’s face and rolled him out of the machine room. She sat on the ground by his feet waiting for LifeCare’s nurse executive, Therese Mendez, to tell her where to take his body. The main morgue was all the way up on the eighth floor, no longer refrigerated,
and possibly full. People passed Isbell and asked for the dead man’s gurney. The requests bothered her. It was all she could do not to snap back in anger. Find your own gurney, she wanted to say. Leave us alone. The man deserves respect.

Almost an hour passed, and then hospital chaplain John Marse approached.

“Come on with me,” he said. Isbell stood up, and Marse guided her and the gurney through a nearby door with stained-glass windows. Therese Mendez pushed chairs to the side of the empty chapel to make space. Inside, Isbell cried in the chaplain’s arms. They prayed together. She had seen patients die before, but this death felt different. Normally, she had what she needed to give people a chance to survive.

The chaplain left and Isbell sat alone for a while in the chapel, composing herself. Then she and Mendez walked to the fourth floor of one of the parking garages and sat in Isbell’s SUV with the air-conditioning blowing. They took a short break. Isbell didn’t want to leave.

In the early morning, Dr. Anna Pou, too, also
took a turn on the second floor squeezing a reinflatable Ambu-bag to ventilate a LifeCare patient. She switched off with a nurse and another staff member as they waited. When Pou returned to relieve one of them, the patient had died.

“What are we gonna do here?” Pou and her colleagues asked one another. It hit her that there was not much she could accomplish without the tools she relied on, without basics, including electricity and running water. As a specialist in head and neck disorders, Pou was particularly attuned to another problem: the loss of hospital suction. Normally the negative airflow—running from an outdoor vacuum pump through a vein-like system in the hospital’s walls—had an outlet in each patient’s room, where an aspirator could be used to clear congestion from patients’ upper airways, helping them to breathe. Overnight Pou had been reduced to tickling the back of one patient’s throat, stimulating a cough. It took about an hour before a nurse found a portable, battery-powered suction device.

Pou was the kind of cancer surgeon who fought to give patients with poor prognoses the latest treatments and every last possible chance to survive. Sometimes she fought after other physicians would have given up hope. Now, robbed of her armamentarium, Pou’s sense of efficacy as a doctor was diminished. She, like Mulderick, had concluded the sickest remaining patients and those on ventilators might not make it out of Memorial alive.

The four LifeCare patients who left on Coast Guard helicopters were successfully transferred to other hospitals. The remaining five ventilator-dependent patients did not make it out of Memorial. One patient died being carried down the staircase. Another, a fifty-one-year-old woman in a deep coma who had a DNR order, never left the seventh floor. Memorial staff members came up to say patients with DNR orders could not go.

WEDNESDAY, AUGUST 31, 2005—MORNING

THE SUN ROSE and with it the temperature. The hospital was stifling,
its walls sweating. Water had stopped flowing from taps, toilets were backed up, and the stench of sewage mixed with the odor of hundreds of unwashed bodies. Interior corridors were enveloped in darkness penetrated only by dancing flashlight beams. Without working phones, televisions, computers, and overhead pagers, information was scarce. Critical messages passed voice to voice up and down the staircases.

Plant manager Eric Yancovich came to tell Susan Mulderick that an official had arrived at the hospital saying he was the cavalry. Mulderick met the very tall, bald man, who wore black pants and a yellow shirt and carried a radio. He introduced himself as a representative of the state’s Department of Health and Hospitals, and in the press of the emergency, Mulderick quickly forgot his name. He said he was going to get the hospital
cleared out by the end of the day. He told Mulderick to get everybody ready to go.

The incident command team met at about seven a.m. They adopted a plan to consolidate resources and patients by moving them to staging areas near exit points on the first and second floors. A nurse was sent to the emergency room to find the color-coded triage armbands the hospital kept in case of emergencies. She was to distribute the bands to each nursing unit and explain how to use them. Patients who could walk would be given green bands, those who needed assistance would get yellow bands, and those who depended completely on care given by others would get red bands. Patients with DNR orders were to get a black band.