Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (24 page)

There is no such thing as a sum of suffering, for no one suffers it. When we have reached the maximum that a single person can suffer, we have, no doubt, reached something very horrible, but we have reached all the suffering there can ever be in the universe. The addition of a million fellow-sufferers adds no more pain.

The quandary of disaster triage had an analogue in everyday American medicine: the allocation of transplant organs. The United Network for Organ Sharing invited both doctors and laypeople to help design allocation schemes as part of an ethics committee. According to medical ethicist Robert M. Veatch,
members of the general public typically favored giving organs to those in the direst need, even if these patients were less likely to survive or lived at a greater distance from where organs became available. In contrast, health professionals tended to favor systems aimed at directing available organs to the patients most likely to benefit medically from them. To achieve this, the professionals were more willing to accept that many of the sickest patients would die without transplants, as would patients who had less of a chance of acquiring a well-matched organ because they were members of ethnic groups that had a higher rate of need or a lower rate of donation (a problem mitigated by the development of newer antirejection drugs). The approach could also disadvantage members of groups whose outcomes tended to be poorer, including, in the case of kidney transplants, those of lower socioeconomic status.

Although no allocation method could ever enlist universal agreement, the process of devising a method, at least, can be made more just. In the case of organ transplantation, including both doctors and laypeople in decision making resulted in policies that prioritized a mixture of both justice and efficiency. Who decides how care is allocated is critically important because it is, at its heart, a question of moral priorities.

At Memorial, however, in the disaster’s vise, only medical professionals
had a say in how patients would be categorized for evacuation. Once the decisions were made, no system was established to share the information with the people who would be most affected by it.

In some cases it was actively kept from them.

On a fifth-floor hallway in Memorial’s Clara Wing, transporters rolled a bed-bound patient toward the stairwell for evacuation, but after seeing she had a DNR order, they stopped and repeatedly maneuvered other patients around her. Nurses were instructed not to tell the patient’s daughter that this was because her mother had a DNR order. To calm her, they said her mother wasn’t the only patient left on the floor, failing to mention that the only other patient was dead. His son had taken him to Memorial’s emergency room before the storm for a cough, but the ninety-seven-year-old man with Alzheimer’s disease, James Lafayette, was discharged and had spent two days lying on the floor of Memorial’s lobby before being admitted. Hours later, nurse Michelle Pitre-Ryals found him pulseless in his bed. Doctors and nurses appeared from everywhere, lighting his room like a Christmas tree with their flashlights. They ran a Code Blue, but extraordinary measures, after the lack of ordinary measures, failed to revive him. Pitre-Ryals was distraught. In her five years as a professional, no patient had died unexpectedly on her watch.

Now a man with a walkie-talkie appeared and told staff members they had to leave the floor. “What are you talking about?” Pitre-Ryals asked. Nobody had come for the DNR patient. The hot, exhausted nurse couldn’t believe she and her colleagues were being told to abandon her and they refused. Pitre-Ryals informed the woman’s daughter of her right to request that the DNR order be discontinued, just as she had approved it after her oxygen-dependent mother was admitted for the storm. “If she goes into cardiac arrest, let her go,” the daughter had said, reasoning it wouldn’t make sense for her mother to be resuscitated at age ninety-three. This situation struck the daughter as entirely different. “I
didn’t mean for her to be left up here,” she told Pitre-Ryals. “When I made my mother a DNR, I did not know it meant ‘do not rescue.’ ”

The daughter asked for the DNR order to be canceled. She even appealed to the self-interest of the nurses who insisted on staying with her despite being ordered to leave. “You people have to get out, and we’re keeping you.” Someone went to find a doctor to remove the DNR order, and the patient was moved downstairs and out into the parking garage on the way to the helipad and rescue, surviving her immediate ordeal.

On a seventh-floor hallway at LifeCare, Angela McManus, another patient’s daughter, panicked when she overheard workers discussing the decision to defer evacuation for DNR patients. She had expected that her frail seventy-year-old mother, Wilda, would soon be rescued, but her mother, too, had a DNR order. “I’ve got to rescind that order,” Angela begged the LifeCare staff. They told her that there were no doctors available to do it.

Wilda McManus stayed upstairs in LifeCare. The doctors in the second-floor staging area told LifeCare staff to stop sending down patients. There was, they said, no more room.

CHAPTER
6

WEDNESDAY, AUGUST 31, 2005—AFTERNOON

IN A PRIVATE PATIENT room on the fourth floor of the Clara Wing at Memorial, Karen Lagasse watched four men take hold of the corners of her mother’s hospital bed sheet and lift her. The men carried Merle Lagasse toward the staircase. Karen and a nurse followed, holding an oxygen cylinder and the single bag Karen had stuffed with belongings.

Merle was, until recent months, a vivacious seventy-six-year-old. She had volunteered in the schools and worked reception at a beauty salon, and was a lover, rescuer, and collector of feral cats.

Dr. Ewing Cook had treated Merle for emphysema until his recent retirement. Merle adored him. She would dress up for appointments at his office. She had an Elizabeth Taylor aura, her brows arched, a corona of mascara radiating around her richly lined eyes, her lipstick bright. Cook would greet her with a huge smile. “Merle,” he’d say, “you’re gonna make a beautiful corpse.” The comment irked her daughter, Karen. But Merle heard only “beautiful.”

The tall, balding doctor had been sober with them from the beginning. Merle had emphysema. There was not much to be done. Cook prescribed
a home oxygen machine and Merle opted for the longest cord so she could walk freely through the house. She went out sometimes with a portable tank. But she was weak. Karen wished Cook would be more proactive. Could physical therapy help?

More recently Merle had learned she had lung cancer—not the curable kind. A little more than a week before Katrina, her new doctor, Roy Culotta, had admitted her to Memorial after she had a bad reaction to a pain medicine patch.

During Merle’s hospital stay, Culotta had worked to relieve her pain, her shortness of breath, and the existential anxiety that grips patients whose hunger for air goes chronically unsatisfied. Before the hurricane, he had prescribed treatment with a Vapotherm machine that directed a high flow of oxygen from the supply in Memorial’s walls into Merle’s nose.

Culotta had another idea he said would help Merle breathe easier. Fluid on the left side of her chest cavity was constricting a lung. He could tap the fluid in her thorax using a sterile needle and a flexible tube, allowing the lung to expand again. This thoracentesis procedure promised temporary relief, perhaps for days or weeks, until the fluid built up again.

Culotta ordered a thoracentesis kit to be placed at Merle’s bedside, but he had not yet come to perform the procedure. On Monday afternoon, after the intermittent bands of wind and rain from Katrina had abated, Karen saw him in the parking garage. He told her he was on his way home to take a shower. She had not encountered him since then. The kit sat at Merle’s bedside still wrapped in plastic as it had been since the day before the hurricane.

After the air-conditioning cut out on Monday, Karen had lifted a box fan to the bedside table and pointed it at her mother. She covered her in ice packs. She ran downstairs to pray in the dark, empty chapel for her mother and their cats, whom she had left at her mother’s house with food and water. She feared they might have drowned.

Overnight on Tuesday, the alarm on the high-flow oxygen machine
began ringing. The respiratory therapist had stopped making visits. To Karen, it seemed to take the nurses on the fourth floor a remarkably long time to figure out the reason for the alarm—the power loss.

They took away the failing Vapotherm machine and replaced it with a less-effective alternative—a mask that connected to the hospital’s bulk oxygen supply, still flowing miraculously from the wall. Karen felt anxious. Her mother’s breathing seemed more effortful. Karen tried to cool her by fanning her with a piece of cardboard printed with the hospital
company logo that a hospital worker had distributed.

The nurses said Merle would be one of the first patients to leave Memorial because she relied on equipment to help her breathe. Then a doctor came to ask whether Merle could sit in a wheelchair. Karen didn’t think so. Karen realized the plan for her mother had changed when the patients who could walk or sit in wheelchairs began leaving the floor first.

When it was finally Merle’s turn, a nurse detached the oxygen tubing from a nozzle on the wall and slid it onto a regulator atop a green metal gas cylinder. Karen noticed that the kit for removing the fluid around her mother’s lungs was still sitting at the bedside. She asked the nurse whether to take it along. “Oh, they’re not going to do that now,” she replied.

Several volunteers gripped the sides of Merle’s bed sheets, lifted her, and carried her to a stairwell. They began their descent with Merle facing headfirst. Realizing the peril of this approach, they backed up and turned her feet-forward before continuing.

When they emerged from the stairwell two flights below, they laid her down in a line of patients leading to the machine room on the second floor. Lying flat made it even harder for Merle to breathe. A nurse whom Karen recognized came to check on Merle. “She’s got to go now!” the nurse said, and twisted the knob on the regulator to maximize the flow of oxygen.

No kidding, Karen thought. Staff members descended on Merle to
begin moving her to the heliport, and Karen was told she had to leave the area. She started to walk away, but heard her mother’s voice. “Karen,” Merle gulped, “I can’t breathe.” Karen turned around and saw the oxygen tank had been disconnected and her mother was about to be passed through the narrow opening in the wall leading to the parking garage.

“She can’t breathe without the oxygen!” Karen yelled at a woman in scrubs who looked like a doctor and seemed to be in charge. “You have to put it back on her!”

“You don’t know what’s going on,” the woman said. Others stood and stared. Karen argued with the woman, even as she was reassured that her mother would receive oxygen on the other side of the hole in the parking garage. Karen was told she needed to leave the area. She was so hot and angry she felt ready to kill the woman speaking to her so insensitively. She knew she had to get out of there and her mother did too. She turned and rushed down to the ER ramp to try to get on a boat so she could begin searching for wherever her mother might be taken. She did not want her to be alone.

ON THE OTHER side of the wall, on the helipad above the parking garage, a fortunate few were being helped aboard helicopters. Among the first to lift off were a pregnant ICU nurse and several patients with kidney failure who needed dialysis. In the bright sunlight on the open pad, hospital volunteers mopped their brows with small white towels that they wore on their heads or tucked around the necks of their scrub shirts. In the helipad’s shadow, wheelchair-bound patients were staged on the gravel-covered roof of the parking garage so that volunteers could bring them to helicopters quickly.

A Coast Guard lieutenant reached Susan Mulderick by phone. His colleagues had been trying to put Memorial staff in touch with state emergency officials but had difficulty reaching anyone at the hospital.
The overnight rescue operation had come in for some official criticism. At least one Coast Guard commander said the local sector and its junior grade lieutenants had stepped on toes by responding directly to Memorial, taking initiative when they received no response from higher officials or those stationed at the state Emergency Operations Center.