Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (32 page)

The physician colleague watching the interaction figured that staff inside the hospital didn’t want to see patients suffering and were at a loss for what to do; while medicine had, of late, been overtaken by a fad of standardization, no guidelines existed for this situation. The idea of euthanizing patients, however, struck him as dangerous, and he shared his opinion with the radiologist. “I can’t imagine getting through all this—with all we’ve been through and all we’ve done—and having a physician go to jail because they were trying to help a patient and did something illegal.”

What would stick with Dr. Richard Deichmann years later would be not this conversation, but another one: He and Mulderick speaking in a quiet hallway alone; she asking him
whether it would be “humane” to euthanize the hospital’s DNR patients (a word and an idea Mulderick would deny, through her attorney, ever having spoken of with Deichmann or anyone else at Memorial); and Deichmann replying, “Euthanasia’s illegal.” Throughout the disaster, he and Mulderick had expressed minor differences about how the evacuation should proceed, which sometimes frustrated the employees, who were confused about whose direction they should follow. But this question, if Deichmann understood
it correctly, represented a major difference. “There’s not any need to euthanize anyone,” he would recall telling Mulderick. “I don’t think we should be doing anything like that.” He had figured the DNR patients should go last, but the plan, he told Mulderick, was still to evacuate them, eventually.

One of the emergency medicine doctors, Karen Cockerham, interpreted Mulderick’s words the same way as Richard Deichmann did and as the radiologist did. However, Cockerham agreed with the idea of euthanizing patients, which was what she was sure was being proposed when she listened to Mulderick on the ER ramp.
When is somebody going to say it?
she’d been thinking.
It’s the thing nobody wants to say
. The ER doctor looked around and saw others nod and noticed that nobody was objecting. This is the United States, she thought, and was surprised at what was being said so frankly, out in the open, with maybe a couple dozen people around. She wondered how smart that was, but she thought that euthanasia needed to be considered. It was obvious to her, although she couldn’t, in her normal life, have imagined it being a viable option. Now it seemed, while not the only option, perhaps the only humane one. She felt confident it was the right thing even before this conversation, and no doubt, she thought, others were thinking it, too.

Why? Because time had come to feel magnified. She was no longer able to envision what would happen when life returned to normal; many people seemed to be wondering whether that would ever happen. Having an end would give them a reference point for their options. Yes, she had heard they would all get out that day, but she couldn’t see it, couldn’t believe it, wasn’t convinced by the CEO or by Susan.

Conditions seemed increasingly unstable. The doctor felt not only unsafe, but also vulnerable. She had fleeting thoughts that at any moment prior to being saved something even more catastrophic would occur—perhaps some sudden, secondary natural consequence of the disaster. This building could explode, she thought, or somebody could come in and hold us up and take everything we have and decide to shoot
us. Her two-year-old was safe with her husband out of town, and she worried increasingly about putting herself in harm’s way when she had a responsibility to return to them. She’d heard gunshots outside the hospital, which she knew was turning away neighbors seeking rescue, and she envisioned racial tensions rising. She was sure these existed because once she—a pale blonde student craving a late night biscuit—had stopped at a chicken restaurant a half-mile from the hospital near the Magnolia public housing project, and a lady warned her, honey, to get on out of here.

In the second-floor lobby, where she stopped several times to help, the temperature felt like more than a hundred degrees. Even breaking windows in the glass oven had not improved air circulation that much.
This is awful
. She saw skinny patients lying almost naked, which was so that the people tending to them could keep them cooler and could more quickly clean up their waste. Some of the patients looked like the cadavers she recalled from gross anatomy in medical school. She was sure they had no idea what was going on, and that they had bedsores from lying in place without a good mattress and someone regularly shifting their bodies from side to side.

She knew what she would want in their place, she would say. “If I were one of those little bitty, skinny, debilitated, confused poor little ladies, I mean let me go to heaven. Don’t do that to me. I’ve lived my life, I’m not going to be watching TV or reading a book or even carrying on a conversation. I got to look forward to being in bed anyway, please don’t do that to me.”

Somebody had already made that choice for the dogs.
Why should we treat the dogs better than we treat the people?

She thought it almost criminal what they were doing to these people, putting them through a torturous process of suffering. And these were people, she would later explain, “who in the best-case scenario might be able to nod or something, but not people who can look forward to going through this horrible ordeal and enjoying anything or being aware of
life.” They were the type of people she thought shouldn’t be resuscitated anyway, “people who have no quality of life in the best case scenario, even if they make it through this horrible ordeal.” Didn’t military guys take a cyanide capsule to war, to have an option to avoid torture? And those, she reflected, would be people who would have hope for a meaningful life after their horrible torture. The people she saw on the second floor would, she thought, “have horrible torture and no meaningful life.” She knew it was torture, because the heat was hard enough on her, too, that, when she took breaks from working, she sought refuge in her air-conditioned car, grateful for having topped off her gas tank before the storm.

The ER doctor said something to Susan Mulderick, but Mulderick told her it was being taken care of.

MULDERICK’S IDEA to medicate the patients found a champion in Dr. Anna Pou.

The two had met for the first time only the previous day when Pou informed Mulderick that the chapel had been converted into a morgue for the LifeCare ventilator-dependent patients who died after staff put an end to the Coast Guard evacuation. Like Mulderick, Pou had also been pressed for advice by a distraught animal owner deciding whether or not to put down his pet. Mulderick had seen Pou directing patient care on the second floor.

Mulderick shared her feelings with Pou now and repeated her statement. They were talking about euthanizing the animals, but not about what they could do to help the patients. She would later remember Pou saying the men and women lying before her were much like many of her cancer patients—at some point there was nothing else to do for them but try to make them comfortable. Pou said she would use pain medications to do that, though she wasn’t sure what to give the patients.

What to give them? Dr. Ewing Cook would know. Mulderick had worked with Cook for two decades, going back to her time as head nurse in the ICU. She knew he believed that certain drugs exist to relieve suffering. Unlike many doctors, he didn’t shy away from ordering them. For years as a pulmonologist he had helped patients who were taken off life support die without pain and anxiety. Cook believed in making dying patients comfortable.

Mulderick said she would ask Dr. Cook to speak with Pou about what to give the patients. Mulderick found Cook readying his gun. He was preparing to leave the hospital by boat to rescue his son, the doctor who had gone home after the storm and been trapped since Tuesday’s flooding. She asked Cook to talk to Pou before he left.

Cook spoke with Pou on the second floor. He had interacted with her during the year she worked at Memorial and thought highly of her. The weary doctors discussed the category 3 patients. These included some of the patients from Memorial and LifeCare who remained in the staging areas, and nine patients who had never been brought down from LifeCare. To Cook, Pou seemed worried that they wouldn’t be able to get them out. Cook hadn’t been to LifeCare since Katrina struck, and that was on purpose. He had not been asked to go there, had no patients there, and knew that any doctor brave enough to venture upstairs would face difficult, gut-wrenching decisions. He considered LifeCare patients to be “chronically deathbound” at the best of times and knew they would have been horribly affected by the heat. Plenty of staff and volunteers remained at Memorial, but they were exhausted, and Cook couldn’t imagine how they would carry nine patients down five flights of stairs before the end of the day. Nobody from outside had arrived to help with that task. If there were other ways to evacuate these patients, other ways to care for them, Cook wasn’t seeing them.

Cook told Pou how to administer a combination of morphine and a benzodiazepine sedative. He later said he believed that Pou understood
that he was telling her how to help the patients “go to sleep and die.” That was different from what she and her colleagues on the second floor already knew how to do and were doing: treat patients for comfort. Over the previous hours, nurses had alerted Pou, Fournier, or King when a patient in the staging area appeared to be in pain or anxious, and the doctors prescribed doses of medicine. Pharmacists had dispensed Ambien, Ativan, diphenhydramine, Geodon, and Restoril to help patients relax and sleep; and morphine, OxyContin, and Vicodin for pain.

What Cook was describing to Pou was something else entirely. The drug combination “cuts down your respiration so you gradually stop breathing and go out,” he would say. He viewed it as a way to ease the patients out of a terrible situation.

Pou wrote out large prescriptions for morphine for three of the patients lying in the second-floor lobby. She ordered nine vials each of a concentrated form of IV morphine, totaling 90 mg for each patient. The highest dose Pou had prescribed for pain in the last two days for her colleague’s patient, the one with cancer who was already on morphine and tolerant to its effects, had been 10 mg of morphine—nine times less than what she was prescribing for each patient now. In terms of how the drug would be given, Pou wrote only: “as directed.” At the bottom of the prescriptions, she filled in her Drug Enforcement Agency number, as required, which authorized her to prescribe legally controlled substances.

One of
Pou’s prescriptions was for LifeCare patient Wilmer Cooley, an eighty-two-year-old former truck driver with heart problems and a serious infection, who required dialysis and had a Do Not Resuscitate order. Another was for Carrie Hall—“Ma’Dear”—the LifeCare patient with a tracheostomy who had so impressed a nurse the previous night with her will to survive. The third was for Memorial patient Donna Cotham, the forty-one-year-old mother of four with liver disease. The day after the hurricane, her condition had worsened, and doctors planned to transfer her to the intensive care unit. But the
unit had been evacuating, and she hadn’t gone. She wasn’t expected to survive. She had looked particularly bad overnight to the nurses fanning her on the second-floor lobby.

Two female doctors approached the pharmacist on duty across the hall. He took the three pieces of paper and filled Pou’s prescriptions.

DR. KATHLEEN FOURNIER had been present, listening, when Susan Mulderick spoke with Anna Pou about giving the patients medication.

“I just disagree with this,” Fournier had said.

“OK, don’t order it,” Mulderick responded. “Don’t give it. I’m just asking. If you don’t want to give it, don’t worry about it.”

Mulderick hadn’t known Fournier before the storm, but after the cat incident she was coming to share the opinion some nurses had of her. They found her aggravating. Fournier didn’t shy away from letting nurses know when she was upset about something, often in a loud voice with colorful curses and comments that struck some as inappropriate. She didn’t filter.

Fournier didn’t have her own medical practice. Dr. Richard Deichmann paid her a flat fee to cover his group’s internal medicine practice, including Memorial and LifeCare inpatients, whenever his turn came up to take call on weekends. Fatefully, while it was not her turn, Fournier had agreed to work because the doctor on the schedule had wanted to throw a birthday party for her daughter. Deichmann had suggested she leave the hospital after Katrina passed. He would later recall that even her physical appearance was concerning. A large patch over an irritated left eye was fixed with a piece of ragged tape whose grip, in the terrarium-like humidity, grew progressively more tenuous.