Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (18 page)

At close to sunset, an orange-and-white Coast Guard Jayhawk helicopter descended onto Memorial’s helipad, landing beside a smaller private aircraft. The roar of the rotors and the odor of fuel carried into LifeCare. Any employee could look out the windows of the nursing station on the west side of LifeCare and watch the evacuations. Patients who remained on the west side could see the helicopters from their beds. A huddle of hospital volunteers, including family members of patients and staff who had been organized into transport teams, lifted a patient into the Jayhawk, then jogged away from its whirring rotor blades, heads bent.

Still, LifeCare patients had not moved. What Memorial offered was this: the corporate overseers at Tenet would be asked for permission to transport LifeCare patients with the Coast Guard. “I hope and pray this is not a long process for getting their approval,” Robichaux wrote to her colleagues. Why Tenet corporate permission should be required for LifeCare to use federal rescue assets was unclear. From Memorial’s fourth-floor command center, community relations manager Sandra Cordray typed a message to Michael Arvin at Tenet about LifeCare. Her message did not sound a note of urgency.

We are priotorizing our patients –can you work directly with LifeCare corp? Thanks.

If Memorial could get LifeCare’s fifty-two patients to a staging area just outside New Orleans, she told him, LifeCare could meet them with ambulances and take them to Baton Rouge.

At around seven thirty p.m., Cordray followed up with Arvin, sending him contact information for LifeCare’s Robbye Dubois. There
would be no more National Guard trucks that day, she added. The water had risen too high. The second set of patients had left for Nacogdoches around six thirty. “Let me know what is worked out for Lifecare patients regarding how will leave. Thanks.”

More than an hour came and went. LifeCare’s Robbye Dubois wrote Cordray from Shreveport to say she was awaiting approval to get ambulances en route, a process she expected to take hours. Arvin had not called her. She requested his phone number and finally spoke with him after nine p.m. “Been on the phone with Tenet,” she reported back to Robichaux. “Will eventually be to our patients. May be in the morning because the water has risen to the point they cannot get trucks to you. I will have ambulances to the staging area. Critical will go first. They will contact me when first patient leaves LifeCare.”

Robichaux confirmed that if the backup power went down and they lost the computer connection, they would proceed with the plan, sending patients to the staging area in the morning, critical ones first with staff to care for them. They expected the patients would start moving between three and eight a.m.

Nobody wrote it directly in a message, but some employees began to worry that the choice of which patients went out first could affect their medical outcomes. A realization dawned on Memorial’s incident commander, Susan Mulderick, that day. The variability in the sizes of helicopters that were landing and the length of time it was taking to move patients to the helipad left her with one conclusion: not all of the patients would be getting out alive.

IT HAD BEEN a grueling few hours for the Memorial command team. During the brief power outage that also affected LifeCare, they had temporarily abandoned the command center and regrouped in an
area of the first floor used by security guards. Then most of the radios that they’d been using to communicate across the hospital’s vast campus had stopped working. So, too, did one of the few ventilation systems left functioning, in the unit for vulnerable bone marrow transplant patients. It was now blowing hot air.

The command staff and Arvin in Texas had worked for hours and found a receiving hospital for those patients, in vain it seemed. At around nine p.m., a call from the Coast Guard to the incident command staff left the impression that the governor had instructed helicopter pilots to take patients to any hospital that would accept them. “We no longer have any control over destinations,” Cordray wrote to Arvin.

What the command staff didn’t seem to have considered, perhaps hadn’t even been aware of, was the relatively small number of medical transport helicopters flying in the region and the large number of hospitals in New Orleans that now needed to be evacuated. Flying a patient or two to a Tenet hospital out of state would take a helicopter out of commission for hours, even as it might provide the best possible care for those patients. Some pilots wanted to make only quick trips to a highway interchange. The cloverleaf at Interstate 10 and Causeway Boulevard served as a staging area just west of the city. The idea that patients would be dropped off on “lily pads” on their way to more definitive care had been part of the Hurricane Pam exercise. The lily pads were known as SARBOOs—search-and-rescue bases of operations. However,
a system to supply the sites and transport patients from them remained to be planned.

At this point, the hospital’s command team believed that Memorial had only hours to go before losing generator power.

The hospital received another stabbing victim at around ten p.m. He waded up to Memorial’s ER ramp. He was taken in for treatment and needed urgently to go out by air. The helicopters taking people out of the hospital complex were highly visible. They attracted other desperate
people. “We’ve had to secure all egress,” one Memorial employee wrote to Tenet colleagues in the evening, “as the community is trudging through three feet of water to try to find shelter here.”

Anesthesiologist Paul Primeaux showed up at the incident command office to report that the situation outside the emergency department was “getting ugly.” Around a dozen people had arrived in boats with their children and were arrayed outside the hospital in need of food and assistance. The National Guard had left. A contingent from the New Orleans Police Department was about to leave. Its officers offered no advice to the hospital’s security guards about where to send these people.

Cordray reported to Tenet that Primeaux and security officers would give the families food and tell them that the hospital wasn’t evacuating any more patients, that they should go to the Superdome—the “shelter of last resort” downtown—to get evacuated more quickly. But this might not have been wise advice. The Superdome was more than two miles away, and on WWL, which Cordray was monitoring, news reports suggested the situation there was abysmal. A reporter described people jumping barricades into the floodwaters trying to flee.

They said the conditions in the Superdome are breaking down, and it is a madhouse. Now, again, this is all hearsay from the folks who are leaving the ’dome, that there have been a couple of murders, people committing suicide jumping from the balconies, rapes, everything.

The New Orleans police captain called in on the radio to say those reports were false. Still, Gov.
Kathleen Blanco announced at a nighttime news conference that roughly 20,000 people were stranded in the Superdome with no power and deteriorating sanitary conditions, and the building needed to be evacuated, particularly those with medical conditions who had been told to take shelter there. “The ’dome is degenerating, the conditions are degenerating rapidly, and there are too many people in there,” she said.

Memorial’s security concerns were relayed to Louisiana’s 911 system by Michael Arvin in Dallas, who stressed that the evacuation of Memorial needed to be expedited.
He wrote back to Cordray to reassure her that the person heading up “all air evac coordination” said there would be a reinforced crew of helicopters at first light. Arvin may have misinterpreted. The EMS coordinator had logged the conversation as a request for help, not a promise to give it.

Before eleven p.m., a Coast Guard officer called the command center at Memorial with an offer.
The Guard would continue sending helicopters and boats to Memorial. “They are deploying as many as five helicopters in a renewed effort to evacuate all patients this evening,” Cordray reported in an e-mail to Arvin and others. When the Coast Guard offered to extend the rescues, anesthesiologist Paul Primeaux was the only clinical employee in the command center, and he gave his wholehearted backing to the plan. “Let’s go, absolutely!” he said. The chaplain agreed. “Fuckin’ A!” Primeaux would remember him saying. Primeaux didn’t have a radio, so he ran downstairs, into the garage, and up to the helipad to alert the evacuation team.

Gunshots punctuated an oddly quiet, dark night lacking in the swoosh of traffic, the buzz of air-conditioners, and the glare of streetlights. The voices of people from the nearby flooded houses, the splashing sounds of swimming, were magnified over water. The staff on the helipad had rigged up industrial lantern flashlights along the perimeter with plastic zip-ties to mark the landing spot, not realizing white light could almost blind pilots using night vision goggles.

The Coast Guard’s offer had arrived before Primeaux had and been declined. Someone had tripped in the dark and nearly plunged off of the helipad. Primeaux understood the danger. Earlier, he had stepped on the ancient flat fencing that extended around the helipad as a safety net, and he had worried it might not hold his weight. Still, the decision to turn away rescuers aggravated him.

The hospital’s sixteen critically ill babies and most of its critically ill
adult patients had been flown away—twenty-five in all, and the stabbing victim, too—before a fog set in that made it difficult to fly.
The Acadian Ambulance flight coordinator did not plan to return with his growing fleet of private medical air ambulances on Wednesday. Their charge was to evacuate critically ill people who had a reasonable chance of survival, and as far as he knew, that had been accomplished at Memorial. Other hospitals were waiting. He packed up his satellite phone and waited out the passing fog, then began looking for a helicopter to wave lights at and flag down to take him to Tulane Hospital downtown. He had no desire to stay at Memorial overnight. He had been down to the emergency room, where it was dark and seemed dangerous. He had only his .45 pistol.

Sometime around eleven p.m.,
a long, low-set Coast Guard Jayhawk helicopter descended. The Acadian coordinator thought he had signaled it, but in fact its crew had been diverted to Memorial by a C-130 turboprop plane flying overhead, relaying search-and-rescue requests from the ground. The Coast Guard crew’s mission was to begin the medevac of all remaining patients. However, someone on the helipad said that there were no more patients who needed to leave and that it would be best if the Coast Guard could return after daylight. A crew member communicated that back up the chain and received permission to fly instead to Tulane Hospital with the Acadian coordinator and about a thousand pounds of medical equipment that had been pulled from private helicopters throughout the day to make room for more patients. They lifted off, and the Coast Guard Jayhawk flew away from Memorial with no patients on board.

Memorial had shaved its patient census from 187 to about 130. Staff counted 460 Memorial employees, 447 family members, and 52 LifeCare employees left in the building. On the seventh floor, all 52 LifeCare patients, including seven who relied on ventilators to breathe, remained.

CHAPTER
5

DAY FOUR
WEDNESDAY, AUGUST 31, 2005, EARLY MORNING

AFTER MIDNIGHT, the intensive care nurses gathered in the unit on the eighth floor. They slapped palms, clapped backs, and congratulated one another. They had managed to get all of their non-DNR patients out safely, despite the smothering heat, confusion, and physical hardship.
Overnight, two nurses cared for the two surviving DNR patients who remained.

Some staff found the strength to clean up and arrange mattresses, and the employees and their family members settled down together for the night. They passed around an oxygen mask, taking hits of the gas and letting it cool their faces. Some, beginning to grasp the enormity of the disaster and how it might scatter them,
wondered aloud if they would ever again work at the hospital where so many of the nurses had grown up together as professionals. Nurse manager Karen Wynn feared they never would. One of her staff nurses, Lori Budo, disagreed. Her mother, the retired ICU nurse, had trained many of the current set of nurses. “I’ll be back,” Budo said.