Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (26 page)

Wynn reached a hand beneath the woman’s tiny frame and felt wetness. A tube had been placed into her bladder to drain her urine, but it had detached from its sterile collection bag. Wynn reattached the bag, even though it was no longer sterile and could eventually cause an infection. “So much for aseptic technique,” she said to herself. She gathered up the wet bed linens. At least the woman would be dry.

“Have you all eaten today?” she asked the woman’s husband. When he said no, Wynn went outside to rummage through her small cache of food. She returned, popped open a can of nutritional supplement, drew some into a straw, and dripped it into the woman’s mouth. The woman swallowed. At least she could do that. Wynn turned the can and straw over to her husband, who coaxed his wife to drink.

Wynn found food for the man, too, and after he finished eating, he told her he was worried about looters. “I gotta go back and lock my house,” he said. Wynn spent about twenty minutes trying to convince him that returning home wasn’t possible. “Sweetheart, you can’t go back home,” she told him. “It’s too dangerous. There’s water and it’s just too dangerous.”

One couple with small children rowed up to Memorial, and the family was told to “go away.” Dr. Bryant King, the young hospital-based
physician who had recently come to work at Memorial, lost his temper. “You can’t do this!” he shouted at CEO Goux. “You gotta help people!”

Karen Wynn saw that the hospital had all the people it could handle. She did not detect a note of racism in the refusals, even as the people being turned away were nearly all African American, as was she. King, by contrast, was offended largely because the people they were turning away had dark skin. As the only African American doctor on duty and one of very few who worked at the hospital, race had not been an issue for him until now. He believed introducing color into his argument would only make everyone touchy, and so he did not. This was a universal issue: the hospital was harboring dogs and cats while babies floated over polluted water on unsteady skiffs.

The family was refused in spite of King’s advocacy.

To Dr. Ewing Cook, watching from the ambulance ramp, the episode reinforced the impression of King he’d developed the previous day when King resisted discontinuing treatments that weren’t absolutely necessary. King was, Cook thought, out of touch with reality. Memorial wasn’t so much a hospital anymore but a shelter that was running out of supplies and needed to be emptied. Cook also worried that intruders from the neighborhood might ransack the hospital for drugs and valuables. He’d had his semiautomatic Beretta in a pocket of his scrub pants since he’d heard rumors that a nurse was assaulted while walking her dog near the hospital on Monday. The CEO had told him to take the damn thing out of his briefcase and wear it.

Now, Wednesday afternoon, a day after his heat-exhaustion episode, Cook was physically and mentally drained, filthy, and forlorn. A painful boil was growing under his wristwatch, and bladder spasms drove him repeatedly into a ghastly-smelling bathroom with a nonflushing toilet.

Cook had also been contending with the illnesses of various family pets. His adult daughter’s massive, ursine Newfoundland had at first frolicked in the floodwater and later began panting heavily in the heat. His daughter, ICU nurse Stephanie Meibaum, wanted to try giving Rolfie
oxygen from the wall supply in the empty surgical building across the pedestrian bridge from the main hospital. The dog lumbered there obediently on shaking legs. As he stepped inside, he collapsed on the floor and convulsed.

Cook wrote a prescription for “Rolfe Meibaum” for five 100 mg tablets of the antiseizure medicine phenobarbital from the hospital pharmacy. On the same prescription form, Cook ordered eight syringes of the powerful anesthetic drug Pentothal, a half gram each. In Louisiana, only licensed veterinarians typically could prescribe medicine for animals. In the context of the disaster, the pharmacist let this go, but he insisted on the prescription as documentation in order to give Cook the controlled substances.

Cook began injecting Rolfie with Pentothal. It took multiple doses before he died. Cook also euthanized one of his daughter’s three cats, which was suffering from a tooth abscess.

Pets weren’t being allowed on the boats and helicopters, leading people to fear they would not be rescued. The owners of the two coddled golden retrievers had departed by boat, leaving them in Cook’s office with instructions not to abandon them to suffer alone. Cook euthanized them, too.

After Rolfie’s death, Dr. Horace Baltz noticed Cook’s wife and daughter weeping and asked what was wrong. Ewing Cook described what had occurred with characteristic bluster, hiding any sadness behind what struck Baltz as a devilish laugh.

At around two p.m., Cook climbed slowly upstairs to check what was happening on the eighth floor in the ICU, where he had worked for many years. Most of the ICU patients had been airlifted on Tuesday, but the four with DNR orders who had been kept behind had not.

“What’s going on here?” he asked the four nurses he found in the unit. “Whaddya have left?” The nurses were down to one patient with advanced uterine cancer, the seventy-nine-year-old woman who had worked as a nurse in segregation-era New Orleans.

The disaster had interrupted plans to move Jannie Burgess into a general medical ward for comfort care. Instead, the ICU nurses were giving her small doses of morphine every few hours as needed for pain. Cook opened Burgess’s medical chart. According to the notes, on Monday night after the storm she had cried and was agitated. Her surgeon had visited on Tuesday and wrote that Burgess had stable vital signs and responded when he spoke to her. At one fifteen on this morning, her electronic monitors had stopped working when the emergency power failed in their section of the hospital. Intravenous pumps continued to drip fluids, sugar, electrolytes, and medicines into her veins for another two hours
until they drained their batteries. Nurses then ran the fluids by gravity through Burgess’s IV tubing, controlling the flow with a slide clamp.

After daylight, her eyes had remained closed. The rhythm of her shallow breaths was irregular, like the tick of a slowing clock with a dying battery.
Sometimes ten to fifteen seconds would go by without an inspiration.

Cook examined Burgess. She was so weighted down by fluid from her diseases that he sized her up at more than three hundred pounds, much more than her normal weight. He arrived at certain conclusions: (1) Given how difficult it had been for him to climb the steps in the heat, there was no way he could make it back to the ICU again. (2) Given how exhausted everyone was and how much this woman weighed, it would be “impossible to drag her down six flights of stairs.” (3) Even in the best of circumstances, the patient probably had a day or so to live. And frankly, the four nurses he found upstairs with her were needed elsewhere, although it was not up to him to tell them where to go.

To Cook, a drug that had been on Burgess’s medication list for several days provided an answer. Morphine, a strong narcotic, was frequently used to control severe pain or discomfort. But the drug could also slow breathing, and suddenly introducing much higher doses could lead to death.

Doctors, nurses, and clinical researchers who specialized in treating patients near the end of their lives would say that this “double effect” posed little danger when the drug was administered properly. To Cook, it was not that clear. Any doctor who thought that giving a person a lot of morphine was not prematurely sending that patient to the grave was a very naïve doctor. “We kill ’em” was, in all bluntness, how he described it.

In fact the distinction between murder and medical care often came down to the intent of the person administering the drug. Cook walked this line often as a pulmonologist, and he prided himself as the go-to man for difficult end-of-life situations. When a very sick patient or the patient’s family made the decision to disconnect a ventilator, for example, Cook would prescribe morphine to make sure the patient wasn’t gasping for breath as mechanical assistance was withdrawn.

Achieving this level of comfort often required enough morphine that the drug markedly suppressed the patient’s breathing. The intent was to provide comfort, but the result was to hasten death, and Cook knew it. The difference between something ethical and something illegal was, as Cook would put it, “so fine as to be imperceivable.”

Burgess’s situation was a little different, Cook had to admit. Being comatose and on occasional doses of painkillers, she appeared comfortable. But the worst thing he could imagine would be for the drugs to wear off and for Burgess to wake up and find herself in her ravaged condition as she was being moved. Cook turned to Burgess’s nurse. “Do you mind just increasing the morphine and giving her enough until she goes?”

Cook returned to Burgess’s patient chart. A sticker on its front cover listed allergies to “egg/poultry” and a sticker on its back cover said “DNR.” Cook turned to an empty lined page of her progress record and scribbled “No respirations or cardiac activity.” He added, “Pronounced dead @,” left the time blank, and signed the note “ECook” in a large squiggle. Then he walked back down the stairs, believing that he had done the right thing for Burgess. He would later call that choice “a no-brainer”
and reflect on it. “I gave her medicine so I could get rid of her faster, get the nurses off the floor,” he would say, perhaps to cover up the deeper emotions of a man who had devoted his career to the sickest of patients and was loath to let them suffer. “There’s no question I hastened her demise.”

The question of what to do with the hospital’s sickest patients was also being raised by others. By the afternoon, with few helicopters landing, these patients were languishing. Incident commander Susan Mulderick, who had worked with Cook for decades, shared her own concerns with him. He would later remember her telling him, “We gotta do something about this. We’re never going to get these people out.”

Cook sat on the emergency room ramp smoking cigars with another doctor, John Kokemor. The patients were lined up in wheelchairs or sitting behind their walkers on mismatched chairs. In their similar blue-patterned hospital gowns, they reminded Cook of a church choir. Help was coming too slowly. There were too many people who needed to leave and weren’t going to make it. It was a desperate situation and Cook saw only two choices: quicken their deaths or abandon them. It had gotten to that point. You couldn’t just leave them. The humane thing seemed to be to put ’em out.

Cook went to the staging area on the second floor, where Anna Pou and two other doctors were directing care. The area was broiling. Only some older wings of the hospital, built to be “productive of coolness” in the age before ubiquitous air-conditioning, had windows that opened. At first, some staff members had been warned they could be charged with destroying hospital property if they broke windows. Now, patients were moved back, and uniformed men and other eager volunteers crashed chairs, two-by-fours, and an oxygen tank through the tall glass panes into the surrounding moat, punishing the building that had failed to protect them.

Cots and stretchers appeared to cover every inch of floor space. An immense patient lay motionless on a stretcher, covered in sweat and almost
nothing else. Cook thought the man was dead, and he touched him to make sure, but the man turned over and looked at him.

“I’m OK, Doc,” Rodney Scott said. “Go take care of somebody else.” He was the licensed practical nurse who had once worked at the hospital and who had been designated, because of his size, to leave the hospital last.

Despite how miserable the patients looked, Cook would later say he felt there was no way, in this crowded room, to do what he and Kokemor had discussed over cigars. “We didn’t do it because we had too many witnesses. That’s the honest-to-God truth.” A different memory of their interactions would be held by Kokemor, who would say he never talked about euthanasia, and, regardless, was not involved in hospital decision making.

The scene in the second-floor lobby also rattled registered nurse Cathy Green. Like many of the other ICU nurses who no longer had their own patients to treat, she had volunteered to help care for others.

Green stood between the rows of recumbent patients and waved a bit of cardboard over them, agitating the dankness. “Help me,” patients said. She offered sips of water.

Separated from their medications and treatments, and the nurses who knew them, they looked so sick. For all her experience with critical care medicine, this scene broke her heart. She couldn’t bear it. She had to leave.

Green went up to the parking garage. Patients were arrayed on the asphalt awaiting helicopter rescue. An elderly lady lying on the ground was wheezing and looked distressed. Her lungs sounded as if they were choked with fluid. The oxygen tank beside her was empty. Green found a partially used tank. She recruited a few other people to help prop up the lady to a partial sitting position, making it easier for her to breathe. Green set up an inhalation treatment to help clear the woman’s lungs. She talked to the woman softly, trying to reassure her.

A doctor came and peered at the lady’s chart. “
She has lung cancer,” he said quietly. He turned to Green and closed the woman’s chart. “She’s
not going anywhere.” He looked at the oxygen tank and shook his head no. “That’s it,” he said, and chopped the air with his hand. There would be no more respiratory treatments. This oxygen cylinder, its gauge indicating a quarter tank left, would be the last.

Green felt numb. She took the lady’s hand and held it. The decision not to move her to safety or support her with oxygen felt personal. Two dozen or so of Green’s relatives were in St. Bernard Parish, an area she’d heard on the radio was the worst and first hit by the flooding. Several times, Green’s young adult daughter, who lived in a different state, had reached her on a cell phone. “Mommy,” she cried, “I really think something happened to Granny. I just have this horrible feeling.”

Green saw the sick lady before her as somebody’s mother, somebody’s grandmother. Many people probably loved this lady. Green felt love for her and she didn’t even know her. The woman was precious, whether she had six months to live, or a year to live, whatever it was.