Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (35 page)

It was close to noon when Isbell and the LifeCare leaders left the seventh
floor to join the evacuation lines. On the way down, they passed the other LifeCare nursing director. He wanted to know what was happening. Isbell avoided his eyes. Tenet people had come up to LifeCare, she told him. Their patients were, she said in a near whisper, “gone.”

Their intention was to stop on the second floor to check on “Ma’Dear” Carrie Hall and several other LifeCare patients who had been moved downstairs on Wednesday. From there the LifeCare leaders planned to proceed through the hole in the machine-room wall to the garage with a dose of Ativan for a staff member they had heard was having a breakdown there. But a Memorial employee blocked the LifeCare team at the stairwell exit on the second floor. A doctor had told certain staff members to direct people away from the patient area on the second floor where the DNR patients lay.

“Should we just make a break for it and just go looking?” one of Therese Mendez’s coworkers whispered in her ear. “Don’t do it,” Mendez said. “We’re going to end up shot or arrested.”

For now only the LifeCare pharmacist was allowed onto the second floor, to go directly to the garage with the medicine. The Memorial employee blocking the entrance gave the others an e-mail address they could use later to find out which of their patients had died. Someone took a pen and wrote the address on Mendez’s scrub shirt.

DR. KATHLEEN FOURNIER walked back into the second-floor lobby at around noon. Her acquaintance from medical school Bryant King was grabbing his bag, looking upset and angry. “
I’m getting out of here,” he said. “This is crazy.” She asked him for a hug. She was upset and angry, too. She told him she knew why he was leaving.

CFO CURTIS DOSCH saw a doctor administer drugs to a patient on the second floor and then flap a hand around the patient’s mouth for some reason he couldn’t discern. Was the doctor trying to cool the patient? Something else? Susan Mulderick had called Dosch to the side of the lobby and told him that some people felt that there were patients who wouldn’t make it. He gathered from her that the patients were being medicated to help make them comfortable in the process of dying. “Really?” Dosch asked her. He was surprised because the patients already looked comfortable to him—comatose even, though he wasn’t medically trained. Also, the evacuation was well under way. Pilots had delivered oxygen tanks and food supplies (although nobody seemed to be able to find a wrench to open the oxygen tank valves), and Memorial’s pharmacy was so well-stocked now with the delivery of its emergency cache, that its drugs were being flown to a Tenet hospital across Lake Pontchartrain where some of the patients were going.

Dosch’s job was to keep tabs on how many people remained at the hospital, updating Tenet officials in Dallas every half hour using the satellite phone that had arrived as promised with the first helicopter. One of the helicopter crewmen had at first said that only patients who could walk would be permitted onboard, but Dosch had called Tenet to clarify and was told that the information was wrong. The helicopters were to take any and all.

Dosch returned to counting people after the conversation with Mulderick. As the hospital cleared quickly, he was “a man on a mission,” as he phrased it, but the conversation concerned him enough that he stopped to talk with CEO René Goux. Dosch asked Goux if he knew what the staff was up to on the second floor. Goux indicated he didn’t. “
I think you ought to go talk to Susan,” Dosch told him and described what she had said. Dosch entered a staircase off of the second-floor lobby and heard the hospital’s chief nursing officer wailing; several nurses surrounded her. He believed she had just learned what had been decided.

ICU NURSE MANAGER Karen Wynn arrived on the second floor after having spent the morning helping clear the first floor of the wheelchair-bound patients who had spent the night there. The plan for these patients had changed as hospital leaders disagreed with one another and with the state police over how best to evacuate them from Memorial.

Rather than going out by boat from the ambulance ramp, most were carried up to the second floor and through the hole in the wall to be evacuated by helicopter. Others were taken, surreptitiously, out by boat from the gently sloping parking garage ramp. The police had opposed the use of this second boat launch, saying it was too insecure.

Several people heard the police say they would be leaving by five p.m. and everyone needed to be out of the hospital because of civil unrest in New Orleans. The police would not stay later to protect the hospital. They stood stone-faced on the emergency ramp, shotguns on their hips, barking threats at anyone who came too close, only increasing the sense of urgency. People felt intimidated, not protected, by them. A large airboat they had brought to Memorial was not used to help transport anyone. A policeman sat in it chain-smoking and taking naps.

Hospital visitors and staff continued to leave from the ER ramp. The surgery chief, anesthesiologist, and plant-operations chief who had left early in the morning returned with an additional boat they had found, and maintenance workers hotwired it. Now staff members were permitted to leave with their pets. It was too late for many. It hadn’t been necessary to euthanize them after all.

Over the course of the morning as Wynn encountered her ICU nurses, she instructed them to leave Memorial, telling them she would not go until they were all on their way. She felt no particular urgency for herself. She had in fact been greatly encouraged by the words of a patient that morning. The woman, Janice Jenkins, had two fractured legs
at the knee joint and was in large casts, having been hit at a bus stop after leaving her job as a nursing assistant at another hospital. Shortly before the storm she’d had surgery and was confined to bed, legs elevated, unable even to sit. Then on Tuesday night, when she was still on the fifth-floor medical ward, her heart had developed a dangerous arrhythmia. Dr. Baltz had run into her room, lab coat thrown over his boxer shorts as he answered the emergency overhead page. He and his colleagues had treated Jenkins successfully, and now Wynn helped her slide with difficulty onto a bedpan and held up a sheet to give the long-suffering woman some privacy. But Jenkins wasn’t thinking about herself. “Y’all going to get this done,” she told Wynn, “
because you’re nurses.”

What cheered Wynn even more was knowing that her daughter was now safe, having boarded a helicopter with another nurse’s teenage daughter. They carried money from Wynn’s purse, a cell phone, and instructions to call Wynn’s parents wherever they arrived. Wynn had watched them go from a window in the seventh-floor stairwell.

Wynn hadn’t left the stairwell to go into LifeCare. She had assumed all the patients there were gone. It later surprised her when one of her most experienced surgical ICU nurses, Cheri Landry, told Wynn she was going up to the seventh floor with Dr. Pou to make patients comfortable. Wynn told her that was fine, but then she wondered: Seventh floor? There’s still patients on the seventh floor?

Wynn could see there was still work to do on the second floor, too. About a dozen patients who were designated as 3’s remained near the ATM wearing big tags that said “DNR.” Other patients were lined up on stretchers and cots on the other side of the lobby and along the corridor to the machine room, awaiting transfer through the opening into the garage. One young male amputee was complaining loudly and repeatedly about the conditions. Wynn wished they could get him out. All it took was one person to spread panic.

Wynn wandered over to a small group of doctors and nurses gathered near the DNR patients. The makeshift unit had an open-air feel.
What had been an alcove on the northern side of the lobby was surrounded now by crashed-out floor-to-ceiling windows, a precipice over the floodwaters. Wynn’s nurse Cheri Landry returned from LifeCare. She told Wynn they were giving sedatives to the patients there on the second floor. “What can I do?” Wynn asked.

“Just check on people,” Landry said, as Wynn would later remember. “See how they are.”

Wynn focused on four women lying in a row adjacent to the corridor. One, an elderly white lady, was breathing slowly with apparent difficulty. “She looks really bad,” Wynn said. “She’s breathing really, really hard. She could probably use some.”

Wynn walked over to a table in the corner that was covered with medical supplies, some of which she had helped organize. “What are we giving?” Wynn asked. There were vials of morphine and the sedative midazolam, known by its brand name, Versed, on the table.

It was a combination Wynn was accustomed to giving to patients on ventilators in the ICU. In that context, it would sedate the patients and, when indicated, reduce their drive to breathe, allowing the ventilator to do the work of breathing for them. The combination was also given to minimize any potential sense of pain, discomfort, or air hunger prior to removing a breathing tube when the decision had been made to withdraw life support and allow a patient to die.

The drugs were meant to be given by vein, but many of the patients didn’t have IVs.
Wynn and Pou requested several boxes of IV catheters, but not IV fluids and tubing, which would have been needed if the goal were to hydrate hot patients who had difficulty drinking on their own.
Pou called for someone with a light, and a male nurse came with a flashlight and held it for her while she started an IV.

Another very young nurse working on the scene found it strange to see doctors and nurses placing IVs in the eight to ten still-living DNR patients; she had been told by Fournier the previous night not to start IVs in these patients because the hospital was in “emergency mode.” Now a female
doctor with short brown hair who had been in charge of triaging patients told the young nurse to get out of the area and go pack up her things upstairs; the nurse didn’t know her name, but she followed her direction.

Dr. John Thiele turned to Karen Wynn and asked, “Can we do this?”

It wasn’t a question of could or couldn’t. In Wynn’s opinion, medicating the patients was something they
needed
to do. The patients needed to be comfortable.

When Cheri Landry had told Wynn she was going upstairs to the seventh floor, Wynn had already heard rumors that patients were being euthanized. Wynn passed them on. “Did you hear that they’re euthanizing patients?” she had asked a colleague, who had cried.

Wynn didn’t cry. OK, so what if they are euthanizing? she’d thought. Unlike that nurse, who managed a regular medical unit, Wynn lived in the world of the ICU, where many patients didn’t get better. Death was often scheduled, orchestrated, the result of decisions to switch off machines.

Withdrawing life support was something Wynn had grown extremely comfortable with from her work in the ICU under the tutelage of Dr. Ewing Cook. She considered him masterful and compassionate in his approach to end-of-life care. They both served on Memorial’s bioethics committee, of which she was the longtime chair because, she sometimes told people, nobody else wanted to do it. Committee members were called in to consult in cases where end-of-life treatment dilemmas arose. The situation seemed analogous now, the only difference being that family members were usually there to receive the message that Wynn had heard Cook, unafraid of bearing bad news, deliver so many times: “We’ve done everything possible for her. Now the only option is to make her comfortable.”