Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (8 page)

Anna Pou rushed to the young man’s side, rolled him over, and bent to his lips. She blew breaths into his mouth and quickly revived him. Pou suggested he go to a hospital. He considered her advice, grabbed another gin, and went to play volleyball.

Friends remarked on how quickly Pou had taken control of the situation. A few years later, she realized her father had been right. Being a laboratory technologist didn’t fulfill her. She applied and was accepted to medical school at Louisiana State University, where her father and uncle had also trained. She was thirty years old.

One night during medical school, Pou attended an outdoor pig roast hosted by medical residents. She met one of their friends, a tall, handsome pharmacist who flew his own single-engine Cessna propeller plane. They
made a beautiful couple, with personalities as different as their heights. Pou was outgoing, dramatic, and testy at times. She worked and played with gusto. Vince Panepinto was smart and engaging but more reserved. It took a few drinks before he felt ready to join her on the dance floor.

Over the next few years of their relationship, Pou’s career took precedence. Panepinto followed her around the country as she did a surgery internship in Memphis and then studied otolaryngology, the “ear, nose, and throat” specialty, at a tough, exacting residency program in Pittsburgh. During her last year there, one of her brothers, five years her senior, died of lung cancer. He was only forty-three. The way the cancer attacked him was horrific. Pou said she was haunted by the way he “lingered.”

While he was sick, Pou applied to yet another training program so she could subspecialize in surgery for head and neck cancers. She was accepted at a hospital in Indiana. This meant another relocation, and this time her husband Panepinto didn’t join her. He moved back to New Orleans to await the end of her training.

If Pou was on a quest to do good in the world, she was taking it to an extreme. Many otolaryngologists had satisfying careers treating routine earaches and sinus infections. The field had a reputation among doctors as being one of the few surgical specialties to offer a reasonable work-life balance. What Pou trained to do in Indiana was at the most arduous end of the specialty spectrum. Microvascular reconstructive surgery was a mix of plastic surgery and cancer surgery. It was physically grueling and technically demanding. Some operations lasted an entire day and through the night.

The goal was often to restore the ability to speak, swallow, and breathe in patients with tumors or injuries of the tongue, throat, larynx, and other parts of the head and neck. Pou learned to repair disfiguring defects by repurposing other tissues from the body. A rarely used thigh muscle could do the work of a tongue. A flap of skin from the forearm filled in for missing facial skin. A bit of leg or hipbone served to rebuild
a jaw. Under a microscope, she sewed tiny blood vessels and nerves together to keep the tissues alive and restore function.

In the academic medical world Pou had entered, fully trained surgeons—the “attendings”—ruled the operating theaters. The younger resident doctors, medical students, and nurses ranked below them and were expected to follow orders. Coming from a big family, Pou knew how to get along with people, but her respect for hierarchy had its limits. She turned on the Southern charm, manners, and deference with attendings who were good to their patients. Some of these doctors became beloved mentors. Others, whom she judged to care more about their careers than their patients, earned her distrust and irreverence.

When Pou finally finished her training in 1997, she was forty-one. She had not had children along the way. There had been many factors to consider, from her demanding career path to the fact that she had many nieces and nephews to dote on. She had also seen how hard her mother had worked to raise her own children. These included a banker, a nurse, and a real-estate broker. They had, on many occasions, made Jeanette Pou proud and happy. Three of the Pou girls had paired up with men whose names bespoke Italian heritage—a Panepinto, a Perino, and a Pappalardo—no doubt delighting their Sicilian-American mother. But Anna Maria had also seen how children can break a mother’s heart. Three of her siblings had died, one was diagnosed with a serious illness, and her oldest living brother was
a federal fugitive indicted for drug trafficking who had gone on the lam in Mexico. A dedicated, loving mother, Jeanette Pou had steered her family through these crises. Anna Pou directed a great deal of her own dedication and love toward her patients. Both women brought a toughness and tenacity to their callings. Others in the family referred to them as “the steel magnolias.”

Pou finished her training, and she and Panepinto selected Galveston as their new home. Pou had received a job offer there from the University of Texas Medical Branch. She worked at the only large hospital on
the island of Galveston. The hospital had existed for more than a century, and about a quarter of all Texas-trained doctors had studied there. As with many teaching hospitals, something of a trade was involved. The patients, often poor, received care regardless of their ability to pay. In exchange, budding doctors learned their craft by practicing on them. The hospital served a prison population as well. It seemed like a good fit for Pou, who enjoyed teaching and had a passion for treating the poor, as her father had done.

The year after Pou was hired,
the hospital began to ration care for people who couldn’t afford to pay for it. UTMB faced an $80 million budget deficit and declining state support. Just over a quarter of its patients were uninsured, and many others had inadequate coverage. Now each one was financially screened and charged an entry fee before being allowed to see a doctor. Those who couldn’t pay, or who already owed the hospital money, could be turned away. Exceptions were made for children and patients in emergencies, as required by law. Nearly everyone else was at the mercy of a committee of doctors and administrators tasked with choosing who would and who wouldn’t get care. Committee members were allotted $25,000 each month and had to decide which impecunious patients would receive drugs, surgeries, or other treatments, much as Louis Bristow, decades earlier at Southern Baptist Hospital, had decided which of his supplicants would receive charity care.

The complex cancer surgeries Pou had spent years learning to perform were expensive. Each patient’s recovery relied on far more than her own skills and efforts. A team of professionals from more than a half dozen other medical disciplines, from radiation therapy to rehabilitation, often needed to be involved. Finding the resources to care for these patients when they lacked health insurance was difficult. Pou vented about her predicament in phone calls with friends. “This is the worst!” she’d begin, pouring her frustration into entertaining tales of woe. “I’ve never had a day like this!” Friends could never be sure which was the
truly worst day of Pou’s life. Those less fond of her found her overdramatic and hyperbolic—too quick to blame others when something went wrong with a patient, as in Dr. So-and-So didn’t care enough or didn’t do a good enough job. Small problems turned into bigger problems. Pou was not always willing to step back and allow other specialists to do their work, and some of them viewed her as controlling.

That drive to be the one on the team always doing her best, however, made her into a strong patient advocate. She was soon promoted to director of the Division of Head and Neck Surgery in her department. She made great friendships in Galveston, but her work came first. Almost two years after she moved into her house, Pou invited colleagues for a visit. She switched on the oven. The house filled with smoke. The packing materials were still inside.

Another time, when a surgeon’s wife asked Pou to help out with Junior League, Pou accepted, despite her packed schedule. The surgeon’s wife asked her to print off labels for a large event mailing. “My grandmother would roll over in her grave,” Pou said. Invitations were hand lettered in New Orleans. The surgeon’s wife reminded her she was in Texas now. It didn’t matter. Pou used her spare free time at night to address the envelopes one by one.

Pou was a lady. She might spend her days in surgical scrubs, but she made it a point to find a favorite Texas hairdresser. Raoul coaxed her straight cinnamon locks into a proper hairdo. On the occasions she had to dress up, Pou tempered New Orleans exuberance with a classic uptown finish, pairing pearls with plunging necklines that flattered her figure.

During those years in Texas, Pou’s father died, leaving her mother a widow in New Orleans. The beloved chairman of Pou’s department stepped down. He had been an innovator in the field and had mentored Pou and taken great interest in her career. A new chairman was promoted from within the department. He was four years younger than Pou and had a PhD in addition to his medical degree. The two weren’t close.
The program seemed headed in a different direction, with more emphasis on research. Pou’s passion was for taking care of patients. She decided to leave, weighing offers from as far away as San Diego.

Over the years, at various national meetings of her specialty, Pou had developed a friendly relationship with the head of otolaryngology at Louisiana State University, Dr. Daniel W. Nuss, whose private practice was located at Memorial Medical Center. Nuss, too, treated head and neck cancers and had built a program focused on tumors and reconstruction—Pou’s type of work. His program also served patients at the Medical Center of Louisiana at New Orleans, better known as Charity Hospital, including prisoners and many people who lacked health insurance. They had both trained in Pittsburgh and grown up in New Orleans; one of Nuss’s brothers had briefly dated one of Pou’s sisters. Nuss had asked Pou several times if she would ever consider moving back to New Orleans. Now Pou was ready to say yes.

“
Dr. Pou, we regard this as an exciting opportunity, and it is indeed with pleasure that we invite you to join our faculty,” Nuss and the dean of LSU’s medical school wrote in her official employment offer. Pou inked her acceptance in April 2004.

While the state university employed Pou and provided her with liability insurance, Memorial Medical Center made an important contribution to her move, advancing the university more than $350,000 to pay her first year’s salary and expenses against her future earnings as a surgeon. In exchange, Pou would join Memorial’s medical staff and also see patients in its emergency room when she was on call, without additional pay. It was a no-lose situation for profit-conscious Tenet Healthcare, Memorial’s owner. The university had to pay back the guarantee payments, and with university physicians on staff, Memorial qualified as a teaching hospital and was eligible for additional funds from Medicare.

On September 1, 2004, Pou took up her position as an associate professor at LSU in New Orleans. She began seeing patients in October.
The move was meant to be a permanent one. In November,
Panepinto purchased a $349,000 house near the hospital, taking out a loan for 80 percent of its price. In early 2005, the couple sold their home in Galveston.

Pou was given a tour of Memorial and introduced to the operating-room nurses. “Dr. Poo?” one asked. “No, Pou,” she said, pronouncing it her family’s way, “Poe,” as if it rhymed with “toe.” “Sorry,” the nurse said. She sized up Pou, a tiny lady rolling a tiny piece of Samsonite luggage behind her. This was the much-heralded new surgeon? “You gotta see this!” the nurse whispered to a colleague. Judging her on looks alone, the nurses didn’t believe that the diminutive Pou was capable of performing tedious, draining, backbreaking all-day operations. She didn’t appear to have that kind of stamina.

Pou would have to prove herself. She did not win over everybody she met.

DR. HORACE BALTZ WAS, at seventy-one when Katrina approached, one of the hospital’s longest-serving doctors and a former president of its medical staff. He had treated patients at Memorial and Baptist for more than four decades and still performed basic blood tests by hand rather than sending them to a lab like just about every other doctor did. In his office, he kept a large black-and-white photo of a nurse in a white cap holding a cup of water to the lips of an elderly man lying on a cot. He and the nurse had worked together in 1965 caring for displaced residents after Hurricane Betsy.

Baltz was the son of a motion-picture projectionist, the youngest of five children, and the first in his family to attend college. He could remember, from his days as a high school delivery boy for the neighborhood drugstore, filling prescriptions for Dr. Frederick Pou, Anna’s father.

Proud, boisterous, and principled, Baltz liked to reminisce about the days when the community’s “medical giants” strode the halls of Southern
Baptist Hospital. In the course of his career, he had witnessed two significant changes in the practice of medicine. One was the advent of high-technology life support for patients with critical illnesses. Southern Baptist was believed to have been the
first hospital in the Southeast to purchase a “crash cart”—a piece of equipment wheeled in during a Code Blue to resuscitate patients who had stopped breathing or whose hearts had stopped beating. The cart contained drugs, a respirator to fill the lungs with oxygen, an aspirator to clear the airway, a cardiac monitor to keep tabs on the heart’s electrical rhythm, a pacemaker to stimulate the heartbeat, and a defibrillator to shock a dying heart back into a functional rhythm. It was a momentous purchase, trumpeted by an article in the local newspaper in 1967. At the same time, Baptist expanded its physical plant and added piped-in oxygen and an intensive care unit for heart patients, complete with alarm systems to alert staff to irregular heartbeats and other emergencies. “In the event of a failure in City electrical power, each unit will be on our auxiliary power, so that no interruption can ensue,” Baptist’s administrator wrote in a June 1967 newsletter.