Five Days at Memorial Read online

  He had arrived here on Sunday. He brought along a friend who was recovering from pneumonia and was too weak to comply with the mayor’s mandatory evacuation order for the city, which had exempted hospitals. Early Monday, Thiele awoke to shouts and felt his fourth-story corner office swaying. Its floor-to-ceiling windows, thick as a thumb, moved in and out with the wind gusts, admitting the near-horizontal rain. He and his colleagues lifted computers away and sopped up water with sheets and gowns from patient exam rooms, wringing out the cloth over garbage cans.

  The hurricane cut off city power. The hospital’s backup generators did not support air-conditioning, and the temperature climbed. The well-insulated hospital turned dank and humid; Thiele noticed water dripping down its walls. On Tuesday, the floodwaters rose.

  Early Wednesday morning, Memorial’s generators failed, throwing the hospital into darkness and cutting off power to the machines that supported patients’ lives. Volunteers helped heft patients to staging areas for rescue, but helicopters arrived irregularly. That afternoon, Thiele sat on the emergency room ramp for a cigar break with an internist, Dr. John Kokemor, who told him doctors were being requested to leave last. When Thiele asked why, his friend brought an index finger to the crook of his opposite elbow and pantomimed giving an injection. Thiele caught his drift.

  “Man, I hope we don’t come to that,” Thiele said. Kokemor would later say he never made the gesture, that he had spent nearly all his time outside the building loading hundreds of mostly able-bodied evacuees onto boats, which floated them over a dozen blocks of flooded streets to where they could wade to dry ground. He said he was no longer caring for patients and too busy to worry about what was going on inside the hospital.

  Wednesday night, Thiele heard gunshots outside the hospital. He was sure people were trying to kill each other. “The enemy” lurked as near as a credit union building across the street. Thiele thought the hospital would be overtaken, that those inside it had no good way to defend themselves. He lost his footing in an inky stairwell and nearly pitched down the concrete steps before catching himself. Panicked and convinced he would die, he reached his family by cell phone to say good-bye.

  Thiele felt abandoned. You pay your taxes, he thought, and you assume the government will take care of you in a disaster. He also wondered why Tenet, the giant Texas-based hospital chain that owned Memorial, had not yet sent any means of rescue.

  Finally, on Thursday morning, the company dispatched leased helicopters, while other aircraft from the Coast Guard, Air Force, and Navy hovered overhead awaiting a turn to perch on Memorial’s helipad. Air-boats came and went with the earsplitting drone of airplane engines.

  The pilots would not allow pets on board the aircraft and watercraft, creating a predicament for the staff members who had brought them to the hospital for the storm. A young internist held a Siamese cat as Thiele felt for its breastbone and ribs and conjured up the anatomy he had learned in a college dissection class. He aimed the syringe full of potassium chloride at the cat’s heart. The animal wriggled free of the doctor’s hands and swiped and tore Thiele’s sweat-soaked scrub shirt. Its whitish fur stuck to him. They caught the animal and tried again to euthanize it, working in a hallway perhaps twenty feet away from the patients in the second-floor lobby. It was craziness.

  A tearful doctor came to Thiele with news she had been offered a spot on a boat with her beautiful twenty-pound sheltie. She had quickly trained it to lie in a duffel bag. Several of the doctor’s human companions were insisting they would not leave without her. Since the floodwaters had surrounded them, the doctor had been sick to her stomach and continuously afraid. She wanted to go while she had this chance, but she felt guilty about abandoning her colleagues and the remaining patients. “Don’t cry, just go,” Thiele said. “An animal’s like a child.” He reassured her: “We gonna get by without you. I promise you.”

  Thiele walked back and forth through the second-floor lobby multiple times as he journeyed between the hospital and his medical office. As the hours passed, the volunteers fanning the patients on their stretchers were shooed downstairs to join an evacuation line snaking through the emergency room.

  Thiele knew nothing about the dozen or so patients who remained, but they made an impression on him. Before the storm, the poor souls would have had a chance. Now, with the compounding effects of days in the inferno with little to no medications or fluids, they had deteriorated.

  The airboats outside made it too loud for Thiele to use a stethoscope. He didn’t see any medical records, he didn’t feel he needed them to tell him that these patients were moribund. He watched a doctor he didn’t know direct their care, a short woman with auburn hair. He would later learn her name: Dr. Anna Pou, a head and neck surgeon.

  Pou was among the few doctors still caring for patients inside the stifling hospital. Some physicians had departed; those who hadn’t were, for the most part, no longer practicing medicine—they had assumed the roles of patient transporters or were overseeing the evacuations outside where it was somewhat cooler. But Pou looked to Thiele like a female Lone Ranger. After enduring four stressful days and four nights of little sleep, she retained the strength and determination to tend to the worst-off. Later, he would remember her saying that the patients before them would not be moved from the hospital. He did not know if she had decided that, or if she had been told that by an administrator.

  Hospital CEO L. René Goux had told Thiele that everyone had to be out by nightfall. A nursing director, Susan Mulderick, the designated disaster manager, had given Thiele the same message. The two leaders later said they had meant to focus their exhausted colleagues on the evacuation, but the comments left Thiele wondering what would become of these patients when everyone else left.

  He also wondered about the remaining pets, which he’d heard would be released from their kennels to fend for themselves. They were hungry. And Thiele was sure that another kind of “animal” was poised to rampage through the hospital looking for drugs. He later recalled wondering at the time: “What would they do, these crazy black people who think they’ve been oppressed for all these years by white people… God knows what these crazy people outside are going to do to these poor patients who are dying. They can dismember them, they can rape them, they can torture them.”

  What would a family member of a patient want Thiele to do? There was no one left to ask; they had all been made to leave, told their loved ones were on their way to rescue.

  The first thing, he thought, was the Golden Rule, do unto others as you would have them do unto to you. Thiele was Catholic and had been influenced by a Jesuit priest, Father Harry Tompson, a mentor who had taught him how to live and treat people. Thiele had also adopted a motto he had learned in medical school: “Heal Frequently, Cure Sometimes, Comfort Always.” It seemed obvious what he had to do, robbed of almost any control of the situation except the ability to offer comfort.

  This would be no ordinary comfort, not the palliative care he had learned about in a week-long course that certified him to teach the practice of relieving symptoms in patients who had decided to prioritize this goal of treatment above all others.

  There were syringes and morphine and nurses in this makeshift unit on the second-floor lobby. An intensive care nurse he had known for years, Cheri Landry, the “Queen of the Night Shift”—a short, broad-faced woman of Cajun extraction who had been born at the hospital—had, he believed, brought medications down from the ICU. Thiele knew why these medications were here. He agreed with what was happening. Others didn’t. The young internist who had helped him euthanize the cat refused to take part. He told her not to worry. He and others would take care of it.

  In the days since the storm, New Orleans had become an irrational and uncivil environment. It seemed to Thiele the laws of man and the normal standards of medicine no longer applied. He had no time to provide what he considered appropriate end-of-life care. He accepted the premise that the patients could not be moved and the staff had to
go. He could not justify hanging a morphine drip and praying it didn’t run out after everyone left and before the patient died, following an interval of acute suffering. He could rationalize what he was about to do as merely abbreviating a normal process of comfort care—cutting corners—but he knew that it was technically a crime. It didn’t occur to him then to stay with the patients until they died naturally. That would have meant, he later said he believed, risking his life.

  He offered his assistance to Dr. Pou, but at first she refused him. She tried repeatedly to convince him to leave the area. “I want to be here,” he insisted, and stayed.

  With some of the doctors and nurses who remained, Thiele discussed what the doses should be. To his mind, they needed to inject enough medicine to ensure the patients died before everyone else left the hospital. He would push 10 mg of morphine and 5 mg of the fast-acting sedative drug Versed and go up from there as needed. Versed carried a “black box” warning from the FDA, the most serious type, stating that the drug could cause breathing to cease and should only be given in settings where patients were monitored and their doctors were prepared to resuscitate them. That was not the case here. Most of these patients had Do Not Resuscitate orders.

  It took time to mix the drugs, start IVs, and prepare the syringes. He looked at the patients. They seemed lifeless apart from their breathing—some hyperventilating, some gasping irregularly. Not one spoke. One was moaning, delirious, but when someone asked what was wrong, she was unable to respond.

  He took charge of four patients lined up on the side of the lobby closest to the windows: three elderly white women and a heavyset African American man.

  It had come to this. Dr. T’s mind began to form a question, perhaps in the faint awareness that there might be alternatives they had not considered when they set this course. Perhaps he realized at the moment of action that what seemed right didn’t feel quite right; that a gulf existed between ending a life in theory and in practice.

  He turned to the person beside him, the nurse manager of the ICUs who also served as the head of the hospital’s bioethics committee. Karen Wynn was versed in adjudicating the most difficult questions of treatment at the end of life. She, too, had worked at the hospital for decades. There was no better human being than Karen. At this most desperate moment, he trusted her with his question.

  “Can we do this?” he would later remember asking her. “Do we really have to do this?”

  CHAPTER 1

  FOR CERTAIN NEW ORLEANIANS, Memorial Medical Center was the place you went to ride out each hurricane that the loop current of the Gulf of Mexico launched like a pinball at the city. But chances are you wouldn’t call it Memorial Medical Center. You’d call it “Baptist,” its nickname since it had existed as Southern Baptist Hospital. Working a hurricane at 317-bed Baptist meant bringing along kids, parents and grandparents, dogs, cats and rabbits, and coolers and grocery bags packed with party chips, cheese dip, and muffulettas. You’d probably show up even if you weren’t on duty. If you were a doctor and had outpatients who were unwell, you might check them in too, believing Baptist a safer refuge than their homes. Then you’d settle down on a cot or an air mattress, and the hurricane, which always seemed to hit at night, would rage against the hospital and leave. The next day, the sun would rise and you would help clean up the debris and go home.

  For nearly eighty years the steel and concrete hospital, armored in reddish-brown tapestry brick blazoned with gray stone and towering over the neighborhood near Claiborne and Napoleon Avenues, had defended those inside it against every capricious punch the Gulf’s weather systems had thrown. In 1965, it “took the century’s worst storm in stride,” weathering Hurricane Betsy “like a sturdy ship” and protecting more than one thousand people who sheltered inside, its administrator bragged in the hospital newsletter. A year before Katrina, when “[Hurricane] Ivan knocked, Memorial stood ready.” As Cathy Green, a nurse in the surgical intensive care unit, told her worried adult daughter when Katrina threatened: “If I’m in trouble at Baptist Hospital, if Baptist Hospital fails, it means the entire city would be destroyed.”

  Utter faith in the hospital traced back to its founding: “I have an optimism that is almost explosive,” the president of the Southern Baptist Hospital Commission board of directors wrote in a letter to the hospital’s superintendent in February 1926, less than a month before a simple luncheon in the basement cafeteria and a dedication in the chapel marked the hospital’s opening. “In my humble opinion we have begun at New Orleans what is destined to be the greatest hospital in all the Southland.”

  The property of the $2 million hospital stretched for two city blocks. Breathless news of its opening, with accompanying ads, occupied nearly three full pages of the Sunday, March 14, 1926, New Orleans Item-Tribune. The newspaper profiled the superintendent of the “magnificent” hospital, fifty-year-old Dr. Louis J. Bristow, and filled several column inches with a list of more than fifty of the items Bristow had carefully selected for it, from electrocardiographs to potato peelers. The hospital, its potential patrons learned, had the appearance of a modern hotel or private home, providing a “general atmosphere of cheerfulness” found wanting in New Orleans’s older hospitals. Nearly an entire page was given over to a tour that described such minute details as the lighting system that produced “ample illumination without glare,” the steam-heated blanket warmers on each floor, and the “dainty electric reading lamp” perched on each bedside table gracing the hospital’s private bedrooms. “Ice is frozen in cubes on each floor in sufficient quantities to supply all patients,” one article trilled. The stories, which read more like press releases or ad copy than news, may well have been penned by superintendent Bristow himself, or perhaps his daughter, Gwen, a writer. “The new institution stands unsurpassed among the hospitals of the south in point of modern conveniences.”

  The age of electrical invention afforded a comfortable convalescence as doctors applied new technologies to their increasingly science-based practices. Suppliers of newfangled appliances filled the Item-Tribune with advertisements celebrating their affiliation with Southern Baptist. The Acme X-Ray Sales Co. had equipped the hospital with a Precision Type Coronaless Roentgen Apparatus, “internationally recognized as the foremost X-Ray machine.” Barnes Electric Construction Co., Ltd., of Gravier Street, which had laid the hospital’s electrical and phone wiring, had also installed a call system incorporating musical gongs and silent luminescent indicators. All operating rooms had been equipped with compressed air and vacuum attachments. The hospital’s design included “ventilation methods productive of coolness in the summer” to shield patients from the Southern heat.

  New Orleans Public Service Inc., NOPSI, a newly consolidated utility company, purchased a nearly full-page advertisement announcing it had installed Frigidaire electric refrigerators on every floor of Baptist. “If the hospital MUST have the protection of FRIGIDAIRE, surely the home, the store and the restaurant SHOULD have it.” To a city where many homes still had iceboxes, the refrigerators’ low, even temperatures were described as a form of health insurance, preventing food spoilage and “the incipient development of germ life.”

  Baptist had its own power plant. A smokestack rose seven stories above it. Workers prepared to feed the hospital’s furnaces 20,000 gallons of oil per week.

  Seven years earlier, city missionary Clementine Morgan Kelly had stood before congregants at a church meeting and announced the conclusion she had reached after years of “prayerful study, deep thinking, hard labor,” and visits to medical charity wards. “The crying need of the hour is a Baptist hospital for New Orleans,” she said. “We shall never convince New Orleans of the seriousness of our purpose to give this city Christ’s pure gospel, until we do missionary work through a Baptist hospital.” Baptists could open people’s hearts to Christ by engaging, as Christ did, in healing.

  The Southern Baptist press spread Kelly’s idea to a receptive church already engaged in a hospital-building movement.
New Orleanians of other religions supported the idea too. Almost eight hundred city dwellers donated money to purchase land for the new hospital.

  The Saturday afternoon of the hospital’s dedication, superintendent Bristow, the champion who had brought Clementine Morgan Kelly’s dream to fruition, rose to speak. “The purpose of the Southern Baptist Hospital, in a single phrase, is to glorify God,” he said. Poor charity patients would have their own rooms like the wealthy instead of being placed in the ghettos of separate wards. “We do not wish to capitalize the sufferings of human beings, but to relieve them.” The hospital opened its doors to serve its stated, three-pronged mission: the alleviation of pain, the prolongation of life, and the relief of suffering.

  The operation was not boundlessly munificent. To receive charity care, a poor family had to supply a letter from a church that testified to the family’s need and promised the hospital a donation. “We cannot undertake to help those whose own church declines aid,” Bristow wrote. The definition of charity cases was narrow at first, limited mainly to widows, orphans, and the elderly. A poor man whose wife required treatment would be given credit and a lecture about how charity would steal his dignity. Bristow often used the stories of charity patients, especially children, to fill pamphlets soliciting donations for Southern Baptist. He highlighted the important missionary work Southern Baptist Hospital was performing as it won converts and raised the profile of “white Baptists” in New Orleans, who were a minority in the city’s twenty-eight Baptist churches and whose Convention had a history of support for slavery, Jim Crow laws, and racial segregation.