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Kindle Notes & Highlights
by
Sheri Fink
Read between
September 18 - September 28, 2024
death felt different. Normally, she had what she needed to give people a chance to survive.
Pou was the kind of cancer surgeon who fought to give patients with poor prognoses the latest treatments and every last possible chance to survive. Sometimes she fought after other physicians would have given up hope. Now, robbed of her armamentarium, Pou’s sense of efficacy as a doctor was diminished. She, like Mulderick, had concluded the sickest remaining patients and those on ventilators might not make it out of Memorial alive.
sweating. Water had stopped flowing from taps, toilets were backed up, and the stench of sewage mixed with the odor of hundreds of unwashed bodies. Interior corridors were enveloped in darkness penetrated only by dancing flashlight beams. Without working phones, televisions, computers, and overhead pagers, information was scarce. Critical messages passed voice to voice up and down the staircases.
“Thank God!” someone yelled in the direction of two flat-bottomed airboats wafting up to the hospital on propellers nearly the size of Ferris wheels. “How
They reached the cloverleaf highway interchange west of New Orleans at Causeway Boulevard. Thousands of people came into sight, sitting, standing, and lying on land bristling with debris and light poles, downed to facilitate helicopter landings. To Sandra it looked like a war zone, unfathomable. They stopped and watched helicopters descend and pour more people onto the grass.
The SARBOO, search-and-rescue base of operations, allowed pilots to make quick loops in and out of the flood zone. Officials had managed to execute only half of the concept described in the Hurricane Pam exercises, however, as they had failed to provide the 600 buses and 1,200 drivers needed to pick up the people being dropped there.
Many, Sandra learned, had experienced a terrifying day and night on their rooftops and urgently needed shelter, food, and water.
She felt horrible. It was crazy. Why wasn’t there water for the people?
Its best hope of rescue, it seemed, lay with her, an EMT teacher who wasn’t even on contract with the state anymore.
“We’re here to rescue people out of the hospitals. That’s what we’re going to do,” one said. Each man had an airboat and was looking for someone to tell him where to go.
what about Memorial, what about Baptist? The woman said it was being prioritized last among the hospitals. Why, she didn’t know.
The LeBlancs couldn’t understand it. Didn’t officials realize that Memorial had lost power and that people there were panicking, getting desperate, even dying? Were the other hospitals in New Orleans somehow worse off? Who was in charge?
They piled into pickup trucks and explored one potential route to the flood zone, then looped back and hit water on Jefferson Highway just east of Ochsner Medical Center, near a set of railroad tracks and the Orleans Parish line. The LeBlancs explained that from there it was a straight shot to Memorial along the highway, which turned into Claiborne Avenue. It was the route, in reverse, that the LeBlancs had used to evacuate the city days earlier. The men backed their trailers into the water
The deeper they ventured into the city, the more intense and frantic the scene. They saw people wading through water up to their necks who turned to look and gesture at the airboats loudening the midmorning.
What hit him first was the heat, then the stillness. Nursing assistants loitered at a desk, looking worn, not tending to patients. Some of them registered shock when they saw him, knowing he had not stayed at Memorial for the storm. The patients he passed were almost naked. He found his eighty-two-year-old mother covered in sweat, lying on a wet bed. She greeted him with a smile and told him she was thirsty. She was, she said calmly, “in a mess.”
Mark was upset. He believed his mother needed an IV to hydrate her and deliver antibiotics for a stubborn urinary infection, but he’d been told the hospital could no longer provide intravenous fluids. Though his mother was a LifeCare patient, Mark complained to a Memorial administrator, who explained that the hospital was in a survival mode now, not a treating mode. “Do you just flip a switch and you’re not a hospital anymore?” Mark asked.
Dr. Anna Pou, always one to take on the most difficult tasks, jumped in to help coordinate the mass movement of patients. Every breath she took of the rancid air burned the back of her throat. She considered the unsanitary conditions in the hospital nearly unbearable, the pitch-black interior rooms exceptionally dangerous. She worried that even healthy people were getting sick and having difficulty breathing in the heat.
The idea of indicating somebody’s destiny by a number struck at least one passing doctor, neuroradiologist Bill Armington, as expeditious but distasteful.
rationing are a barometer of how those in power in a society value human life. During World War II, the British military limited the use of scarce penicillin to pilots and bomber crews. Before lifesaving kidney dialysis became widely available in the United States, some hospital committees secretly factored age, gender, marital status, education, occupation, and “future potential” into treatment decisions to promote the “greatest good” for the community.
After years of decisions that favored white South Africans, how could the process itself be made more just?
In the United States at the time of Katrina, at least nine well-recognized triage systems existed to prioritize patients in the case of mass casualties. Because of the difficulty of investigating outcomes, including deaths, in emergencies—and perhaps because of the potential for political embarrassment or due to a lack of financial incentives—almost no research had been done to see whether any of the commonly used triage systems achieved their intended goals or even that they didn’t paradoxically worsen overall survival. Most systems called for people with relatively minor injuries to wait
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Consigning certain sicker patients to go last has its risks, however. Predicting how a patient will fare is inexact and subject to biases.
POU WOULD LATER SAY that the goal in a disaster must be to do “the greatest good for the greatest number of people,”
But what does the “greatest good” mean when it comes to medicine? Is it the number of lives saved? Years of life saved? Best “quality” years of life saved? Or something else?
The idea is to distribute care based on need. Those in the most imminent danger of dying without care have a bigger claim to the pool of aid, much as French surgeon Larrey articulated, even if that inconveniences a larger number of patients with less urgent conditions who have to wait. This is the approach taken in most American emergency rooms in non-disaster settings.
also argued that suffering is not cumulative between individuals—for example, that it is impossible to add up the suffering of a large number of people with minor headaches to equal the suffering of a single person with a migraine, as a utilitarian might do. This concept was also elegantly expressed many years earlier by the author C. S. Lewis, who wrote: There is no such thing as a sum of suffering, for no one suffers it. When we have reached the maximum that a single person can suffer, we have, no doubt, reached something very horrible, but we have reached all the suffering there can ever be
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analogue in everyday American medicine: the allocation of transplant organs.
At Memorial, however, in the disaster’s vise, only medical professionals had a say in how patients would be categorized for evacuation. Once the decisions were made, no system was established to share the information with the people who would be most affected by it. In some cases it was actively kept from them.
“I didn’t mean for her to be left up here,” she told Pitre-Ryals. “When I made my mother a DNR, I did not know it meant ‘do not rescue.’ ”
Culotta had worked to relieve her pain, her shortness of breath, and the existential anxiety that grips patients whose hunger for air goes chronically unsatisfied.
It frustrated her when people on the cusp of freedom suddenly hesitated to leave the hospital.
The stress of the disaster narrowed people’s fields of vision, as if they wore blinders to anyone’s experience but their own. Again and again, Wynn saw signs that others were not appreciating the gravity of the situation inside Memorial.
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
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.
No hoofbeats had been heard from the cavalry promised by the imposing man with the handheld radio. He seemed to have accomplished nothing. He told Sandra LeBlanc that no more helicopters would be coming for the day.
Nutrition. Hydration. Elimination. Memorial’s Karen Wynn and LifeCare’s Gina Isbell worked with other staff to meet the patients’ basic needs. Medical care, for the most part, was not provided.
Some nurses said the woman was a Holocaust survivor, and as the day progressed, she grew more confused about where she was. “I need to get my sister out of here,” she said, and unlocked the brakes of her sister’s wheelchair, sending it rolling down the sloping pavement toward the floodwater. Isbell ran to catch the patient, but her sister kept repeating the trick.
Patients weren’t the only fearful ones. National Guardsmen and local policemen had left for the night. Many in the hospital sensed danger in the coming darkness.
One serviceman told her they were in a safe building. They had supplies. Matherne hadn’t expected to have to do any convincing. “They don’t have electricity!” she said. “You can’t take care of patients without electricity.”
With so many people waving rags on rooftops, the Coast Guard air-response units, which could talk to one another when flying, worked freelance, setting their own priorities, often rescuing people as they saw them.
Staff at every agency seemed happy to nudge another agency.
Fingers pointed every which way, much as they had when New Orleans flooded in the 1920s.
the state of Louisiana requested that the federal officials take charge.
Dubois was upset to learn, late in the day, that four LifeCare patients and seven LifeCare staff members from Memorial were stranded on the corner of Napoleon and St. Charles Avenues. She worked the phones in the evening to seek help for them from the Coast Guard and Knox Andress—the disaster preparedness coordinator she still thought worked for FEMA.
Conditions in Memorial are deteriating fast. We may lose 30-45 patients overnight. There is rampant looting in the streets and the hospitals do not have security to protect. It has become our priority to get all patients and employees/families out of Memorial.
spread to the other people resting in the room. Maybe, she thought, there’s just that little seed in the back of their brain, and I don’t want this to grow into an acorn and an oak tree.
One story below Wynn, in LifeCare, shattered windows also opened onto the stage of the shattered city, echoing with gunshots, shouts, and blaring car alarms. Staff members, convinced the hospital had been broken into, blockaded the stairwells for the night.
Angela had quit her job and spent more than a year as her caregiver. She had not put limits on her sacrifices. Tending to her mother and ensuring her dignity was her life’s current purpose. Living on a cot or reclining chair for days under unremitting fluorescent hospital lights, frequently being awakened at night, making life-and-death decisions, watching mistakes being made, and being buffeted again and again by new test results was stressful, even unhinging. Hospital life was so different from normal life that it could be jarring to step outside and see people smiling and laughing.
“The hunger, the anger, the rage is growing among people who have nothing, and if they have nothing they get violent and they get angry,” Jefferson Parish president Aaron Broussard said, appealing to the governor for more armed military police: “Basic jungle human instincts are beginning to creep in because they lack food, they lack a decent environment, a shelter.”
“hordes of ’em,” Thomas said, seemed to have waited out the storm in order to start breaking and entering. “I heard one lady say maybe this is Sodom and Gomorrah.”
