Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

by Sheri Fink

prayed with her mother. Wilda had been fond of reciting the Lord’s Prayer and the Twenty-Third and Ninety-First Psalms. Before the storm, LifeCare staff members would bow their heads as she prayed in sessions the staff had come to call “church.”

It encouraged Angela when she overheard staff members lamenting that they couldn’t leave the hospital until every patient was gone. In her mind, that meant they would not leave the patients behind.

The drugs were federally controlled substances, kept locked away and signed out when needed, their misuse subject to criminal penalty. But these were extraordinary times. Even the firmest rules softened in the intense heat.

nursing board had put her on probation for treating patients with drugs that had not been ordered by a doctor. She was supposed to be closely supervised, to “work in a restrictive environment,” but here she was working with great autonomy, undertaking extra shifts with the assistance of her teenage daughter while some other colleagues wilted into inaction in the heat.

Chatelain had severe chronic back pain, and eventually the temptation of the drugs, which she had placed at the nursing station under cover of torn-up rags, was too great. She gave herself an injection of the morphine. She saw that her patient Wilda McManus also seemed like she could use something—in McManus’s case to calm and quiet her. This was how, just before midnight, McManus came to receive a small dose of Ativan. Her daughter Angela wasn’t there to warn the nurse about the drug’s previous paradoxical effect. And even if it worked like magic, no drug could replace the comfort and reassurance of a daughter, of Angela, who had been told to leave her.

“That’s what it took to get you here?” the hospital locksmith asked. He knew the looting report wasn’t true, but he was upset that the job of staying up all night to protect everyone had fallen to civilian duck hunters like him rather than trained law enforcement officials. The

All around her on the second floor, dozens of LifeCare and Memorial patients lay on dirty, sweaty cots. It was so crowded there was barely enough space to walk between them. Most of the nonmedical volunteers who had fanned and offered sips of water to the patients had gone elsewhere, dismissed and told to take a break by the doctors, who said too many people were present. Workers had included little girls, the “PBJ and cracker brigade,” who made snacks for diabetic patients.

Overnight, a patient stopped breathing and died on the floor where Pou was fanning. Pou would later remember thinking, We live in the greatest country in the world and yet the sick could basically be abandoned like this. As she, too, awaited rescue, she felt sad, frustrated, and helpless.

Here, even King recognized Katrina’s shattering of the sterile, digital, odorless, dehumidified, gloved, and gowned illusion of mastery over death and suffering doctors typically maintained. The smashed windows and lack of power left them exposed, like an army field hospital, to the elements. Knitted together for safety overnight, they felt as isolated as if they were under fire.

“We need to have a little bit more of a surgeon’s attitude,” Walsh said. Surgeons were men and women of action. The group of doctors in the suite opted for insubordination over inaction. Rather than await the scheduled morning meeting to discuss options, Walsh left after first light with an anesthesiologist on the plant-operations director’s fishing boat to try to organize a more concerted rescue effort.

Mulderick wanted to slap her. How could the doctor express more concern for a cat than for the patients all around her? Pets were everywhere—everywhere!—in spite of Mulderick’s exhortations to keep them out of the hospital. Staff members simply ignored the rules, walking their dogs through the areas where patients were lying and telling her they wouldn’t leave their pets behind.

was to rid the patients of their pain and dull their senses to the point they would no longer care that they were smelling the feces they were lying in, that panting dogs were weaving past and licking their hands. But the radiologist seemed to interpret her intentions differently. A physician colleague heard him ask Deichmann if they could convene a meeting to discuss euthanasia, because some of the staff were concerned about the patients and wanted to consider

Why? Because time had come to feel magnified. She was no longer able to envision what would happen when life returned to normal; many people seemed to be wondering whether that would ever happen. Having an end would give them a reference point for their options. Yes, she had heard they would all get out that day, but she couldn’t see it, couldn’t believe it, wasn’t convinced by the CEO or by Susan. Conditions seemed increasingly unstable. The doctor felt not only unsafe, but also vulnerable.

If there were other ways to evacuate these patients, other ways to care for them, Cook wasn’t seeing them. Cook told Pou how to administer a combination of morphine and a benzodiazepine sedative. He later said he believed that Pou understood that he was telling her how to help the patients “go to sleep and die.” That was different from what she and her colleagues on the second floor already knew how to do and were doing: treat patients for comfort.

Fournier asked a nurse manager, Fran Butler, what she thought of the talk going around about putting people to sleep or out of their misery. “That is not an option,” Butler said. She’d held that view for a quarter century—personally, professionally, and spiritually—since becoming a nurse. She didn’t turn up the morphine unless a patient looked uncomfortable.

“I can’t be a part of anything like that,” King said. “I disagree one hundred percent.” The idea was stupidity itself. They had only been there two days since the floodwaters rose, and they were dry and had food and water. He told her that hastening death was not a doctor’s job.

The remaining patients were hot and uncomfortable, a few might be terminally ill, and it was hard on the staff to care for them and see them like this, but he didn’t think they were in the kind of pain that called for sedation, let alone mercy killing.

The conversation deepened King’s desperation to escape Memorial. He was nearly ready to swim out, despite having watched nurses foul the murky water with the contents of bedpans.

ANGELA MCMANUS couldn’t believe that three men who looked like police, holding sawed-off shotguns, could be demanding that she leave her mother’s bedside near the nursing station on the LifeCare floor. They told her they were evacuating the hospital and she had to go.

Though she had been told on Wednesday her mother would soon be evacuated, she’d had a sense that her mother and the other bed-bound LifeCare patients would be staying for a while.

The able-bodied were leaving, not the sick.

Kathryn had been trained as a registered nurse and knew from working in the ICU that even patients in comas could hear and remember what was said to them. She told her mother she was the best mom any girl could have and she was proud to be her daughter. At around eleven fifteen a.m. she kissed her mother good-bye, said a prayer over her, and, with the nurse executive, departed LifeCare.

Isbell tried not to think about what was going to happen. For five days she and her colleagues had tried so hard to keep everyone alive. She didn’t want to accept that they couldn’t save everyone who had made it this far. A colleague told her that they were under martial law. Isbell believed she had to follow orders. She did what she was instructed to do.

before her patients died; she didn’t want to believe that no one would come.

A doctor had told certain staff members to direct people away from the patient area on the second floor where the DNR patients lay.

The helicopters were to take any and all.

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.

“Y’all going to get this done,” she told Wynn, “because you’re nurses.”

All it took was one person to spread panic.

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 later remembered asking a colleague, who had cried.

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.

It was starting to hit her that what was really causing the patients to decline was dehydration. How easy it had been to lose presence of mind in an emergency, addled from nights without sleep. Of course you could run an IV without an electric pump. You could hang a bag of fluids above the patient and, with the right kind of tubing, allow gravity to do the work of dripping it into a vein.

depriving these patients of liquids was undermining their chance of surviving.

Later her recollection of it would all be a blur that left her with the discomfiting sense that, at least in some people’s minds, the medicines were being given “for the greater good,” to get the exhausted, frightened employees out more quickly because there were too many patients who were immobile. “This is what needs to be done,” one colleague told her when she asked what could be done to stop it. Several staff members said that Dr. Pou had ordered the drugs, though the nurse had no idea if that was true or what her intentions might have been.

Several nurses familiar with the patients who were injected believed that after they had survived everything so far, there was no reason they couldn’t still make it to safety. Most of the other employees milling around the second floor seemed to think what was happening was horrible but necessary. One employee even suggested that the objectors weren’t being realistic and needed to grow up.

The young nurse saw other staff drawing sheets over the patients. She was frightened. She was only twenty-two years old and three months out of nursing school, and she had never seen a patient die. The previous evening she had broken down in fear for her own life. Now the doctor asked her to help carry the dead patients and line them up inside the chapel. The young nurse began assisting.

Culotta had been treating Lagasse with narcotics for weeks because she had pain and anxiety from her spreading cancer, so he knew her tolerance was high. It would take a large amount of morphine, he felt, to relieve her gasping and suffering. It would also, he believed, undoubtedly hasten her death. While she and her daughter had not agreed to a DNR order, he, as her doctor, had felt during her hospitalization that her therapeutic options were limited, and a central goal of his care was keeping her pain and anxiety in check.

Reddy could not piece together why these very sickest patients had not yet been airlifted. Reddy watched clusters of volunteers hoist stretchers on their shoulders and carry patients up the narrow metal steps to the helipad. He scribbled in his notepad. “Urine and feces rolled off the beds and onto the workers, forcing them all to wipe down with sanitizing liquid every time,” his story would say.

Weighing more than three hundred pounds, recovering from surgery and heart trouble, and unable to walk, Scott had been designated the last to go through the hole in the wall because of his weight. Ewing Cook had mistaken him for dead the previous day. And yet he had been successfully airlifted, alive. Scott was the last living patient to leave Memorial.

Memorial’s director of maternal-child nursing, Marirose Bernard, had agreed to go on camera in exchange for what she thought was a promise from the news crew to help rescue her children, husband, and mother, who had left Memorial on Wednesday only to end up hungry, thirsty, and terrified at the New Orleans Convention Center.

She was a small woman, but every day she had dutifully helped transfer Emmett to a wheelchair so that he could sit in their yard, read the Bible, play with their dog, and clown around with his seven-year-old granddaughter, who rode on his knees. Little Krystal was his eyes, Carrie would say.

had visited him in the hospital every day, but she’d been told to stay at home when the LifeCare patients on the Chalmette campus were transferred to Memorial Medical Center. Emmett had called her to let her know that he had made it there with no problems, brought a photograph of his granddaughter with him, and was safe. That was the last she had heard from him.

AS FAMILIES SEARCHED FOR loved ones, bodies lay decomposing in the flooded city. Days passed as government officials argued about whose responsibility it was to recover them. On Tuesday, September 6, MSNBC cameraman Tony Zumbado paddled to Memorial Medical Center in a kayak and followed the overpowering smell of death to the Myron C. Madden Chapel. A small piece of yellow lined paper reading DO NOT ENTER was duct-taped to the wooden door. Inside, Zumbado’s camera panned to take in more than a dozen bodies lying on low cots and on the ground, shrouded in white sheets.

A chaplain who came to search for survivors compared what he saw when he entered Memorial’s chapel with Dante’s The Divine Comedy. “It was like a picture of hell,” he said on CNN. When members of a disaster mortuary team finally arrived on Sunday, September 11, more than a week after the last living patients and staff members had departed, they recovered forty-five bodies from the chapel, morgues, hallways, LifeCare floor, and the emergency room.

It was the largest number of bodies found at any Katrinastruck hospital or nursing home.

It began to appear that people in hospitals and nursing homes accounted for a significant proportion of all deaths from the massive disaster.

Were deaths at hospitals and nursing homes regrettable results of an act of nature, a chaotic government response, and poorly constructed flood protection overlaid on a degraded environment? Or had lax oversight allowed individual or corporate greed to play a role? Did some hospital and nursing home leaders decide not to evacuate before the storm primarily to avoid the substantial costs of emptying and closing health facilities? Were emergency plans not followed, important pre-storm investments not made, and health workers not properly prepared?

If the company could show the disaster plan had been followed, there was every reason to expect the case could quickly be closed and the locus of blame for the deaths could be pursued elsewhere.

nine LifeCare patients on the seventh floor at Memorial had died under suspicious circumstances. Although we are just beginning to collect the relevant facts, we have information that the patients involved were administered morphine by a physician (Dr. Poe, whom we believe is not an employee of LifeCare) at a time when it appeared that the patients could not be successfully evacuated.