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

by Sheri Fink

amputation from medicine, did Americans want doctors again to conjure death? Could the societal embrace of suicide for terminally ill or disabled people lead members of those groups to feel more worthless, devalued, and abandoned? Would it discount the meaning to be had from family reconnections, insights, and various forms of spiritual enrichment and personal growth that may accompany death’s approach? Did it not violate all manner of secular and religious moral proscriptions?

To address the very real issues of pain and suffering in the last stages of deadly illnesses, hospitals and doctors increasingly offered palliative and hospice care programs. These employed an array of medical treatments, counseling, and support to address symptoms and keep patients comfortable rather than to attempt to cure them. Hospice was considered a philosophy and a movement to care for the terminally ill and their families,

A proposal that would have explicitly legalized the practice upon request of “mortally injured and diseased persons” had been made and voted down by the Ohio legislature in the first decade of the 1900s, but interest in it surged again in the 1990s.

Some observers suggested the Memorial health professionals, if indicted, could claim palliative sedation as their defense.

The apparently rapid introduction of large amounts of drugs known to be lethal, without any prior use in these patients, concerned him. It also disturbed him that at least some of the patients did not appear to have been terminally ill. No effort seemed to have been made to consult with the family members who were present at Memorial.

He was unconvinced that the sole option to relieve any pain or suffering was to kill.

One of the few doctors to see jail time was Jack Kevorkian. He escaped conviction for first-degree murder several times in the 1990s, even as he hooked up more than 100 suicidal patients to his death machines. Kevorkian finally goaded a judge to send him to prison for second-degree murder after he videotaped himself injecting drugs into Lou Gehrig’s disease patient Thomas Youk in 1998 to put him to sleep, paralyze his muscles, and stop his heart, killing him.

medical determination of homicide from the coroner—simply that the deaths were caused by the actions of another human being, without regard to fault or legal responsibility. It was a step toward a criminal finding of homicide, in which a Louisiana court assigns fault for a killing.

What will it look like for New Orleans when this all comes out, Rider asked, when the world knows that the truth was swept under the rug? A coroner’s job was to discover and report the truth! Minyard told her he had to consider what was best for his city, whose reputation had already suffered so much damage.

Almost before she had asked the question, the officials in the room said, “No!” It was easier to avoid doing the just thing if the victim was only a name.

Growing up in a state where politicians exploited every opportunity for corruption, she had deposited her faith in the burnished version of the American justice system her teachers had described in school. She believed in it. She believed, even to her ripe old early forties, that good would prevail over evil. She had given so much of herself to this ideal.

This wasn’t a case of investigate, arrest, and you’re done. Look at the overall picture here, he’d tell her: a city underwater, politics in the background, multimillion-dollar corporate interests, the medical profession on trial. He had tried to warn her not to get emotionally involved, that the case would tear her heart out. And now it had.

He examined the evidence and concluded that it was absurd to try to determine causes of death in bodies that had sat at 100 degrees for ten days.

that the drugs were present. “These people were given Versed and morphine shortly before they died,” he explained to Minyard, “and there’s no other competing cause of death.”

The parish would lose the case over reasonable doubt. This, in his estimation, would not be good for the city, for the recovery. This was the bigger picture that he felt he had to consider beyond what pure basic science suggested about the deaths.

The kind words boosted Pou emotionally, but in the days before the grand jury was set to convene, she felt “very alone, very abandoned and very betrayed,” she would later say.

The state medical board had not sanctioned or investigated Pou. She even received something of a promotion, being named director of Louisiana State University’s residency training program for her specialty, which required the approval of national medical organizations.

Of course the contention wasn’t true. In the days after Katrina, Coast Guard air crews had donned night-vision equipment and risked tangling themselves in power lines to land on rooftops, hack into attics, and rescue people, including patients at Memorial. The Coast Guard had specific policies and procedures for flying at night.

Pou could fix on an idea and be absolutely convinced of it, and convince others of it, even without all the evidence. “Trust me, they don’t fly at night,” she said to the audience. “Ask Vince.” Her husband, a pharmacist who was a recreational pilot, had heard this.

“We just have to give people a shot of hope,” she said without irony.

One of Pou’s friends thought it improper for “Disco Dick” to be enjoying himself so visibly—after all, the purpose of the dinner was to raise money to pay him. “I’m telling her to get a new lawyer,” she said.

The good news in an accompanying letter was that the district attorney had decided not to prosecute them. The bad news was that he was compelling the women to testify without counsel before the grand jury so he could find out what they knew about Anna Pou.

The deal was this: in light of their Fifth Amendment privilege against self-incrimination, the women’s testimony and any information derived from it could not be used against them in a criminal case, except if they gave false statements or otherwise failed to comply.

He’d grown to enjoy the prospect of coffee and doughnuts, the relaxed repartee, the aura of pride and concern most citizens exuded when exercising their civic duty. He might be one witness of several, but he knew his opinion on the manner of death was pivotal in a murder case. Today he didn’t want to go. This case was different. He felt pressure from family and friends who opposed Pou’s prosecution. He felt pressured by the bad publicity the city was getting. On the other side were his religious convictions. In his years as coroner, he regularly saw people die who had no reason to die and people survive accidents that should have left no one alive. He had seen the young perish quickly and the old live unexpectedly. You could never figure out God’s plan. You just had to try to fit into it, like water taking the shape of its vessel. He liked to tell that to young people. The secret to life is learning what God has planned for you.

Respecting life was the most important thing. The road to heaven was paved by God’s grace.

Minyard couldn’t bring himself to follow up and investigate additional deaths and alleged perpetrators. It was taking every bit of his energy to go through what he was going through with this lady.

What would he have done? He would have done what he thought was best for each person. And, by his ethic, sick people came before non-sick people. One thing he wouldn’t do if they told him to leave the hospital, that they were closing it down at five p.m., everybody out, he wouldn’t walk around with two syringes and shoot up nine people to kill them because they couldn’t get them off the seventh floor. “I know I wouldn’t do that,” he said.

His typical cases were 100 percent clear. The Memorial case remained a mystery to him.

conscious limbo, there were certain things that even a drug known for causing amnesia could not erase. He experienced what he later described as nightmarish distortions, visions of monsters and pods. Many times he was underwater, struggling to surface, only to feel someone pushing him down.

After a month in death’s shadow, he still saw a difference between himself and the people he had helped inject at Memorial. True, in twenty-five years of practicing in the intensive care unit, he had rarely if ever seen a patient go through what he did and live. He had developed nearly every sign known to predict poor survival in the ICU. Still, and this was crucial, every problem he had was potentially reversible.

But he would have kept going, kept treating a patient like himself because there was nothing that happened to him that couldn’t get better with good fortune and the grace of God. Potential reversibility, that was key; it differentiated his constellation of illnesses from those of some of the patients at Memorial.

“This was in the hands of God. I shouldn’t be here. The fact that I came out with my kidneys intact, my brain intact, and went back to some degree of normalcy is just miraculous. There’s no other word for it.”

DR. HORACE BALTZ resented the thrust of what he began calling the “euthanasia rally.”

In her talks, she rewrote history.

she did not say that she was arrested for having allegedly murdered patients, not for having made the challenging and controversial triage decisions she discussed. In fact, she left out mention of injecting patients entirely. In lectures to hospital executives in Sacramento, disaster preparedness planners in Chicago, doctors in Texas, and attorneys in New Orleans, she did not discuss or explain the decision she and her colleagues made to medicate at least nineteen patients on Thursday, September 1, all of whom died as helicopters and boats emptied Memorial.

In fiscal year 2009–2010, at Anna Pou’s request, the general fund of the state of Louisiana paid $456,979.41 in legal fees and expenses for her successful defense, reimbursing the LSU Health Network and the Dr. Anna Pou Defense Fund.

Each claim effectively reduced the payout to other claimants in the same category. Anna Pou opted in for a share of the settlement. According to the guidelines, she qualified for $2,090.37 for each day she was at Memorial.

She still saw the faces of her Katrina patients in nightmares and was angry and bitter—not at Pou but at the thought that help came too slowly. She considered herself a different person after the storm, forever changed by the trauma of those days and how they had ended.

What was it about death in the United States? Why did it seem like Americans were so unprepared for it when it occurred? She had seen it again and again working in the ICU. People often did not want to talk about death with the dying, or be there with a relative when it happened. Why did we celebrate every milestone in life except this one? she wondered. Everyone wanted to be there to witness the beginning of life, but the ratio of birth to death was one to one. She would ask, “If your best one got on the slow boat to China, you would not be at the dock saying good-bye?”

Given a choice, would someone rather die a painless death or live after being lowered, however uncomfortably, from a window? A great disservice was being done to the field of medicine, because the events were covered up and medical leaders reacted emotionally, without knowledge about what had happened.

Justice did not require, ultimately, a conviction. It could be served in a retelling through the court process.

It was imperative to know how they would react under pressure, to learn that simply because people were medical professionals did not mean they would always act in the interest of their patients, whether from a self-serving motive or muddled thinking.

This case had changed the way Rider looked at the world more than almost anything in her life besides her children. It had led her to set out her own end-of-life preferences very clearly in an advance directive: for example, that she should be removed from life support only if two doctors and a sister she had designated as her health-care proxy agreed; that she would want pain medicines, yes, but no more than necessary for pain, and not in an amount that would carry a great risk of killing her. Members of the public deserved to know the story, so that they, too, could use its lessons to make informed choices.

Most of all, the victims deserved to have the...

As a prosecutor, you learned that many of the people you brought to trial wouldn’t be found guilty. You couldn’t spend your life sulking about it.

she didn’t necessarily want to see Pou in prison, but she didn’t believe Pou should keep her medical license. She had broken her primary oath. The nurses had too. What was to stop them from doing it again?

She thought of the wars going on across the ocean in Iraq and Afghanistan. Americans didn’t leave their dead troops behind, no matter how intolerable the situation. But here at home a war against nature had been lost because some people were killed and left behind.

CARRIE EVERETT wanted to see justice done, to see Pou accept responsibility for her actions. Even though her husband, Emmett, had lost the use of his legs and the control of his bladder, and had depended on her care for nine years, she would still rather be bathing him, putting a diaper on him, laughing and clowning and arguing like every couple did—she would still rather have him there.

If nothing else was learned, what he hoped people took from Memorial’s misfortune was simple: “Every time you can save a life, save it.” If they could get him out, they could get everyone out. What had happened need not have happened. “There’s a way for everything,” he would say. Every option should have been explored.

He could not wrap his mind around it. And he could not believe that Pou was allowed to continue practicing medicine.