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

by Sheri Fink

“Heal Frequently, Cure Sometimes, Comfort Always.” It seemed obvious what he had to do, robbed of control over almost everything except the ability to offer comfort.

“It is only when service fails that any thought is given to the provision of means for improving it,”

A storm hit on Easter weekend, days before the river’s predicted rise. In less than twenty-four hours, 14.01 inches of rain fell. It was the greatest total twenty-four-hour rainfall in more than half a century of record keeping—nearly a quarter of the rainfall for a typical year. Only once in the eight decades that followed would daily rainfall surpass April 16, 1927, in New Orleans.

Again came calls for action. The homeowners’ association of the hard-hit Lakeview District demanded that the levees be raised and the drainage system strengthened so that “the ‘hand of God’ will not be blamed as often for what the hand of man has neglected to do.” It called on city authorities to use their charter rights to issue emergency bonds for the work rather than await approval of a larger refinancing plan. A Times-Picayune editorial backed the proposal: “We believe the people of New Orleans stand ready to pay whatever sum may be needed for reasonably adequate and efficient protection against these temporary but costly flood nuisances.”

Still, the area around Baptist Hospital in the Freret neighborhood remained the site of some of the worst flooding. The city failed to get a handle on it. Staff had to develop their own coping mechanisms. In the first years of the twenty-first century, workers knew a moderate storm could fill the streets around Memorial Medical Center with enough water that they would have to park their cars a block or so away on “neutral ground”—the high berms between lanes. Hospital maintenance men would put on waders and pull colleagues to work in a battered metal fishing boat kept suspended from the ceiling in the parking garage basement. Equipment, supplies, food, records, and linens were again stored in the basement. Many Memorial employees had long ago stopped seeing water as a significant threat.

The question was whether to move the patients somewhere safer, just in case. The risks of transporting very sick patients for a false alarm had to be weighed against the possibility that floodwaters could rise over the rooftop if the forecasts were accurate.

Many remembered the levee breaks, devastating flooding, and pumping-system failure that followed the Category Three Hurricane Betsy in 1965. St. Bernard residents had little faith that their officials or their levees would protect them.

“The ways and means of dying must be carefully considered,” Baltz commented in the newsletter.

“We’ve got a duty to die,” Lamm said, “and get out of the way with all of our machines and artificial hearts and everything else like that and let the other society, our kids, build a reasonable life.”

with drug and device developers figuring out how each organ that threatened to quit could be repaired or replaced, the practice of life support surged ahead of the practice of relieving pain, both physical and existential. Patients weren’t given much of a say in how much of this new medicine they really wanted if they became critically ill and unable to speak for themselves.

As the storm approached, there were about 183 patients at Memorial—a little more than usual due to last-minute storm admittances—and nearly as many staff members’ pets. LifeCare-Baptist had 55 patients, including the ones nursing director Gina Isbell had helped move from the St. Bernard campus. Around 600 staff members had arrived to provide care, along with hundreds of family members and companions. Memorial served a diverse clientele, a short drive to the genteel mansions of Uptown and a half-mile from a public housing project. Some community members had also come for shelter. Administrators tallied the census of humans in the medical center buildings at between 1,800 and 2,000.

Despite the request, and the fact that executives from some Tenet hospitals, like Atlanta, had already expressed a willingness to provide evacuation support, Tenet officials continued to rely on governmental resources to respond to the emergency.

Concepts of triage and medical rationing are a barometer of how those in power in a society value human life.

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.

Other philosophers have gone further afield, arguing that potentially lifesaving resources should be allocated randomly, because everyone deserves an equal chance to survive, and because it is dangerous to endow groups of people with the power to assign who lives and who dies. This argument sparked a debate that played out in the pages of philosophy journals for a decade beginning in the late 1970s. Proponents rejected the popular idea that the number of lives saved should be a central consideration when prioritizing rescues. The writer of an influential paper, John M. Taurek, 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.

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 in the universe. The addition of a million fellow-sufferers adds no more pain.

The stress of the disaster narrowed people’s fields of vision, as if they wore blinders to anyone’s experience but their own.

Life and death in the critical first hours of a calamity typically hinged on the preparedness, resources, and abilities of those in the affected community with the power to help themselves and others in their vicinity. Those who did better were those who didn’t wait idly for help to arrive. In the end, with systems crashing and failing, what mattered most and had the greatest immediate effects were the actions and decisions made in the midst of a crisis by individuals.

Perhaps most important, Charity’s leaders avoided categorizing a group of patients as too ill to rescue. The sickest were taken out first instead of last.

Emergencies are crucibles that contain and reveal the daily, slower-burning problems of medicine and beyond—our vulnerabilities; our trouble grappling with uncertainty, how we die, how we prioritize and divide what is most precious and vital and limited; even our biases and blindnesses.