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

by Sheri Fink

While the mayor commanded everyone to leave, many didn’t have cars or other means to do so, and officials knew that the city’s plans to help transport them had significant holes, including a lack of sufficient drivers. Residents who could go on their own were already stuck in traffic on the interstate leading out of town. The Superdome, the giant stadium that hosted the New Orleans Saints football team, was designated as a “shelter of last resort.” New Orleanians who had no way to get out of the city could take a shuttle bus there. Mayor Nagin appealed to one population in particular. “If you have a medical condition, if you’re on dialysis or some other condition, we want you to expeditiously move to the Superdome,” he said. He didn’t mention what kind of help people could expect there. Many tourists whose flights had been canceled had no ability to flee on their own either, and so Nagin’s evacuation order exempted essential hotel workers to serve them. It also exempted essential criminal sheriff’s office workers, who were needed to keep their eyes on prisoners at the parish jail. They, too, were not being moved. A questioner at the press conference asked for a clarification: “People should stay put in the hospitals…or what?” The mayor said he had also exempted hospitals and their workers. People might get hurt in the hurricane. If hospitals closed and turned them away, that would, he said, create “a very dangerous situation.

Dispatchers for the region’s largest ambulance company, Acadian, were swamped with calls to transport patients from threatened hospitals, nursing homes, and houses. Many of the roughly two dozen ambulances the company made available were frozen on the jammed interstate. To save time, some ambulances began delivering patients to the Superdome instead of taking them out of town.

The main hospital in St. Bernard Parish, Chalmette Medical Center, managed to begin evacuating, but after the first round of critically ill patients left, ambulances never returned. Administrators from one New Orleans hospital wanted to move nine of their sickest patients to western Louisiana. But unless they could arrange an urgent, costly airlift, it seemed to be too late. The roadways were now so clogged with evacuees, the vulnerable patients could be trapped for up to a day in an ambulance before arriving. One nursing home had, before hurricane season, retained a New Orleans tour company at a cost of $1,400 to drive its residents to Mississippi in seven large buses in case of emergency. The dispatcher had reported on Saturday night that he only had two buses and no driver and would not fulfill the contract.

The Gold Seal was not a rarefied designation. Some 99 percent of hospitals achieved it, and details of their inspection deficiencies were hidden from public view. Most of JCAHO’s revenues came from fees paid by the very hospitals it accredited. In some cases, its survey teams missed serious problems at hospitals that law enforcement investigators later uncovered.

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?

“When I made my mother a DNR, I did not know it meant ‘do not rescue.’

When a very sick patient or the patient’s family made the decision to disconnect a ventilator, for example, Cook would prescribe morphine to make sure the patient wasn’t gasping for breath as mechanical assistance was withdrawn. Achieving this level of comfort often required enough morphine that the drug markedly suppressed the patient’s breathing. The intent was to provide comfort, but the result was to hasten death, and Cook knew it. The difference between something ethical and something illegal was, as Cook would put it, “so fine as to be imperceivable.”

A bioethicist uninvolved with the group shared a similar view. “Rather than thinking about exceptional moral rules for exceptional moral situations,” Harvard’s Dr. Lachlan Forrow, who is also a palliative care specialist, wrote, “we should almost always see exceptional moral situations as opportunities for us to show exceptionally deep commitment to our deepest moral values.”