People of Northwest Public Radio
Tue September 3, 2013
Exclusive First Read: 'Five Days At Memorial,' By Sheri Fink
As the floodwaters rose in New Orleans over Labor Day weekend in 2005, hundreds of people were left stranded at Memorial Medical Center, in triple-digit temperatures, without power or running water. Not all of them made it out alive — and in the aftermath, several medical professionals were arrested and charged with hastening the deaths of some of the sickest patients.
Sheri Fink's searing Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital — originally a ProPublica investigation — chronicles those terrible days, and the choices that led to them. In this scene, a daughter cares for her desperately ill mother as they await rescue. Five Days at Memorial will be published Sept. 10.
WEDNESDAY, AUGUST 31, 2005 — NIGHT
NURSE MANAGER KAREN WYNN lay awake beside her sleeping teenage daughter in an operating-room hallway on the eighth floor. It was so hot, it hurt to breathe. The air stirred only with the complaints of an older woman, the girlfriend of an ICU nurse's father. "We never gonna get out of here," she moaned. "We gonna die in here."
The woman's cries threatened to wake Wynn's daughter. Wynn worried the panic would 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. Wynn stood up and steered the woman to a stairwell to sit, breathe, and quiet down.
The floor was full of glass, and Wynn had gone barefoot in her haste. Exhaustion played on her perceptions and emotions. Through the open windows, Wynn could hear amplified movement and conversations out- side the building over the water, eerie in the dark.
When she returned to her pallet, Wynn had the sense the fearful woman was right. They were never going to get out of Memorial. Thoughts of her sleeping daughter uprooted the feeling. They would get out. They had to.
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.
Just before midnight, a nurse pushed a dose of the sedative drug Ativan through a syringe into LifeCare patient Wilda McManus's IV line. It wasn't a drug McManus normally took. Her daughter Angela had made sure of that because Wilda had once had a bad reaction to the drug, growing more agitated instead of calmer.
McManus was lying on a bed by a doorway near the nurse's station, uncharacteristically alone. Late Wednesday morning, she'd been "en route," according to a note in her medical chart, "to the heliport." She had never even made it off the floor. All day she had waited, Angela by her side, asking in vain for a doctor to rescind her mother's DNR order.
Angela served as the voice and advocate for her mother. Wilda had been the longtime patient information manager at Charity Hospital, the first person visitors would see when they walked beneath an ornate metallic screen through that hospital's Art Deco entranceway. Wilda could still smile sweetly but couldn't always make herself understood due to a stroke and the brain-muddying effects of certain medicines. A note in her hospital admission paperwork said "daughter stays with patient at all times." Angela had quit her job and spent more than a year as her care-giver. 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, apparently carefree.
Though it was difficult for Angela McManus to accept that death might come soon for seventy-year-old Wilda, she was not unreasonable about this. Carefully counseled by the infectious diseases specialist on duty the day Katrina hit and Wilda's infection worsened, Angela had opted against surgical intervention in an operating room on backup power. She also agreed that if her mother's heart or lungs shut down there was no sense in trying to revive her with breathing tubes, electric shocks, or chest compressions — interventions that would have no effect on chronic, underlying health problems. But the role Angela McManus had chosen was not to preside over her mother's dying process. She found value even in Wilda's less active life. Angela's role was to ensure that for every last moment her mother would be well cared for, and, until this latest setback, that she would be given every chance modern American medicine could afford her to survive.
All day Wednesday, the McManuses had watched dozens of other LifeCare patients bundled into cocoons of sheets and carried into the stairwells ahead of Wilda. More than once, nurses returned crying after patients had died in transit.
The day brought Wilda no closer to the heliport, but helicopter rotors washed wind and the smell of fuel into the unit. Although reaching the helipad involved an arduous journey — down five flights of stairs, through the hole in the machine-room wall, up the parking garage ramp and three stories' worth of metal steps — from the windows across the hallway, the helipad looked almost touchable, framed like a picture in the windows.
A radio played in the corridor, transmitting tales that alarmed the LifeCare staff: hostage situations, prison breaks, someone shooting at police. Looters had used AK-47 assault rifles to commandeer postal vehicles, filling them with stolen goods, according to a councilman from Jefferson Parish, which shared a border with the city. A deputy sheriff said on air that he saw a shark swimming around a hotel — or perhaps it was just debris that looked like a shark fin; he wasn't sure.
"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."
WWL announcer Dave Cohen denounced the looting on the station's marathon ad-free, call-in broadcast, being fed out to AM and FM stations all over southeast Louisiana. "It's such a big problem that state police have sent in a tactical team — two task forces [ . . . ] The governor is making it so clear," Cohen said. "It's time for a full evacuation of the city of New Orleans."
Officials and civilians called into the station and stopped by its make- shift studio in the basement of an emergency operations center near New Orleans. Two guests referred to the people remaining in the city as zombies. Cohen described them as "a mass of humanity, slowly wandering." "It's like Night of the Living Dead," Oliver Thomas, the city council president of New Orleans, said. "And you look at the look in their eyes; they're stressed, they're hungry, they're thirsty. The governor has asked for armed reinforcements."
An organized group of criminals, "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."
Some of the staff on the seventh floor at LifeCare seemed to be taking the stories to heart, freaking out, Angela McManus thought as she listened to them cry out what amounted to, Oh Lord, the world's coming to an end! Nurses worried aloud about their children and roamed the halls for a spot where their cell phones would work to try to locate their families. Employees who had visitors were beset by requests for water and other necessities. A poodle owned by Wilda McManus's nurse barked and barked from a nearby room. "Shut that dog up!" Wilda said to her daughter. Angela's own eyes and throat were scratchy from pet allergies. A cat escaped its quarters in a shower stall and the nurse's dog pinned it behind a cage. The nurse, frantic with worry about leaving her dog behind to be euthanized, spent more time feeding and doting on it in the room next door than she did caring for Wilda, Angela thought. She overheard nursing assistants argue over whose turn it was to do the un-enviable work of cleaning and toileting patients in the awful heat.
Angela, exhausted, dizzy, and anxious about a sibling who lived close to the levees, nonetheless found the strength to nurse her mother herself. She nourished Wilda through her feeding tube, removed and replaced the colostomy bag that collected her feces, and ran her hand under her mother's backside after her fever broke to find it slick with sweat and wound discharge. There was no running water to bathe her. It took hours for Angela to recruit a nurse to help her wipe Wilda down with alcohol, dry her, and change her wound dressing. All the while Angela talked, sang, and 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. Finally in the late afternoon on Wednesday, Angela was told that the remaining patients would soon be on their way and it was time for her to leave the hospital by boat. Before agreeing to leave, she asked where her mother would be taken. "I don't have any idea where your mom is going to end up," LifeCare's nurse executive Therese Mendez told her. "But where are you going? Let's put that number on your mom." They tried to inscribe her with a permanent marker, but her skin was too wet. Instead they wrote contact phone numbers with a brief message on pieces of gauze and wrapped them around Wilda McManus's right arm and right leg below her hospital gown: daughter — angela mcmanus, asap.
Angela was taken downstairs and put in line for a boat, as was another devoted daughter, Kathryn Nelson, whose mother, Elaine, was a gravely ill LifeCare patient.
Hours later, in the evening, the infectious diseases doctor who had made Wilda McManus a Do Not Resuscitate patient after the storm came up to LifeCare. She surveyed the ragged, fearful nurses, pronounced the death of the ventilator-dependent patient with a DNR order, who had passed away earlier, and checked on all the remaining patients. McManus was one of them. "Are you in pain?" she asked each one. "Do you feel anxious?" Some of the patients said no, including Rose Savoie and her remaining roommate, "Miss Alice" Hutzler, and McManus. Others could not answer. None of the patients said they needed anything, but the doctor was struck by how weak they appeared in the heat. She was sure that the gravely ill lady, Elaine Nelson, would die overnight. Her eyes had been glazed, and she seemed to be breathing with great difficulty. The doctor was sad to find her alone in a room at the end of a hallway, her daughter absent. She asked the staff to move Nelson closer to the other patients.
The doctor had no intention of staying the night on the seventh floor, and she saw that the LifeCare nurses would have no easy way to contact a physician. She left standing orders for nurses to give small injections of morphine and Ativan to any patient who might become agitated or restless. The nurses could also have Xanax pills to quell their own anxiety.
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. The LifeCare pharmacist did not feel safe when he went back into the pharmacy. He gathered two boxes of morphine, each with twenty-five glass vials of the powerful drug, and one smaller box of Ativan vials, and handed the drugs to one of the nurses on duty to use on the honor system.
The nurse, Cindy Chatelain, had struggled with narcotics addiction and had previously had her license suspended for prescription painkiller abuse. Two weeks before the storm, the 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, shouldering 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.
Copyright 2013 by Sheri Fink. From Five Days at Memorial, published by Crown Publishers, an imprint of the Crown Publishing Group, a division of Random House, Inc. Reprinted with permission.