Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (47 page)

Thiele looked at the scene on the second floor, lit naturally through vacant window frames—the dozen or so supine patients, the nurses and doctors attending them, the fans and water bottles, and the refuse thrown everywhere. Thiele saw morphine, midazolam, and syringes set up on a table near the ATM. He remembered his friend’s gesture on the emergency ramp, miming an injection. This is happening, he thought.

Thiele didn’t know Anna Pou by name, but she looked like the physician in charge on the second floor. She told him the category 3 patients were too sick to be moved, and without looking at their medical charts, he believed her. Some were sweaty, others slack with dehydration, breathing quickly. From some came unearthly rasps, then silence, rhapsodic
frog song, the cadence of the dying. He was sure they wouldn’t survive a trip to safety.

“Can I help you?” he asked Pou several times.

She told him no, he didn’t have to be there.

“I want to be here,” Thiele insisted. “I want to help you.”

Pou and several nurses took care of the patients lying near the hallway. He took charge of the four closest to the windows—three elderly white women and a heavyset black man—trying to start IVs for those who didn’t have them. The patients’ blood pressures were so low, their veins had collapsed like empty fire hoses. Apart from their breathing and the soft moans of one, they appeared lifeless and did not respond to him.

A nurse cleaned a patient’s IV port with an alcohol swab before giving an injection. The unintentional irony of the gesture struck him. What infection could have time to develop in a patient about to die?

Moral clarity was easier to maintain in concept than in execution. When the moment of truth came, he wavered. That’s when he turned to nurse manager Karen Wynn, trusting her experience in the ICU and her leadership of the hospital’s ethics committee. “Can we do this?” he asked. He was grateful for her assent.

Thiele gave patients a shot of morphine and midazolam at doses higher than what he normally used in the ICU. He held their hands and reassured them, “It’s all right to go.” Most patients died within minutes of being medicated. But the heavyset African American man with the labored breathing hadn’t.

Thiele gave additional shots of morphine. He thought it must have amounted to 100 mg. He chanted Hail Marys with Karen Wynn. The man kept breathing. Perhaps his circulation was so poor that the drug wasn’t getting into him.

Thiele covered his face with a towel.

He remembered it took less than a minute for the man to stop breathing and die.

It had gone against every fiber in his body to smother the man. It was something he had never thought he would ever have to do in any circumstance, was not in his “database.” Though he’d felt what he had done was right, immediately afterward the question of whether it was indeed right continued to play in his mind.
Can we do this?
If the man was unaware of what was going on, if he would have died in an hour anyway, how cruel was it to have suffocated him?

Thiele left the hospital that Thursday evening by helicopter and landed at the airport, where the patients he had injected—had they survived—would have gone.

Beneath a skylight in an open concourse, patients lay everywhere on litters and on the carpeted ground. They sat propped in wheelchairs and in hard airport seats, some moaning, most motionless. The stench of urine, overflowing diapers, and feces-soiled garments suffused the swampy air. Brain-surgery patients. Transplant-surgery patients. Patients with breathing tubes in their throats who needed oxygen, respiratory therapists, and ventilators. Hundreds had arrived and continued to arrive from the city’s hospitals and nursing homes. Thousands of hungry, thirsty, sodden evacuees, separated from their medicines for hypertension, diabetes, schizophrenia, and other ailments, camped under signs for Jesters Bar and Grill, Back Alley Jazz, and other airport concessions. Their voices swelled and rose, as did, in many cases, their blood pressures and their blood-sugar levels. The skeleton medical staff of doctors, nurses, and paramedics, many at work for more than two days without sleep, ranted at one another in exhaustion.

Thiele and a nurse who had accompanied him offered to help.
Stay outta the area;
a female doctor shooed them.
We got it covered
. The intermittent federal employees—members of Disaster Medical Assistance Teams, or
DMATs, who underwent specialized training—were not supposed to work with unvetted outsiders. There was no good system for checking whether or not someone who walked up to offer medical assistance
might be qualified. Per protocol, the teams at the airport turned away Thiele and other doctors and nurses, even as their members were utterly overwhelmed.

A DMAT had arrived that Thursday to join three other DMATs that had established the field hospital early Wednesday morning. Three dozen paramedics, nurses, and a few doctors who had trained and drilled and volunteered to respond in times of national emergency toured the site in disbelief. Many cried. Their supply caches, driven rather than flown from the West Coast, were late and short. Minute after minute, the helicopters landed and the patients kept arriving from hospitals and nursing homes, many times more than the volunteers had been told would come, ten times more than anyone who worked with a DMAT knew could possibly be cared for. Where were the departing flights to take these patients to real hospitals? Supplies ran out within a day. And they had no communications with superiors, no provisions for resupply.

Federal officials outside New Orleans touted the work of the DMATs in news interviews.

That Thursday night passed in moans and screams and death. No time to move the bodies. Thiele lay listening. His moral clarity returned. If the patients he had injected with morphine and midazolam at Memorial had come, instead, to this place, they would only have suffered and died.

Can we do this?
After the disaster, the question had shifted for Thiele from a moral to a legal one, the price of conviction in the currency of consequences. His attorney warded off the attorney general’s advances while Thiele—his home destroyed, and out of a job because of the hospital’s closure—sought the means to pay him.

In December, he attended a meeting of Memorial Medical Center doctors planning for an eventual reopening of the hospital. Thiele read aloud from a letter his lawyer had sent to the medical staff president. “Tenet, through its attorneys, has not agreed to pay the legal fees and costs incurred and to be incurred by John S. Thiele, MD, in connection with an ongoing inquiry by the state Attorney General.” Thiele’s attorney
argued that Tenet had the authority to pay, even though Thiele, as a physician contractor, was not a direct employee. Thiele wanted his colleagues’ support.

“Did you do anything you’d need a lawyer for?” a doctor, Brobson Lutz, asked Thiele.

“Let’s just say what I did I thought was right. Others think it was wrong.”

A gasp escaped from Dr. Horace Baltz, the senior doctor who had served during the storm. “Oh my God, John. I pray for you.”

Baltz had been an evacuee in northern Alabama when Dr. Bryant King appeared on CNN. Baltz had turned off the television and sat in a daze. This couldn’t be true. He fretted about the tarnished reputation of the hospital where he had invested his entire career, the sterling reputation so many colleagues had worked hard and long to build and uphold at Baptist and Memorial. How could he show his face after this, especially having recounted his hurricane experiences with pride at the small, rural hospital that served the region where he had taken refuge?

Baltz had only encountered King once, at an emergency meeting before the storm, and the young doctor had impressed him as conscientious and participatory, a team player. Why would he want to stir up a mess? Other colleagues spoke of King in terms of treachery. Rumor spread that he had fled the hospital soon after the floodwaters rose and was not even present on Thursday, September 1, despite the people who recalled interacting with him on that day. As hard as it was, Baltz had to believe that King was reporting events as he had seen them, events that he’d thought were wrong.

Baltz searched his memory for clues and settled on a conversation he had overheard. The scene: Thursday morning, September 1, in a doctor’s office on the second floor of Memorial. Three doctors in conversation. One said: “Our most difficult job will be to convince the nurses that what we ask them to do is all right.” Baltz stopped and asked what his colleagues were discussing, and one of the three said that some of the patients
couldn’t make it out on their own and would need to be “helped.” Baltz had wondered for a moment whether the doctor was talking about euthanasia. He dismissed the thought as absurd. This was loose and crazy talk, talk in which he did not care to be involved. He departed.

Dr. John Kokemor had, a short time later, guided Baltz and his elderly sister to the head of the boat evacuation line. Baltz was sure Kokemor knew his opinion of euthanasia. He was one of the colleagues Baltz believed espoused the “Governor Lamm philosophy.” Baltz and Kokemor, who had practiced together briefly in the early 1980s and then split, held low opinions of each other. Kokemor would later ridicule the idea that he had put Baltz on a boat to get him out of the way so that euthanasia could proceed. Kokemor called the idea a “fabrication,” a product of Baltz’s guilt over the
death of one of his longtime patients.

The seventy-eight-year-old woman with an advanced case of the movement disorder Parkinson’s disease had died that Thursday at Memorial after Baltz had last seen her. She hadn’t been acutely ill. He had admitted her for safety before the storm because she relied on electrical equipment for her care. He did this whenever hurricanes approached, throughout the eight years of her illness. And at her request, he always gave her a Do Not Resuscitate order, because she did not want any heroics in case her heart or her respiratory system failed unexpectedly. Her caregiver, a loyal sister, had been separated from her at Memorial.

The death of Baltz’s patient had surprised him. Her vocal cords were paralyzed. She couldn’t speak for herself. Could she have been euthanized? He resolved to find out what had happened and who was responsible. He resolved not to be silent about it.

SPECIAL AGENT Virginia Rider harbored a similar moral outrage. What had happened at Memorial was wrong. It was as basic as the tenets of her Catholic religion, but she wasn’t a rigid thinker. While she
wouldn’t ever want to be euthanized, she could understand that some people in some circumstances would. She had no problem with the illegal acts of the then-imprisoned Dr. Jack Kevorkian, who had built a killing machine and helped patients die, patients with advanced cancers, with progressive dementias that robbed them of their memories and independence. The difference was that they had requested his services. The doctors at Memorial, as far as Rider knew, had acted without consent. Rider spoke with the doctor who had treated Emmett Everett before the storm. Despite his years of paralysis and many medical problems, Everett had seemed content with his lot and had told his medical team to do “whatever it takes,” including surgery, so he could get as well as possible and return home to the grandkids who visited him often and the wife who would never agree to put him in a nursing home.

According to his caregivers, Everett’s passion for life had remained strong throughout the disaster. One of his nurses, Cindy Chatelain, told investigators that she had helped round up food for Everett on Thursday morning. (It was tuna fish, crackers, and relish, according to another staff member.) Chatelain said Everett had eaten his breakfast and was alert and oriented. He had worried aloud about his wife and asked if the three other patients who had been his roommates, who had left, were OK. He also expressed concern about himself. “Cindy, don’t let them leave me behind,” she remembered him saying.
She had promised him she wouldn’t. She lived now with a heavy burden of guilt and leaned harder on alcohol and prescription painkillers.

Rider spoke with Everett’s wife, Carrie, who told Rider that he had desired to live. She also gave the investigators a copy of a picture of him, the only one she had. In his photograph, Emmett Everett sat in front of a CocaCola machine in a cafeteria, holding a fork and a plate of food. He wore a tie and a white dress shirt across his broad shoulders. His eyes sparkled in the flash, giving him a boyish look even with a closely cropped gray goatee. Schafer, who was fond of nicknaming, began calling Everett the case’s “poster child.” The name stuck.

Schafer was also raised Catholic, like Rider, and he also was not an absolutist on matters of life and death. As an attorney, he had drawn up living wills for many people who wished to document their end-of-life preferences in advance of any problems. He, too, had done this, after getting older and thinking more about the issue. If he was a “vegetable,” he wanted that life-support plug pulled. But that was his decision. He didn’t want someone else making it for him.

While he felt it wasn’t his place to form opinions, given their medical conditions, he could perhaps understand why some of the patients at Memorial had been given the drugs. Others, like Everett, made him say “No way.” The point was that there were so very many cases, and each one was different. When some members of the public said, “If it was my mother, I’d want them to do that,” he wanted to ask, “How about
this
mother, this daddy, this uncle, this grandpa, this one over here?” How many people had to be injected before they’d no longer think, “It’s OK to do that.”