Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (48 page)

In 1979, Schafer’s father had spent two or three weeks at the hospital, sick with what his doctor described as “everything natural at one time.” Some people just wore out. Daddy was wearing out. Schafer had been with him, holding his hand, until he died. It never would have occurred to him to ask the doctor, “Why don’t you just kill him?”

It was hard not to be personally affected by the case. Schafer had developed the famous “Katrina cough” that seemed to strike everyone who spent time in New Orleans. He traced it to their tours of Memorial without masks; God knew what had come up from the sewers and drains.

The people Schafer spoke with—whether it was the family members of the dead or the nurses and doctors—had so much more on their minds than talking to investigators. He found himself feeling sympathy for nearly all of them; they were heroes.

As the scale and complexity of the case grew, Schafer saw that Rider in particular as lead investigator was spending a huge amount of time
ramrodding it. It had become so big that she had been taken off all other hospital and nursing-home investigations. She said that even at night, at home, she thought about the case. Only the two of them, investigative partners and allies, fully understood and shared each other’s passion.

They lived the case from early in the morning until nighttime. Every day. Every day. Every day. They held conclaves in his office with a big notepad on an easel. They brainstormed in the smoking area outside the building. They made frequent trips to New Orleans, where the blue tarp roofs everywhere were an inescapable reminder of tragedy.

They bounced ideas off of each other. It was never prosecutor-investigator. It was never him or her. It was them. Their case, their situation, what were they going to do. They got to the point where they almost thought alike. They talked constantly about the case. Theirs was a rare partnership, a great friendship. Schafer had never had one like it. He enjoyed every minute of it.

He thought the way they got along was like Rosalind Russell and Cary Grant in
His Girl Friday
. She, tenacious and idealistic in the pursuit of truth. He, a wily plotter who knows he needs her. Both addicted to their callings—two opinionated people who got along best when they were focused on their work—finishing each other’s sentences, lighting each other’s cigarettes (well, Rider didn’t smoke), knowing what the other was thinking.

They were perfect together. He couldn’t type. She could type a thousand words a minute. He loved seeing Rider, because seeing her meant it was going to be an exciting day. He knew it was unusual for two people to enjoy working together as much as they did.

Schafer felt Rider was the only person with whom he could discuss everything. He thought he couldn’t share details of the high-profile case with his wife. You just didn’t talk about those things with a spouse or with anyone else outside of the unit. You didn’t want secrets to be passed on to the grocer, the neighbor, whomever.

He knew his wife saw that he was caught up in something, and that
she worried about him working too hard. She worried that he might injure his health.

Schafer and his wife were dealing separately with an accumulation of family losses: first their daughter, then his wife’s cousin who was like a sister to her, and most recently his wife’s father—all in under five months. Schafer received a call about his father-in-law’s death while he was in the middle of an interview with a Memorial doctor, and he finished the interview. He plunged into work and tried to fill his time with the Memorial investigation. His wife retreated, sitting for hours in solitude on the back patio in their quiet subdivision, immersed in mourning. Schafer thought she grieved better by herself.

Schafer’s wife was a painter who also ran an art gallery that specialized in images of angels—a career launched years earlier when their now-deceased daughter had dreamed of an angel. Schafer admired his wife as an active and outgoing woman. The change in her was drastic.

Schafer grieved, but differently. He drove his daughter’s Honda Accord around the neighborhood. He patted the shift lever as if it were her hand.

As Rider and Schafer interviewed the employees who had received subpoenas, they had other investigators make screening phone calls to dozens more Memorial employees to assess where they were assigned to work during the storm and whether they had been on the seventh or second floor on Thursday, September 1. Most were storm-displaced and unreachable, or refused to talk, or requested lawyers, who often made their clients unavailable for interviews.

Rider prepared subpoenas for several doctors who might have worked on the seventh floor. Among them was young Roy Culotta, whom Butch Schafer began referring to as Doogie Howser, MD, referring to the child medical prodigy from the eponymous TV show.

People in the unit came up with nicknames for all the major players in the case. Several of the opposing attorneys were “Mr. Wonderful.” Tenet, “the Evil Empire.” Suspects were “the Cajun Injectors,” after the
Louisiana food brand of injectable meat marinades, which came packaged with a gargantuan needle and syringe. One syringe, available in chrome-plated copper, was called the “Fat Boy Injector.” Like doctors, law enforcement officials sometimes made tasteless jokes as a means of coping with tragedy.

Culotta came to his interview without a lawyer and spoke confidently. He had dark hair, darker eyes, and a youthful face.

Rider asked him to begin with the night of Wednesday, August 31.

“I remember being in the respiratory area,” he said. This was on the second floor. “We all took oxygen tubing from the wall and just … had it just blowing all over me because it was so hot.”

Did he realize how terrible this could sound when Dr. Bryant King and others had spoken of running out of oxygen for patients in the second-floor lobby? Why weren’t patients who needed oxygen carried to wherever it was, on the same floor, that oxygen could so easily be had?

Rider and Schafer did not ask these questions. If they had even thought of them they would have had to interrupt Culotta, who spoke for many minutes without another word from them, instead posing questions to himself and answering them. How was euthanasia first raised? In the context of pets. Was he aware of any patient deaths? “There were at least two patients who they brought all the way onto the, ah … at the top of the parking garage, who, you know, sitting there waiting for helicopters, went into respiratory distress and, you know, we decided that there was no way that they could make the trip.”

One was an African American man. Culotta didn’t know him, but “he was in really bad shape … and it was me and a nurse and essentially we gave him pain medicine, ah … as he was taking his last breaths.”

The other patient who went into distress atop the parking garage was one he had cared for in the hospital for the preceding two weeks, Merle Lagasse, who had end-stage lung cancer.

“I was trying to get her evacuated and she basically went into, ah … call … it’s called Cheyne-Stokes respiration where … it’s just, ah … it’s
kind of … it’s … it’s before you die and you start breathing in a certain pattern and, ah … and we, you know, we did everything we could to make her comfortable.”

Culotta’s monologue drifted to other events. Schafer politely brought him back to the deaths in the parking garage. “I hope you don’t read anything into this line of questioning, but you’re the first one that I’ve listened to that has had firsthand knowledge of this.”

“I knew she was dying.” When Merle Lagasse went into a breathing crisis, he had sent a nurse from the parking garage across the rooftop into a hospital window on the seventh story to go up and fetch medicines from the ICU. “I said go in the back, get some … some morphine and Ativan.”

The nurse returned with several drugs—Culotta recalled morphine, Ativan, and Versed. “Morphine is … it relieves that sense of, you know, gasping and yeah, it does hasten death, I mean, it’s no doubt about it but at that point it’s … the intention is to relieve any suffering, ah … and that’s what we did.”

He remembered being with Lagasse when she died. “The other gentleman, I was with him and I assessed him, gave him medicines, I went back fifteen, twenty minutes later, he was still struggling, we gave him some more medicine.”

Schafer asked how this differed from normal medical practice. Normally, Culotta said, the patient would have an intravenous line, and an electric pump would dispense precisely controlled amounts of the drug over time. “You can easily titrate the medicine, you know, so you start someone off at ten milligrams an hour and, you know, you feel like they’re struggling or in pain, you can easily go up to twenty.”

Without electricity, at the top of the parking garage, the nurse had simply injected a bolus of the drugs into the patients’ veins. Culotta didn’t remember the exact dose he ordered for Lagasse other than that it was a high one. She had been taking narcotic pills for pain and had developed tolerance to their effects.

“When we went to give her morphine, it ended her life.” Culotta’s
matter-of-factness surprised his interviewers. Was it standard practice to administer high doses of narcotics and sedatives when a patient developed the irregular breathing pattern Culotta had described? After the interview,
one of the investigators researched the question and shared the results with Rider and her team. The revving and stalling pattern of Cheyne-Stokes breathing could precede death, but also occurred in numerous other situations—for example, when certain people, especially those with heart failure or brain damage, were sleeping. This suggested there was at least some possibility that the patients Culotta had medicated were not about to die.

The agent found an article about a different type of breathing they had been hearing about in their interviews, called “agonal”—a gasping reflex that often occurs just minutes or moments before death when the level of oxygen in the body drops extremely low and the brain stem, a hardy and evolutionarily ancient part of the brain, is left in charge.
“Given our current knowledge of pain, suffering, and brain function, patients who are gasping are probably not experiencing pain or suffering.” That is because so little oxygen is reaching their brains.

Still, the gasping
looks
uncomfortable, a sharp contraction that rocks the body as if the patient is struggling to breathe, horrifying family members and even nurses when it persists. Some medical experts believed it was ethical to treat potential pain and suffering in these dying patients with morphine and other drugs, even if this could suppress breathing and quicken death, because it was impossible to know whether the patient experienced discomfort. Moral and legal culpability for the deaths rested on the wisps of contrast between wanting, foreseeing, and intending death.

ANNA POU was the focus of Rider’s every day. She began as a ghost, a dim presence haunting the seventh floor. Soon Rider had a sketch of
the woman. She knew her vital statistics. Name. Birth date. Last known address. She kept her driver’s-license photograph in a binder of others she passed before the eyes of hospital workers to identify.

Rider knew Pou’s signature, the round, generous cursive inked on a job relocation agreement setting out her employment at Louisiana State University with benefits contributed by Memorial a year before the storm. The same signature appeared beneath the words “morphine sulfate” on the three prescription forms dated Thursday, September 1, 2005, neat and assured in the foreground of chaos.

Rider knew that one of Pou’s older brothers, Frederick, named after their physician father but using the aliases “Johnny Morales” and “Cecilio Romero,” was a federal fugitive on the US Drug Enforcement Administration’s Most Wanted list, indicted for drug running with a last known address in Mexico.

Rider also knew Pou by proxy: a sketchy, phantom Pou, conjured at interviews conducted in hospital offices smelling of antiseptic and bathed in fluorescence; in a slideshow of living rooms; in the familiar formality of her building’s conference room, or at her or Butch’s desk, in Baton Rouge. She gleaned descriptions of the woman: “Fluffy-haired.” “Nervous.” “Incredibly dedicated.” Dabs and brushes of color on canvas.

Rider knew Pou’s allegedly used objects, collected and submitted to the crime lab, awaiting analysis for fingerprints. A plastic tray. A Sterilite drawer. Empty morphine vials. Discarded syringes.

Most of all, Pou materialized each time Rider returned to the dank cavern of Memorial in person or in her mind, retracing the doctor’s steps by light of day or in dreams at night. Rider tracked her, drawing nearer.

In early December, Rider, Schafer, and their team returned to Memorial with LifeCare’s pharmacist, Steven Harris. Three months had elapsed since the hurricane, and
the buildings were full of restoration workers, administrators, and other short-term visitors like them. Former employees and doctors returned to pick up personal property and medical records. Contractors arrived each day to tear out stained carpets,
mop floors, pump out elevator wells, and replace wires corroded by the muck that had swamped up from the sewer grates. They drilled away mold-spangled drywall like caries from a bad tooth. Each day each contract worker signed a sheet of paper beneath a bold-faced warning from Tenet Healthcare: “The Property is not in safe condition and entry into the property may subject the undersigned to a substantial risk of personal injury or death.” The workers agreed that they were entering at their own risk and would not sue the hospital.