Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (78 page)

In 2010 I visited Pune, India. The previous year, during an outbreak of H1N1 influenza, health officials had panicked. Worried about the spread of the illness, they restricted patients with flu symptoms to a small number of local hospitals. Those hospitals were quickly overwhelmed.
A pediatrician, Dr. Aarti Kinikar, watched babies die because she did not have enough ventilators for them.

Triaging better was not enough for her. For years she had treated children in a public hospital where expensive resources were often in short supply. “God has given you the brain, just use it,” she liked to tell her students. “Just keep on thinking.” When the ventilators ran out during H1N1, she thought and she improvised. In the past, she had helped newborns with premature lungs breathe better with a therapy known as bubble CPAP, for continuous positive airway pressure. CPAP devices cost thousands of dollars, but Kinikar’s staff managed to patch together a homemade version out of a few dollars’ worth of plastic tubing and saline bottles readily available at the hospital. It seemed to work well on premature babies, and she decided, in the midst of the H1N1 crisis, to see what it might do for older babies with flu. “I didn’t know whether people will back me using a technique which doesn’t seem to have much scientific push,” Kinikar told me. The alternative seemed worse to her. “It was a decision between not doing anything and allowing the baby to die as against doing something and maybe keep your fingers crossed and let it work.”

When one baby with flu showed signs of improvement on a ventilator, she decided to try to wean him off the machine early and instead support his breathing with the improvised bubble CPAP system. The baby’s mother watched warily, but her son did well on the makeshift contraption. The ventilator was put to use to help another child. Over
the weeks of the pandemic, Kinikar used bubble CPAP to support the breathing of hundreds of children at her hospital. Colleagues credited her quick thinking with saving lives.

Perhaps American health professionals, dependent on the highesttech gadgets, could learn something from Kinikar. While there is little financial incentive in the marketplace to develop low-tech, inexpensive medical goods for disaster preparedness, the US government has made some investments. A recent federal grant was awarded to a company to create cheaper, easier-to-use ventilators. Already at least one firm, St. Louis–based Allied Healthcare Products, is marketing a line of ventilators specifically for use in disasters.

In the end, Kinikar-style thinking turned out to be the most important, life-saving aspect of what happened at Bellevue Hospital in New York after the generator fuel pumps failed. Volunteers formed a chain and passed fuel up thirteen flights of stairs to feed the generators manually. Swift improvisation prevented the backup power from cutting out, which prevented horrible choices from having to be made. Dr. Laura Evans’s patients were all maintained on backup power as evacuation of the hospital proceeded.

Hours later, climbing one of Bellevue’s long staircases, I passed personnel in blue scrubs carrying a baby in a transport incubator down to a waiting ambulance. Other staff huffed and puffed up the steps with supplies. Diesel fumes wafted into patient corridors. The situation balanced just on the edge of control.

With elevators out, the evacuation of the gigantic hospital took days, just as it had at Memorial. Two patients were kept for last. One was morbidly obese. He weighed around six hundred pounds—much more than Emmett Everett at Memorial. With the elevators out of order, staff members were very concerned about moving him. The other was, like patients at Memorial, extremely sick and fragile. His doctors were afraid he could die while being carried.

Nobody gave up hope. After the other patients were rescued, National
Guard soldiers carried fuel up thirteen flights of stairs for several more days until the elevators could be operated. Doctors in the disabled hospital performed heart surgery on the fragile patient, and both he and the obese man were safely moved to another hospital.

Dramatic scenes like this do not occur often. But being in New York for Sandy was a reminder that terrible triage conundrums can arise anywhere, at any time, and that they have the power to change lives irrevocably. Across the country many hospitals in flood zones have electrical backup power systems in their basements. Others, in earthquake zones, were constructed before modern building codes. Others are simply situated in Tornado Alley. To the extent that protections and plans have been put in place since Katrina, recent events have often shown them to be inadequate or misguided. Life and death in the immediate aftermath of a crisis most often depends on the preparedness, performance, and decision making of the individuals on the scene.

It is hard for any of us to know how we would act under such terrible pressure.

But we, at least, have the luxury to picture in advance how we would want to make the decisions.

ACKNOWLEDGMENTS

DEEPEST THANKS TO ALL who shared their experiences and knowledge in interviews, listed in the Notes for each chapter, particularly individuals for whom the trauma of those five days resurfaces upon remembrance. Several in particular took a risk to tell what they did and why. They are brave, as are the others who spoke outside of the “cone of silence” so that those of us who have not yet faced the consequential choices described here could learn from them. This book also owes a great debt to the other journalists who pursued the story, as described in the Notes section and the book itself. Further, Memorial staff members and others who wrote memoirs and articles about their involvement in the events brought to light unique details and insights.

This book grew out of the magazine article “The Deadly Choices at Memorial.” The product of a collaboration between ProPublica and the
New York Times Magazine
, it benefited from not one but three key editors. First came Susan White, now at the helm of
InsideClimate News
, whose wise early guidance on structure and narrative carried over from the article to the book. The
New York Times Magazine’
s Ilena Silverman’s suggestions and edits always rang true and bettered my work. The news genius that is Steve Engelberg edited “Deadly Choices” with the energy of two people while also serving as managing editor of ProPublica.
My ProPublica colleagues have been a source of inspiration. Other editors who read and improved the story included: Paul Steiger, Gerald Marzorati, Jill Abramson, Bill Keller, and Alex Star. Charles Wilson, David Ferguson, and Aaron Retica checked every fact, and Richard Tofel, David McCraw, and Loretta Mince had my back. ProPublica’s Krista Kjellman Schmidt, Jeff Larson, Dan Nguyen, Mike Webb, Lisa Schwartz, A. C. Thompson, and Robin Fields all made essential contributions; as did the
Times
’s Clinton Cargill, Joanna Milter, Patty Rush, Patricia Eisemann, and Matt Purdy; as well as Paolo Pellegrin, Macaulay Campbell, Stan Alcorn, and Bruce Shapiro.

Another wizard of an editor, David Baron, along with the exceptional staff of Public Radio International’s
The World
, provided an outlet to report on horrific triage dilemmas on the ground in Haiti after the 2010 earthquake and, with Patrick Cox, to explore medical rationing across countries and cultures, including the impossible choices made weekly in public dialysis units in South Africa. During the 2012 hurricane season, the
New York Times
Metro desk, ProPublica, and the
Times-Picayune
provided homes for reporting on what had and had not changed since Katrina. As this book neared completion, Julie Tate worked tirelessly to check facts and locate additional sources from afar.

Those who filled the margins of
Five Days at Memorial
in manuscript form with comments of exquisite insight and occasional blistering humor improved it greatly. Thanks to Nam Le, Susan Burton, Edward Broughton, Herschel and Adrienne Ruby Fink, Dr. Randi Cohen, Christine Kenneally, Paul Steiger, and Marian Moser Jones. Thanks to Harriet Washington for friendship and support.

The following individuals at libraries, archives, and news organizations were particularly helpful in locating historical material: Taffey Hall, archivist, and Bill Sumners, director, the Southern Baptist Historical Library and Archives in Nashville, Tennessee; Jim McCutcheon, production manager, Entercom New Orleans; Carl Lindahl, codirector, Surviving Katrina and Rita in Houston, Texas; Ann Hogg of the American
Folklife Center, Library of Congress; StoryCorps’s Nadia Wilson (archive intern) and Tayla Cooper (senior archive director); Irene Wainwright and coworkers at the New Orleans Public Library; Greg Lambousy, director of collections, Louisiana State Museum; Janet Spikes, Dagne Gizaw, and Michelle Kamalich at the Woodrow Wilson Center library; from the NBCUniversal archives, Jaime Severino, Luis Aristondo, and Sade Craig; from the ABC archives, Lidia M. Guardarrama and Joy S. Holloway; CBS’s Ann Fotiades and Matt Danowski; and J. T. Alpaugh of Helinet Aviation in Van Nuys, California. For responding to some large public records requests and assisting with interviews, thanks are due to staff members of the Louisiana Attorney General’s Office, the US Department of Health and Human Services, and the United States Coast Guard. I’m also grateful to the many attorneys and public relations professionals who took the time to facilitate contact with their clients and provide contextual information.

Thanks to Andres Martinez and the New America Foundation’s Bernard L. Schwartz and Future Tense programs. NAF research associate Rebecca Rabinowitz relived Katrina moment to moment in parsing hours of WWL radio broadcasts. Olivia Wang ventured back with me to 1926 and 1927 at the Library of Congress. Faith Smith, Caroline Esser, Rachel White, Steve Coll, Shannon Brownlee, Nicole Tosh, Rebecca Shafer, Allison Lazarus, and the other staff and fellows bolstered my work in myriad ways over the past three years.

The Woodrow Wilson International Center for Scholars provided a much-appreciated base of operations in 2010, thanks to Lucy Jilka and colleagues. The Center’s relationship with the Library of Congress facilitated my research, as did Phillip Wilcox, who dug for instances of healthcare rationing around the world; Aamenah Yusafzai, who amassed a small library on euthanasia; and the helpful Ted Miles.

This work began when I was a freelancer teaching part-time at the Tulane School of Public Health, and my research benefited from the early support of Penny Duckham and the Kaiser Family Foundation’s
media fellowships in health. Prior to that, the opportunity to work in the immediate aftermath of Katrina came by way of affiliation with the Harvard Humanitarian Initiative, where Dr. Michael VanRooyen, Dr. Jennifer Leaning, Vincenzo Bollettino, and colleagues work hard to improve medical care in crisis situations and have facilitated my access to Harvard’s library collections.

Sincere thanks for the kindnesses of Cheryl Young, David Macy, and the staff members and supporters of the MacDowell Colony and its De-Witt Wallace/Reader’s Digest Fellowship; Elaina Richardson, Candace H. Wait, and the staff members and supporters of Yaddo and its Dorothy and Granville Hicks in Literature Residency; and the Rockefeller Foundation, Rob Garris, Pilar Palacia, and the staff members of the Bellagio Center for the Arts.

Family members and friends were wonderful supporters of this work throughout its years-long evolution. The members of the Invisible Institute in New York have been dear companions in the world of ideas for nearly a decade.

I’ve saved the most important book-conjurers for last.

Tina Bennett is a miracle. Agent, advocate, sharp-eyed reader. She celebrates every least bit of success with motherly pride and shows up in times of trouble. She championed my work on this story from the moment I described it to her casually over lunch in early 2007. I appreciate her more than she knows and so, too, her peerless assistant Svetlana Katz.

I’m profoundly grateful for the way Crown has gone about putting
Five Days at Memorial
into the world. The house is filled with talented individuals who prove the value of traditional publishing in supporting the creation of books and helping readers discover them. Molly Stern, publisher, force of nature, makes the impossible happen. Thank you to Maya Mavjee, David Drake, Jacob Lewis, Christine Edwards, Candice Chaplin, and the outstanding sales force; the powerhouse publicity and marketing teams of Jay Sones, Jessica Prudhomme, Carisa Hays, Annsley Rosner, Michael Gentile, Leila Lee, and colleagues; Chris Brand for the
water-stained brilliance of the cover; Elizabeth Rendfleisch for interior design perfection; Rachel Meier, Amy Boorstein, and Luisa Francavilla for managing the near unmanageable; Terry Deal and Rachelle Mandik for their utmost patience and precision; and the great support of Wade Lucas, Kelly Gildea, Kirsten Potter, Linda Kaplan, Diane Salvatore, and Tina Constable. Special thanks to Rachel Rokicki, this book’s inimitable publicist, for her hard work and authentic zeal; Matthew Martin for careful and numerous legal reads; and to Claire Potter, for expertly liaising as editorial assistant, following on the excellent work of Miriam Chotiner-Gardner, who continued to contribute after becoming an assistant editor. Jeffrey Ward created beautiful maps that orient readers to a most disorienting situation.

Finally, all the adjectives in the world wouldn’t be enough to express my gratitude to Vanessa Mobley, perhaps the only editor who would leave the comforts of the big city behind to venture without a car in snowy, icy winter to the New Hampshire wilds to help her author bring her book home. Vanessa, thank you for your generous gifts of time, attention and editorial insight, your tremendous backing, and your unflagging trust in me and my work. Thank you for understanding why the story of these people, this place, matters. Thank you for making this a better book in every way.

NOTES

These notes are meant to clarify sourcing when it may not be apparent in the text, to offer finer detail on important points, and to guide the reader seeking additional information. Interviews with the author that informed the narrative are grouped by chapter and not typically referred to by page number.