Through Hell and High Water

CHAPTER 22: TRIUMPHS, TEARS AND CHANGED LIVES

By Jane O. Hansen | Saturday, May 27, 2006, 03:22 PM

The Atlanta Journal-Constitution

New Orleans — On Tuesday morning, Feb. 14, the sun shone in a crisp blue sky as dozens of people wearing scrubs and business suits gathered on the rooftop of Tulane Hospital’s Saratoga Street parking garage. In a few hours, Tulane would resume business, the first hospital to reopen in downtown New Orleans.

There to celebrate were Tulane staff and Hospital Corporation of America executives. They laughed and hugged, some seeing each other for the first time since Hurricane Katrina had changed their lives more than five months before.

“You smelled worse than me,” a physician said to a paramedic. “There’s a certain aroma missing. We’re all clean.”

Suddenly a helicopter appeared on the horizon, hovered above, then landed in the middle of the garage roof, its deafening rotor wash knocking some people nearly off their feet. The crowd roared when out of the aircraft stepped John Holland, the Georgia medical pilot — “The Man” — who had served during the rooftop rescue as air traffic controller.

Holland brought with him the huge American flag that had been draped over the hospital the week its employees and patients were stranded inside. Solemnly, he helped carry the flag on a stretcher across the roof and into the arms of those who would rehang it.

A champagne toast followed. Then everyone went downstairs to a tent outside the emergency room to await the arrival of Mayor Ray Nagin. The celebration was quintessential HCA. The tent was decked out with palm trees, chandeliers, hanging plants and refreshments. A Dixieland band played as more than 200 medical staff, seated on bleachers, did the wave. When the mayor arrived, the crowd hooted and hollered. Nagin and Mel Lagarde, the HCA executive who had helped run the Tulane evacuation, embraced.

“New Orleans is back!” Nagin shouted. “And we’re going to take it to the next level with HCA driving us all the way!”

With a snip of giant scissors, Nagin then cut the green ribbon stretched in front of the emergency room entrance. The ER, operating rooms, ICU and one-third of the hospital’s beds were now open. Full service is expected to resume in late summer or early fall.

Across the street, Charity Hospital — and its future — stood in stark contrast. A Georgia consulting firm has concluded the 67-year-old building is “unsalvageable” and not worth the cost to repair. There are preliminary plans with the U.S. Department of Veterans Affairs to build a new public hospital on a 37-acre plot of land a few blocks away. It will not bear the Charity name, and could take more than five years to complete.

In the meantime, a reduced medical staff is offering emergency medical services out of an old Lord & Taylor store next to the Superdome. A scaled-down trauma center has temporarily opened in leased space at another hospital.

As the Tulane party spilled onto a side street, “Big Charity” looked forgotten and forlorn, like an old grande dame whose glory days had passed. There was no music, no celebration. No workers had labored to clean her up or bring her back to life. Rather, Charity was alone, like a sick patient who has finally been taken off life support.

In the end, Tulane got all 178 of its patients out alive. All were safely transported to other hospitals. Among them was a 15-year-old boy on life support who was awaiting a heart transplant. He has since gotten a new heart at Texas Children’s Hospital in Houston and is doing well. The rescue operation involved 231 helicopter landings and cost HCA at least $2.7 million.

Six of Charity’s 347 patients died before they could be evacuated. Two were nursing home patients who died in the Tulane parking garage while waiting for helicopters. Four others — all critical — died in the hospital the first two days after the storm. An unknown number of patients, like Preston Johnson, died after their evacuation. But so many more lived, thanks to the countless doctors, nurses, pilots, administrators, family members and others who put patients’ lives above their own.

Mel Lagarde and Ben deBoisblanc were on opposite sides of the street during the storm. Each had been terrified patients would die. Each stayed until the end, protecting his hospital — Lagarde at Tulane, Dr. Ben at Charity. They didn’t know each other, yet their lives were intertwined by Katrina, and since have taken similar turns. Each has begun to rebuild his life, with a new sense of purpose.

One day last October, six weeks after the hurricane, Mel Lagarde was feeling the pressure to find the right people to chair his committees. The list of positions stared at him in large letters from a chart that hung on the wall.

After Katrina, Lagarde’s life took on a complexity he never imagined. On Sept. 30, the mayor named him co-chairman of a commission to help rebuild the city.

Sitting in an HCA office in Covington, across Lake Pontchartrain from New Orleans, Lagarde grew tearful as he recalled the images of his city under water: “Pictures can’t capture the death, the smells, the sounds,” he said. “You were speechless, breathless.”

Soon after his evacuation, Lagarde settled into life as a bachelor, his wife and children scattered. Their house in New Orleans was uninhabitable. A vacation home in coastal Mississippi had been leveled.

It was OK for the time being to live alone in a hotel room, because the rebuilding of the city is a “daunting task,” said Lagarde, who met four times with President Bush before the commission turned over its final report in January.

Last week, the newly re-elected Nagin asked Lagarde to chair the implementation of the plan. “Nobody’s ever done anything like this; 9/11 was a 12-block radius in a town that was mostly still operative,” Lagarde said. “We’re looking at models from World War II where entire cities were obliterated.”

Lagarde doesn’t like to talk about the week he spent at Tulane Hospital or his role in what happened. But he feels the experience helped prepare him for this next phase of life. He’s more comfortable not always being in control. He feels a deeper connection to people, to his city.

“It has made me have a profound bond with the people who were here with me,” he said. “To a certain extent, it bonded me to the city in a different way.” He choked up before continuing.

“It’s fragile now,” Lagarde said softly. “It needs help. There’s so much devastation. There are people whose lives have been destroyed.”

After the storm, he was at the helm of a sinking ship. Yet he and others saved it and pulled others aboard in the process. “You were part of something you never want to go through again,” he said. “But you’re proud to have been a part of it.”

His biggest regret from that week was not getting to know the Charity staff. Even after their sickest patients were gone from Tulane’s rooftop, and they had the chance to leave themselves, Dr. Ben deBoisblanc and others returned to Charity.

“I thought in a world of heroic events, this was like another completely selfless act,” Lagarde said. “To this day, I would love to meet that staff. I would love to tell them, whatever it’s worth, what an honor it was for me to be there and have seen that act.”

He and Dr. Ben didn’t get along on the rooftop. The impassioned Dr. Ben didn’t much like the calm, “cold” corporate executive. At one point, he referred to Lagarde as a “son of a bitch.”

Like Dr. Ben, Lagarde understands that one person’s perception is not necessarily another’s reality. “No one person has the complete view of everything that happened,” he said. But Lagarde saw something in the physician:

“I would hope that when I am acutely ill that I have a doctor like Ben deBoisblanc taking care of me,” Lagarde said. “I want that passion. I want that patient advocacy. I want that person fighting for my life like he was.”

Months after the hurricane, Dr. Ben went back to living on his beloved boat, Creola, in a Lake Pontchartrain marina. He had left the boat the day before Katrina hit and reported to work at Charity. A picture of his late father, who had instilled in him his love for sailing, was one of the few items he left behind. The photo was irreplaceable, but Dr. Ben had a feeling his father would watch over the vessel. Of about 300 boats in the marina, Creola was one of a handful still floating after the storm.

After Katrina, his 14-year-old son was in Houston, his 16-year-old daughter in north Louisiana and he was back on the boat, alone. Several months before, his wife of 20 years had left him. His children have since returned to live with her.

It has been a tough year for Dr. Ben. “My wife left me, I turned 50 and I spent a week in hell.”

But it has also been a year of triumph. “One of the remarkable things about having a mission is that it completely takes your mind off the fact that you haven’t bathed, you’re hungry, you don’t have water, people are dying,” Dr. Ben said. “We had a focus.”

Dr. Ben cried when he left Charity, knowing it might be for the last time. “Even if we built a new facility, part of me would die in that building,” he said. To him, Charity is more than a stately public hospital that has been the lifeline for generations of poor New Orleanians.

“It has a heart and a soul,” he said, “and to abandon it just doesn’t seem like an appropriate way to put it to rest.”

He’s committed to seeing a new Charity take its place, whether the old one gets a face-lift or a new hospital is built. “The option I can’t accept is we don’t need it anymore.”

He realizes the patient population in New Orleans has declined, and no one knows how many people will return. Only about 161,000 — or a third of the city’s population before the storm — have moved back. The pool of doctors, nurses and medical residents has also shrunk.

Although he has not completely resolved for himself what happened on the Tulane rooftop, Dr. Ben was surprised — and humbled — that Lagarde said he would choose him for his doctor.

“It was a difficult time,” he said, tearing up. “I think he understood my passion. For him to say such a kind thing tells me he’s a first-class guy. Like I said, if we could do it all again, we’d all do things differently.” He later added he appreciated “everything everyone did, from Jim Montgomery to Mel Lagarde. But they’re absolutely right. We were totally out of our league. Totally.”

He said the harsh comments about Tulane by Dwayne Thomas, CEO of Charity and its affiliate, University Hospital, were also born of passion.

“I’m a white kid from a middle-class family,” Dr. Ben said. “I believe in what I do, but I don’t live in the other universe.” Thomas, who is black, “grew up in the other universe. I see it as haves and have-nots… . But when you look at the have-nots in New Orleans, most of them are black, and Dwayne feels that pain.”

Thomas may have been “speaking on hearsay” when he said Tulane did not aid the evacuation of Charity, Dr. Ben said. But that’s no different from the media reporting rapes and murders that later turned out to be rumor.

“Those were believable rumors by people who wanted to believe them,” Dr. Ben said. “The stereotype of poor black people in southern Louisiana is they must be murderers and rapists.”

Similarly, he said, it may have been easy for Thomas to believe that the private hospital’s employees were evacuating themselves before his public hospital’s patients. “I could imagine hearing that just burned a hole through him.”

One incident in particular rankled Thomas - but it involved patients from University Hospital, not Charity. He told The New York Times that he put babies from University in boats with their mothers and doctors, “but they were turned around at gunpoint by Tulane police.” Tulane officials say it never happened. But Dr. Brian Barkemeyer, a neonatologist at University, saw six nurses leave with babies, and he saw them return. “They told me when they approached Tulane, guards with guns turned them away.”

Whatever happened, Barkemeyer said, “It probably happened at the hospital security level. I don’t believe it would have been mandated from above.”

When Dr. Ben heard about the babies, he understood Thomas’ outrage, and how the heat of the moment can affect a person’s viewpoint.

Since his evacuation, Dr. Ben has kept a set of keys in his pocket. They belonged to a patient who dropped them as Dr. Ben loaded him into a helicopter the final day of the airlift. He never learned the man’s name, or whether he survived. “They somehow connect me, I guess, to my past — to all those experiences that I had. And I sort of look at them as a bridge to the future.”

Just as that man’s future was uncertain, there are unknowns in his own life. A critical care pul- monologist, he is working in intensive care units in two far-flung hospitals — one public, one private. He remains on the LSU medical school staff.

Other than the end of his marriage, he calls his week trying to save Charity “the most phenomenal experience I’ve had as a human being.”

“I don’t have post-traumatic stress disorder. I’ve never felt more alive. I feel like it’s awakened something inside of me. I have post-traumatic elation disorder.”

Before that week, he was a “techno-geek” working in a technologically driven environment. Patients had become little more than a diagnosis. “When we lost the technology,” he said, his voice catching, “it was as though the patient emerged. The human being had been covered by this veil of technology, and we peeled back the layers and all of a sudden we reconnected.”

There were so many heroes and heroines that week, he said, people who have now lost their jobs. He doesn’t see himself as a hero. “I’m just a schmo schlepping through life.”

There were no bad guys, he said, just a lot of individuals trying to do the right thing in a very bad situation. Together, they achieved something remarkable.

“The story of triumph in our days there was that none of us would have chosen to walk away, to abandon our patients,” he said. “It was so crystal-clear what our responsibility was — that we had been entrusted with these patients, with their lives, with their futures. And that was a trust we were not going to break.”

It was the essence of Charity.

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Chapter 21: THREE MOMS: HARDSHIPS SHARED, FRIENDSHIPS FORGED

By Jane O. Hansen | Friday, May 26, 2006, 01:38 PM

The Atlanta Journal-Constitution

Nearly two weeks after her son’s death, Carolyn Lewis was still searching for his body.

It wasn’t at Baton Rouge General, where he had died shortly after his evacuation. Carolyn called the local sheriff’s department.

I’m trying to find out where my child’s body is, she said.

Her sister called the governor’s office. Someone said he had been taken to Huey P. Long Medical Center in central Louisiana. But when Carolyn’s oldest son called there, asking about Preston Leon Johnson, the hospital had no one by that name.

She went on local television, pleading for help from anyone who might know where the body of her 25-year-old son had been taken. In the second week of September, she got in touch with Celeste Waddell. Perhaps the respiratory therapist from Charity Hospital could help.

Waddell had told Carolyn she wanted to stay in touch. The year before, Waddell had lost her own son, and she knew what Carolyn was going through. You will always have a place in my heart, Waddell had told her while they were both still trapped inside Charity.

After making some calls, Waddell told Carolyn it was likely Preston’s body had been taken to the mass morgue for Katrina victims set up by the federal government in a warehouse in St. Gabriel, La., a small town about 70 miles northwest of New Orleans. A funeral home would have to claim the body.

Carolyn told the local funeral director he would be able to identify her son by a tattoo on his left arm of praying hands and the words, “Only God can judge me.” On Sept. 13, the man found Preston at the makeshift morgue. The keepsakes Charity nurses had wrapped around his arm and middle finger before his evacuation — a wooden cross and a key chain with pictures of his little boys — were gone.

Recently, Carolyn sat in her small, tidy home in Lake Charles, La., surrounded by religious objects and family pictures. She wore a blue denim sweat suit and large silver hoop earrings, her hair piled on top of her head. She said her son’s death could have been prevented had he been moved out of Charity earlier and into a functioning hospital that could have given him proper care.

“I feel everybody passed the buck,” she said. “The president did his share of it, the governor did her share of it, and the mayor did his share of it.”

Although it was not the family’s custom, Carolyn had Preston’s body cremated. The remains are in an urn in her home.

At 55, she is helping raise two active little boys, her grandsons, ages 6 and 4. The last promise she made to her son was to be there for his boys. “I thank God for him,” she said. “I was proud of him. I thank God that he was mine.”

Sherry Hebert went straight to Hunter’s bedside at Earl K. Long Medical Center in Baton Rouge after saying goodbye to Carolyn. It had been three days since she had seen her son.

He had been evacuated from Charity Hospital Wednesday night. But she didn’t get out until Friday, Sept. 2. That night, she had begged everyone — the Federal Emergency Management Agency, the National Guard and the Louisiana State Police — not to make her fly from the New Orleans airport to a military base in San Antonio. Her son was lying critically ill in a hospital in Baton Rouge, close to her home. She wanted to head there. But authorities told her evacuees were under marshal law and now “federal refugees.” For the time being, they would do as they were told.

Almost as soon as they landed in Texas, Sherry and Carolyn had walked away, grabbed a taxi and gotten on a plane to Baton Rouge with a layover in Memphis. They were back in Louisiana the next morning.

When Sherry arrived at the hospital, Hunter was still critical and on a respirator. He was swollen all over; his kidneys no longer worked. He would remain in the hospital for 49 days. Sherry slept on the floor the first 22, while he was in intensive care.

If he had been evacuated from Charity a day or two earlier, she believed, he wouldn’t have lost his kidneys. But Hunter, now 24, got out alive, and for that she is eternally grateful. Had it not been for Dr. Ben deBoisblanc and all the staff on the sixth-floor ICU at Charity Hospital, Hunter would not have survived. By putting a tube into his chest on the way to the Tulane Hospital helipad, they had saved his life.

Hunter was eventually discharged from the Baton Rouge hospital, had a seizure and returned. In the coming months, it would be touch-and-go with more seizures and treatment for Goodpasture’s syndrome, a rare immunological condition with symptoms like those of leukemia. But he made gradual improvements.

On Saturday, Dec. 3, Hunter Reeves married his fiancee, 18-year-old Kristy Arceneaux. He wore a tuxedo and a cowboy hat to hide his loss of hair from chemotherapy. Dr. Ben was there, and after the couple was pronounced husband and wife, Hunter made a speech. He thanked Dr. Ben and resident Dr. Jeffrey Williams for saving his life.

On March 17, Hunter’s wife gave birth to a baby, Kali Ann. “She is a sweet baby and doing fine,” Sherry said. “Oh, she looks just like Hunter.”

The family hopes Hunter will be placed on the list for a kidney transplant. Sherry said they were told it could take a year. Meanwhile he gets dialysis and physical therapy three times a week.

In recent months, Sherry has spoken by phone with Carolyn and Celeste Waddell. Carolyn asked about Hunter’s wedding and told Sherry she had a gift for her new grandbaby. Sherry wants to surprise her one day with a visit.

“I think the three of us felt the heart-wrenching pain of what our kids were going through,” Sherry said. “They both touched my life. It’s something I’ll never forget.”

On Sunday: The fate of two hospitals and two men who helped lead them through crisis. Last of 22 chapters.

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Chapter 20: KINDNESS FROM STRANGERS, AND WORDS THAT STING

By Jane O. Hansen | Thursday, May 25, 2006, 03:57 PM

The Atlanta Journal-Constitution

On Friday, Sept. 2, Susan Sanborn lined up for a tetanus shot and a dose of Cipro at a hospital in Covington, La. The vaccine and antibiotic would help ward off bacteria that the Charity Hospital student nurse might have picked up from the filthy water in New Orleans.

A chartered bus then drove her to a shelter in Lafayette, La., where she received fresh underwear, new scrubs, flip-flops, toiletries, a towel and washcloth. She took her first shower in nearly a week, luxuriating in the soap, water and shampoo.

A school bus took her to a banquet hall where evacuees were regaled with a feast of Popeyes chicken and home-cooked jambalaya. Sanborn, already a slim, small woman, had lost nearly 4 pounds while marooned in Charity Hospital after Hurricane Katrina.

Her evacuation had come courtesy of the Hospital Corporation of America and a makeshift helipad across the street, at Tulane Hospital’s parking garage. Now she was in the care of HCA, Tulane’s corporate owner, which had set up shelters in Lafayette. About 1,200 evacuees, mostly Tulane employees and staff, would come through them in the next 24 hours.

Sanborn was overwhelmed by the outpouring of assistance. Someone asked for her name, Social Security number and where she wanted to go. They handed her information on how to get relief assistance, disaster benefits and, if she were a Tulane employee, a paycheck.

Where do you want to go? they asked her. She said she was from Columbus, Ohio, but joked she would be happy to stay put. I’m clean, there’s nobody here with weapons, the food is wonderful, it’s air-conditioned.

The next day, Sanborn and about 60 others boarded buses for the Lafayette Regional Airport. HCA had chartered planes to Houston and Atlanta. Anyone going farther would receive a ticket to a final destination.

At the airport, security stopped her. She had forgotten she was still carrying her scalpel. Guards confiscated it.

In Atlanta, HCA representatives met the evacuees at the gate. Anyone who had to stay overnight received cash and a hotel reservation. Sanborn was booked on Delta Flight 1630 to Columbus. Before heading to the gate, she said goodbye to the people she knew, and for the first time that week she felt lonely. Wearing scrubs and flip-flops, she started to board her flight that Saturday night, when a Delta representative suddenly pulled her aside.

Here, my dear, you have a different seat, he told her. My cousin, Katrina, upgraded you to first class.

Sanborn was confused. Oh, my God, she didn’t have to do that, she said. Later, she wondered whether he thought she had lost her mind.

Columbus was the city where Sanborn had grown up and trained to be a dancer. Other than the people at Charity, she felt she had no real family. But she did have a friend and mentor in Columbus — her ballet professor, who offered her a room until she could get settled.

One day, after arriving in Columbus, Sanborn saw a picture of one of her patients in U.S. News & World Report. He was sitting on a New Orleans median strip. What do you mean they put him there? she said to herself.

She spent hours on the Charity Web site looking for her patients’ names on the list of those who had been evacuated. All had left her unit alive, and she wanted to know they were OK. But one of her patients was missing from the list: the man she initially knew as Ebony.

Ebony and Ivory were the names Sanborn and others had coined for two elderly nursing home patients, one black and one white, brought to Charity the day of the storm. They were on ventilators, with no medical information. Sanborn had grown attached to the two men.

Later she would learn that Ebony was one of two patients who had died in the garage while waiting for a helicopter. The student nurse felt empty, sad and angry. How could the government just leave a city like that?

She spent much of her time those first few weeks watching television coverage of the hurricane. She had developed conjunctivitis in both eyes, probably from the water she had crossed from Charity to Tulane, but she remained glued to the set, and wept.

On Sept. 8, she was watching a CNN broadcast called “Angels in the Storm” that chronicled individual tales of heroism. Toward the end was a segment about the helicopter rescue off Tulane Hospital’s parking garage.

There on the screen was Dr. Ben deBoisblanc from Charity, speaking excitedly about his patients. “Two of them have already died here on this ramp waiting to get out!” he said. “In this very spot!”

The correspondent reported, “The Charity staff watches as Tulane’s people get out while their own patients are ignored.”

Sanborn immediately called CNN. She was transferred several times and finally left a message: That’s erroneous reporting. It’s not true. Tulane delayed evacuation in order to help our critical care patients.

She left her number, saying she was a student nurse who had been there. But no one called back.

Spurred on by the broadcast, the next day Sanborn e-mailed HCA. She was tired of the media focusing on snipers and guns. “There are truly no words to express my gratitude to HCA for absorbing and rescuing our patients at Charity Hospital and for rescuing me, five nurses and two children from our unit,” she wrote. “I wish you and your staff members and hospitals the very best as we all try to put the pieces back together after this tragedy.”

Jack Bovender, CEO of HCA, would be one of the first to read the student nurse’s e-mail.

The CNN account was one of several media reports in which Charity officials criticized Tulane Hospital’s treatment of their patients.

A Sept. 11 article in The Philadelphia Inquirer quoted Dr. Ben: “We sat there from 7 a.m. Thursday until 7 p.m. trying to keep these patients alive … while HCA landed helicopter after helicopter after helicopter to carry off healthy people. I had to physically restrain some of the residents who went ballistic.”

Some of the most critical comments came from Dr. Dwayne Thomas, CEO of Charity and its affiliate, University Hospital. In a Sept. 14 broadcast, he told CNBC, “In actuality, HCA did not assist us in evacuation at all.”

In a Sept. 19 article in The New York Times, “a quietly furious” Thomas blasted Tulane: “To load able-bodied staff before you let patients off a roof is reprehensible.” Thomas, who now refuses to comment, was never at Charity that week, nor was he on the Tulane garage roof.

Months later, some bad feelings remain.

Since Hurricane Katrina, HCA administrators have refrained from criticizing the government for failing to rescue Charity, or Charity for sitting back and waiting. They have said that as a private hospital, Tulane has far more resources than the public hospital. It would be unfair to make a comparison. But they are quick to defend what they did for Charity’s sickest patients, and they bristle at Thomas’ disparaging remarks.

“Let me make something clear,” said Mel Lagarde, the HCA executive in charge that week at Tulane. “At no point in time did we ever turn away a patient from this hospital. At no time did we say less acute patients are going ahead of critical patients. That would never enter the minds of anyone. The last thing we wanted was for someone to die.”

Hospital administrators had nothing to do with the triage of patients, he said. That was handled by physicians whose sole goal was to save as many lives as possible. Dr. Norm McSwain, trauma director at Charity, was one of those who helped decide who went out first.

McSwain, who as chief of trauma surgery for the Tulane medical school had affiliations with both hospitals, blames criticism of Tulane on “smoke and mirrors.” By making Tulane the bad guy, he said, Thomas could deflect criticism away from the state.

“The true story is the government didn’t show up,” McSwain said. “Nobody showed up — not the state, not the federal government, not the local government. Nobody showed up to evacuate Charity’s patients.”

Had it not been for HCA, McSwain said, Charity’s critically ill patients would not have been rescued, at least not in as timely a fashion.

There were heated arguments on the rooftop. Jim Montgomery, president and CEO of Tulane Hospital, says he had words with Dr. Ben when Charity brought over not just patients on stretchers, but those who could walk.

“We were hot, tired, sweaty, hungry, all the above, and yeah, it was frustrating,” he said. “But at the end, when you turn around and think about it, you knew you had to help them. And that’s what has irritated us — their somewhat aggressive attitude in trying to say we didn’t.”

In the end, Lagarde said, “We were able to accomplish for them what they were unable to do on their own.”

As time has passed, the harsh remarks about Tulane have dwindled. At a slide presentation to medical students and residents two months after the storm, Dr. Ben steered away from criticizing Tulane.

But the already strained relationship remains fragile between the public and private hospitals. Like thousands of others in New Orleans, those inside the hospitals lived through a disaster of near-biblical proportions, and chaos at times reigned. Tulane “was a different world” from Charity, Dr. Ben said. “It’s a parallel universe.” In recounting what happened, “Everybody’s telling the truth. It’s just a different perspective.”

From his perspective, a breakdown in communication on the rooftop and the lack of a command-and-control structure higher than Tulane or Charity led to a “Lord of the Flies” struggle to survive. It was the haves vs. the have-nots, and Charity got in Tulane’s way.

“They had their own responsibilities to evacuate their own patients, their own medical staff. And basically, they helped us when they could, but we were more of a nuisance than anything.”

Still, his perspective has changed with time, at least partially. “It’s become obvious to me that they did care a lot,” he said recently. “The truth is probably somewhere between those two perspectives. It usually is.”

About a week after sending her e-mail to HCA, Susan Sanborn got a call. Bovender, the CEO, had instructed his human resources department to track Sanborn down.

The woman on the phone asked Sanborn her plans. Sanborn told her she hoped to get her associate nursing degree at a state school in Ohio, where she now lived. The woman told her HCA wanted to offer her a scholarship and encouraged her to go to Mount Carmel College of Nursing, a private school in Columbus where she could get her bachelor’s degree.

Sanborn was stunned. You understand, I have nothing to do with y’all, she said.

On Sept. 20, Sanborn wrote another e-mail to HCA: “This will not be an eloquent letter because I have not yet sorted out my feelings,” she wrote. “However, I must in some small way, again acknowledge the great gift you have given to me. In time, I will have the words I need in order to thank you properly. In the meantime, know that I am crying. And these tears are the first I’ve shed in several weeks that are not out of grief, but out of joy.”

ON SATURDAY: Two mothers go on. Chapter 21 of 22.

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Chapter 19: CATCHING RIDES TO FREEDOM, SAYING THEIR GOODBYES

By Jane O. Hansen | Wednesday, May 24, 2006, 01:08 PM

The Atlanta Journal-Constitution

New Orleans — By Friday morning, Sept. 2, Dr. Ben deBoisblanc was nearly a one-man operation on autopilot. As long as helicopters continued to land on the roof of the Tulane Hospital parking garage across the street, the impassioned physician was going to get his patients over there.

Wednesday, he had managed to get four patients from Charity Hospital evacuated by choppers; Thursday, about 30 more. All were critical and two had died while waiting in the garage.

But Friday more than 200 patients remained trapped in Charity, as well as about 800 employees and their families. Four days after Hurricane Katrina, they were nearly out of food, water and medicine.

Don Smithburg, CEO of nine public hospitals, including Charity, held a news conference at the state command post in Baton Rouge, pleading for help. Provisions were running low at Charity and University hospitals, he said. People were feeding themselves intravenously. They needed to be rescued. Today.

“I pray for that,” he said on air. He felt prayer was all he had.

Dr. Ben had given up hope that the Federal Emergency Management Agency or anyone else from the government was on the way. All week, he had heard that FEMA was coming, and no one showed. Occasionally, a National Guard truck or a Louisiana Wildlife and Fisheries boat arrived to take away some patients. But there was no wholesale evacuation.

Some doctors had already flown out with patients. Dr. Ben could have gone, too. Instead, he had waded back from Tulane to Charity Friday morning to help others.

It was just like Dr. Ben to be there until the end, Celeste Waddell thought. The respiratory therapist had worked with him for years on the medical intensive care unit. All week, he had come around telling Waddell and others, *Believe me, trust me, we’re going to get you out of here.

*Many nurses on her unit were young, and afraid. One had come to Waddell and asked: *You’ve known him longer. Do you think he’ll get us out?

*Dr. Ben had always told Waddell that a person was only as good as his word.

If he said he’s going to get us out, *Waddell told her, *he’ll get us out.

Midday Friday, Dr. Ben arrived back on the Tulane roof with another group of patients. But this time, he found the place deserted, except for a police helicopter from north of Chicago.

Hadn’t they known he would be back with more patients? It was just as Dr. Ben had thought all along. They didn’t care about his patients. The Tulane people had abandoned them.

*The show’s over, *the pilot, Cmdr. Dan Bitton, told Dr. Ben.

You gotta help us, Dr. Ben said. *We got sick patients we need to get out of here.

*Dr. Ben didn’t know that executives of the Hospital Corporation of America in Nashville had offered to keep sending helicopters at its expense, and that Dr. Jim Aiken, one of those in charge at Charity, had declined.

Bitton’s aircraft wasn’t designed to transport patients on stretchers. But he agreed to get in the air and try to signal more helicopters to come to their aid. Once airborne, Bitton called HCA. Soon, the right kind of helicopter was on the way.

At Charity, a noisy exodus was by then under way. Susan Sanborn lined up with others against the yellow-tiled walls on the first floor, leading out to the emergency room ramp. Her own patients had been evacuated the day before, but now the staff were being told to grab their belongings. They, too, might get out.

Someone with a bullhorn yelled for a nurse to come to the front and accompany patients on a boat to Tulane.

Nurse, stretcher, go, go, go!

Sanborn’s supervisor pushed her ahead. Sanborn was unsure of herself. She was still a student, and they were calling for a nurse. You know what to do, her supervisor reassured her. You’re better than some of the nurses.

Sanborn didn’t want to be separated from her unit. But she and another nurse boarded a boat with patients for what should have been a short trip to Tulane’s Saratoga Street parking garage. Instead, the man piloting the boat took a long way around, to avoid a truck and two other airboats blocking the way.

When they eventually pulled up at “the beach” — the partially submerged first-floor ramp of the garage — Dr. Ben was there to drive them to the roof in a pickup truck.

If Sanborn had been frightened in her final days at Charity, it didn’t compare with the fear she felt in the ride to the roof with Dr. Ben behind the wheel. He raced up the ramps, tires screeching as he turned the sharp, steep corners to get them to a helicopter before it left. Sitting against the cab of the truck, she lifted her arms and held onto the rack behind her. Her two patients were taped to tabletops that served as stretchers. The tailgate was down, and she looped her feet under the tape to prevent her patients from flying out the back.

Sanborn vowed never to get into another moving vehicle with Dr. Ben.

As they neared the roof, she saw the evidence of a triage operation — empty oxygen tanks, rubber gloves, Ambu bags used to squeeze air into patients’ lungs. Wow, she thought, so this is where it all happened.

Despite the harrowing ride to the roof, Sanborn made it in time. She climbed into the helicopter with her patients, surprised and happy to find her supervisor and other nurses from her unit already on board. They had arrived earlier, and their patients had already been airlifted by medevacs equipped with their own medical staff.

As she lifted off Friday afternoon, Sanborn shared the feelings many experienced upon getting out. Operating in their own silos all week, they hadn’t seen the television images of mile after mile of devastation along the Gulf Coast. There was so much water, fires still burning, unbelievable damage. It wasn’t until they left New Orleans that they began to understand the enormity of what had happened — to their city, their hospitals, themselves.

But like others, Sanborn also would feel an intense pride. She had been part of something extraordinary. So few people had died in the face of so much danger.

One of the last people Dr. Ben helped evacuate Friday afternoon was a man who had been found at the side of a building doubled over in pain. The Louisiana Department of Wildlife and Fisheries had brought him to the Tulane garage by boat.

The man was lying on a piece of cardboard, clutching his abdomen. Dr. Ben didn’t know what was wrong, just that he was in so much pain he couldn’t speak. Dr. Ben noticed he was dressed nicely in khakis, as if he were a foreman or a manager.

As the doctor helped load him onto the chopper, the man’s hand opened and a set of keys fell onto the concrete. Dr. Ben picked them up. But as he reached to clip them to the man’s belt buckle, the helicopter lifted into the air.

The physician didn’t know who the man was, where he was going, whether he would survive. Like so many of Charity’s patients, he was heading to some unknown place, facing an uncertain future.

Dr. Ben thought of the Tomb of the Unknown Soldier. Maybe he could find him one day and give him back his keys.

Dr. Ben slipped them into his pocket.

If she did not get out of Charity on Friday, Sherry Hebert had decided, she would swim out the next day. She wanted to get to her son Hunter. He had been the first Charity patient airlifted from Tulane’s parking garage Wednesday night. The water no longer scared her, not as much as the possibility of dying in the hospital.

But Friday afternoon, more than three days after Charity had been told FEMA was on its way, the government finally showed up with a cavalcade of boats and trucks. The water had receded enough that giant 18-wheelers could pull up to the hospital.

Like the Chinook helicopters that had sped up Tulane’s evacuation, the trucks helped do the same for Charity. As many as 20 people at a time climbed aboard — first the remaining patients, then family, and finally exhausted but jubilant staff.

Sherry was shepherded onto an airboat with Carolyn Lewis. The women had become friends in a hospital waiting room, worrying and struggling to keep their critically ill sons alive. Sherry had been there for Carolyn when the woman learned her son Preston hadn’t made it.

The day before, the two mothers had lined up to go out by airboat, but the rescue was aborted when the craft came under fire. This time, a member of the National Guard rode with them, his rifle pointed in the air.

Later Friday, Celeste Waddell left Charity in the back of an 18-wheeler. The respiratory therapist was taken to the New Orleans airport, where the military hustled her onto a plane to San Antonio. From there, she would fly to Dallas, where her sister lived.

Waddell had grown close to Sherry and Carolyn. The three shared the bond of motherhood. Each had a son. One had died, one survived, and one was long since gone.

As her plane left New Orleans, Waddell’s thoughts were of her son, Chris, who was buried there. She looked out the window into darkness.* I’m not abandoning you,* she told him.* You’ll always be with me.*

Dr. Ben oversaw the air rescue of 21 more patients from the Tulane helipad that day. By the time he arrived back at Charity about 3:30 p.m. Friday, the long-awaited evacuation of the hospital was at last in progress. It would all be over in a few hours.

Twenty-eight years earlier, as a young medical student, Dr. Ben had started his career at Charity. He’d done his residency there and never left. The hospital was central to his life, just as it was to New Orleans.

He was one of the last to leave. On the way out, he passed a sign welcoming people to a place “Where the Unusual Occurs and Miracles Happen.”

Dr. Ben cried. He had a feeling he would never walk through Charity’s doors again.

ON FRIDAY: Susan Sanborn searches for her patients; Charity officials publicly criticize Tulane. Chapter 20 of 22.

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Chapter 18: FOR ONE HOSPITAL, A MARINE PROTECTOR AND A FINAL EXIT

By Jane O. Hansen | Tuesday, May 23, 2006, 01:46 PM

The Atlanta Journal-Constitution

New Orleans — *The Tulane Hospital parking garage shook as the sky lit up in one spectacular explosion, followed by three smaller ones. Flames shot 1,000 feet into the air.

It was 4:35 a.m., Friday, Sept. 2. Everyone on the rooftop jolted awake. It felt like an earthquake. It was actually a chemical depot exploding. But after four days of isolation, and having come to believe that their own government had abandoned them, the doctors, nurses and administrators had no idea what it was. In that moment between sleep and wakefulness, their minds ran amok.

Attack helicopters are firing missiles, Dr. Granville Morse thought.

The feds couldn’t fix this so they decided to nuke it, thought Dr. Ben deBoisblanc.

Dr. Jennifer McGee, a chief resident for trauma surgery assigned to Charity Hospital, was among those who had spent the night in the garage after laboring for hours to get the sickest patients evacuated by helicopter. Concern for them had been paramount. Now, for the first time, she worried about herself.

I’m going to die, she thought. I’m not going to get out of here.

A young Marine was their defender. He had touched down in their makeshift bedroom earlier that night, and would soon win a place in their hearts. He told them he had just returned from his second tour of duty in Iraq.

He looked no older than 25. But what he lacked in size and age, he made up in confidence. A member of a Marine sniper team, he was a fearless Rambo who sprinted along the edge of the parapet encircling the garage roof. He would dive full-length onto the narrow wall, pointing his M-16 to the streets below. He’s going to fall off, they thought.

In other circumstances, his antics might have seemed bizarre. But in this frightening, surreal situation — with armed looters roaming the flooded city and fires and explosions dotting the horizon — his actions seemed perfectly normal. This was a war zone and those on the rooftop found his presence, and his weapon, reassuring.

As the sun rose, Dr. Ben, director of Charity’s medical intensive care unit, prepared to return to his hospital across the street to bring back more patients to the helipad. Although the most critical were gone, more than 200 patients were still stranded at Charity, along with about 800 staff and family members.

Jim Montgomery, president of Tulane Hospital, told Dr. Ben that his residents on the rooftop were welcome to get in line with the hundreds of Tulane employees and family members waiting to leave. Dr. Ben told the young doctors they were free to go, but he was returning to Charity.

An emotional struggle ensued as Morse and several other residents debated whether to wade back through the filthy water or leave by helicopter.

They forged an agreement: If a boat or truck arrived before the last helicopter, they would return to Charity and help rescue the remaining patients. If the helicopter came first, they would climb aboard and leave.

Shortly after Dr. Ben and a handful of others left for Charity, a 55,000-pound Chinook appeared on the horizon. It was followed by a second, then a third.

The mission Tulane administrators had thought would take days to accomplish was over in 2 1/2 hours as 50 to 60 people boarded each massive helicopter. Mel Lagarde, a division president of the Hospital Corporation of America, didn’t know why the flow of military choppers had resumed; he believed they were a gift from God.

By late morning, the garage was nearly empty. At last, it was the animals’ turn.

John Holland, the pilot and retired Army colonel who had run the rooftop operation, had been surprised to learn earlier in the week that in addition to the people, there were 79 animals waiting to get out. They were the pets of employees and family members who had brought them to the hospital before Hurricane Katrina hit.

There had been a tense moment when someone ran onto the roof to tell Sharif Omar, We’ve lost one.

The overwrought Tulane administrator, who had been assisting Holland nonstop, thought the person meant a patient. No, we didn’t; no one’s going to die, Omar had said.

But the casualty was a cat. The animal had pitched itself from the sixth-floor railing of the garage to the watery streets below. Many there considered it an act of suicide.

Friday morning, the evacuation of pets looked like Noah’s ark. The procession of animals included an Afghan hound, little bitty dogs, cockatiels, parrots and cats.

As the animals emerged single file with their owners onto the rooftop, they were blasted by the Chinook’s powerful rotor wash and the roar of its turbine engines. Those watching could see the fear in the animals’ eyes. It was as if they were saying to their owners, My God, what are you asking me to do?

John Holland had left the Tulane rooftop at around 3 Friday morning, turning over the air traffic control mission to Stiles Clarke, a MedFlight administrator and paramedic. Holland had refused to leave until the last of Charity’s critical patients was off the rooftop.

By midday Friday, among the handful of people left were Lagarde, Clarke, two ham radio operators and the Marine. Lagarde’s mission shifted to turning the helicopter operation over to Charity.

When he was unable to contact anyone across the street by phone, he decided to go over by boat to talk directly to whoever was running Charity’s command post.

Lagarde went down to “the beach” — where the water came up the ramp of the parking garage — and started to board an airboat operated by the Louisiana Department of Wildlife and Fisheries, when suddenly a report crackled over the radio: Gunfire in the area. People in boats are being targeted.

Lagarde returned to the roof.

In Nashville, Jack Bovender, CEO of HCA, made contact Friday with Dr. Jim Aiken, medical director for emergency preparedness and one of those in charge at Charity Hospital. It was easier to make a phone connection from out of town than from across the street. Nashville patched through Lagarde, and the three held a conference call.

Bovender told Aiken that Tulane officials were waiting for Charity to set up a command-and-control structure on the garage rooftop so they could hand over the operation. Aiken would need to send his own people over to run it. The Tulane doctors and nurses were now gone, and they would need to send ample medical staff with their patients.

Stuck at Charity all week, Aiken had seen the helicopters flying every which way. He had glimpsed the massive Chinooks dodging buildings as they lumbered over the city. It reminded him of the evacuation of Saigon. He knew the pilots were risking their lives. He was not the only one who considered it a miracle that none of the choppers had crashed.

Dr. Ben’s daring and desperate plan to take Charity’s sickest patients through the water to Tulane had terrified Aiken. He felt responsible, as if by allowing them to go, he had put them in harm’s way. He never could have forgiven himself if anything had happened to them.

Now Aiken felt they had pressed their luck with the helicopter evacuation. What about the sniper fire? What if thugs commandeered the boats carrying patients?

Bovender offered to continue sending helicopters at HCA’s expense until all the Charity people were out. But Aiken turned down the offer. By then, he had reason to believe his people would be going out by ground.

It was a little after noon on Friday. After Aiken hung up, Bovender told Lagarde:

Mel, get on the next helicopter. Just get out of there.

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Chapter 17: BIRTHDAY OF LIFETIME -- AND AN UNEXPECTED GIFT

By Jane O. Hansen | Monday, May 22, 2006, 12:44 PM

The Atlanta Journal-Constitution

New Orleans — When Charity Hospital administrators asked for volunteers to escort patients across the street, then ride out with them on military helicopters, Granville Morse was one of the first to raise his hand.

Man, take care of patients and ride on a Black Hawk? said the emergency medicine resident. What could be better?

Others volunteered, but they all agreed “Granny” should go. This was his 34th birthday.

It was Thursday, Sept. 1, and for the first time that week, something the Charity staff had been told would happen finally did. Two military trucks with beds that sat high off the ground showed up to help evacuate the hospital’s sickest patients, ferrying them across the water to Tulane Hospital’s parking garage.

One of the patients was a boy named Jacob, about 8, who had been dropped off at Charity earlier in the week, along with five other critically ill patients from a nursing home. He had a feeding tube in his stomach and a tracheotomy for a tube into his lungs. He had no parents or other relatives by his side.

In Tulane’s stifling garage, Morse helped care for Jacob and other Charity patients. He was there when two of them died. And like Dr. Ben deBoisblanc, who had led the exodus from Charity, he watched as helicopters landed and took off from the rooftop, not with critical Charity patients but with healthy Tulane people.

Finally, at about 9:30 Thursday night, a Black Hawk arrived that could take three patients who could sit up and two on stretchers. One would be Jacob.

Who knows the patient? the man in charge of air traffic asked.

Morse raised his hand.

You’re going, the man said.

Morse climbed aboard the aircraft, and they began loading the patients. But Jacob’s spine board would not fit.

Just hand him to me, Morse said. Jacob was soaked in urine and sweat. Morse cradled the child in his arms.

Although it was dark, the young resident got his first glimpse of Katrina’s devastation that night as the helicopter headed for Louis Armstrong International Airport. Like others at Charity, his isolation had kept him from knowing the scope of the disaster. He cried as they flew over the city.

He could see tiny lights below — the flashlights of people still trapped on rooftops, waving for help.

The evacuation continued late into the night. John Holland would not rest until he got all of Charity’s critical patients out. The Georgia pilot had arrived the day before and volunteered to run air traffic control on the Tulane roof. If a military chopper with no seats landed, he put as many Charity stretchers on board as it could hold.

It was a painstaking process, just as it had been two days earlier when they evacuated Tulane’s critically ill patients. Chinooks, which could each hold 50 to 60 passengers, had suddenly quit coming. Jim Montgomery, Tulane Hospital’s president, heard from his daughter that Gov. Kathleen Blanco had just announced Tulane had been completely evacuated. She was only off by about 400 people, he thought.

Holland got on the pilot’s radio in the aircraft he had flown in on from Georgia. This is an emergency, he said. Could someone please come get these patients?

To Holland, it was the good Lord who then sent the Coast Guard. It was after midnight when its chopper arrived. Holland loaded the last three of Charity’s sickest patients; two were on ventilators.

After the Coast Guard chopper lifted off, there was silence on the rooftop. Many of those remaining broke down. The more than 30 critical Charity patients who had come to the Tulane parking garage before noon were finally gone. It had taken a little more than 12 hours to evacuate them. All but two had survived.

Under a starry night, about a dozen exhausted Charity staff lay down to sleep on the concrete floor of the parking garage. Dr. Ben was there. So was Granville Morse. He had flown back to the rooftop after dropping off Jacob and the other patients at the airport.

It was hot and humid, and some slept sitting up against the wall of the helipad to catch the slight breeze. Others slept one floor below the roof, where they had cared for patients. They scrunched up their scrubs shirts to lay their heads on. A few slept on stretchers.

Well, this is a good way to end my birthday, Morse thought. I’ll never forget this one.

Sharing the rooftop were Tulane staff members, including Associate Vice President Sharif Omar, Chief Nursing Officer Danita Sullivan, and Montgomery. Mel Lagarde, the Hospital Corporation of America executive who had stationed himself at Tulane, was also there.

Sullivan had finally gotten used to the heat, cutting off the pant legs of her scrubs to cool herself. It was still 90 degrees, and now she was freezing as sweat evaporated from her skin. She scrounged around and found three washcloths and placed them strategically on her body for warmth. Dr. Norm McSwain, Charity’s trauma director and Tulane medical school’s chief of trauma surgery, was tucked inside a red plastic hazardous materials bag, his head poking through a hole and resting on diapers.

Before closing his eyes, Morse got up to go to the bathroom. Trying to be discreet, he sneaked off to a corner of the rooftop. As he was about to relieve himself, a call came from above.

Hidey-ho, Doc!

Morse looked up. Huddled on the fire escape of a hotel about 10 feet away was a group of people. They had been living there to escape the heat inside the hotel. The helipad crew had seen them barbecuing food earlier in the week.

As they talked to Morse, the building’s owner appeared and asked whether he needed anything.

Morse looked down at the hard concrete.

Yeah, do you have any pillows?

The man disappeared inside. A few minutes later, dozens of pillows floated down from hotel to helipad.

Morse was elated. Wow, this is great.

The Charity and Tulane staffs were not on the best of terms. But just as death unites enemies in a cemetery, disaster had united them on the roof of the parking garage.

As Morse walked around the roof, he made no distinction between his Charity colleagues and the Tulane staff. Distributing his precious cargo, he felt a little like the pillow fairy.

ON WEDNESDAY: An explosion, a Marine’s arrival and a staff’s departure. Chapter 18 of 22.

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CHAPTER 16: AN EXODUS IN SLOW MOTION

By Jane O. Hansen | Sunday, May 21, 2006, 04:04 PM

The Atlanta Journal-Constitution

New Orleans — Nerves frayed as the city slipped toward anarchy. By Thursday afternoon, Sept. 1, it felt to Mel Lagarde as though security around Tulane Hospital was breaking down.

Gunfire could be heard on the streets. There were reports from law enforcement that gangs were targeting hospitals. He had to protect his people.

As a division president for Tulane’s corporate owner, the Hospital Corporation of America, Lagarde was responsible for the hundreds of people still inside the hospital. Tulane had requested security from the state command post in Baton Rouge, but there was no sign of the National Guard.

That night, Lagarde made the decision to move everyone out of the hospital and into Tulane’s Saratoga Street parking garage. With fewer entrances and exits to secure, Tulane guards would have an easier time protecting them. Since Tuesday, the garage roof had served as a landing zone for helicopters. The floors below were a staging area, so patients and staff could move quickly to the rooftop once a chopper landed.

But moving everyone into the garage was risky. Pulling the security force out of the interior of the hospital meant they would no longer be able to prevent people from breaking in. They would need to seal the doors back into the hospital, and that would cut off further access to supplies.

Lagarde knew this was a point of no return, and he struggled with the decision. If he moved everyone to the garage and they weren’t airlifted out soon, he worried he would begin to lose control. He also feared he would start losing patients because of the heat. Yet through it all, he remained calm. His faith kept him focused.

Lagarde had risen fast and early as a corporate executive. But it was his faith, as much as his business success, that defined him. The Catholic Church was central to his life, as it was to his wife, parents, grandparents and siblings.

In his early 20s, just as he was about to launch his career, Lagarde felt his faith had not matured. He knew little more about religion than he’d learned in catechism school. In pursuing a deeper faith, he regained a quiet commitment that hadn’t waned. It was a part of Lagarde, a self-effacing man, that not everyone knew.

In the past five years, he had become friends with New Orleans Mayor Ray Nagin. The two were charter members of the city’s chapter of Legatus, an international Catholic organization that brings together CEOs and other executives to discuss how they can live out their faith in their professions. Lagarde rose to president of that, too.

He may have seen himself as a behind-the-scenes guy. But he was comfortable as a leader. In the midst of crisis, his confidence inspired those around him.

Lagarde knew Tulane’s helicopter rescue needed to move faster. Feeding Charity Hospital patients into the evacuation had slowed it down. Intermittent fog, rain and lightning — as well as shooting — had also interrupted the flow. And now there were problems at the airport.

Earlier, HCA had set up a staging area at Louis Armstrong International Airport. Lagarde, a member of the New Orleans Aviation Board, had pulled some strings by calling the airport’s executive director. But Thursday, as HCA’s copters dropped off evacuees, officials from the Federal Emergency Management Agency commandeered a number of their medevacs. The day before they had grabbed four.

Lagarde put an end to it. The next time a government official tries to take one of our choppers, he told a Tulane executive stationed at the airport, tell him this: I’m sorry, but you can’t do that. This aircraft has already been commandeered by someone else.

It worked.

By Thursday afternoon, though, HCA executives in Nashville had made the decision to abandon the airport as a staging area for their patients. Others had begun to use it as a makeshift hospital and triage center, and conditions were deteriorating. Hundreds of sick, moaning people lay on the floor or on baggage conveyor belts. Many were elderly, alone and confused. There weren’t enough doctors, nurses or security officers. Intravenous bags were empty. Feces were smeared on the floor. Generator-powered fans made it cold, yet some patients were naked.

HCA felt the situation was dangerous. Instead of evacuating patients to the airport, then moving them by ground, it would fly them to an HCA hospital in Covington, La.

Wherever the helicopters would fly, however, they couldn’t get everyone out quickly enough; most could carry only one or two people at a time.

Lagarde began to focus on the big beautiful bird he saw for the first time flying overhead. It was a military chopper, a Chinook, and it could carry up to 40 seated passengers and 12 patients on stretchers.

If only they could get the attention of the military.

Police Cmdr. Dan Bitton had been flying Tulane rescue missions since Wednesday night. He, too, was concerned that the operation was too slow. His aircraft was not equipped for stretcher patients, only those who could sit up. And it could take only four to seven at a time, depending on their weight.

Bitton, a commander with the Winthrop Harbor Police Department north of Chicago, had no affiliation with HCA or Tulane. But he had served in Vietnam in the Army, and he didn’t hesitate to use his military contacts.

On Thursday, without authorization, Bitton landed his chopper at Eagle Base, the military command post at the Superdome, where he told the officer in charge that the situation at Tulane was urgent. There were Charity patients being kept alive by nurses who had been manually ventilating them for days. Hundreds of Tulane employees and their families were also trapped. The military needed to dedicate two Chinooks and two Black Hawks to Tulane. Now.

The military officer may not have appreciated Bitton’s directness, but he turned to an aide.

Can you get the commander the helicopters? he said.

Yes, sir.

The officer told Bitton he could expect his Chinook on the roof of the Tulane garage at 1700 hours — 5 p.m.

But how would they land it?

At HCA headquarters in Nashville, the design and construction staff had tried to calculate whether the rooftop could support a 55,000-pound machine that stretched 99 feet from rotor tip to rotor tip.

Bitton knew it would be a difficult approach. The pilots would have to clear the concrete lip around the top of the garage, then rest only enough of the aircraft’s weight on the ground to stabilize the chopper. The back wheels would go down, the front wheels barely touching. It was a huge risk. He discussed the landing at length with the officer and told him to let the crew know he would wave them off if he felt it wasn’t safe.

As 5 p.m. approached, Bitton, back at Tulane, started looking at his watch. He’d gone out on a limb, assuring the doctors from both hospitals that the Chinook would be there. Lagarde was waiting on the roof, in communication by phone with HCA headquarters. He worried about the patients underneath. What if concrete fell on them?

At 5:01, a huge helicopter came up over the buildings, like the extraterrestrial spaceship that arrived to rescue E.T. What a beautiful thing, Bitton thought to himself. Now it would be “kick ass” moving people out.

As the Chinook landed, the rooftop shuddered even under the partial weight of the giant chopper. The crowd in the garage erupted into cheers. HCA executives, who were huddled around a speakerphone in their boardroom, could hear the vibrating rumble of the Chinook all the way back in Nashville. They too broke out in applause.

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CHAPTER 15: SCAVENGING FOR FOOD, FEARING FOR THEIR SAFETY

By Jane O. Hansen | Saturday, May 20, 2006, 05:44 PM

The Atlanta Journal-Constitution

New Orleans — Susan Sanborn heard the sound but wasn’t sure what it was. It came from somewhere outside Charity Hospital. Was someone setting off fireworks?

Sanborn looked at another nurse, and he answered her question before she could ask it.

Yeah, that’s what it is, he said.

Gunshots.

For all the devastation it had done to Charity, the 5-foot-deep floodwater protected the hospital like a moat around a castle. Sanborn began to worry about what would happen when the water receded. People might storm the hospital — there were rumors of armed gangs.

On Thursday morning, Sept. 1, Sanborn’s unit got the order yet again: Prepare for evacuation. Staff pinned to each patient’s gown a plastic biohazard specimen bag that held a medication list, a discharge summary from the physician and the name of the person’s next of kin. Under the critical patients’ arms, they tucked paper bags filled with three days’ worth of medicine.

More than 48 hours after losing their emergency power, Charity doctors had abandoned hope that the government would come. They had begun taking patients by boat to Tulane Hospital’s parking garage to be flown out by helicopter. But Sanborn had no idea where they were going or who would care for them. She assumed someone had arranged for their continued medical care. But she still worried about their fate.

The student nurse’s dedication to Charity patients extended to the institution itself. She was so proud of her hospital. She knew a few co-workers didn’t feel the same attachment. They considered Charity a hellhole.

So what if it wasn’t a new, shiny, state-of-the-art hospital? Sanborn loved the rough-and-ready place, a Bellevue of the South that served the neediest. She felt at home there. Her own childhood had been tough, and she knew what it was like to be abandoned and live on welfare. Some of her patients shared similar backgrounds, and she didn’t mind giving back to people like herself.

One of her patients was a native of Ecuador, an illegal immigrant who had come to this country to make a better life for his family back home. Then he had been in a car accident and lost his leg below the knee. On the note she pinned to him, Sanborn wrote: Next of kin: U.S. Department of Homeland Security. Please try to find his family.

The staff had run out of spine boards for carrying patients down to the ramp outside Charity’s emergency room. When a resident asked Sanborn whether she had a screwdriver, she broke into a nurse’s locker to get one. The resident removed the legs from tables, and they taped patients to the tabletops.

After she helped carry down all the unit’s patients, Sanborn sat down and cried out of exhaustion and relief. Among those who had gotten out were two elderly men from a nursing home who had been dropped off at Charity earlier in the week. They had arrived on ventilators, unable to talk and with no medical records. Sanborn felt particularly protective of the men — one black, one white — whom the staff, not knowing their names, had dubbed Ebony and Ivory.

All nine of her unit’s patients were going to make it, she believed. They were going to live.

The patients were gone from Sanborn’s unit by 1 p.m. Thursday. But word began to filter through the hospital that there was no plan to evacuate Charity’s staff and faculty.

Some staff members called Don Smithburg, CEO of the state’s public hospitals, in tears. Smithburg had been at the state command post all week in Baton Rouge. He understood their despair and felt angry and frustrated by his inability to effect their rescue. Some were young and fresh out of school. This was the first disaster they’d faced. They felt helpless, forgotten and afraid.

With the patients gone, the goal on Sanborn’s unit was to set up camp. With no water pressure, she and another nurse devised a makeshift toilet. They found a bedside commode, then searched for plastic bags to line it.

Sanborn had come to the hospital prepared to ride out the storm, with cans of tuna fish, crackers, peanut butter and water. Others had done the same. And at least once a truck had dropped off some packaged food. Now Sanborn made trips to vacated areas of the hospital, scavenging for half-used jugs of water, granola bars and other food that had been left behind.

Remaining on the unit were Sanborn, eight nurses and two of their children. How can we shut down the unit so we’re safe? her supervisor asked.

Even if the floodwaters did not recede, they began to fear that those inside the hospital were growing as desperate for food and water as those outside. Sanborn didn’t mind sharing her provisions; she just didn’t want anyone to hurt her for them.

They locked what doors they could, then moved tables and chairs against them. The main entrance could not be locked, so they set up a barricade of supply carts. If anyone entered, at least they would hear them.

Like most public hospitals, Charity had holding cells for prisoners requiring medical care. The nurses asked one of the prison guards whether he would mind sleeping in their unit. When he said he had six handguns, Sanborn asked him something she had never before contemplated:

Can you teach me to shoot?

TOMORROW: At Tulane Hospital, preparing for the worst, hoping for a Chinook. Chapter 16 of 22.

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CHAPTER 14: ROOFTOP BLOWUP AS FEARS FOR PATIENTS MOUNT

By Jane O. Hansen | Friday, May 19, 2006, 12:56 PM

The Atlanta Journal-Constitution

New Orleans — John Holland, the Georgia pilot running the Tulane Hospital helipad, wrote down the precise number of critical patients Dr. Ben deBoisblanc said he needed to evacuate from Charity Hospital: 21.

But on Thursday, Sept. 1, more than 30 crowded into Tulane’s parking garage — and not all were on ventilators or stretchers. Some were able to walk. And one was a prisoner.

Jim Montgomery, president of Tulane, was livid. He still had the last of his own patients to get out, as well as 700 hospital employees and their family members, including 100 children.

Some of his employees were not pleased that Charity people were interrupting their own long-awaited rescue, especially nonmedical staff who did not understand the crisis patients faced. With many helicopters taking only one or two people at a time, the evacuation was, in the words of one doctor, like emptying a swimming pool with a teacup.

When Montgomery heard that the number of Charity patients was growing and some weren’t even on stretchers, he left the command post and headed for the garage.

You told me it was going to be 21 patients; you got 33, Montgomery said to Dr. Ben. I told you we’d take critically ill patients, and people who are ambulatory are coming over here.

One was a prisoner who had gone without dialysis for nearly a week, a life-threatening condition. Like Grady in Atlanta, Charity was where sick inmates were taken for treatment.

Dr. Ben radioed back to Charity. Do not bring any more patients. They’re not taking any more.

To Dr. Ben, the rejection was another reminder of his hospital’s second-class status. The Tulane administrators didn’t care about Charity patients. They were simply in the way.

Montgomery saw it differently. So did Mel Lagarde, the Hospital Corporation of America executive who had stationed himself at Tulane. They’d been airlifting patients for two days. They had a process that was working. They had rules everyone was following, and they weren’t about to let Dr. Ben take control.

Dr. Ben was the passionate physician frantic to save his patients. Lagarde was the coolheaded corporate leader who had helped put in motion an effective rescue operation.

What would play out that day in the Tulane garage occurred against a backdrop of competing cultures, different perspectives and the fear of losing lives.

From one vantage, a private hospital stepped in to do what the government had not: It rescued the sickest and most helpless.

The other view said the have-nots were first abandoned by their government, then relegated to second-class status as the haves put their own safety above the lives of the have-nots.

Two hospitals. Two universes. And they were on a collision course.

It was the arrival of a military Black Hawk that touched off the showdown.

The Charity staff had been told the military was sending Black Hawks to the Tulane roof to evacuate their patients. But when one landed that afternoon, Charity staff watched as Tulane employees boarded to a round of applause.

Dr. Ben ran to the rooftop, yelling at Holland and anyone he could grab. He accused Tulane administrators of hijacking helicopters intended for Charity, while his staff hand-ventilated patients who had waited hours in the hot, stuffy garage.

Lagarde, who was on the roof, knew the physician was desperate, and he understood why. He had gone down to the seventh-floor holding area and surveyed the scene of sick Charity patients lying on the floor. He’d ordered Tulane staff to find additional oxygen cylinders for patients who were running out. But Dr. Ben kept accusing him of not giving priority to Charity patients, of not understanding how ill they were.

After the Black Hawk took off, Lagarde braced himself. But as the enraged physician walked up to him, the calm executive also lost his cool. Red-faced, standing nose to nose with Dr. Ben, Lagarde yelled back,

These are our helicopters. Where are yours?

With a walkie-talkie in each hand, Dr. Ben screamed into both, not knowing who might be listening. Get some helicopters down here NOW!

From their staging area one floor below, the Charity staff had seen only one thing: Healthy adults leaving before their very sick patients.

They didn’t know that the Black Hawk had seats and could take only people who could sit up. It could not — and its military pilot would not — take patients on stretchers.

They didn’t know that another helicopter they had watched fill up with able-bodied people had been contracted by Hibernia National Bank to take away 40 bank employees. Tulane had agreed the day before to let the bank use its rooftop as a landing site.

The whole atmosphere angered the Charity crew. Their experience in the garage magnified the fundamental difference between the two hospitals. Tulane could pick up a phone, call HCA and anticipate a cavalry of resources. Charity could pick up a phone and call CNN.

Another difference between them was in the arrangements they had made for their patients once they were evacuated. Tulane’s leaders considered it imperative to know where patients were going and had taken great pains to line up receiving hospitals. But Charity staff were at a different level of desperation. All they cared about was getting their patients out.

A quarrel broke out when a Tulane pediatric surgeon defended the helicopter operation, and Dr. Granville Morse, an emergency medicine resident at Charity, argued back.

I don’t know what your problem is, the Tulane surgeon said to Morse. Nobody would transport critically ill people in a school bus. They would put them in an ambulance. Some of these helicopters weren’t outfitted to take patients, the surgeon said.

Is your parking garage outfitted to be an ICU? Morse yelled back. Can you honestly say these patients are better off here?

Holland sympathized with the Charity staff. He knew they couldn’t see the whole picture. They didn’t understand that most pilots had no way of knowing which people they were supposed to carry. All they had were the coordinates for Tulane and where they would be headed. Holland also knew that the evacuation of Charity’s critical patients would take time. Two days earlier, it had taken 18 hours to evacuate the most critical of Tulane’s patients.

Holland assured Dr. Ben he was on his side, and the physician believed it, but he was not a patient man, and he was used to being in control. He kept returning to the roof, demanding someone pay attention to him. He believed that out of sight, Charity patients remained out of mind.

Late Thursday afternoon, Dr. Ben’s worst fear became a reality.

A patient in her mid-50s, suffering from emphysema, grew short of breath. Miss Mabel was one of the nursing home patients found earlier in the week by the National Guard and brought to Charity.

Although she had a tracheotomy and was on a ventilator, she had been alert and able to communicate before Charity staff brought her to the garage. Her biggest concern was making sure her family knew where she was.

In the Tulane garage, as they waited for a helicopter, Miss Mabel became increasingly unstable. Without monitoring equipment, the medical personnel had no way to anticipate the crisis, nor could they diagnose exactly what was going on. One