Through Hell and High Water

DR. BEN DEBOISBLANC

MEL LAGARDE

CHAPTER 3: FROM CALM TO CALAMITY: PRAYERS FOR STRENGTH

By Jane O. Hansen | Tuesday, May 9, 2006, 04:18 AM

The Atlanta Journal-Constitution

New Orleans — Mel Lagarde fell asleep on an office floor at Tulane Hospital Monday night, lying on a quilt and using a pillow he had brought from home. He closed his eyes feeling confident. The hospital had absorbed the best punch nature could throw, in the words of a colleague. Clearly, the doomsday models had been wrong.

In the middle of the night, a hospital executive shook Lagarde awake with ominous news: Water surrounded the hospital, and it was rising at an alarming rate.

He went down to the first-floor boiler room, where the hospital’s emergency generators were located. As Lagarde and his colleagues opened the door leading out back to Cleveland Avenue, they could see the water rising. It was inches from the top stair.

Lagarde knew it would be only a few hours before the water reached the switchgears that ran the generators. For the first time in its history, the hospital would lose backup power. And for the dozens of critically ill patients hooked up to machines that breathed for them, pumped their hearts, suctioned their lungs, or cleansed their blood, the loss of electricity could mean imminent death.

Lagarde, a division president for Tulane’s parent company, stepped back and turned away from the others. He knew this was going to be unlike anything he’d ever dealt with. On his own, he was not physically or mentally prepared for what lay in store.

To maintain control of the situation, he would have to maintain control of himself. Inside the hospital were more than 1,200 people — patients, staff and family members who had joined them at the hospital rather than flee the city. All would depend on him. He couldn’t show how nervous he was, how scared.

In the corner of the hallway, Lagarde silently prayed for the grace of God to direct him.

Please give me the strength, the confidence, the courage and the calmness.

Flooding forces Charity Hospital to use makeshift emergency room.

About the time Lagarde was roused from his sleep at Tulane, Dr. Ben deBoisblanc snapped awake at Charity Hospital. The white noise of the air conditioner had suddenly fallen silent. The hospital was black.

It was about 3 a.m. — the moment the switches for Charity’s generators slipped under water.

The flooded basement housed the morgue — where there were 10 bodies that morning — as well as the cafeteria, radiation and oncology, medical records and the generators’ switchgears. As the water crept up the stairwell toward the main floor, nurses frantically woke the emergency medicine residents. The water’s coming in! Everybody’s got to pack up and go.

They grabbed supplies from the first-floor emergency room and carried them to the second-floor auditorium, where they set up a makeshift ER, with gurneys, IV poles and a nurses’ station. Next they moved up the patients — more than 40 in all. Most could not walk, so they strapped them to spine boards and, with the elevators dead and the halls dark, carried them one by one up a partially enclosed outside staircase. They laid the most seriously ill patients on the floor on sheets until they could find mattresses.

Come daybreak, the auditorium’s large windows would afford them light. But even with the windows open, there would be little relief from the sweltering heat.

The building facilities manager and his staff parceled out seven small portable generators to the ER and critical care units. The generators would run the lifesaving equipment — as long as there was fuel.

In the fourth-floor surgical intermediate care area, where student nurse Susan Sanborn worked, three patients were being kept alive by ventilators. With the loss of power, these machines ceased.

In normal conditions, when a patient on life support has to be moved from one room to another, the ventilator is disconnected and an Ambu bag is connected to the patient. A nurse squeezes the bag, manually doing the work of the ventilator: forcing air from an oxygen tank into the patient’s lungs through an incision in the throat, called a tracheotomy, or through the patient’s mouth, using an endotracheal tube.

“Hand-bagging” a patient is supposed to be a stopgap measure. It is exhausting work. Few can do it more than a half-hour. Now nurses and residents grabbed bags and got to work. They assumed it was only temporary.

As a student nurse, Sanborn had little experience with the procedure. She silently coached herself.

*OK, Susan, breathe, and match your breath with squeezing the bag.

Inhale, squeeze. Exhale, release.

Please don’t die.*

Where was the water coming from? How high would it rise?

At Tulane, Lagarde wondered whether the sewers had backed up or whether the pumps had failed. He wasn’t thinking about a possible breach in the levees. In all the disaster models he had seen, the worst scenario depicted the storm surge topping the levees. But that would have happened during the storm, not a day later.

They had to move quickly. Lagarde and Jim Montgomery, the hospital’s president and CEO, started calling City Hall, the governor’s office, the National Guard — anyone who could help. Someone will get back with you, they were told. Or the lines were busy.

Finally, they reached their contact in the state emergency operations center in Baton Rouge, the command post for a host of state and federal agencies. Among them were the Federal Emergency Management Agency, the National Guard and officials from the governor’s office. The region’s hospitals also had representatives there, including Coletta Barrett from the Louisiana Hospital Association.

Barrett told Lagarde and Montgomery that something drastic had happened, but no one seemed to know what.

Do we need to evacuate? they asked. We have patients on vents.

Her reply was clear: Yes, they should try to evacuate. There was no orchestrated plan to rescue them.

You’re on your own.

At Charity, a different message filtered through the building: FEMA is coming. Get your patients ready.

Physicians began triaging patients in their units to make sure the sickest got out first. Using kits made for mass-casualty disasters, they assigned a color-coded tag — red, yellow or green — to each patient. A red tag marked the most critical; green the least.

For each, Dr. Ben and others wrote notes describing the patient’s condition and treatment. They placed these in a plastic bag and taped it to the patient’s arm or leg, along with a three-day supply of medicine. They strapped patients to spine boards and waited for orders to carry them down to the ER ramp.

The word that the federal government was on the way had come from Don Smithburg, Charity’s representative at the command post in Baton Rouge. Chief executive officer of Louisiana State University’s nine hospitals, the state’s largest health care system, Smithburg had been alerted Saturday that New Orleans was “in the cone” — the path of the hurricane. He was confident that the LSU hospitals, and particularly “Big Charity,” would get attention. Where else would there be so many poor, sick, desperate people gathered in one place?

The sickest person on Sanborn’s unit was a woman in her 50s with mouth cancer and staples in her throat from a recent operation. She was on life support, her vital signs deteriorating. A nerve disorder complicated her condition, causing excruciating pain at the mere touch.

When the signal came to move her, Sanborn and five others tied her to a chair and carried her and her oxygen tank down three floors, hand-ventilating her as they went. It was too dark in the hospital to see the stairs; they picked their way down the outside fire escape.

For two hours, they manually ventilated their patient on Charity’s emergency room ramp, trying to keep the conscious woman calm. Then they were told the rescue boat wasn’t coming. Looters and shooters made it too dangerous.

Demoralized, they carried the woman back up the outside staircase. They had failed to get even their most critical patient to safety.

This is wrong, Sanborn thought. You have to come get these people.

She didn’t even know whom she was talking to. But she knew they needed help from some higher power.

Please, come get my patients. I’m begging you, whoever you are, please come get these people.

ON WEDNESDAY: Word of Tulane’s crisis reaches executives of the hospital’s parent company in Nashville. Chapter 4 of 22.

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