Through Hell and High Water

DR. BEN DEBOISBLANC

MEL LAGARDE

CHAPTER 5: A FIGHT TO SURVIVE THIRD WORLD CONDITIONS

By Jane O. Hansen | Thursday, May 11, 2006, 04:23 AM

The Atlanta Journal-Constitution

New Orleans — At Charity Hospital, even the walls were sweating.

By Tuesday afternoon, Aug. 30, it was over 100 degrees in some units. The air was palpable, and the walls dripped with condensation.

Nursing student Susan Sanborn would cut off the pant legs of her maroon scrubs and roll up the sleeves, exposing a tattoo on her right biceps of a fish on an ocean wave. She apologized to her supervisor; Charity’s nursing school frowned on tattoos. The supervisor responded with a look: You gotta be kidding. A rule about tattoos hardly mattered now.

The hospital’s backup power had shut off about 3 a.m., after the levees broke and floodwaters drowned the generators’ switchgears in the basement. Already, conditions were deteriorating, inside the hospital and out.

The lack of air conditioning threatened the lives of Sanborn’s patients in the surgical intermediate care area on the fourth floor. Most had recently undergone surgery and were feverish. Nurses rubbed their bodies with bath wipes stored in the still-cool refrigerator.

Toilets overflowed with solid and liquid waste. Administrators issued 5-gallon buckets and hazardous waste bags to use as commodes, but not everyone got them. People went to the bathroom wherever they could — in stairwells, cardboard boxes, garbage cans. A few came down with gastrointestinal viruses. Baby wipes were as precious as cigarettes in a prison.

At the same time the hospital lost backup power, the entire city was losing water pressure. Soon, there would be no clean sheets or linens, and no more water for bathing patients.

On top of the stench of human waste and body odor, the nauseating smell of diesel fuel permeated the air on some floors. Tuesday afternoon, a nurse on Sanborn’s unit somehow powered up a portable generator by using hair spray. Sanborn didn’t understand the science, but it worked. They moved the generator onto the fire escape outside, but the fumes were still overpowering.

As if in combat, doctors, nurses, even family members of patients and staff focused on one mission: to save lives. They manually ventilated patients on life support until their hands were numb. They held water to their parched lips to hydrate them. They spooned cold creamed corn from plastic cups to nourish them. They fanned them with cafeteria trays to cool them. And when there was nothing else they could do, they held their hands to comfort them.

In this 20th-century medical facility, care was reduced to rudimentary first aid or, as one doctor described it, worse than Third World medicine.

Without power, they couldn’t dialyze patients with kidney disease. They couldn’t suction the fluid from their lungs. They couldn’t take X-rays, EKGs or CT scans. They had no working labs for running blood tests, monitoring heart function or conducting other diagnostic tests. The best that doctors could do was examine their patients and ask themselves, Do I see or hear something I shouldn’t?

Two floors above Sanborn, in Room 11 of the medical intensive care unit, Hunter Reeves’ kidneys were shutting down. His fever was so high, he was drenched in sweat. His mother, Sherry Hebert, was terrified for her son. What if no one was coming to rescue him?

An ambulance had brought Hunter to Charity four days before the hurricane hit. He had been diagnosed with a rare autoimmune disease that attacks the kidneys and lungs. But the treatment that could save his life had ended. Blood reappeared in the tube to his bladder, he was unconscious, and he could no longer breathe on his own.

When the backup power went out, his ventilator stopped working. Celeste Waddell, a respiratory therapist, ran to his room and began manually pumping air into his lungs to keep him alive. She was reluctant to let anyone relieve her.

Even though Waddell felt powerless to give Hunter the medical treatment he needed, she wanted to make him as comfortable as possible. She rubbed him down with bottled water while Sherry fanned her 23-year-old — her baby — with a piece of cardboard. Hunter’s stepmother, Cindy Reeves, was also there, doing what she could.

Dr. Ben deBoisblanc, the unit’s director, was trying to find a way to get Hunter’s respirator going again. Portable generators were brought in, but eventually those would run out of fuel. A respiratory therapist used a hammer, a screwdriver and a piece of oxygen tubing to siphon fuel from an ambulance on the ER ramp.

Sherry overheard Dr. Ben speaking to administrators. Hunter was extremely critical. They had to get him out.

At 46, with smooth skin and big smiling brown eyes, Waddell spoke in a soft, soothing voice. Her job was to monitor patients’ ventilators to make sure they received oxygen at the rate and volume the doctor ordered. She suctioned endotracheal tubes to clear airways.

Before the storm, she made a point of regularly stopping by bay No. 4 to see Preston Johnson, even on days when another respiratory therapist was assigned to his care. She wanted to check on his mother, Carolyn Lewis, who often seemed overwhelmed. The woman’s 25-year-old son remained in a fight for his life.

Carolyn and her husband had brought Preston to Charity the month before. But he wasn’t getting better, and at times he worsened. His skin turned yellow from liver failure; his kidneys failed, requiring dialysis. When he began to bleed internally, they poured blood into him. He remained on a ventilator, but doctors had not yet settled on a definitive diagnosis.

Most of the time, Preston remained conscious. His mother rarely left his side.

Good morning, Waddell would say to Carolyn. How are you doing? Are you hanging in there?

Waddell was more than a kind professional with nearly 22 years of experience dealing with patients and families. When she tended to Preston or Hunter, she couldn’t help but think of what had happened to her own son.

Around her neck, she wore a gold cross he had given her and a necklace with three gold charms: a little boy, a football helmet and the words, “No. 1 Mom.”

On Tuesday, fires erupted sporadically around downtown. Looters broke windows along Tulane Avenue. With little communication from the outside world, rumors ran rampant inside Charity: Gangs are roaming the streets and trying to break into the hospitals with guns.

The water that surrounded the hospital and entrapped them was now contaminated with gasoline and oil. Sanborn watched from a fourth-floor window as people carrying children on their shoulders waded through chest-deep water to the emergency room ramp, pleading for shelter. The hospital’s armed security guards pointed them instead toward the Superdome a couple of blocks away. The student nurse felt devastated.

Charity had always seemed invincible, the last resort for those in need. Now it was turning people away.

Charity is such a poor old thing, Sanborn thought, long neglected by the Louisiana Legislature.

During eight of the past 10 years, lawmakers had appropriated no new funds for the state’s public hospitals. As a result, Charity had been forced to reduce services and take in fewer patients, despite waiting lists. In 2005, a report by a national hospital accrediting body said Charity’s trauma treatment area was so crowded and cramped, it was “a disgrace for a modern Level 1 trauma center in a major metropolitan area with two major medical schools.”

Dr. Granville Morse, an emergency medicine resident, shared Sanborn’s anguish. He was on the ER ramp when a National Guard truck drove up.

Lying in the open bed of the truck were six critically ill patients, all with tracheotomies, all being hand-ventilated by National Guard members who stared back at the doctor, terrified.

A young idealistic physician with dark hair, dark eyes and a round boyish face, Morse had volunteered to be on the hospital’s activation team when it appeared the approaching storm would trigger a code gray — a weather-related emergency. The Atlanta native had helped evacuate his wife and two young children before reporting for duty. But he hadn’t expected this.

The driver of the truck said the patients were from a nursing home and had been taken to a hospital just before the storm. But that hospital had lost its power and run out of oxygen. Its staff had flagged down the truck and told the driver, Take them to Charity.

None of the six could talk, and none had pinned to them any medical information. One was a little boy about 8 who was alone and had a feeding tube in his stomach.

Look, we don’t have any power; there’s no way we can care for these patients, Morse and a staff physician told them. There’s nothing we can do.

Surely some of the private hospitals must be in better shape, they thought. They assumed their facility was the most incapacitated, that the patients would get better care elsewhere. They told the driver to head for Memorial Medical Center.

It was a difficult decision for the young Charity resident. Others on the ramp expressed outrage. A veteran respiratory therapist called it inhumane to send people in need of medical care back into the streets. It’s counterintuitive to what we do.

As the truck drove away, emotions were running high. Four hours later, the truck returned. Morse, just shy of his 34th birthday, felt awful when he learned that one hospital after another had turned the patients away. This time, Charity took them in.

Sherry Hebert left her son’s bedside and went down to the emergency room ramp to smoke. She noticed for the first time the water in the streets. She’d been thinking of nothing but Hunter.

Maybe it’s from the rain, she remarked to the father of another patient.

No, it’s rising, he said. He laid some leaves on the dry part of the ramp. Soon they were floating.

Inside the hospital, an internal struggle was developing. Younger surgical physicians wanted to consolidate critically ill patients — spread over four floors in different intensive care units — onto one floor where doctors and nurses could care for them more efficiently. A committee of administrators, appointed before the storm by the hospital’s CEO, resisted. They believed the government would arrive any minute.

Many inside Charity began to question whether there even was a rescue plan — or who was at the helm. Dwayne Thomas, the CEO of Charity and its affiliate, University Hospital, was trapped five blocks away, at University. The administrators he had put in charge had trouble reaching him. They held daily staff meetings in the lobby, but staff on the front lines were spread throughout the huge building, and many heard little — or nothing — of the meetings.

Impatience grew with each false promise that the government was on the way. One surgery resident, who had been told that FEMA, the Federal Emergency Management Agency, was coming, carried a patient on his back down seven floors. Nobody came.

Hunter’s mother was outside when someone did show up. Before the water got too high on Tuesday, Mayor Ray Nagin drove onto the ramp in a black SUV. A number of people were there, including a news crew. Sherry inched her way through the crowd.

When are we going to get help? she asked the mayor.

She was crying as she told him her son would die if he didn’t get out soon.

The mayor held Sherry’s hand.

Just that morning, he told her, he had called the federal government. Help was on the way, he assured her. The National Guard would be there that very day.

ON FRIDAY: At Tulane Hospital, a rescue mission begins. Will the rooftop hold? Chapter 6 of 22.

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