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Thursday, May 18, 2006
CHAPTER 13: TWO MOTHERS' SUSPENSE, DOCTOR'S S.O.S.
The Atlanta Journal-Constitution
Multimedia
New Orleans — Wednesday evening, Aug. 31, Sherry Hebert and Carolyn Lewis watched from a window at Charity Hospital as helicopters landed and took off across the street. They had no way of knowing whether their sons were aboard any of the rescue craft — or, if they were, whether they would survive the trip.
All the mothers could do was wait — and pray. Stuck inside the hospital and exhausted, they fell asleep in the sixth-floor waiting room.
Nurse Dawn Pevey found them there about 1:30 a.m. Thursday. Sitting down with the women, Pevey told Sherry they had almost lost her son Hunter while taking him by truck to the helipad at Tulane Hospital. His second lung had collapsed, and doctors had performed an emergency procedure to save his life. Dr. Jeffrey Williams had to insert a tube into Hunter’s chest. Sherry cried.
He’s OK. He’s OK, Pevey assured her. Hunter was still fighting. He had been airlifted to Lafayette, where doctors had stabilized him. From there, he had been flown to Earl K. Long Medical Center, another of the state’s public hospitals, in Baton Rouge.
Pevey turned to Carolyn. Her son Preston also had experienced trouble after leaving Charity, the nurse said. His blood pressure had dropped while he waited to be flown out from the Tulane parking garage. Pevey told Carolyn he was on his way by ambulance to a hospital in Baton Rouge. She wasn’t sure which facility. At daybreak she would call and try to find him.
After grabbing some sleep, Pevey called all three major hospitals in Baton Rouge, asking whether Preston Johnson had been brought there. No, each said. Pevey was puzzled. Then it dawned on her what might have happened. She would call the hospitals back — and this time ask a different question.
Early Thursday morning, Dr. Ben deBoisblanc — director of Charity’s medical ICU — crossed over to Tulane Hospital on a boat piloted by the Louisiana Department of Wildlife and Fisheries. The night before, he had overseen the evacuation of his four most critically ill patients from the parking garage roof. He was desperate to rescue more.
Dr. Ben arrived at “the beach,” as the Tulane people called the entrance to their Saratoga Street parking garage, where the water lapped along the bottom of the first-floor ramp. He rode by pickup truck to the roof, where he met with John Holland, the Emory LifeNet pilot and former Army colonel who had taken charge of the helipad.
Dr. Ben told Holland his hospital was in a meltdown. It could get no response from the government, and it had critically ill patients on ventilators who would die if it did not get help soon.
How many? Holland asked the physician.
21.
How are you going to get them over here?
I came by boat.
Sir, how long will it take you to get your patients over here?
Two or three hours.
OK, get them over here. Take them to the next level down.
Holland was assisted on the roof by Sharif Omar, a Tulane associate vice president, and Kim Graham, director of pediatric services and a nurse. They ran from one end of the garage to the other, up and down stairs, guiding patients up the ramp and onto the choppers. By Thursday, Omar was running on adrenaline, having slept only a few hours, and his feet had developed painful blisters from the loose-fitting tennis shoes he wore. In the mornings, Graham wrapped his feet in gauze. When she changed the dressing at night, the flesh was raw. Eventually a doctor would give Omar pain pills.
Though Holland was at the mercy of the pilots and the type of aircraft they flew, he was not averse to pleading. When a pilot told him he was nearing his limit of 12 hours on duty and this would be his last transport, Holland cajoled him: Just give me one more run.
After talking to Dr. Ben, Holland directed the Charity physician to clear the evacuation plan with those in charge: Mel Lagarde, a Hospital Corporation of America division president, and Jim Montgomery, president of Tulane Hospital.
Montgomery could see that Dr. Ben was worn-out and panicked. He asked what the state was doing to help. They’re not engaged, Dr. Ben said.
Montgomery asked where Dwayne Thomas, Charity’s CEO, was. Thomas was at University Hospital and out of touch, Dr. Ben told him.
Lagarde and Montgomery knew that evacuating Charity’s patients would slow the rescue of their own people. They still had 19 patients and 700 staff and their families to get out. But they had to respond. Helping Charity was the right thing to do.
About the time Dr. Ben left for Tulane, nurse Pevey finally located the hospital where Preston had been taken.
After Hunter was evacuated from the Tulane garage Wednesday night, Preston and two other patients had waited more than two hours for another chopper.
At first, Preston had done all right in the garage. But after a couple of hours, he had begun to fail. His blood pressure fell. Blood oozed from his nose and mouth. He needed blood, and the hospitals had run out.
Finally, a Black Hawk that could take stretcher patients had arrived on the roof. When it landed at the I-10 interchange, an ambulance crew from east Texas had seen how grave Preston’s condition was. Their vehicle was equipped with a ventilator, and they had offered to take him.
Williams had climbed in back with Preston for the hour-plus trip to Baton Rouge General. When they arrived, the receiving physician had taken Preston to the intensive care unit and ordered platelets, blood transfusions and a series of tests. Once Williams told him how long Preston had been in shock, the physician ordered a blood gas test to determine his viability. The result: “incompatible with life.”
It was as if Preston had been undergoing CPR for hours. Any further efforts at resuscitation, the doctors had concluded, would be futile and cruel.
In Baton Rouge, Williams had no way to contact Pevey or the others who had returned to Charity. But the next morning Pevey figured out what had happened.
The first time she had called the Baton Rouge hospitals, she had asked whether they had a patient by the name of Preston Johnson. The second time, she asked whether they had a Preston Johnson in their morgue.
Late Thursday morning, Charity patients began arriving at the Tulane garage by boat. Under the rules of triage, they would leave the rooftop based on the severity of their condition. That meant some Charity patients would go out before Tulane patients. Among those put at the front of the line was a 2-day-old infant with a severe infection, along with her mother and grandmother.
The open garage, transformed into a makeshift ICU, was littered with sick people. Charity residents and nurses knelt beside their patients on the concrete floor and manually squeezed the bags that pumped air into their lungs. Tulane nurses, in line to be evacuated, jumped in and helped.
Patients’ tracheotomy tubes were beginning to clog, and there was no way to suction them. Oxygen supplies were running low. A man who had suffered a stroke before the storm gasped for air. A resident quickly intubated him, performing a delicate procedure that required threading a lifesaving tube down the throat and into the lung.
Dr. Ben had risked patients’ lives by ferrying them over on boats amid gunfire. Now they suffered in the heat of the parking garage, waiting to lift off into a sky grown increasingly dangerous with unmonitored air traffic. He felt the full weight of responsibility.
Tulane’s chief nursing officer ran into her hospital to scavenge for oxygen tanks. Someone on the Tulane staff found a portable generator and set up a “suck out station” where the tubes of Charity patients could be cleaned out, allowing them to breathe.
For patients who were conscious, the vibrating roar of the helicopters just one floor above could not have been comforting. Yet as sick as they were, many expressed gratitude to the nurses, residents, respiratory therapists and doctors who had gone days with little sleep, food or water. Some patients even tried to relieve the health care workers by hand-bagging themselves.
An elderly woman in her 80s, labeled with a handwritten sign that said “Fractured Hip,” waved over emergency medicine resident Granville Morse. He thought she needed something, but when he leaned over to listen, she gave him a kiss.
Dr. Ben watched the Charity residents and nurses with awe. The field hospital they had created was a marvel; he was proud of their patience and dedication.
But as the afternoon wore on, his temper would flare.
Tensions in the garage were rising. Soon, they would explode.
Accompanied by a physician, Pevey returned Thursday morning to the waiting room on Charity’s sixth floor and asked everyone but Carolyn to step into the hallway.
Hunter’s mother, Sherry, knew then that Preston had not survived. Standing in the hall, she heard Carolyn sob at the news.
Pevey told Carolyn that her son had been pronounced dead at a hospital in Baton Rouge. When Sherry went back into the waiting room, she didn’t know what to say to comfort her friend. Only hours earlier the two mothers had held hands and watched their sons leave, hoping and praying they were going to a better place. A shy, reserved woman, Sherry felt so bad knowing her son had made it and Carolyn’s had not.
Pevey went to find Celeste Waddell. The respiratory therapist, who had cared for both Hunter and Preston, was in the empty cardiac care unit, now substituting as a sleeping area for staff.
Preston died, Pevey told her.
Waddell sat still for a minute, then began to cry. Forgive me, she said silently to Preston. I tried. Everybody tried.
Waddell found Carolyn in the waiting room, being comforted by Sherry and other patients’ family members. The women walked together down the hall to the chapel, located at the other end of the sixth floor.
They sat there for about 45 minutes. Waddell told Carolyn to brace herself. In their ignorance, people would say stupid things. They just don’t know what to say. Don’t let anybody tell you how you should feel.
Waddell told her she knew how acutely painful it was to lose her son. She had lost her own son, Chris, just the year before, at the age of 18. But you don’t want him to suffer, Waddell said of Preston. And he’s not suffering anymore.
Then Waddell told Carolyn one more thing. Her son, Chris, would take care of Preston. Everything’s going to be all right.
TOMORROW: Dr. Ben goes ballistic as two hospitals’ cultures clash. Chapter 14 of 22.
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