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.

Permalink | Comments (25) |

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.

Permalink | Comments (6) |

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.

Permalink | Comments (7) |

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.

Permalink | Comments (3) |

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.

Permalink | Comments (8) |

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.

Permalink | Comments (10) |

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.

Permalink | Comments (2) |

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.

Permalink | Comments (4) |

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 theory was the anxious woman’s airway had become blocked by a mucous plug. About 4 that afternoon, a resident cradled Miss Mabel in his arms as she took her last breath.

Dr. Ben had not expected Miss Mabel to die. Had the woman been evacuated in a more timely fashion, he believed her death might have been prevented.

Then, a second crisis arose with another nursing home patient — an elderly man who had been cared for in the fourth-floor unit where student nurse Susan Sanborn worked. On the Tulane rooftop, Holland had just loaded him onto a helicopter when his heart stopped. Holland made the difficult decision to take his body off the helicopter. They had to make room for someone else.

At the height of the chaos, a CNN reporter and cameraman arrived on the Tulane helipad.

A shrill Dr. Ben shouted into the reporter’s microphone, “Two of them have already died here on this ramp waiting to get out!”

They had died because Tulane was evacuating its own staff before Charity’s patients, he told the reporter.

At the end of the day, when the doctor appeared on the roof with a bullhorn, Holland took it from him, then had him removed. Dr. Ben was escorted to the seventh floor, where a Tulane police officer blocked his return with an M-16.

TOMORROW: Fear drives one unit in Charity Hospital to set up a barricade. Chapter 15 of 22.

Permalink | Comments (6) |

CHAPTER 13: TWO MOTHERS' SUSPENSE, DOCTOR'S S.O.S.

By Jane O. Hansen | Thursday, May 18, 2006, 01:08 PM

The Atlanta Journal-Constitution

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.

[ • See map of evacuation]

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.

Permalink | Comments (12) |

CHAPTER 12: RESCUE OPERATION UNDER BATTLE CONDITIONS

By Jane O. Hansen | Wednesday, May 17, 2006, 01:44 PM

The Atlanta Journal-Constitution

New Orleans — Tulane Avenue was the River Styx — as foul and fearsome as the Greek mythological river of hell. Yet brave souls crossed the waters from the public hospital to the private one, in hopes of rescue.

Wednesday evening, Aug. 31, Dr. Ben deBoisblanc, nurse Dawn Pevey and critical care resident Dr. Jeffrey Williams made the journey in the back of a National Guard truck with four very ill patients.

Dr. Ben had chosen Hunter Reeves as the first to evacuate from Charity Hospital, knowing the 23-year-old had a treatable condition but would die without medical care.

He had Goodpasture’s syndrome, an autoimmune disease causing his body’s antibodies to attack his lungs and kidneys. Several days before Hurricane Katrina struck, his right lung had collapsed. As the truck neared the ramp to Tulane Hospital’s Saratoga Street parking garage, Hunter’s oxygen level plummeted. Dr. Ben and the others suspected his other lung had collapsed.

There was no time to get him to a sterile emergency room. Under Dr. Ben’s supervision, Williams stuck a needle into Hunter’s chest wall. Air hissed out, confirming the doctor’s hunch. Hunter was no longer getting oxygen.

Four people would have to sit on Hunter’s legs and body for what came next. They had grabbed an emergency kit with surgical instruments before leaving Charity, but had no anesthesia. They could only sedate him lightly with medication.

Using a scalpel and guided by flashlight, Williams cut a 2-inch slit near Hunter’s left nipple, then inserted a tube between two ribs, allowing the lung to expand. Dr. Ben assisted the young resident while pinning down Hunter’s flailing arms. It would have felt as if someone were stabbing him in the chest with a knife, then wiggling it around inside.

If the streets of New Orleans were hell, the skies above were Armageddon. Helicopters flew in all directions; fires lit up the horizon; gunfire erupted sporadically.

Some pilots stowed body armor — courtesy of the Hospital Corporation of America and a police department — beneath their seats to stop bullets aimed from below. Like the evacuation of the U.S. Embassy in Saigon in 1975, the exodus from Tulane was a chopper-borne operation.

Oh, my God, this feels like a war, Tulane’s chief nursing officer would say, peering at the sky from the roof of the Tulane garage.

John Holland, the former military man acting as air traffic controller, put his arm around her.

Honey, you are in a war, he said. It’s just a different type.

If it felt like a war, it was also a well-honed military operation.

In two days, Tulane had set up a makeshift helipad, corralled nearly two dozen helicopters, fashioned an air traffic control system, organized patients into staging areas for evacuation, and arranged for each to be transferred to another hospital so care would be continued.

By Wednesday night, most of Tulane’s 178 patients were gone, including 58 brought over from the Superdome before the storm.

It may not have been evident at the time, but when Dr. Ben and his colleagues arrived that night from Charity, they left behind an environment bordering on anarchy and stepped into a hierarchical system in which people had followed commands and moved in lock step for two days.

Frustration and anger had grown at Charity, where time and again they’d been told the government was coming to rescue them. When the owner of a Missouri-based helicopter company promised to send four helicopters for Charity’s sickest patients, Dr. Ben assumed those choppers would be dedicated to his hospital. But it wouldn’t work that way.

When those from Charity arrived at the garage, they were told to stay downstairs. For safety’s sake, no one could be on the helipad except those loading patients and bringing in aircraft.

As director of medical intensive care at Charity, Dr. Ben was used to being in charge. He didn’t like being told to wait anywhere.

Maybe the seeds of enmity weren’t planted that night, just nurtured. There had always been some bad blood between the hospitals. Tulane was the for-profit facility owned by the wealthy Hospital Corporation of America; Charity was the poor public stepchild, neglected by state government, always short of cash, yet depended on to serve the city’s poor and forgotten.

After an hour, a truck came down to the first floor and carried Hunter to the rooftop, where he was loaded onto a medevac and taken away. Then the real waiting started.

For the next two to three hours, Dr. Ben and the others watched as helicopters landed and departed while their three critical patients suffered. One, 25-year-old Preston Johnson, began bleeding from the nose and mouth.

Finally, Dr. Ben radioed Charity to find out what had happened to the four promised helicopters — and learned they had come and gone. Other than the medevac that took Hunter, evidently the other three had carried out Tulane patients.

Dr. Ben was outraged. The government had abandoned them, and he felt Tulane was doing the same.

Yelling, swearing, he ran to the roof and demanded that his patients be evacuated immediately. They had no way back to Charity, and he was frantic about their safety. Holland understood the doctor’s desperation. He was also aware that the physician knew nothing about helicopters and rescue operations.

Doc, I’m on your side, Holland quietly told him.

Late Wednesday night, thanks to Holland’s military contacts, a Black Hawk that had no seats landed; it could take patients on stretchers. Holland put Preston and the other two Charity patients on board. Dr. Ben, Williams and nurse Pevey climbed in.

As they lifted off into the black, moonless night, Dr. Ben had a sense of the surreal. The military pilot wore night vision goggles, and Dr. Ben, wearing a headset, listened in on the communication in the cockpit. OK, slide a little bit left. Slide a little bit right. The buildings were so close, he felt he could reach out and touch them.

After about 10 minutes, Dr. Ben saw on the distant horizon what looked like Emerald City. As the chopper drew closer, he spotted a familiar sign for I-10. Then suddenly the sky lit up as they landed on a cloverleaf bathed in blinding lights. It reminded him of the movie “Apocalypse Now.” The lights belonged to ambulances — dozens of them — sitting on the highway.

Dr. Ben jumped out and approached a driver.

What are you guys doing here? he asked.

We’re waiting.

How long have you been waiting?

For three days, the driver told him, for patients who had never come.

ON FRIDAY: Two mothers learn the fate of their sons. Chapter 13 of 22.

Permalink | Comments (13) |

CHAPTER 11: THREE MOTHERS, THREE SONS AND A SORROW SHARED

By Jane O. Hansen | Tuesday, May 16, 2006, 12:51 PM

The Atlanta Journal-Constitution

New Orleans — Celeste Waddell didn’t know whether Hunter Reeves felt her presence. A respiratory therapist at Charity Hospital for nearly 22 years, she refused to leave her patient’s side as he struggled for his life. Hunter, unconscious, had come to Charity the week before Hurricane Katrina, in critical condition. Waddell, 46, didn’t want him to die alone.

At 23, he was barely older than her son, Christopher, her only child. She’d always been so proud of him. Christopher had been sickly as an infant, but he’d grown into a strapping young man. At 6-foot-2 and weighing 300 pounds, he’d been a freshman walk-on player the previous year for the Northwestern State University football team in Louisiana.

It was the mom in her that drew Waddell to Hunter. His medical treatment had been cut off by the storm. But she didn’t want the young man to suffer.

When the emergency power failed, she kept him breathing by squeezing a bag to pump oxygen into his lungs. When the heat rose, she fanned him. She poured her drinking water onto a towel and put the cloth on his fevered brow.

Dr. Ben deBoisblanc, director of the medical intensive care unit, tried to relieve her, but she snapped at him. Leave me alone, she said. I’m all right. Go help somebody else. The two had worked together for 15 years, and often fussed at each other.

Throughout Charity, people were on edge. They felt as if they were trapped on a sinking ship.

Someone who became known as “The Food Angel” brought the staff half-full Dixie cups of cold canned pork and beans or cold tomato soup. But food was running out for everyone. Nurses gave hungry patients multivitamins to provide at least some basic nutrients; some gave themselves intravenous fluids to prevent dehydration.

In the delirium of little sleep, food or water, they could see helicopters circling above and landing across the street at Tulane Hospital. But they were locked inside their own prison. They had no idea what was going on.

By Wednesday, rumors were flying. They’re coming to evacuate Tulane but not us. Gangs have taken over the hotels. People are committing suicide in the Superdome.

They could see looters wading through the water with stolen goods. They heard the crashing of storefront windows and occasional gunshots. In the growing anarchy, they feared that armed thugs would storm the hospital. The crisis in morale was evolving into mutiny.

Dr. Ben and others came to a conclusion: The only way we’re going to get off this rock is to rescue ourselves.

He was fed up with the false promises that the government was coming. He questioned whether hospital leaders were even asserting themselves. The CEO, Dwayne Thomas, remained five blocks away at Charity’s affiliate, University Hospital, which had also lost backup power.

Dr. Ben respected those who seemed to be in charge at Charity — Ed Burke, chief financial officer; Ron Broadus, director of human resources; Adler Voltaire, Charity’s chief administrative officer; and Dr. Jim Aiken, medical director for emergency preparedness. But they didn’t appear to him to be thinking outside the box. Katrina was its own breed of hurricane; it didn’t fit into the neat confines of the emergency preparation plan they were relying on.

Some medical staff felt those in charge were like generals in a war room who seldom ventured into the field. They cared deeply about the patients, but they didn’t know what it was like to watch them gradually wither away without dialysis. The doctors and nurses were in the trenches, their hands aching from hand-ventilating people they feared would die in their arms.

Charity staff had called CNN to let the world know of their plight. Soon afterward, the CEO of an air ambulance company headquartered in West Plains, Mo., contacted someone at Charity. His helicopters were already assisting in the evacuation of Tulane Hospital. He had four medevacs that could each take one patient if Charity could get its four sickest over to the Tulane parking garage, to a makeshift helipad.

Dr. Ben consulted with other doctors: Which four should go first?

Dr. Ben stopped by Hunter Reeves’ bed to reassure his mother, Sherry Hebert. Hang in there, he said, grabbing her by the arm. We’re going to get him out of here.

Of the four patients they had chosen to evacuate, Hunter was No. 1. He was young and his condition was treatable, and that meant his chances of survival were good if he received the medical care he needed.

Preston Johnson, on the other side of the ICU from Hunter, was also among the four. Preston, 25, had periods of consciousness, but his condition was unstable. He would bleed from his ears, nose and mouth; then the bleeding would stop.

Doctors were unsure what was wrong with Preston, although they knew he had suffered abdominal trauma during a fight. When Katrina hit, the pathology remained uncertain, but an oncologist said he had some type of lymphoma. They had started him on steroids, and the medication seemed to be helping.

His mother, Carolyn Lewis, had brought him to Charity a month before the storm. A former staff sergeant in the Air Force, Carolyn had been living on the sixth floor ICU, sleeping in the waiting room when she wasn’t at her son’s bedside reading Scripture, stroking him or singing his favorite hymns. She was good medicine for him, the staff felt. Every time she walked in, he perked up.

Waddell, who had helped care for Preston before the storm, had seen a similar reaction when the young man’s children came to visit. A couple of weeks earlier, Preston had been so gravely ill that doctors suggested his two little boys, 5 and 3, be summoned to see him. The older one, nicknamed Bubba like his father, ran in and said, Daddy, are you coming home, are you getting well? Preston opened his eyes and smiled. Waddell was struck by how happy Carolyn was to see her son’s reaction.

The respiratory therapist was a little more optimistic about Preston’s prognosis than she was Hunter’s. After the hospital lost backup power, staff had begun weaning some patients from their ventilators to see whether they could breathe on their own. Their evacuation would be easier if the machines did not have to be moved with them. Preston did fairly well in his trial off the ventilator.

Waddell knew the anguish Carolyn and Sherry felt. The mothers had become close, and she understood why. One day, when Preston had taken a sudden turn and seemed near death, she had spoken with his mother in private.

Waddell wore a necklace with three gold charms: a little boy, a football helmet and the words, “No. 1 Mom.” She also wore a gold cross — a gift from her son. For the first time, Waddell had told Carolyn about Chris.

He would have been 20 this year.

On March 1, 2004, Christopher Waddell collapsed during football practice and died from a heart attack. Losing her only child had been life-altering. He was “a kind and gentle giant,” she wrote for the college athletics Web site a year after his death. His life was a testimony “that it is possible to beat the odds by making the right choices in life.”

Carolyn was stunned by Waddell’s loss. I would never get over that, she thought. Her only child.

Waddell had told Carolyn gently that there could come a time when she, too, might have to say goodbye to her son.

I know you don’t want to see him suffer. So you may have to let him go.

Once again, medical staff prepared patients to leave. This time, they were determined to evacuate their four sickest, with or without government help.

When it was time to take Hunter, Waddell knew she had to say goodbye. She could not accompany him; patients here still needed her help. But it was hard to let him go. She wanted to be there for Hunter because she hadn’t been able to be there for her son, Chris, when he died.

She didn’t know whether Hunter could hear her, but she leaned over his bed and whispered goodbye, squeezing his hand.

Tell Chris I love him. He’s going to take care of you.

After strapping Hunter onto a spine board, doctors and nurses carried him down five flights of stairs to the outside. His mother lighted the way with a flashlight.

Then they prepared to move Preston. Carolyn watched as they wrapped around his arm a wooden cross someone had made him. They slid a key ring, with photos of his boys, around his middle finger.

Like everything in this operation, getting to Tulane from Charity would be hit-or-miss. How would they move four very sick people through channels of deep infested waters?

A Tulane employee had managed to float out in a canoe and flag down a National Guard trooper with a truck big enough to navigate the floodwaters. The trooper, who had lost contact with his unit, at first hesitated to help. But with no radio to ask permission, he agreed to go ahead.

Down on the ramp, Sherry jumped onto the truck with Hunter, but was told to get off. She did not complain; she wasn’t worried about herself. Like Carolyn, the mother was thinking only of her son. She kissed him goodbye.

Carolyn could not see Preston after they put him onto the back of the truck. She asked whether she could go with him, knowing she was his strength. No, they told her; she’d have to stay behind. A doctor and a patient’s father lifted her up so she could touch him. Mommy’s right here, * she told him. *I’m not going anywhere.

When he opened his eyes, she kissed her hand, then touched it to his cheek. Crying, Carolyn told Preston she loved him.

The two mothers stood on the emergency room ramp, holding hands and watching until the truck was out of sight. Each wondered: Will I ever see him alive again?

ON THURSDAY: Trouble in the parking garage. Chapter 12 of 22.

Permalink | Comments (18) |

CHAPTER 10: RUMORS, RED TAPE AND DESPERATE CALLS FOR HELP

By Jane O. Hansen | Monday, May 15, 2006, 03:19 PM

The Atlanta Journal-Constitution

New Orleans — The story spread rapidly through Charity Hospital, devastating those who were scrambling to save lives but running out of time: Gov. Kathleen Blanco had announced that Charity had already been evacuated.

One nurse began to cry. We’re going to die. We’re never going to get out of here.

Many news reports out of New Orleans the week that Hurricane Katrina hit were wrong or skewed. The governor had told CNN on Tuesday, Aug. 30, that Big Charity, without backup power, was “not functional at this time, and we are trying to evacuate the patients there.” Soon after, the television network reported that Charity was already “being evacuated.” By the time the statement reached those inside the hospital, it had falsely morphed into a done deal: Everyone was out.

Over and over, they had heard that the Federal Emergency Management Agency was on its way to rescue them. Now they felt truly forgotten. No one knew they were still there. No one would be coming.

Student nurse Susan Sanborn watched as a nurse snatched up her two young children and waded away from the hospital in chest-high water. Looking down from her fourth-floor window, Sanborn cried. She didn’t think they’d make it. How could the woman risk her children’s lives? How could she desert her job and patients?

Another nurse from Sanborn’s unit was relieved of her duties and threatened with being sent to the psychiatric ward.

The misinformation marked a turning point.

Doctors and nurses began calling CNN, Fox News and anyone they could reach to get the word out that they were still there. Miraculously, the WATS line in Sanborn’s unit still worked. By Wednesday, the nation was getting a firsthand account of the life-and-death crisis inside Charity.

Among those put on the air was Krystin Smith, a registered nurse who was caring for one of the hospital’s sickest patients, 23-year-old Hunter Reeves.

“Our patients are sitting in feces, and just — it’s awful,” Smith told Paula Zahn of CNN. “I mean, we are — and not only that, we are scared for ourselves too because it’s becoming a hazard to take care of the patients, because we are now getting sick… . That’s why we contacted you, because we thought that you all would get it out there that we’re suffering here, that we’re not doing too well, and not just our patients, but us too.”

As chief of trauma at Charity and director of trauma for the Tulane medical school, Dr. Norm McSwain had loyalties to both Charity and Tulane Hospital. He was in Tulane’s command post most of that week. But as time wore on, his concern grew for Charity; he worried it was being left behind.

McSwain, 68, saw how the Hospital Corporation of America was mobilizing to get everyone out of Tulane. Mel Lagarde, an HCA executive, refused to accept no from anyone. On the other side of the street, the Charity administrators weren’t nearly as aggressive, McSwain felt, in part because they had been told the government was on its way.

A nationally known trauma expert who trained at Atlanta’s Grady Memorial Hospital, McSwain called a leader in the National Association of Emergency Medical Technicians. We’re having trouble getting through to anybody who will help us out, he told him. Can anybody get through to somebody in the White House?

Within minutes, an Associated Press reporter and a reporter with USA Today reached McSwain on his cellphone. He told both that if Charity didn’t get help soon, people would die.

“Somebody needs to come in a hurry,” McSwain told USA Today.

“By ‘in a hurry,’ I don’t mean tomorrow or the next day. They need to get here tonight. By tomorrow we’ll have dead patients simply because they were not evacuated.”

Don Smithburg, chief executive officer over all nine public hospitals in the Louisiana State University system, including Charity, also felt powerless. Since Saturday, he’d been stationed at the state command center in Baton Rouge. Now he watched as Michael Brown, head of FEMA at the time, held a news conference at the center, blaming state and local governments for their slow response.

Brown defended his agency, telling reporters it was taking so long to evacuate hospitals because medical staff needed time to get their patients ready. Smithburg knew that Charity’s patients had been ready since Tuesday morning when the basement flooded.

He had been buttonholing everyone at the state emergency operations center. He pleaded for help from representatives of FEMA, the National Guard, the Coast Guard and any other government official who would listen.

The governor was also at the state command post, and Smithburg spoke regularly to her. Conditions in Charity and its affiliate, University Hospital, were dire and deteriorating, he told her. She too asked federal officials for help.

But there was no clear chain of command, and Smithburg felt buried under bureaucratic red tape. Instead of walking across the room and saying what he needed, he had to sit at a computer and type up a cumbersome e-mail request, whether it was for security or to evacuate two entire hospitals.

Three times, he was told the government was on its way to Charity and University hospitals. Three times between Tuesday and Thursday, he radioed the information to the hospitals: FEMA is coming! The National Guard is coming! A National Guard truck did show up Wednesday night and took away some of Charity’s less critical patients. But there was no wholesale evacuation.

In the void, more and more employees began calling Smithburg after someone obtained his cellphone number. He knew it was unusual for employees to reach out to a CEO, but he had become their lifeline. Some nurses sobbed uncontrollably, and he tried to reassure them.

They didn’t think they were going to get out. As their leader, he felt helpless.

Employees told him they were starting to feed themselves intravenously.

TOMORROW: Dr. Ben deBoisblanc tries to save his four most critical patients — including Hunter Reeves and Preston Johnson. Chapter 11 of 22.

Permalink | Comments (10) |

CHAPTER 9: 'THE MAN' FROM MACON: A COMMANDING PRESENCE

By Jane O. Hansen | Sunday, May 14, 2006, 05:11 PM

The Atlanta Journal-Constitution

New Orleans — Col. John Holland stepped off the red, white and blue Emory Flight helicopter Wednesday morning — a vision of calm and control.

I need to get to your command center, he said.

A new player in the bold rescue of Tulane Hospital was about to assume control of the rooftop helipad. He would make all the difference in how many choppers could land, how quickly they could load up and take off, and whether they could do it without anyone getting killed.

Tulane’s corporate owner had marshaled all the resources. But it would be a Georgian in a teal blue flight suit who would bring expertise to the operation. The mission may have appeared simple and smooth to some onlookers. But the landing of so many helicopters was fraught with peril — something pilots understood better than anyone.

With 30 years in the military and 36 as a pilot, Holland would become known simply as “The Man.”

That night, when police Cmdr. Dan Bitton flew his helicopter into New Orleans, there wasn’t a star in the sky. He told his crew — all cops from north of Chicago — that when they located the parking garage roof at Tulane, they wouldn’t land without first doing a “go-around.”

That’s the command used on approach by any member of the crew who becomes uncomfortable with a landing. He simply says, “Go around.” The pilot pulls up and out. No questions asked.

The four agreed Wednesday night they would do a maximum of two go-arounds. If they weren’t confident by then, they’d abort the mission.

Even in daylight, the flight path to Tulane was risky, requiring pilots to navigate through a canyon of tall buildings. On a pitch-dark night, in a city without light, it was death-defying.

Bitton was at the controls, wearing night vision goggles.

As a seasoned cop, Vietnam veteran and pilot with more than 14,000 hours of flight time, Bitton, 52, was a fearless cowboy prone to pushing the envelope. He was among the first to be trained in a new generation of goggles approved for use in taking off and landing.

As he maneuvered around buildings and power lines, his head was in constant motion. The helicopter, a Eurocopter EC-135, was equipped with sophisticated radar equipment. But nothing could prepare them for this sea of blackness.

The night vision goggles blocked peripheral vision, so Bitton swiveled his head to the left, to the right, up, down. To see what was in front of him, he had to look directly ahead through the goggles. To see the aircraft’s instrument panel, he had to look beneath them. If he looked under and out, he’d see nothing but pure black.

To get everyone out of Tulane quickly, the Hospital Corporation of America would eventually lease 24 helicopters and secure the aid of six military choppers. HCA also positioned nearby supplies of food, water and medicine. Pilots such as Bitton, trained to fly at night, were critical to keeping the operation moving.

Building to your left! Building to your right! yelled his crew from the Winthrop Harbor Police Department.

After about 15 minutes, Bitton’s crew spotted what they believed was the parking garage roof. They had no way to communicate with anyone there. Bitton discussed his approach with the crew — what angle he would bring in the aircraft, from what direction, where he’d land.

The tension was high, and Bitton tried to lighten the mood. Hey, it’s as easy as pie to fly, he said. But they all knew this wouldn’t be easy.

As they began the approach, no one spoke. Then, Go around! Bitton immediately gave the helicopter power and climbed to a safe altitude to circle.

OK, guys, what do you think?

The crew member who’d spoken had suddenly seen a nearby hotel and thought Bitton was too close.

Then another crew member spoke: Commander Bitton, do you think you can do this?

Yes.

He told them where he planned to start and finish. They agreed to give it one more try. But only one.

As each helicopter landed, Sharif Omar waited until the rotors slowed down enough that he could run up and yell, What can you take? The pilots called the shots.

They told him the type of patient the craft could carry — ambulatory or stretcher. Where they could take patients depended on how much fuel they had, where they were based, and how many hours they had been flying. Under federal aviation regulations, pilots can be on duty only 12 hours before they have to rotate out.

Some helicopters had no medical equipment on board and could not take patients who would need it. If the aircraft was low on fuel, it could fly only a limited distance. Others could fly only to the location from which they had come.

Omar, Tulane’s 26-year-old associate vice president of operations, had been put in charge of the makeshift helipad Tuesday morning. But he had no experience directing air traffic. When John Holland and his co-pilot alighted Wednesday, wearing helmets and visors and saying they were there to help, to Omar they were knights in shining armor.

Less than 24 hours earlier, Holland had been home in Macon with his wife of 28 years, Betty. At 55, he was director of aviation for the Southeast region of LifeNet, a private company that provides helicopters for medical emergencies. The company owns Emory Flight, which transports patients to and from Atlanta hospitals.

Holland grew up on a dirt farm in Reidsville, Ga., raised by his grandparents, who were sharecroppers. He went straight from high school into the Army and finished advanced flight training by the time he was 22.

Over three decades, he served around the world — in the hostile demilitarized zone of Korea, in South America, in the Middle East. By the time he retired from the Army in 1999, he had reached the rank of colonel.

Taking control of the Tulane roof was not out of character for Holland. Nor was this his first disaster rescue.

He had learned the value of communication systems while running the air rescue operation for Hurricane Andrew in 1992. In addition to the satellite tracking system on each of the three aircraft he brought to New Orleans, he made sure each had cellphones with different providers. He knew some would get signals where others wouldn’t. Also key was finding a place to refuel.

Once inside the Tulane command post — a small, dark, windowless room — Holland could see how exhausted everyone was. Four or five senior personnel huddled around their only light, a battery-operated lantern.

Holland told them he had some experience in this type of disaster and if he could help with the helipad … Yes, please, they interrupted.

He was impressed with their demeanor. He had seen commanders lose it in a crisis, yelling and screaming at troops. But these people were calm, clear and professional. As a retired colonel, Holland knew how senior leadership should act, and he saw in them model behavior.

Returning to the roof, he asked for a head count.

The first estimate: About 500 employees and family, plus 120 or so patients. Not good enough, Holland said. I need a more accurate count. The total grew from 620 to 800, then to 1,000. Eventually, it topped 1,200.

Holland briefed Omar and the others on how the rooftop operation would work. With reddish-brown hair, a matching mustache and smile lines around his eyes, Holland had an uncommonly melodic voice that rarely rose out of control yet commanded respect. There would be no running and no yelling, he said. Both fueled chaos and threatened safety.

He trained them to use hand signals to communicate over the din of the helicopters. Fist in the air meant “Stay where you are.” Arms out to the side: “Hold your hover.” Arms straight up: “Land here.” Arms straight down: “Bring it down.” Finger across throat: “Shut it down.”

He encouraged upper management to wear the same colored shirt each day; he would remain in his teal blue Emory flight suit. The uniforms would signal who was in charge.

When a helicopter landed, Holland checked the fuel and used a steno pad to scratch out notes to the pilot. How many more flights could he make? “One more, fuel first, then we’ll be back,” one pilot wrote back in a jagged scrawl, his hand shaking from the vibrating aircraft.

When helicopters returned, they brought back batteries, food and other supplies coordinated by HCA headquarters. Holland developed a taste for honey nut granola bars and Pop-Tarts.

He wrote down a radio frequency that pilots could use to communicate with other aircraft headed to Tulane. Radio traffic was building, and he had found a frequency that wasn’t commonly used.

To expedite the rescue, Holland ordered that a secondary staging area be set up on the seventh floor of the parking garage, just below the rooftop. He formed two lines: Patients on stretchers or in wheelchairs would be carried or wheeled up the ramp; ambulatory patients and others who could walk would climb the stairs to the roof.

After he communicated with each pilot, Holland pointed to the appropriate line and held up fingers indicating how many could come up. Omar and the others repeated the gesture like an Indian hand signal, relaying the information down the ramp.

The roof was becoming a more dangerous place. To save time, they had begun “hot loading” the helicopters — a risky procedure. It involved putting people aboard with the rotors running instead of shutting them down, shaving 25 minutes off the process.

Later, when ham radio operators arrived to help, the system began moving even faster.

“Hams,” as they call themselves, live for the roles they can play during disasters when other forms of communication fail. Two members of the Tallahassee Amateur Radio Society had volunteered to go to New Orleans. One set up on the Tulane roof; the other initially was stationed at the airport and later joined his buddy at the garage. They communicated with a third ham at the Tallahassee office of HCA, who relayed information on which hospitals had agreed to take patients, which kind of aircraft were on the way, and the grid coordinates to pass on to the pilots.

By late Wednesday, they had such an organized flow of traffic that some helicopters landed there by mistake. One — a chopper filled with isolettes — was due at another hospital to evacuate babies.

To improve night landing, Holland instructed staff to drive four cars up and park them in the corners of the garage roof, their high beams pointed toward the middle. The beams’ cross point gave pilots a reference as they descended into the concrete valley.

When Bitton finally landed Wednesday night, Holland helped bring him down. Pilots like Bitton, who had a military background, recognized a kindred spirit in Holland. Bitton told Holland he was short of fuel. Where could he find some? Holland told him there was a military post at the I-10 causeway.

*That’s a zoo, *Bitton said.

Holland didn’t know where Bitton was headed when he lifted off. He just knew he’d be back.

By now, the operation was running so well that, where once they wondered whether they could land a single helicopter, they were landing six. In a gesture of support, an HCA hospital in Florida airlifted in a giant American flag. The maintenance staff hung it just under the storm-battered Tulane Hospital sign that crowned the building at its highest point.

I was put here for a purpose, Holland thought to himself. This is where I’m supposed to be.

Still, he worried the operation was moving too slowly. Hundreds of people awaited evacuation.

And what about the animals? someone asked as people were being loaded into a chopper.

Holland responded with a blank stare.

What animals?

ON TUESDAY: At Charity Hospital, desperate calls to the media. Chapter 10 of 22.

Permalink | Comments (17) |

CHAPTER 8: STIFLING HEAT, SLIPPING MORALE, SURPRISE PATIENTS

By Jane O. Hansen | Saturday, May 13, 2006, 03:21 PM

The Atlanta Journal-Constitution

New Orleans — At Charity Hospital, Susan Sanborn held tight to her sanity by keeping up with her job.

As a student nurse, the petite woman with curly auburn hair was in charge of bathing patients, cleaning their bedpans and changing their sheets in her unit on 4-Central. By Wednesday, Aug. 31, she had only 10 sheets and two clean hospital gowns left. The toilets were so gross, someone put up a sign saying, “For the love of God, please do not use this toilet anymore — go to Port-A’s for crap (or at least another floor).” It was signed “The new management.”

Sanborn’s domain was the “hopper room,” where she emptied catheters and bedpans into a huge receptacle. She obsessively calculated how many days she had left before even the hopper overflowed.

What am I going to do with this urine and feces? she asked herself.

Sanborn, 37, had gone into nursing as a second career after fleeing a bad relationship and moving from one hurricane-prone area to another. A professional modern dancer with an undergraduate degree in psychology, she’d lived in Florida where she did dance therapy in shelters for troubled children. In New Orleans, she was working on a geriatrics psychiatric unit when her supervisor asked whether she’d ever considered becoming a nurse.

Wow, you think I could do this? she had asked him.

She applied to Charity’s school of nursing and quickly fell in love with the hospital’s patients, staff and program. The doctors and nurses took time to teach her. She felt respected and was allowed to practice her skills. She never dreamed she’d become such an expert in packing bullet holes — one of the benefits of working in the city’s only Level 1 trauma center.

She was eight days into her last year of nursing school when Hurricane Katrina hit.

As her patients’ anxiety level rose, Sanborn tried to comfort them. They repeatedly asked for water, but many just wanted attention. An 83-year-old woman who had been in an automobile accident asked whether her doctor would be angry if she sucked a peppermint. Her mouth was so dry. She had nothing but her bathrobe and nine peppermints. Sanborn said sure.

The heat inside the hospital was so unbearable that doctors and nurses — sweat dripping off their noses — heaved oxygen tanks through sealed windows to let fresh air inside. As diesel for the portable generators began to run low, they siphoned fuel from trucks and ambulances.

Morale was slipping. More than 24 hours had passed since the state command post in Baton Rouge had sent word that the federal government was on the way.

Four patients had died, although all had been very critical before the storm — a woman with end-stage cancer, a young man with multiple injuries from a motorcycle accident, a man who had overdosed on cocaine, and an elderly woman from a nursing home. With the basement morgue flooded, staff put the bodies in upper stairwells.

A prayer meeting led by the chaplain on the emergency room ramp Wednesday afternoon lifted some spirits. It became as much a pep rally as a prayer service, and they would repeat it every day. Someone would speak a thought, say a prayer; then they would hug and cry. Some people had no idea where their family members were — or whether they’d survived. As the energy mounted, they clapped and sang gospel songs and “We Shall Overcome.” Doctors, nurses, janitors, family members swayed to the music as if they were at a Baptist revival.

On Sanborn’s unit, nurses made a banner and hung it out the fourth-floor window. Maybe someone would see it. On a sheet, in huge purple, red and blue letters, they wrote: “FORGOTTEN BUT NOT LOST!”

Throughout New Orleans that week, many were forgotten and lost. A National Guard unit found some nursing home patients and brought them to Charity.

We can’t take care of these people, Sanborn thought. We want you to take people away, not bring us more.

Sanborn’s unit got two of the patients. Both men were on ventilators, had tracheotomies and couldn’t speak. They also had catheters and feeding tubes. No one knew what was wrong with them, what medications they needed, what kind of treatment they had been receiving. Were they on insulin? The staff couldn’t read the names pinned to the clothes of the two men. Because one was black and one white, they named them after the Stevie Wonder/Paul McCartney song “Ebony and Ivory.”

At first, Sanborn felt certain they wouldn’t survive.

Not knowing what else to do, nurses gave them Ensure — a high-calorie nutritional drink — through their feeding tubes. They gave them water every four hours and Ativan to relieve anxiety.

There was no room for them in the open ward where staff had crammed the other patients to take advantage of the limited working equipment. So they put Ebony and Ivory on the “dark side” of the unit, across the hall, where there was no light or working devices. Sanborn felt it was symbolic. They’d been abandoned to the water and now they were being abandoned again.

She quickly grew attached to the two elderly men. Ivory in particular seemed aware of what was going on, and he and Sanborn developed a rapport.

Oh, it’s time for lunch, she would say to him, making light of the hospital’s shortage of food and water. Today it’s vanilla Ensure. He rolled his eyes at her.

As a bonus for you, there’s water. And guess what? This water is not from the street. It’s from a bottle!

He smiled at her. He seemed to enjoy the banter; it helped them both.

Then Ebony, who medically had seemed the stronger of the two, took a turn for the worse. Sanborn couldn’t get his blood pressure, suggesting his heart had stopped beating or was so weak she couldn’t get a reading with a blood pressure cuff. His temperature soared to 104 degrees. The nurses knew he needed intravenous fluids, but his veins had collapsed and they couldn’t get in a line.

A group of surgical residents — doctors in their final years of training — ran up the stairs and began the more complicated procedure of threading a line into Ebony’s femoral vein in his groin. Midway through, a doctor burst into the room.

What are you doing? he demanded. I thought we agreed all these people from the boats are DNR [medical code for “Do not resuscitate”]. He ordered them to quit wasting their time.

The residents and nurses grew very quiet, recalled Sanborn and two others who were there. They didn’t say they would do what the staff physician ordered. And they didn’t say they wouldn’t. The physician left, they completed the procedure, and they began giving the man IV fluids. By the end of the day, Ebony’s blood pressure was back up to 92 over 48 — not normal but he was alive.

Ebony and Ivory were going to survive this, Sanborn told herself. They had to.

ON MONDAY: On the rooftop at Tulane Hospital, “The Man” arrives. Chapter 9 of 22.

Permalink | Comments (12) |

CHAPTER 7: RESCUE PLAN FROM A TO Z

By Jane O. Hansen | Friday, May 12, 2006, 01:12 PM

The Atlanta Journal-Constitution

Nashville — Within hours after the levees broke in New Orleans, executives of the nation’s largest for-profit hospital chain were thinking ahead: What would they do with their stranded employees after airlifting them to safety?

A risky helicopter rescue of Tulane Hospital’s most critical patients was well under way on the roof of a parking garage. But more than 1,000 doctors, nurses, employees and family members were also imprisoned by the floodwaters that surrounded the hospital and rushed inside, drowning the emergency generators. The Hospital Corporation of America would act decisively, not waiting for — or even expecting — government help.

From its hushed, cushiony boardroom, the company early Tuesday launched a sweeping plan that would later be regarded as a textbook example of disaster response. Jack Bovender, the CEO and the son and husband of nurses, led his team of executives, each of whom had years of experience in health care administration.

First, their evacuated employees would need to be decontaminated, fed and given clothes and a cot to sleep on. HCA set up three shelters 135 miles west in Lafayette, La., at a dance studio, a banquet hall and a catering center. The company ordered pharmaceuticals and supplies, and called upon its army of employees from around the country to assist in the relief effort.

Each employee would receive a tetanus shot and a six-day supply of the antibiotic Cipro to stave off cholera and other bacterial infections. New underwear, scrubs, flip-flops, toiletries and towels would be issued. Employees would receive information about how to get their paycheck, relief assistance, federal disaster benefits and cash. The plan was so comprehensive that HCA even arranged to have tampons and children’s toys available for any employee who wanted them.

The company would use private aircraft to fly in dozens of nurses and staff from other HCA facilities. Through its temporary staffing agency, 170 nurses stood by, ready to be deployed from nine U.S. cities. Staff organized volunteers in Lafayette to cook a down-home Cajun meal of jambalaya for the weary evacuees’ first night of freedom.

Knowing that many employees would have lost their homes to Hurricane Katrina and the flooding, Bovender had floated the idea of housing them in a chartered cruise ship. When the CEO of the Hospital Corporation of America speaks, a hierarchy of willing officials listens. But in no time Tuesday they nixed the notion. They would later laugh when Bovender himself summed up the findings of their cost analysis: It would be cheaper to fly everyone to Chicago and put them up at the Ritz-Carlton.

The federal government, on the other hand, would embrace the idea. While desperate New Orleanians still clung to their rooftops, the Federal Emergency Management Agency signed a six-month, $236 million contract with Carnival Cruise Lines for three ships to house evacuees.

Critics in Congress later lambasted the decision, calling it a “sweetheart deal” for the cruise line. Even with the ships at full capacity, the cost to taxpayers would have been $1,275 a week to house each evacuee. The ships, however, would never become as popular as the government envisioned. By the end of September, they were only half full, according to two U.S. senators. Apparently people who had lost everything to the water didn’t want to go live on it.

Instead of a ship, on Tuesday afternoon, HCA reserved 1,500 hotel rooms in Atlanta, Houston, Orlando, Nashville and Dallas. It chartered two 727 jetliners to fly to Atlanta and Houston. It would purchase 200 one-way tickets to get people from there to the destinations of their choice.

Throughout the elaborate preparations, Mel Lagarde, the executive in charge inside Tulane, remained in constant touch with headquarters in Nashville. His cool, calm voice over the speakerphone inspired the HCA executives; their regular updates from Nashville in turn gave Lagarde confidence and hope.

By late Tuesday afternoon, all but two of the hospital’s 31 most critical patients were en route to hospitals in Houston; Pensacola, Fla.; and Lafayette, Covington and Alexandria, La. Still, Sam Hazen, president of HCA’s Western Group, was worried. Most of the helicopters in use were designed to take only one to five passengers at a time. The flights to Lafayette and Pensacola, where many of the critical patients had been taken, took as long as four hours round trip.

Hazen did the math. We need to turn over these helicopters faster, he said.

The Louis Armstrong International Airport was only an eight-minute helicopter ride away, less than 20 minutes round trip. What if they turned the airport, closed to regular traffic, into a staging area? HCA already had a relationship with the company that operated one of the private hangars. The helicopters could refuel there and load up with food, water and other supplies for the return trip to Tulane. They could drop their employees at the airport, then bus them to the shelters in Lafayette.

The plan would go into effect the next morning, Wednesday, Aug. 31.

That day, another turning point would come with the arrival on the roof of someone who understood helicopters, human behavior and life-and-death situations.

The HCA executives didn’t even know it yet, but their rescue operation was in desperate need of “The Man.”

ON SUNDAY: At Charity Hospital, a student nurse tends to two mystery patients. Chapter 8 of 22.

Permalink | Comments (4) |

CHAPTER 6: ROOFTOP DRAMA AS COPTERS HAZARD RESCUE

By Jane O. Hansen | Friday, May 12, 2006, 04:43 AM

The Atlanta Journal-Constitution

New Orleans — Sharif Omar normally spent his days darting about Tulane Hospital armed with a walkie-talkie and cellphone as he directed the transporting of patients and oversaw food service and laboratory operations. On Tuesday, Aug. 30, the hospital administrator was ordered to the rooftop to do whatever one does to help a helicopter land.

The sun had barely come up when Omar walked across the enclosed bridge from Tulane to the Saratoga Street parking garage and went up to the roof. The hospital had lost emergency power and was surrounded by water. Patients’ survival depended on getting airlifted out.

Maintenance staff had worked through the night to reconfigure the rooftop into a helipad by removing light fixtures. In Nashville, at the hospital’s corporate headquarters, design and construction staff had tried to calculate whether the roof would support the aircraft. But Omar knew there were no guarantees.

Alone on the roof, he didn’t have to wait long before spotting the first helicopter from Acadian Ambulance Service flying toward him. He watched it maneuver through city buildings.

As the helicopter made its approach, Omar wasn’t sure how to help; he had no way to communicate with the pilot.

He literally held his breath.

Staff at Tulane had moved their most critical patients onto one floor in anticipation of Hurricane Katrina so they could be cared for more efficiently. At Charity Hospital, critical patients remained spread over four floors.

Tulane established clear lines of authority: The president of the hospital, Jim Montgomery, and Mel Lagarde, a division president for the Hospital Corporation of America, were in charge. At Charity, where a committee was at the helm, the chain of command was fuzzy.

At the private hospital, Tulane administrators were equipped with six to eight satellite phones. They had established a command center in a second-floor conference room, where they had miraculously found two working landlines. At Charity, the public hospital depended on irregular cellphone service and a single satellite phone that worked sporadically.

Tulane’s corporate owner, HCA, had learned the lessons of 9/11 — the need for a command and control structure and a reliable means of communication. Tulane had both. And it had something else Charity lacked: hope.

Montgomery and Lagarde were in constant communication with company headquarters in Nashville. They knew the corporation was mobilizing a rescue operation. As a wealthy company with 180 hospitals, HCA could draw on a cavalry of resources.

The two men also walked the halls of Tulane, keeping patients and their families informed. They held regular meetings with managers and separate meetings with physicians.

They maintained order, and they maintained calm. In the boardroom in Nashville, the sound of Lagarde’s quiet confidence over the loudspeaker helped executives keep their own emotions in check.

Up on the parking garage roof, the first helicopter landed and the rooftop held, to everyone’s relief. Tulane’s rescue had officially begun.

Staff had begun moving critically ill patients to the second-floor bridge to the parking garage, then to a holding area on the garage’s second floor. From there, they planned to drive patients by ambulance up six floors to the roof. When the ambulances wouldn’t go up the garage ramps — they were 2 inches too tall — they used pickup trucks instead.

First to be evacuated were 13 newborns from the neonatal intensive care unit and four children from the pediatric intensive care unit. Five of the 17 were on ventilators. Texas Children’s Hospital in Houston had agreed to take them. Montgomery watched as staff loaded the tiny babies on board.

Good God, he thought, how many of these people might not make it?

Hour after hour, helicopters landed and took the hospital’s most critical patients safely away, one or two at a time. The security in the city, meanwhile, was breaking down.

From the rooftop, dozens of people could be seen wading down Tulane Avenue carrying goods stolen from nearby stores. Looters took over the hotel next door where employees’ families had sought refuge during the storm, forcing them to move into the hospital.

But by late Tuesday afternoon, all except two of Tulane’s most critical patients had been evacuated. The two who remained were awaiting heart transplants.

One was a 15-year-old boy on a heart machine that was being powered by a portable generator. Once disconnected, the machine could be hand-cranked, but only for 30 minutes. So the boy could not be moved to the second-floor staging area until a helicopter arrived. And that copter had to be specially fitted with a battery system to keep the machine going. The Arkansas Children’s Hospital in Little Rock arranged to send the special aircraft.

As it grew dark, gunfire erupted on the streets below. Exercising caution, the Tulane command center agreed with Acadian Ambulance Service that it should halt its nighttime evacuation.

Omar sent all but one other person off the roof. He was still expecting the helicopter from Arkansas. He sat waiting in darkness.

Suddenly, a helicopter circled above. Jumping up, he wondered what he should do with the flashlight in his hand. This was the first chopper he would bring in at night. Should he point the light at the ground? At the helicopter?

At first he shone the light into the air. But he worried he might blind the pilot. So he trained it at the ground.

As the helicopter landed, Omar radioed on his walkie-talkie, Move the patient!

On the fourth floor of the hospital, 20 people began the arduous task of carrying the 15-year-old — and the 500-pound machine keeping him alive — down the stairs by flashlight. They had 30 minutes to get him down the stairs, across the bridge, onto the truck, up to the roof, onto the helicopter and hooked up to the battery.

They made it in time, and the boy lifted off. It was no small success. In 18 hours’ time, Tulane had evacuated all but one of the hospital’s 31 sickest patients. Across the street at Charity, where staff had been told the government was on its way, they were still waiting.

About 2 Wednesday morning, Omar lay down to sleep on the floor of his office. He was hot and exhausted but relieved.

So far, at least, no one had died.

ON SATURDAY: New scrubs, flip-flops and a Cajun meal — a comprehensive rescue and relief plan takes shape at HCA headquarters in Nashville. Chapter 7 of 22.

Permalink | Comments (4) |

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.

Permalink | Comments (11) |

CHAPTER 4: A DARING RESCUE PLAN -- BUT WILL IT WORK?

By Jane O. Hansen | Wednesday, May 10, 2006, 04:43 AM

The Atlanta Journal-Constitution

Nashville — Jack Bovender immediately understood the enormity of the situation at Tulane Hospital. The chairman and CEO of the nation’s largest for-profit hospital chain had just walked into the boardroom Tuesday morning about 8 o’clock when Mel Lagarde called from New Orleans, his voice filtering through the speaker system so all could hear.

*The water is coming in.

*It was rising a foot an hour.

We’re going to lose our backup power.

Among the executives gathered at the table, the sense of urgency ratcheted up. CNN was broadcasting reports that the 17th Street levee might have been breached. The update from Lagarde, a division president, meant a new challenge.

Just the day before, Bovender and the others had been preoccupied with the company’s hospital in Gulfport, Miss. Of the Hospital Corporation of America’s four facilities in Katrina’s path, it had sustained the most wind damage from the hurricane.

Now Bovender was thinking: *The whole ballgame is going to significantly change.

*Tulane had ventilator-dependent patients, babies in intensive care.

We’ve got to get the critically ill out of there as quickly as we can.

Lives were at stake. With no power or water pressure, Tulane would need to evacuate not just its critical care patients but the entire hospital — more than 1,200 patients, staff and family members who’d taken refuge there.

It was the direst situation the company had faced in its 37-year history.

Located down a carpeted hall behind two huge wooden doors, the boardroom at HCA headquarters was well-suited as a command post, with its massive mahogany table, large flat-screen TV, computers and sophisticated communications system. Bovender, who had spent three years in the Navy’s Medical Service Corps, would be the man in charge.

Short, with gray hair and clear-rimmed glasses, the 60-year-old Bovender became both chairman and CEO in 2002. He was at the helm when HCA paid the last of nearly $1.7 billion to settle Medicare and Medicaid fraud claims stemming from a nine-year investigation by the U.S. Department of Justice.

Bovender had grown up around hospitals; his mother was a nurse. So was his wife. He’d dreamed of being a hospital administrator since he was a young man.

He had learned that the job involved a lot more than medicine and money. HCA’s facilities in Florida had taught Bovender that running a hospital corporation also meant being prepared for disasters.

Four hurricanes had ripped through Florida in 2004, leading HCA to convene its hospital leaders from around the country to bolster their readiness for storms. They concluded that medicine, food, water, diesel fuel and portable generators should be stockpiled on site and in nearby warehouses. Hospitals needed to be armed with satellite phones to ensure communication when phone service and cell service were disrupted. Increased generator capacity would help preserve air conditioning — critical to the operation of computers that run lifesaving medical equipment.

By the time Katrina hit, HCA executives felt more than ready. But they had prepared for a hurricane, not a flood.

Although the company often used medevacs to airlift critical patients, HCA for the first time would have to evacuate an entire hospital. It would need a lot of helicopters.

How many? Bovender asked.

*At least 20.

Get them.*

Bovender’s team went to work, studying a color-coded map and assessing all the corporation’s assets in the region, from supplies to hospitals.

The plan was to move Tulane’s critically ill babies, children and adults first. But it wasn’t just a matter of getting sick people out. They had to arrange for continued medical care. They had to line up receiving hospitals.

Where would they take the patients? Where would they stage medical personnel to assist in the evacuation? Where would they refuel the helicopters?

Engineers studied Tulane’s garage. Its rooftop hadn’t been designed to function as a helipad. Was there enough room to land there safely? How many cars could it normally hold? Could it bear the weight of a helicopter? How many?

Ed Jones, a vice president of supply chain operations, moved to a side room off the command center where there was a phone. He called Chuck Hall, president of HCA’s North Florida Division in Tallahassee. Although Katrina had merely brushed the state as a Category 1 storm the week before, Hall’s command center was still up and running.

*We need to identify as many helicopters as we can, *Jones told Hall.

They required a variety of types, from medevacs equipped as ambulances that could carry one or two patients on stretchers, to those that could carry ambulatory patients in seats. They needed large high-volume helicopters for staff and their families, and ones that could carry supplies.

With a cellphone in his left hand, a BlackBerry in his right and a landline phone cradled on his neck, Jones leased helicopters from HCA contractors as well as other companies.

A police department north of Chicago offered a helicopter used in Amber Alerts, complete with a cop trained in night vision. An HCA competitor — Sacred Heart Hospital in Pensacola, Fla. — volunteered a medevac.

Within hours, Jones and Hall had lined up choppers from Atlanta, St. Louis, Chicago, Mobile, Houston, Pensacola and Ocala, Fla. They would eventually secure 24 helicopters, including two privately owned Black Hawks that could carry between 15 and 20 people and one Russian Mi-8. Jones began hounding the Federal Aviation Administration for clearance to fly the craft into New Orleans.

He would earn the nickname “Chopper Ed.”

At Tulane, as water inched up the stairs toward the backup generators, Lagarde and Jim Montgomery, the hospital’s president and CEO, did not sit back.

Soon after being awakened in the middle of the night, Montgomery had called Acadian Ambulance Service, a company with air ambulance helicopters based in Lafayette, La. He told them he needed to evacuate 13 critically ill infants, four critically ill children and 14 critically ill adults.

In the next four hours, atop the Saratoga Street parking garage adjoining the hospital, the Tulane maintenance crew dismantled four 15-foot light poles to make way for helicopters. HCA had once sought FAA approval to convert the rooftop into a helipad. But the hospital had never gotten the go-ahead. No helicopter had ever landed there.

By the end of the day, both in Nashville and in Tulane’s darkened command center, the guiding principles were clear:

We’re not going to wait for the government to rescue us. We have to rely on ourselves. We won’t take no for an answer.

Already, they were looking ahead to what they would do with the more than 1,000 Tulane staff and their family members who had joined them at the hospital before the storm. Many had lost their homes. Where would they take them?

Bovender tossed out an idea.

What if we secured a cruise ship?

ON THURSDAY: At Charity Hospital, staff is reduced to practicing Third World medicine. Chapter 5 of 22.

Permalink | Comments (14) |

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.

Permalink | Comments (19) |

CHAPTER 2: TWO FORTRESSES AGAINST THE STORM

By Jane O. Hansen | Monday, May 8, 2006, 04:13 AM

The Atlanta Journal-Constitution

New Orleans — The news stunned Susan Sanborn on Saturday morning: Hurricane Katrina, on its way to becoming a catastrophic Category 5, was hurtling toward her beloved city like a heat-seeking missile.

The professional dancer-turned-student nurse didn’t consider evacuating. She had totaled her car and used the insurance money to pay for nursing school. Her only transportation was a bicycle. If Katrina really did have New Orleans in its cross hairs, she figured her workplace — the fortress of the venerable Charity Hospital — was the safest place to be.

Like many hospitals, the building had served as a civil defense shelter during the Cold War, and in its 60-plus years had sheltered patients — among the city’s poorest — through dozens of storms. No emergency plan had ever called for a wholesale evacuation of the 20-story hospital. Charity remained open for business, come hell or high water.

If hospital administrators called a code gray — the term used to signal a weather emergency — Sanborn planned to be there. The 37-year-old Ohio native had volunteered for the activation team, which would report to work with enough food and water to last three days. They would tend to Charity’s 347 patients in 12-hour shifts, and once the emergency ended, a recovery team would relieve them.

By Saturday afternoon, the storm’s path and intensity spurred hospital administrators to activate the code, a decision that would cost about half a million dollars in staffing and supplies. It would take effect at 8 a.m. Sunday, Aug. 28.

Another nurse offered Sanborn a ride to work. She’d have too much stuff to carry on her bike. Although this was Sanborn’s first code gray, she was in the company of experienced Charity staff, such as Dr. Ben deBoisblanc.

Since coming to the hospital as a medical student 28 years earlier, deBoisblanc had soldiered through a half-dozen code grays. A passionate, emotional man with thinning reddish-blond hair, the New Orleans native looked like the actor Ed Harris of “Right Stuff” fame. At 50, he was director of the medical intensive care unit. Staff and patients called him “Dr. Ben” — far easier than pronouncing his French name.

Several months before the storm, his wife of 20 years had left him. He was shocked; never even saw it coming. A sailor from childhood, he moved out of their home in New Orleans and onto his boat, Creola, moored at a marina on the south shore of Lake Pontchartrain.

Before leaving Sunday morning for Charity, Dr. Ben prepared the boat as well as he could, then grabbed his children’s pictures and other mementos. One prized possession was his only photo of his late father, who had instilled in him his love for the water. His father had never graduated from high school, and more than anything had wanted his son to get a good education.

As he started to take the picture off the wall, Dr. Ben felt his father’s presence. Somehow, he believed, his father’s spirit would watch over Creola. He left the photo behind.

Over the years, with every major storm, Dr. Ben had heard the dire predictions: With the right conditions, the storm surge would put this bowl of a city that sits below sea level under water. Each time Charity had braced itself, and each time the storms petered out or veered away from the city. This time, Katrina promised something more.

As Dr. Ben reported for duty on Sunday morning, he told himself he’d be on lockdown no more than a day or two. But he also couldn’t help thinking:

This could be the big one.

Three hundred fifty miles away in Houston, Sharif Omar collapsed in bed after a Saturday night spent celebrating. Tall and slim, with bushy black hair and long eyelashes, the young man was getting married the next weekend in Virginia, and his bachelor’s party had stretched past midnight.

At 26, Sharif Omar — named for the star of the movie “Doctor Zhivago,” only in reverse — was associate vice president of operations at Tulane Hospital, located across Tulane Avenue from Charity. It was his job to ensure that there was plenty of food, water and blood on hand. He also was in charge of transporting patients. It was a big job under normal circumstances, and critical when a storm threatened.

Before falling asleep, Omar checked the news: Still churning several hundred miles away in the Gulf, Katrina was a Category 3. When he awoke the next morning, it was a 5.

As traffic snaked out of New Orleans Sunday under a mandatory evacuation ordered by Mayor Ray Nagin, Omar sped in the opposite direction, sometimes topping 90 mph as police just watched. He arrived in the city around 5 p.m., grabbed some clothes at his house, then headed to the hospital. The hurricane’s initial bands of wind and rain were starting to blow in.

While other businesses boarded up their shops, the city’s hospitals prepared to hunker down and remain open. Critical patients could not be safely moved without tremendous risk, especially those on ventilators and other life-support equipment. The hospitals’ emergency power systems — gas- and diesel-fueled generators — would keep the machines going if the city’s power failed.

At Tulane, administrators made routine preparations, taking inventory and deciding on staffing for their 178 patients. Owned by the Hospital Corporation of America, the largest for-profit hospital chain in the country, Tulane was one of four HCA hospitals in the path of Katrina.

All were the responsibility of Mel Lagarde, president of HCA’s Delta Division. Lagarde decided to base his command post at Tulane because it was centrally located. From there he would help the hospitals secure resources through the company’s headquarters in Nashville. He too was familiar with the decades-old models that predicted total devastation if a big enough storm overwhelmed the city’s levees. He had a particularly bad feeling about Katrina.

Lagarde looked younger than 48, with a boyish face and dark hair parted on the side. A graduate of the Tulane University School of Public Health and Tropical Medicine, he had become a hospital CEO at 26, one of the youngest in company history. He was division president by the time he was 37. Like Dr. Ben, he was a New Orleans native. But after more than two decades with HCA, he epitomized corporate culture; he knew how to follow unspoken rules and respect the hierarchy, which he himself had climbed quite high.

It was little surprise that he and Dr. Ben would eventually collide.

Sunday night, as the winds intensified, residents and nurses on the day shift at Charity gathered in the on-call room on the 16th floor. Off-duty, they cooked hot dogs, ate chips and dip, and played poker. There was nothing they could do but try to relax, so most avoided television coverage of the storm and played video games on the Xbox.

At about 3 Monday morning, both hospitals lost power and the emergency generators kicked on.

Katrina made landfall at 6:10 a.m. with 125-mph winds. Palm trees were uprooted; light poles broke in half; trees bent to the ground.

As the storm’s eyewall passed through the city, the windows at Tulane bowed inward. Staff moved patients out of their rooms and into the hallways. Jim Montgomery, Tulane’s president and CEO, looked across the street and watched Charity’s awnings rip free of the moorings and fly away.

If God’s ever angry, we’re going to lose big, he thought.

The storm blew out windows on Charity’s upper floors and destroyed the roof over the operating rooms. Charity was so old that its ORs had been built on the top floor of a 12-story wing, some say to take advantage of sunlight.

Now the hospital was without an operating room, sterilization equipment or critical laboratory equipment. Doctors and nurses could no longer do blood or urine analyses or conduct other tests. They converted an outpatient clinic on the second floor into a makeshift operating room.

On student nurse Sanborn’s unit on the fourth floor, staff secured sheets over the windows to protect patients from flying glass. They couldn’t see out, but they could hear debris bouncing off the roof. They heard windows on the floors above them blow out and shatter on the ground below.

In the sixth-floor medical intensive care unit, where Dr. Ben cared for critically ill patients Hunter Reeves and Preston Johnson, water poured through the ceiling, pulling down tiles and light fixtures.

Suddenly, the emergency power shut down in their wing. Medical staff knew the drill: They ran to connect bags to ventilator patients — including Hunter and Preston — and began squeezing them, manually pumping air into their lungs. Later, the staff ran extension cords to a Coke machine outlet in a wing that still had power. At least for now, they were able to restart some ventilators.

Soon after the eye of the storm passed through, Dr. Ben’s team mopped up the inch-deep water. With power temporarily restored, calm settled over the ICU.

At Tulane, Mel Lagarde surveyed the building. The hospital had suffered minor roof damage and broken windows, but not much else. He turned his attention to Garden Park Medical Center in Gulfport, Miss., the HCA hospital that had sustained the most structural damage.

By midday on Monday, Aug. 29, the sun peeked through broken clouds, and hospital employees poured out of their safe harbors to inspect the surroundings. Sharif Omar and others walked five minutes away to the Superdome, where parts of the roof were gone. The Hyatt Regency hotel reminded them of the federal building in Oklahoma City after the bombing, its face sheared off, curtains flapping in the breeze like surrender flags.

The damage to the city was evident, but nothing close to the doomsday scenario the models had predicted.

Many people said the same thing: New Orleans had dodged another bullet.

From a walkway, Sanborn saw a homeless man curled under the steps of the historic St. Joseph Catholic Church on Tulane Avenue. It struck Sanborn that the church had somehow protected the sleeping man in the storm, as if surrounding him with a magnetic field.

That night, the student nurse ducked outside to smoke a cigarette at the bottom of Charity’s emergency room ramp. Her hospital was on emergency power, but the rest of the city was black and quiet. There were no cars, and the stars shone like never before. Sanborn sat on a bench and curled her feet beneath her. She figured the worst was behind her. The recovery team would arrive in a couple of days, and she could go home.

About 10:30, Sanborn stood up to go back inside. For the first time, she noticed it: Where the ground had been dry, she stepped into water.

Where had this come from?

ON TUESDAY: The white noise falls silent — a frightening realization. Chapter 3 of 22.

Permalink | Comments (21) |

CHAPTER 1: THE EPIC STRUGGLE OF TWO HOSPITALS TO RESCUE THE ABANDONED

By Jane O. Hansen | Friday, May 5, 2006, 04:28 PM

The Atlanta Journal-Constitution

New Orleans — It wasn’t the dark that scared Sherry Hebert. It was the silence.

The whir of the machines keeping her son alive at Charity Hospital suddenly shut off, signaling a failure in the backup power system. Sherry stood over her son’s bed in the intensive care unit where he lay unconscious. A ventilator had been breathing for him, an infusion machine pumping in his medication, a dialysis machine cleansing his blood.

Pointing a flashlight at a clear plastic tube attached to his bladder, she watched helplessly as the tube filled with blood. Sherry knew what that meant. Hunter, her 23-year-old son, would soon die.

I have to get him out. I have to get him help.

Across the ICU and behind a curtain, Carolyn Lewis read Scripture to her son Preston, and sang “Jesus Loves Me” and “At the Cross,” his favorite hymns. Like Hunter, Preston was on a ventilator. With the electricity off, he gasped for air. It seemed to Carolyn that her 25-year-old son was choking to death.

How is my child going to survive? What are they going to do?

The day before, on Monday, Aug. 29, Hurricane Katrina had roared through the city, snapping telephone poles, flipping cars, ripping off the hospital’s awnings and blowing out windows. When the power went out, the hospital’s backup generators kicked in. Now those were dead, too, the switchgears drowned in water that had appeared out of nowhere.

The two mothers had feared for their sons more than they worried about the storm. They’d met the week before in the sixth-floor waiting room of the medical intensive care unit the day Hunter was admitted. Carolyn, who had been there nearly a month with Preston, was a seasoned hand at the routine of living in the waiting room of a hospital; Sherry was the bewildered newcomer. They bonded quickly — two strangers united by the struggle to save their sons, then bound forever by Katrina.

It was not coincidence that brought Hunter Reeves and Preston Johnson to Charity Hospital. The young men were among the 23 percent of Louisiana adults lacking health insurance.

Charity was like Atlanta’s Grady, Chicago’s Cook County, New York’s Bellevue. One of the nation’s oldest continuously operating hospitals, it was a grand institution of an earlier era that rose majestically 20 stories above the city. Like the Statue of Liberty, it stood as a beacon for the poor and downtrodden.

For many in New Orleans, Charity was the only place they ever went for medical treatment. They were born there, and they would die there. In between, they relied on Charity’s emergency room, where they trusted they would get the best of care. A deeply revered place, the hospital was a wormhole between the parallel universes of those who could afford health care and those who could not.

Sitting diagonally across the street — and worlds apart — was Tulane University Hospital and Clinic, owned by the Hospital Corporation of America, or HCA. Built largely in 1976, the Tulane hospital was a seven-floor sterile-looking conglomerate of brownish brick buildings. No glorious art deco flourishes like those at Charity.

After Hurricane Katrina struck, the patients, staff and family members inside Tulane were just as desperate as those inside Charity. But the two hospitals could not have been more different. Tulane belonged to the largest for-profit hospital chain in the country. Charity depended on the state. One private. One public.

What happened to these two hospitals — and the hundreds of patients like Hunter Reeves and Preston Johnson marooned inside — is a metaphor for what happened to the city itself. The private hospital had lifelines and outside resources, as did many New Orleanians who escaped that week. The public hospital, an institution for the needy, had to rely on the government for help and wound up stranded, as did so many of New Orleans’ poorest. For the sickest patients at Charity, the government never arrived.

But the story of what unfolded inside Tulane and Charity is a tale not just of what went wrong, but of all that went right.

It is a chronicle of human goodness and ingenuity. Faced with an unprecedented loss of emergency power, medical professionals frantically rigged up crude devices and used their own hands to pump life into their patients. Stripped of the medical technology they had come to rely on, they could offer only Third World health care. Yet the result was a profound reconnection to the humanity of their patients. Each was no longer just a diagnosis.

It is also the tale of a daring helicopter rescue, a clash of hospital cultures, and a company that acted decisively and creatively, sparing no expense to save its people and patients.

The rescue operation was not perfect. People died. But many more lived. The perception of what happened depended on which side of the street the viewer was on.

But one thing is indisputable: More people would have died had individuals on both sides of Tulane Avenue not risked their own lives to save them.

Post-9/11, and now post-Katrina, there are lessons to be learned for when the next disaster strikes.

How had this happened? Sherry asked herself in the hot, dark hospital room. And why?

Hunter had always been healthy, so full of life, a tall, thin mischievous young man with wavy dirty-blond hair who had once dreamed of going to college on a baseball scholarship. He’d been that good.

Now he was on life support.

At 53, Sherry was a small, thin, reserved woman with shoulder-length blond hair and clear blue eyes that crinkled into slits when she smiled. She’d learned her son was gravely ill only a few weeks earlier. At first, she thought he had the flu. But when he coughed up and urinated blood, his family had taken him to the hospital near Sherry’s home in Robert. There, he was diagnosed with a rare autoimmune disorder called Goodpasture’s syndrome.

On Thursday, Aug. 25, an ambulance had transported him across Lake Pontchartrain to “Big Charity” — the large public hospital that has served as a lifeline to generations of New Orleanians. Hunter had no insurance, and it was there that he could get the treatment that could save his life.

By Saturday, two days before the most destructive storm in U.S. history would make landfall, Hunter was showing signs of improvement: His lungs and urine were clearing of blood. The treatment was working. But soon the unthinkable would happen.

Preston’s illness puzzled doctors. They couldn’t figure out what was going on.

His mother thought he looked like a skeleton. He had always been slender, with a strong, athletic build. Now even his nose was skinny and pointed. His skin was yellow. He was on dialysis and couldn’t breathe on his own. But he was conscious. Sometimes when Carolyn appeared by his bedside, he opened his arms for a hug.

He had been healthy, working and living in Houston with his girlfriend when he became ill six months earlier. The cause wasn’t clear, but Carolyn suspected it was linked to a fight that broke out during a pickup basketball game. Preston took a blow to the gut from a metal pipe. When he didn’t recover, he moved back home to Lake Charles in southwest Louisiana to live with his mother and stepfather.

By then he was throwing up and losing weight. He refused to go to the nearby hospital. But when he passed out one night in the bathtub and nearly drowned, his family took him to the emergency room. Doctors said his stomach was engorged with blood, his pancreas damaged. After nearly three weeks, they recommended that Carolyn take her son to “Big Charity” in New Orleans because it was a research and trauma center. She believed the real reason was that Preston lacked insurance. He had let the payments on his policy lapse.

The family couldn’t afford to pay $4,000 for an ambulance, so they laid Preston down in the front seat of their 9-year-old Lincoln Continental for the three-hour drive. He was hallucinating by the time they reached Charity.

Now Carolyn watched as her son wasted away.

Mama promises I’m not going to leave you, she assured him.

At 54, Carolyn was short, with a full face, brown eyes and a deep religious faith. Every now and then, she walked to the other side of the nurses’ station to see Hunter. The medical intensive care unit held only 11 beds — and some of the hospital’s sickest patients. Hunter was in an isolation room, a small beige cubicle with a fluorescent light that no longer shone. She stood at the window looking in and prayed for Hunter and his family.

Taking breaks in the waiting room, the mothers shared stories about their sons. Sherry told Carolyn it seemed like yesterday that Hunter was fine — playing golf with her husband, Hunter’s stepdaddy. Earlier, she had introduced Hunter’s pregnant fiancée and told Carolyn how excited she was to be expecting a new grandbaby.

Carolyn told Sherry about Preston’s life in Houston and his two little boys. She saw so much of her son in her two young grandsons, Preston III and Jaden. Preston had a key chain with their pictures on it. When the nurses changed his bed, they hung the chain from the lamp overhead so he could see his boys, along with the wooden cross someone had made him.

The women felt close, and Carolyn even thought to herself that it was as if they were the same color. One black, one white, the two families took care of each other. They brought one another food, water and comfort. Carolyn told Sherry she was praying for Hunter. Sherry was doing the same for Preston.

Both young men already had come close to dying. Now the storm, and the power failure, threatened their survival. Their mothers would have to wait and see.

In places all over New Orleans, Katrina was raising a question:

Who would live and who would die?

ON MONDAY: Before Katrina hits, two hospitals hunker down, assuming the buildings will be safe. Chapter 2 of 22.

Permalink | Comments (20) | Categories: FrontPage

By AJC | Friday, May 5, 2006, 04:24 PM

The Atlanta Journal-Constitution

“Through Hell and High Water,” a serial narrative told in 22 daily chapters, reveals what happened inside two hospitals, one private and one public, during the days after the levees broke in New Orleans.

It is an intimate portrait of medical professionals who faced unprecedented conditions and acted heroically to keep their patients alive. It is also the tale of daring rescuers who came to the aid of those the government had abandoned.

As the official beginning of hurricane season approaches on June 1, this series offers an opportunity to examine what became a textbook example of disaster response.

To report this story, staff writer Jane O. Hansen interviewed more than 50 people over six months, beginning two weeks after Hurricane Katrina hit, when recollections were still fresh.

She spent time in New Orleans, where she went through both hospitals. To interview sources, she also traveled to Nashville; Houston; Columbus, Ohio; and the Louisiana cities of Baton Rouge, Covington, Robert and Lake Charles.

While the story may read like a novel, it is reported using the same principles of accuracy and fairness we apply in every article.

Dialogue and reflections recalled by participants appear in italics. The words are precisely as they remember saying or thinking them. Statements in quotes were spoken directly to the reporter or appeared in documents or media transcripts. In instances where people’s perceptions of events differed, both versions are presented. In reconstructing events, the reporter corroborated the details with multiple sources. All dates and times in the story reflect the participants’ recollections of the chronology.

Participants provided hundreds of photographs they shot during the week to document the events. Some are used in the series with their permission.

Finally, in each of the two hospitals, there were more than 1,200 people who faced extraordinary circumstances, and dozens of others outside the hospitals were involved in the rescue. Many who played important roles are not mentioned here. This story captures that remarkable week through the eyes of a handful of key participants.

Permalink | | Categories: About