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She was admitted to Memorial to investigate the cause of her severe weakness. She had a bowel blockage. A surgeon opened her abdomen and found cancer in her liver.
She developed an infection, possibly as a result of the surgery, and her kidneys began to fail, possibly as a complication of the antibiotics used to treat the infection. Under no circumstances, she said, did she want that. The doctor discussed these preferences with Burgess, her sister, and a doting niece, then shifted the goal of her care from treating her medical problems to ensuring her comfort.
She was scheduled to move out of intensive care and onto a regular medical floor as soon as a bed became available. Small doses of morphine had been ordered as needed to control any pain. Mother and daughter talked frequently, but visits were rare and often did not go well. This distinction had brought shame to the observant Catholic mother she referred to as a Holy Roller.
Years of tension over various issues followed. With the mayor demanding that New Orleanians evacuate the city, the relatives who had driven Linette Burgess Guidi to the hospital were anxious to begin their exodus west. It was time to leave. She told her mother she loved her and thanked her for all she had done to raise her and make her the woman she was. They parked their cars in multistory garages above the flood-prone streets.
They emptied car trunks full of hurricane provisions onto borrowed carts and pushed them down the hospital corridors. Those with pets carried kennels and a requisite three-day supply of food to the medical records department on the ground floor, checking the animals into rooms that filled with the sounds of frenzied barking. Unlike many others, Dr. She sought the company of the experienced operating-room and recovery-room nurses and offered to help them move equipment.
Pou lugged supplies and equipment from the new building to an old set of operating theaters in the main hospital. She organized the rooms so that she and any other surgeon could operate in them during the storm if necessary. Other doctors retreated to private offices to sleep, but Pou had decided for the moment not to do that. She was there to work. They carried stretchers to an empty endoscopy procedure suite to create an ad hoc bedroom.
Staff members set up a table and unloaded abundant, picniclike provisions, having been told to bring food for three days, the amount of time local hospitals and their employees were expected to be self-sufficient in emergencies.
They watched as Pou unpacked only a six-pack of bottled water, crackers, tuna fish, and something that flashed in her hand. Was that all she thought she needed? The nurses howled. Water, tuna, and crackers were all Pou had been able to scrounge up at home. Although she was beautiful, funny, and sociable by nature, at age forty-nine her life revolved around her surgical career.
His wife, Jeanette, was the daughter of Sicilian immigrants. She gave birth to eleven children, and he worked tirelessly to provide for them. He treated patients in a corner house in the Bywater, a working-class neighborhood on the opposite side of town. He sometimes scheduled office appointments until ten p. Frederick Pou made weekend house calls, and his wife sent Anna Maria and her siblings along with him on alternating weekends so they could spend more time with him.
The children helped raise one another. Anna was the seventh, and her older siblings doted on her when she was little. One liked to dress her up in doll clothing and lead her across their lawn and the broad, tree-shaded street to show her off at St. Rita Catholic School. Later, as a grade-school student there, Pou listened closely to the nuns who taught her.
They talked about purgatory and the importance of being good. A nun held up a picture of a snowman. That was the soul, pure and white. She drew an ugly black mark on it. That was what sin did. Pou went to a Catholic all-girls high school, Mercy Academy, where the mascot was a high-stepping poodle.
Pou and her siblings were popular, attractive kids, petite in stature like their father, the smallest in his family. Most of the siblings strongly resembled one another with brown hair, prominent eyelids, and full brows that contrasted with peach-hued skin.
Anna had the wide, dimpled smile of a prom queen. She frequented the Valencia Social Club, mingling with other local teens who stopped by after school for a snack at the diner and partied to the beat of live bands in the evenings. As Pou grew older, it became her turn to help mother the younger ones, driving them to after-school activities and helping prepare meals. Taking care of others was a family value, taught and modeled by her parents, a way of doing good. Some of the boys developed crushes on her.
Instead of a doctor she became a medical technologist in a hospital laboratory, running tests for infections. This switch in her professional direction disappointed her father. The cool waters of a long swimming pool beckoned. One young man challenged another. Who could swim the farthest without coming up for air? They took sips of their gin and dove in. The two thrashed out one long lap. In the middle of the return lap, the challenger surfaced.
His competitor trounced him, swimming to the end of the lane, then rubbing it in by floating in place without lifting his head. A friend jumped in and playfully shoved the macho victor underwater. He stayed down. It took a while before everyone realized he was no longer holding his breath. He was unconscious, drowning in the shallow water. Someone hauled him out of the pool. His skin looked grayish. There was no doctor at the party. They were all just kids, most of them drunk and some of them stoned.
There was a veterinary student, but it was someone else who reacted. She blew breaths into his mouth and quickly revived him. Pou suggested he go to a hospital. He considered her advice, grabbed another gin, and went to play volleyball. Friends remarked on how quickly Pou had taken control of the situation. A few years later, she realized her father had been right. She applied and was accepted to medical school at Louisiana State University, where her father and uncle had also trained.
She was thirty years old. One night during medical school, Pou attended an outdoor pig roast hosted by medical residents. She met one of their friends, a tall, handsome pharmacist who flew his own single-engine Cessna propeller plane.
They made a beautiful couple, with personalities as different as their heights. Pou was outgoing, dramatic, and testy at times. She worked and played with gusto. Vince Panepinto was smart and engaging but more reserved.
It took a few drinks before he felt ready to join her on the dance floor. During her last year there, one of her brothers, five years her senior, died of lung cancer.
He was only forty-three. The way the cancer attacked him was horrific. While he was sick, Pou applied to yet another training program so she could subspecialize in surgery for head and neck cancers.
She was accepted at a hospital in Indiana. He moved back to New Orleans to await the end of her training. If Pou was on a quest to do good in the world, she was taking it to an extreme. Many otolaryngologists had satisfying careers treating routine earaches and sinus infections.
The field had a reputation among doctors as being one of the few surgical specialties to offer a reasonable work-life balance. What Pou trained to do in Indiana was at the most arduous end of the specialty spectrum. Microvascular reconstructive surgery was a mix of plastic surgery and cancer surgery. It was physically grueling and technically demanding. Some operations lasted an entire day and through the night. The goal was often to restore the ability to speak, swallow, and breathe in patients with tumors or injuries of the tongue, throat, larynx, and other parts of the head and neck.
Pou learned to repair disfiguring defects by repurposing other tissues from the body. A rarely used thigh muscle could do the work of a tongue. A flap of skin from the forearm filled in for missing facial skin. A bit of leg or hipbone served to rebuild a jaw. Under a microscope, she sewed tiny blood vessels and nerves together to keep the tissues alive and restore function. The younger resident doctors, medical students, and nurses ranked below them and were expected to follow orders.
Coming from a big family, Pou knew how to get along with people, but her respect for hierarchy had its limits. She turned on the Southern charm, manners, and deference with attendings who were good to their patients. Some of these doctors became beloved mentors. Others, whom she judged to care more about their careers than their patients, earned her distrust and irreverence.
When Pou finally finished her training in , she was forty-one. She had not had children along the way. There had been many factors to consider, from her demanding career path to the fact that she had many nieces and nephews to dote on. She had also seen how hard her mother had worked to raise her own children. These included a banker, a nurse, and a real-estate broker.
They had, on many occasions, made Jeanette Pou proud and happy. Three of the Pou girls had paired up with men whose names bespoke Italian heritage´┐Ża Panepinto, a Perino, and a Pappalardo´┐Żno doubt delighting their Sicilian-American mother. Three of her siblings had died, one was diagnosed with a serious illness, and her oldest living brother was a federal fugitive indicted for drug trafficking who had gone on the lam in Mexico.
A dedicated, loving mother, Jeanette Pou had steered her family through these crises. Anna Pou directed a great deal of her own dedication and love toward her patients. Both women brought a toughness and tenacity to their callings. Pou finished her training, and she and Panepinto selected Galveston as their new home. Pou had received a job offer there from the University of Texas Medical Branch. She worked at the only large hospital on the island of Galveston.
The hospital had existed for more than a century, and about a quarter of all Texas-trained doctors had studied there. As with many teaching hospitals, something of a trade was involved. The patients, often poor, received care regardless of their ability to pay.
In exchange, budding doctors learned their craft by practicing on them. The hospital served a prison population as well. It seemed like a good fit for Pou, who enjoyed teaching and had a passion for treating the poor, as her father had done. Just over a quarter of its patients were uninsured, and many others had inadequate coverage. Now each one was financially screened and charged an entry fee before being allowed to see a doctor.
Exceptions were made for children and patients in emergencies, as required by law. The complex cancer surgeries Pou had spent years learning to perform were expensive.
A team of professionals from more than a half dozen other medical disciplines, from radiation therapy to rehabilitation, often needed to be involved. Finding the resources to care for these patients when they lacked health insurance was difficult. Pou vented about her predicament in phone calls with friends. Those less fond of her found her overdramatic and hyperbolic´┐Żtoo quick to blame others when something went wrong with a patient, as in Dr.
Small problems turned into bigger problems. Pou was not always willing to step back and allow other specialists to do their work, and some of them viewed her as controlling. That drive to be the one on the team always doing her best, however, made her into a strong patient advocate.
She was soon promoted to director of the Division of Head and Neck Surgery in her department. She made great friendships in Galveston, but her work came first. Almost two years after she moved into her house, Pou invited colleagues for a visit. She switched on the oven. The house filled with smoke. The packing materials were still inside. Invitations were hand lettered in New Orleans.
Pou used her spare free time at night to address the envelopes one by one. Pou was a lady. She might spend her days in surgical scrubs, but she made it a point to find a favorite Texas hairdresser.
Raoul coaxed her straight cinnamon locks into a proper hairdo. On the occasions she had to dress up, Pou tempered New Orleans exuberance with a classic uptown finish, pairing pearls with plunging necklines that flattered her figure. He had been an innovator in the field and had mentored Pou and taken great interest in her career. A new chairman was promoted from within the department. He was four years younger than Pou and had a PhD in addition to his medical degree.
The program seemed headed in a different direction, with more emphasis on research. She decided to leave, weighing offers from as far away as San Diego. Over the years, at various national meetings of her specialty, Pou had developed a friendly relationship with the head of otolaryngology at Louisiana State University, Dr. Daniel W. Nuss, whose private practice was located at Memorial Medical Center. His program also served patients at the Medical Center of Louisiana at New Orleans, better known as Charity Hospital, including prisoners and many people who lacked health insurance.
Nuss had asked Pou several times if she would ever consider moving back to New Orleans. Now Pou was ready to say yes. Pou inked her acceptance in April The university had to pay back the guarantee payments, and with university physicians on staff, Memorial qualified as a teaching hospital and was eligible for additional funds from Medicare.
She began seeing patients in October. The move was meant to be a permanent one. In early , the couple sold their home in Galveston. Pou was given a tour of Memorial and introduced to the operating-room nurses. She sized up Pou, a tiny lady rolling a tiny piece of Samsonite luggage behind her. This was the much-heralded new surgeon? Pou would have to prove herself. She did not win over everybody she met. He had treated patients at Memorial and Baptist for more than four decades and still performed basic blood tests by hand rather than sending them to a lab like just about every other doctor did.
In his office, he kept a large black-and-white photo of a nurse in a white cap holding a cup of water to the lips of an elderly man lying on a cot. He and the nurse had worked together in caring for displaced residents after Hurricane Betsy. Baltz was the son of a motion-picture projectionist, the youngest of five children, and the first in his family to attend college. He could remember, from his days as a high school delivery boy for the neighborhood drugstore, filling prescriptions for Dr.
In the course of his career, he had witnessed two significant changes in the practice of medicine. One was the advent of high-technology life support for patients with critical illnesses.
It was a momentous purchase, trumpeted by an article in the local newspaper in At the same time, Baptist expanded its physical plant and added piped-in oxygen and an intensive care unit for heart patients, complete with alarm systems to alert staff to irregular heartbeats and other emergencies.
Intensive care grew to become a major specialty at Memorial and across the country. When should life support be instituted? Critical care, transplant surgery, and other new practices were expensive. On the heels of their invention came the second big change: cost consciousness and the rise of for-profit medicine. By the early s, health care was a medical marketplace.
Baptist was still nonprofit and faith-based, but it had to compete in an increasingly commercialized environment. Its doctors, and many across the country, feared being told by accountants and other nonclinicians what tests and treatments they could give to which patients. As doctors began to rely more on machines and focus more on business, Baltz worked to remind his Baptist Hospital colleagues of the ethical tenets of their profession.
As medical staff president, he urged them to stay compassionate and be selective about adopting new technologies. Baltz encouraged the establishment of an ethics group at the hospital and participated in a discussion of groundbreaking cases, including that of fifty-eight-year-old Clarence Herbert, a comatose patient whose doctors were tried for murder in Los Angeles after they withdrew his life support and IV fluids.
The charges against the doctors were ultimately dismissed. Over the years, Baltz continued the dialogue with colleagues. LifeCare leased the seventh floor of the main building in , establishing the long-term acute care hospital within the main hospital. A Medicare payment change created incentives for these types of business arrangements, and they proliferated at hospitals around the country. At a meeting of the Colorado Health Lawyers Association, Lamm bolstered his argument by citing a recent critique of antiaging research penned by the prominent University of Chicago bioethicist Dr.
Leon R. Medicare covered the new technologies regardless of cost, and by the s some policymakers worried about the projected growth in medical spending. To limit life-saving care would be to deny the human impulse to rescue individuals in extremis.
To handicap the race for new treatments that might prolong life would be to call off the eternal search for the elixir of immortality. Plus it would be bad for capitalism. At the time, the US-Soviet war urge was sublimated into battles for technological innovation. We were going to the moon. Why not also cure cancer or raise the dead? On the other side, with drug and device developers figuring out how each organ that threatened to quit could be repaired or replaced, the practice of life support surged ahead of the practice of relieving pain, both physical and existential.
And there were deeper, more unsettling questions. How now to define death? When was it permissible, even right, to withhold or, more wrenchingly, withdraw life-sustaining care?
One of his patients had developed a pouch in the esophagus that trapped food and caused problems eating and swallowing. Who was she? What was she like? They raised their eyebrows. From what little they volunteered, Baltz guessed that they considered Pou a loose cannon, someone to avoid. Baltz judged her competent, but lacking in finesse. After the incident, he took it upon himself to give her some constructive criticism.
He made it a practice to improve the work of those around him, especially younger, newer doctors. Pou seemed to listen to him. After having spent seven years in Galveston, it would have been a challenge adjusting to the culture, etiquette, tools, and systems of any new hospital.
When Pou was passionate about something, whether or not she was right, she stated her beliefs as unequivocally as a partisan talk-show host. One day, Pou cornered the nurse in charge of her postsurgical patients at Memorial. The previous night, one of her patients had become confused after surgery. Nurses caught him trying to get out of bed and pulling at the breathing tube in his neck.
A nurse had paged the medical resident on duty to order a set of soft, loose cuffs with long straps. This would limit his movements and keep him safe until he was less agitated. When Pou arrived the next morning and saw her patient restrained, she was unhappy.
It was an unusual request. It earned Pou respect from the nurse in charge. To her, it meant that Pou had compassion for her patients. Unlike many surgeons who manifest their authority by getting ugly or impatient in the operating theater, Pou was methodical and explained things carefully to residents and nurses. She had a way of speaking like a schoolteacher, enunciating her words to draw out each syllable and nodding her head for emphasis.
Perhaps more than anything it was the type of patients Pou cared for that impressed those around her. These patients were dealing not only with cancer, but also the way it deformed their faces. Some coughed and sputtered and had a hard time speaking.
Pou split her time between several hospitals. At Charity, she created a clinic for low-income patients with head and neck cancers to receive advanced treatments and reconstructive surgery. She convinced an array of doctors and therapists to provide these services without receiving additional pay. The festivities took place under crystal chandeliers.
The Blackened Blues Band belted out rock, blues, and soul music. Giant trays of oysters and shrimp balanced on the banquet table beside bouquets bursting with lilies, birds-of-paradise, and irises. Dessert tables adorned with Mardi Gras beads, masks, and candles held trays laden with tarts.
Pou wore a short-sleeved pantsuit with a double strand of pearls and pearl drop earrings and a sleek, chin-length hairstyle. She spent the evening socializing with other members of the medical staff and their spouses, flashing her broad, toothy smile for the event photographer. Tenet faced falling stock prices, multibillion-dollar operating losses, a federal lawsuit for overbilling Medicare to inflate revenues, and a class-action lawsuit by shareholders for allegedly having misled investors.
The doctors affiliated with Memorial followed the news, but they still had much to celebrate. For the staff at Memorial, the year looked bright. Dan Nuss, the department chairman, called her, concerned.
None of their postsurgical patients, spread over several area hospitals, were terribly sick. Two resident physicians were on call with Pou that weekend. She dismissed them so they could be with their families.
At four p. Pou had resolved to stay in case anyone trapped in the city needed the kind of specialized care she and few others could provide.
As the surgical staff hunkered down that Sunday evening, the endoscopy suite they had claimed for quarters took on the atmosphere of a slumber party. Many of the nurses and Pou were coevals. They had grown up in New Orleans, attended private and Catholic schools, and now, with time to talk, they found they had friends in common. He was a sturdy man with playful eyes, apple cheeks, and a lopsided smile who now had a wife, three daughters, and a graying, receding hairline. Pou took out her lipstick and began applying it.
What are you doing? Pou said she wanted to look her best in case she saw him. The nurses laughed and reassured her. He had recently left his job. It was hot outside, but cold in the hospital; the plant operations team had lowered the thermostat to make the buildings extra cool while there was still city power. The nurses knew from previous experience it would heat up quickly.
Pou made a few phone calls to friends and family. If anything bad happened, they could find her at the hospital, she said lightly. LifeCare-Baptist had an additional 55 patients, including the ones nursing director Gina Isbell had helped move from the St. Bernard campus. Around staff members had arrived to provide care, along with hundreds of family members and companions. Memorial served a diverse clientele, a short drive to the genteel mansions of Uptown and a half-mile from a public housing project.
Some community members had also come for shelter. Administrators tallied the census of humans in the medical center buildings at between 1, and 2, Lightning flashed in the dark night. Rain rippled onto the road beneath the streetlights and beat against the windows with the undulations of the wind. Pou did what came naturally and what she would do many times over the coming days. She prayed. And, um, most of the patients who take critical care have been actually moved away from windows.
The news announcers reported that three people had died on a bus on the long exodus from a New Orleans nursing home to a Baton Rouge church. Many of the survivors were dehydrated. Katrina shed some of its fury over the Gulf and spun north before beginning to envelop the coast in its massive grip. Area residents called in, concerned about what would happen over the coming hours. They were among those awaiting the answer. She and her family members scrambled to gather their belongings and ran out of her office into the corridor.
Mulderick slammed her office door shut behind them to protect passersby from flying glass in case the windows shattered completely.
The sturdy building shook violently. The sounds of the wind stealing through invisible crevices added to the aura of terror, a moaning, like a ghost, up and down the musical scale. In the corridor, a panicked crew from plant operations ran toward Mulderick.
She was in charge. What did she want them to do? The fifty-four-year-old nursing director appeared well qualified for this job, with the authority of her thirty-two years of employment at the hospital´┐Żdecades more than CEO L. Mulderick directed sixteen nursing departments and had more than fifteen years of experience on the hospital emergency committee, which she now led. Mulderick had another sort of crisis-management experience´┐Żthe family kind.
Like Pou, she belonged to a large, Catholic school´┐Żraised New Orleans brood. But as she grew up, despite the outings to City Park in perfect, matching Easter dresses and bonnets, beyond the swingset and white shingles, beneath the high ceilings and crystal chandeliers, a certain chaos reigned. The third of seven children, the care of her younger siblings had often fallen to her, and she emerged from childhood remarkably strong and calm, a manager, an emergency responder. Mulderick began her nursing career in the ICU at Baptist in and never left.
She raised her own children and painted as a hobby, but for more than three decades, she had given almost everything else of herself to the hospital. She rarely took a break and once, when she did, a deadly storm nearly ended her life. In , after spending five years planning a trip to Las Vegas with friends from Southern Baptist and another local hospital, she and they were bumped off an overbooked flight at the last minute, leaving their suitcases behind on Pan Am The people on board that airplane plus eight more on the ground were lost when a violent form of wind shear, a microburst, blew the Boeing back down to the ground soon after takeoff.
Mulderick saw smoke billowing out of the trees from a window of the plane her group had boarded fifteen minutes later. True to her coolheaded nature, Mulderick did not tell her friends what she saw so as not to make them worry. Hospital life and family life intertwined.
A sister, with help from Dr. Horace Baltz, had been saved there from a bleeding brain aneurysm. Mulderick held on to her position as a nursing director for more than a decade, through significant changes. Under financial pressure, Southern Baptist Hospital merged with a New Orleans Catholic hospital, Mercy, in the early s and then both were sold to giant, for-profit Tenet Healthcare Corporation in Gone, on paper, was the Baptist name; calling it that became a satisfying, if minor, form of rebellion.
Success was rewarded with progressively tighter budgets. Mulderick adapted and survived. Tall and fair-skinned, with straight red hair cut short in a pageboy, she had a tough, no-nonsense manner that intimidated some employees.
She was known as calm and cool, even cold, under pressure. After the maintenance crew came running to announce the breaking windows, Mulderick got on the phone with Cheri Landry. The senior intensive care nurse was camping in the new surgery building across Magnolia Street where Pou and her group were. Mulderick told Landry to get everyone out of there before the bridge linking the two buildings collapsed or its windows shattered. The staff members and their families would have to make a terrifying dash across its swaying, rattling expanse.
Anna Pou called one of her sisters before making the trip. Pou knew she was tough, but she prayed for her anyway. Mulderick went with the maintenance men to survey the hospital. They roped off the danger zones and moved patients out of exposed areas into interior hallways. Most patients were attached to oxygen tubing, IV pumps, and EKG monitors plugged into outlets and would be difficult to move away from windows. Instead, for the first time anyone could remember, maintenance crews had boarded up the windows with plywood from the inside.
The exposed sides of the windows shattered under a hail of rocks launched from nearby rooftops. The ICU filled with screams. Plywood grew wet and buckled. Water slipped inside to pool on the floors, creating another hazard. The father of one of the nurses on duty, who had taken shelter in the hospital with her, tried to stop his daughter from entering the area to do her work. The metal window frames strained and creaked like the Titanic , it seemed to one doctor, who finished up his work and headed to a lower floor.
This is not a decision he can make. His rage threatened to ripple chaos into the calamity. There was enough going on without this.
At a. Televisions in patient rooms flicked off. The system was designed to supply only emergency lights, certain critical equipment, and a handful of outlets on each floor; the air-conditioning system shut down.
Nurses trained box fans on their patients. On the sixth floor in the newly renovated family waiting room outside of Labor and Delivery, the windows shimmy shook so hard they blew themselves out with a sound like a sonic boom. Rain sheeted onto the carpeting. Elsewhere, winds funneled through broken windows and scrambled narrow aluminum blinds. In their offices, doctors drew drapes across picture windows and stanched leaks with hospital gowns and bed sheets, the scene outside black and thundery.
The storm raged after daybreak. The view outside Memorial, for those who dared to get close enough to a window to look, was an impenetrable white blanket. Gusts of miles per hour were expected by nine thirty.
Between squalls it was possible to stand outside on the emergency room ramp and peek out from behind a heavy post. The US and Louisiana flags flapped madly on their flagpoles against a gray sky.
Water raced like a river down Clara Street. A red car and a red van were bathed to the middle of their wheel wells. The wind kicked up whitecaps and spray. The basement began taking water. Incident commander Mulderick helped pack the supplies onto rolling dollies and move them upstairs, an arduous process that took hours because of the limited number of hand trucks. For now, the emergency patients stayed put.
Surgeon Anna Pou joined a chain of hospital volunteers and National Guard soldiers to help pass kennels up a staircase to the eighth floor and place them in the old, unused surgical suites behind the ICU. The area filled up with cages and the earsplitting barking and the stench of frightened animals. Another concern was drug reserves. They never delivered the drugs. Memorial would need more supplies by Tuesday morning.
Some patients were not being seen because their doctors were off-site and unreachable by phone. The medical staff president, Reuben L. Chrestman III, was on vacation. In his absence, Dr. Most of them were, like Anna Pou, university doctors or private contractors credentialed to admit patients, but not employed by the hospital.
These doctors had stayed either because they were on call for the weekend like Pou or had, like Dr. John Thiele, grown accustomed over years of hurricane warnings and near misses to spending storms in their offices. More doctors seemed to be on hand than in any previous hurricane, perhaps because the storm had fallen on a weekend and those on call had simply stayed.
Several, Deichmann and Baltz among them, were internists. Thiele was one of three lung specialists present who treated critically ill patients in the ICU. Others included a kidney specialist, an infectious diseases doctor, emergency medicine doctors, and neonatologists who took care of the youngest, sickest babies.
There were several surgeons, including Pou, and three anesthesiologists. Deichmann assigned these clinical doctors to different nursing stations so that someone would be in charge of each of the fifteen patient units. Katrina rapidly lost strength after moving onto land. The rain lessened and the winds began to ease by late morning. The water level outside Memorial stabilized at about three feet. Maintenance crews began to survey roof damage and broken windows, downed ceiling tiles, and sodden carpets that, in the growing heat, invited mold.
By midafternoon, the waters outside began to recede. Pets and food were carried back downstairs. Nurses mopped floors for hours until the rain and the ceiling leaks stopped completely. Patients tried to call loved ones to check on them and let them know they had come through all right.
Bernard Parish, was unable to reach his wife on her cell phone and told his nurse he was worried about her. By evening, the flooding was gone, and it was possible to walk dogs outside. Some doctors who lived nearby navigated the debris-filled streets to check on their property and even stay the night at home. Other staff crossed back to their campsites in the new surgery building.
Katrina had weakened before arrival, buffeting the city with only Category One or Two winds, not the Category Five tempests envisioned by the doom-prophesying weathermen. Memorial had sustained damage but remained functional on backup power. The hospital seemed to have weathered one more storm. She shoved them on her feet and ran the length of two city blocks from the new surgery building over the footbridge into the main hospital and down to the first-floor emergency room, struggling not to trip or cut her feet on broken glass.
Along the way, the ICU nurse manager tried to sort through her confusion. It had to be four or five in the morning. Why were they summoning her to a Code Blue in the emergency room? The ER staff members could resuscitate patients by themselves.
Besides, who would be coming into the hospital when most of the city had been evacuated? She arrived, panting. Blood was everywhere. A woman was lying on a gurney.
She looked to be in her late sixties. The story came from her grandson, who had carried her up the ER ramp. There had been drinking. A fight. The grandson ran for help and found policemen, but they told him there were no ambulances running and he would have to find some other way to get her to the hospital. The page operator called overhead for all doctors to come to the emergency room.
Internist Horace Baltz appeared in a white coat, with bare legs. In an effort to get there quickly, the senior doctor had thrown the coat on over his shorts, then tied on his black Oxford shoes and run downstairs. The patient, at first conscious and communicative, began struggling to breathe. Blood could be collecting in the sac around her heart, constricting it and limiting its ability to fill and pump. Someone called for an ultrasound machine technician to check this, but for now there was no time to await answers.
Another tube went into her throat and was attached to a mechanical ventilator to help her breathe. The woman was taken by elevator to the eighth floor. The ICU nurses on the overnight shift received their new patient at about six a.
The machines breathed for her, checked her blood pressure at regular intervals, measured her pulse, pumped fluid into her veins, and monitored the oxygen level in her capillaries´┐Żall just as if a hurricane had never happened. Some of the ICU nurses had radios on their carts. They tuned them to WWL, a popular 50,watt talk radio station that was broadcasting on generator power.
On the radio, the president of neighboring Jefferson Parish announced that martial law had been declared. The hosts aired his message repeatedly, but martial law´┐Żan extremely rare assumption of police powers by the military typically requiring an act of Congress´┐Żhad not, in fact, been declared in the disaster zone. A caller complained that looters were ravaging New Orleans. Throughout the early morning, callers began describing something even more ominous.
Water from the storm was still sitting in the streets. He was sitting in the attic of his home in the Gentilly neighborhood near Lake Pontchartrain, surrounded by about nine feet of water. The area, one of those that had flooded badly in the storm, was several miles northeast of Memorial. With him were four other people, including a baby. They had punched a hole through the roof and, using candles, a lantern, and a flashlight, had tried for four hours to signal a helicopter.
It made no sense. The street flooding around the hospital had gone away. Anyone who had taken a break and ventured outside during the night knew it was clear and still. The news was confusing and worrisome, but there was work to do. The sun rose, and around Memorial the streets remained dry. The sky outside the windows was blue. At seven a. White linoleum tables held a bank of computers normally used for training nurses.
The computers were connected to the Internet and plugged into the red emergency outlets that operated off the generator system. The room offered a sense of remove. Homey pink, pleated valances framed windows overlooking a courtyard enclosed by the reddish-brown tapestry brick of the old hospital building. There were mismatched sofas, brown cabinets, and a sink. Staff hunched down to peer at it, though it showed mainly static.
Wynn trusted Mulderick, who had hired her as a staff nurse when she started her career in the s, then promoted her to manager when Wynn was pregnant and on bed rest. While others saw only the professional, intimidating Mulderick, Wynn knew inside she was a marshmallow, a cream puff. She had always set clear expectations and given Wynn the freedom and support she needed to meet them. Wynn adored Mulderick and admired her intelligence and creativity. An Acadian ambulance worker on-site had confirmed with his dispatchers that one of the canals in New Orleans had been breached.
That meant water could be headed toward the hospital. Wynn and the other department heads checked in.
Their reports were relatively upbeat. The hospital was functioning almost normally, in spite of the heat. Maintenance workers were picking up debris, taking down floodgates, and patching holes in the roof exposed when the wind ripped away ducts and flashing.
Kitchen employees were handing out Styrofoam cups filled with scrambled eggs and bacon. The sight of low-wage cooks tending the stoves in the swelter with tied-up hair and cut-off sleeves and scrub pants had awed one executive who came down to the kitchen seeking extra food for a patient. Feeding not only the patients but also everyone else, it was thought, might help calm the hundreds of family members and hospital neighbors who had taken shelter at Memorial and were getting antsy.
Some headed to a darkened Winn-Dixie supermarket about eight blocks away and returned, arms laden with diapers, food, and drinks. All staff and physicians were instructed to stay at the hospital. Family members were advised to stay too. The hospital could expect flooding. Medically stable patients were to be discharged, even though they may not have had anyplace to go or any way of leaving.
Some were taken to the lobby in wheelchairs to wait. The head pharmacist was still scrambling to arrange for a drop-off from his supplier to replace the dwindling stores of medicines. The command team also sought any nurse with experience performing kidney dialysis.
Their clients were showing up at the hospital, where there was only one dialysis nurse on hand for Memorial and LifeCare patients, including some of the new patients transferred from Chalmette. A nursing director from LifeCare and another nurse volunteered to help, and they tutored the kidney specialist, a doctor who was adept at ordering dialysis, not providing it. The dialysis procedure required water, but the city water was reportedly so heavily contaminated with chemicals and bacteria that it would be dangerous to bathe in it.
The doctor faced a decision. The patients would die without dialysis, and it was unclear how quickly they could be transferred out of Memorial. Workers would filter the water and hope for the best. Staff members formed an assembly line to boil water in the microwave and stockpile it for other uses. Within view of the hospital windows people were ransacking a Walgreens.
One Memorial administrator wrote an e-mail to her family at ten twenty in the morning describing what she had heard from the security supervisor. They are locking down the whole hospital to keep the looters out. We are under marshall law so our security officers can shoot to kill if they want.
He was outside snapping photographs to document the damage Katrina had caused the hospital. Blown-out windows and light fixtures. A collapsed penthouse. Bent antennas and exposed roof joints. The National Guardsman told him the levees protecting New Orleans had been breached. Yancovich knew they were in trouble. Kevin Stephens. The following year, he had surveyed representatives of every hospital in the city, asking whether they could withstand a flood with fifteen feet of water, how much it would cost to elevate generators if needed, and whether there was interest in having the city look into the possibility of federal funding to make improvements.
The response from the hospitals was unenthusiastic. It would cost much more than they had to spend, millions of dollars in at least one case. The initiative never went anywhere, and that was why, the day before Katrina made landfall, the federal emergency management officer had been told that all but two of the hospitals in New Orleans had either generators, electrical switches, or both at ground level.
That was the case at Memorial. He learned that if a Category Four or Five storm hit the city and caused the lake or the river to flood it, twelve to fifteen feet of water could rise up around Memorial, which sat three feet below sea level. By hand, on a piece of lined paper after the Army Corps of Engineers meeting, Yancovich had sketched out the elevation of various hospital entrances and critical outdoor equipment in relation to the center of Magnolia Street, a narrow road perpendicular to Napoleon Avenue that ran along the back side of the hospital.
His calculations showed it would take less than four feet of street flooding for water to flow over the loading dock and into the hospital. The story this told was clear and grim. He predicted that power would be lost in the main hospital and all patients would have to be moved to the newer Clara Wing, where he believed the electrical circuitry was better protected.
But more extensive work needed to be done. Yancovich had recommended elevating basement and ground-level emergency power transfer switches and the pumps that supplied most of the hospital with medical air and vacuum suction, needed by patients with respiratory problems. A partial bid for the electrical work came to more than a quarter of a million dollars. The backup generator system was only as robust as its weakest part. They all needed to get out of the hospital. Yancovich knew it. Susan Mulderick knew it.
He told them that evacuation looked likely. The nurse asking about Dr. Vince Panepinto had surprised Pou the previous evening by showing up at the hospital. A security guard had paged her through the overhead speakers. Panepinto had spent the night with Pou and the surgical nurses in the endoscopy suite, his tall frame squeezed onto a little stretcher. He charmed the nurses with his dark good looks, and they agreed Pou had done well after the breakup with her former boyfriend.
Panepinto left the hospital that morning to take care of their recently purchased home about a mile from Memorial. He had wanted Pou to join him, but she still had patients at the hospital, and the staff was not supposed to leave.
Water was gushing out of the sewer vents. They stared in disbelief. Then they jogged up three flights of stairs to the eighth floor to get a better look at the neighborhood. Water was flowing up Claiborne Avenue, a main city artery just north of the hospital. Faces appeared at windows all over Memorial. Our lake? User icon An illustration of a person's head and chest. Sign up Log in. Web icon An illustration of a computer application window Wayback Machine Texts icon An illustration of an open book.
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|Five days at memorial pdf download||Cookie settings. Just over a quarter of its patients were uninsured, and many others had inadequate coverage. A decade later, between the vownload andat least six employees filed charges of race discrimination against the hospital with the Equal Employment Opportunity Commission, the downlload responsible for enforcing key parts of the Civil Rights Act of in at least two of the cases, the agency found no cause to believe the allegations were true. A remarkable book, engrossing from start to finish, Five Days at Memorial radically transforms your understanding of human nature in crisis. ATOS Level: 8.|
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|Ciulla medtech reviewer pdf free download||Thiele walked back and forth through the second-floor lobby multiple times as he journeyed between the hospital and his medical office. Across the city, hundreds of cars were similarly trapped, and nearly all streetcar lines window 11 download halted operations. She shoved them on her feet and ran the length of two city blocks from the new surgery building over the footbridge into the main hospital and down to the first-floor emergency room, struggling not to trip or cut her feet on broken glass. Some headed to a darkened Winn-Dixie supermarket about eight blocks away and returned, arms daya with diapers, food, and mrmorial. Availability can change memoiral the month based on the library's budget. Many had been put in wheelchairs and pushed to a central nursing station to sit with fans blowing on them. An armed band of robbers hit a series of abandoned homes by boat.|
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|Five days at memorial pdf download||Arvin let Cordray know that the company was working on securing medicines and blood for Memorial, memoria, he was not sure how to get anything to her. During her last year there, one of her brothers, five years her senior, died of lung cancer. Instead of a doctor she became a https://happylabordayus.com/mizzou-software-download/10096-download-pic-from-instagram-pc.php technologist in a hospital laboratory, running tests for infections. There are no reviews yet. Internet Arcade Console Living Room.|
Internet Arcade Console Living Room. Books to Borrow Open Library. Search the Wayback Machine Search icon An illustration of a magnifying glass. Sign up for free Log in. Five days at Memorial : life and death at a storm-ravaged hospital Item Preview.
EMBED for wordpress. Want more? Advanced embedding details, examples, and help! After Katrina struck and the floodwaters rose, the power failed, and the heat climbed, exhausted caregivers chose to designate certain patients last for rescue. Months later, several health professionals faced criminal allegations that they deliberately injected numerous patients with drugs to hasten their deaths. Five Days at Memorial, the culmination of six years of reporting, unspools the mystery of what happened in those days, bringing the reader into a hospital fighting for its life and into a conversation about the most terrifying form of health care rationing.
In a voice at once involving and fair, masterful and intimate, Fink exposes the hidden dilemmas of end-of-life care and reveals just how ill-prepared we are for the impact of large-scale disasters - and how we can do better.
A remarkable book, engrossing from start to finish, Five Days at Memorial radically transforms our understanding of human nature in crisis Includes bibliographical references and index Deadly choices -- Reckoning. There are no reviews yet. Purchase this in-depth summary to learn more.
In this collection, including two never-before-published essays, Nussbaum writes about her passion for television, beginning with Buffy the Vampire Slayer, the show that set her on a fresh intellectual path. She explores the rise of the female screw-up, how fans warp the shows they love, the messy power of sexual violence on TV, and the year that jokes helped elect a reality-television president.
The book also includes a major new essay written during the year of MeToo, wrestling with the question of what to do when the artist you love is a monster. Through it all, Nussbaum recounts her fervent search, over fifteen years, for a new kind of criticism, one that resists the false hierarchy that elevates one kind of culture violent, dramatic, gritty over another joyful, funny, stylized.
I Like to Watch is a joy. From Sheri Fink, author of Five Days at Memorial, winner of the National Book Critics Circle Award for Nonfiction In April , a handful of young physicians, not one of them a surgeon, was trapped along with 50, men, women, and children in the embattled enclave of Srebrenica, Bosnia-Herzegovina.