Chapter 6 questions

1. Why did the hospital decide to turn people in need away? Was race a factor in this decision? Why or why not?

The hospital wanted to evacuate everyone safely and they were waiting for airboats to rescue everyone, so they put the patients on the ER landing to wait for the airboats. On page 151, there was an outpatient who was determined to walk into the hospital for a chemotherapy appointment and Wynn tells her she is not having an appointment today. Wynn was beside herself – she thought people coming from the outside were not getting the gravity of the situation at the hospital. “The stress of the disaster narrowed people’s fields of vision, as if they wore blinders to anyone’s experience but their own. Again and again Wynn saw signs….” On page 152, a guy showed up for a dialysis appointment and Wynn noticed he was not one of hers and he needed to be evacuated on the next boat because he showed up – he was wet from walking in the flood waters and muck plus his dialysis port was hanging out of his chest. On page 153, there was a group of men, who waded through the toxic muck and flood water with a gaunt looking lady who was very ill on a mattress floating on the toxic muck flood water. The patients on the ER ramp told them to go away even though this woman clearly needed help immediately. One of the doctors took the ill lady and her husband in and the hospital administrators sent the men back out, gave them directions on where to get rescued. Wynn took care of the woman and her husband – got the husband food. Wynn told the husband not to go back out and lock his house because it was too dangerous. This couple was not the same race as Wynn and race was not a factor. If anything, everyone’s safety was the factor for turning people in need away. The hospital patients, families and staff were overwhelmed, running out of supplies and food, and in dire need of rescue – it was chaotic because the doctors and nurses moved patients to the second and first floors of the hospital to help speed the airboat rescue up. They were all in cramped quarters on those floors. The focus was not on emergencies of people from the outside but on getting everyone rescued from the hospital.

2. Was it necessary to euthanize the pets left at the hospital? What alternatives existed given the chaos?

It was Dr. Cook who decided to start euthanizing family pets – he was Chief Medical Officer at Memorial, he was in charge; And he decided to end the lives of two Golden Retrievers, his daughter’s Newfoundland, and his daughter’s cat. On page 154, Dr. Cook had scripts written for medications that were to be used to euthanize the pets and he had to name the pets as if they were patients to get the scripts accepted and passed even though Veterinarians are the ones who are supposed to euthanize animals in Louisiana. No, I don’t think it was necessary to euthanize any pets, but it was a humane thing to do if the pet was suffering. It would have been better to send a few floating barges with the airboats and rope the crated pets down on the barge and take them to safety too. Mark and Sandra LeBlanc who brought the airboats to rescue everyone – including the pets.

3. Dr. Cook’s views in this chapter are sharply contrasted with nurse Cathy Green’s. Is it possible to hold the view that Merle Lagasse is dying of cancer AND that she is somebody’s mother? Why or why not?

Dr. Cook and Cathy Green are both health professionals but have very different approaches to doing patient care. Dr. Cook made final and crucial decisions for the patients while the hospital was in survival mode. Dr. Cook oversaw and micromanaged the patients on numerous floors. He oversaw staff (this example on page 80) Dr. Cook told Dr. King, that he was the one in charge of the floor and to disconnect using a heart monitor machine on a patient. Dr. Cook thought Dr. King was out of touch with reality because he kept doing medical care (page 154). On page 143, Dr. Cook was Merle Lagasse’s pulmonologist for a while and every time he saw her, he would say she would make a beautiful corpse and the comment would offend Merle’s daughter Karen, but Merle just saw it as doctor-patient banter. Dr. Cook went to the 8th floor of the ICU, and he saw that there was only one patient left and four nurses that could be used somewhere else in the hospital. Dr. Cook examined the last patient, who was Jannie Burgess, she was on small doses of morphine. He wrote her impending time of death in her doctor’s notes. He upped her morphine knowing she was going to pass before being rescued. Dr. Cook prided himself as the go to man for difficult end of life decisions (page 157).

Cathy Green is one of the four ICU nurses moved to the second floor. She empathized with the patients and their suffering and did not want to do any harm. Cathy Green had the empathy to put herself in her patients and families’ shoes. She saw how sick the patients looked on the second floor and she was heartbroken. Yes, it is possible to hold the view that Merle Lagasse is dying of emphysema/cancer and that Merle is someone’s mother too. On Page 160, Cathy Green went to the parking garage and she saw a patient, laying on the garage floor, struggling to breathe and she got an O2 tank so the lady could breathe – she was told by the doctor that the lady had lung cancer and no more medical treatment for her can be done and that tank Cathy gave the lady is the last tank to be used. Cathy thought about her own daughter out of state and her own mother who lived in St. Bernard Parish. Cathy felt love for the dying lady, but she did not want to know her. Cathy was so overwhelmed with the inability to care for the sick because of the lack of medical care at the hospital that she decided to move onto another patient.

4. Mark and Sandra evacuate Vera LeBlanc as many others wait. What factors continue to plague communications during this disaster?

Mark and Sandra LeBlanc decided to take Vera LeBlanc and go – they were not going to wait for the hospital to give any OK because helicopters were not landing often, and ambulances were not at airboat drop offs – only a few patients had been rescued that day. They knew the airboats were running low on fuel and people were shooting rescuers – the LeBlancs decided they were going to take Vera to safety. Vera’s DNR was in the event her heart stopped and not for a UTI – which is why Vera was at the hospital in the first place. Vera was pushed to the end of the line to be rescued and Mark and Sandra chose to leave the hospital with Vera. The doctors first would not let Mark and Sandra into the patient area, and they threatened to call off the airboats. They were told they could not take Vera and they told the doctors off and took her onto an airboat anyway and took a security guard who wanted to leave on an airboat too.

The first factor was the absent communication between Tenet and Memorial because the hospital lost power and access to phone communications. Tenet was having a hard time getting the go ahead to do the evacuation of the hospitals though the local, state, and federal agencies in charge of the evacuations. Tenet decided to take matters into their own hands to rescue Memorial and another New Orleans hospital by hiring private helicopters aka air ambulances and they requested Dept Wildlife and Fisheries to use swamp boats and pontoons to rescue the hospitals. It was an idea given to Tenet Senior VP Bob Smith from the Emergency Hospital Manager at New Orleans City Hall Cynthia Matherne who told (Tenet) that rapid evacuations are best done by private assets (page 167).

The second factor was miscommunication hiccups from issues with software that current authorities were using was not shareable across the federal, state, and local agencies (page 168). The information was also not up to date which led to more miscommunications and rumors of what was going on in New Orleans.

The third factor was the Hurricane Pam workshop failed to outline who was responsible (which local, state, or federal agency) for evacuating the hospitals. That the workshop outlined that the first three days were to focus on rescuing people on roof tops and the hospitals were on their own for seven days. The hospitals needed to plan to be on their own (page 166).

The fourth factor was no set priority list for which hospitals were being evacuated first, second or last. Each agency had a different idea of where Memorial fell on the list, and it led to more confusion on how Memorial would be evacuated (page 169).

The fifth factor was the Coast Guard’s air station problems because the radio antenna was damaged in the hurricane and the helicopters which were doing the rescuing had limited communication with the air station and the hospital – they were able to only communicate in flight and had to a lot of freelancing flying during rescue flights (page 166-167).