In the afternoon of 13 August 291, the 80% of New Orleans was under water.
Katrina, the most powerful hurricane to hit the city in decades, had generated a storm surge of almost 8 meters in addition to torrential rains and winds of more than 200 Km/h.
The water exceeded the limits of the levee system built decades ago to protect the city, producing one of the deadliest and costliest natural disasters in US history: more than 1,800 people died and more than $150,000 million in material losses.
One of the places that historically had served as a refuge for the inhabitants of New Orleans in the face of the threat of a hurricane was the Memorial Medical Center.
When Katrina hit the city, about 2,000 people were evacuated from the hospital, in addition to some 200 patients and healthcare personnel.
For 5 days, the team of healthcare professionals at Memorial took care of their patients under the most difficult conditions imaginable: no water, no light, hot, tired and surrounded by fetid waters.
The failure of the New Orleans levee system left a 80% of the city under water. (Photo: GETTY IMAGES)And in those five days , the medical team had to make difficult decisions, some of which, it was later alleged, may have contributed to the deaths of some patients.
The ones that generated the most controversy were those attributed to Dr. Anna Pou, who was investigated by the Louisiana Department of Justice for allegedly injecting patients – some terminal, others not – with lethal doses of morphine and other medications.
In the end, Pou and two nurses against whom charges were also filed were not prosecuted due to lack of evidence, although doubts about what happened persist to this day.
Sheri Fink, columnist for the newspaper The New York Times -and who is also an MD – researched what happened at Memorial Medical Center after Katrina and published the Pulitzer-winning book “Five Days at Memorial,” which Apple just adapted as a TV series with the same title.
At BBC Mundo we talked with Fink about the events that took place in that hospital in New Orleans and its consequences.
Do Not Resuscitate Orders
The day after Katrina passed through New Orleans, the levee system that protected the city was beginning to collapse.
According to what witnesses told Sheri Fink, seeing the water level rise in the streets, the Memorial workers began to develop a plan for the evacuation of more than 176 sick and decisions were made about how and who to prioritize during the rescue.
Children in neonatal intensive care, pregnant mothers and patients with wounds would go first
In addition, after a brief discussion, it was also decided that the last to be evacuated would be those patients who had a Do Not Resuscitate Order (DNR), a document that in most cases requires c Informed consent of the patient or their main caregiver.
Under Louisiana law, an DNR is used to tell medical staff not to perform cardiopulmonary resuscitation on a patient in case of heart or respiratory failure.
But as Fink explains, some of the doctors, including the doctor who proposed the With the idea of evacuating people with DNR last, they interpreted the document differently: They believed that DNR orders were for people with terminal or irreversible illnesses, so they would “have less to lose” if a disaster struck.
“I think an important distinction is that in this case, the staff decided to use the existence of an NRO as if it were an authorization to rescue someone last and, in some cases, not to rescue him completely”, Fink told BBC Mundo.
“But a well-known group of independent doctors, part of which today is known as the National Academy of Medicine, concluded that DNRs should not be used as authorization for rescues because their purpose is totally different and may not be related to the best chances of survival”.
Additionally, when less 52 seriously ill or injured patients, who were in the process of recovery under the care of the LifeCare clinic, which operated independently on the seventh floor of the hospital, they stayed on the premises after the first rescue fleet arrived. Many were in the process of recovery, not sentenced to death.
The “selection” system used in the Memorial prioritized access to resources for those most likely to survive. (Photo: GETTY IMAGES)“A DNR is a very important and very difficult decision,” Fink explains about the importance of its proper use in medicine.
“If people feel that those orders are being used in a way different from what they expect, they will stop trusting them and will stop getting involved with the plans for the end of life”, points out the journalist.
Those on the seventh floor
Around 2 in the morning on Wednesday 31 August 2005, the Memorial’s standby power plant stopped working, and with it, the life-support machines began to fail, one by one. to the most severe patients.
For days, the doctors at the Memorial had to treat their patients under the intense heat, darkness and exhaustion. (Photo: GETTY IMAGES)Just a few minutes later, a nurse arrived on the seventh floor of the Memorial, where the ventilators of 7 patients from the independent LifeCare clinic were already operating with the reserve battery, and announced that the Coast Guard would be able to evacuate the most seriously ill group, if they moved to the heliport located on the second floor of the parking lot next to the hospital.
Despite the darkness, exhaustion and heat, the hospital’s medical team began to move patients, lowering them on stretchers down five flights of stairs, while an assistant pumped air into their lungs, replacing mechanical respirators.
During these efforts, most of the patients were evacuated with an artificial respirator, but at least four lives were lost on the way.
This made the medical team decide t transport the 48 remaining patients remaining in the hospital to the first floors, prioritizing those who could move more easily.
Then, they would move those who needed more assistance and, at the end, they would move those who were considered “very sick” or that they had signed the ONR.
“In a certain way, it is a metaphor for what happens all the time”, Fink told BBC Mundo about it.
“We know that there are those who have, and those who have nothing. We know that not everyone has access to life-saving technologies.”
This patient categorization system, Fink explained in his report on 2009, is known as “triage”, and there are at least 9 recognized ways to implement it. “Most ask that people with minor injuries wait while those in worse condition are treated or evacuated,” Fink explained in his article.
But at a time when the number of injured exceeds As medical capabilities and supplies grow, such as in war zones, triage focuses health care professionals’ attention and resources on those with the best chance of survival.
Morphine to suppress breathing
Among the people Fink managed to interview at the time was one of the hospital’s administrators, Dr. Ewing Cook, a veteran of the ICUs. intensive care.
LifeCare Independent Clinic patients remained in the hospital due to the triage system. (Photo: GETTY IMAGES)
Cook told him that he had made the decision to inject a terminally ill comatose patient with a dose of morphine high enough to stop her breathing, when she realized that it would be impossible to remove her from the intensive care unit due to the weight she had gained from retention of fluids.
In addition, the doctor told Fink that the 4 nurses who were treating her could be of more use elsewhere.
Cook confessed to Fink that he knew he was “hasting the death” of the woman, but stressed that the woman would have died just the same without his intervention, only a few hours later.
As the situation at Memorial worsened by the hour, with fewer and fewer resources for each patient, other hospital workers began to wonder what to do with the sickest patients . Director of Nursing Susan Mulderick expressed her concerns to Cook.
“We got to the point where you felt you couldn’t just walk away. The human thing was to let them go“, the specialist told Fink.
Finally, the hospital management company announced that it had hired a fleet of helicopters to finish the rescue work that day.
4 charges of homicide were filed icide in varying degrees against Pou. None prospered. (Photo: GETTY IMAGES)But due to the violent looting and gunshots that were heard throughout the city during the nights that followed Katrina, the police ordered that the evacuation be completed before 5 in the afternoon.
Fink says that Cook and Dr. Anna Pou had a discussion about what to do with the most serious patients, considered category 3. There were at least 9 patients on the seventh floor and there was no way to get them down in time, since no outsider had come to help move them.
Dr. Cook assured that he had explained to Dr. Pou how to inject a mixture of morphine with benzodiazepines to suppress breathing and that patients died in their sleep.
In one of the only interviews that Pou gave, to Newsweek magazine in 2006, the doctor agreed to speak injected into some category 3 patients, but he assured that his intention had been “to help patients who were in pain and to sedate patients who were anxious.”
The evacuation of the survivors from the Memorial was ended that day, although the bodies of those who died remained in the medical center for almost two more weeks.
The trial against Pou
The doctor Anna Pou was arrested on July 2006, along with nurses Lori Budo and Cheri Landry.
After months of forensic investigations, prosecutors thought they had a strong enough case to prosecute the doctor they believed had administered lethal doses of medication to at least s four patients, helped by the nurses.
After the autopsies, the forensic pathologist had found traces of morphine and midazolam (a drug used in euthanasia) or both in at least half of the 45 Bodies found at the Memorial on 11 September 2005.
Some coroners saw what had happened in the hospital as cases of euthanasia . But others assured that the high degree of decomposition of the bodies made it impossible to determine the causes of death, and therefore, impossible to confirm euthanasia.
Doubts like these, which even to this day today surround the events of those five days at the Memorial, they were enough for the members of a grand jury from the state of Louisiana to decide not to indict Pou because the evidence had not convinced them that the doctor had “a specific intention to kill” the patients.
The nurses obtained immunity for their testimonies, in which they assured that they had injected patients who they believed would die.
After the experience, Pou became an activist defending the rights of doctors to make decisions freely, without legal risks, during emergencies.
The waters of the lakes surrounding the city exceeded the capacities of the dams. (Photo: GETTY IMAGES)
“The dilemmas about the end of life arise in medicine all the time, and one of the reasons why I feel passionate about reporting in emergencies, is the opportunity to see them more closely”, Fink told BBC Mundo.
“Telling a story like this gives us an opportunity to help us think about these difficult issues and define where we want to go as a society”, concluded the journalist.
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