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F
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 sheri fink

five days at memorial

life and death in a
storm-ravaged hospital

Crown Publishers
N e w Yo r k

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 Copyright © 2013 by Sheri Fink
All rights reserved.
Published in the United States by Crown Publishers, an imprint of the Crown Publishing
Group, a division of Random House, Inc., New York.
www.crownpublishing.com
crown and the Crown colophon are registered trademarks of Random House, Inc.
“The Deadly Choices at Memorial,” by Sheri Fink. Copyright © 2009 by Pro Publica,
Inc. All rights reserved. Portions reprinted by kind permission of Pro Publica, Inc. First
published in the New York Times Magazine.
“Flu Nightmare: In Severe Pandemic, Officials Ponder Disconnecting Ventilators From
Some Patients,” by Sheri Fink. Copyright © 2009 by Pro Publica, Inc. All rights reserved.
Portions reprinted by kind permission of Pro Publica, Inc.
“Rationing Medical Care: Health Officials Struggle With Setting Standards,” by Sheri
Fink. Copyright © 2009 by Pro Publica, Inc. All rights reserved. Portions reprinted by
kind permission of Pro Publica, Inc. First published on MinnPost.com.
“Preparing for a Pandemic, State Health Departments Struggle with Rationing
Decisions,” by Sheri Fink. Copyright © 2009 by Pro Publica, Inc. All rights reserved.
Portions reprinted by kind permission of Pro Publica, Inc. First published in the New York
Times.
“Doctors Face Ethical Decisions in Haiti” and “Rationing Health in Disasters,” by Sheri
Fink. Copyright © 2010 by Sheri Fink. All rights reserved. First broadcast on PRI’s The
World.
“In Hurricane’s Wake, Decisions Not to Evacuate Hospitals Raise Questions,” by Sheri
Fink. Copyright © 2012 by Sheri Fink. All rights reserved. First published on ProPublica
.org.
“Beyond Hurricane Heroics: What Sandy Has to Teach Us All About Preparedness,”
by Sheri Fink. Copyright © 2013 by Sheri Fink. All rights reserved. First published in
Stanford Medicine Magazine.
Endpapers: Memorial Medical Center complex, viewed from the south side, on Thursday
September 1, 2005. Brad Loper /Dallas Morning News
Library of Congress Cataloging-in-Publication Data is available upon request.
ISBN 978-0-307-71896-9
eISBN 978-0-307-71898-3
printed in the united states of america
Maps by Jeffrey L. Ward
Jacket design by Chris Brand
10 9 8 7 6 5 4 3 2 1
First Edition

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 S. ROBERTSON STREET

NEW ORLEANS SURGERY

MEMO

E
NU
AND HEART INSTITUTE

JENA STREET
E
AV
BRIDGE FROM NOSHI TO SOUTH WING
ON

[blank]
LE
PO

SOUTH WING HELIPAD

NA

LIFECARE METAL STAIR

MAGNOLIA ST. COVERED TUNNEL

PARKING GARA
ORIGINAL 1926
HOSPITAL BUILDING
CORE PLANT BUILDING
WITH GENERATORS

INTENSIVE CARE UNIT SHORTCUT OVER ROOF TO

PARKING GARAGE AND HELIPAD

LIFECARE

BRIDGE

SMOKING BALCONY SECOND-FLOOR LOBBY

ER RAMP

GENE

water level on north side

CLARA ST. CLARA STREET

DOCTORS’ OFFICES
BRIDGE
PARKING LOT
JENA STREET

NEW ORLEANS
CANCER INSTITUTE

DOCTORS’ OFFICES

S PHARMACY

E W

N SMOKING BALCO

© 2013 Jeffrey L. Ward

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 MEMORIAL MEDICAL CENTER HOSPITAL COMPLEX
JENA STREET

South to Mississippi River

GARAGE
DOWN RAMP
HELIPAD
FECARE METAL STAIRCASE

MAGNOLIA STREET
ED TUNNEL

CA
PARKING GARAGE

DI
ZS
ILDING

TR
ATORS

EE
T
OF TO CLARA WING
HELIPAD

BRIDGE

D-FLOOR LOBBY

GENERATOR ROOM
SECOND-FLOOR PLAN
ARA STREET
AND ROUTE TO GARAGE

IDGE
JENA STREET

MACHINE ROOM

PARKING GARAGE AND

HATCH TO GARAGE STAIRS TO HELIPAD

PHARMACY

CHAPEL
SECOND-FLOOR LOBBY
STAGING AREA

ATM
SMOKING BALCONY

BRIDGE
BRIDGE

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 note to the reader

THIS BOOK RECOUNTS what happened at Memorial Medical

Center during and after Hurricane Katrina in August 2005 and fol-
lows events through the aftermath of the crisis, when medical profes-
sionals were arrested and accused of having hastened the deaths of their
patients. Many people held a piece of this story, and I conducted more
than five hundred interviews with hundreds of them: doctors, nurses,
staff members, hospital executives, patients, family members, govern-
ment officials, ethicists, attorneys, researchers, and others. I was not at
the hospital to witness the events. I began researching them in February
2007 and wrote an account of them in 2009, copublished on the inves-
­ roPublica and in the New York Times Magazine: “The
tigative news site P
Deadly Choices at Memorial.”
Because memories often fade and change, source materials dating
from the time of the disaster and its immediate aftermath were particu-
larly valuable, including photographs, videotapes, e-mails, notes, dia-
ries, Internet postings, articles, and the transcripts of interviews by other
reporters or investigators. The narrative was also informed by weather
reports, architectural floor plans, electrical diagrams, and reports pre-
pared by plaintiff and defense experts in the course of civil litigation;
and I visited the hospital and other sites depicted in the book.

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 xviii  note to the reader

Dialogue rendered in quotation marks is reproduced exactly as it was

recalled in interviews, or is taken directly from transcripts and other pri-
mary sources. If one person recounted an important conversation, I gen-
erally attempted to contact all participants, but some declined to speak,
and at times memories were at odds. The main text and Notes highlight
areas of significant dispute and indicate the sources of quotes when they
do not derive from interviews with me. Typographical mistakes are pre-
served in quoted e-mails to give the reader a sense of the urgency in-
volved in their production.
This book relates the thoughts, impressions, and opinions of the
people in it, perhaps the most fraught aspect of narrative journalism.
Attributed thoughts or feelings reflect those that a person shared in an
interview, wrote down in notes, a diary, or a manuscript, or, less com-
monly, expressed to others whom I interviewed. As any book reflects
the interwoven interpretations and insights of its author, I have tried to
make these distinct. All errors are mine.

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 PART I
deadly choices
Blindness was spreading, not like a sudden tide flood-
ing everything and carrying all before it, but like an
insidious infiltration of a thousand and one turbulent
rivulets which, having slowly drenched the earth,
suddenly submerge it completely.
—José Saramago, Blindness

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 PROLOGUE

AT LAST THROUGH the broken windows, the pulse of helicop-

ter rotors and airboat propellers set the summer morning air throbbing
with the promise of rescue. Floodwaters unleashed by Hurricane Katrina
had marooned hundreds of people at the hospital, where they had now
spent four days. Doctors and nurses milled in the foul-smelling second-
floor lobby. Since the storm, they had barely slept, surviving on catnaps,
bottled water, and rumors. Before them lay a dozen or so mostly elderly
patients on soiled, sweat-soaked stretchers.
In preparation for evacuation, these men and women had been lifted
by their hospital sheets, carried down flights of stairs from their rooms,
and placed in a corner near an ATM and a planter with wilting greenery.
Now staff and volunteers—mostly children and spouses of medical work-
ers who had sought shelter at the hospital—hunched over the infirm, dis-
pensing sips of water and fanning the miasma with bits of cardboard.
Supply cartons, used gloves, and empty packaging littered the floor.
The languishing patients were receiving little medical care, and their skin
felt hot to the touch. Some had the rapid, thready pulse of dehydration.

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 4  sheri fink

Others had blood pressures so low their pulses weren’t palpable, their
breathing the only evidence of life. Hand-scrawled evacuation priority
tags were taped to their gowns or cots. The tags indicated that doctors
had decided that these sickest individuals in the hospital were to be evac-
uated last.
Among them was a divorced mother of four with a failing liver who
was engaged to be remarried; a retired church janitor and father of six
who had absorbed the impact of a car; a WYES public television vol-
unteer with mesothelioma, whose name had recently disappeared from
screen credits; a World War II “Rosie Riveter” who had trouble speak-
ing because of a stroke; and an ailing matriarch with long, braided hair,
“Ma’Dear,” renowned for her cooking and the strict but loving way she
raised twelve children, multiple grandchildren, and the nonrelatives she
took into her home.
In the early afternoon a doctor, John Thiele, stood regarding them.
Thiele had taken responsibility for a unit of twenty-four patients after
Katrina struck on Monday, but by this day, Thursday, the last of them
were gone, presumably on their way to safety. Two had died before they
were rescued, and their bodies lay a few steps down the hallway in the
hospital chapel, now a makeshift morgue.
Thiele specialized in critical care and diseases of the lungs. A stocky
man with a round face and belly, and skinny legs revealed beneath his
shorts, he answered often to “Dr. T” or, among friends, “Johnny,” and
when he smiled, his eyes crinkled nearly shut. He was a native New
Orlean­ian, married at twenty, with three children. He was a golfer and a
Saints football fan. He liked to smoke a good cigar while listening to Elvis.
Like many of the hospital staff around him, his professional asso-
ciation with what was now Memorial Medical Center stretched back
decades, in his case to 1977, when he had rotated at the hospital as a
Louisiana State University medical student. A classmate would later say
that Johnny Thiele had turned into the sort of doctor they all wished to
be: kind, gentle, and understanding, perhaps all the more so for having

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 five days at memorial  5

struggled over the years with alcohol and his moods. When Dr. T passed
a female nurse, he would greet her by name with a pat on the back and
sometimes call her “kiddo.”
Thiele had undergone part of his training at big, public Charity Hos-
pital, one of the busiest trauma centers in the nation, where he learned,
when several paramedics burst into the emergency room in close succes-
sion, to attend to the most critical patients first. It was strange to see the
sickest here at Memorial prioritized last for rescue. At a meeting Thiele
had not attended, a small group of doctors had made this decision with-
out consulting patients or their families, hoping to ensure that those
with a greater chance of long-term survival were saved. The doctors
at Memorial had drilled for disasters, but for scenarios like a sarin gas
attack, where multiple pretend patients arrived at the hospital at once.
Not in all his years of practice had Thiele drilled for the loss of backup
power, running water, and transportation. Life was about learning to
solve problems by experience. If he had a flat tire, he knew how to fix it.
If somebody had a pulmonary embolism, he knew how to treat it. There
was little in his personal history or education that had prepared him for
what he was seeing and doing now. He had no repertoire for this.
He had arrived here on Sunday. He brought along a friend who was
recovering from pneumonia and was too weak to comply with the may-
or’s mandatory evacuation order for the city, which had exempted hos-
pitals. Early Monday, Thiele awoke to shouts and felt his fourth-story
corner office swaying. Its floor-to-ceiling windows, thick as a thumb,
moved in and out with the wind gusts, admitting the near-horizontal
rain. He and his colleagues lifted computers away and sopped up water
with sheets and gowns from patient exam rooms, wringing out the cloth
over garbage cans.
The hurricane cut off city power. The hospital’s backup generators
did not support air-conditioning, and the temperature climbed. The
well-insulated hospital turned dank and humid; Thiele noticed water
dripping down its walls. On Tuesday, the floodwaters rose.

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 6  sheri fink

Early Wednesday morning, Memorial’s generators failed, throwing

the hospital into darkness and cutting off power to the machines that
supported patients’ lives. Volunteers helped heft patients to staging areas
for rescue, but helicopters arrived irregularly. That afternoon, Thiele
sat on the emergency room ramp for a cigar break with an internist,
Dr. John Kokemor, who told him doctors were being requested to leave
last. When Thiele asked why, his friend brought an index finger to the
crook of his opposite elbow and pantomimed giving an injection. Thiele
caught his drift.
“Man, I hope we don’t come to that,” Thiele said. Kokemor would
later say he never made the gesture, that he had spent nearly all his time
outside the building loading hundreds of mostly able-bodied evacuees
onto boats, which floated them over a dozen blocks of flooded streets to
where they could wade to dry ground. He said he was no longer caring
for patients and too busy to worry about what was going on inside the
hospital.
Wednesday night, Thiele heard gunshots outside the hospital. He was
sure people were trying to kill each other. “The enemy” lurked as near
as a credit union building across the street. Thiele thought the hospital
would be overtaken, that those inside it had no good way to defend them-
selves. He lost his footing in an inky stairwell and nearly pitched down
the concrete steps before catching himself. Panicked and convinced he
would die, he reached his family by cell phone to say good-bye.
Thiele felt abandoned. You pay your taxes, he thought, and you as-
sume the government will take care of you in a disaster. He also won-
dered why Tenet, the giant Texas-based hospital chain that owned
Memorial, had not yet sent any means of rescue.
Finally, on Thursday morning, the company dispatched leased heli­
copters, while other aircraft from the Coast Guard, Air Force, and Navy
hovered overhead awaiting a turn to perch on Memorial’s helipad. Air-
boats came and went with the earsplitting drone of airplane engines.
The pilots would not allow pets on board the aircraft and watercraft,

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 five days at memorial  7

creating a predicament for the staff members who had brought them
to the hospital for the storm. A young internist held a Siamese cat as
Thiele felt for its breastbone and ribs and conjured up the anatomy he had
learned in a college dissection class. He aimed the syringe full of potas-
sium chloride at the cat’s heart. The animal wriggled free of the doctor’s
hands and swiped and tore Thiele’s sweat-soaked scrub shirt. Its whitish
fur stuck to him. They caught the animal and tried again to euthanize it,
working in a hallway perhaps twenty feet away from the patients in the
second-floor lobby. It was craziness.
A tearful doctor came to Thiele with news she had been offered a
spot on a boat with her beautiful twenty-pound sheltie. She had quickly
trained it to lie in a duffel bag. Several of the doctor’s human companions
were insisting they would not leave without her. Since the floodwaters
had surrounded them, the doctor had been sick to her stomach and con-
tinuously afraid. She wanted to go while she had this chance, but she
felt guilty about abandoning her colleagues and the remaining patients.
“Don’t cry, just go,” Thiele said. “An animal’s like a child.” He reassured
her: “We gonna get by without you. I promise you.”
Thiele walked back and forth through the second-floor lobby mul-
tiple times as he journeyed between the hospital and his medical office.
As the hours passed, the volunteers fanning the patients on their stretch-
ers were shooed downstairs to join an evacuation line snaking through
the emergency room.
Thiele knew nothing about the dozen or so patients who remained,
but they made an impression on him. Before the storm, the poor souls
would have had a chance. Now, with the compounding effects of days in
the inferno with little to no medications or fluids, they had deteriorated.
The airboats outside made it too loud for Thiele to use a stethoscope.
He didn’t see any medical records, he didn’t feel he needed them to tell
him that these patients were moribund. He watched a doctor he didn’t
know direct their care, a short woman with auburn hair. He would later
learn her name: Dr. Anna Pou, a head and neck surgeon.

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 8  sheri fink

Pou was among the few doctors still caring for patients inside the
stifling hospital. Some physicians had departed; those who hadn’t were,
for the most part, no longer practicing medicine—they had assumed the
roles of patient transporters or were overseeing the evacuations outside
where it was somewhat cooler. But Pou looked to Thiele like a female
Lone Ranger. After enduring four stressful days and four nights of little
sleep, she retained the strength and determination to tend to the worst-
off. Later, he would remember her saying that the patients before them
would not be moved from the hospital. He did not know if she had de-
cided that, or if she had been told that by an administrator.
Hospital CEO L. René Goux had told Thiele that everyone had to be
out by nightfall. A nursing director, Susan Mulderick, the designated di-
saster manager, had given Thiele the same message. The two leaders later
said they had meant to focus their exhausted colleagues on the evacua-
tion, but the comments left Thiele wondering what would become of
these patients when everyone else left.
He also wondered about the remaining pets, which he’d heard would
be released from their kennels to fend for themselves. They were hun-
gry. And Thiele was sure that another kind of “animal” was poised to
rampage through the hospital looking for drugs. He later recalled won-
dering at the time: “What would they do, these crazy black people who
think they’ve been oppressed for all these years by white people . . . God
knows what these crazy people outside are going to do to these poor
patients who are dying. They can dismember them, they can rape them,
they can torture them.”
What would a family member of a patient want Thiele to do? There
was no one left to ask; they had all been made to leave, told their loved
ones were on their way to rescue.
The first thing, he thought, was the Golden Rule, do unto others as
you would have them do unto to you. Thiele was Catholic and had been
influenced by a Jesuit priest, Father Harry Tompson, a mentor who had
taught him how to live and treat people. Thiele had also adopted a motto

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 five days at memorial  9

he had learned in medical school: “Heal Frequently, Cure Sometimes,

Comfort Always.” It seemed obvious what he had to do, robbed of al-
most any control of the situation except the ability to offer comfort.
This would be no ordinary comfort, not the palliative care he had
learned about in a week-long course that certified him to teach the prac-
tice of relieving symptoms in patients who had decided to prioritize this
goal of treatment above all others.
There were syringes and morphine and nurses in this makeshift unit
on the second-floor lobby. An intensive care nurse he had known for
years, Cheri Landry, the “Queen of the Night Shift”—a short, broad-
faced woman of Cajun extraction who had been born at the hospital—
had, he believed, brought medications down from the ICU. Thiele knew
why these medications were here. He agreed with what was happening.
Others didn’t. The young internist who had helped him euthanize the
cat refused to take part. He told her not to worry. He and others would
take care of it.
In the days since the storm, New Orleans had become an irrational
and uncivil environment. It seemed to Thiele the laws of man and the
normal standards of medicine no longer applied. He had no time to pro-
vide what he considered appropriate end-of-life care. He accepted the
premise that the patients could not be moved and the staff had to go. He
could not justify hanging a morphine drip and praying it didn’t run out
after everyone left and before the patient died, following an interval of
acute suffering. He could rationalize what he was about to do as merely
abbreviating a normal process of comfort care—cutting corners—but
he knew that it was technically a crime. It didn’t occur to him then to
stay with the patients until they died naturally. That would have meant,
he later said he believed, risking his life.
He offered his assistance to Dr. Pou, but at first she refused him. She
tried repeatedly to convince him to leave the area. “I want to be here,”
he insisted, and stayed.
With some of the doctors and nurses who remained, Thiele discussed

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 10  sheri fink

what the doses should be. To his mind, they needed to inject enough
medicine to ensure the patients died before everyone else left the hos-
pital. He would push 10 mg of morphine and 5 mg of the fast-acting
sedative drug Versed and go up from there as needed. Versed carried a
“black box” warning from the FDA, the most serious type, stating that
the drug could cause breathing to cease and should only be given in set-
tings where patients were monitored and their doctors were prepared to
resuscitate them. That was not the case here. Most of these patients had
Do Not Resuscitate orders.
It took time to mix the drugs, start IVs, and prepare the syringes. He
looked at the patients. They seemed lifeless apart from their b­ reathing—
some hyperventilating, some gasping irregularly. Not one spoke. One
was moaning, delirious, but when someone asked what was wrong, she
was unable to respond.
He took charge of four patients lined up on the side of the lobby clos-
est to the windows: three elderly white women and a heavyset African
American man.
It had come to this. Dr. T’s mind began to form a question, perhaps
in the faint awareness that there might be alternatives they had not con-
sidered when they set this course. Perhaps he realized at the moment of
action that what seemed right didn’t feel quite right; that a gulf existed
between ending a life in theory and in practice.
He turned to the person beside him, the nurse manager of the ICUs
who also served as the head of the hospital’s bioethics committee. Karen
Wynn was versed in adjudicating the most difficult questions of treat-
ment at the end of life. She, too, had worked at the hospital for decades.
There was no better human being than Karen. At this most desperate
moment, he trusted her with his question.
“Can we do this?” he would later remember asking her. “Do we
­really have to do this?”

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 Pur
chas
eacopyof

F
IVEDAYSATMEMORI
AL
atoneoft
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eret
ail
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: