Sheri Fink - Five Days at Memorial

Arvin, in Texas, had no background in emergency management. His normal job was to direct business development for Tenet in the Gulf Coast region, which he referred to as “the market.” It was amazing how quickly his duties had changed. Two days earlier, Arvin had interrupted a tennis match with his kids at a Dallas country club to join a conference call with the CEOs of Tenet hospitals in the Gulf region as Katrina took aim at the coastline. Now, three of Tenet’s six hurricane-affected hospitals needed to evacuate.

Tenet did not have preexisting contracts with medical transport companies. The corporate headquarters did not have an incident command system in place for emergencies. One of its executives had served in the National Guard and knew something about crisis management, but he was on vacation and offered tips by cell phone from a secluded beach retreat in Oregon.

Arvin let Cordray know that the company was working on securing medicines and blood for Memorial, but he was not sure how to get anything to her. Again he mentioned the National Guard, explaining that Memorial’s sister hospital, Tenet’s Lindy Boggs Medical Center, the former Catholic hospital Mercy, was waiting for troops to arrive.

We suggest you do the same. If you are beginning your plans to evacuate it is our understanding the National Guard is coordinating. Good luck.

Cordray wrote back, incredulous:

Are you telling us we are on our own and you cannot help?

AT 12:28 P.M., Memorial’s director of case management took matters into her own hands. She typed “HELP!!!!” in the subject line of an e-mail and sent it to colleagues at other Tenet hospitals outside New Orleans. She told them the hospital was expecting fifteen feet of water and it needed to find places for its current census of 187 patients. Hospitals that might accept them should contact Arvin at Tenet headquarters.

Arvin was quickly inundated with responses. Many hospitals offered space and at least one offered to send relief staff. But Arvin, too, had been busy trying to line up assistance, contacting Tenet hospitals in Houston and Nacogdoches. His message back to the Memorial administrator who sounded the alarm was brusque:

please route any requests through to me and Bob Smith. We are getting overwhelmed with your MAY DAY to the entire company!!

Among the hospitals that responded was Atlanta Medical Center. Like Memorial, Atlanta was a former Baptist hospital founded in the early 1900s and now owned by Tenet. By e-mail and phone, its hospital executives offered support, including aeromedical helicopters to help evacuate Memorial’s patients.

Michael Arvin reined them in, saying that the National Guard was coordinating all relief efforts. The Atlanta CEO understood.

Michael, per our conversation, we will “sit tight” unless we hear from you or someone at the Dallas office regarding the need for assistance in the evacuation of patients.

AT MEMORIAL, word spread that all available doctors and nurse managers should report to the ER ambulance ramp, which overlooked Clara Street. Anna Pou walked out of the hot hospital into a bright, slightly breezy day. In a small parking lot across the street, water was rising up the wheel wells of the cars.

Dr. Richard Deichmann, the head of the internal medicine department, told the doctors that the hospital was going to be evacuated. They needed to work on getting patients transferred, the sickest first.

Deichmann took stock of who was present and reassigned two physicians to cover each of the fifteen patient wards. At the suggestion of Dr. Horace Baltz, to avoid duplicating work, doctors would no longer visit their own private patients unless they were on the designated ward. The doctors were to categorize every patient and to prepare a count by four p.m. Patients would be marked down for transfer to one of several types of care settings: an ICU, a general hospital ward, a rehabilitation facility, or a nursing home. Patients ready to be discharged could be given a week’s worth of medications and sent on to an evacuation center. The medical staff should get the patients packed up and work on transfer orders.

Pou paired up with a thirty-five-year-old internist, Kathleen Fournier, and went to the fourth floor, where Pou had several surgical patients. She knew the nurses well, and one confided in her that many of the staff and patients were frightened and worried about their homes and their loved ones outside the hospital. Pou met with the nurses and offered what reassurance she could.

Pou and Fournier walked from patient to patient, evaluating and classifying them. There were around two dozen, a full complement. Many had been put in wheelchairs and pushed to a central nursing station to sit with fans blowing on them.

Nurses began photocopying charts and readying a few of the sicker patients to go out first. Throughout the day, Pou shuttled back and forth to the fourth floor, bringing the nurses whatever news she heard.

One of Memorial’s veteran critical care doctors was Ewing Cook, a pulmonologist who was Dr. John Thiele’s former partner. Cook took responsibility for another section of the fourth floor, replacing his son, also a doctor, who had gone home the previous night and was prevented from returning by the flooding. To ease the load on nurses, Cook decided all but the most essential treatments and care should be discontinued. Bryant King, a thirty-five-year-old internist who had recently joined Memorial as part of its new inpatient hospitalist program, which offered care for other doctors’ patients during their hospital stays, came to check on one of his patients there. Bucking the directive to see only patients in assigned wards, he still planned to submit billing claims on his existing patients as usual. He canceled the senior doctor’s order to turn off his patient’s heart monitor. Cook found out and was furious. He thought that the junior doctor did not understand the circumstances, and he directed the nurse to reinstate his instructions. “I’m in charge of this floor,” he told the nurse in front of King. “I told you what to do; I don’t care what any other doctor says. Do it.”

Outside on the ER ramp, maintenance workers watched a fuel truck approach to top off the generator tanks. The shiny chrome truck inched toward the hospital along the wrong side of Napoleon Avenue in the lane where the water was shallower. As the tanker turned the corner onto Magnolia Street a hundred yards away from the hospital it stopped, backed up, and left. “Oh jeez,” an electrician said, disheartened. The driver seemed to have judged he couldn’t make it the rest of the way without flooding his vehicle.

Workers paddled one of the small, flat-bottomed boats kept for minor street flooding to the ER and carried it to the top of the ambulance ramp, which was dry. With dark humor, Susan Mulderick jumped in with chief financial officer Curtis Dosch and hammed for the maintenance chief’s camera, pretending to row. Behind them, Clara Street was a rising lake, calm enough to bear an image of the dappled blue sky, to double the stature of twisty-limbed oaks along Napoleon and add two reflected floors to the cancer institute across the street while now engulfing the cars in its parking lot to their door handles.

Downstairs in the basement, puddles expanded on the floor. Maintenance staff shut off some lighting and electrical panels to try to prevent a fire. An electrician heard the sound of a waterfall pouring through the breached seals of a ground-level window. Two carpenters raced to buttress the loading dock against flooding with custom-built plywood walls. They layered duct tape around a vulnerable set of doors, but water sought its level, spurting through cracks ten feet into the hospital shop.