Agonal breathing

Agonal breathing is the term used in the account of a Memorial Medical Center patient whose occasional, labored breaths became part of a dispute over her condition and the care she should receive. The scene gives the sign several meanings at once: a clinical observation, a point of disagreement among medical workers, and a term in the later investigation into medication and intent.

The Patient in the Hallway

On the hospital’s seventh floor, pathologist John Skinner and laboratory director David Heikamp encountered Anna Pou and nurse manager Mary Jo D’Amico with a woman lying on a bed near the nursing station. The woman appeared unconscious and was taking occasional, labored breaths. Skinner and Heikamp did not identify her by name; based on her location and description, the account suggests she was probably Wilda McManus.

Skinner tried to adjust the woman’s intravenous line. When that did not work, he attempted to administer medicine by injection. Heikamp was upset by the woman’s breathing, which recalled the way his own mother had breathed for hours before her death the previous year. Skinner described the breaths as agonal and told him that patients in that condition had so little brain function that they did not experience pain.

Skinner then asked to speak with Pou privately. He told her he believed the patient was still alive and should be evacuated, and offered to find someone to help carry her. The account records this as his assessment and intervention; it does not establish that the workers shared his interpretation of the breathing or the patient’s prospects.

DNR Status and the Meaning of Rescue

The encounter took place amid Memorial’s decision to place patients with do-not-resuscitate orders last in the evacuation sequence. A DNR order applied to resuscitation if a patient’s breathing or heartbeat stopped; it was not the same as a living will requesting the withdrawal or withholding of life-sustaining treatment under specified conditions. Yet during the evacuation, the distinction between not resuscitating and not rescuing became consequential.

A separate episode on another floor made that confusion explicit. When a patient’s daughter learned that her mother’s DNR order was keeping her from evacuation, she asked for it to be canceled, explaining that she had agreed to forgo resuscitation in the event of cardiac arrest, not to have her mother left behind. The patient was moved toward rescue. Against this background, the breaths Skinner observed were not merely a description of a dying process: they bore on whether a patient was understood as alive and eligible for evacuation.

From Clinical Observation to Investigative Term

The account later places agonal breathing among the terms that prosecutor Michael Morales learned while studying the Memorial case. He kept a glossary that also included double effect, euthanasia, palliative care, and triage. The vocabulary reflected the case’s central problem: whether drugs were administered to relieve suffering or with the intention of causing death, a distinction Morales connected to Louisiana’s requirement to prove specific criminal intent in a murder case.

The term therefore entered a broader inquiry without resolving it. Investigators and experts considered witness accounts, medical records, the timing of deaths, and toxicology results. Those results required caution because the bodies had remained in heat before samples were taken, and experts disagreed about how reliably postmortem drug levels could establish what had happened before death. Agonal breathing was one part of the case’s clinical and ethical vocabulary, not by itself proof of a drug’s effect or of anyone’s intent.

Significance in the Account

The scene sets two readings of the same visible sign beside one another. Skinner interpreted the patient’s breathing as a reason to regard her as living and seek evacuation; he had explained agonal breathing to Heikamp as a condition associated with very limited brain function and an absence of pain. The narrative preserves both the attempted clinical explanation and Skinner’s insistence on rescue, rather than treating the term as a self-evident verdict.

That tension gives the phrase its importance in the book’s account. In a hospital where DNR status had been used to determine evacuation order, judgments about a patient’s condition could acquire consequences beyond bedside care. Later, as the case was examined through legal concepts of palliation and intent, agonal breathing became part of the language through which those judgments were discussed—while leaving the underlying questions to be assessed alongside other evidence.