August 31, 2005

August 31, 2005, was the fourth day of the Memorial Medical Center crisis during Hurricane Katrina and a turning point in the hospital’s struggle to keep patients and staff safe. The final backup generator failed in the early hours, after the intensive care nurses had managed to evacuate their non-DNR patients. The day that followed joined institutional breakdown to intimate, conflicting experiences: patients and staff waited for rescue, the hospital’s improvised routines continued, and the prospect of leaving alternated with fear that help would not come.

A city already difficult to evacuate

The conditions of August 31 had been shaped by New Orleans’s late, mandatory evacuation order. Many residents had no cars or other way to leave, while officials knew that the city lacked enough drivers to carry everyone who needed transportation. People who could evacuate independently were already caught in traffic, and the New Orleans Superdome was designated as a shelter of last resort. Mayor Ray Nagin urged people with medical conditions, including those needing dialysis, to go there, without specifying what care they could expect. Hospitals, meanwhile, were exempt from the evacuation order because officials feared that injured people might otherwise have nowhere to go.

Transport capacity was failing even before the hospital’s own emergency worsened. Acadian dispatchers received requests to move patients from hospitals, nursing homes, and homes, but many of the roughly two dozen ambulances made available were stuck on the interstate. Some began taking patients to the Superdome rather than trying to drive them out of the city. This wider shortage formed part of the day’s setting: the need to move vulnerable people was known, but the means to do it were scarce and disrupted.

The generator failure and the morning after

In the hours after midnight, intensive care nurses gathered on the eighth floor and congratulated one another for getting all their non-DNR patients out safely. Two nurses remained to care for the two surviving DNR patients still in the unit. Staff and family members found places to rest together, while the nurses’ accomplishment coexisted with uncertainty about whether they would ever work together at the hospital again. Karen Wynn feared they would not; Lori Budo believed she would return.

That fragile pause ended when the hospital’s remaining electrical supply failed. Workers had tried to manage the generator load and avoid a short circuit, but another generator broke down and could not be repaired with the parts available. At about 2 a.m., nearly forty-eight hours after Katrina made landfall near New Orleans, the last backup generator surged and stopped. Alarms sounded on the eighth floor. Wynn climbed onto a chair and struck an alarm panel with her shoe to silence it, then told the nurses to try to sleep. The gesture captures the day’s altered scale: even an alarm had become something staff had to manage by hand.

By morning, the hospital was dark, hot, and without running water. Toilets were backed up, and communications systems—including phones, televisions, computers, and overhead pagers—were unavailable. Critical information moved from person to person on the staircases. When plant manager Eric Yancovich told Susan Mulderick that a state health official had arrived and promised to clear the hospital by the end of the day, Mulderick told staff to prepare to leave. The promise offered a concrete deadline amid the breakdown, but evacuation remained difficult and uneven.

Rescue, waiting, and the limits of perspective

The previous overnight evacuation had not carried every critically ill patient to safety. Four LifeCare patients dependent on ventilators were transferred successfully by Coast Guard helicopters; five others did not leave the hospital. One died while being carried down a staircase, and a woman in a deep coma with a DNR order remained on the seventh floor. Staff had told the LifeCare unit that patients with DNR orders could not go. These outcomes formed part of the situation staff confronted as the day began, when the hospital’s physical and communications systems were failing together.

Later, the evacuation strategy shifted toward taking patients who were well enough to be discharged by boat. Doctors oversaw loading at the emergency-room ramp, and employees and family members were allowed to leave with them. Some people hesitated when asked to board without their belongings. Wynn tried to persuade one woman to leave without her purse, even offering to take responsibility for it, but the woman would not board. The episode showed how the danger inside the hospital could be obscured by the immediate meaning of a treasured possession or by uncertainty about where a boat would take its passengers.

That gap in perspective appeared in other encounters. A patient arrived through the floodwater for a scheduled chemotherapy appointment, and Wynn had to tell her that chemotherapy would not be given. A hospital in Baton Rouge also called to complain that a male psychiatric patient had been sent there with neonates. Wynn’s attention was consumed by the conditions at Memorial; she did not fully grasp how many displaced patients might have been sent elsewhere. At the same time, she cared for patients awaiting rescue on the ambulance ramp and memorized their faces to avoid losing track of them. The date’s emergency therefore extended beyond the hospital’s walls, even when its staff could not see the wider picture.

A day remembered in fragments

John Thiele’s later account of Wednesday preserves both practical discoveries and mounting fear. The basement cafeteria’s soda machines still worked, and he waded through ankle-deep water to fill a cup. He also found relative coolness and working electrical outlets in the cancer institute, reached by a bridge to a medical office building. Administrators used the powered space to make coffee, charge phones, and sit by fans; Thiele slept in a recliner intended for chemotherapy patients. These pockets of normal utility did not restore the hospital, but they provided temporary shelter within it.

Thiele also spent hours on the emergency ramp with John Kokemor, smoking cigars from a humidor he had brought to the hospital for safekeeping. They wondered when they would get out and why doctors were expected to stay until last. Thiele later recalled that a friend made a gesture miming an injection, to which he responded with reluctance; the friend would later deny that the exchange had occurred. That disputed recollection connects August 31 to the later controversy over medication and hastened death without resolving what the conversation meant.

The day’s fear intensified when Thiele heard shouting and gunshots and was told that rescuers might not come. A plainclothes sentry said he had been given a gun despite never having fired one. Thiele became disoriented in a dark stairwell, went to his car, and called his family in Georgia to prepare them for the worst. His recollection places the threat of violence among the dangers staff believed they faced, while later accounts of the wider disaster found that some of the most alarming rumors had been exaggerated.

By Thursday morning, messages from Mulderick and Memorial’s chief executive, L. René Goux, that everyone had to be out by that night gave Thiele renewed hope. The shift from Wednesday’s expectation that the hospital might be on its own to a stated deadline for evacuation marks the day as a hinge in the crisis. Later assessments placed individual decisions within a broader chain of failures: delayed evacuation, insufficient transport, uncoordinated rescue, poor communications, and hospitals and nursing homes without robust backup power and water. August 31 is thus remembered not as a single isolated emergency but as a day when the consequences of those failures became immediate inside Memorial, while the people there experienced only fragments of the larger disaster.