Do-not-resuscitate (DNR) status at Memorial and LifeCare

Do-not-resuscitate (DNR) status at Memorial Medical Center and LifeCare became a consequential evacuation classification during the hospital crisis. An instruction about what to do if a patient’s heart stopped was used alongside judgments about who should be rescued first—and, in some cases, who could be left upstairs. The distinction mattered: some patients’ families understood a DNR order as a limit on resuscitation, not as a request to withhold rescue.

From medical instruction to evacuation category

At about seven in the morning, Memorial’s incident command team planned to gather patients in staging areas near exits on the first and second floors. Staff were asked to retrieve emergency triage armbands: green for patients able to walk, yellow for those needing assistance, red for those dependent on care, and black for patients with DNR orders. This proposed color system placed DNR status in the same visible sorting process as mobility and care needs, even though those categories described different things.

The hospital could not find enough official armbands. Staff instead divided the more than one hundred remaining Memorial and LifeCare patients into groups numbered 1, 2, and 3. Patients in relatively good health who could sit up or walk were placed in group 1 for first evacuation; sicker patients needing more help were group 2; and group 3, scheduled to leave last, included patients judged very ill and patients with DNR orders. Thus the substitute system joined a medical instruction to a broader judgment about illness and evacuation priority. Patients and relatives were not included in making the classifications.

What DNR status meant to families

The consequences were clear on a fifth-floor hallway in Memorial’s Clara Wing. Transporters began moving a bed-bound patient toward the stairwell, then stopped when they saw her DNR order and repeatedly moved other patients around her. Staff were told not to explain the reason to her daughter. Instead, they said that other patients remained on the floor, without disclosing that the only other patient there had died.

That other patient, ninety-seven-year-old James Lafayette, had Alzheimer’s disease. After being brought to the emergency room before the storm with a cough, he was discharged and spent two days on the lobby floor before being admitted. Nurse Michelle Pitre-Ryals later found him without a pulse. Doctors and nurses attempted resuscitation, but could not revive him. His death added to the distress of a nurse who had not previously experienced an unexpected patient death while working.

When a man carrying a walkie-talkie told staff to leave the floor, Pitre-Ryals objected that nobody had come for the DNR patient. She explained to the daughter that the order could be discontinued, just as the daughter had agreed to it when her oxygen-dependent mother was admitted. The daughter had understood the order to mean that her mother would not be resuscitated after cardiac arrest, not that she would be left without rescue. She requested its cancellation. Staff found a doctor, the patient was moved downstairs and toward the helipad, and she survived the immediate ordeal. The episode showed how a family’s understanding of an order could change when it was applied to evacuation rather than resuscitation.

A parallel case at LifeCare

On the seventh floor at LifeCare, Angela McManus overheard staff discussing the decision to defer evacuation for patients with DNR orders. She had expected that her frail seventy-year-old mother, Wilda, would soon be rescued. Learning that Wilda’s DNR status placed her among those waiting, Angela asked LifeCare staff to rescind the order. They told her that no doctor was available to do so.

Wilda remained upstairs. Doctors at the second-floor staging area then told LifeCare staff to stop sending patients down because there was no more room. Her case therefore reflected both the priority assigned to DNR patients and the immediate constraint at the staging area. Unlike the patient in Memorial’s Clara Wing, whose daughter secured a change to the order and whose mother was moved toward evacuation, Angela could not obtain a doctor to alter her mother’s status in time.

Vera LeBlanc’s case further demonstrated that a DNR order did not necessarily reflect a current wish to be left behind. Her status came from a request made more than a decade earlier: if her heart stopped, she did not want it restarted. Her heart was still beating during the crisis. Although family members had been told she would leave by helicopter, she remained in the second-floor lobby, among patients with DNR orders, far from the front of the evacuation line. Her family’s names and phone numbers had been written on her hospital gown in anticipation of that helicopter transfer.

Information, responsibility, and aftermath

The evacuation classifications were made by medical professionals, but no system was established to explain them to the people most affected. In some cases, information was deliberately withheld. The family accounts reveal the cost of that gap: relatives had to infer what a DNR order meant in a crisis, challenge staff decisions, or seek a doctor who might not be available. The order’s clinical meaning and its practical use in the evacuation had come apart without a clear process for resolving the difference.

The wider evacuation unfolded amid severe shortages and obstacles. New Orleans had ordered an immediate evacuation, but many residents lacked a way to leave; ambulances were caught in traffic, and some delivered patients to the Superdome rather than taking them out of the city. Inside Memorial, the staff’s numbered groups were devised to speed the movement of more than one hundred patients. Those pressures help explain why staff sought a quick sorting method, but they do not erase the separate question of whether DNR status should determine rescue priority or how patients and families should be informed.

The book’s later accounts also show that the crisis did not end when the hospital was evacuated. LifeCare nursing director Gina Isbell described poor sleep, nightmares involving patients’ faces, and guilt about the people who had died; years later she still regarded herself as changed by the disaster. Karen Wynn’s account of preparing for possible testimony likewise describes how discussing the events could feel like reliving them. These are broader consequences of the hospital crisis, not evidence that every distressing aftermath arose from DNR decisions. The DNR cases nevertheless make one of the crisis’s central distinctions concrete: an order limiting resuscitation could be treated as a reason to delay rescue, even when a patient was still alive and a family believed the order meant nothing of the kind.