Karen Cockerham

Karen Cockerham was an emergency medicine doctor at Memorial Medical Center during the disaster. She understood Susan Mulderick’s remarks on the emergency-room ramp as raising the possibility of euthanizing patients, and, unlike some colleagues who heard the same implication, Cockerham considered the proposal potentially justified. Her account presents that view not as a settled policy or an action she carried out, but as a judgment formed amid deteriorating conditions, fear, and what she believed the patients were enduring.

Reading the Proposal

Cockerham thought the possibility was already present in the conversation, even though no one seemed willing to name it. As she looked around, she saw people nodding and noticed no one objecting. She was struck that the discussion appeared to be happening openly, before a group of perhaps two dozen people. She wondered whether speaking so plainly was wise, but she considered euthanasia an option that needed to be faced. In that moment, she regarded it as perhaps the only humane choice, though not the only option in principle.

The uncertainty of the evacuation shaped her reasoning. Time seemed magnified, and Cockerham could no longer picture a return to ordinary life or trust that the crisis would soon end. She had heard assurances that everyone would get out that day, including assurances from the chief executive and Mulderick, but she could not make those promises seem credible against what she was seeing. The prospect of an end gave her a point from which to judge the patients’ remaining options; without confidence in rescue, the duration and meaning of their suffering looked different to her.

Fear and Conditions at the Hospital

Cockerham felt unsafe and vulnerable, and imagined that another catastrophe could occur before help arrived. She feared the building might explode or that someone might enter, rob the people inside, and shoot them. She had heard gunshots outside the hospital, which was turning away neighbors seeking rescue, and believed racial tensions were rising. Her interpretation drew in part on an earlier experience: as a pale-haired student seeking a late-night biscuit at a chicken restaurant near the Magnolia public housing project, she had been warned by a woman to leave the area. The memory informed her sense of danger, but the account presents these fears as her perception of events, not as proof of a specific threat inside the hospital.

Her concern for her family sharpened that sense of exposure. Her two-year-old child was safe with her husband, who was out of town, but Cockerham worried that by remaining at the hospital she was putting herself in harm’s way when she had a responsibility to return to them. She also experienced the heat as severe. When she took breaks from work, she sought refuge in her air-conditioned car and was grateful that she had filled its tank before the storm. Even that temporary retreat did not resolve the central uncertainty: she remained unable to see when or how the people inside would be brought to safety.

On the second floor, where she stopped several times to help, the temperature felt to her as if it exceeded one hundred degrees. Breaking windows had done little to improve the air circulation. She saw frail patients lying with little clothing, a measure intended to help keep them cool and make it easier for caregivers to clean them. Some reminded her of cadavers from medical school. She believed they might not understand what was happening and thought some had developed pressure sores because they were left in place without adequate mattresses or regular repositioning. These were her observations and conclusions; they formed the basis of her view that the conditions themselves had become a prolonged ordeal.

Her Moral Reasoning

Cockerham imagined the patients’ situation by placing herself in the position of a debilitated person who could scarcely communicate or anticipate a life beyond bed. She thought that a person in such circumstances might prefer to die rather than endure the ordeal. In her assessment, even survival might mean a life with little capacity for awareness or enjoyment. She described the patients as having, at best, the possibility of a minimal response such as a nod, and believed they had little prospect of recovering a meaningful quality of life after the crisis.

She compared the patients’ predicament with the decision already made for the dogs: if people had chosen to spare animals, she wondered why people should receive less consideration. She also invoked the idea of a soldier carrying a cyanide capsule as a means of avoiding torture. In her reasoning, soldiers might still have hope of a meaningful life after captivity, whereas the patients she saw faced what she regarded as suffering without such a prospect. The comparison reveals the standard she was applying: she weighed the expected experience after survival, not survival alone. Her conclusion depended on her judgment about the patients’ capacities and futures, rather than on evidence that any of them had expressed a wish to die.

Speaking to Mulderick

Cockerham considered the care being provided to the patients nearly criminal because she believed it was subjecting them to torment. She raised the matter with Mulderick, who told her that it was being taken care of. The exchange is the clearest recorded action Cockerham took in response to her conviction. It does not establish that she administered medication, participated in a decision to hasten anyone’s death, or knew what Mulderick meant by her reply.

Cockerham’s account gives the ethical debate a distinct vantage point: an emergency physician trying to interpret a public conversation while personally frightened, uncertain that rescue would come, and confronted with patients whose condition she viewed as profoundly diminished. Her reasoning joined a judgment about suffering to a prediction about patients’ futures, while the pressures of family responsibility and perceived danger narrowed her sense of time. The book records the strength of her belief, but also its limits: her confidence that she understood what patients would want is not the same as their having communicated that choice.