Nathalie LeBrun

Nathalie LeBrun is a thirty-eight-year-old patient encountered by an American disaster medical team in Haiti after the 2010 earthquake. Initially identified in the field hospital’s records only as Jane Doe 326, she depended on oxygen for a chronic condition that the earthquake had worsened. When supplies ran short, staff decided to withdraw her oxygen without telling her. Her transfer became an intimate test of a problem the book also traces through Katrina: how emergency teams distribute limited care, and what is lost when a patient affected by that decision is left out of it.

Identity and Arrival

In January 2010, the book’s narrator traveled with US federal disaster medical teams to Port-au-Prince to report on their work and examine how professionals handled triage when critically injured patients exceeded the medical system’s initial capacity. The American team set up a tent field hospital on a college campus. Because staff had difficulty recording unfamiliar names, they assigned patients numbers. LeBrun entered its records as Jane Doe 326, a bureaucratic label that concealed the identity of a person who could describe her own needs.

LeBrun arrived the week after the earthquake. She was wearing a white nightgown with lace trim. Through a translator, she explained that her breathing problems and swelling predated the disaster, though both had worsened since it. Her case therefore did not fit neatly into a distinction between earthquake-related injuries and other medical needs: the emergency had intensified a pre-existing condition, while the treatment that kept her breathing required supplies also needed elsewhere.

Oxygen and Scarcity

The team found an oxygen tank and connected it to LeBrun. When it ran out overnight, her blood oxygen level fell to a dangerously low level. A nurse who believed LeBrun was dying sat with her in tears and was told that no oxygen remained. Doctors and staff searched for another tank, connected it, and eased her breathing. That short reprieve revealed how precarious her care was: each improvement depended on finding a supply that could not be assumed to last.

The wider supply chain remained unreliable. Another patient’s brother managed to obtain a large oxygen tank elsewhere in the city. Staff also tried a portable oxygen concentrator, which extracts oxygen from the air, but it repeatedly overheated and shut down. It required electricity, while fuel for the generators was scarce. At a morning meeting beneath a mango tree, a logistician warned the medical staff that only one can of diesel remained for each generator. The problem was not simply the number of oxygen tanks: the equipment intended to provide an alternative depended on power and fuel that were themselves in short supply.

The Allocation Decision

The team’s liaison officer, a nurse responsible for managing patient flow, considered LeBrun’s continuing need for oxygen against the needs of patients who might require it only temporarily, such as people undergoing surgery for earthquake injuries. Because her breathing difficulties were probably caused by a chronic heart problem and her need might continue indefinitely, he reasoned that the limited oxygen would do more good if reserved for those patients. He checked the decision with the head doctor, who agreed, and staff planned to reduce LeBrun’s oxygen gradually before transferring her to a partly destroyed Haitian hospital where they believed no oxygen was available.

LeBrun was neither consulted nor informed of that plan. Staff told her only that she would be transferred. That afternoon she smiled broadly and spoke hopefully about her future. Her response underscores the difference between a clinical judgment made about a patient and a decision made with one: the people planning to discontinue her oxygen understood the intended destination and rationale, while she did not know that the resource sustaining her breathing was to be withdrawn.

Transfer and Treatment

The plan to taper her oxygen was not carried out gradually. Staff were occupied with patients who had broken bones and complex wounds, as well as two women giving birth at the same time. Shortly after five that afternoon, a staff member unplugged LeBrun’s concentrator when medics from the US Army’s 82nd Airborne Division arrived to transport her. The medics, unaware of the plan, reassured her through the translator that she would be taken to another place and cared for. Although an oxygen tank was available in the ambulance, a nurse from the field hospital’s command staff described LeBrun’s breathing problem as chronic; following the triage decision, the medics gave her no oxygen.

After the ambulance reached the receiving hospital, Dr. Paul Auerbach, an emergency physician volunteering there, found a tank with a small amount of oxygen and treated LeBrun with diuretics to reduce fluid in her lungs. She stabilized to the point that, at least temporarily, she no longer needed oxygen. This outcome does not erase the danger of the transfer or establish that the earlier decision was harmless. It shows instead that her condition and prospects could not be reduced to the assumption that her need was permanent and therefore a poor use of scarce supplies.

Significance in the Book

LeBrun’s story extends the book’s examination of disaster triage beyond New Orleans. The same broad question recurs across the accounts: what happens when lifesaving resources are limited and some patients are judged less likely to benefit from them? But the case turns that abstract question toward the person who bears the decision’s consequences. A number in an unfamiliar record system, a chronic condition, and an ongoing need for oxygen all shaped how LeBrun was seen; none made her unable to participate in a decision about her own care.

The episode also separates the logic of allocation from the way it is implemented. The team faced real shortages, and its reasoning compared a continuing need with temporary needs among other patients. Yet the plan was made without telling LeBrun, and the transfer proceeded without the oxygen available in the ambulance. The receiving hospital’s intervention then altered the immediate outlook. Through those reversals, LeBrun’s experience makes visible the uncertainty hidden by a categorical judgment: scarce resources demand choices, but a patient’s actual condition, voice, and changing prospects matter to what those choices mean.