August 30, 2005

August 30, 2005, is identified in the book as Tuesday and as the third day of the crisis. At Memorial Medical Center, it marks a turn from trying to maintain ordinary hospital operations to confronting the possibility that flooding would isolate the building and disable its essential systems. The day’s significance lies not in a single decision, but in the collision between warnings that had been available beforehand and the practical limits of emergency plans once danger drew close.

The city’s evacuation and its limits

Before the hospital’s situation came fully into view, New Orleans was already facing a severe problem of evacuation. The mayor had ordered residents to leave, but many had neither cars nor another reliable way out. Officials knew that transportation plans were incomplete, including a shortage of drivers, while people who could leave by road were caught in traffic. The New Orleans Superdome was designated a shelter of last resort, and people without other options were told they could travel there by shuttle. The appeal specifically included people with medical conditions, such as those requiring dialysis, although the public announcement did not clarify what assistance they would find at the shelter.

The transport system was strained well beyond the roads. Dispatchers at Acadian, the region’s largest ambulance company, were inundated with requests to move patients from hospitals, nursing homes, and private homes. Many of the roughly two dozen ambulances made available were stuck on the interstate. Some began taking patients to the New Orleans Superdome rather than attempting to carry them out of the city. The experience made the problem plain: evacuation orders could identify the need to move, but could not themselves supply vehicles, drivers, open routes, or a workable destination for every medically vulnerable person.

The city’s hospitals had also been exempted from the evacuation order. At a press conference, a questioner asked whether people should remain in hospitals; the mayor said hospitals and their workers were exempt because closing them could leave injured people without care. That reasoning addressed the danger of shutting hospitals, but the events at Memorial would expose the opposing danger: keeping a hospital open in a flood without reliable power, communications, or a practicable way to evacuate.

Memorial shifts to survival mode

At Memorial, the command team changed the hospital’s operating posture from assault mode to survival mode after receiving word that a New Orleans canal had been breached. An Acadian ambulance worker on site had confirmed the breach with dispatchers. The possibility that water might be heading toward the hospital altered the expected routine: staff who had anticipated handing patients over to a returning shift and going home began to understand that they could be stranded at work.

The hospital was still functioning relatively normally in some respects. Staff reported that maintenance workers were clearing debris, removing floodgates, and patching roof damage; kitchen workers continued preparing food for patients and others sheltering in the building. Family members and neighbors had also taken refuge there. But these signs of continued operation existed alongside the growing danger beyond the hospital. Roads were obstructed by trees and power lines, and reports of flooding nearby made departure hazardous.

A National Guardsman told plant operations director Eric Yancovich that the levees protecting New Orleans had failed and that the hospital should prepare for fifteen feet of water. Yancovich initially doubted the warning, then recognized its seriousness and asked the guardsman to accompany him to the command center. The news was especially alarming because Yancovich had already examined the building’s exposure. His earlier handwritten measurements, made on lined paper after a review of storm-surge models, showed that less than four feet of water in Magnolia Street could overtop the loading dock and enter the hospital. Although the backup generators themselves were on the second floor, parts of the power-distribution system were at or below ground level.

Yancovich had previously warned that relatively little flooding could disable most of the medical center. He expected that patients might have to be moved to the newer Clara Wing, where he believed electrical circuitry was better protected. Some improvements had been made, including floodgates and a raised vent for underground diesel tanks, but proposed work to elevate transfer switches and pumps for medical air and suction had not been approved. A partial bid for electrical work exceeded a quarter of a million dollars, and Yancovich had recorded that the hospital lacked the capital to proceed. As water approached, the difference between a generator’s elevation and the vulnerability of the equipment distributing its power became decisive.

Floodwater and the plans that did not fit

The view of water entering the city made the warning immediate. Water poured from sewer vents near Memorial and flowed up Claiborne Avenue. People looked out from windows across the hospital. From the smoking balcony, Angela McManus saw darkness spreading across the ground; inside, staff struggled to comprehend that the water was advancing from Lake Pontchartrain rather than the Mississippi River. Cathy Green, an intensive-care nurse, understood the news as a decisive change in the hospital’s prospects.

An unplanned meeting followed in the command center. In the heat, someone broke windows with a small metal oxygen tank. Susan Mulderick told those assembled that as much as fifteen feet of water was expected around the hospital. Memorial had extensive emergency documentation, but its separate plans had not been joined into a response for the conditions now confronting the staff. Its hurricane plan did not anticipate flooding; its flooding plan did not account for evacuation; and its evacuation plan did not address a simultaneous loss of power or communications. The hurricane plan assumed that generators would function for at least seventy-two hours, though they had never been tested for that length of operation. Across the hospital’s 273 pages and twenty separate plans, there was no guidance for complete power failure or evacuation through flooded streets, and no arrangement for helicopter evacuation.

This failure of planning was not simply an absence of paperwork. Yancovich had identified the vulnerability of the electrical system, and officials had discussed the risk that hospital generators and switching equipment in flood-prone areas might fail. Yet the warnings had not produced the investments or integrated procedures needed for the crisis. The hospital’s predicament was therefore both environmental and institutional: the flood created the emergency, while known weaknesses and disconnected plans narrowed the options available to staff.

The overnight failure

The consequences extended beyond August 30 itself. The generators had been operating for two days, although they were not designed for continuous, prolonged use and staff on site were not generator mechanics. Workers first restarted one engine after it overheated by adding water to its radiator; later, they tried to address low oil pressure and other failures with diesel and improvised repairs. As sections of the hospital lost power, maintenance workers entered the flooded basement in rubber boots to reconnect electrical loads. They suspected that water had submerged low-lying transfer switches and distribution panels, a vulnerability Yancovich had predicted.

The effort to keep the generators running lasted about two hours. At roughly two in the morning on August 31, 2005, the last backup generator surged and stopped. The transition from August 30 into the following day thus carried the crisis from anticipated electrical danger to total backup-power failure. The date’s narrative significance is sharpened by that boundary: the water threat had been recognized, and the system’s weaknesses had been documented, but recognition did not prevent the loss of power on which patient care depended.