Decision to remove Nathalie LeBrun’s oxygen after the Haiti earthquake

The decision to remove Nathalie LeBrun’s oxygen after the Haiti earthquake exposes the human consequences of triage under scarcity: clinicians treated her continuing need as a reason to redirect a limited resource, while LeBrun herself was not told what that decision entailed. The plan to transfer her without oxygen appeared to close one path of care, but the journey and treatment at the receiving hospital unsettled the assumptions behind it.

Patient and Setting

The American medical team operated a tent field hospital on a college campus in Port-au-Prince. Unfamiliar names were difficult to record, so patients were assigned numbers; LeBrun entered the records as Jane Doe 326. She was thirty-eight and wore a white nightgown with lace trim. Through a translator, she described breathing difficulties and swelling that had begun before the earthquake and had worsened afterward. Her condition therefore did not fit neatly into a picture of injuries caused by the disaster, even as the emergency placed new demands on the hospital’s supplies.

The immediate question arose a week after the earthquake, when bottled oxygen remained scarce. LeBrun’s oxygen concentrator was her backup source. The hospital team had found more fuel, but that had not resolved the shortage of oxygen. A nurse serving as liaison officer, responsible for managing patient flow, confronted the choice of what to do about her continuing need.

The Allocation Decision

The liaison officer believed LeBrun’s breathing problems were probably caused by a chronic heart condition and that she might need oxygen indefinitely. He reasoned that the limited supply would do more good if reserved for people likely to need it temporarily, such as earthquake casualties requiring oxygen during surgery. This was a judgment about how to allocate a scarce resource across patients, but it also made duration of need decisive: LeBrun’s possible long-term dependence counted against her in comparison with patients whose needs were expected to pass.

The officer checked the decision with the head doctor, who agreed that it was right. They planned to lower LeBrun’s oxygen gradually and transfer her to a partially destroyed Haitian hospital where she had received treatment before. The team believed that the receiving hospital had no oxygen at all. The plan thus joined two judgments: that the field hospital should conserve its supply, and that another facility could take over her care despite having fewer resources.

LeBrun was neither consulted nor informed that her oxygen was being withdrawn. She was told only that she would be transferred. That afternoon, she smiled broadly and spoke hopefully about her future. The contrast is central to the episode: the staff were planning around a decision with grave consequences for her treatment, while she understood the move as a transfer of care, not as the execution of that plan.

Transfer and Reversal

Shortly after five that evening, a staff member unplugged LeBrun’s oxygen concentrator as medics from the U.S. Army’s 82nd Airborne Division arrived to transport her. The medics, unaware of the plan, tried to reassure her through the translator that she would be taken to another place and cared for there. During the transfer, a military doctor noticed that she was beginning to struggle to breathe. An oxygen tank was available in the ambulance, but a nurse from the field hospital’s command staff characterized her problem as chronic. In keeping with the triage decision, the ambulance did not provide oxygen.

At the damaged hospital, the expected absence of oxygen was not the end of the story. Paul Auerbach, an emergency physician volunteering there, found a tank with some oxygen remaining. He also treated LeBrun with low-cost diuretics to reduce fluid in her lungs. The treatment stabilized her enough that, at least for a time, she no longer needed the oxygen. This outcome does not establish what would have happened under a different plan, but it does show that the receiving hospital had resources and a clinician able to help her that the original team had not anticipated.

Significance

The episode turns on the difference between a resource-allocation assessment and the experience of the person being assessed. Staff judged that LeBrun’s likely chronic need made oxygen less useful to her than to patients with temporary needs; yet her distress during transport made the immediate stakes of that judgment visible. The decision was approved by the head doctor and implemented through a transfer plan, but LeBrun was excluded from the information and discussion that shaped her care.

The eventual intervention also complicates any simple account of the transfer as either successful triage or inevitable abandonment. LeBrun reached a hospital where treatment was possible, and Auerbach stabilized her for a time; that result depended on a remaining oxygen tank and care that the field hospital’s plan had not counted on. The narrative therefore presents scarcity not as an abstract calculation alone, but as a decision made amid uncertainty about an individual patient’s needs, what another institution could provide, and what the patient herself understood was happening.