End-of-life care

End-of-life care in the book is not a single medical act or a synonym for stopping treatment. It appears as a continuing obligation to relieve suffering when cure is uncertain, as practical work performed by relatives and clinicians, and as a set of decisions whose meaning can change sharply in a disaster. The account distinguishes comfort from abandonment and a Do Not Resuscitate order from a general refusal of care, while showing how crisis conditions can blur distinctions that matter in ordinary practice.

Comfort as a Clinical Responsibility

John Thiele’s understanding of care begins with the Golden Rule and with lessons from the Jesuit priest Father Harry Tompson, who had taught him how to live and treat others. Thiele also carried a medical-school motto: Heal Frequently, Cure Sometimes, Comfort Always. At Memorial Medical Center, as the disaster stripped away much of his control over events, he understood comfort as something he could still offer. The motto makes relief of suffering a responsibility in its own right, rather than a consolation reserved for medicine’s failures.

The book places that principle beside the everyday use of comfort medication. In an interview, Susan Mulderick described the idea of giving patients medication such as Ativan to relax them as her suggestion. But prescriptions seized from the pharmacy showed that Pou and other doctors had already prescribed Ativan and other ordinary comfort drugs during the disaster. That detail matters to the distinction the narrative draws: medication can be part of routine comfort care, while the circumstances and purpose of its use remain essential to how an action is understood. The presence of a drug alone does not settle that question.

Care Beyond the Hospital Bed

Care also means the sustained, intimate work of attending to a person’s needs. At LifeCare Hospitals of New Orleans, Angela McManus was exhausted, dizzy, and anxious about a sibling living near the levees, but she continued to care for her mother, Wilda McManus. She gave Wilda nourishment through a feeding tube, changed her colostomy bag, and sought help from a nurse to clean her and replace a wound dressing. With no running water available for bathing, even basic care required improvisation and time. Angela stayed with her through conversation, singing, and prayer.

Those acts connect bodily care with the routines and beliefs that gave Wilda comfort. Before the storm, LifeCare staff had bowed their heads during the prayer sessions they called church, where Wilda recited the Lord’s Prayer and the Twenty-Third and Ninety-First Psalms. In the crisis, prayer did not replace nursing work: it accompanied it. The scene presents care as both material and relational, requiring hands-on attention as well as presence.

The history of Jannie Burgess adds a further dimension. She had entered nursing to support her children, after working as a taxi dispatcher and secretary to a mortician. In mid-twentieth-century New Orleans, her light-brown skin permitted her to care for patients at many private hospitals but did not permit her to receive care at those institutions. Although she was born only months after Memorial opened as Southern Baptist Hospital in 1926, more than four decades passed before she could be a patient there. Her history makes the promise of care inseparable from the question of who can obtain it.

Directives, Triage, and Disaster Decisions

A Do Not Resuscitate order carries a specific meaning; it is not, by itself, a decision to withhold every form of care. The book’s discussion of Louisiana advance directives emphasizes that the order is different from other future-care choices. At Memorial, however, doctors used DNR status to determine evacuation priority: they decided that patients with such orders would be moved last, making an exception to the usual priority given to the sickest patients and those dependent on machines. Four DNR patients were in the intensive care unit, including Helen Breckenridge and Jannie Burgess. The classification thus had consequences beyond resuscitation, shaping access to a scarce chance of evacuation.

The surrounding events show how authority and uncertainty complicated care. When Susan Mulderick announced that floodwaters were approaching, Karen Wynn recalled that the command room shifted from managing a hospital emergency to operating like a military mission, focused on acting before power failed. On the helipad, doctors disputed with a Coast Guard pilot about how many patients his helicopter could carry; he departed to rescue people elsewhere. A nurse who was also an Air Force captain then offered her flight-line experience, and Richard Deichmann put her in charge of the helipad. Her intervention cleared the landing area and directed people away from the rooftops so pilots could continue to land.

Even the transfer of fragile newborns forced a choice under incomplete information. Neonatal ICU nurses resisted sending babies to an unfamiliar hospital because they did not know whether it could support them. Deichmann told them the babies could leave and would be taken wherever the pilot was going, stressing the disaster conditions. The scene does not resolve the risks of either course; it shows how decisions about continued care and rescue were made amid limits on knowledge, capacity, and time.

Death, Withdrawal, and Public Argument

The book sets the Memorial crisis within a longer debate about whether withdrawing treatment is equivalent to killing. It cites the Clarence Herbert case through an article explicitly framed around the claim that withdrawing care is not murder. It also refers to reporting on end-of-life dilemmas that examined the orchestration of dying, judgments about quality of life, and the uncertainty surrounding care for the dying. These references establish that the boundary between allowing death and causing it was already a contested ethical and legal subject, not a question created solely by the hurricane.

A related public controversy concerned Colorado governor Richard D. Lamm’s remarks about a duty to die. The book explains that the Denver Post account substituted you for we, and that the New York Daily News headline wrongly suggested that Lamm had specifically told elderly or terminally ill people they should die. Lamm later obtained a correction from The New York Times. The episode illustrates how arguments about mortality and responsibility can be transformed by quotation and headline into claims broader and harsher than the underlying remarks.

Care, Faith, and Its Afterlife

Religious practice recurs as a means of sustaining people facing illness, disaster, and the aftermath of accusation. During the hospital emergency, a public-address announcement invited everyone to a prayer service. After Pou’s arrest, she stayed at her mother’s house in New Orleans; her mother urged her to entrust herself to the Sacred Heart of Jesus. The following morning, friends gave Pou a silver medal bearing Our Lady of Prompt Succor, whose intercession was associated with quick aid. Later, as the grand jury approached, Pou said she felt alone and betrayed. An old friend invited her to Father Seelos Shrine and St. Mary’s Assumption Church as a place of healing.

These moments do not answer the clinical or legal questions surrounding end-of-life decisions. They show instead that care extends into the period after a medical crisis, when patients’ relatives and clinicians must live with loss, uncertainty, or scrutiny. Across bedside routines, evacuation choices, religious practices, and public debate, the book presents comfort as indispensable while insisting that compassionate purpose cannot by itself erase the importance of what was done, to whom, and under what conditions.