Ewing Cook—Anna Pou

Ewing Cook’s consultation with Anna Pou at Memorial Medical Center took place amid a collapsing evacuation effort, when patients were crowded in staging areas and staff saw few remaining ways to get them out. Asked by Susan Mulderick to advise Pou about medication, Cook recommended Morphine combined with a benzodiazepine sedative. He later said he believed Pou understood the combination as a way to make patients “go to sleep and die.” The account sets that advice against the comfort medications already being prescribed in the hospital, making the distinction between relieving distress and deliberately hastening death central to the relationship’s significance.

The Consultation’s Circumstances

Mulderick turned to Cook because she knew him as a physician who was willing to order medication to relieve suffering. They had worked together for two decades, going back to her time as head nurse in the intensive care unit. As a pulmonologist, Cook had helped patients die without pain or anxiety after they were taken off life support, and he believed that dying patients should be made comfortable. In the emergency at Memorial, Mulderick thought his experience could help answer what to give patients who might not be evacuated.

The request came at a moment when Cook was preparing to leave. He was readying his gun and planning to travel by boat to rescue his son, a doctor who had gone home after the storm and had been trapped since Tuesday’s flooding. Mulderick asked him to speak to Pou before he departed. The consultation was therefore brief and situated between two urgent obligations: the patients still inside the hospital and Cook’s effort to reach his son.

Cook met Pou on the second floor. He had interacted with her during the year she worked at Memorial and thought highly of her. They discussed the patients classified as category 3: people from Memorial and LifeCare still in staging areas, as well as nine patients who had never been brought down from LifeCare. Cook understood Pou to be worried that those patients could not be evacuated. He had not visited LifeCare since Katrina struck; he had no patients there, had not been asked to go, and knew that a doctor entering the unit would face difficult decisions.

Cook’s Assessment and Advice

Cook regarded the LifeCare patients as chronically close to death even under ordinary conditions and believed the heat would have affected them terribly. Although staff and volunteers remained at Memorial, they were exhausted. He could not imagine how they would carry nine patients down five flights of stairs before the day ended, and no outside help had arrived for that task. The account presents his advice against this bleak assessment: he could not see another way to evacuate the patients or care for them.

Cook told Pou how to administer Morphine with a benzodiazepine sedative. His later explanation was that he believed Pou understood he was describing how to help the patients “go to sleep and die.” He characterized the combination’s effect as one that “cuts down your respiration so you gradually stop breathing and go out,” and said he saw it as a way to ease patients out of a terrible situation. These are Cook’s reported understanding and rationale; they do not, by themselves, establish what Pou understood or intended.

The narrative carefully differentiates this advice from ordinary comfort care already occurring on the second floor. In the hours before Cook spoke with Pou, nurses had alerted Pou, Kathleen Fournier, or Bryant King when patients in the staging area seemed to be in pain or anxious. Doctors prescribed medication in response. The pharmacy had dispensed drugs to help patients relax and sleep, including Ambien, Ativan, diphenhydramine, Geodon, and Restoril, as well as Morphine, OxyContin, and Vicodin for pain. Cook’s described respiratory effect marked a different purpose from those existing prescriptions, rather than simply introducing Pou to medications for comfort.

Prescriptions After the Conversation

Pou wrote large Morphine prescriptions for three patients in the second-floor lobby. For each, she ordered nine vials of concentrated intravenous Morphine, a total of 90 milligrams. The highest dose she had prescribed for pain during the previous two days had been 10 milligrams, for a colleague’s cancer patient who was already taking Morphine and tolerant to its effects. The new amount was nine times that dose. On the prescriptions, Pou specified only “as directed” and included her Drug Enforcement Agency number, which authorized her to prescribe controlled substances legally. A pharmacist across the hall filled the three prescriptions after two female doctors approached him.

The patients named on the prescriptions had distinct circumstances. Wilmer Cooley, an eighty-two-year-old former truck driver, had heart problems, a serious infection, and a need for dialysis; he was also a LifeCare patient with a Do Not Resuscitate order. Carrie Hall, known as Ma’Dear, was a LifeCare patient with a tracheostomy whose determination to survive had impressed a nurse the previous night. Donna Cotham, a forty-one-year-old Memorial patient and mother of four, had liver disease. Her condition had worsened after the hurricane, and although doctors had planned to transfer her to intensive care, that unit was evacuating and she had not gone. Nurses who had fanned her in the lobby overnight thought she looked particularly ill, and she was not expected to survive.

Competing Accounts of Intent

Later, Mulderick described the idea of medicating patients that Thursday as having originated with her, but framed her intention as providing comfort. In an interview, she offered giving a patient Ativan to relax as an example of what she meant. Yet prescriptions seized from the pharmacy showed that Pou and other doctors had already been prescribing Ativan and other ordinary comfort medications for patients during the disaster. The account therefore presents a tension: Mulderick’s stated rationale concerned familiar comfort care, while Cook’s reported advice involved a combination he associated with gradually stopping respiration.

The distinction does not resolve the full question of responsibility or intent. Cook’s account of what he told Pou, his understanding of what she understood, Pou’s prescriptions, and Mulderick’s later description are separate pieces of evidence. Taken together, they make the consultation a pivotal link between the exhausted hospital’s search for a response to patients who might remain trapped and the later dispute over whether medication was intended to ease suffering or to hasten death. The evidence supports the importance of Cook’s advice and the scale and circumstances of Pou’s prescriptions, while leaving their precise exchange and Pou’s subjective understanding unsettled.