Memorial patients’ DNR status

At Memorial Medical Center, some patients’ Do Not Resuscitate status became more than a limit on resuscitation: it was used to rank them last for evacuation. The designation did not itself mean that a patient should not be rescued or moved. Yet amid the hospital’s crisis, that distinction blurred, with consequences for patients, families, and staff trying to decide what care remained possible.

What the designation meant

A DNR order concerned what to do if a patient’s heartbeat or breathing stopped: the patient should not be revived. It was signed by a doctor, usually with the informed consent of the patient or a health-care proxy. It was distinct from a living will, which under Louisiana law allowed a person with a terminal and irreversible condition to request that life-sustaining procedures be withheld or withdrawn. Neither definition made a DNR order a refusal of evacuation.

At Memorial, however, doctors decided that all patients with DNR orders would be moved last, departing from the protocol of prioritizing the sickest patients and those dependent on machines. Four DNR patients were in the intensive care unit, including Helen Breckenridge and Jannie Burgess. When staff brought Breckenridge downstairs, a doctor ordered her returned because she could not go in the first evacuation sweep. Richard Deichmann, Memorial’s medical chairman, later said he believed the law required DNR patients to have a certified terminal or irreversible condition. He thought they had the least to lose if calamity struck. The policy thus rested on a mistaken understanding of both the order and its implications: a directive about resuscitation became a judgment about comparative claims to escape.

How the label governed movement

The distinction became visible in the hospital’s makeshift evacuation spaces. On the second floor, about a dozen patients designated as category 3 remained near an ATM, wearing large DNR tags. Other patients waited on stretchers and cots along the lobby and corridor for transfer through an opening into the garage. The tags made the designation legible to anyone moving through the crowded hospital, but their practical effect was to hold patients back from the flow of evacuation.

The seventh-floor LifeCare unit faced the same unresolved question. Its staff had previously been told not to bring DNR patients down to the staging areas because they were too crowded. When three LifeCare leaders asked Susan Mulderick what to do with nine patients still on the floor, she told them the plan was not to leave any living patients behind and directed them to speak with Anna Pou. Two of the remaining patients had temperatures of 104 and 105 degrees; another was a large paraplegic patient the staff were unsure they could move themselves. Mulderick left the decision to the LifeCare leaders but pressed them to make it and act. The rule had not settled whether patients would be moved or how; it had transferred that question to staff working in worsening conditions.

A young nurse then saw doctors and nurses starting IVs in eight to ten living DNR patients. The previous night, Kathleen Fournier had told her not to start IVs in those patients because the hospital was in emergency mode. Now a doctor who had been involved in triage sent the nurse away to pack her things. Nearby, John Thiele asked Karen Wynn whether they could do this. Wynn’s answer, as the account presents her judgment, was that the patients needed to be comfortable. She believed that even unconscious patients might feel what was happening to them, and the heat and the patients’ labored breathing made their suffering difficult for her to dismiss. The presence of IVs and sedatives in this scene did not erase the central ambiguity: comfort care, evacuation priority, and a DNR order were distinct matters, but were unfolding together under pressure.

Families contest the meaning

On the fifth floor, transporters stopped moving a bed-bound patient when they saw her DNR order and repeatedly maneuvered other patients around her. Nurses were told not to tell her daughter that the order was the reason. They reassured her that her mother was not the only patient left on the floor, without mentioning that the only other patient was dead.

The daughter had agreed to the DNR after her oxygen-dependent, ninety-three-year-old mother was admitted for the storm. She had thought that if her mother suffered cardiac arrest, she should be allowed to die rather than be resuscitated. When staff were told to leave the floor without having taken her mother, the daughter understood the situation differently: she had not meant for the order to prevent rescue. She asked for it to be canceled. A doctor was found, and the patient was moved downstairs toward the helipad; she survived that immediate ordeal. At LifeCare, Angela McManus likewise pleaded to rescind the order for her frail, seventy-year-old mother, Wilda, after learning that DNR patients’ evacuation was being deferred. Staff told her that no doctor was available to do so. The two families encountered the same disconnect, but only one could quickly secure a change in the order.

Individual histories and unequal stakes

The DNR category gathered patients with very different histories and prospects under one evacuation rule. Jannie Burgess, one of the ICU patients assigned that status, had worked for thirty-five years in New Orleans hospitals and nursing homes. Because of racial segregation, she had been able to care for patients at private hospitals where, as a Black woman, she could not receive care herself. Though she was born a few months after Memorial opened as Southern Baptist Hospital in 1926, more than four decades passed before she could become a patient there. Her history gave the designation an additional resonance: a nurse long entrusted with other people’s care was now among the patients whose place in the rescue sequence was determined by a DNR label.

Another ICU patient, Tesfalidet Ewale, had initially had a daughter who resisted his DNR designation. He had been resuscitated once, come off a ventilator, and stabilized with a special oxygen mask, though his medical problems remained grave. He had been expected to be airlifted, possibly to a hospital in Atlanta. The designation nevertheless shaped how staff viewed the possibility of resuscitating him again. After the power failed and vacuum lines stopped working, staff struggled to suction his airways effectively. At Roy Culotta’s direction, Ewale received Ativan and morphine for comfort. He choked on his secretions for hours and was pronounced dead shortly before two in the afternoon on Wednesday. His course shows how a DNR designation intersected with clinical judgments and failed equipment; the order alone does not explain every treatment decision or the circumstances of his death.

Aftermath and significance

The designation remained a source of distress after the evacuation. Gina Isbell, a LifeCare worker, slept poorly, had nightmares in which she saw her patients’ faces, and felt guilt about the staff she had selected to work during the hurricane and the patients who died. Karen Wynn, too, later described the emotional cost of revisiting the events while preparing for possible grand-jury testimony. Conversations with her lawyer could make her feel as though she were reliving the crisis; she recognized what she believed were symptoms of post-traumatic stress in herself and colleagues. These accounts do not reduce their different experiences to a single response, but they show how decisions made around the DNR category continued to shape the people who had carried them out or witnessed their consequences.

The status was medically narrow, but its use in the evacuation became expansive. It could determine who was moved, prompt relatives to withdraw consent they had given for another purpose, and leave care teams trying to distinguish a patient’s wishes about resuscitation from a judgment about whether that patient should be rescued. At Memorial, the gap between those meanings was not abstract: it was written on tags, enforced in crowded corridors, and negotiated at the bedside.