Susan Mulderick—Anna Pou

Susan Mulderick and Anna Pou’s connection at Memorial Medical Center formed in the compressed emergency after the Coast Guard evacuation stopped. They had met only the previous day, but Mulderick soon made Pou the physician to whom she turned when patients remained in the hospital and she could see no clear way to relieve their suffering. Their brief working relationship became part of the chain of consultation that led to large morphine prescriptions for three patients. Its significance lies in both the urgency of their collaboration and the limits of what the evidence establishes about each woman’s part in the decisions that followed.

A New Acquaintance in a Hospital in Crisis

The women’s first encounter occurred amid the consequences of the interrupted evacuation. Pou told Mulderick that the chapel had been converted into a morgue for LifeCare Hospitals of New Orleans patients who had depended on ventilators and died after staff ended the Coast Guard evacuation. The next day, Mulderick had seen Pou directing patient care on the second floor. They were not long-standing colleagues: their professional connection was only a day old when Mulderick sought Pou’s advice.

Mulderick had already been asked to advise an anguished owner about whether to put down a pet. The contrast that troubled her was that people were confronting euthanasia for animals while the patients before them had no evident solution to their suffering. She voiced this concern to Pou, returning to the same comparison rather than presenting the problem as a settled clinical plan. Pou, who had cared for cancer patients, understood the patients’ condition through the limits of treatment: sometimes, she said, nothing more could be done except to make them comfortable. She offered to use pain medication, while acknowledging that she was unsure what to give.

Mulderick Seeks a Second Clinical Opinion

Mulderick did not answer that uncertainty by specifying a drug regimen herself. She turned to Dr. Ewing Cook, a pulmonologist with whom she had worked for two decades, beginning when she was head nurse in the intensive care unit. She knew him as a physician willing to order drugs to relieve suffering and as someone who had helped patients die without pain or anxiety after life support was withdrawn. Those earlier experiences informed why she considered him an appropriate person to consult; they also meant that his advice came from a practice of caring for dying patients, not simply from a medication list.

The request came as Cook was preparing to leave the hospital by boat to rescue his son, who had been trapped since the flooding. Mulderick asked him to speak with Pou before he went. On the second floor, Cook and Pou discussed the remaining category 3 patients, including people from Memorial and LifeCare in staging areas and nine LifeCare patients who had not been brought downstairs. Cook understood that Pou was worried they could not be evacuated. He had not gone to LifeCare since the storm, and he could not see how the exhausted staff could carry nine patients down five flights of stairs before the end of the day. In that setting, Mulderick’s referral connected Pou’s immediate uncertainty to Cook’s experience with medication at the end of life.

From Comfort Medication to a More Consequential Regimen

The distinction between ordinary comfort care and Cook’s advice is central to understanding what passed through this working relationship. Before their discussion, doctors had prescribed medication when nurses alerted Pou or other physicians that a patient in a staging area appeared to be in pain or anxious. Available drugs included medicines for relaxation and sleep, as well as opioids for pain. Cook described something different: a combination of morphine and a benzodiazepine sedative. He later said that he believed Pou understood him to be explaining how to help the patients “go to sleep and die.” He described the combination as reducing respiration until a patient gradually stopped breathing.

The account places Mulderick at the beginning of this consultation, not at every subsequent step. She raised the problem with Pou and asked Cook to advise her; the evidence does not say that Mulderick chose the doses or wrote the prescriptions. Pou wrote large prescriptions for three patients in the second-floor lobby: nine vials apiece of concentrated intravenous morphine, totaling 90 milligrams per patient. For comparison, the highest dose Pou had prescribed for pain in the previous two days was 10 milligrams, for a colleague’s cancer patient who was already taking morphine and tolerant to its effects. The prescriptions said only “as directed.” A pharmacist across the hall filled them after two doctors brought him the papers.

The three patients were not interchangeable cases. One, Wilmer Cooley, was an eighty-two-year-old LifeCare patient with heart problems, a serious infection, and a need for dialysis; he had a do-not-resuscitate order. Another, Carrie Mae Hall, was a LifeCare patient with a tracheostomy whose determination to survive had impressed a nurse the night before. The third, Donna Cotham, was a forty-one-year-old Memorial patient and mother of four with liver disease. Her condition had worsened, she had not been transferred to an intensive care unit that was evacuating, and nurses had spent the night fanning her in the lobby. These different circumstances underline the stakes of the prescriptions that followed the consultation, without making the patients’ conditions or wishes identical.

The Relationship’s Limits and Its Significance

The surviving account presents Mulderick and Pou not as established confidantes but as two medical workers brought together by an emergency and a specific question: what could be done for patients who remained in a failing evacuation? Mulderick’s part was to recognize Pou’s uncertainty and seek out a physician she trusted to discuss symptom relief. Pou’s part was to speak with Cook and then write the prescriptions. Cook’s advice supplied the pivotal change from medication for pain or anxiety to a combination he associated with gradual respiratory suppression.

That sequence matters because the language of comfort could cover distinct clinical intentions and consequences. Pou described making patients comfortable; Cook later characterized his guidance as a way to help them die. The evidence does not establish that Mulderick shared Cook’s understanding of the regimen, knew the specific doses Pou would prescribe, or directed how the drugs would be administered. What it does show is how a hurried referral linked Mulderick’s concern, Pou’s uncertainty, and Cook’s experience at a moment when exhausted staff saw no workable route to move some patients. Their relationship is therefore best understood through its actions and boundaries: a new professional connection, a request for help, and a consultation whose consequences extended beyond the conversation itself.