Power gone, food low, doctors focused on life

GONZALES, La. -- As flood waters rose in the wake of Hurricane Katrina's fury, Memorial Medical Center in New Orleans ran out of the diesel fuel that powered its generators. Gunfire crackled in the streets, sometimes aimed at the rescue helicopters and boats that arrived only intermittently. Food stocks were running low, and toilets were overflowing.

In the harrowing days after the storm, hospital staff members broke windows with two-by-fours and set up ''fan brigades" to keep air moving by hand, according to detailed accounts by a doctor and a hospital official. They rationed food until meals were down to only bagels and jam. They hotwired an orthopedist's boat and siphoned gas for it from cars in the parking lot to evacuate staff, patients, and their family members.

Dr. John J. Kokemor, 53, said he spent three days helping to evacuate people, deciding who could walk well enough to leave by water, which required wading two blocks from the boat to safety, and who needed helicopter evacuation.

Louisiana officials said yesterday that they are investigating what happened at Memorial, where 45 bodies were recovered. Kokemor, who specializes in internal medicine, strongly defended the hospital, saying no one died of neglect or lack of food and water. He said some were patients who were on ventilators and others, critically ill, succumbed to their illnesses in oppressive heat that soared to 110 degrees inside after the backup generators ran out of fuel.

''To my knowledge -- and I'll go to my grave with this -- there was no one there who could have been salvaged" and wasn't, Kokemor said in a phone interview from Gulf Shores, Ala., where he is staying. ''Sure, some did die, but they were 'do not resuscitate' or in their death throes anyway."

As Katrina roiled menacingly in the Gulf of Mexico, the staff at Memorial Medical Center in the uptown neighborhood of New Orleans prepared for its arrival. Additional doctors and nurses were summoned, and caches of extra food and water checked, according to Harry Anderson, a spokesman for Tenet Healthcare Corp. of Dallas, the hospital's parent company.

Those patients whose conditions would permit it were discharged -- but not all. Doctors must authorize each release, and some physicians had already evacuated the region and could not be reached.

When Katrina hit Monday morning, about 260 patients were in the 317-bed hospital, along with about 1,800 others -- a mix of staff and family members of patients and staff. A long-term critical care facility that rents a floor of the hospital housed more than 60 patients, Anderson said.

Although winds violently shook the building and broken glass flew everywhere, Memorial fared well during the hurricane itself, Memorial CEO Rene Goux said in a first-person account published on modernhealthcare.com.

The trouble began when the generators started fading Tuesday afternoon as the diesel fuel began running out, Kokemor said, just as levees ruptured in New Orleans, flooding the city and the streets around Memorial.

Diesel trucks came to resupply the hospital, but the rising waters prevented them from delivering the fuel, so the hospital lost all power by the early hours of Wednesday morning, Kokemor recalled.

Electricity is critical in a hospital. In addition to keeping lights and air conditioning running, it powers breathing machines and other equipment necessary to sustain critically ill patients.

In wards throughout Memorial, medical machinery groaned to a halt. Hospital administrators asked government authorities for help in removing patients. Coast Guard helicopters ferried 18 babies from the hospital's neonatal intensive care unit to safety, and National Guard trucks evacuated 24 dialysis patients, but couldn't return because of rising flood waters, according to the accounts of Kokemor and Anderson.

Soon, the hospital was surrounded by 6 feet of water, which flooded the first floor, including the kitchens, Kokemor said. After Tuesday evening, the hospital had only cold food such as sandwiches, crackers, bagels, and fruit juice.

Doctors, nurses, and volunteers fanned patients to keep them cool and, in some cases, used manually operated devices to keep patients breathing.

''If you have fragile patients, they're going to have a very difficult time surviving that," said John Matessino, president of the Louisiana Hospital Association, an industry organization. ''Unfortunately, some didn't make it."

Hospital officials said Monday that 44 bodies had been removed, but Anderson said yesterday that the hospital now defers to the Orleans Parish coroner, who reported that 45 bodies were recovered.

Of that number, Anderson said 15 to 20 were recovered from the long-term care facility on Memorial's seventh floor. Such facilities typically treat patients near the end of life.

Fewer than 10 of the bodies removed from the hospital's morgue had actually been moved there before the storm, Anderson said.

The remaining bodies, many of which had been placed in the hospital chapel, were those who died in the four days between Katrina's arrival and the evacuation of the last patients.

So many patients died that the hospital ran out of body bags, instead having to cover bodies in sheets. Officials converted the chapel into a makeshift morgue, and when it was full, the deceased were left with identification in patient rooms, Kokemor said.

Coast Guard helicopters made a few visits to the 10th floor helipad over the course of the week, but only intermittently, especially after they came under fire from people outside the hospital, Kokemor said, though he was unsure of which day that happened.

Soon after the storm, an emergency official supplied the hospital with two satellite phones, but calls to the Federal Emergency Management Agency and state and local officials often went unanswered, Kokemor said.

On Wednesday morning, Anderson said, a state official advised a senior hospital administrator to consider enlisting a private air service to remove patients. Tenet contracted with Aviation Services of Dallas, which had to redirect helicopters from as far away as Montana, where they were being used to battle forest fires.

Anderson said the air evacuation of patients began Wednesday afternoon, although Kokemor said he was certain no private helicopters arrived until at least Thursday.

As the hospital waited for more helicopter rescuers, a few private boats showed up to help, ferrying patients about 10 blocks away to the corner of Napoleon Avenue and Dryades Street, where they could wade another two blocks to dry land.

One was operated by two men who had driven from Arkansas to help, Kokemor said, while the New Orleans Times-Picayune reported that another belonged to two men who came to rescue their mother. She died, but they helped evacuate several hundred from Memorial, the paper reported.

But the hospital staff needed to get more creative, Kokemor said. The hospital had a boat that lacked a motor, so they tied it with rope to the one that did have a motor, and an oar was used to steer it. They also commandeered and hotwired a boat belonging to an orthopedist.

The boats probably made 20 trips, Kokemor estimated. Staff members siphoned gas from cars left in the parking lot. At least one boat came under gunfire.

Kokemor said that during the days after Katrina he kept two things on him: a credit card in case he made it out, and a driver's license in case he didn't.

The hospital never ran out of food or water, though Kokemor said he tried to conserve by not washing his hands and face for 24 hours. Each meal was smaller. On Wednesday, two women made 2,000 tuna sandwiches. On Thursday morning, they were down to a bagel with jam.

''The cook told us we had food for two weeks, but I think he was just trying to keep us cheerful," he said.

Kokemor made it out Thursday afternoon, on the second-to-last boat run. The last patients and staff left on the private helicopters Thursday night, Anderson said.

''It was totally an unselfish effort and a miraculous recovery," Kokemor said.

Stephen Smith reported from Louisiana and Marcella Bombardieri from Boston. Scott Allen of the Globe staff contributed to this report from Boston.