Recalling Katrina: Saving the Weakest From the Storm

Medical personnel from Memorial Medical Center hand-ventilate infants who had been staying in the hospital’s NICU. (Photo courtesy of Marirose Bernard)

If there’s a memory Marirose Bernard will never forget, it’s the day the helicopters came for what may have been New Orleans’s tiniest evacuees.

It was the day after Hurricane Katrina, and the levees had breached. Surging floodwaters surrounded Memorial Medical Center with 8 to 12 feet of toxic floodwater, leaving staff with no way to get outside food, water, or medicine — or to escape.

Among the 2,000 people trapped in the building were 16 critically ill newborns. One, a baby born more than 10 weeks early, weighed only a pound, and it was Bernard’s job to figure out how to get him to safety.

“Really, there’s no neonatal transport course in the world that ever could have prepared you for this task,” Bernard tells Yahoo Health, recalling her role as the hospital’s director of nursing for women’s and infants’ services.

Marirose Bernard was working at Memorial Medical Center when Hurricane Katrina struck. (Photo courtesy of Marirose Bernard)

Over time, as with other New Orleans hospitals, the scene at Memorial became chaotic. There was no running water and no power. Heat soared to 110 degrees. In the wake of what would be declared one of the most destructive natural and manmade disasters to occur in United States history, Bernard was among thousands of doctors, nurses, and other medical personnel forced to make difficult and creative decisions in order to save their patients.

Reflecting on the storm 10 years later, medics say they did the best they could, given unprecedented circumstances and the realization of worst-case scenarios — lost power, sweltering heat, overflowing sewage, exposure to disease, and worse. But with gained perspective also came lessons learned about disaster preparedness, including better security plans, better ways to communicate when power is out, and a better supply system for when hospitals have to suddenly become self-sustaining.

At Memorial, preparation to protect some of the hospital’s most vulnerable population began days in advance, according to Bernard. Evacuation from Memorial was discouraged because, statistically, mortality rates increase during evacuation of critically ill patients. Anticipating strong winds and flooding, the hospital staff moved all the critically ill babies out of the NICU room, which had large windows and was located on the sixth floor.

It ended up being a smart decision — the NICU windows were among those blown out entirely from the wind, and giant shards of glass, along with several feet of blown-in rainwater, destroyed the room.

Soon, however, Bernard and her team realized the babies weren’t safe even in the other part of the hospital. When the storm and ensuing flood raged through New Orleans, conditions became dangerous for anyone. But for the critically ill, like Bernard’s newborn population, stifling heat, contamination from raw sewage from backed-up toilets, and the lack of ventilation could be downright deadly.

Bernard made the decision to evacuate Tuesday morning. Little cellphone service and sporadic Internet made communication difficult. The widespread emergency and chaos elsewhere in the city resulted in the National Guard never coming to assist with evacuation. Plans were made with the Coast Guard, but they didn’t materialize. In the meantime, some babies had elevated temperatures and were beginning to become lethargic. Some of their parents were still at the hospital, too.

Marirose Bernard (in the yellow shirt) and the hospital staff assemble the cribs with equipment, charts, and other materials in preparation for the arrival of the helicopters. (Photo courtesy of Marirose Bernard)

Bernard and her staff went ahead with evacuation preparation, creating an assembly line of transport cribs holding two babies each. Ventilators, instant warming pads, and oxygen all became mobile.

The hospital staff leaves the NICU. (Photo courtesy of Marirose Bernard)

Eventually, the helicopters did come. But the challenges didn’t stop there.

That’s because there was no easy way to get to the heliport, which hadn’t been used in decades, Bernard says. The elevator leading there had lost power, so security personnel were forced to saw a hole in a wall between the hospital and its adjacent garage. From there, babies were lifted through the hole, placed in the back of a pickup truck, and driven up nine stories out of the garage.

Finally, they had to be carried up two flights of stairs to reach the helicopter, where they were loaded in along with oxygen tanks and other supplies.

The Memorial Medical Center staff and the infants on the heliport. (Photo courtesy of Marirose Bernard)

As the last babies were placed in a helicopter, they were hand-ventilated by medical staff, because the ventilation machine had failed when it got to the hospital’s roof.

The timing of the rescue, Bernard said, was almost miraculous.

“The last helicopter left right, really, at dusk. And it was right after the last helicopter left that the last bits of power in our generators died,” Bernard says. “And so at that point in time we would have been hand-ventilating all of our babies.”

Ultimately, Bernard says, the hospital staff did end up hand-ventilating several of the other patients. Some of those patients, including critically ill adults, wouldn’t make it out of the storm alive — experiences that have been chronicled by journalists around the country in the years post-Katrina.

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After the generator power gave out, staff struggled to care for patients with bare-bones resources. Portable fans no longer worked, and temperatures climbed to 110 degrees. Staff and family members who had sought refuge in the hospital volunteered, taking shifts to fan patients with anything available — cardboard, newspapers, sheets of paper. Patients, as well as staff members and family members, had to get IV fluids administered for dehydration. As conditions worsened, the exhausted, dehydrated, and sick staff reduced their shifts from six hours to two.

In the meantime, toilets overflowed and restrooms were covered in human waste. The risk of exposure to disease skyrocketed. Staff began emptying human waste into large trashcans in patient rooms, with only hand sanitizer available for hand washing. “The stench was unimaginable,” Bernard recalls.

As Memorial’s babies were being brought to safety, across town, staff at Charity Hospital in Mid-City were still waiting for even their most critical patients to be evacuated. According to Kiersta Kurtz-Burke, MD, a rehabilitation doctor, staff and more than 300 patients there were left on their own for six days before they were eventually taken to safety by boat.

Even then, she said, it wasn’t the National Guard or the Army who saved them — it was the Louisiana Department of Wildlife and Fisheries, or a group that would become affectionately known as the “Cajun Navy.”

“I love those guys,” Kurtz-Burke tells Yahoo Health. “They came on fan boats. It was probably one of the happiest moments of my life, standing on the ramp, seeing fan boats come down the street.”

But before the rescue occurred, Charity Hospital was also a place with no power and dwindling supplies. Patients there — the sickest of the sick — were forced to live with rationed water, and, like hospital staff, had become extremely dehydrated.

Among Kurtz-Burke’s patients was a 19-year-old who had been shot nine times in the abdomen and in his limbs. He had such bad fractures on his arms and leg that metal components were holding them together.

Then there were the women who had had strokes. One also had kidney failure and was in imminent danger because she couldn’t receive dialysis.

Like Bernard, Kurtz-Burke thought at some points that her patients might die. In one harrowing instance, there was a gas leak, and no one knew where it was coming from. Because staff and patients’ families were using lighters to see in the dark, the threat of fire was severe.

“It was a low moment for a lot of us,” Kurtz-Burke says, recalling her thought process about what she would do if the building caught fire. “What are we going to do? Are we going to carry patients down the stairs, out into the water and hope for the best?”

And, like Bernard, she also dealt with “false start” evacuations, when boats or helicopters were supposed to come but never did. She describes the notion as “inconceivable” — until she realized that she couldn’t control anything except what was happening within the walls of the hospital.

Ultimately, Kurtz-Burke says, the experience made her a better doctor, able to work in seemingly impossible conditions, such as in Haiti in 2010, when a devastating 7.0 earthquake killed more than 230,000, displaced close to 1.5 million, and left millions more without power.

Kurtz-Burke says her story ended happily, as all of her patients survived. Her success, she added, was in large part because of them.

“I don’t think it was skill, I think it was a lot of luck. And an incredibly strong will to survive, across the board,” she says. “I was absolutely amazed at how people acted and reacted.”

Bernard’s baby patients were also reunited safely with their parents — a feat she attests to a dedicated team that never stopped fighting.

The Memorial Medical Center hospital staff works to evacuate infants who had been staying in the hospital’s NICU. (Photo courtesy of Marirose Bernard)

“You are a patient’s advocate,” Bernard said. “And even in the case of extreme disaster, you have to do what you have to do to advocate for your patients.”

Bernard and Kurtz-Burke say they think often about what could have been done differently. What most bothers Kurtz-Burke is how isolated the hospital she worked in had become, even though there were other rescue efforts going on around them, with boats riding through floodwaters and helicopters circling in the air.

As basic hospital supplies like bottled water and batteries dwindled, Kurtz-Burke says her staff got desperate for help that never came — even as a nation watched on in horror when the news stations got wind of the staff’s isolation.

“It has always been a mystery to me, and I still cannot understand to this day, why we could not have had boats supply water, batteries,” Kurtz-Burke says, exasperation audible in her voice.

Bernard also spends a lot of time thinking about what to do in case of “next time.” In the past 10 years, she’s traveled the country advocating for preparation plans that include developing “anti-looting” security plans, equipping hospitals with wells to ensure adequate water supply, and obtaining needed materials such as additional generators and fuel. She published her advice for other doctors, nurses, and medical administration in an article in the American Journal of Maternal/Child Nursing. Among other suggestions, she urges hospitals to have evacuation plans with defined roles at local, state, and federal levels.

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By the time the water receded and the body count was tallied, it was estimated that Hurricane Katrina and the levee failures resulted in the deaths of more than 986 Louisiana residents. Nearly 40 percent of those who died drowned, and another quarter died from injury or trauma.

Approximately 80 percent of the city flooded, and more than a million people in the Gulf Coast region were displaced.

The city has adopted new emergency measures after the storm. Building codes, for one, have been revised for hospitals in hurricane-prone areas. Patient evacuation plans now include prearrangements with designated facilities for specific patient groups. Louisiana now has a statewide plan for the evacuation of infants. And hospitals have developed partnerships with vendors to supply large amounts of food, medications, and medical supplies during a disaster.

Bernard says people find it impossible or unlikely that a catastrophe as big as Katrina could happen elsewhere in the United States. But she cautions that while conditions in New Orleans may have created the perfect storm for chaos during Hurricane Katrina, disasters like earthquakes, fires, or tornadoes could wreak similar havoc anywhere.

“The big takeaway is that no matter where you live, don’t think something can’t happen,” Bernard says. “Really take the disaster plans and the disaster drills seriously. Take it seriously.”

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