Unless you were there, it's really difficult to imagine just how much damage Hurricane Katrina inflicted on the city of New Orleans in 2005.
And by damage, we don't just mean physical destruction. The people who experienced this natural disaster were forever changed by the aftermath, which left nearly 1,800 dead—as far as the authorities know. (As FiveThirtyEight wrote in 2015, officials didn't have the resources to keep track of the remains.)
Of the reported 1,800 people who died after Hurricane Katrina, 45 of the 215 deceased hospital patients recovered came from the Memorial Medical Care Center, an usually high number compared to the other hospitals, leading authorities to question just what happened.
Now, that story is being told in Apple TV+'s Five Days at Memorial, a truly heartbreaking and frustrating show which chronicles the events that led to the arrest of multiple hospital staffers. Keep reading for all you need to know...
What happened at Memorial Medical Care Center during Hurricane Katrina?
As Five Days at Memorial author Sheri Fink, whose book is the basis for the Apple TV+ series, reported for the New York Times in 2009, more than 2,000 people—including 200 patients, 600 staff members and locals—sheltered in the hospital during the hurricane, which made landfall on Aug. 29, 2005.
The hospital itself sustained little damage during the storm. The real problem came after the city's power grid went out on the morning of Aug. 29. The hospital's backup generators kicked in, but as Fink wrote, "The system was designed to power only emergency lights, certain critical equipment and a handful of outlets on each floor."
As temperatures began rising, the flood waters in the surrounding area receded and evacuations began.
How did the flood waters impact the hospital?
By Aug. 30, nurses and doctors were optimistic they had weathered the worst of the storm—until they began noticing the flood waters rising again. As CBS News reported in 2006, nearby levees and flood walls had been damaged in the storm, sending a current of water into the surrounding area.
Officials, including then-President George W. Bush, said at the time that nobody could have predicted the flooding. But a year after the disaster, the Senate Homeland Security and Government Affairs Committee discovered that government agencies had warned the White House about the potential damage 48 hours before the storm touched land, according to ABC. While the flood walls and levees couldn't have been fortified in time, this knowledge could've informed FEMA's response, which Congress later described in a report as "a failure of leadership."
Case in point: Memorial Medical Care Center. The hospital's power box was only a few feet above ground level, leaving it vulnerable to the rising waters. Once the water reached the box, the generators would stop working. Hospital personnel warned higher-ups of this issue in 2004 but, as Fink wrote, "Fixing the problem would be costly; a few less-expensive improvements were made."
How did doctors decide who to evacuate from Memorial Medical Care Center first?
The hospital's emergency-incident commander, Dr. Susan Mulderick, was responsible for leading the doctors, but she faced a problem when she pulled out the hospital's emergency plans. "The 246-page document offered no guidance for dealing with a complete power failure," Fink wrote, "or for how to evacuate the hospital if the streets were flooded."
While nurses tended to patients and administrators sought help from outside entities, Mulderick gathered the doctors and told them they needed to decide which of the remaining 180 patients would be evacuated first—and how. Fink wrote, "The doctors quickly agreed that babies in the neonatal intensive-care unit, pregnant mothers and critically ill adult I.C.U. patients would be at great risk from the heat and should get first priority."
They ultimately decided that patients with Do Not Resuscitate orders would be saved last.
When Fink spoke to Mulderick for the NYT, the incident commander said, "We were well prepared. We managed that situation well."
Why were LifeCare patients evacuated last?
But another group was left out of the evacuation discussions: LifeCare Hospitals, a separate rehab hospital that operated on the seventh floor of the Memorial Medical building. "LifeCare's goal was to assist patients until they improved enough to return home or to nursing facilities," Fink explained, "It was not a hospice."
Almost all of the 52 patients under LifeCare's watch, Fink noted, "were bedbound or required electric ventilators to breathe, and clearly, they would be at significant risk if the hospital lost power in its elevators."
But none of the LifeCare patients were considered in the evacuation discussions happening a few floors down, leading to further issues down the line.
How were patients rescued from Memorial Medical Care Center?
Meanwhile, the Memorial nurses and doctors worked tirelessly to find a way to transport patients from the hospital to the helipad above the parking garage. It was a long trek as staff carried patients down flights of stairs and through a 3-foot by 3-foot hole that led to the garage, where a pickup truck was waiting to drive them to the helipad. Once there, nurses had to carry patients up another two flights of stairs before they could reach transport.
Importantly, some of the patients, including newborns, still required medical attention during the transport. Nurses held the infants in their arms and manually pumped air into their lungs, hoping they'd make it through the trip to another hospital.
More than 50 patients were evacuated on Aug. 30, but it exhausted hospital staff. So when the Coast Guard said they could airlift more patients overnight, the doctors declined, according to Fink. "The helipad had minimal lighting and no guard rail," she wrote, "and the staff needed rest."
What happened when the hospital lost power?
By Aug. 31, the backup generators stopped working entirely, rendering the ventilators and other necessary medical equipment useless. Since so many patients in LifeCare were on ventilators, the nurses—who carried the patients down seven flights of stairs to await evacuation—used bags to manually pump air into patients' lungs. Fink recounted in her article that one LifeCare nurse kept an 80-year-old patient alive for more than an hour. "Finally a physician stopped by the stretcher and told her that there was no oxygen for the patient and that he was already too far gone," Fink wrote. "She hugged the man and stroked his hair as he died."
As bodies began piling up in the hospital's chapel, nurses and doctors made the difficult decision to begin triaging patients. "Those who were in fairly good health and could sit up or walk would be categorized '1's' and prioritized first for evacuation," Fink wrote. "Those who were sicker and would need more assistance were '2's.' A final group of patients were assigned '3's' and were slated to be evacuated last. That group included those whom doctors judged to be very ill and also, as doctors agreed the day before, those with D.N.R. orders."
Who stayed behind to care for the patients?
Three days into evacuations, the hospital's food and water supplies—as well as medical supplies—were dwindling, helicopters couldn't come fast enough and there was havoc on the streets of New Orleans. Because of the flood waters, sewage had backed up, adding to the stench of decay and filth.
"Down on the emergency-room ramp that morning, stone-faced State Police officers wielding shotguns barked that everyone had to be out of the hospital by 5 p.m. because of civil unrest in New Orleans," Fink wrote, "they would not stay later to protect the hospital." But there were still nine patients on the LifeCare floor, who needed medical attention to stay alive. If the doctors abandoned them, they'd likely die within hours. If they did survive, there would be no one there to provide basic care, like help them get a sip of water or a cold compress. And there was no knowing when rescue operations would resume.
As the 5 p.m. deadline drew closer, the few remaining doctors were forced to make a decision. Among those individuals were otolaryngologist Dr. Anna Pou and pulmonary specialist, Dr. Ewing Cook, who, according to Fink, "told Pou how to administer a combination of morphine and a benzodiazepine sedative. The effect, he told [Fink], was that patients would 'go to sleep and die.'"
Cook felt this was the best route of action, according to Fink, who wrote that he told her, "'The humane thing would be to put 'em out.'''
What happened after the bodies were found?
Following a state investigation into the unusual death toll from Memorial, Dr. Pou and nurses Cheri Landry and Lori Budo were arrested in July 2006 in connection with the deaths of four LifeCare patients, as reported by the New York Times, who wrote that the charges against the nurses were later dropped in exchange for their testimony against Dr. Pou. (Landry and Budo haven't publicly commented on the case.)
At the time of Pou's arrest, her attorney Rick Simmons said she was "absolutely innocent" and asserted that Pou was just doing her job. "She volunteered for storm duty and stayed there for five days,'' Simmons told The New York Times in July 2007, "and then the State of Louisiana abandoned the patients and the hospitals and everybody else."
In July 2007, a grand jury refused to indict Dr. Pou on one count of second-degree murder and nine counts of conspiracy to commit second-degree murder, according to Fink, as they couldn't definitively say that Pou had "a specific intent to kill." The charges were expunged from Pou's criminal record.
Since then, Pou has resumed practicing medicine. "As of the summer of 2022," Fink wrote on her website, "she was practicing medicine as a head and neck oncologic surgeon in Louisiana."
E! News reached out to Dr. Pou and Dr. Cook for comment.
New episodes of Five Days at Memorial stream Fridays on Apple TV+.