Doctor Blog - New Orleans Doctor - Chaos, Murder, and Triage
Dr. Anna Pou has been exonerated of murder charges. Following this
case in the media has had many doctors holding their breath.
Every doctor can be faced with the decision to stay and help in a crisis and Anna
Pou chose to stay. Every doctor has a desire to help people who are sick or suffering. That is
what drives most of us. And that is apparently what drove Dr. Pou in the midst of
post-Katrina New Orleans while people who were already terminal, lay dying
and in pain.
Early reports by media included sordid details reported by various other personnel
including a Dr. Bryant King who opined that "most people know that something happened
that shouldn't have happened".
To understand how decisions were made we have to understand the concept of Triage and
how the idea is used.
Secondly, we have to understand the context or situation in which these decisions were made.
Without these two discussions, and a clear understanding of what was at stake, decisions
can seem baseless and cruel.
The conditions in the hospital included sweltering heat to 110 degrees, low food supplies,
rationing of narcotics because the pharmacy was on lock down from roaming gangs, and
flood conditions in the hospital with no/limited electricity. There was minimal assistance to
evacuate and communication was non-existent such that one of the doctors had to
hitch a ride on a boat to go for help.
The Washington Post described the scenes around the city in the days following Katrina.
Even some local news media had to leave the city when faced with the chaos.
The Online NewsHour describes looting and lack of communication for law enforcement.
It is clear that near total anarchy was encompassing the city of New orleans.
Unfortunately, under these strenuous conditions, medical personnel garnered charges of
murder while trying to take care of critically ill and dying patients under war-like conditions.
A few points of interest about this particular situation:
Dr. Pou is an Ear, Nose, Throat specialist. This is a surgery subspecialty that generally
deals with such things as throat cancer, mouth cancer, ear disorders, and various other
disorders such as thyroid cancer, etc.
She is not an emergency physician nor would she have necessarily had patients in the
hospital for extended stays. ENT specialists usually operate on their patients and then
have critical care specialists or intensivists alongside for hospital follow up care.
In other words, the fact that she stayed on to help is a tribute to her professional commitment.
If electricity was down and there was flooding in the hospital, it is very likely that the
ability to maintain life support systems such as ventilators would have been compromised.
I can imagine that some patients would have been suffocating to death in the midst of
the melee.
If gangs and rapists were roaming the city and the hospital wards, it is unlikely they were
there to console the sick and the dying. And, personnel had no knowledge of when or if an
evacuation would be completed. Reports are consistent that food and
medicines were in short supply in the hospital.
Under such egregious conditions, medical staff had to triage the patients and care for
them to the best of their ability with limited resources and no information.
A systematic approach to such chaos is called Triage. Every doctor is trained to handle this
often daunting aspect of crisis care at some point in their career. Every doctor hopes that
they will not face the kind of conditions Dr. Pou faced in New Orleans.
TRIAGE---a system used by medical or emergency personnel to ration limited medical
resources when the number of injured needing care exceeds the resources available to
perform care so as to treat those patients in most need of treatment who are able to
benefit first. The term comes from the French language word for sort. Wikipedia
There are a number of different triage systems used in different settings; some on the
battlefield, some in emergency rooms.
The essential component is to help the most patients that can be helped.
By definition, some cannot be helped--this involves making a decision to
walk away from one patient in favor of helping another. I think it is fair to say, that
American doctors, in particular, have been trained to do everything possible for every patient
and are loath to admit defeat even in the face of the deadliest diseases. So, the concept
itself is gruesome, but, sometimes necessary.
UNDERSTANDING THE SITUATION--WHAT SHOULDN'T HAVE HAPPENED
A hurricane shouldn't have hit New Orleans.
Nobody should have stayed or been left in New Orleans during the hurricane.
The levees shouldn't have broken.
The city shouldn't have flooded.
The emergency systems shouldn't have fallen apart.
The City's infra-structure shouldn't have failed.
The State's infra-structure shouldn't have failed.
The Federal Government's response shouldn't have failed.
Total loss of control by law enforcement shouldn't have happened.
Losing communication with a hospital shouldn't have happened.
Gangs roaming and pilaging the city shouldn't have happened.
CONCLUSION:
If I am ever a patient in a hospital under these conditions, may God provide me
with an Anna Pou to hover over my bedside and to struggle with the most humane
and merciful treatment she can provide.
case in the media has had many doctors holding their breath.
Every doctor can be faced with the decision to stay and help in a crisis and Anna
Pou chose to stay. Every doctor has a desire to help people who are sick or suffering. That is
what drives most of us. And that is apparently what drove Dr. Pou in the midst of
post-Katrina New Orleans while people who were already terminal, lay dying
and in pain.
Early reports by media included sordid details reported by various other personnel
including a Dr. Bryant King who opined that "most people know that something happened
that shouldn't have happened".
To understand how decisions were made we have to understand the concept of Triage and
how the idea is used.
Secondly, we have to understand the context or situation in which these decisions were made.
Without these two discussions, and a clear understanding of what was at stake, decisions
can seem baseless and cruel.
The conditions in the hospital included sweltering heat to 110 degrees, low food supplies,
rationing of narcotics because the pharmacy was on lock down from roaming gangs, and
flood conditions in the hospital with no/limited electricity. There was minimal assistance to
evacuate and communication was non-existent such that one of the doctors had to
hitch a ride on a boat to go for help.
The Washington Post described the scenes around the city in the days following Katrina.
Even some local news media had to leave the city when faced with the chaos.
The Online NewsHour describes looting and lack of communication for law enforcement.
It is clear that near total anarchy was encompassing the city of New orleans.
Unfortunately, under these strenuous conditions, medical personnel garnered charges of
murder while trying to take care of critically ill and dying patients under war-like conditions.
A few points of interest about this particular situation:
Dr. Pou is an Ear, Nose, Throat specialist. This is a surgery subspecialty that generally
deals with such things as throat cancer, mouth cancer, ear disorders, and various other
disorders such as thyroid cancer, etc.
She is not an emergency physician nor would she have necessarily had patients in the
hospital for extended stays. ENT specialists usually operate on their patients and then
have critical care specialists or intensivists alongside for hospital follow up care.
In other words, the fact that she stayed on to help is a tribute to her professional commitment.
If electricity was down and there was flooding in the hospital, it is very likely that the
ability to maintain life support systems such as ventilators would have been compromised.
I can imagine that some patients would have been suffocating to death in the midst of
the melee.
If gangs and rapists were roaming the city and the hospital wards, it is unlikely they were
there to console the sick and the dying. And, personnel had no knowledge of when or if an
evacuation would be completed. Reports are consistent that food and
medicines were in short supply in the hospital.
Under such egregious conditions, medical staff had to triage the patients and care for
them to the best of their ability with limited resources and no information.
A systematic approach to such chaos is called Triage. Every doctor is trained to handle this
often daunting aspect of crisis care at some point in their career. Every doctor hopes that
they will not face the kind of conditions Dr. Pou faced in New Orleans.
TRIAGE---a system used by medical or emergency personnel to ration limited medical
resources when the number of injured needing care exceeds the resources available to
perform care so as to treat those patients in most need of treatment who are able to
benefit first. The term comes from the French language word for sort. Wikipedia
There are a number of different triage systems used in different settings; some on the
battlefield, some in emergency rooms.
The essential component is to help the most patients that can be helped.
By definition, some cannot be helped--this involves making a decision to
walk away from one patient in favor of helping another. I think it is fair to say, that
American doctors, in particular, have been trained to do everything possible for every patient
and are loath to admit defeat even in the face of the deadliest diseases. So, the concept
itself is gruesome, but, sometimes necessary.
UNDERSTANDING THE SITUATION--WHAT SHOULDN'T HAVE HAPPENED
A hurricane shouldn't have hit New Orleans.
Nobody should have stayed or been left in New Orleans during the hurricane.
The levees shouldn't have broken.
The city shouldn't have flooded.
The emergency systems shouldn't have fallen apart.
The City's infra-structure shouldn't have failed.
The State's infra-structure shouldn't have failed.
The Federal Government's response shouldn't have failed.
Total loss of control by law enforcement shouldn't have happened.
Losing communication with a hospital shouldn't have happened.
Gangs roaming and pilaging the city shouldn't have happened.
CONCLUSION:
If I am ever a patient in a hospital under these conditions, may God provide me
with an Anna Pou to hover over my bedside and to struggle with the most humane
and merciful treatment she can provide.
Cherie Landry and Lori Budo, nurses who worked with Dr.Pou, have been out of work for a year as the charges against them were considered. I hope that all these brave women will be back at work, and their good names will be cleared.
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I agree. It's nice to see she was finally vindicated.
- Dean
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I was outraged that the actions of these brave women were questioned yet alone prosecuted.
It seems to me that we Americans now wish to live in a Disneyland where the cavalry always arrives and fine people don't have to make dire choices. The Federal government and Fema could not seem to rescue NOLA yet CNN managed to get there. The Feds should have been taken to task not some poor doctor and nurses in a partially submerged hospital. I sometimes wonder if the prosecution of these ladies wasn't meant to divert attention away from what an ineffectual president and a horseman had done to NOLA. I've more than once wondered how long help would have been delayed had Kennebunkport been underwater.
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I think if anyone should have been under attack it should have been the doctors that left those patients alone to die. I do understand that, given the circumstances, they were fighting to save themselves, however, it is the duty of any doctor to put their patients first. If, in this case the doctors had not left and stood by that duty...the situation never would have happened. Those nurses, along with Anna, were very courageous for what they did. It is disgusting to be a 23 year old and see that, in a profession I hope to one day be in, this is what happens when you stand by your obligations.
We could very well point blame to anyone in that situation, including, FEMA, and the United states government for not responding sooner, or actually having a stable plan of action in place for a crisis such as this. It makes me afraid of anything else that could possibly happen and for us to not be prepared for. Why not prosocute the President of the United States?
It is so ridiculous living in the hypocracy of the United States at times. We can send soldiers out to kill and be killed, spending trillions of dollars a day to do it...however, when a doctor, who is willing to sacrifice themself to save another persons life, does the best she can in given circumstances and for the comfort of the patient, she is put on trial for murder..remind you..everyone else decided to run when faced with disaster.
Everything is such a mess, and no one seems to have the right direction/or priorities at this point. I think the point I am trying to make is that this case stems far beyond Anna Pou and those 3 nurses that acted in such a heroic manner. It stems back to what our priorities are as a nation.
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