Balls and Walnuts
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In extremis: the case of Anna Pou, M.D.
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I may be tardy to the Hurricane Katrina blogswarm (explained by Shakespeare’s Sister), but better late than never. Thanks again to Blue Gal, who kicked me in the butt suggested I post something pertinent.
Anna Pou, M.D., is an ENT (ear, nose, and throat doc) who, during the Katrina debacle, volunteered to stay behind to provide basic services to the patients of Mercy Hospital. Last month, Louisiana Attorney General Charles Foti had Dr. Pou and nurses Lori L. Budo and Cheri Landry booked with four counts of second-degree murder. They are accused of euthanizing patients with morphine and Versed (midazolam).
Kevin, M.D. has excellent coverage of the story. Suffice it to say that the facts of the case are unclear, so (in my opinion) the more savvy commentators are reserving judgment.
I’d like to give you my thoughts on this as an ENT and as someone who has worked at a County Hospital under less than ideal circumstances.
Mind you, I don’t pretend my experience comes anywhere close to the horrors of Mercy Hospital, but I do think I have enough street cred to tell you one thing: if you weren’t there, if you didn’t put in your time, shut the hell up. Judge not, etc.
Image: NPR, New Orleans Hospital Staff Discussed Mercy Killings
From the NPR story:
Despite repeated phone calls and letters, Dr. Pou could not be reached for comment. In a written statement, Pou’s lawyer, Rick Simmons, said: “Dr. Pou and other medical personnel at Memorial hospital worked tirelessly for five days to save and evacuate patients, none of whom were abandoned.” In a telephone interview, Simmons said, “Dr. Pou did not engage in any criminal actions.” He said he is confident that the facts will reveal heroic efforts by the physicians and the staff in a desperate situation.
How many of the folks calling for Dr. Pou’s head (um, Mr. Foti?) have worked five days straight under extreme conditions? The volunteer doctors at Mercy Hospital undoubtedly had to deal with emotions, fatigue, and agonizing judgment calls for which they had little preparation.
In the early 90s, I worked at LA County Hospital during the Rodney King riots. Again, I do not think this was in the same ballpark as the Mercy Hospital situation, but it made an impression on me nonetheless. The trauma load was phenomenal. We worked as hard and as fast as we could, but the stretchers kept rolling in. Tired does not begin to describe the hour-to-hour grind of this work. Giddy, perhaps. Punch-drunk.
But we could leave the hospital after our 24- to 36-hour call shift. We could go home and get a few good nights’ sleep before re-entering the fray. Unlike Dr. Pou, we were able to focus our skills on ENT patients; we weren’t asked to treat patients outside our area of expertise.
For a specialist, few things are worse than being asked to treat something outside our specialty. Often, we know less about these problems than the nursing personnel. To take the plunge — to treat someone when we have but shabby knowledge of their condition — feels wrong. It feels like malpractice, or like practicing medicine without a license. Given the choice, we won’t do it.
I seriously doubt the volunteer doctors of Mercy Hospital had the choice. I suspect they treated everyone to the best of their abilities, simply because there was no one else around better equipped than they. If I were an ENT in that situation, I would have to say to myself: I’m not an internist (general surgeon, neurologist, anesthesiologist, you name it), but for this patient, I’m a lot better than nothing.
Bad enough to be pushed to the limits of fatigue and beyond, to be confronted with horror after horror, to feel abandoned, to see no end in sight. On top of all that, these doctors were obliged to give what they must have felt was substandard care — a bitter pill for any health care provider to swallow, one which must have caused considerable emotional distress.
My gut feeling is that Mr. Foti is looking for a scapegoat, but like everyone else, I’ll wait for the facts to surface.
I do think this case demands us to remember that Dr. Pou is innocent until proven guilty; but for me she’ll be a hero, too, until someone convinces me otherwise.
D.
Hey there Dollface. Long time no see.
I only have the barest recollection of this incident (reported perhaps 2 weeks after Katrina). And I haven’t seen any of the blogs speaking of this subject (barring yours).
I remember my thoughts at the time were, Here are some poor schmos who held on as long as they could and they are being condemned for NOT being heroes. Is someone morally obligated to sacrifice their life for anothers? To sacrifice their life for a lost cause? I don’t frickin think so. It would be fairly unlikely I would. Would you?
And for some perspective. No water, no electricity. And who knows how many other crisis they were dealing with. So the most obvious question? What should have been done? Did they have communications with the outside? Unlikely. Were they in danger if they stayed?
If everyone is so certain that the action the medical staff took (and I’m uncertain what action if any they took)is the wrong action, then what should have been done?
In a perfect world they would have called for aid. (At the very least jumped in their dinghy and paddled to dry land.) The patients would have ALL been evacuated. And as we saw, the evacuation after Katrina was such a smooth operation. I don’t think the fact that this was not done is the responsibility of the medical staff left behind.
But hey, if I learn there was a red cross camp right across the street and aid in abundance I may have to rethink this.
X
What happened to N.O. was unconscionable. Our “glorious and benevolent leader” wouldn’t allow Cuba to ship in the medical personnel and material they had waiting just outside the legal limit even after the emergency management system took its head out of the sand long enough to admit there was a problem. Our own ships weren’t allowed in to give aid because “the military can’t interfere (??? WTF look at Iraq!). There was enough mismanagement of safety systems there to last a third world continent into the NEXT millenium. So don’t anybody go dissing the medical personnel who stayed in place to minister to the best of their abilities.
And you know what else, Dr. Doug? If I get to the point where I’m suffering and there’s no way to help me, I pray somebody has enough morphine that I don’t have to suffer any more – weather related emergency or not…
In short, leave these people alone and clean up our systems (political and emergency management) so this never happens again!
Hi X! Thanks for coming by. As far as I can tell from what I’ve read, folks overheard the medical staff discussing the possible necessity of euthanizing patients who were so critically ill that they could not survive evacuation. Second item, someone saw Dr. Pou with a handful of syringes. There must be more to the case than that, or the DA wouldn’t press on, right? Or is he just grandstanding? Anyway, as regards Katrina, there are far worse criminals out there, and they’re still holding office.
Hi Leslie. My thoughts exactly.
A wonderful post as only you could tell it, Doug. Thanks.
I concur with yer thoughts, Dear Douglas. T’those who would condemn, STFU unless ye were scrub-to-scrub with these people…
Amen, Doug. If it were one of my loved ones that had to be left behind in that nightmare, I’d be saying thank you to Dr. Pou for ending their suffering. The whole staff did what they had to do – certainly nothing worthy of condemnation.
Thanks for this post! I would like to have anyone who has brought charges against these heroes to someday be in a similar situation. My level of disgust cannot be communicated through words. Again, thanks.
Thanks, folks. Personally, I’m dreading this trial. The DA will (I think) try to destroy this woman’s reputation — he’ll have to, because the defense will have an easy job depicting her as the hero she is, making difficult choices in horrific situations.
It could get very ugly.
For a country that takes it upon itself to spread justice, freedom and democracy around the world, they sure are mean, cruel and hateful towards their fellow countrymen (and women)
After the circus surrounding Mr. John Karr, I trust any prosecutor as much as I trust the Lapdog Media. The truth will come out in a trial, if it goes that far.
[…] Matthew Holt takes a different, but supportive, view: But where the hell was the Louisiana or New Orleans AG (or for that matter any other level of government) when desperate physicians, nurses and patients needed help? Absolutely effing nowhere. A humane person wouldn’t leave a dog to slowly die or drown in the 105 degree heat, let alone another human. And it seems to me that in absolutely desperate circumstances, Dr Anna Pou did what she felt was best for those patients.Yet six months later a grandstanding DA gets his jollies off by sending physicians and nurses on trial for homicide. (source) […]