When firefighters cry you know it's bad.
Shreveport Fire Chief Kelvin Cochran pondered that thought in his office Friday, a somber look on his face.
 

"I am so proud of the men and women who went down there and the way they conducted themselves," Cochran said. "They maintained order and were so well disciplined they were able to save thousands."

Shreveport sent more than 100 firefighters to help with the rescue effort in the weeks after Hurricane Katrina wrecked devastation along the Gulf Coast and left New Orleans flooded.

Each team of 27 firefighters sent were equipped with firetrucks, medical units, search and rescue supplies, and food and water.

"It turned out to be a benefit to be totally self (reliant)," Cochran said, adding the situation was so chaotic, that there was no command-and-control structure in place.

As each firefighter returned, counselors were used to help acclimate them back to normalcy.

"Some of the firefighters were having a difficult time with what they experienced," Cochran said. "One firefighter told me 'I saw more in four days down there than I have seen in 25 years in Shreveport.'

"Firefighters are used to trying to save everybody," Cochran explained. "In this case, they were directed to save only those that had a chance of living. In some cases, that meant people who were breathing and had a pulse were left behind because in the assessment of their doctor, they wouldn't make it. That was what made it very difficult for the firefighters emotionally."

Two days after the hurricane, the generators at Lindy Boggs Medical Center in New Orleans failed. There was no blood for transfusions and very little medication besides morphine. One floor below the ICU, a plea had been written on a piece of cardboard: "Patients dying; please be respectful."

Shreveport firefighters arriving in boats were the first relief the hospital had seen.

Horrifying choices

What happened on Wednesday, Aug. 31, in the hospital's intensive-care unit -- recounted by the relatives of two transplant patients and two of the last doctors to leave -- reveals the horrifying choices and conflicting realities faced by those who stayed, or were left, behind.

Today, the 187-bed hospital is abandoned; 21 bodies have been removed. But the story of the struggle to stay alive there in the dark days after the hurricane underscores the chaos, anger and desperation that overwhelmed the city.

"You think of a hospital as a place that gives treatment. But it had become kind of a medieval nursing facility," said anesthesiologist James Riopelle, the last of the living to leave. "We were just providing comfort to the dying. That's what we were doing. There was no good solution. There were only bad choices."

For two critically ill transplant patients and their families, hope quickly turned to horror when they learned that the rescue boats would be evacuating others instead. Ultimately, the two patients did get out after other patients had been evacuated by firefighters. They made it out thanks to two family members who refused to leave them and to a doctor who returned to ferry them out himself with a stolen boat.

Disaster rescue rules

Inside Lindy Boggs that day, doctors began to prioritize patients for evacuation, placing cards on each one with one of three letters: A meant they could walk out on their own; B meant they had medical issues that needed attention; and C was condition critical.

Those who got C's -- the most desperate for care -- were told they would be sent out first.

That all changed, the doctors and family members say, when firefighters from Shreveport arrived and gave the hospital staff new rules for the rescue. The healthiest of the hospital's 120 patients would be evacuated first, the firefighters declared. The most ill or infirm -- the C's -- would have to remain. For how much longer, no one knew.

Thiagarajan Ramcharan, a transplant surgeon, knew that two of his patients, Laticia Young, 28, and Carl LaSalle, 32, had suddenly been moved from the top to the bottom of the evacuation list.

Both were critically ill. LaSalle was recovering from a liver and kidney transplant. Young, who had suffered from an autoimmune disease since she was 12, was considered too sick at that moment to survive a transplant operation, but doctors were trying to stabilize her so she could get a new liver.

Young's mother, Elaine Bias, and LaSalle's wife, Jessie, refused to leave the patients' rooms. "I said, 'This is wrong,'" Bias says. She had brought her daughter to the hospital and had no intention of leaving her there to die. But Ramcharan told her, "This is out of my hands. There's nothing I can do."

"I was going crazy because I felt that was wrong," says Jessie LaSalle. Looking back, she says, her husband wasn't being treated like he was human.

The trapped

Bias and LaSalle were connected by fate before Katrina hit. Both were in the intensive-care unit playing the role of patient advocate for their daughter and husband, respectively. Both patients were under the care of the transplant team.

As the storm battered the city on Aug. 29, emergency plans kicked in at area hospitals. Generators powered breathing machines, and plans called for the sickest of the sick to be evacuated first.

Downstairs from the Lindy Boggs ICU, in the hospital's hospice ward, patients with cancer and other terminal diseases were already dying, most from the heat and dehydration, according to Ramcharan. "Those patients did not have a chance for life at all," he says. He believes the hospice patients account for the bulk of the deaths at Lindy Boggs.

When the levees broke and the waters continued to rise Tuesday, the staff grew alarmed. Rescue crews were busy across the city plucking people in danger of drowning from trees and rooftops. There was no way for hospital staff to call for help, and no help came.

"I don't know if people were aware that there were so many people inside (the hospital)," Ramcharan says. "Every time we stepped out, the water was rising."

Inside Lindy Boggs, the hospital began to slowly shut down as power, water and replenishments of medical supplies were cut off. "It became a trap," Riopelle says.

By Wednesday morning, with generators failing and patients facing their third day without medication, blood or even basics such as clean sheets, one of the elderly patients in the ICU died.

For Bias and LaSalle, it seemed as if death was creeping toward them. "I saw them body-bagging people," LaSalle says.

There was one "old patient and I don't know what the problem was," Ramcharan says. "The morgue in the basement was flooded, so we could not take the patient away. He was there for a while."

When firefighters in boats arrived at the hospital on Wednesday afternoon, they said they could move some of the patients to a dry spot where helicopters could land. But the Shreveport firefighters said those who were likely to die anyway had to stay behind.

Worse, "they said there was a good chance they would not show up tomorrow depending on orders from higher up," Ramcharan says.

Doctors and hospital staffers huddled and decided that several of the patients in the ICU, among them Young and LaSalle, would be left behind. LaSalle and another patient, suffering from tetanus, were on ventilators to help them breathe. The firefighters said they could not take anyone who could not breathe on their own. Young was bleeding internally.

The escape

By Wednesday night, with the hospital largely emptied and the air heavy with what LaSalle describes as "a bad odor of death," the two women clung to the hospital beds in fear.

"I didn't want to leave him because I knew something bad was going to happen," LaSalle says of her husband. "I was scared, but I knew the Lord was with us. I kept praying and finally he answered our prayers."

On Thursday, Sept. 1, Ramcharan and other hospital staffers "borrowed" a boat, siphoned some gasoline from abandoned cars and returned to the ICU to get the patients.

When Ramcharan walked into the intensive-care unit about 11 a.m., LaSalle says, "he told us it was time to go." The two transplant patients were carried downstairs -- with LaSalle, 24, ventilating her husband by squeezing air into his lungs with a plastic bag -- and loaded into the boat.

Haunting memories

The patients landed in Dallas at Baylor University Medical Center, where Carl LaSalle Jr. is now awake and breathing on his own. His condition is improving. Jessie LaSalle says her husband still thinks he's in Louisiana. She blames his disorientation on the trauma of being left to die. They have a daughter, Alicia, who turned 5 on Sept. 6.

Laticia Young is still struggling to survive. Her mother fears she won't live for very long without a new liver. Her three children, ages 9, 7 and 6, are staying with other relatives.

The doctors say that Elaine Bias and Jessie LaSalle saved the lives of their loved ones by refusing to abandon them.

"I hate to use the word 'abandon,' but that is what it was," says a still-shaken Ramcharan. He says he has had trouble sleeping since he got out of Lindy Boggs.

Back in Shreveport, Cochran, who is chairman of the Metropolitan Fire Chiefs Section of the International Association of Fire Chiefs, is critical of the command structure and response to the disaster in New Orleans.

From reports he has received the National Incident Management System -- developed by FEMA -- was not utilized. "It's a great system and it would have worked well," he said.

Cochran embraced President Bush's call for an investigation into what went wrong and how to correct the problems in responding to natural or terrorist disasters in the future.

USA Today reporters Alan Levin in New Orleans, Dan Reed in Dallas, and Blake Morrison in McLean, Va. contributed to this story.