The wind ripped chunks off the hospital's roof and the entire building rumbled. One nurse said the cement pounding into the walls sounded like the loudest bowling alley she could imagine. Another felt like she was inside a meteor shower.
One of the most powerful hurricanes in the nation's history was barreling into south Louisiana. Fifty miles (80 kilometers) southwest of New Orleans, the staff at Leonard J. Chabert Medical Center in Houma was already weary from a year and a half of caring for patients with COVID-19.
Now water was pouring from the ceiling tiles. A giant metal beam tore off the building and thumped into a glass door, over and over, like a battering ram. The medical staff prepared to keep patients on ventilators alive by hand if the worst were to happen.
Hurricane Ida was colliding with the country's out-of-control pandemic. Hospitals facing a Category 4 storm typically either evacuate or discharge as many patients as possible. But this time, amid the community's fourth, brutal surge of COVID, many of Chabert Medical Center's patients were too sick to be sent home. And hospitals that lay outside the hurricane's most destructive path were too full of COVID patients to absorb any more. So here they stayed — nurses, doctors, paramedics — exhausted from battling one catastrophe, watching through the windows as a second one tore into town with 150 mph (240 kph) winds.
"The mental stress on our employees is much worse now than it's ever been," said Richard Zuschlag, the owner of Acadian Ambulance Service, the state's largest emergency medical outfit. "COVID set us up for that. And the hurricane is the icing on the cake."
Some nurses wept. The staff stood in a hallway, held hands and asked God to protect them. They feared any minute the building might collapse.
Across town, huge sections of the roof blew off Terrebonne General Health System, the largest hospital in Terrebonne Parish, whose bayous brimming with sinewy cypress trees run through the region like veins. Water poured in so quickly it looked like it was raining inside. The windows shattered, the walls shook and it sounded like a freight train.
As the hours passed, some nurses began asking the same question about the storm that they'd been pondering about the pandemic for months: "When is this ever going to end?"
By the time the sun came up, both hospitals in Houma had endured so much damage, they had to coordinate a massive evacuation.
Dr. Chuck Burnell, the chief medical officer of Acadian Ambulance, was in the basement of Terrebonne General sorting out how to move more than 100 patients, many of them infected with COVID, some on ventilators.
Burnell has been an emergency physician for almost 30 years, and he said this is among the worst storms he's been through, arriving as it did just as the state's COVID deaths soared and its vaccination rate remained among the lowest in the country.
"We have the perfect twin-demic going on," Burnell said. "This could not have happened at a worse time. Mother Nature was not kind to us."
"Are there happy moments here at all?"
In the spring of 2020, as Louisiana became one of the first places in the U.S. to be crushed by a COVID surge, Shayna Boudreaux worked 18-hour shifts for 33 days straight. As a paramedic for Acadian for 13 years, she's used to handling seriously ill and injured patients in unforgiving conditions. On a good day the hours are long, she said, the work physically demanding and sometimes dangerous: She's been attacked, assaulted and confronted with a gun. But nothing prepared her for this pandemic.
She raced panicked people gasping for breath to emergency rooms already teeming with sick patients. Many didn't survive. It nearly broke her.
"I cried for days just thinking about how we're the last thing people see or talk to. We tell their family members, 'Hey, they're going to be all right' to console them," she said. "But then reality sets in that they weren't all right. It wasn't OK."
Boudreaux and hundreds of other paramedics wore respirator masks and two pairs of gloves to try to keep the virus away from their bodies. They worked in blazing heat and stifling humidity, and through two hurricanes last year. Many stayed away from their families for months to avoid infecting loved ones, or stripped down naked outside their homes after each shift to keep from bringing the virus inside.
"We have a metal box where everything's flying around at you," said Burnell, the medical director. "It is a cesspool of COVID. I tell people there is a COVID fog in every ambulance."
South Louisiana hospitals were stretched to their limits long before Ida brought her screaming winds and pelting rain.
Intensive care units filled to capacity, with some hospitals creating overflow units to accommodate patients so sick they couldn't survive without extraordinary medical intervention. To keep up, nurses and doctors pulled extra hours, filling in for colleagues who'd caught the virus or simply had enough.
"You couldn't even have a patient pass away before the room needed to be used," said Phyllis Peoples, president and chief executive officer of Terrebonne General. "And some of our docs in there said, 'Are there happy moments here at all?'"
Chabert hospital's chief nursing officer, Jana Semere, said some nurses are burning out and leaving the profession after grueling 60-hour weeks filled with an unrelenting flow of COVID patients. Of Chabert's eight ICU beds, they can only staff six: They simply don't have the staff power amid a nationwide shortage of nurses.
Health care workers are now seeing whole families fall critically ill due to the highly communicable nature of the delta variant and the region's low vaccination rate.
In recent weeks, Semere has watched patients in their 20s and 30s go on ventilators and die. A few weeks ago, a man and his mother were admitted to the ICU at a neighboring hospital. They died within five hours of each other. Semere was on the phone with a nurse at that hospital, and could hear the man's wife wailing through the receiver.
"After 41 years of being a nurse, hearing it through the phone, I got goose bumps," she said, "because it's so sad."
Acadian Ambulance dispatcher Bart Savoy answers calls from those frantically seeking medical assistance.
"They're so out of breath trying to talk to you, and they're just crying for help," he said. "And I was the last guy they were talking to."
Often that burden falls on nurses when families can't visit sick loved ones because of infection risk.
"It's a difficult time for the nurses," said Chabert's house supervisor, Jeanie Songe, a longtime nurse who is in charge of logistics such as shift changes and hospital transfers. Nurses are now so busy, so stressed, so emotionally drained that some feel they have little left to give, she said.
"And then this freaking storm," she said. "It was a nightmare here."
"The walls were breathing"
The power went out at Terrebonne General around 3 p.m. the Sunday the storm rolled in and for 10 seconds the staff stood in darkness. Nurses ran toward the intensive-care beds, where the worst COVID patients depended on ventilators to breathe. The back-up batteries were fully charged, but still they prayed.
Then with a pop, the generators roared to life, and they sighed in relief.
The hospital anticipated flooding but now water was coming from above. Parts of the roof had flown off, and the pounding rain flooded the fifth floor. It then gushed down to the fourth floor, then the third.
Peoples, the hospital executive, put her hand against a wall and it was shaking. The windows blew out. The staff scrambled to move patients to the middle of the rooms, and then to the hallways. The wild wind created a sucking force, and it took Peoples and two others to push open a fire exit. They lost water.
Before the storm, they'd discharged as many patients as they could, but still had 120.
Other hospitals around the region had already evacuated, and Terrebonne General is the largest acute care facility there. In 65 years, the hospital has never fully evacuated, Peoples said. If they closed their doors, some patients would be 50 miles from the closest hospitals in the middle of dueling disasters.
But then she thought: Without water, there was no air conditioning, and it was pushing 100 degrees. Downed electrical lines were scattered outside, and if something caught fire, they wouldn't be able to put it out. Peoples didn't think she could keep her patients and staff safe.
"I said, 'I hate to say it, but I think we're going to have to say that we need to evacuate,'" she recalled, "which everyone knows is a major, major thing. We don't take it lightly."
Admitting defeat to the storm was agonizing for those who work in this hospital and have cared for their community for generations.
"It's our home. It's our home," Peoples said. "And to say we can't do it anymore just makes you very emotional."
Burnell, the ambulance company's medical officer, coordinated the evacuation from the hospital's basement. They had no radio communication and no cell reception. To tell each other anything, they had to run. Nurses, doctors, medics and administrators sprinted across floors wet and slippery from the rain and the sweat. They worked off printed papers to choreograph who would go where and when, to make sure patients positive for COVID didn't cross with those who weren't.
Ambulances darted around the region's shredded buildings and overturned utility poles to deliver patients to other hospitals that were also overwhelmed by the coronavirus and rushing to make room.
Paramedics are used to working grueling hurricane seasons, Burnell said.
"It's three or four months normally," he said. "Now they've been going 18, 19 months without a break."
Across town, Chabert hospital had made the same excruciating choice to evacuate.
The smaller hospital had just over 40 patients, 17 with COVID and five on ventilators in the ICU. The nurses there had prepared the equipment they might need to keep these patients alive if the generators failed, and stacked it on the beds.
The generators held, but like Terrebonne General, the hospital lost water and air conditioning. As the storm raged, a bleeding man arrived to drop off his fiancée, who had been sucked out of their wrecked home a few blocks away. The emergency room staff got to work mending her wounds as water poured from the ceiling.
Several nurses learned that their own homes had been destroyed, but kept working.
The staff was too scared to trust the elevators so they ran up and down the stairs, five flights, slippery from water and howling in the wind. They had no working bathrooms. It was torturously hot under their face masks, and sweat dripped into their eyes.
Songe, the house manager, watched the walls pulsating. She suspected she might be delirious because she was so tired. She took her glasses off, refocused her eyes, and it was true: "The walls were breathing," she said.
The staff watched from the windows as the top of a doctor's SUV peeled away. Tiny twisters rose up out of the wind.
"I was like, 'Is this building falling apart?'" said physician's assistant Erin Kinnard. She's lived in Houma most of her life, and has been through many hurricanes.
"But I've never been this scared," she said. "Never, ever, ever."
Ceiling tiles collapsed onto the head nurse, Jana Semere.
"I had COVID patients with no air conditioning. And it's already hard for them to breathe. Imagine how that must have felt," she said. "The floor was soaked, it was sweating."
The hospital decided to evacuate but had to wait until the sun came up.
When Semere heard the sirens in the distance at dawn, she went to the loading dock and watched a parade of ambulances pull into the lot. She wept.
"It was like hope showed up."
"It didn't go away. It's not going to go away."
Early in the morning after the hurricane, emergency medical technician Caitlyn Rappé raced up the stairs of a storm-battered house. It was still dark but the humidity hung heavy in the air over a New Orleans suburb.
Beads of sweat ran down her forehead and her back, and moistened the mask strapped and sticky over her face. They found a woman splayed across the floor. She was COVID positive.
Rappé reached down to feel her neck — still warm — and the team intubated her, started chest compressions and gave her IV medication and fluids. Rappé and her partners loaded the woman onto a stretcher and trudged through the mud toward the truck, parked a football field away. By the time they made it to a hospital 15 minutes later, the woman was dead.
"All of us, you could see us sink," she said. "All three of us slumped onto the hospital floor."
As soon as the crew got back to headquarters, Rappé's 24-year-old partner turned white and collapsed from exhaustion and dehydration. When he came to, he begged Rappé to call his wife, and asked if he was going to die too.
The morning had been so hectic, it would be hours before Rappé had a chance to wonder: What happened to my house? She'd later learn that a tree crashed through the roof of her bedroom. She moved into a supply closet in the Acadian warehouse in New Orleans so she could keep working.
EMTs and paramedics fanned across south Louisiana in the days after Ida struck, responding to everything from heart attacks to scrapes and bruises to low blood sugar.
"Now is the time people start to crack," Burnell, the Acadian medical director, said several days after the storm.
Burnell has been tarping roofs of employees whose homes were flooded, tracking down medications and treating patients in the field. A man showed up with a severe dog bite to his face — an injury that would normally need stitches — and Burnell dressed it as best he could. He found two precious doses of antibiotics for an EMT whose children were suffering from ear infections so she could stay on the ambulance and work.
"Right now, they're not just scared of infection and miserable. They're working extra hours. They're also hot. They may not have a house. Some of them haven't seen their family in days," he said.
Terrebonne General was so badly damaged it remains closed, save a makeshift emergency room set up in tents across the street. The ER at Chabert has reopened, but the generator still trips every so often, briefly leaving the hospital in darkness. Medical staff are trying to patch the holes, sweep up the debris, wipe down the floors and begin the process of recovery. But what awaits them on the other side is grim.
During physician assistant Kinnard's 12-hour shift a few days after the storm, patients came in seeking help for issues unrelated to the virus. Some were diabetic and hadn't been able to take insulin for days. Four tested positive for COVID.
After so many in their community were forced to shelter through the hurricane wherever they could, it's almost inevitable some were exposed to people who were infected.
"It didn't go away. It's not going to go away," Kinnard said.
When Semere finally left the hospital, she was stunned by the state of her town: crumbled buildings, blown out windows, twisted metal strewn in the street.
"I haven't let it hit me yet, the devastation," she said. "I've just been basically trying to take it one step: what's next, what's right after this."
She's heard some of her staff pondering if they should retire because they're not sure they can keep going.
Nurses are frustrated that people in their own community, whom they've known for years, are refusing to get vaccinated against the coronavirus. When the pandemic began, nurses were hailed as heroes and sent pizzas for lunch. But as the months have worn on, many now feel unappreciated because people refuse to trust them when they say to get the shot. The state's vaccination rate is only around 43%. And the relentlessness of the virus won't end when the power comes back on.
"It's daunting, it's very daunting," said Semere. "When we get this hospital up and running again, we're still going to be in a crisis."