NEW ORLEANS — The 92 acutely mentally ill patients on Charity Hospital's third floor normally may not even stand near the double-locked windows without supervision.
But on the second day of flooding in downtown New Orleans, nurses escorted them out onto the fire escape, two at a time.
"Some of them wanted to leave the hospital, and we had to show them the water below the balcony," nurse Yvonne Buggage said. "We had to make them feel they were safe with us."
For five days and nights, Buggage and her colleagues weathered Hurricane Katrina and its aftermath with the schizophrenics, severe depressives and bipolar personalities who were stranded in the third-floor ward.
It wasn't easy, but the Monopoly games and the wallet making helped. So did the hospital's well-stocked supply of mood-leveling drugs.
And in the end, nurses and doctors say, patients who first seemed to pose the greatest risk of crumbling from anxieties turned out to be among the steadiest.
"As the 'psych' patients were exiting," Dr. Keith Van Meter, head of Charity's emergency services, said of the hospital's evacuation, "they were the most cooperative and polite, strangely enough."
By then, however, Buggage, 49, had spent the better part of a week comforting, medicating and, in one case, bonding with her patients -- in castaway conditions that included smothering heat and unnervingly dark nights.
On most days, she and her colleagues were lucky to steal a few hours' sleep.
"We all had one ultimate goal: to get out," said Buggage, who was born at Charity and lost her home to the storm.
Charity Hospital of Louisiana is New Orleans' main hospital for the poor as well as a teaching institution for Louisiana State University's Health Sciences Center. Its dingy white towers dominate a city block near the Superdome.
Katrina's floodwaters surrounded Charity and filled its basement but did not inundate the treatment areas. The hospital lost power after its generator malfunctioned. Its staff was left to care for about 250 patients without heart monitors, laboratory tests, X-rays or air conditioning.
The psychiatric patients were not physically infirm, but their doctors thought it best not to evacuate them before Katrina hit.
"We felt they should stay in a medical setting," said Cheryll Bowers-Stephens, a psychiatrist who heads mental services for the state Department of Health and Hospitals, which provides physicians to Charity. "They were in that setting for a reason."
A total of 215 mental health patients were evacuated from state hospitals, Bowers-Stephens said.
Eight non-psychiatric patients died while Charity was isolated by the flooding, Van Meter said. He said all had been critically ill before the hurricane.
The doctors and nurses practiced "intuitive medicine" while they awaited evacuation, Van Meter added.
On the third floor, that meant improvising ways to soothe people who had enough trouble coping with everyday life. This is Buggage's account:
First came basic precautions, such as keeping a sharp eye on them whenever they approached the windows. The patients ranged in age from about 18 to 60.
Apart from the poverty that most had in common, they possessed a variety of backgrounds -- a maid, a cook and a store clerk -- and presented a mix of challenges as the siege wore on.
On the first day, things seemed almost routine because the water hadn't risen yet and there was still electricity. The telephones worked, and there appeared to be plenty of food.
"We had TV and we put movies in," Buggage said. "They watched 'Ray.' We made some popcorn." But an older woman could not stop talking, and she had a persistent demand. Unlike the others, she didn't insist on leaving, but on staying -- until the staff relinquished her disability check. She had gotten it into her mind that the check had been mailed to the hospital.
"She would talk and talk, saying, 'I'm not going anywhere until you give me my check,' " Buggage said.
Eventually, the nurses gave the woman an antihistamine to relax her. Patients who became more agitated received a cocktail of antipsychotic and anxiety-reducing drugs.
"We only gave it when it was needed," Buggage said.
That need became greater on the second day. The power went off for good, and temperatures in the ward climbed toward 100 degrees. The toilets stopped working. The nurses filled trash cans with water to dump into the toilets so that they would flush.
Then a man in his 40s wanted to bolt. "He said he couldn't take it," Buggage said. "He said he didn't live far, he could make it."
He paced and paced.
Other patients became fidgety. They had questions that nurses couldn't answer: How long would they have to stay? Why weren't they being rescued?
A 25-year-old woman who had been scheduled for discharge remonstrated with the nurses. Buggage said she had the woman call her mother, and she settled down.