Tuesday, April 19, 2016

No Easy Answers: Five Days at Memorial by Sheri Fink

Hurricane Katrina reminded us that disaster preparedness is fundamental and imperative, especially for New Orleans.

New Orleans for-profit Memorial Hospital owners were unwilling to invest money in moving generators from the basement. They neglected to arrange for emergency transportation of patients. Staff lacked sufficient training.  When levees broke after Katrina, flooding the hospital, the result was five days of dysfunction, chaos, and horrific decisions made by ad hoc leadership.

And deaths. Lots of deaths. 45 patients died in those five days.

When I joined Blogging for Books I was given choices of books to request. I decided on Five Days at Memorial based on the numerous awards and commendations Sheri Fink's book has earned.

Fink's story The Deadly Choices at Memorial appeared in the New York Times Magazine and won a 2010 Pulitzer Prize and National Magazine Award. Her six years of research culminated in a 500+ page book that cogently presents a complex and unsettling account of medical professionals under unusual stress and raises ethical questions.

Fink reconstructs the events during the disaster in narrative with vividly drawn portraits of patients and health professionals. The conditions inside the hospital were hellish. Generators were flooded and power was lost. Ventilators stopped and so did air conditioning. The heat was stifling. Communication to the outside was lost and unreliable information was being passed. Toilets were overflowing. Patients were moved into the lobby. Patient families were evacuated first. As conditions worsened, and staff suffered from lack of sleep and shock, things spun out of control.

Triage ordained those in good health evacuated first, then those who needed some assistance, and those most ill were to be last. Evacuation of patients involved carrying them carried down unlit stairs, pushing them through a whole in a wall into a parking lot, then carrying them up open metal steps to the helipad. Helicopters arrived sporadicly. Waiting patients died.

Respected surgeon Dr. Anna Pou had assumed leadership. When the staff was told to evacuate a decision had to be reached about what to do with the remaining patients--the most seriously ill, many with DNR orders. Dr. Pou and several others injected these patients with a potent mix; they all died. No patients were left behind when the last nurse and doctor left.

When it became apparent that these patients had not died a 'natural' death Pou and two nurses were arrested. The public was outraged: the nurses and doctors of Memorial were seen as heroic and no one wanted to see them charged with manslaughter. The jury acquitted them.

Patients who were airlifted out ended up languishing in open air while waiting for ambulances to reach them. Doctors watched them die. Had Dr. Pou's decision saved the patients from a painful death? Is euthanasia, or putting patients to 'sleep' ever an ethical choice? At least one patient was injected because he was too obese to move although mentally alert and viable. Do conditions of war or disaster alter moral prerogatives. and should we condemn people in untenable circumstances for not behaving as if conditions were normal?

There are some things we do not want to think about. They are the most important things we need to address. Fink's book is a warning and offers a vehicle for conversation about complex and frightening situations.

I received a free book through Blogging for Books in exchange for a fair and unbiased review.

Five Days at Memorial
Sheri Fink
Broadway Books
$17.00 paperback
ISBN: 978-0-307-71897-6