Hurricane Katrina and its aftermath produced great dramas and tragedies, many played out eight years ago before transfixed television audiences. Along with the devastation wrought by nature in New Orleans and across the Gulf Coast, we witnessed the failures caused by feeble disaster preparations and delayed and inadequate governmental responses.
Less visible initially were the anguished decisions of individuals caught up in these awful circumstances. As Sheri Fink shows in “Five Days at Memorial,” those decisions were revelatory not only of character but of the ethical complexities of making life-and-death judgments in the absence of perfect information and clear guidelines.
Fink, a physician and neuroscientist who has worked in disaster zones, won a 2010 Pulitzer Prize for Investigative Reporting for a 13,000-word article titled “The Deadly Choices at Memorial.” Co-published in the New York Times Magazine and on the investigative news site ProPublica, the piece reconstructed events at Memorial Medical Center in New Orleans during and after the storm. In Fink’s story, some health-care workers admitted roles in administering fatal doses of morphine and another sedative to patients whom they believed would not survive late-arriving evacuation efforts.
“Five Days at Memorial,” based on more than 500 interviews, is Fink’s heroic expansion of that narrative. It embraces not just a detailed recreation of those five harrowing days, told from a dizzying series of viewpoints, but the long, unsatisfying legal aftermath. Fink also attempts to cover the practical and ethical issues raised by that health-care crisis, as well as disaster scenarios and end-of-life care in general.
That’s a tall order, and it’s reflected in the book’s length and complexity. Fink has done a masterful reporting job, and “Five Days at Memorial” is often engrossing, particularly those pages that take readers inside the hospital. We experience all too vividly the heat and stench and panic there, as backup generators expire, rescuers fail to appear, and health-care workers battle over how to triage and treat the most endangered patients.
Fink describes the attachment of family members to their dying relatives in the midst of disaster, reminding us how heart-wrenching and emotionally rich those final encounters can be. Meanwhile, administrators at Tenet Healthcare, the hospital’s Dallas-based parent company, emerge as not just distant, but clueless, and top hospital officials exercise less than inspired leadership.
The hospital, Fink writes, was “a microcosm” of the failures experienced by New Orleans in the wake of Katrina, “with compromised physical infrastructure, compromised operating systems, and compromised individuals.” At Memorial, as elsewhere, there were “also instances of heroism.”
Fink’s book is essential reading for anyone who cares about New Orleans, the breakdown of order in disaster zones, and medical dilemmas under crisis circumstances. But as a work of narrative nonfiction, “Five Days at Memorial” is frustrating: overly long and detailed, sometimes hard to follow, and without a real narrative payoff.
One major problem is that, although other doctors and nurses are candid about their complicity in euthanasia, much of Fink’s focus is on the actions and motives of a respected surgeon named Anna Pou. And while Fink did interview Pou, she “repeatedly declined to discuss most details related to patient deaths, citing wrongful-death suits and the need for sensitivity in relation to those who did not sue her.’’
That leaves the reader wondering what actually happened, even if the outlines of the story are clear enough. Pou was the primary target of a post-Katrina homicide investigation involving Memorial’s care of chronically ill, intensive-care patients under the aegis of LifeCare Hospitals of New Orleans. Pou, along with two nurses, was arrested and charged. The nurses were granted immunity in exchange for turning state’s evidence, but a grand jury declined to indict the doctor.
The charges against Pou were eventually expunged, and the surgeon waged a successful campaign to pass state laws limiting the liability of health-care workers in disaster situations. Those lobbying efforts helped spark Fink’s initial reporting.
Interestingly, Fink’s magazine article summarizes her findings far more clearly than the book. It is now evident, Fink wrote then, that more medical professionals were involved in the decision to inject patients — and far more patients were injected — than was previously understood. When the names on toxicology reports and autopsies are matched with recollections and documentation from the days after Katrina, it appears that at least 17 patients were injected with morphine or the sedative midazolam, or both, after a long-awaited rescue effort was at last emptying the hospital. A number of these patients were extremely ill and might not have survived the evacuation. Several were almost certainly not near death.
The epilogue details Fink’s interest in disaster protocols. “Withdrawing care from those who have not given their consent is troubling enough,” she writes. “Doing so by following a protocol that is unlikely even to save more lives would be indefensible.”
The point, Fink writes with some passion, is to do “everything possible to . . . minimize the need to compromise standards, and promote the ability to rebound as quickly as possible to normalcy.’’ She adds: “One of the greatest tragedies of what happened at Memorial may well be that the plan to inject patients went ahead at precisely the time when the helicopters at last arrived in force, expanding the available resources.”