Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, by Sheri Fink (Crown Publishers)
By Diane Carman
In the scheme of things, many, many people were responsible for the deaths of patients at Memorial Medical Center in New Orleans on Sept. 1, 2005 after Hurricane Katrina devastated the city.
The bureaucrats who filed useless disaster plans for the 317-bed hospital certainly qualify. The hospital’s corporate owners in Texas who referred desperate nurses and administrators to public agencies when they beseeched them for help are on the list, as are the federal, state and local governments whose responses to the disaster were mismanaged, belated and grossly inadequate.
Administrators who for years had failed to prepare for the most obvious disaster scenario by moving emergency equipment above flood levels deserve plenty of the blame. And then there were the public officials and the taxpayers who ignored every warning, failed to make needed investments in infrastructure and disaster training, and left the city utterly vulnerable when the levies failed.
Sheri Fink recreates the harrowing episode in vivid detail in her Pulitzer Prize-winning book, “Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital.” For anyone interested in the intersection of health care, public policy, ethics and humanity, this book is essential reading.
When the hurricane made landfall in New Orleans on Aug. 29, 2005, hundreds of patients – some clinging to life in the neonatal and intensive care units, others under round-the-clock care on skilled nursing floors for the elderly – were left at Memorial, increasingly stranded as flood waters surrounded the hospital and inundated its vital operating systems.
A team of intrepid doctors and nurses brought their pets and family members, and camped in the hospital during the disaster to care for patients.
The health care workers functioned in conditions previously unthinkable in 21st century America. They had no functioning toilets, no running water and no electricity to power lights, elevators, refrigeration, cell phones, computers, ventilators or IV pumps. They used furniture and empty oxygen tanks to smash windows in an attempt to cool the facility after the air conditioning failed and temperatures exceeded 100 degrees.
Rumors of gangs of armed hoodlums roaming the streets were rampant, and even as nurses and doctors struggled to care for the sick and elderly patients left behind when the storm struck, more patients arrived at the hospital in boats or floating on mattresses, seeking emergency services or, in some cases, refuge.
Among the health care workers living in the hospital on little food and even less sleep were Dr. Anna Pou, a beloved head and neck surgeon, who specialized in cancer surgery, and two dedicated, highly-respected nurses Lori Budo and Cheri Landry.
A year after Katrina, when Charles Foti, the Louisiana Attorney General, went looking for someone to prosecute for the deaths of four of the patients, he settled on these three women, accusing them of administering lethal doses of painkilling drugs to put them down.
While Fink’s account of the events at Memorial and the investigation that followed leave little doubt that the patients were given a combination of morphine and midazolam just hours before helicopters evacuated the last of the patients and the staff from the hospital, the question of whether those acts constituted criminal behavior under the circumstances at Memorial is still hotly debated.
Some argued that the drugs were given to reduce pain and anxiety in the patients. Others insisted that the patients had never been prescribed the drugs until that day, so there was no reason other than euthanasia for giving them at that moment.
Some investigators believed that one patient, Emmett Everett, who was severely obese and unable to walk, was given a lethal dose of the drugs because the staff was unable to carry him up the several flights of stairs to gain access to the helicopters that finally arrived to evacuate patients.
Many in the medical community and the general public contended that the circumstances in the hospital at that time were akin to a battlefield, where traditional medical protocols and ethical constructs no longer made sense. Patient advocates believed the rights of the victims and their families had been trampled; that homicides were committed and justice should be rendered.
Fink depicts this roiling debate with great skill and passion, but without a whiff of bias. Readers are left to examine the episode in all its troubling moral and legal complexity.
Years later, when Superstorm Sandy was bearing down on New York City, Fink visited a hospital it its path to see what lessons might have been learned from the catastrophe in New Orleans. She stayed there through some of the worst hours of the storm and discovered that not nearly enough progress had been made in preparing vital health care facilities and their critical personnel for disasters.
“Five Days at Memorial” is an extraordinary work of narrative journalism. It brutally portrays the roles that politics, corporate greed and government ineptness played in the tragedy in New Orleans. It focuses our attention on the unresolved debates over end-of-life decisions and rationing of medical care in an emergency. It lays bare the often wondrous and sometimes awful power a physician has over her patients.
Mostly it makes us wonder if our policymakers and the health care system are capable of mounting a better, more thoughtful, effective and humane response when the next disaster strikes.