Five Days at Memorial

 

“He would push 10 mg of morphine and 5 mg of the fast-acting sedative drug Versed and go up from there.”       –  Sheri Fink, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

Five Days at Memorial is about five days in hell.

After Hurricane Katrina wreaked havoc on New Orleans, staff at Memorial Medical Center thought the facility and everyone in it had survived the storm intact.

Then the levees broke and the water came.

Darkness ensued, air conditioning stopped, and life support equipment shut down. No rescue was forthcoming from federal, state, or local disaster relief agencies or the hospital’s corporate owners. Toilets overflowed. Hospital staff could hear gunshots and see looters ransacking the big box store nearby.

Memorial Medical Center had no evacuation plan for a disaster of this type, and staff were not trained in disaster management, even though the hospital had a history of flooding.

To get patients (most of them frail and elderly) to the helipad for the occasional helicopter that eventually did show up, staff had to carry them in sheets down several flights of dark stairs, through a small shaft into the the parking garage, and up two more flights. This took well over half an hour for each patient brought to the helipad.

By the time Memorial Medical Center was entirely evacuated, 45 patients had died. Twenty-three bodies were found to have high levels of morphine and other drugs. The DA arrested one physician and two nurses for the second-degree murder of 20 patients. According to the account Dr. Fink pieced together, it was believed some patients were going to die anyway – they wouldn’t survive evacuation – and so they were euthanized to prevent needless suffering. (Another physician who allegedly administered lethal doses of drugs was not arrested.) Ultimately, the nurses weren’t prosecuted, and a grand jury did not indict the physician.

Sheri Fink, a physician and journalist who tells the fraught story of a hospital in chaos and the legal and political aftermath, won a Pulitzer Prize for her initial reporting of these events in 2009. She spent six years researching and writing the book, including interviews with hundreds of people. Her narrative is sometimes hard to follow, and she necessarily leaves many questions unanswered but, overall, Dr. Fink has done an amazing job of reporting this story.

Five Days at Memorial will leave you unsettled, dumbfounded at the perfect storm of failure on every level, and considerably more informed about the rationing of health care resources in a disaster. Dr. Fink has focused her investigative reporting on the nearly impossible ethical decisions that must be made in disasters such as Katrina and the earthquake in Haiti, when there are not enough resources to save everyone.

Who should be rescued first – the most critically ill patients or the patients most likely to survive? Which patients should be allowed to remain on scarce, generator-powered life support?

Should patients and families be involved in these decisions?

If you’re a doctor or nurse and you’ve deemed someone not a high priority for rescue (because you feel their chances of survival are poor), do you tell her (if she is conscious) or her family?

Let’s say you’re a family member and you’ve been with your critically ill, elderly mother for days in a dark, flooded, sweltering hospital. You’re ordered to evacuate. The hospital staff assures you your mother will be taken care of. Do you leave her behind? What if you never see her again, and find out weeks later, via email, that she passed away in the hospital? An autopsy indicates high levels of morphine and other drugs.

That is what happened to one mother and daughter at Memorial Medical Center.

I’m greatly oversimplifying events in my summary. But here are some points I took away from Five Days at Memorial:

Everyone involved in the disaster – patients, families, and hospital staff – was heroic, but the corporate owners failed miserably and were never held accountable.

If what Dr. Fink writes is accurate, many patients were euthanized. While I don’t agree with that decision, I can sympathize with doctors and nurses who were exhausted, sleep deprived, and unable to make the best judgments. It seems, too, that a few patients were euthanized who would not have died.

I think it’s important that Dr. Fink’s book has brought this story to the attention of a wider audience. Clear, rational protocols and ethical guidelines need to be established for these types of situations. Patients, families and communities need to become involved in this discussion. (And that’s all of us, isn’t it?)

After Katrina, a ruling was proposed that would have required health care facilities to have emergency preparedness plans in place in order to participate in Medicare and Medicaid. No such ruling exists at the time of this writing, and there should be one.

Dr. Anna Pou, one of the physicians who allegedly euthanized patients and has lobbied for laws to exempt health care providers from legal prosecution in disasters such as Katrina, has accused Dr. Fink of misrepresenting herself, being a “journalist for hire,” and profiting “from the pain and suffering of others.” I believe journalism is an honorable profession, and I think there are easier ways to make money than writing a complex piece of investigative journalism like Five Days at Memorial. It’s an important book that needed to be written.

I think it will save lives.