Title: Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital
Author: Sheri Fink
Rating: **** 1/2
In the tradition of the best investigative journalism, physician and reporter Sheri Fink reconstructs 5 days at Memorial Medical Center and draws the reader into the lives of those who struggled mightily to survive and to maintain life amid chaos. After Katrina struck and the floodwaters rose, the power failed, and the heat climbed, exhausted caregivers chose to designate certain patients last for rescue. Months later, several health professionals faced criminal allegations that they deliberately injected numerous patients with drugs to hasten their deaths. Five Days at Memorial, the culmination of six years of reporting, unspools the mystery of what happened in those days, bringing the reader into a hospital fighting for its life and into a conversation about the most terrifying form of health care rationing (from Goodreads).
Thoughts: Five Days at Memorial is a Pulitzer Prize winning book that follows Hurricane Katrina and its aftermath through the lens of the events that occurred at Memorial Medical Center in New Orleans. Ever since this book came out last year and I saw all the wonderful reviews, I’ve been meaning to read this one. Nonfiction November finally gave me the impetus to move this book from the ‘read someday in the undetermined future’ pile to the ‘read now’ stack- which I am very glad about because I really enjoyed this book.
Memorial Medical Center is a hospital in New Orleans that has been around for almost eighty years. Originally a private hospital known as Southern Baptist Hospital, by the time of Hurricane Katrina it had been bought by Tenet Healthcare, which owns several hospitals nationwide. The seventh floor of Memorial was rented by LifeCare, a private hospital that provided long-term care to extremely sick patients, most of them on ventilators and dependent on other machines with its own staff; the floor was commonly known as LifeCare Baptist.
On Sunday, August 28, 2005, at 10 o’clock in the morning, the day before Hurricane Katrina hit the city, Mayor Ray Nagin ordered a mandatory evacuation for the entire city; hospitals and their staff were exempted. When Katrina hit the next day in all its glory, the levees broke, and water flooded into the city. Like many hospitals, Memorial’s generators were located below ground level; as the hospital basement began to flood, the power failed, and eventually the back up generators did as well. With no electricity, the temperature inside the hospital climbed to up to 110 F, the toilets backed up, and workers had to manually ventilate patients who had depended on the mechanical ventilators to breathe. It took til Friday to completely evacuate the hospital, but by then several patients had died under suspicious circumstances, most of them LifeCare patients. Five Days at Memorial follows the events that occurred inside Memorial during the hurricane and the ensuing investigation into the deaths and the trial by grand jury, who ultimately decided not to indict the doctor who was mainly thought to be responsible.
This book won the Pulitzer Prize for good reason; its wonderfully researched, thought-provoking, and engrossing to read. I think I read it within four or five days. Fink takes a complex subject dealing with dozens of people and breaks it down for us, tracing the events as they happened while also giving us the necessary background information to understand these events in context. She connects the events at Memorial to other, larger happenings in the city during the hurricane and other overreaching issues dealing with end of life care, the euthanasia and right to die movement, and the medical industry and disaster preparedness.
As good as this book is, it is not impartial. Although she never outright states her opinion, Fink clearly believes that a crime took place at Memorial and, based on her book, I think I agree. Dr. Anna Pou was accused of willfully injecting patients with a concoction of drugs to sedate them while knowing the medicine would most likely hasten their deaths. While some of the patients were very close to death, and would most likely not survive the evacuation, one of them, Emmett Everett, was awake, alert, and eating and talking the morning he was injected. The fact that those involved with the injections discussed how to convince Everett to let them sedate him- they decided to tell him that the shot would help him with his dizziness- to me seems to show a clear intent to kill. Everett was an obese man, and without working elevators, those involved seemed to think that it would be impossible to carry him out of the hospital. I don’t buy this, and neither does Fink, as hospital staff had previously successfully carried a patient weighing over 300 pounds up to the hospital’s helipad for evacuation. The fact that these lethal injections were carried out on Friday, when the large-scale, total evacuation of the hospital was finally underway after days of sporadic evacuations via a few helicopters and boats, is also telling. While the grand jury trial dealt with only five patients’ deaths, of the 45 patients who died in the hospital during Hurricane Katrina, 23 of those tested positive for the same drug cocktail found in Emmett Everett. I find it particularly heartbreaking that some family members, who had stayed with their loved ones through the hurricane, were forced out of their rooms to join the lines of others waiting to leave when the large scale evacuation began and that when they left, their relatives were lethally injected. So no, Fink is not impartial, but its hard not to be.
This book evoked a lot of emotions in me. Hurricane Katrina was clearly an extreme situation, there was rampant miscommunication in the hospital itself, between hospital staff and Tenet Headquarters, and between both of these entities with LifeCare staff inside and outside the hospital, the National Guard, and other rescue personnel and organizations. However, this miscommunication and the extreme circumstances do not excuse what happened at Memorial and the decisions that were made leading up to the events on Friday: Tenet Healthcare was not prepared for the storm and its consequences and, when the hurricane hit, at first told Memorial that it was on its own and that it would have to coordinate its own rescue efforts. The staff in charge at Memorial refused to coordinate its rescue plans with the smaller LifeCare staff on the seventh floor and gave very little assistance in caring for LifeCare’s severely ill patients; Memorial staff also prioritized their own patients’ evacuations at the expense of LifeCare’s. In the beginning, Memorial staff agreed to evacuate its sickest patients first, then later changed their minds and began to instead evacuate able-bodied and healthier patients, leaving those who needed the most care in an overheated and overwhelmed hospital.
There was also the issue of some of the higher level staff at the hospital during the storm. The new cancer ward, which was connected to the old hospital by way of a glass, elevated walkway, was evacuated before the storm and its patients moved into the old wing. Afterwards, when the power failed, some high level Memorial staff discovered that the power in the newer building had not failed. Instead of being proactive and perhaps moving those patients who were severely overheated,sickest, or relied on mechanical ventilators into the cancer ward, with its working air conditioning and electricity, these employees instead used this building as a sort of rest zone, where they heated up their meals, charged their phones, and rested in the air conditioning. This to me was unconscionable and showed a severe lack of ability to consider and emphasize with the suffering of others, even when that was occurring right in front of them.
While none of the above made certain the deaths of those patients injected with sedatives by the doctor in question and others who assisted her, they did contribute to an environment where medicating patients in a manner known to speed up the approach of death possible. Those deaths, and the decisions detailed above, also do not make the hardworking staff who stayed during the hurricane, many voluntarily, or those doctors and nurses who were not aware of what was happening that Friday, and those who, upon finding out what had occurred, spoke out against those who had participated, and assisted in the investigation, any less worthy of our praise and respect. Something terrible happened at Memorial Medical Center during Hurricane Katrina, and many details are still unknown and many questions will never be answered. But many good things happened too, things that have been overshadowed due to the publicity of the bad. Nobody went to jail, or lost their medical license due to what happened at Memorial. The case is closed and what’s done is done. After Hurricane Katrina, Tenet Healthcare sold Memorial and it is now known as Ochsner Baptist Hospital. I think it’s better now to focus on the good things that did happen at Memorial, the lives that were saved, and those nurses, doctors, and hospital staff who did, and continue to do, what is right for their patients.
Five Days at Memorial was not a perfect book by any means, but I think it’s an important one that raises questions worth considering carefully. For this reason alone it was worth the read. The fact that I found it completely engrossing, well written, and just plain interesting was an added bonus.
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