Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

by Sheri Fink

“Heal Frequently, Cure Sometimes, Comfort Always.” It seemed obvious what he had to do, robbed of control over almost everything except the ability to offer comfort.

“We do not wish to capitalize the sufferings of human beings, but to relieve them,”

“It is only when service fails that any thought is given to the provision of means for improving it,”

“We need more viable patients,” the therapist heard a voice say in the dark. “Y’all can’t keep bringing patients like this

The effect of ICU treatment on quality of life should be considered.

For now the lessons seemed to be that in a disaster if you’re a doctor, you’re in charge. If you feel giving large doses of morphine and Versed are appropriate, go ahead. It’s your call. “Is this what we want young doctors to learn?” he asked. “It’s a goddamn precedent, a very dangerous, bad precedent.”

It was imperative to know how they would react under pressure, to learn that simply because people were medical professionals did not mean they would always act in the interest of their patients, whether from a self-serving motive or muddled thinking.

“How can you say euthanasia is better than evacuation? If they had vital signs, you could evacuate them…get ’em out. Let God make that decision.”

Emergencies are crucibles that contain and reveal the daily, slower-burning problems of medicine and beyond—our vulnerabilities; our trouble grappling with uncertainty, how we die, how we prioritize and divide what is most precious and vital and limited; even our biases and blindnesses.

New York planners published a protocol for rationing ventilators. The guidelines, devised by experts in disaster medicine, bioethics, and public policy, were designed to go into effect if the United States was ever struck by a pandemic comparable to the 1918 Spanish flu outbreak,

Setting out guidelines in advance of a crisis was a way to avoid putting exhausted, stressed frontline health professionals in the position of having to come up with criteria for making tough decisions

In Seattle, members of the public at large were concerned that using survival statistics to determine access to resources might be “inherently discriminatory,” the project report said, “because of institutional racism in the health care system; if some groups (e.g., African Americans and immigrants) do not receive the same quality of care, then their rates of recovery and other survivability measures would be biased.”

An earlier report also addressed DNR orders, saying they were not useful parameters of triage decision making in disasters.

“If you don’t plan, then you are less likely to be able to reuse, reallocate, and maximize the resources at your disposal, because you have people who’ve never thought about how they’d respond to those circumstances.”

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.

Life and death in the immediate aftermath of a crisis most often depends on the preparedness, performance, and decision making of the individuals on the scene.