Diane's Reviews > Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

Five Days at Memorial by Sheri  Fink
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it was amazing
bookshelves: medical, nonfiction, ethics, disaster

This book is a devastating account of what happened at a hospital in New Orleans after Hurricane Katrina hit in 2005. Sheri Fink spent years reporting on this story and her writing is strong, filled with grim details and dreadful scenes, but it needed to be told.

After the storm, Memorial Medical Center was flooded and lost power, stranding a large staff and nearly 200 patients, many of whom needed oxygen and ventilators to help them breathe. Due to communication breakdowns, a lack of emergency preparedness, and massive failures from both the hospital's owner and the government, rescue operations were slow and stalled, leading doctors and nurses to prioritize patients into groups of who would be rescued first, or at all.

"Nobody wrote it directly in a message, but some employees began to worry that the choice of which patients went out first could affect their medical outcomes. A realization dawned on Memorial's incident commander, Susan Mulderick, that day. The variability in the sizes of helicopters that were landing and the length of time it was taking to move patients to the helipad left her with one conclusion: not all of the patients would be getting out alive."

On the third day after the hurricane, the most critical patients — the ones who staff members didn't think could be evacuated and who had a slim chance of survival — were given drugs that would help ease their pain, and also helped them to die. Some called it euthanasia, others called it a necessary decision during an extreme disaster.

"In the days since the storm, New Orleans had become an irrational and uncivil environment. It seemed to [Dr.] Thiele the laws of man and the normal standards of medicine no longer applied. He had no time to provide what he considered appropriate end-of-life care. He accepted the premise that the patients could not be moved and the staff had to go. He could not justify hanging a morphine drip and praying it didn't run out after everyone left and before the patient died, following an interval of acute suffering. He could rationalize what he was about to do as merely as abbreviating a normal process of comfort care — cutting corners — but he knew that it was technically a crime."

The first half of the book provides almost an hour-by-hour account of what happened leading up to the storm and in the days following its landfall. It is a gripping, emotional read, and the situation is horrifying. With no power or running water, conditions worsened inside the hospital -- it was hot and humid, the only light came from flashlights, and there was an overpowering smell of urine and feces because the sewers were overflowing. The staff described it as a hellish war zone and as a place that no longer seemed like America. There was also a fear of looters and of violence breaking out amidst the chaos, and gunshots were frequently heard outside the hospital. Doctors tried to prevent panic from spreading, both among the patients and among the staff. It was difficult to read this section without frequently pausing to come up for air, both out of sympathy for those who suffered and frustration for how the hospital (and the city) could have been better equipped and prepared.

The second half of the book, called The Reckoning, focuses on the investigation into the patient deaths. One doctor and two nurses were eventually arrested, but charges were later dropped due to a lack of evidence, overwhelming public and political support for the workers, and criticism of the lack of preparedness and support from the government: "The issue of larger responsibility and blame, regardless of whether it would be admissible in a court of law, was on many people's minds. Individual decisions at the hospital had occurred in a context of failures of every sort. Since the storm, government agencies, private organizations and journalists had churned out reports that analyzed and found fault with actions and inaction at nearly every level of every system."

Fink's epilogue highlights the lessons learned, if any, from what the hospitals in New Orleans faced after Katrina. Fink compares the situation to what happened after the earthquake in Haiti and when Hurricane Sandy hit New York City. In both cases, health care workers had to make tough choices about who would get access to limited medical resources. Fink's reporting is alarming because it addresses the issue of how many hospitals and other medical facilities have their generators in the basement or on the ground floor, which can become useless in event of flooding. Similarly, not enough has been done to plan for emergency situations, such as a massive flu outbreak or another natural disaster. "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. It is hard for any of us to know how we would act under such terrible pressure."

I hope this book inspires some good discussion and decision-making about emergency preparedness and the moral dilemmas of triage. Who gets priority medical care when resources are limited? What else can be done to plan for disasters? I would highly recommend the book to health care professionals, first responders, those interested in bioethics, and anyone who appreciates excellent reporting.
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Reading Progress

September 7, 2013 – Shelved
September 30, 2013 –
page 10
1.79% "AMAZING prologue. This book is going to be incredible."
October 1, 2013 –
page 48
8.6% "This book on the aftermath of Hurricane Katrina at a New Orleans hospital is great so far. It brings up tough issues: "There were deeper, more unsettling questions. How now to define death? When was it permissible, even right, to withhold or, more wrenchingly, withdraw life-sustaining care?""
October 1, 2013 –
page 106
19.0% ""Nobody wrote it directly in a message, but some employees began to worry that the choice of which patients went out first could affect their medical outcomes ... The variability in the sizes of helicopters that were landing and the length of time it was taking to move patients to the helipad left one conclusion: not all of the patients would be getting out alive.""
October 27, 2013 –
page 118
21.15% "This book is so disturbing. It's Day 4 after Hurricane Katrina and conditions are dire in the hospital. There is also confusion about how to handle evacuations. One nurse said: "With these people in charge, we may very well die here.""
November 29, 2013 –
page 137
24.55% "A Memorial administrator explained that the hospital was in survival mode now, not a treating mode. "Do you just flip a switch and you're not a hospital anymore?" one family member asked."
Started Reading
November 30, 2013 –
page 162
29.03% "This book about Hurricane Katrina is devastating. Doctors and nurses have to decide which patients will be first to be rescued and which will probably end up dying while waiting."
November 30, 2013 –
page 179
32.08% ""The hunger, the anger, the rage is growing among people who have nothing,and if they have nothing they get violent and they get angry. Basic jungle human instincts are beginning to creep in because they lack food, they lack a decent environment, a shelter." --Jefferson Parish president Aaron Broussard, appealing to the government for more military police after Hurricane Katrina"
November 30, 2013 –
page 348
62.37% ""Life and death in the critical first hours of a calamity typically hinged on the preparedness, resources and abilities of those in the affected community...Those who did better were those who didn't wait idly for help to arrive. In the end, with systems crashing and failing, what mattered most and had the greatest immediate effects were the actions and decisions made in the midst of a crisis by individuals.""
November 30, 2013 –
page 422
75.63% "Politics are as poisonous as a drug."
November 30, 2013 – Finished Reading

Comments Showing 1-10 of 10 (10 new)

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message 1: by Cheryl (new)

Cheryl Wow, what a gripping story. Just reading the snippets from your review is chilling. So the book covers a span of five days I take it?

Diane Cheryl, the first half of the book covers five days at the hospital during and after the storm. The rest of the book is about the investigation and what's been learned since 2005. It is a gripping read!

message 3: by Cheryl (new)

Cheryl Ahh, yes, "The Reckoning."

message 4: by Ted (new)

Ted Hopefully lessons can be learned from this by people at all levels of governance. I must admit however that I'm not very optimistic. Rather than the Katrina experience becoming a turning point towards better preparedness and better emergency management, it may be just the first chapter in what has been termed by James Howard Kunstler The Long Emergency.

Or perhaps, if it becomes partially the latter, it can also be partially the former.

message 5: by Samadrita (new)

Samadrita Sounds like a harrowing book. Gripping review!

message 6: by Lance (new)

Lance Greenfield Wow! Powerful stuff!

When I hear, on the newscasts, professionals talking about "lessons learned" and "we must ensure that nothing like this happens ever again", I automatically transpose that into "lessons which should be learned, which will be filed away for next time it happens, when we'll trot out exactly the same phrases because it happened again."

Call me an old cynic if you like, and I hope that I will be proved wrong.

message 7: by Margitte (new)

Margitte Amazing!!! I hope this book will attract all the attention it deserves. It is horrifying. But I feel sorry for the staff who had to make those terrible choices due to proper support. It is just shocking!

Diane Thanks, Samadrita!

Lance, one of the problems, as you probably already know, is that true disaster preparedness usually involves public support for a tax increase or a bond issue. Trying to get those things pushed through the political process is often where emergency planning falls apart. The author addresses this issue by referring to previous hurricanes and flooding problems that New Orleans has faced, but by the time the tax or bond issue is on the ballot, the public has lost interest and doesn't support it. It's very frustrating to read about.

Diane Margitte, yes, I also hope that more people read this book and that it will help get some emergency issues addressed.

message 10: by Jennifer (new)

Jennifer Latham I am currently reading this book and find it fascinating for many reasons. First, I think Sheri Fink's writing is amazing and her investigation was thorough. Second, I really appreciate that this account presents both sides of a very controversial issue. That is not easy to do well. Third, this book brings to light what a lot of people may not remember or even know. Hurricane Katrina brought about a lot of destruction but it was really the subsequent flooding and lack of a plan to deal with that flooding that sent everything in to a tailspin.

I am fascinated by this book and read a few pages every day. I wish it was longer!!

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