One-Minute Book Reviews

September 22, 2013

Sherri Fink’s ‘Five Days at Memorial’ – Fatal Choices at a Hospital Hit by Katrina

Filed under: Current Events,Nonfiction — 1minutebookreviewswordpresscom @ 12:47 am
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“What is the line between appropriate comfort care and mercy killing?”

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. By Sherri Fink. Crown, 558 pp., $27.

By Janice Harayda

If you’d like to read a horror story, you could pick up Stephen King’s just-published sequel to The Shining. Or you could brace yourself for this nonfiction account of the disasters that unfolded after Hurricane Katrina trapped more than 200 patients at Memorial Medical Center in New Orleans.

The scale of the calamities took on an alarming legal dimension when, a year after the 2005 storm, the Louisiana attorney general ordered the arrests of a doctor and two nurses suspected of having given fatal overdoses of morphine and a sedative to critically ill patients stranded at Memorial by floodwaters. The case was complicated by an ad hoc evacuation plan that the hospital staff had developed as the crisis intensified: The healthiest patients, doctors decided, would leave first when rescuers arrived. Two groups would go last: the sickest patients and those who had filled out Do Not Resuscitate orders — even if, as was true of 81-year-old Vera LeBlanc, a patient had filled out the form more than a decade earlier. The evacuation plan specified that patients who could walk would be among the first to board the Coast Guard helicopters and privately hired airboats that were arriving intermittently. And it meant that in the five days before the last person left Memorial, doctors and nurses had to make life-or-death decisions they might have avoided if they had received a timely rescue or if the hospital had followed the widely accepted medical protocol of giving the highest priority to the sickest patients and those whose lives depended on machines.

Faced with these realities, a grand jury declined to indict the arrested doctor and the New Orleans district attorney decided not to prosecute the nurses. But the situation raised lingering ethical issues that the physician-turned-journalist Sherri Fink explored in a Pulitzer Prize-winning article for the New York Times and the nonprofit website ProPublica. As Fink summarized them in the Times: “Which patients should get a share of limited resources, and who decides? What does it mean to do the greatest good for the greatest number, and does that end justify all means? Where is the line between appropriate comfort care and mercy killing? How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them?”

Fink explores those questions further in a book that is as important as it is repetitive and disorganized. Laura Miller has noted on Salon that parts of Five Days at Memorial read like a “notebook dump.” If that is perhaps too harsh, it suggests the lack of a cohesive point of view that might have unified a book for which the author says she drew on more than 500 interviews. Fink tells her story from multiple perspectives — among them, those of doctors, nurses, and relatives of patients who died while waiting to be evacuated. As she moves from the hospital that provides the setting the first half of the book to the legal proceedings that inform the second, she repeats facts and shifts gears imperfectly. Fink says five times that a patient named Emmett Everett weighed 380 pounds. And a long dramatis personae does not always prevent confusion about who is speaking or why someone appears in the book.

Amid the welter of viewpoints, Fink withholds her own except in an epilogue that deals with what doctors in New Orleans and elsewhere have learned — or not learned — about disaster relief.  Does she believe staff members at the Memorial committed murder or euthanasia? She offers only clues. In one of them, she gives the last line of her story to a grand juror who says she was convinced — and believed her fellow jurors were, too – that “a crime had occurred” at Memorial.

That is a remarkably tepid conclusion for a book about 45 deaths, more than a few of them suspicious. Unlike physician-authors such as Atul Gawande and Perri Klass, who merge elegantly their literary and medical identities, Fink seems to be groping for a voice. In the absence of one, she relies on the honorable journalistic tradition of looking for sources who express her views. But that approach works best when reporters structure their books in a way that leads to the clear and inevitable — if implicit – conclusion that is missing from this one. Few people can be better-informed than Fink on some of the urgent questions raised by Five Days at Memorial. As valuable as her book is, it might have been all the more so had she risked offering a few of the answers that she is uniquely qualified to give.

Best line: Fink notes that Charity Hospital in New Orleans had nearly twice as many patients as Memorial and faced similar challenges, including lost power and a lack of working plumbing, elevators, telephones and computers. But fewer than 10 people died at Charity while 45 did at Memorial. Charity did better, in part, because the staff continued to provide services like physical therapy and encouraged workers to maintain shifts and a regular sleep schedule: “This signaled that the situation was under some degree of control and kept panic to a minimum. There was an active effort to stem rumors. ‘You can only say it if you’ve seen it,’ staff were told.
“Perhaps most important, Charity’s leaders avoided categorizing a group of patients as too ill to rescue. The sickest were taken out first instead of last.”

Worst line: “Like many of the hospital staff around him, his professional association with what was now Memorial Medical Center” stretched back decades.

Published: September 2013

Read Fink’s Pulitzer Prize-winning article on how doctors at Memorial cared for patients during and after Katrina.

Jan is a novelist and award-winning journalist who spent 11 years as the book editor of The Plain Dealer. You can follow her (@janiceharayda) on Twitter by clicking on the “Follow” button at right.

© 2013 Janice Harayda. All rights reserved.
http://www.janiceharayda.com

February 15, 2012

Jesmyn Ward’s ‘Salvage the Bones’ – A National Book Awards Reality Check

A pregnant teenager faces several kinds of storms, including Hurricane Katrina

Salvage the Bones: A Novel. By Jesmyn Ward. 259 pp., $24.

By Janice Harayda

Jesmyn Ward writes in Salvage the Bones at a 10-year-old reading level – that of a student who is just starting the fifth grade – according to well-established measures of comprehension. That fact in itself isn’t a problem. Some of the most popular classics of American literature have the same reading level, including The Grapes of Wrath and The Old Man and the Sea. So do at least two other recipients of the National Book Award for fiction, which Salvage the Bones won in 2011: Tree of Smoke and Let the Great World Spin. To Kill a Mockingbird has a reading level of only a half grade higher.

But Salvage the Bones differs from most adult novels with relatively low reading levels in an important way. It also has a young narrator – a pregnant teenager named Esch who lives with her widowed father, her three brothers, and their pit bull, China, who is giving birth to a litter as the novel opens. The Batistes live in “the black heart of Bois Sauvage,” a rundown town set apart from white neighborhoods near the Gulf Coast of Mississippi, which Hurricane Katrina will destroy over the 12 days that give the novel its time frame. The family becomes caught up in a revenge tragedy in which Mother Nature punishes her children with a fury as unreasonable as that of Medea, whose story Esch has been reading in Edith Hamilton’s Mythology during the summer after tenth grade. Their tale tells us that motherhood is rational and irrational, tender and savage, a theme developed through the actions of Esch, China and Katrina.

It’s a task of alpine difficulty to hitch such a metaphorical load to a young narrator, almost a literary suicide mission. Even Harper Lee didn’t try it but told To Kill a Mockingbird from the point of view of an adult looking back on her childhood. Novelists who hope to create believable young narrators must invest those characters with the powers of observation needed to describe what they see and the wisdom to deal with it. That fact requires authors to become, in effect, faux-naïfs, writing as though they didn’t know much of what they do. The challenge is all the greater when an author intentionally or unintentionally limits the vocabulary, sentence structure and other elements that determine a reading level.

Ward brings large advantages to her work: intelligence, a respect for language, and first-hand knowledge of Katrina, gained while she was living in Mississippi. She knows how you kill a chicken by twisting its neck, how much meat you’ll have after you skin a squirrel (an amount “as thick as two pork chops laid together”), and how boys talk at backwoods dogfights, one of which gets 23 pages in her novel. She knows that if you’re poor, you prepare for a hurricane by covering windows with a wooden patchwork that leaves bits of glass exposed, not the custom-fitted boards of the well-off.

Salvage the Bones nonetheless has a hole at its center: Ward’s inability to create a narrator who sounds like a tenth-grader instead of an adult impersonating one. Esch says she slept with boys because they wanted sex, not because she did: “I’d let boys have it because for a moment, I was Psyche or Eurydice or Daphne.” Those words ring false not just because they are overwrought and imprecise but because they clash with others in the book. Esch says she started sleeping with boys at the age of 12, or in about the seventh grade. She read about the Greeks in Hamilton’s Mythology after the tenth grade. So she was having sex for three years before she knew of Psyche and Eurydice and Daphne. And are we to believe that wanted to feel like Eurydice stepping on a poisonous snake and spending the rest of her life in darkness after her beloved failed to rescue her? Here as elsewhere, the references to mythology hang on the tale like Spanish moss on a live oak. They may look pretty, but they grow on the story, not from within it.

Ward works hard to transcend the limits of telling the Batistes’ story in a young voice and at 10-year-old reading level. She weighs down her tale with similes and metaphors in duplicate or triplicate and lets you know exactly how you are supposed to feel about every character at nearly every moment. Esch says of Katrina, in one of many allusions to Medea, “She was the murderous mother who cut us to the bone but left us alive, left us naked and bewildered as wrinkled newborn babies, as blind puppies, as sun-starved newly hatched baby snakes.” That’s a metaphor and three similes in one sentence. Those figures of speech, at least, make sense. Esch says that cooked meat had “turned as brown and small with as many hard edges as a jewel” when the novel offers no evidence that she has seen a jewel. And Ward’s promiscuous us of color shows the limits of chromatic writing. Esch says that Manny, the father of her baby, had a face “marked with red sunburn.” Can’t we assume that sunburn is red? Apparently not. (Ward’s “red suburn” may be a clumsy attempt to signal that Manny is Latino or white given that black skin shows sunburn differently than white skin does.) Salvage the Bones has much, much more of this kind of writing.

All of this might have more of a payoff if the novel had larger ideas at its core. But Ward instead gives us belabored parallels to the Medea myth and bumper-sticker sentiments. “Bodies tell stories.” “Everything deserve to live.” “Everything need a chance.” Who could disagree with such lines? All the florid metaphors that surround them can’t elevate them. Leon Edel once said that Henry James, in his letters, could “disguise the absence of thought by the shameless gilding of his own verbal lilies.” Something similar occurs in Salvage the Bones. Journalists have called Hurricane Katrina “the mother of all storms,” and you may wonder whether Ward improves on it with her ponderous reminder: “Katrina is the mother we will remember until the next mother with large, merciless hands, committed to blood, comes.”

Best line: “Manny could dribble on rocks.”

Worst line: “She was the murderous mother who cut us to the bone but left us alive, left us naked and bewildered as wrinkled newborn babies, as blind puppies, as sun-starved newly hatched baby snakes. She left us a dark Gulf and salt-burned land. She left us to learn to crawl. She left us to salvage. Katrina is the mother we will remember until the next mother with large, merciless hands, committed to blood, comes.”

About the reading level of this book: The 10-year-old or fifth-grade reading level of this book comes from Perma-Bound, which sells books to school libraries. Other reading-level assessment tools confirmed it and ranked some passages in the novel at a level as low as third grade or age 8.

Furthermore: Salvage the Bones won the 2011 National Book Award for fiction and a 2012 Alex Award for “books for adults that have special appeal to young adults, ages 12 through 18.”

A reading group guide to Salvage the Bones appeared on this site on Feb. 15, 2012, in the post before this one.

Read more about the book or buy a copy from an independent bookstore in Ward’s area.

You can follow Jan (@janiceharayda) on Twitter by clicking on the “Follow” button at right.

© 2012 Janice Harayda. All rights reserved.
www.janiceharayda.com

January 21, 2010

A Victim of Hurricane Katrina, Then of FEMA

Filed under: Biography,Nonfiction — 1minutebookreviewswordpresscom @ 10:32 pm
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The story of a man who stayed in New Orleans when others left

Zeitoun. By Dave Eggers. McSweeney’s Books, 349 pp., $24.

By Janice Harayda

Like Infidel and A Long Way Gone, Zeitoun tells such an important story, you wish you could believe more of it. Dave Eggers gives a captivating if hagiographic account of the plight of Abdulrahman Zeitoun, a well-off Syrian-born painting contractor and landlord who refused to leave New Orleans when the mayor ordered a mandatory evacuation of the city during Hurricane Katrina.

As the book has it, Abdul Zeitoun stayed to look after his buildings when his wife and four children fled to Baton Rouge. Then he traveled by canoe through the flooded New Orleans streets, performing humanitarian acts such as rescuing trapped people and feeding abandoned dogs.

The Federal Emergency Management Agency was not impressed. More than a week after defying the evacuation order, Zeitoun was arrested. And he says his jailors refused to let him to make a phone call — to his wife or anyone else – and deprived him of other rights while implying that he belonged to the Taliban.

If all of this is true, it adds to the damning evidence of FEMA’s mishandling of Katrina. But Eggers writes from point of view of the Zeitouns, and their accounts are often self-serving or inconsistent. In one vivid incident, Zeitoun returns to check on dogs – no breed specified – that he had fed by crossing a plank bridge he rigged up between a tree and the house abandoned by the animals’ owners. He finds the pets dead: “The dogs were just under the windowsill, a tangle of limbs, heads to the heavens, as if they had been waiting, for weeks, for him.”

This scene, on first reading, seems heartbreaking. But it holds up poorly under scrutiny. Zeitoun casts himself as wholly innocent, but his repeated entry into a stranger’s house was – for however worthy a reason — tempting fate when the police were watching for and arresting looters. And the incident reflects questionable dog behavior. Eggers says that after feeding the abandoned pets, Zeitoun left a window open so they would have fresh air. Dogs can swim and leap out of windows. And Eggers gives us no reason to believe that the dogs he describes, in their desperation, wouldn’t have tried. Like much else in Zeitoun, the incident may have unfolded exactly as he says. Or it may be nothing more than a great story.

Best line: “This day he ventured closer to downtown, passing families wading through the water, pushing laundry tubs full of their possessions. He paddled by a pair of women pushing an inflatable baby pool, their clothes and food inside.” Zeitoun has many details like these that make you see life in New Orleans after Hurricane Katrina hit.

Worst line: “Laying on sweat-soaked sheets, he had a thought.” Was one of those thoughts: What’s that difference between “lie” and “lay” again?

Published: 2009

Furthermore: Eggers’s books include A Heartbreaking Work of Staggering Genius and What Is the What, a National Book Critics Circle Award finalist about the civil war in Sudan.

You can also follow Jan Harayda (@janiceharayda) on Twitter at www.twitter.com/janiceharayda. She satirizes American literary culture, including the book publishing industry, at www.twitter.com/FakeBookNews.

© 2010 Janice Harayda. All rights reserved.

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