“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.