In a world of 30-second news blips and catchy sound bites,
Five Days At Memorial: Life and Death in a Storm-Ravaged City offers an uncommon investigative expose. In her book, Sheri Fink, shines a light inside a hospital at ground zero of Hurricane Katrina. It was a natural disaster followed by a bureaucratic disaster. The forces of nature and human error collided into a horror where post-apocalyptic fantasies became reality on the grounds of New Orleans' most esteemed medical facilities.
Fink's story begins in the days before the hurricane hits. New Orleans' citizens are no stranger to hurricanes, and the medical staff at Memorial embarks upon their normal pre-hurricane routine. Doctors, nurses, and other personnel, flock to the hospital as they have done in all previous storms. The hospital, with its sturdy construction and back-up generators is a refuge in the storm. Hospitals are supposed to be built to withstand the most treacherous elements, as they are rarely evacuated when storms hit. The medical staff comes with their families, their pets, and coolers full of food in tow. This is standard operating procedure for Memorial. They have to let the families come - including the pets. If they did not, all qualified medical staff would be hightailing it out of the city with their loved ones.
This storm will be different. Katrina's deadliness was not simply in the strength of her winds, but in the flooding levees and the waters that raged throughout the city. The hospital's backup generators were on the first floor. Slowly they started shutting down, taking with them the life-force that many terminally ill patients depended on.
When Katrina hit, Memorial had an unusually high proportion of patients on hospice care. The Lifecare facility, which provided this type of care and operated as a hospital-within-a-hospital, had imported some patients from other facilities in the days before the storm. Four days in, the staff and volunteers are exhausted The heat, the stench of human waste, the hopelessness, and the fear of looters bear down on them hard. Helicopters are coming irregularly. There is no organization to the rescue effort. The hospital's execs, miles away in Texas don't want to foot the bill to charter a private helicopter company, so they leave evacuation to the overextended Armed Forces, who are flying day and night in the wake of the storm. These pilots are torn between rescuing premature babies from hospitals and desperate people off rooftops. All sorts of questions arise. Who goes first? The ones with the greatest chances or survival? Or the sickest? Where are they going? If they are seriously ill, will they receive appropriate care wherever the helicopter lands? Do we send the old? The young? What about the 300+ pound man that would be almost impossible to move up to the helipad?
They start by euthanizing the pets. I nearly cried. Not the dogs! The next step was clear. And somehow, killing sick people saddened me far less than killing healthy dogs. When I pictured the terminally ill Lifecare patients, lying hot, sweaty, wafting in and out of consciousness in their own vomit and feces, I really couldn't help but be glad for them. According to Fink, the order was given to inject the patients with Do Not Resuscitate orders. These patients were given a cocktail of sedatives that would lead to a quiet, peaceful, and somewhat dignified death, under the circumstances. But, as Fink points out, a DNR order only means that the patient does not want to be revived if his or her heart
stops beating. It does not mean they are signing themselves up to be sacrificed for the greater good. And, ironically, as the order was given Tenet executives were finally signing on with a private contractor to send in helicopters and evacuate the rest of the patients. By the time these round-the-clock airlifts were provided, there were significantly fewer patients to be airlifted.
The second half of the book deals with the aftermath of the tragedy. It largely centers around Dr. Anna Pou who, according to Fink, commandeered the euthanasia at Memorial. At this point in the book it is somewhat difficult to follow. There are a lot of attorneys, Tenet execs, doctors, patients, and nurses whose stories weave in and out of the book. While it is clear that Fink assumes Dr. Pou was guilty of euthanizing patients, I do not get the sense that Fink is entirely repulsed by Pou's decision. As I read the book, I found myself attributing most of the blame to the Tenet company itself, and to the hospital's shoddy disaster-preparedness plan. This plan seemed to have been made up from a standard template downloaded off the Internet. It is ridiculous to me that a hospital located below sea level would put its generators on the ground floor. And that is only one of the many failings in the bureaucratic mess that was Katrina. The medical personnel never should have
had to choose between life and death. This whole thing could have been easily avoided.
But they did. They felt, in the moment, that they had to choose. We know now that Tenet's contract with the private helicopter firm would have evacuated all the patients, but the doctors did not know that at the time. Communication was abysmal. What galls me, as one of the interviewees pointed out, was that Dr. Pou was arrested and put on trial while violent murderers and criminals roamed the streets of New Orleans. New Orleans has one of the highest per capita crime rates. Dr. Pou should not have been the priority for law enforcement. Even in the days following the hurricane, the city was plagued by looters. There are haunting stories of rapes and violence at the Superdome. But this doctor, if she was indeed "guilty" of administering lethal doses of sedatives, was forced to endure a long trial and a media frenzy because she was making, what she felt to be, the most humane choice in a disaster.
I know that life is sacred, and obviously doctors shouldn't be going around euthanizing patients without proper consent under normal circumstances. I know that most of my fellow Evangelicals, and religious people in general, stand firmly opposed to euthanasia. But I often wonder why. If we're the ones with the most hope for an afterlife, why are we so attached to keeping our lives here on this earth? If we truly believe we're not made for this world, that our earthly bodies are dying from the moment they are born, then why do we work so hard to stick around? Quite honestly, if I were a terminally ill patient at Memorial, I'd be asking for that cocktail! Get me out of this broken body ASAP! While it's true, that most of the patients at Memorial were not being artificially kept alive
at the moment (most of those who depended on ventilators, etc had already been evacuated), I wonder how many were still breathing only because advanced surgeries, expensive drugs, and high-tech equipment prolonged their physical lives months and years after they had lost all
quality of life. Do we ever use our advanced medical knowledge to
subvert God's will to take life? Is that possible to do? You often hear the anti-euthanasia set rail on their opponents for "playing God." But don't we play God every day by offering chemotherapy, cholesterol drugs, resuscitation, etc? Or do we assume that He's given us the knowledge and ability to prolong life so it's
always His will for us to use it? Are we
only supposed to use our God-given intelligence to artificially prolong life? Or are we allowed to use our knowledge to end life when it seems humane and appropriate? And personally, I wonder, is it wrong to want a Fast Pass into Heaven? I mean I would love to just bypass all the pain and suffering that comes with old age and death (pain and suffering that our drugs and technology often prolong). I don't want my body to outlive my brain - and with my genetics I'm a little afraid that's going to happen.
Don't get me wrong, I'm not against using medical knowledge/technology to prolong life and save lives - especially when there is hope for recovery. But at some point, I feel like we're not doing ourselves any favors. While I don't think it was
right for doctors at Memorial to make a decision without the consent of the patient or proxy, I don't exactly blame them either. At any rate, it does us cause to stop and ponder some of these end-of-life issues. Do we really want to be alive, but confined to a bed or a wheelchair? Perhaps, more practically, the book has given me impetus to think about making a living will (not that any of
that was followed at Memorial, but I'm going to hedge my bets on probabilities and assume I won't die during a natural disaster).
In conclusion,
Five Days At Memorial was a heavy, heavy book. Literally and metaphorically. It was quite long and chock full of information. It was easy to get lost. However, in the end, it made me think. It didn't leave me with any easy answers, but it forced me to take a look into the complex world of medical ethics and ponder its convergence with Divine intervention. Medicine is a realm I don't often ponder, and Divine sovereignty is a thing I don't really understand. But journeying into the unfamiliar and unknown, is, after all, the whole reason why we read.