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Sun September 8, 2013
Book Reviews

'Five Days' Of Ambiguous Morality At Katrina-Hit Hospital

Originally published on Sun September 8, 2013 5:26 pm

If we didn't experience Hurricane Katrina ourselves, we saw it: the ominous red pinwheel on the radar, the wrecked Superdome, the corpses. And certainly we saw our shame — America's inequality, negligence and violence were all laid bare by the storm.

But one tragedy went largely unwitnessed. And this is the subject of Sheri Fink's provocative new book, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. The Pulitzer Prize-winning writer examines what happens when people make life-and-death decisions in a state of anarchy.

On Aug. 29, 2005, Hurricane Katrina made landfall as a Category 3 storm. The windows at New Orleans' Memorial Medical Center shattered. But the facility itself remained functional. The staff exhaled. Wow. "We dodged a bullet," they said.

Then the levees broke. Memorial's back-up generators were located at ground level.

As floodwaters poured into the streets, the building was plunged into darkness. Life-support systems shut down; temperatures rose; food and medicine dwindled. Gunfire could be heard outside. Tenet, the corporation that owned the hospital, had no evacuation plan. Hospital staff repeatedly sent desperate emails: "WE NEED PATIENTS OUT OF HERE NOW!" "Please can you take patients." "Is anyone out there?"

When the answer finally came, it read: "We have been told getting into the city is not going to happen. Have you contacted the National Guard?"

Tenet's corporate negligence, Fink suggests, bordered on criminal.

Some staffers became convinced that the most critical patients would not survive. One of these believers was Dr. John Thiele. Fink writes, "[Thiele] had no time to provide what he considered appropriate end-of-life care ... He could not justify hanging a morphine drip and praying it didn't run out ..."

And so Dr. Thiele assisted another doctor, Anna Pou, and several nurses, doing what they believed was the only ethical thing left. They injected the most critically ill patients with lethal doses of morphine and sedative.

Eleven months later, as New Orleans staggered back to life, Dr. Pou and two nurses were arrested and charged with "principal to second-degree murder."

The public was largely outraged over the arrests. It was the Tenet corporation, the government and overall leadership that should have been put on trial.

And in 2007, a grand jury agreed.

But Five Days at Memorial is more nuanced in its judgment. Fink describes not only the exhausted, dedicated medical staff, but also the once-vibrant and beloved patients who died in their care. Yet she refuses to weave all the threads of her story into one neat polemic — which is sometimes as frustrating as it is admirable. If she lays blame anywhere, it's on the for-profit health care company.

Five Days at Memorial may be fair and balanced to a fault, for ultimately, it provokes more debate than it answers. The book is neither definitive nor palliative. Perhaps, Fink is suggesting, nothing is — or should be.

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Transcript

JACKI LYDEN, HOST:

Eight years ago this week, the nation was still struggling to comprehend the devastation Hurricane Katrina had caused: scores of displaced people, entire neighborhoods wiped out. The scale of the destruction was shocking. In a new book, author Sheri Fink documents the destruction in a microcosm affected by the storm. She tells the story of what happened at one New Orleans hospital. Author Susan Gilman has this review of Fink's book, "Five Days at Memorial."

SUSAN JANE GILMAN: The windows at New Orleans Memorial Medical Center shattered, but the facility itself remained functional. The staff exhaled - "Wow, we dodged a bullet," they said. Then the levies broke. As floodwaters poured into the streets, the building was plunged into darkness. Life-support systems shut down; temperatures rose; food and medicine dwindled. Tenet, the corporation that owned the hospital, had no evacuation plan. Hospital staff repeatedly sent them desperate emails: We need patients out of here now. Please, can you take patients? Is anyone out there?

When the answer finally came, it read: Getting into the city is not going to happen. Have you contacted the National Guard? Tenet's corporate negligence, Fink suggests, bordered on criminal. Some staffers became convinced that the most critical patients would not survive. One of these believers was Dr. John Thiele. Fink writes: Thiele had no time to provide what he considered appropriate end-of-life care. He could not justify hanging a morphine drip and praying it didn't run out.

And so Dr. Thiele assisted another doctor, Anna Pou, and several nurses; doing what they believed was the only ethical thing left. They injected the most critically ill patients with lethal doses of morphine and sedative. Eleven months later, Dr. Pou and two of the nurses were arrested. The public was largely outraged over the arrests. And in 2007, a grand jury agreed.

But "Five Days at Memorial" is more nuanced in its judgment. Fink describes not only the exhausted, dedicated medical staff but also the once-vibrant and beloved patients who died in their care. Yet she refuses to weave all threads of her story into one, neat polemic. "Five Days at Memorial" may be fair and balanced to a fault for ultimately, it provokes more debate than it answers. The book is neither definitive nor palliative. Perhaps, Fink is suggesting, nothing is - or should be.

LYDEN: The book is called "Five Days at Memorial," by Sheri Fink. Our reviewer is Susan Jane Gilman.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.