Anyone who’s attended an introductory college course on philosophy will recall the fiendish ethical puzzles professors would occasionally present the class. They’d range from “Would you steal food for your family?” to the Trolley Problem to worse. Because the questions were all hypothetical, it was hard to commit to the premise. The ethical hypotheticals came to mind as I read Sheri Fink’s engrossing Five Days at Memorial. Five Days at Memorial recounts the week doctors, nurses, patients, and family members spent at Memorial Medical Center when Hurricane Katrina hit in August 2005. A week after the hospital was evacuated, 45 patients’ bodies were recovered. The first half of the book vividly describes the week of the storm and the evacuations; the second half is appropriately titled “The Reckoning” as investigators worked to find out what really happened at Memorial.
What happened at Memorial Medical Center during Hurricane Katrina began decades earlier—centuries earlier if you take climate change into account. After a brief prologue to give us a glimpse of the worst moments of post-storm panic, Fink takes us back to the late 1920s. Memorial Hospital—then Southern Baptist Hospital—was brand new when a huge storm flooded the city. Fingers of blame pointed at every possible responsible agency. Plans and proposals were drawn up to prevent the flood from ever happening again, but nothing was ever done. New Orleans kept growing. Memorial grew, too. It weathered storm after storm. After September 11, Memorial was charged with creating disaster preparedness plans along with every other hospital in the country. Months before the storm, Memorial staff went through a hurricane “worst case scenario” training.
Then Katrina hit. Memorial lost power when its generators (still in the basement, just like they were in 1926-1927) 48 hours after the storm battered New Orleans. Before long, the hospital was hot and dark. Patients, staff, and the people sheltering at the hospital suffered in the heat, growing increasingly panicked at reports of violence from outside. After the storm, as Fink portrays it, miscommunication and lack of communication, lack of infrastructure, conflicting orders from various authorities, just compounded the problems Katrina brought. Fink drives us relentlessly forward until the day—five days after Katrina made landfall—when several patients were apparently euthanized and the hospital was finally completely evacuated.
There are no villains in Five Days at Memorial—just people who made bad decisions. It’s tempting to try and apportion blame after the fact, but the truth is that none of us were there. We can’t know what we would have done in the position of the hospital staff. Along with all the other problems Memorial staff faced, the most difficult was evacuation triage. As Richard Simmons, Dr. Anna Pou’s lawyer, later found, there are no official guidelines to help doctors decide who gets out first. Should the sickest be evacuated first? They need the most help. Theoretically, the less sick and injured could hold on a little longer for help. Once Memorial lost power, doctors and nurses lost access to most of the equipment to keep the worst off alive and comfortable. But then, moving patients with advanced metastatic cancers, dementia, and so on might worsen their condition. Should doctors then evacuate the more mobile and less sick patients first because the sickest might not survive the move? Even at the best of times, triage and deciding who gets access to scant medical resources has brought out the worst in people. Fink writes:
Concepts of triage and medical rationing are a barometer of how those in power in a society value human life…Before livesaving kidney dialysis became widely available in the United States, some hospital committees secretly factored age, gender, marital status, education, occupation, and “future potential” into treatment decisions to promote the “greatest good” for the community. (139*)
The question of triage is a the heart of Five Days at Memorial.
There was so much panic and bad communication right after Katrina that some doctors and nurses believed (Fink is always careful to use the word believed rather than knew) that it might not be possible to evacuate everyone. Some feared that looters were moments from breaking into the hospital. They might have been risking their lives to care for people who would never get better, who were unwittingly preventing the doctors and nurses and staff from being evacuated themselves. With no one who had any kind of “situational awareness”—knowledge of the larger rescue and relief efforts—”The stress of the disaster narrowed people’s fields of vision, as if they wore blinders to anyone’s experience by their own” (154). One doctor “recognized Katrina’s shattering of the sterile, digital, odorless, dehumidified, gloved, and gowned illusion of mastery over death and suffering doctors typically maintained” (189). Katrina made conditions primitive and it made some people primitive, too.
As I read, I was disturbed at how language itself was warped. The phrases “take care of someone” and “make someone comfortable” became euphemisms so quickly. Some doctors and nurses were using “take care of someone” in the literal sense; others were using it in the mafia sense. One doctor, Anna Pou, was later quoted as telling patients that she was going to give them something to make them comfortable before allegedly giving them lethal doses of morphine and midazolam. (Pou was later acquitted of all charges of second degree murder and manslaughter.) The drugs can be used for patients in pain who need to be intubated, but too much will suppress breathing and kill. Over and over, doctors and staff are quoted saying that “no living patients will be left behind.” Depending on where one puts the emphasis, this phrase can either stir pride at the heroism of nurses and doctors or chill if patients are deliberately euthanized.
Five Days at Memorial is meticulously researched. Fink is able to show us emails written during and just after Katrina. She spoke with survivors from the hospital and read yet more interviews. In spite of this, the first half of the book has a large, perceptible gap in the narrative: Dr. Pou’s version of events. After the storm and its immediate aftermath, Pou was encouraged by Memorial’s parent company to get a lawyer when federal investigators tried to find out why there was such a high death rate at the hospital. We don’t know for certain what happened at the hospital. Five Days at Memorial is constructed from accounts that weren’t sealed by lawyer-client privilege. There will always be questions.
* Quotes are from the 2013 hardcover edition by Crown Publishers.