Five Days at Memorial by Sheri Fink

  I have wanted to read this story for a long time, even more so after visiting New Orleans for the first time earlier this year. It is the story of what happened at Memorial Hospital during and immediately after Hurricane Katrina struck the city of New Orleans and the levees broke, and the resulting aftermath. Long story short, after Katrina hit medical personnel (mostly doctors & nurses), 100+ patients, as well as family members and pets of personnel and patients found themselves stranded at the hospital. They made it through the hurricane but then as everyone knows, the levees broke. The floodwaters rose, power in the building failed, the heat rose, and running water became a thing of the past. Help was slow in coming and was sporadic. Medical personnel made a decision about who should be evacuated first - the healthiest. As the days passed, another decision was made to administer what turned out to be lethal doses of medications to some of the patients. Later, after the waters receded and the city began to grapple with what happened criminal charges were brought against one doctor and two nurses for the second-degree murders of several patients.

For prosecutors the question in the case was did Dr. Anna Maria Pou and nurses Lori Budo and Cheri Landry administer morphine and other medications with the intent to hasten the death of certain patients or was their intent simply to ease patients pain? According to a grand jury, the answer was no. I would break this down into two questions: One, did they inject patients with drugs to hasten their death? Two, was that the right thing to do, or if not excatly right, at least justifiable and understandable given the circumstances? After reading Sheri Fink's account of what happened, my answer to the first question is an unequivocal yes. I don't at all believe Pou, Budo, and Landry were simply easing pain. In one case, a patient was given something like nine times the amount of morphine in a single doze that he normally received and he hadn't been complaining of pain. As to the second question, I don't know.

When something like this happens the people involved are either portrayed as heroes and villains, but in reality people are often a little both or maybe neither. One of the problems with portraying a story in black and white is that it leaves little room for nuance or for talking about what could be done better. Dr. Pou, Budo, and Landry are not villains as I see it, but nor are they unsullied heroes either. Perhaps better choices could have been made, but they did the best they could under the circumstances. That being said, it is bothersome that in the end there seemed to be no accountability for what happened. Dr. Pou and nurses Budo and Landry were not entirely forthcoming about what they did after the fact. (And, there was a fourth doctor that was never charged even though he also administered the lethal doses.) For legal reasons I get why those involved would be wary of telling the full truth of what happened. Still, I wish there could be a truth and reconciliation commission to discuss what they did, why they did it, and why the other doctors and nurses didn't intervene or speak up if they thought what was happening was wrong (or help if they thought it was right). Further, I wish the company that owned the hospital, especially the executives in charge, as well as state and local officials were held accountable for what they did and didn't do. One of the things that struck me in this story was how the possibility that New Orleans might be flooded was not a surprise to anyone. For decades that had been concern but few precautionary measures were ever taken.

"Forensic Expert Cyril Wecht did not care if Pou was punished. What he cared about was the truth and what could be learned from it. For heaven's sake, he thought, Memorial wasn't on a goddamn battlefield with enemy shells coming in. This was New Orleans, and there were helicopters and boats. And really, were they saying they couldn't get patients off the seventh floor? Given a choice, would someone rather die a painless death or live after being lowered, however uncomfortably, from a window? A great disservice was being done to the field of medicine, because the events were covered up and medical leaders reacted emotionally, without knowledge about what had happened. For now the lessons seemed to be that in a disaster if you're a doctor, you're in charge. If you feel giving large doses of morphine and Versed are appropriate, go ahead. It's your call. 'Is this what we want young doctors to learn?' he asked. It's a goddamn precedent, a very dangerous, bad precedent." [page 454]

Although I don't want to condemn the doctors and nurses involved in what happened in Katrina, I have to admit this book undermined my faith and trust in the American medical system just a little bit. So many decisions were made without talking to patients or their families even when it was possible. There didn't even seem to be consensus or a discussion among all the medical personnel present at the hospital. Rather a few people made a decision that effected many. But of course when there was a threat of criminal prosecution then all the doctors and nurses rallied together, leaving little room for a real discussion of how to make life and death decisions during a disaster. My biggest takeaway from Five Days at Memorial, and I mean this is all seriousness, is that if there is a major disaster, do not go to the hospital. The doctors and nurses might help you. They might not. Or they might take active measures to hasten the process of helping you "let go" (a euphemism used often in the book) because they have decided that your quality of life is poor enough to justify ending it, all without consulting you or your family. And the doctors and nurses will never have to justify their decisions, because unless one can prove they acted with actual malice it seems to be considered "unfair" to question the decisions of a doctor or nurse during a disaster.