Five Days at Memorial Discussion Thread

Five Days at Memorial by Sheri Fink is a book that generates many emotional and intellectual responses, and, for those of us who are not reading the book as part of a book club, I thought it might be nice to have a place to discuss the book and our thoughts about it.

Sheri Fink won the 2010 Pulitzer Prize for Investigative Journalism for her piece Her biography on the Pulitzer Prize website reads as follows:

Dr. Sheri Fink has reported on health, medicine and science in the U.S. and from every continent except Antarctica. Before joining ProPublica, she was a frequent contributor to the public radio newsmagazine PRI’s “The World” covering the global HIV/AIDS pandemic and international aid in development, conflict and disaster settings. Her articles have appeared in such publications as the New York Times, Discover and Scientific American.

Fink’s book, War Hospital: A True Story of Surgery and Survival (Public Affairs, 2003), won the American Medical Writer’s Association special book award and was a finalist for the Overseas Press Club and PEN Martha Aibrand awards. Fink received her M.D. and Ph.D. from Stanford, and worked with humanitarian aid organizations in more than a half dozen emergencies in the U.S. and overseas. She has taught at Harvard, Tulane and the New School. Most recently Fink was the recipient of a Kaiser Media Fellowship in Health from the Kaiser Family Foundation.

History of Memorial Hospital:

Darryl, would you mind if I posted the historical part of your review here?

Links to additional information:

Incident at Memorial

Tenet Statement Concerning Memorial Medical Center (September 13, 2005)

Times-Picayune coverage

Dr. Anna Pou

60 Minutes: Was It Murder?
Doctor, Two Nurses Were Accused Of Murdering Patients (September 24, 2006)

Ethics of Rationing Healthcare

The complete series website for "Rationing Health" on PRI's The World

Other Articles by Sheri Fink

NYT: A Queens High Rise Where Fear, Death and Myth Collided (December 19, 2012 - after Hurricane Sandy)

PRI's The World: Doctors Face Ethical Decisions in Haiti (February 23, 2010)

I know the book left me with lots of questions. I listed a few here to get us started. Please feel free to respond to them or make your own comments or post your review.

How significant a role did the media play (and their false report of martial law) in the decisions that were made at Memorial? Should the media have to be accountable for wrong information?

Do you think the $25 million that Tenet put in a pool to settle the class action suit was sufficient? Who do you think should have received that money? Dr. Pou, for instance, received over $2,000 per day.

The route chosen to get to the helipad was difficult; there was an easier way from the seventh floor. Do you think it would have made a difference if that route had been thought of at the time? Or was it more complex than simply a difficult route?

Why did the babies on ventilators make it out, but not the elderly? Was it a conscious decision or the matter of individual decisions?

Who were the heroes in this story? Who is to blame?

Why did Charity Hospital have such a different experience, despite similar conditions? What factors made the difference?

Disasters happen every day, around the world. Why, with plenty of clean water, food, and medicine did things go so wrong in such a technologically advanced place?

What are the takeaways from this experience? Do you think they are being implemented?

What do you think of Dr. Pou's successful attempts to prevent doctors from being prosecuted in future disasters?

Why do you think the medical profession "closed ranks" according to the author?

How has this book effected you personally?

Just popping in to thank you for creating this thread. I'm going to think a bit and post in the morning when my brain works.

Hi Lisa! Thanks. I'll be back!

Hi Lisa,
Thanks for setting up a thread for us!

I think I'll be answering one (or more) of your questions with these comments:

I am particularly intrigued by the differences in outcomes between Memorial and Charity Hospitals. Based only on information provided by Sheri Fink (I've not read anything else - yet), it appears that effective and calm leadership may have made a huge difference. One thing that quite got my attention was that the leaders at Charity held regular meetings of all staff and volunteers to share information, provide directives, and guide decisions. In addition, it sounds like the leaders at Charity were aware of the potential damage caused by rumors and inaccurate information. Their directions to staff and volunteers not to engage with rumors ("if you didn't see it, you can't say it") might have been huge in controlling the emotional climate.

This second point harkens back to your first question regarding the media. It wasn't entirely clear to me where people were hearing rumors, but it does seem that the media played a role in the chaos in NOLA immediately following Katrina's landfall. I am, frankly, censorious of irresponsible (hasty) journalistic reporting so I think they hold some responsibility. I'm not saying they (who?) should be prosecuted, but journalistic ethics demand some fact-checking and I'm not sure that is what happened in NOLA during those days.

Still, at the risk of sounding self-contradictory, I also think it's very hard to lay blame after the fact and when none of us was experiencing what they were experiencing (here I am talking about the docs and nurses in the hospital, not the media). I appreciated the author's compassionate tone for doctors and nurses in a horrific situation. I also appreciate that she doesn't let them off the hook for what appear to be some basic decision-making errors. Why not identify the alternate route to the helipad? A calm meeting with the determination that someone needed to do some reconnoitering might have helped. Yes, we're in a crisis. Yes, this is awful and we're all terrified. So, let's take the time to find out what we're up against and what our options are. This might have also led to the recognition that there was, in fact, clean water to be had (although I was struck by the doctor's later saying that he let himself get dehydrated because he didn't want to use the filthy loo).

One more point from me for now. In my work, we make judgments every day that involve risk management. We make decisions regarding care of suicidal clients and they are almost always in the gray area. Our most important tool in making these decisions is consultation with one another. I tell my staff repeatedly: we can't be 100% certain that what we're doing is "the best" thing to do. But we will always make better decisions when we consult with one another. I believe this deeply. If Anna Pou had overtly engaged in consultation, similar decisions might have been made. And, if they had, there would have been so much more clarity about why those decisions were made. I tend to believe that others can be fair in evaluating our decisions if they understand the basis on which we made them and are assured that we took the decisions very seriously. It appears that a lot went unspoken, especially on that Thursday.

Whew! I don't think I realized I had so much to "say" about this!

Thank you, Ellen, you make some very good points. We are just sitting down to dinner, so I will have to come back, but I wanted to thank you for starting off our discussion with a great post.

7 Excellent points! The book left me with very mixed feelings -- empathy for what the health care providers were going through, but a strong feeling that things weren't handled as they should have been. I think a lot of blame goes to officials of Tenet health care system for wanting to depend upon government rescue resources rather than mobilizing helicopters from within their system. They just seemed clueless as to the scope of the disaster.

I definitely had some sympathy for Dr. Pou and how the situation would have affected her judgment, until I saw the accounts of her words and actions AFTER the disaster was over. There seemed to be a shortage of honesty and an over-abundance of self-serving posturing. A little humility would have been nice.

Radio interview from last month with Sherri Fink about her book:

http://www.cbc.ca/player/Radio/The+Current/Full+Episodes/2013/ID/2423387283/?pag...

One of the differences between Charity and Memorial is that Charity is a local publicly owned charity hospital, as well as a teaching hospital for Tulane Med. School and LSU Med. School. Memorial is private, and was owned by an out-of-town private business (Tenet), which if I recall also owned the nursing home whose patients (located in Memorial because of the seriousness of their illnesses) were the majority of those who died. I read the book a while ago, but I think I recall that a great deal of confusion was caused by the upper management (not on site--not even in NO) issuing conflicting orders, or none at all. During much of the 5 days, the staff at Memorial was waiting for the corporate owner to send rescue boats or helicopters or whatever--and these were not sent.

The two hospitals are located in very different places too. Charity is right downtown, and although the area flooded, it is on higher ground than Memorial, and is fairly close to areas that did not flood at all. I also assume that the Charity area probably drained a lot faster, and would have been more accessible even while flooded. I'm guessing that there were a lot more resources concentrated downtown. And don't forget all those young medical students available to carry patients to the roof and otherwise assist the staff.

Memorial is located in a residential neighborhood
"uptown" in an area that is very low, and notoriously floods even in an ordinary thunderstorm. (Arguably this should have made them more prepared, perhaps.)

All of this is not to excuse the mismanagement at Memorial. I just wanted to point out that there were other things affecting the differences in outcome.

Or maybe this was just an instance in which government handled things better than the private sector.

I followed the news reporting of the homicide investigations, and at the time, based on what I knew, I thought that the actions of the doctors and medical staff were entirely reasonable. When I read the book, however, I had several concerns. First, while the patients in question had terminal illnesses, not all of them were on death's door, and they could have continued to live for an indefinite period. Relatives of some of the patients who had sat with the patients through all the days of waiting were told to go on to the rescue boats and that staff would care for getting the patients out. It was almost immediately after these relatives, having been reassured, left, that the drugs were administered. It also disturbed me that the rescue helicopters had arrive in force when the mercy killings took place, and I don't understand why these actions suddenly became necessary. I also recall that it was at least implied that the staff was reluctant to attempt to move one of the patients who was extremely obese for that reason alone. Some of the patients were alert enough that clearly their consent should have been sought (and obviously the relatives should have been consulted and concurred).

I admire all these medical professionals, and I think they acted bravely and selflessly throughout the five days. Although I don't think any of them should be prosecuted, I remain very puzzled by why they thought it necessary to take these actions, without advising relatives and patients and receiving consent, and at a time when the emergency was winding down.

>11 arubabookwoman:, 12: Very good observations, Deborah. I share some of the concerns that you raise in #12. It's not entirely clear that the docs knew the emergency was winding down, but it does seem like their decision making was fuzzy.

Deborah, I was discussing this book with my father, who had a good friend who was a hospital CEO. He agrees largely with you, finding a big part of the problem was with the hospital being part of a for-profit company, which was reluctant to spend money to get rescue out to Memorial immediately.

I saw a lack of leadership from the CEO and executives who were at the hospital through Katrina and afterward. Instead of leading, they stayed in the one air conditioned area with power, waiting in relative comfort. Their lack of leadership as well as the lack further up the ladder did much to contribute to the results.

I found Pou to be problematic. I think she was reacting as best she could in terrible circumstances. That her actions were not ideal or even necessary is something that someone sitting comfortably outside of her circumstances can see, but I don't think she should have been targeted. I think there should have been a more sensible discussion afterwards, but I do understand how emotive an issue this is -- I spent much of my time while reading this book angry.

But to upend the idea that the sickest and most vulnerable should be the first evacuated is the wrong conclusion, in my opinion. Charity evacuated the sickest first and had dramatically fewer deaths. Shouldn't that be shown to be the more effective procedure? Pou seems to have doubled down on her decision and comes across in the book as defensive. I'd probably be the same, but I don't think she's the best person to determine future policy. She did her best under terrible circumstances, but she's a cautionary tale rather than one of excelling under pressure.

^ I agree, but I was struck by Fink's articulation of some of the modeling that has been done with regard to who gets evacuated first, who receives care first, etc. It makes sense to me to evacuate the sickest first, and I'm also willing to concede that there are always so many factors, some of which we can't see. Lack of leadership at many levels, emotion-based decision making, and lack of constructive consultation during the crisis: All contributed.

#11 The two hospitals are located in very different places too. Charity is right downtown, and although the area flooded, it is on higher ground than Memorial, and is fairly close to areas that did not flood at all. I also assume that the Charity area probably drained a lot faster, and would have been more accessible even while flooded. I'm guessing that there were a lot more resources concentrated downtown. And don't forget all those young medical students available to carry patients to the roof and otherwise assist the staff.

Actually, according to Fink, the circumstances were not dissimilar. In fact, it took Charity one more day to evacuate than Memorial (until Friday instead of Thursday), perhaps because they had no helipad. Charity too was flooded, lost power/plumbing/computers/telephones/elevators. They also had twice as many patients and a lower staff to patient ratio. Only 3 patients died.

"Doctors said that staff continued to provide medical care to patients in their rooms until the end, despite similar or even worse conditions of existential threat, including a gunman reported to be on a nearby roof, disrupting the evacuation, and the presence of more than a hundred psychiatric patients inside. People urinated on stair landings. Convoys attempting to reach the hospital over water were reportedly shot at and looted. news reports suggested the hospital had been evacuated when it hadn't. Soldiers had brought additional ventilator-dependent patients to the hospital." p. 379

Edited to fix typography.

Like Kay, I was angry while reading the book. So many poor decisions were made. Like why stop giving patients their routines medicines and IVs two days in? They had the medicines, but nurses were actively stopped from giving blood pressure medicine, pain meds, etc and starting IVs. They were told they were in "survival mode". What kind of a decision is that? At Charity they kept people in their rooms and continued all their routine care, which not only prevented patients from declining, but also helped prevent panic. Staff were kept to their schedules with regular rest periods, no 1-2 hour of sleep per night like Pou. Depriving people of routine care is almost as criminal as euthanizing them, and probably contributed to their decline, leading some to think they were unsavable.

One thing that brought tears to my eyes (in a good way) was the actions of the neonatologist, Dr. Juan Jorge Gershanik, who fought with the hospital staff and with pilots until he got all the babies out, including one he bagged the whole way, because the incubator wouldn't fit in the helicopter. And bagging a preemie (and changing an o2 tank) in the dark with no oximeter to tell you if you have the o2 levels right is no mean feat. It was a nightmare, but every single one of those babies survived thanks to him. (p. 93-96)

One of my takeaways was definitely: "In a crisis, try to keep as much routine as possible. And get rest. Don't go into heroics mode unless it's clearly needed in the moment."

I think the getting the babies out was a good example of heroics mode and it worked.

Sharing a quotation from Chocolate Wars:

"The problem with the way we have developed our system of shareholder capitalism is that the shareholder is being divorced from his role in ownership," explains Sir Dominic Cadbury, the last family chairman.

and of course the CEOs. Trying unsuccessfully to remember the book a couple of years ago about CEO mental diagnosis - mostly narcissistic.

Well, then there is the Ronson argument that CEOs are 4 times more likely than most people to be psychopaths.

Thanks everyone for contributing here and thanks for the links to interviews etc. I just finished the book and it was a very interesting read.

Hi, Mary, welcome. So what are your initial thoughts/reactions?

Hi Lisa,
I rarely do a review but I did one for this book. I was fascinated and riveted. It was such an extreme circumstance. It was perplexing as some fundamental questions about why the doctor and 2 nurses did such a thing were never answered and that there was so much community support for them too afterwards, I never got that figured out either. It looks as if these questions will never be answered. It was such a devastating situation and I thought very well written to try and explain everyone's point of view and the complexity of analysis and the time involved in the follow up. It must have been so awful for all involved. But I did not think that Fink's point of view was neutral as some of the reviews have pointed out. It was good to read the epilogue and see that people are trying to grapple with conversations around the potential for medical limitations in future crisis situations. The thing that I thought could have been developed more was the complete lack of leadership from the administrators and their unconscionable aloofness and self interest for their own comfort. Yes, I agree with you the stopping of medical routines on day two just made no sense. So is this a story about heart of darkness?

Ridgewaygirl, I'm not sure the decision to leave the sickest patients til last was made for the correct reasons, but since Tenet was not doing their part in the evacuation, the patients were being left on highway exit ramps for days or at the very best, the airport. I was unclear how the babies got placements but few of the other patients were. The sickest were safest at the hospital, well, until they weren't.

I think Fink really dropped the ball by not focusing on the hospital administrators safe and comfortable in the adjacent building. Who were they? Why were they not taking responsibility and/or interfacing the Corporate HQ? Did they even realize what was happening in the hospital itself? Granted, since Fink told us so little (and since my copy has been returned to the library so I can't check), it could be that these were mid level administrators who had no muscle, but still that area should have been used for the sick.

Teresa, the executives at the hospital through the ordeal included the CEO for the hospital and the executive who would go on to be the next hospital CEO. I agree that very little emphasis was put on their role in the disaster. Fink did point out that there seemed to be a disconnect -- these guys seemed to think that they had no responsibility and went through some sort of endurance test. It was mentioned that they reclined in the chemotherapy chairs, watched tv and ate chicken soup, but that the CEO graciously made coffee for the nurses at some point. And this is where my own bias shows, because the few paragraphs mentioning these supposed leaders made me madder than the larger faults of people further up the line or down the line.

You make a very good point about how the people involved were worried about the fate of the patients further down the line. A seriously ill patient would have had a difficult and painful death if left on a freeway on-ramp to fend for him or herself. Even the patients delivered to the airport at the end were not being given the best care.

I think that Tenet Healthcare escaped accountability.

Lisa, would you like me to add this thread to the Theme Reads and Group Reads section on the main group page?

That would be nice, thank you, Rebecca.

Done!

I'm only halfway through the book so far but was thrilled to see this conversation thread. When I'm done with the book (it's all I'm reading so it should be in a few days) I'll come back and read more and look at those links.

My own personal reaction is hard to express fully but one thing that has come clear to me and I hope will stick with me that in times of crises/disaster whether natural or otherwise the sick and elderly really are vulnerable. Not just those who live alone independently but also those who are in a rest-home or hospital and it can't be assumed that they will be ok and looked after.

I'm listening to the book as an audiobook and have finally reached a point where I felt like I could join the discussion here. What a gripping read. I am so impressed by the remarkable work that Fink has done in synthesizing together such a diverse and untraditional collection of sources. She perfectly captures the sense of tunnel vision and isolation that the residents of Memorial almost certainly experienced by repeatedly highlighting how they had no idea what conditions elsewhere were like, where many of the evacuees were going, and what was true or false from the huge body of rumors that they were hearing.

So far I am both impressed and saddened by the actions of the medical professionals at Memorial, who seem to simultaneously have gone to extraordinary lengths to care for patients and written off patients as untreatable or expendable.

It is also amazing to me to realize that the hospital had largely survived through the actual storm itself and that it was only after the storm had passed that things got really bad, with the post-Katrina flooding. I confess that I don't live in an area that experiences any sort of extreme weather and have very little sense of how hurricanes typically "work." I had not realized that most of the really dire actions had been taken at the end of the five days that the title alludes to.

Thank you Lisa for setting up this thread and for all of the additional information links at the top. I know so little about Hurrican Katrina and remember even less, so I really appreciate the supplementary material, which I will definitely be diving into because this is not a story that I was even aware of until this book started getting publicity.

Thank you, Lisa and Fanny, for joining our conversation. I finished reading the book almost a month ago, and I'm still processing. My emotions flare up unexpectedly. For instance, when I heard about Darryl moving into the hospital for two days knowing that bad weather was coming, and then not being relieved for 51 hours because no one else had planned ahead, I was thinking "how could we not have learned?"

I'm still angry and frustrated and saddened. I don't know that I have any answers as to how to ensure that hospital and nursing home staff are better trained in disaster planning, given the economy and public opinion which only seems to care after the fact. But I think about the weather we have had this winter: warm in Alaska and Canada; avalanches in Colorado; frigid temperature in the upper Midwest and New England; significant snow in Atlanta, not once but twice. Tsunamis, hurricanes, blizzards. I think a piece of the climate change conversation needs to be not only about stopping global warming, but how to handle the problems we have already created. But where is the money and the mandate going to come from?

Ok, that's a little off topic, but it's one tangent that my mind has been following post Five Days.

31 - I was having the same reaction, thinking about Darryl's experience during the SECOND storm recently. WTH? as for the funding, remember the old poster, It'll be a great day when schools get funding and the army has to have bake sales? Something to that effect? We could sell a couple of B52s. or whatever - dating myself here.

I've finished reading the book and I think it was done very well. I feel like I can't express myself very well. The author has managed to talk about the history of the hospital and New Orleans hurricanes, the event itself, the investigation, the politics/public opinion, and lessons learned (or not). And I don't feel like the author was biased (others may feel differently?) or making any assertions as to what *she thought* had happened, I think she has just gathered the information together and put it out there and leaves it to the readers to process it all.

After reading the book I found a documentary on YouTube called "When the Levees Broke" which was also very good to watch. It was about Katrina, the event itself, the flooding, the aftermath for the city and it's citizens and even a few years later. Lots of interviews with citizens, and officials like the mayor and governor. It didn't mention the hospitals at all but it was a good companion to the book, to see what was going on outside the hospital at the same time.

I thought I'd add a little background information about N.O. and hurricanes. During the 18 years I lived there, 1968-1986, there were frequent hurricane warnings (perhaps once or twice a season--at least it felt like that), but the last major hurricane to hit N.O. before Katrina was Betsy in 1965. (Camille, the other major hurricane, hit in 1969 and affected the Mississippi gulf coast and not so much N.O.) Betsy caused a great deal of flooding (a lot of it in the Ninth Ward, the area most affected by Katrina), and there were also many deaths.

I followed the tv coverage of Katrina from my present home in the hurricane-safe but earthquake-prone Northwest. When the news began to say on the morning after that N.O. had "dodged a bullet" since Katrina had veered slightly to the east instead of being a direct hit, I was very puzzled. During the entire time I lived in N.O. we were always advised that the worst case scenario was for a hurricane to hit slightly to the east of N.O. This was because the Gulf of Mexico was connected to Lake Ponchartrain and Lake Bourgoyne (both spelled wrong I think), and a hurricane hitting there would force the tidal surge from the gulf into these lakes, and then over the levees into N.O. And in fact this is what happened: the tidal surge went into the lakes, and the levees could not withstand this and broke or were overtopped.

During the entire time I lived there scientists and engineers regularly warned that the levees were in poor shape and should be repaired and/or replaced. These warnings were ignored, either because they weren't believed or there were not funds available to repair or rebuild. I have to say that the levee 4 blocks from my home looked sturdy enough--my 6 year old daughter referred to it as a "mountain"--and I had a difficult time believing it would burst.

Beyond the areas we most heard about as having been affected, (the Ninth Ward and Lakefront), the area called New Orleans East was virtually destroyed. I believe that there were other nursing homes in NO East in which elderly patients died (drowned) due to the failure to evacuate. New Orleans East was largely developed after Betsy, and was built on land known to be on marshy ground subject to flooding. In addition, the Corps of Engineers had built (dredged) a ship channel from the lakes along the Mississippi gulf coast in aid of the shipping industry. At the time, there were warnings that the ship channel would exacerbate potential tidal surge into the lakes and into New Orleans East. After Katrina, claims were brought against the Corps of Engineers arguing that the dredging of the ship channel caused a lot of the damage, at least in New Orleans East. I don't know the outcome of that. I think that one complication is that the Corps of Engineers is not liable for damages caused by the failure of things it builds for protection, but that there may be liability if the purpose of what it builds is not protective.

I second Kiwiflowa's recommendation to watch the documentary "When the Levees Broke". It was produced (by Spike Lee I believe) shortly after Katrina.

I also highly recommend the book Nine Lives: Death and Life in New Orleans by Dan Baum. This book focuses on the lives of nine quintessential New Orleanians from the time of Hurricane Betsy until after Katrina. While Katrina plays a part in this book, the book is more a story of why New Orleans matters so much--there is nowhere else like it in the world.

I also recommend the HBO series "Treme", which takes place in New Orleans shortly after Katrina. The first season in particular is "must see" in my view for anyone who wants to get a feel for New Orleans.

Also, the book The Great Deluge by Douglas Brinkley, who at the time was a history professor at Tulane. It was written about a year after Katrina, so may not have the objectivity time may provide, but it is an excellent hour by hour account of what went on during the storm and its aftermath. This may be the book to read if you want to learn about the rumors of violence that permeated the city, as well as information on the actual police brutality that went on.

Sorry to make this so long, but I guess I wanted to make a couple of points: most of the damage and deaths were not caused by the hurricane itself. Also, in the aftermath of the hurricane there were a lot of people arguing that NO should not be rebuilt since it was located in an unsuitable area. I'd like people to know what a treasure NO is, and that with proper precautions a Katrina-catastrophe doesn't have to happen again. I know here in the NW and in California all the buildings are being retrofitted and/or built to withstand earthquakes, but much infrastructure is nevertheless inadequate.

Very interesting post, arubabookwoman! It helps immensely to have some first hand knowledge.

I'm lurking along, also listening to the audiobook.

The hospital-within-a-hospital certainly complicated matters. It's unimaginable to me that they didn't have a joint disaster plan worked out. It's also unimaginable to me that the Memorial doctors stepped in to inject Life Care patients whom they hadn't been caring for and didn't have knowledge of their cases.

DNR coming to mean Do Not Rescue. Having just been through the death of my father who resided in a nursing home the last year and a half of his life, the scenario is hugely emotionally charged for me.

>34 arubabookwoman:, aruba, thanks so much for posting your thoughts.

re your comments: "and a hurricane hitting there would force the tidal surge from the gulf into these lakes, and then over the levees into N.O." and "most of the damage and deaths were not caused by the hurricane itself" - These two points come through clearly in Fink's book and were really a surprise to me, as my perception of Katrina prior to reading this book had been that it was the immediate storm and not its aftermath that was responsible for so much of the death and destruction. It's horrible to think - as the people inside Memorial in Fink's book did - that one has "dodged a bullet" only to find that the aftermath is worse than the event itself.

Moving along in the book, the following things are on my mind:

-- the role of assumptions and lack of information in fueling decisionmaking at Memorial

Obviously, the people at the hospital cannot be blamed for being cut off from knowledge of what was going on outside. But it is amazing to me how much key actors seem to have relied on rumor and assumption in making the decision to end patients' lives. I've recently listened to a passage where one of the nurses thinks about the lives of some of the Life Care patients and how little they have to look forward to and how their lives are basically nothing. She knows nothing about their specific cases, their personal histories, their families, their lives; yet she assumes that their lives have so little meaning that there is no reason for them to suffer through the conditions at Memorial. Surely this attitude and assumptions will contribute to a willingness to eventually "put them out of their misery."

Additionally, the rumors going around about security conditions in New Orleans seem to have had a significant influence on doctors' and nurses' willingness to kill their patients and in shaping their belief that they were saving these patients from a worse fate. NO is under martial law, armed thugs are everywhere, people in the Superdome are murdering and raping each other, etc. These were all stories that circulated around the US in the aftermath of Katrina and I believe most of them turned out to be untrue. But people believed them because they corroborated stereotypes about American blacks and urban dwellers, the behavior of people when law and order breaks down, etc. And the willingness to believe these rumors warped doctors' and nurses' reasoning, in my opinion.

-- the inability of those in Memorial to see their situation clearly

Again, it is not surprising that people in a horrible situation and under considerable stress should lack perspective, but Fink calls attention to the way in which the residents of Memorial, unable to visualize an end to their suffering, lost all sense of time and scale. She mentions that because the people still in the hospital saw no light at the end of the tunnel, they were unable to plan logically or allocate resources in a way that maximized their survival. She also highlights the comments of one doctor who is shocked that other doctors are discussing taking the drastic step of euthanizing patients only two days after the worst of the storm's aftermath. I had a bit of shock during this portion of the audio, because I had to remind myself that things had deteriorated so much in five days. Yes, Memorial lacked power (though there apparently was power in a connected building, but I have not gotten to this point in the book yet) and yes sanitary conditions had completely deteriorated, but the building seemed to have ample staff, food and water, medicine to treat patients, and they were generally safe (despite rumors that armed men were roaming the building). So much of the deterioration seems to be the result poor planning and a decision to basically stop treating patients. It seems like things did not have to get as bad as they were allowed to get. And it seems like allowing things to get so bad made it easier for doctors and nurses to think that the LifeCare patients were unsaveable.

The lack of sleep had to play into it as well. Two hours a night, under such stressful conditions, ensured that no one was making good decisions.

Does anyone know whether Memorial was unique? Did other New Orleans hospitals also have similar deaths?

I haven't read any of the posts above, as I hadn't read the book. I just wanted to say that I am only about 20% through it (according to Kindle) and I am already pis#%ed. My blood pressure may not be able to take it. Rant over. I'm headed back to the book.

#38 In post #16, I talk a little bit about the experience at Charity Hospital, which Fink describes as a counterpoint to the Memorial example.

ETA: #39 I had the same reaction, Colleen.

# 38--There was at least one, and I think up to three, nursing homes where there were multiple deaths of elderly patients. There was no question of euthanasia in these other cases--the victims were drowned. The owners of one of the nursing homes were criminally investigated and I think prosecuted. The other home was run by nuns and there didn't seem to be any hint of possible criminal liability. These are vague memories from the time of Katrina, and I haven't had a chance to go back and research.

Edited to add:

Here is a NYT article about the nursing home operators who were prosecuted (and acquitted):

http://www.nytimes.com/2007/09/08/us/nationalspecial/08nursing.html?_r=0

Here is a link to a Houston Chronicle about deaths in nursing hoes during Katrina:

http://www.chron.com/news/nation-world/article/Katrina-s-toll-on-the-sick-elderl...

Thanks aruba, reading now!

Finally finished the book on Friday and just now catching up with the conversation. I feel a little guilty because I wasn't as emotionally involved as some of you were.

I'm also all too opinionated, though. The biggest thing to me is that Tenet's corporate side did not act, did not and does not seem to care. That is disturbing - present tense.

The saddest thing to me is that we will never have the complete story because no one can talk without exposing themselves to serious legal consequences. So all these family members and loved ones will never get answers. They can't get closure. And yet the answers are available!

I wonder if giving immunity would be worth getting better answers. Probably not realistic.

I finished this last week as well. I was really surprised at my reaction to the latter portion of the book - that dealing with the investigation. I found myself really empathizing with the two nurses and Dr. Pou, who were the only people arrested and put under legal scrutiny in connection with this whole thing. While what they did was clearly wrong, I found that I could not believe that they acted maliciously. They were in a bad situation; their thinking was faulty because of lack of sleep and information. They made a number of terrible assumptions about quality of life for patients and these patients' chances of surviving the rescue operations. But I think ultimately, they were trying to minimize suffering.

I was also disturbed by the amount of apparent corruption or unseemliness that occurred during the investigation. Some actors seemed determined to crucify the medical staff, others seemed determined to show that they were decent people, but very few people seemed interested in the truth. Understanding that the New Orleans medical community is close-knit, it was disturbing that so many of the people investigating each other had personal or professional ties. It is unbelievable that the prosecutors in the case did not choose to call their most compelling witnesses - those with firsthand knowledge of the situation inside Memorial - before the grand jury.

The role of the media in perpetuating misconceptions about conditions in the hospital and sensationalizing the story was also reprehensible. Why, with facts clearly showing the opposite, was Dr. Pou allowed to repeatedly claim that Memorial had no water? Why did no one question her on this? At the same time, calling her an angel of death with a God complex obscures what she actually did and her motivations for doing it.

In the end, I'm like other readers of this book here. Just rather sad. I think most people at Memorial during Katrina probably tried to do the best with the material, mental, and emotional resources they had. In the end, however, those were simply not enough.

>34 arubabookwoman: Thanks for taking the time to share that info. Amazing book. Wonder what Fink will tackle next.

Has anyone read her previous book War Hospital which "Recounts the story of a handful of young doctors who experienced war, death, camaraderie, rivalries, romance, and moral decisions while trapped in Srebrenica, Bosnia-Herzegovina in 1992"?

>45 fannyprice: the corruption and incompetence of the prosecution was strange and pathetic. Amazing that New Orleans can't convict anyone for anything. And that the coroner makes a murder call based on how it will affect him politically.

>45 fannyprice: and >48 dchaikin: I agree about the investigation, the prosecution and the coroner. There is a big part of me that sympathizes with Pou and the nurses. But I keep returning to Emmett Everett.

Lisa, I hadn't even heard of War Hospital, but I'll keep my eye out for a copy.

Transporting the healthiest patients first worked against Everett. If he'd been one of the first, the staff would have still had the energy and ability to get him to the helicopter pad. But after those days of not enough sleep, stress and exhaustion, I wonder if his death had to do more with people being too strung out to be capable to thinking through the logistics than with thinking he'd be unable to withstand the stresses of transport.

>50 RidgewayGirl:, Good point on Everett. One thing that I keep going back to is the decision on day two (someone correct me if I'm wrong on that) to cease basically all medical treatment. This was before the power went out (again, correct me if I'm wrong - the curse of audiobooks is that I lack a decent way to go back and fact check my memory); Memorial still had plenty of food and water; medicines ran low at one point but were later replenished. Why did the medical professionals decide that things were already in such dire straights? Surely such a decision probably made ill patients seem less likely to survive.

>49 cabegley:, Chris, I'm completely with you. It's hard reading a book like this, where I think the events were so wrong but it is hard to see malice on the part of anyone, just a series of really bad decisions and poor prioritization.

That's a hard decision for me to understand too, Fanny. And a decision that was the exact opposite of the one made by the other hospital that had such better outcomes. What did they see as the advantage to stop giving routine medications?!

I think they originally made that decision on the basis that they had to get the patients ready to evacuate - but that didn't happen as quickly as they anticipated? I can't remember when exactly they made that decision in relation to the evacuations but I remember the doctor trying to get the first patient evacuated (an infant?) and the helicopter pilot telling him that he took too long to get the patient to the helicopter to him and they needed to be quicker. Yet of course they never knew when the helicopters would arrive.

I really want to know who was in the cancer ward with power and and what lines of communication was going between that group and the medical team looking after the patients.

Parkerpal
Has anyone read the web sites of both Dr. Pou and Memorial? Many of the author's facts are disputed. There are many who view this book as fiction. It just goes to show that nothing is black and white....so many gray areas in this horrible situation.

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