Lethal prescription

January 28, 2014

Five Days at Memorial is a descent into hell—Memorial Medical Cen­ter in New Orleans during and after Hurri­cane Katrina. After six years of interviews and painstaking research, Sheri Fink has composed a harrowing, deeply disturbing narrative of overwhelmed health-care workers in a hospital under siege, of an inept corporation (Tenet Healthcare), and of socially unjust acts committed by medical personnel that resulted in more than 20 patient deaths by euthanasia.

The book is a tour de force in which we witness the rapid disintegration of 21st-century medical care and the frightening collapse of the basic moral standards of doctors and nurses who ended the lives of patients they were sworn to protect. By page 200 we have had enough of the heat, stench and death at Memorial, and we beg for the story to end. It continues. Fink piles disgusting detail on top of tragic event as the waters rise, the lights go out, food and water become scarce, and human decency evaporates. Fink not only reports what happened at the hospital but forces us to be there, to stand amid the rubble, to stare at the breakdown of humanity and ask, “What would I have done if I had been there?”

Fink’s mass of excruciating details of slipshod triage and bungled evacuations tempt the reader to empathize with the overstressed doctors and nurses at Memorial. And yet the truth of what happened there is so tragic that if we sympathize, we risk complicity in evil. Fink refuses to allow us to explain away or excuse the reprehensible chain of events. There are few justifications or rationalizations as we watch a doctor, Anna Pou, directing nurses to go through the halls of the hospital with syringes of morphine and deadly sedatives to end the lives of patients they deemed unworthy of further treatment.

Surely these five days will go down as some of the worst in modern hospital history. By vividly telling us the story, just reporting the facts, Fink provokes pressing questions. What are the limits of corporate medicine? Ought we do more to train physicians to think through the ethical quandaries of administering death-dealing drugs in a time of crisis? Can standard “do not resuscitate” orders be too easily abused by doctors in a crisis situation? How can our medical centers better prepare for disasters? Why did other New Orleans hospitals (Charity, for instance) respond differently to the crisis? What gave some nurses the power to question the orders of the doctors? What role did race and income play in the staff’s selection of which patients were to be evacuated and which left to perish?

Although there were a few heroes in the story and Memorial’s nurses fare better than the doctors, the cumulative effect of these 576 pages is shame. One interviewee said that the hospital morgue was “like a picture of hell.” Disaster workers recovered 45 bodies from the hospital—“the largest number of bodies found at any Katrina-struck hospital or nursing home.” But there was little accountability for the tragedy. Tenet Healthcare fired some of the nurses but not the doctors. In the aftermath, Pou and a couple of nurses were arrested for second-degree murder but not indicted. The medical community and many in New Orleans rallied in support of the accused doctor and nurses, arguing simply, “You were not there. You are not a doctor. Who are you to judge?”

As a Christian clergyperson I found it remarkable that medical ethics are comparatively absent from Fink’s book, though she does offer a very brief theological discussion of euthanasia, includes a few pages on the ethical ramifications of what happened at Memorial, and presents some brief incriminating testimony by ethicist Arthur Caplan, who said that even considering the chaos at Memorial after Katrina, the way drugs were given was “not consistent with the ethical standards of palliative care that prevail in the United States.”

Fink’s lack of discussion of ethical thought suggests to me that the field of medical ethics may be irrelevant to the practice of disaster medicine. At the least, ethical ruminations appear to play no role in the thinking of physicians making decisions in the heat of the moment. This was basically Pou’s argument when she delivered lectures on the medical speaking circuit after the charges against her were dropped. That the medical community did not seriously reflect on the ethics of what happened at Memorial is an indictment of both the medical community and the field of medical ethics.

In this engrossing, exhausting, disturbing book, Fink tells a story that must be pondered in spite of the pain. No future medical ethics course in seminary or medical school should ignore it. And anyone concerned about goodness, justice and the practice of medicine in life-and-death crises must face the challenge of Five Days at Memorial.

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