Five Days at Memorial

Five DaysEarly on in Sheri Fink’s account of events at Memorial Medical Center in New Orleans during and after Hurricane Katrina, we see a doctor helping a hospital employee euthanize a cat. The doctors and nurses and other staff members had brought their pets to Memorial to wait out the storm, as they’d done many times before. These pets were not allowed on rescue boats and aircraft, and leaving them behind to suffer and die seemed cruel. Later in the book, we learn that pets were eventually allowed to be evacuated with their owners. “It was too late for many.” Fink writes. “It wasn’t necessary to euthanize them after all.”

But this book is not about the pets. It’s about the people. And that line continues to haunt me—even more so because it doesn’t just apply to pets. Although stories about exactly what happened vary, multiple patients were given injections that are believed to have hastened their deaths. Were these people euthanized? Why? And was it necessary?

Fink spent six years investigating what happened and following the criminal investigation that followed. The result is an absorbing account of heroism and maddening failures, both large and small. Although she makes no direct accusation, Fink makes a strong case that some of the staff at Memorial would decide it was best to let their sickest patients die comfortably that to subject them to more pain or risk what they believed would be a fatal evacuation attempt (if it could even be attempted).

The first half of the book recounts what happened at Memorial itself. As the power failed and the waters rose, the medical staff and their family members sought ways to keep patients safe, comfortable, and alive. When rescue became possible, they set priorities regarding who should be evacuated first. The building was hot, and the toilets didn’t work. It was a nightmare situation. With hindsight and an outsider’s view, it’s possible to see where operations broke down, where communication failed, and where judgment slipped. The staff at Memorial were making life-and-death decisions, but they were themselves tired and scared, and many did not have complete and accurate information.

Fink interviewed many of the people who were there, and their stories are consistent in some areas and inconsistent in others. Memory being fallible, it’s hard to know who’s correct, and it’s certainly possible that some were hiding the truth from Fink—or from themselves. What is clear is that people made mistakes. But many of those mistakes are understandable. For example, at one point, helicopter pilots offered to continue evacuating patients throughout the night. This offer was declined because the staff members responsible for bringing patients to the helipad needed rest, and the pathway to the helipad was poorly lit and dangerous. Was the risk of falling greater than the risk of staying another night?

The triaging of patients was similar. In general, the healthiest patients were evacuated first. They were, it was believed, better able to survive being moved and then to cope with whatever conditions they would find at the evacuation site. (Some evacuees were left at a highway cloverleaf to await transit, so this was no small concern.) Yet this meant that patients who needed oxygen to breathe were left at a hospital with no electricity.

For me, one of the most alarming aspects of the story was what happened to the patients and staff of LifeCare, a smaller hospital housed within Memorial but run separately. For much of the book, they seemed to be entirely off the radar of the Memorial staff—an afterthought. Few of their patients got out, and large doses of morphine were found in many of their bodies.

The second half of the book focuses on the investigation into what happened at Memorial. One doctor in particular, Anna Pou, faces the greatest scrutiny. Witnesses identified her and two nurses as the ones who administered morphine to the remaining Memorial and LifeCare patients. This half was less engaging overall than the first half, but Fink drops some significant revelations in this half of the book. For example, investigators couldn’t figure out why hospital staff took one of the more difficult routes to the helipad. And why didn’t they bring patients to the adjacent cancer center, which had power? Questions are raised about how close to death some of these patients actually were. One man, it seems, was left because he was so large, and no one could figure out how to transport him. Some patients were alert and responsive the day before they died. Their family members, who were told to evacuate without them, couldn’t figure out what happened to cause them to take such a turn in just one day.

Fink does not place blame in one place or on one person. She may have her own opinions, but she doesn’t share them. I sensed some frustration with statements Pou has made in talks she’s given about medical care during disasters. Overall, though, this book shows how impossible it is to place blame on one person. Even if Pou did intend to give lethal doses to these patients, what led her to that decision? What false information did she have, and what true information did she lack? How much had stress and fear skewed her judgment? Here’s where placing blame gets tricky.

This book is lengthy—both exhausting and exhaustive—but if you can bear to stay with the story, it’s riveting. Fink does well at letting her subjects speak for themselves and sorting through the various voices, even as they contradict one another, and allowing readers to draw their own conclusions. I have many thoughts after reading this, but no conclusion to draw, other than that I hope never to have to know what choice I’d make in the face of this kind of disaster.

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20 Responses to Five Days at Memorial

  1. I’m getting shuddery spine just from reading this review — the pets thing reminded me of all the awful stories I heard during Katrina. As many years as it’s been, and as little as I was personally affected by the storm, I still can’t read about it without feeling sick to my stomach. It’s a strange emotional reaction I can’t account for.

    That said, this sounds really interesting, and I’m glad of course that the stories keep being told.

    • Teresa says:

      Pet stories always get to me. I saw a documentary focused on pets found and adopted after Katrina and the difficulties of reuniting them with their owners. There’s a scene in which a dog is brought back home to his previous owner, and the dog is so overwhelmed with excitement that you can’t help but cry.

      I’m not sure I could read this, or any similar Katrina stories, if I were from the area.

  2. I’ve been struggling to remember the name pf this book. I read about it at the start of the year and decided it was one I wanted to read but then went and lost the info. Thanks for the memory jog and also writing such a good review.

  3. This is a fantastic review Teresa, the kind of post that takes a book I wouldn’t have considered and makes it sound like a must-read. Like you I’m fascinating and terrified at the thought of decision making in extreme situations. Who knows what would seem right in the heat of the moment, in difficult circumstances.

  4. ravingreader says:

    Good review. I’ve just got this title from the library, and am looking forward to reading it even more now. Thanks!

  5. ravingreader says:

    Sorry – meant to add that another excellent Katrina NF read is by Chris Rose: “1 Dead in the Attic” – harrowing and riveting at the same time…

  6. Alex says:

    It’s one of those situations that you just pray that you will never find yourself in. I can’t imagine how people manage to go on functioning, let alone make rational decisions in that sort of disaster. While I’m sure that there were many things that could and should have been done better I’m not sure that pointing the finger of blame helps anyone in these circumstances unless it be towards the powers that be who have failed to put in place the necessary support systems in the first place.

    • Teresa says:

      Understanding what happened and why is valuable if it helps prevent similar mistakes in the future, and I can definitely see why family members would want to know what happened, especially when several of them saw their loved ones the day before and they seemed nowhere near death. But the situation was much too complex for blame to fall on just one person, especially a person acting under extreme stress. I can’t even imagine what it was like.

  7. Deb says:

    I live on the Northshore of Lake Pontchartrain. We evacuated two days before Katrina hit and were unable to get back for six weeks (our house had massive damage). Let me just say one thing–even had we had a supportive, pro-active administration in the White House–which we most certainly did not (don’t get me started)–it would still have been an almost impossible task to ride out a storm like that. Given the fact that there was absolutely no national preparation, what a surprise that our overwhelmed local and state-level infrastructure failed. The sister of one of my husband’s co-workers was a nurse at another hospital during Katrina and she and her fellow nurses spent 48 hours working ventilators by hand to keep patients alive. Everyone down here has these stories; there are no easy answers.

    • Teresa says:

      One of the things I liked about this book was that it showed how multifaceted the problems at Memorial were. It wasn’t just flooding or loss of power or poor communication or lack of preparation. It was lots of things, some of them really small on their own, and it added up. It was too big a disaster to expect everything to go smoothly. The people on the ground were doing their best in a terrible situation.

  8. This demonstrates so well the ethical nightmare of on-the-ground decisions during crises — a really fascinating review.

  9. aartichapati says:

    I was listening to this one on audiobook some time ago and had to stop. This was more because I think the characters and pacing and the timelines were VERY difficult to follow over audiobook than anything else. This will probably make me sound horrible, but I also thought Fink spent way too much time talking about the pets. I have never really been a pet person, so I probably just don’t understand the bond, but seriously, I feel like she talked about the pets SO MUCH, and then I started to get confused between the pets and the people, which made me realize that the audiobook was just not going to work.

    I should try it in physical format, but probably not soon. I agree – it was tough to read.

    • Teresa says:

      There are a lot of details that I think would be difficult to follow on audio. That was somewhat true with the print, but a lot of the time with books like this, I don’t worry too much about keeping every individual straight and focus more on the overall arc of what was happening. There were a few people I knew were really important, like Dr. Pou, so I worked harder to keep track of them.

      I’m very much a pet person, so I was interested in how they dealt with the animals. I think, for me, the reason is that I’ve always had pets, and my cat is a little creature whose life and health I’m responsible for in a way that I’m not responsible for any particular person’s life right now. What would happen to my cat is one of my big worries when I think about disasters like that, so it’s easy for me to put myself in the place of the pet owners. But I do get that it would harder for someone who isn’t a pet person to relate to and might seem trivial when stacked against questions surrounding the human lives. It’s interesting to me that euthanasia didn’t seem cruel or wrong when it came to pets but it did when it came to people. That difference in perception is probably one of the reasons she talked about the pets a fair amount. (To me, it didn’t seem like that much, but that’s probably because I was interested in the pets.)

      • aartichapati says:

        Yes, I can completely understand that. I think if I had a bond with a pet, I would probably feel very similar to how you feel – as though it were a member of my family. But as I’ve never had a pet before, I just can’t even fathom that kind of relationship. As you probably suspected, to me the euthanasia for pets felt very different to me vs that for the people. Not that it wasn’t cruel in both circumstances, but that one situation seemed of a much greater magnitude to me than the other.

        Overall, though, this book was quite frightening, even the small part I did read, just because it shows how even a place and group of people literally PRIMED for emergency situations and decisions could fall into panic mode so quickly …

      • Teresa says:

        The euthansia of the pets felt different from that of the people to me as well. To me, the tragedy with the pets was mostly that it was unnecessary, but I could support the animal euthanasia in a way I couldn’t when it came to the people.

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