Early 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.