Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

by Sheri Fink
Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

by Sheri Fink

Hardcover

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Overview

Notes From Your Bookseller

Through the lens of both physician and journalist, Sheri Fink investigates the mysterious deaths that occurred in a New Orleans medical center shortly after Hurricane Katrina. Fink explores the role of ethics in the medical field, especially regarding the issue of patients being euthanized by medical staff. Fink’s journalistic work here not only makes for a captivating read but also serves as a grim reminder about the vulnerability of health systems during major crisis.

NEW YORK TIMES BESTSELLER • The award-winning book that inspired an Apple Original series from Apple TV+ • A landmark investigation of patient deaths at a New Orleans hospital ravaged by Hurricane Katrina—and the suspenseful portrayal of the quest for truth and justice—from a Pulitzer Prize–winning physician and reporter

“An amazing tale, as inexorable as a Greek tragedy and as gripping as a whodunit.”—Dallas Morning News


After Hurricane Katrina struck and power failed, amid rising floodwaters and heat, exhausted staff at Memorial Medical Center designated certain patients last for rescue. Months later, a doctor and two nurses were arrested and accused of injecting some of those patients with life-ending drugs.

Five Days at Memorial, the culmination of six years of reporting by Pulitzer Prize winner Sheri Fink, unspools the mystery, bringing us inside a hospital fighting for its life and into the most charged questions in health care: which patients should be prioritized, and can health care professionals ever be excused for hastening death?
 
Transforming our understanding of human nature in crisis, Five Days at Memorial exposes the hidden dilemmas of end-of-life care and reveals how ill-prepared we are for large-scale disasters—and how we can do better.
 
ONE OF THE TEN BEST BOOKS OF THE YEAR: The New York Times Book Review • ONE OF THE BEST BOOKS OF THE YEAR: Chicago Tribune, Seattle Times, Entertainment Weekly, Christian Science Monitor, Kansas City Star

WINNER: National Book Critics Circle Award, J. Anthony Lukas Book Prize, PEN/John Kenneth Galbraith Award, Los Angeles Times Book Prize, Ridenhour Book Prize, American Medical Writers Association Medical Book Award, National Association of Science Writers Science in Society Award

Product Details

ISBN-13: 9780307718969
Publisher: Crown/Archetype
Publication date: 09/10/2013
Pages: 576
Product dimensions: 6.72(w) x 9.48(h) x 1.71(d)

About the Author

Sheri Fink is the New York Times bestselling author of Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital and War Hospital: A True Story of Surgery and Survival. She is a correspondent at The New York Times, where her and her colleagues’ stories on the West Africa Ebola crisis were recognized with the Pulitzer Prize for international reporting, the George Polk Award for health reporting, and the Overseas Press Club Hal Boyle Award. Her story “The Deadly Choices at Memorial,” co-published by ProPublica and The New York Times Magazine, received a Pulitzer Prize for investigative reporting and a National Magazine Award for reporting. A former relief worker in disaster and conflict zones, Fink received her M.D. and Ph.D. from Stanford University.

Read an Excerpt

Prologue

At last through the broken windows, the pulse of helicopter rotors and airboat propellers set the summer morning air throbbing with the promise of rescue. Floodwaters unleashed by Hurricane Katrina had marooned hundreds of people at the hospital, where they had now spent four days. Doctors and nurses milled in the foul-smelling second-floor lobby. Since the storm, they had barely slept, surviving on catnaps, bottled water, and rumors. Before them lay a dozen or so mostly elderly patients on soiled, sweat-soaked stretchers.

In preparation for evacuation, these men and women had been lifted by their hospital sheets, carried down flights of stairs from their rooms, and placed in a corner near an ATM and a planter with wilting greenery. Now staff and volunteers—mostly children and spouses of medical workers who had sought shelter at the hospital—hunched over the infirm, dispensing sips of water and fanning the miasma with bits of cardboard.

Supply cartons, used gloves, and empty packaging littered the floor. The languishing patients were receiving little medical care, and their skin felt hot to the touch. Some had the rapid, thready pulse of dehydration. Others had blood pressures so low their pulses weren’t palpable, their breathing the only evidence of life. Hand-scrawled evacuation priority tags were taped to their gowns or cots. The tags indicated that doctors had decided that these sickest individuals in the hospital were to be evacuated last.

Among them was a divorced mother of four with a failing liver who was engaged to be remarried; a retired church janitor and father of six who had absorbed the impact of a car; a WYES public television volunteer with mesothelioma, whose name had recently disappeared from screen credits; a World War II “Rosie Riveter” who had trouble speaking because of a stroke; and an ailing matriarch with long, braided hair, “Ma’Dear,” renowned for her cooking and the strict but loving way she raised twelve children, multiple grandchildren, and the nonrelatives she took into her home.

In the early afternoon a doctor, John Thiele, stood regarding them. Thiele had taken responsibility for a unit of twenty-four patients after Katrina struck on Monday, but by this day, Thursday, the last of them were gone, presumably on their way to safety. Two had died before they were rescued, and their bodies lay a few steps down the hallway in the hospital chapel, now a makeshift morgue.

Thiele specialized in critical care and diseases of the lungs. A stocky man with a round face and belly, and skinny legs revealed beneath his shorts, friends called him Johnny, and when he smiled, his eyes crinkled nearly shut. He was a native New Orleanian, married at twenty, with three children. He golfed and watched televised sports. He liked to smoke a good cigar while listening to Elvis.

Like many of the hospital staff around him, his association with what was now Memorial Medical Center stretched back decades. He had rotated at the hospital as a Louisiana State University medical student in 1977. A classmate would later say that Johnny Thiele had turned into the sort of doctor they all wished to be: kind, gentle, and understanding, perhaps all the more so for having struggled over the years with alcohol and his moods. When Dr. Thiele passed a female nurse, he would greet her by name with a pat on the back and sometimes call her “kiddo.”

Thiele had pursued part of his training at the big public Charity Hospital, one of the busiest trauma centers in the nation, where he learned, when several paramedics burst into the emergency room in close succession, to attend to the most critical patients first. It was strange to see the sickest here at Memorial prioritized last for rescue. At a meeting Thiele had not attended, a small group of doctors had made this decision without consulting patients or their families, hoping to ensure that those with a greater chance of long-term survival were saved. The doctors at Memorial had drilled for disasters, but for scenarios like a sarin gas attack, where multiple pretend patients arrived at the hospital at once. Not in all his years of practice had Thiele drilled for the loss of backup power, running water, and transportation. Life was about learning to solve problems by experience. If he had a flat tire, he’d later say, he knew how to fix it. If somebody had a pulmonary embolism, he knew how to treat it. There was little in his personal history or education that had prepared him for what he was seeing and doing now. He had no repertoire for this.

He had arrived here on Sunday. He brought along a friend who was recovering from pneumonia and was too weak to comply with the mayor’s mandatory evacuation order for the city, which had exempted hospitals. Early Monday, Thiele awoke to shouts and felt his fourth-story corner office swaying. Its floor- to-ceiling windows, thick as a thumb, moved in and out with the wind gusts, admitting the near-horizontal rain. He and his colleagues lifted computers away and sopped up water with sheets and gowns from patient exam rooms, wringing out the cloth over garbage cans.

The hurricane cut off city power. The hospital’s backup generators did not support air-conditioning, and the temperature climbed. The well-insulated hospital turned dank and humid; Thiele noticed water dripping down its walls. On Tuesday, the floodwaters rose.

Early Wednesday morning, Memorial’s generators failed, throwing the hospital into darkness and cutting off power to the machines that supported patients’ lives. Volunteers helped heft patients to staging areas for rescue, but helicopters arrived irregularly. That afternoon, Thiele sat on the emergency room ramp for a cigar break with an internist, Dr. John Kokemor, who told him doctors were being requested to leave last. When Thiele asked why, he later recalled, his friend brought an index finger to the crook of his opposite elbow and pantomimed giving an injection. Thiele caught his drift.

“Man, I hope we don’t come to that,” Thiele said. Kokemor would later say he never made the gesture, that he had spent nearly all his time outside the building loading hundreds of mostly able- bodied evacuees onto boats, which floated them over a dozen blocks of flooded streets to where they could wade to dry ground. He said he was no longer caring for patients and too busy to worry about what was going on inside the hospital.

Wednesday night, Thiele heard gunshots outside the hospital. He was sure people were trying to kill each other. “The enemy” lurked as near as a credit union building across the street. Thiele thought the hospital would be overtaken, that those inside it had no good way to defend themselves. He lost his footing in an inky stairwell and nearly pitched down the concrete steps before catching himself. Panicked and convinced he would die, he reached his family by cell phone to say good-bye.

Thiele felt abandoned. You pay your taxes and you assume the government will take care of you in a disaster, he thought. He also wondered why Tenet, the giant Texas-based hospital chain that owned Memorial, had not yet sent any means of rescue.

Finally, on Thursday morning, the company dispatched leased helicopters, while other aircraft from the Coast Guard, Air Force, and Navy hovered overhead awaiting a turn to perch on Memorial’s helipad. Airboats came and went with the earsplitting drone of airplane engines.

The pilots would not allow pets on board the aircraft and watercraft, creating stressful choices for the staff members who had brought them to the hospital for the storm. A young internist held a Siamese cat as Thiele felt for its breastbone and ribs and conjured up the anatomy he had learned in a college dissection class. He aimed the syringe full of potassium chloride at the cat’s heart. The animal wriggled free of the doctor’s hands and swiped and tore Thiele’s sweat-soaked scrub shirt. Its whitish fur stuck to him. They caught the animal and tried again to euthanize it, working in a hallway perhaps twenty feet away from the patients in the second-floor lobby. It was craziness.

A tearful doctor came to Thiele with news she had been offered a spot on a boat with her beautiful twenty-pound sheltie. She had quickly trained it to lie in a duffel bag. Several of the doctor’s human companions were insisting they would not leave without her. The doctor had been sick to her stomach and continuously afraid. She wanted to go while she had this chance, but she felt guilty about abandoning her colleagues and the remaining patients. “Don’t cry, just go,” Thiele said. “An animal’s like a child.” He reassured her: “We gonna get by without you. I promise you.”

Thiele walked back and forth through the second-floor lobby multiple times as he journeyed between the hospital and his medical office. As the hours passed, the volunteers fanning the patients on their stretchers were shooed downstairs to join an evacuation line snaking through the emergency room.

Thiele knew nothing about the dozen or so patients who remained, but they made an impression on him. Before the storm, the poor souls would have had a chance. Now, after days in the inferno with little to no medications or fluids, they had deteriorated.

Interviews

A Conversation with Sheri Fink, Author of Five Days at Memorial

How did your background in medicine and disaster relief inform the writing of Five Days at Memorial?

I'd been in situations where exhaustion and fear make it difficult to think, and when the number of patients overwhelmed a small triage station where I worked on the border of a war zone. When a previously respected doctor was arrested for allegedly having murdered her patients in the aftermath of Hurricane Katrina, I knew that this was more than an amazing, sensational story, but also an exceptionally important one. It was urgent to know the truth of what happened at Memorial Medical Center, because any of us could be caught up in a disaster and need medical care. Learning from what went wrong could help save lives in the future.

You give a very balanced view of the events at Memorial and their aftermath. Was it hard to stay objective in the face of the evidence you had?

It wasn't too hard because I don't have a personal stake in the contentious issues at the core of Five Days at Memorial. Unlike those involved in the events, who naturally have strong points of view based on what they endured, I found myself empathizing with nearly all of the doctors, nurses, patients and family members I met. Every one of us has opinions, but I saw my goal as digging for the truth and presenting it fairly and accurately to readers. That's why the book took over six years and involved interviewing hundreds of people, searching for every piece of documentation. What's important is that readers understand what happened, grapple with the dilemmas on their own terms, and emerge more prepared for an emergency and perhaps even activated to find ways to prevent what happened from happening again.I aimed to give readers that same feeling of discovery of this multi-faceted situation as I did. My role was to discover the truth and tell it.

You bring up very complicated issues of morality and justice in the face of crisis response. Is there a hero in this story?

Saying there are heroes and wrongdoers is a little too simplistic. These are real people. Some of them acted heroically yet also committed acts that many would consider deeply wrong.

You write that Memorial doctors "had established an exception to the protocol ofprioritizing the sickest patients," and that patients "in fairly good health who could sit up or walk" were evacuated before patients with "Do Not Resuscitate" orders. Why did they prioritize the evacuation of the healthier patients and even some staff and family members first?

Very early in the disaster, even before the power failed at Memorial, a small group of doctors decided that patients with Do Not Resuscitate orders (orders not to revive them if their hearts stopped) would be rescued last. One doctor told me he felt that DNR patients, who may have been closer to the end of their lives, would have the "least to lose" compared with other patients.

The hospital had large stocks of drinking water and medicine, but there were roughly 2000 people in it, and many were afraid and uncomfortable. To some extent, those who took charge tried to make the most efficient use of the rescue resources and get the majority of people out as quickly as possible. You can fit more people sitting up in a boat than lying down, and able-bodied people could wade to dry ground once a boat reached shallow water rather than having to be carried. Also, there was some uncertainty as to where patients would be taken on the other side of a boat or helicopter ride.

However, the decision to keep some of the sicker patients for last wasn't changed even when officials implored hospital leaders to allow Coast Guard pilots to rescue some of them the first night—patients who depended on ventilators to breathe. Family members of patients with DNR orders also protested the decision to keep them for last.

Ultimately these are questions of values as much as medicine. We have dissention in this country over how much care, at what cost, is appropriate toward the end of life. Sometimes disasters have a way of making issues that are with us all the time more apparent. We need inclusive conversations about how to distribute vital healthcare resources in an emergency. However, these issues are almost never discussed outside of small groups of disaster planners at hospitals and health departments.

In the book's epilogue, you report on conditions during Hurricane Sandy, when it seemed like hospitals were still—years after the tragic events at Memorial Medical Center—unprepared for what to do in the face of a complete loss of electrical power. Why haven't hospitals addressed these issues? Are there any formal efforts under way industry-wide to do so? What can people do to improve preparedness?

It's scary for healthcare professionals to contemplate the scenario of losing all electrical power. Just about everything in an American hospital these days relies on electricity, down to medical records and drug dispensing machines. However, just like an astronaut practices worst case scenarios in a simulator before zooming into space, we need to exercise and prepare for what can go wrong. Even when there's a backup, the backup can fail. Generators, fuel pumps, and electrical switches often aren't protected from local hazards like flooding. That's because they're generally not required to be. It's expensive to fix these problems, and hospitals and nursing home owners aren't always willing or able to make those investments in the absence of regulations or financial assistance. The U.S. Centers for Medicare and Medicaid Services, which documented "systemic gaps" in the ability of healthcare providers to plan for and respond to emergencies after Katrina, has delayed for years the release of emergency preparedness requirements. However, there is much we as individuals can do. Have a personal preparedness plan (see, e.g., www.ready.gov) and be ready to adjust that plan as needed in an emergency. Look out for family members and neighbors. Advocate for loved ones in the hospital. Ask tough questions of local hospitals and nursing homes. If you happen to be a health professional, go over emergency plans with your patients and establish multiple ways to get in touch with them. Perhaps most importantly, think through what might go wrong in your own home or workplace before you ever have to face it, and contemplate the decisions you'd want to make.

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