Storm Warning: Sheri Fink’s Five Days at Memorial

In 1967, New Orleans’ Southern Baptist Hospital became one of the first facilities in the Southeast to purchase a collection of a miraculous technology known as the crash cart. Its gadgets–respirator, aspirator and defibrillator, among others–could breathe life into a body given up for lost. For doctors who used the crash cart, it meant nothing less than redefining death. And it raised major ethical questions about who would do that redefining and how.

Thirty-eight years later, Southern Baptist Hospital, renamed Memorial Medical Center, lay in the flood zone of Hurricane Katrina. Stranded in a city given over to chaos, with neither a clear path to safety nor a clear internal chain of command, a small group of staffers classified patients according to triage conventions. Those least likely to survive would be evacuated last. As Sheri Fink writes in Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (Crown; 558 pages), conditions deteriorated to the point at which a handful of doctors and nurses became convinced that certain patients with do-not-resuscitate orders were not going to make it.

Even in the best circumstances, medical professionals are charged not only with protecting life but also with easing the passage to death. So when a few began quietly administering high doses of morphine and other sedatives to the 20 most critical patients, were their actions criminal or humane–or both?

The story of what happened at Memorial unfolds with creeping doom. Fink interviewed hundreds of sources, creating detailed portraits of the staff and patients and a terrifying sense of atmosphere. The rains came on Sunday; by Wednesday conditions inside resembled less a 21st century medical facility than a refugee camp: “The hospital was stifling, its walls sweating. Water had stopped flowing from the taps, toilets were backed up, and the stench of sewage mixed with the odor of hundreds of unwashed bodies.”

The danger shape-shifted from the winds to the heat to the floodwaters to the apathy of the hospital’s Texas-based administrators. (Sample e-mail: “If you are beginning your plans to evacuate it is our understanding the National Guard is coordinating. Good luck.”) Darkness brought the menace of looters and desperation on the part of those marooned inside. Each new threat exposed yet another flaw in Memorial’s arrangements:

The hospital’s preparedness plan for hurricanes did not anticipate flooding. The flooding plan did not anticipate the need to evacuate. The evacuation plan did not anticipate a potential loss of power or communications.

Those plans were written shortly after 9/11; water wasn’t the paramount fear. Memorial’s bioterrorism plan, Fink writes, “ran 101 pages, as opposed to the 11 pages devoted to hurricanes.”

Katrina was an American tragedy–you can’t read this book and think otherwise–but its aftermath holds valuable lessons. Fink, a Pulitzer Prize–winning journalist who trained as a physician, writes powerfully of the investigation into the Memorial deaths and, in her epilogue, of subsequent disasters: the earthquake in Haiti, Hurricane Sandy in the Northeast, an influenza pandemic in India. Her findings are troublingly murky. Detailed protocols help, but better results often come from improvisation. Extra supplies help too, but when devices like ventilators must be rationed, all the time in the world can’t provide easy answers to the question of who should be first in line. But in chronicling the devastating events at Memorial, Fink shows how important these discussions are, in a time of crisis or not. For the need to draw a line between life and death doesn’t always announce itself with storms and floods.