FIVE DAYS AT MEMORIAL: LIFE AND DEATH IN A STORM-RAVAGED HOSPITAL

by Sheri Fink, Reviewed by Rita Marker

(Crown Publishers, 558 pp., 2013, $27.00)

 The drugs were federally controlled substances, kept locked away and signed out when needed, their misuse subject to criminal penalty. But these were extraordinary times. Even the firmest rules softened in the intense heat.

During the last week of August 2005, the nation was absorbed in the drama of Hurricane Katrina.

Television screens were filled with images of people fleeing to safety after a catastrophic failure of the levee system flooded New Orleans. Conditions at the New Orleans Superdome, where thousands had taken shelter, were heart-wrenching. Virtually every news broadcast led with reports about horrendous conditions in the city.

During this time, outside of media scrutiny, the storm’s aftermath was creating desperation at Memorial Medical Center—a place where, for decades, people had gone for refuge during hurricanes. So when Hurricane Katrina began bearing down on New Orleans, many of those who worked there brought their families, friends, and pets to ride out the storm. By the time the storm hit, there were nearly as many non-patients as patients and staff at Memorial.

People brought coolers and grocery bags. In the past, a picnic-type atmosphere would often reign as the hurricane passed over and then, the next day, it would be time to go home.

But that didn’t happen in August 2005.

Sheri Fink, a physician and Pulitzer Prize-winning journalist, has portrayed the day-to-day events at Memorial Medical Center in a meticulous account that takes the reader inside the medical center during those five fateful days, masterfully weaving together the stories of patients, doctors, and staff. Rarely have I read a book so gripping and so thought-provoking.

The book is divided into two parts: “Deadly Choices,” which recounts conditions within the medical center during the five days of the hurricane and subsequent flooding, and “Reckoning,” which describes the investigation of the euthanasia deaths that allegedly took place on the last two of the five days at Memorial.

It is almost impossible to fully absorb the horrors that happened in this brief window of time. To those who lived through it, however, those few days seemed like an eternity. Unbearable heat, no electrical power, and lack of sleep fatefully affected decision-making ability. The author provides valuable lessons in right and wrong, while still recognizing the good intentions that often lead to very bad actions.

The first day mirrored other days when a hurricane was anticipated. As the second day dawned, everyone felt that, once again, New Orleans had dodged the bullet. But that soon changed.

Day three was pivotal. A canal had been breached. Trees were down. The water was rising. Conditions rapidly deteriorated in the city and in Memorial. With electricity down and the hospital turning to back-up generators, the air conditioning went out, leading to sweltering heat. Water climbed up the emergency room ramp. There were reports of looting and gunshots could be heard. Fink recreates the scene as physicians, nurses, and staff began making some deadly choices.

Sandra Cordray, Memorial’s community relations manager, took charge of communicating with executives at Tenet Healthcare (Memorial’s Texas-based parent company), begging for assistance and stating in an e-mail, “WE NEED PATIENTS OUT OF HERE NOW.” But Tenet responded that other hospitals in New Orleans were waiting for the National Guard and that Memorial needed to do the same. Tenet ended its message, “Good Luck.”

But there wasn’t any good luck. And hospital leaders began to make incredibly bad decisions.

One of those physicians was Dr. Ewing Cook, a pulmonologist who had retired from clinical practice a year before but was now a chief medical officer at the facility. He, his wife, his daughter, three cats, and a large dog were there. The Cooks always stayed for hurricanes. Dr. Cook took responsibility for a section of the 4th floor to replace his son—also a physician—who had gone home the night before and could not get back. Cook decided that all but the most essential treatment and care should be discontinued.

Steps were taken to prioritize the order in which patients would be evacuated. Breaking with protocol, Memorial’s doctors made the decision to evacuate the sickest patients last. One doctor who agreed with the plan explained that he thought such patients would not want to be saved at the expense of others. Among those to be evacuated last were patients with Do Not Resuscitate (DNR) orders. The physician who made that suggestion later explained that he thought the law required patients with a DNR to be certified as having a terminal or irreversible condition. He was tragically mistaken. No law requires such a diagnosis for a DNR order.

As one elderly woman was being moved to the evacuation site, someone noticed that she had a DNR order and other patients were put in front of her. Her daughter later explained that her 93-year-old oxygen-dependent mother had been admitted just for the storm and was not terminally ill. She said, “When I made my mother a DNR, I did not know it meant ‘do not rescue.’”

Another patient not slated for evacuation because of a DNR order also was not close to death. In fact, her DNR status dated from more than 10 years earlier, when she had decided that, if her heart stopped, she wouldn’t want it to be restarted. Fortunately, her son and daughter-in-law—against doctors’ orders—carried her out of Memorial and put her on a boat that was at the edge of the ambulance ramp.

At one point on the third day, Dr. Richard E. Deichmann, chairman of medical services and in charge of organizing physicians, turned Coast Guard rescuers away. Deichmann told them to come back in the morning because the staff needed rest. When a senior Coast Guard officer tried to persuade staff to continue evacuating patients, hospital leaders yelled at him and turned him away again.

As conditions deteriorated, evacuations were handled miserably, and seemingly every possible mistake was made, there were clear signs that the overworked and exhausted staff were still caring for patients.

Among them was Dr. Anna Pou, a surgeon already known for caring for the poor. During those days at Memorial, she cared for patients, changed their diapers, dipped rags into water to make cool compresses and said prayers with anxious nurses. Pou considered the evacuation system heart-wrenching, but by the third day she sensed that doctors wouldn’t be able to save everyone. Later, she said that the goal in a disaster must be to do “the greatest good for the greatest number of people.”

By day four, the back-up generators were out. Water was out. Toilets were backed up. There were no working phones. The only lights were flashlights. The unbearable conditions had grown even worse.

Euthanasia—directly ending the lives of some patients—was being seriously considered. One doctor who was considering it said that “time had come to feel magnified,” even though a few days earlier the mere prospect would have been unthinkable.

As more physicians and staff became aware of the possibility of hastening the deaths of some patients, even those who were uncomfortable with the prospect said little or nothing to oppose it. One exception was a young internist who was new to Memorial. He was clearly concerned for the sickest patients and, on the fifth day, when another doctor raised the idea, he said, “I can’t be part of anything like that,” explaining that he disagreed one hundred percent. He noted that it had only been two days since the floodwaters rose, and the hospital still had food and water.

Yet instead of striving to stay and protect patients, the doctor became desperate to get out of Memorial, texting his sister and a friend that “evil entities” were discussing euthanasia for patients. He begged them to get him out of there.

Less than 72 hours after the hurricane had hit, the staff were drenched with perspiration. They were dirty and had had little or no sleep. The heat was stifling and the stench was intense. Pets—those that were still alive—were wandering everywhere. Bodies of patients were being taken to the chapel.

There was still plenty of pain medication, but more doctors were leaving—some on a staff fishing boat that had pulled up to the hospital. The able-bodied—doctors, nurses, family members—continued to leave ahead of patients.

When an emergency mortuary team arrived at Memorial, they found 45 bodies—the largest number of any health facility struck by Hurricane Katrina.

Two days after the last living patients and staff had left Memorial, an attorney from a facility whose patients had been moved to Memorial to wait out the storm sent a fax to Louisiana officials alleging that deadly doses of morphine had been administered to some patients when it seemed likely that they couldn’t be successfully evacuated.

The task of investigating the allegation fell to Arthur “Butch” Schafer, an assistant attorney general in the state’s Medicare Fraud Control Unit. Schafer, an experienced criminal prosecutor, initially thought the allegations were outlandish. But as he and his partner, Special Agent Virginia Rider (a 10-year veteran of the Fraud Control Unit), delved deeper into the situation, they uncovered information that would eventually lead to one physician and two nurses being arrested and charged with the deaths of four patients. The facts surrounding the investigation, the personalities involved, and the political considerations leading to the eventual outcome of the case are stunning.

Five Days at Memorial raises soul-searching questions, the most insistent of them being, “What would I have done in that situation?”

We’ve all said, “I’d never do that.” However, we also know that there have been many times in our lives when we’ve done things we’ve thought we’d never do.

The question for us, then, should be not “What would I have done?” but “What should I do in such a situation?”

Reading about the deadly decisions made at Memorial confronts us with the reality that we could easily fall into the trap of rationalizing behavior that, bluntly put, is just plain wrong. But unless we are willing to face that possibility, we may find ourselves, like those at Memorial, someday doing what should not be done.

If you are going to read only one book in the near future, I would recommend Five Days at Memorial.

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—Rita L. Marker is an attorney and executive director of the Patients Rights Council.