Five Days at Memorial

Hurricane Katrina, in 2005, unleashed a million stories, but one of the most vivid is what happened at Memorial Hospital. During the storm and its immediate flooding, the hospital became a hell on Earth, as staff desperately tried to care for the sick as they were evacuated. But some patients did not make it, and it would be suspected that one doctor and two nurses hastened their death by morphine injections. Sheri Fink has told the tale in her riveting book, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital.

Memorial, which had been known for years as Baptist, was built in the 1920s, just in time for the devastating flood of 1927. As Katrina bore down in late August 2005 it was unthinkable, apparently, that the hospital might completely lose power. As Fink puts it: "The scenario was familiar to every student of mass disasters around the world. Systems always failed. The official response was always unconscionably slow. Coordination and communication were particularly bad. These were truths Americans had come to accept about other people's disasters. It was shocking to see the scenario play out at home."

The first half of the book is an almost hour by hour recitation of what happened at Memorial, introducing the key players: the nurses, doctors, patients, and patients' families. Fink comes to the conclusion that Tenet, the corporation that owned Memorial, was too reliant on government help to evacuate patients: "Despite the request, and the fact that executives from some of Tenet hospitals, like Atlanta, had already expressed a willingness to provide evacuation support, Tenet officials continued to rely on governmental resources to respond to the emergency."

The prose reads like horror fiction as the flood waters rise. "Some doctors would later say the sight of the water advancing toward the hospital, pushing the hurricane debris ahead of it, was like something out of a movie: a glob of murderous slime from a '60s sci-fi thriller, or the mist-cloaked Angel of Death wafting down Egyptian streets to envelop the homes of firstborn sons in Cecil B. DeMille's The Ten Commandments."

The staff was heroic in their efforts, working almost around the clock. One doctor tucked a baby against his breast and hopped aboard a helicopter--all of the babies were successfully evacuated. But as the days wore on, and patient after patient was evacuated (Fink tells the story of one couple who rescued their mother by their own boat) there remained a number of patients on the seventh floor, part of a facility called LifeCare.

Here is where the story of Dr. Anna Pou comes in. I've read on the Internet, including Dr. Pou's own Web page, that she strenuously disagrees with Fink's book. Dr. Pou writes: "The book is not only an insult to the self sacrificing doctors, nurses and other medical personnel who stayed in harms way tending to patients in the most difficult of circumstances, but a disruption to the closure of this tragedy by suggestions to family members of patients who lost their lives that their loved ones were murdered."

From Fink's investigation, Pou, who is presented as a extremely caring cancer surgeon, injected a number of patients with morphine because they could not be evacuated. Particular emphasis is placed on a man named Emmett Everett, who weighed over 300 pounds, but was alert and not on death's door. Here is where the crux of the issue comes down--did Pou and two nurses inject these patients intending them to die: "In fact the distinction between murder and medical care often came down to the intent of the person administering the drug." Secondly, if she did, was this the right thing, ethically, to do?

The second half of the book, once the waters have receded and the city began to try to get back to normal, is the investigation and subsequent charging of Dr. Pou and two nurses with murder. The issue was very divisive. Many were outraged that these heroic doctors and nurses were charged with such a crime, while others, including those in the medical profession, including doctors were at Memorial at the time, couldn't believe that a doctor would take steps to kill a patient without the patient, or their families, consent. The issue divided the city and the medical establishment. Fink focuses on two investigators from the state Attorney General's office, who believe that murder was committed. Later the Attorney General himself will make a hash of his career by attempting to get an indictment, that despite the ruling of the coroner that homicide was committed, does not come.

According to Fink, as Pou objects, there was euthanasia. It's difficult to ascertain whether this was the right thing to do. Fink notes, in the epilogue, "Emergencies are crucibles that contain and reveal the daily, slower-burning problems of medicine and beyond--our vulnerabilities; our trouble grappling with uncertainty, how we die, how we prioritize and divide what is most precious and vital and limited; even our biases and blindnesses." It's a classic "what would you do?" scenario.

The best part of the book is the first half, which is less dry (no pun intended) and reads more like fiction. Consider this passage, which puts the reader right there in the hospital: "The sun rose and with it the temperature. The hospital was stifling, its walls sweating. Water had stopped flowing from taps, toilets were backed up, and the stench of sewage mixed with the odors of hundreds of unwashed bodies. Interior corridors were enveloped in darkness penetrated only by dancing flashlight beams."

The latter half of the book, particularly the epilogue, seems to go off the rails a bit, as Fink considers the larger implications of how to handle medical crises during disasters. Still, this is a book of great interest to anyone in the medical profession, or those who consider medical ethics.