On August 29, 2005, Hurricane Katrina struck New Orleans. Most of us know what happened after that, when the levees failed, the city flooded, and over 14,000 people ended up trapped in horrific conditions at the Super Dome for days without any supply drops or rescue attempts, thanks more or less equally to the innumerable failures of both federal and local government and the sheer magnitude of the disaster at hand.
Fewer people, however, know about what was going on in the hospitals of the region, which, unlike the rest of the city, were not under mandatory evacuation and thus remained full of patients and staff (as well as family members and dozens of pets), struggling on as the power went out, the water began to rise, supplies got low, and life support machines failed.
This book, which began as a Pulitzer Prize-winning investigative news article for the New York Times and ProPublica, tells the story of the most infamous of those hospitals, Memorial Medical Center, where, weeks after Katrina was over, details about a series of “mercy killings” hit the media.
It’s the story of a group of doctors and nurses struggling to care over a hundred of patients, many of whom had life-threatening conditions, as the air conditioning went out (resulting in temperatures of up to 110 in some parts of the building), water became contaminated, food got scarce, the plumbing failed, the stench of human waste and dead animals thickened the already-stifling air, and violence broke out all around the city outside.
It’s also the story of a hospital (one of many just like it) that was completely unprepared for a disaster of this scale. Despite all the federal funding and training for terrorist attack readiness post-9/11, most of the hospitals in the New Orleans region hadn’t bothered doing much prep for natural disasters, particularly floods. And even fewer had given any thought to what might happen if the power went out and stayed out. (In many cases, hospitals even kept their back-up generators in the basement or on lower floors, where they were almost immediately incapacitated by water as soon as the levees broke.)
It’s ALSO the story of Tenet Healthcare and the federal government — two forces that could’ve acted much more quickly and efficiently and saved countless more lives if they hadn’t had their heads so far up their butts. Tenet, the corporation that owned Memorial, even received numerous phone calls at their Texas HQ early in the week from people and organizations with helicopters offering to assist with rescue efforts — offers they rejected, telling people the federal government was in charge and they could do nothing.
Helicopters did finally start landing at Memorial a day or two after the levees broke. But by then, the staff were so overwhelmed and underprepared they hardly knew how to respond. Elevators were out, so every patient evacuated had to be carried up numerous flights of stairs by staff (one reason given for leaving obese patients out of the initial rescue plan), and there was a total lack of leadership. The whole place was in chaos. Ultimately, a decision was made to get the healthiest people out first — the opposite of standard triage and not something that had ever been discussed and formalized outside of an actual crisis situation.
By Thursday morning, five days after the hurricane had struck and the levees broken, the sickest were dying, and two doctors and a handful of nurses made the decision to euthanize several of them rather than let their suffering continue, something they did without consent from the patients themselves or their family members. After all, they’d been euthanizing pets for several days already and for the same reasons — imminent, painful death and fear they’d be abandoned to die alone (pets were not being allowed on the helicopters or boats, and the sickest of the patients were theoretically too ill to be safely moved). Was the animals’ suffering somehow more worthy of mercy? Was that mercy at all?
By the time everyone finally got out, there were 45 corpses in Memorial — dramatically more than at any other hospital affected by Katrina. Forensic pathologists found deadly levels of pain killers and sedatives in several of the dead, including one man who had reportedly been in relatively stable condition, but weighed over 300 pounds. Was he euthanized because nobody wanted to try to carry such a heavy man up the stairs? It’s impossible to know for sure, but I definitely got the distinct impression Fink believed that played a part, though I’ll also say one of the most powerful elements of this book is Fink’s relatably authentic tone — compassionate, confused — and her clear lack of clarity in her own opinion on what happened.
This book is extremely detailed, based on interviews with over 500 people and covering not only the actual events in the hospital, but the entirety of the aftermath, when Dr. Anna Pou and two nurses were accused of the first-degree murder of four patients by the state attorney general, much to the horror of many who felt they did the best they could under the unfathomable circumstances.
Though a Grand Jury ultimately refused to indict, the debate about whether or not euthanasia was the right move continues, and only gets more complicated, in my opinion, the more you learn about what actually happened. For that reason alone, I think this book is an extremely important one. It really challenged my thinking on the subject (I went into the book confident the doctors had made the right choice — and left it a little less certain, while simultaneously recognizing the value of hindsight in regards to that, something the doctors and nurses in the moment didn’t have).
This book is incredibly hard to read — it’s heartbreaking, terrifying, discouraging (especially the epilogue, where Fink describes the myriad ways in which hospitals appear NOT to have learned any lessons from Katrina), and tragic. But it’s also fascinating and a good reminder of what happens to human beings when they are put in desperate situations — both the bad and the good. (And there was a lot — a lot, a lot, a lot — of good, too.) Though it has a few weak spots — Fink is at her best when describing the situation inside the hospital, but much of the middle-to-end portion of the book, focusing on the investigation and Grand Jury case, gets bogged down by repetition and relatively unimportant detail — overall, this is a powerful book — well-written, extraordinarily well-researched — and a vital record of one of the most heinous natural horrors this country has seen.
Recommended, though if you can’t bring yourself to read the whole book, I’ll let you off the hook as long as you read the original article, located online here: http://www.nytimes.com/2009/08/30/magazine/30doctors.html?ref=sherifink. It’s worth your time, and it’s important. So. Read it.