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Michael Hayton
School of Medicine
Faculty of Medical and Health Sciences
University of Auckland
I am sure we have all asked
ourselves at some point how we
might react if the worst struck.
If faced with a disaster, would
we show some semblance of
courage or bravery? Would
we make the ‘right’ call? The
numerous stories of heroism
to come out of any significant
event, like the earthquakes
and the recent tragedy in
Christchurch, are examples of
how the worst situations can
bring out the best in people.
Part of what differentiates
medical professionals from
the public is how we respond
to these life-threatening situations involving patients. This ability to
work under pressure and make the right call is paramount. This is
why resuscitation scenarios are practised regularly. But we are still
fallible. We are all human and we are all capable of making mistakes,
especially when we are under pressure.
The events to come out of Memorial Medical Center in New Orleans,
Louisiana following Hurricane Katrina highlight this fallibility in the
most tragic way. In 2005, Katrina hit New Orleans and led to signifi-
cant flooding surrounding the medical center. For five days, the hos-
pital was cut off from power, water, or any basic services. Windows
were smashed to circulate air, and at night gunshots and looting could
be heard echoing through the city. In the days following, staff and
patients were left to survive while the hospital was slowly evacuated
by air and boat. The evacuation process was flawed from the begin-
ning. Rescue helicopters were turned away after daylight hours with
over 100 patients still left inside. Priority was given to the healthiest
patients, the ones deemed most likely to survive, and over 50 of the
sickest patients lay in an Intensive Care Unit in the sweltering August
heat and humidity. When supplies were almost gone, doctors and
nurses were grappling with decisions about administering fatal doses
of morphine to patients that they felt were not going to make it out.
Ultimately, 45 patients never made it out alive. A state investigation
was launched and it was determined that 20 out of the 45 were vic-
tims of homicide, yet a grand jury refused to convict the doctors and
nurses in question.
Sheri Fink, a former medical doctor and now investigative journal-
ist for the New York Times, reported on the story as the truth of
what happened in the hospital became public knowledge. Five Days
at Memorial is the culmination of her six years of reporting, which led
her to a Pulitzer Prize in 2009. 1 The story is told in two parts: how
the five days played out inside the hospital, and the legal and political
consequences of what followed the disaster. The book is well-paced,
keeps you hooked, and I constantly found myself absorbed in a tale
that seemed too outlandish to have actually occurred.
Despite the gravity of accusations toward some of the staff, you nev-
er get the sense that Fink is condemning them. The desperation of
the staff caring for these critically-ill patients without power, running
water, or basic medications is not lost on us and this provides a very
balanced view of what really happened. Fink allows the reader to
understand the staff’s perspective of the palliative care they were
providing, while also making it clear about her own position. ‘Moral
clarity was easier to maintain in concept than in execution.’ 2 This clar-
ity surrounding her own position while offering a balanced viewpoint
is certainly one of the book’s strongest points.
Five Days at Memorial is also Fink’s condemnation of the lack of pre-
paredness by Tenet Healthcare, the organisation that owned Memo-
rial Medical Center. She writes, ‘sometimes the ethical—the most
important ethical question sometimes is the one you ask not at the
moment of crisis, but the duty you have to anticipate certain kinds
of crises and avoid them.’ 1 You get a sense of not only what hap-
pened during the five days, but how Memorial Medical Center was
so unprepared for the flooding. Fink addresses the numerous system
failures of the privately-owned hospital. She shows us that post 9/11,
disaster planning was focused on terror rather than natural disaster.
She shows us that previous flooding in New Orleans had exposed
how poorly prepared the city and the hospital were for a significant
weather event. It is clear that Fink blames the company as much as
the individuals for what took place over those five days, and you can-
not help but agree.
There are books that we typically read as medical students. These
often focus on medical professionals that exemplify the characteris-
tics of what makes a great doctor. We read them in awe, and often
finish them aspiring to be the next Oliver Sachs or Atul Gawande.
Five Days at Memorial does not have this allure. It certainly does not
provide many glowing examples of doctors or nurses in their finest
hour. However, I believe it is a necessary read for any medical profes-
sional who wants to understand medical ethics and medical systems
in practice. There is no question in my mind that we all will face similar
scenarios with extremely ill patients in front of us. The actions of the
doctors and nurses who were administering lethal doses of morphine
to patients who were critically ill, obviously seemed like best practice
palliative care to them. Conversely, the idea of ‘first, do no harm’
comes to mind and had been forgotten. On reflection I can under-
stand their reasoning, even though it is flawed. While I hope that I am
never in the same situation, the same ethical decisions apply to how
we treat particular patients on the ward. Decisions to halt treatment,
decisions to make some patients not for resuscitation, and decisions
to ease their passing with medication; all of these decisions need the
ethical framework required to make the ‘right call’, something that the
doctors at Memorial Medical Centre had forgotten. Having read Five
Days at Memorial, I hope I make the ‘right’ call, but it also showed me
that wrong decisions can still be made with the best intentions.
References
1. Berry J. Harrowing questions, and ethics, during Katrina. The New
York Times [Internet]. 3 Sep 2013. Available from: https://www.
nytimes.com/2013/09/04/books/five-days-at-memorial-by-sheri-fink.
html
2. Fink S. Five days at Memorial: life and death in a storm-ravaged
hospital. New York: Broadway Books; 2013.
Correspondence
Michael Hayton: [email protected]
Michael Hayton
School of Medicine
Faculty of Medical and Health Sciences
University of Auckland
I am sure we have all asked
ourselves at some point how we
might react if the worst struck.
If faced with a disaster, would
we show some semblance of
courage or bravery? Would
we make the ‘right’ call? The
numerous stories of heroism
to come out of any significant
event, like the earthquakes
and the recent tragedy in
Christchurch, are examples of
how the worst situations can
bring out the best in people.
Part of what differentiates
medical professionals from
the public is how we respond
to these life-threatening situations involving patients. This ability to
work under pressure and make the right call is paramount. This is
why resuscitation scenarios are practised regularly. But we are still
fallible. We are all human and we are all capable of making mistakes,
especially when we are under pressure.
The events to come out of Memorial Medical Center in New Orleans,
Louisiana following Hurricane Katrina highlight this fallibility in the
most tragic way. In 2005, Katrina hit New Orleans and led to signifi-
cant flooding surrounding the medical center. For five days, the hos-
pital was cut off from power, water, or any basic services. Windows
were smashed to circulate air, and at night gunshots and looting could
be heard echoing through the city. In the days following, staff and
patients were left to survive while the hospital was slowly evacuated
by air and boat. The evacuation process was flawed from the begin-
ning. Rescue helicopters were turned away after daylight hours with
over 100 patients still left inside. Priority was given to the healthiest
patients, the ones deemed most likely to survive, and over 50 of the
sickest patients lay in an Intensive Care Unit in the sweltering August
heat and humidity. When supplies were almost gone, doctors and
nurses were grappling with decisions about administering fatal doses
of morphine to patients that they felt were not going to make it out.
Ultimately, 45 patients never made it out alive. A state investigation
was launched and it was determined that 20 out of the 45 were vic-
tims of homicide, yet a grand jury refused to convict the doctors and
nurses in question.
Sheri Fink, a former medical doctor and now investigative journal-
ist for the New York Times, reported on the story as the truth of
what happened in the hospital became public knowledge. Five Days
at Memorial is the culmination of her six years of reporting, which led
her to a Pulitzer Prize in 2009. 1 The story is told in two parts: how
the five days played out inside the hospital, and the legal and political
consequences of what followed the disaster. The book is well-paced,
keeps you hooked, and I constantly found myself absorbed in a tale
that seemed too outlandish to have actually occurred.
Despite the gravity of accusations toward some of the staff, you nev-
er get the sense that Fink is condemning them. The desperation of
the staff caring for these critically-ill patients without power, running
water, or basic medications is not lost on us and this provides a very
balanced view of what really happened. Fink allows the reader to
understand the staff’s perspective of the palliative care they were
providing, while also making it clear about her own position. ‘Moral
clarity was easier to maintain in concept than in execution.’ 2 This clar-
ity surrounding her own position while offering a balanced viewpoint
is certainly one of the book’s strongest points.
Five Days at Memorial is also Fink’s condemnation of the lack of pre-
paredness by Tenet Healthcare, the organisation that owned Memo-
rial Medical Center. She writes, ‘sometimes the ethical—the most
important ethical question sometimes is the one you ask not at the
moment of crisis, but the duty you have to anticipate certain kinds
of crises and avoid them.’ 1 You get a sense of not only what hap-
pened during the five days, but how Memorial Medical Center was
so unprepared for the flooding. Fink addresses the numerous system
failures of the privately-owned hospital. She shows us that post 9/11,
disaster planning was focused on terror rather than natural disaster.
She shows us that previous flooding in New Orleans had exposed
how poorly prepared the city and the hospital were for a significant
weather event. It is clear that Fink blames the company as much as
the individuals for what took place over those five days, and you can-
not help but agree.
There are books that we typically read as medical students. These
often focus on medical professionals that exemplify the characteris-
tics of what makes a great doctor. We read them in awe, and often
finish them aspiring to be the next Oliver Sachs or Atul Gawande.
Five Days at Memorial does not have this allure. It certainly does not
provide many glowing examples of doctors or nurses in their finest
hour. However, I believe it is a necessary read for any medical profes-
sional who wants to understand medical ethics and medical systems
in practice. There is no question in my mind that we all will face similar
scenarios with extremely ill patients in front of us. The actions of the
doctors and nurses who were administering lethal doses of morphine
to patients who were critically ill, obviously seemed like best practice
palliative care to them. Conversely, the idea of ‘first, do no harm’
comes to mind and had been forgotten. On reflection I can under-
stand their reasoning, even though it is flawed. While I hope that I am
never in the same situation, the same ethical decisions apply to how
we treat particular patients on the ward. Decisions to halt treatment,
decisions to make some patients not for resuscitation, and decisions
to ease their passing with medication; all of these decisions need the
ethical framework required to make the ‘right call’, something that the
doctors at Memorial Medical Centre had forgotten. Having read Five
Days at Memorial, I hope I make the ‘right’ call, but it also showed me
that wrong decisions can still be made with the best intentions.
References
1. Berry J. Harrowing questions, and ethics, during Katrina. The New
York Times [Internet]. 3 Sep 2013. Available from: https://www.
nytimes.com/2013/09/04/books/five-days-at-memorial-by-sheri-fink.
html
2. Fink S. Five days at Memorial: life and death in a storm-ravaged
hospital. New York: Broadway Books; 2013.
Correspondence
Michael Hayton: [email protected]