SHERI FINK Five Days at Memorial: Life and death in a storm-ravaged hospital. Reviewed by Sonia Nair
This book examines human behaviour and moral choices in a hospital fighting for its patients’ lives and its own in the aftermath of Hurricane Katrina.
It was like a knife, death. Always waiting to cut.
The medical profession is predicated upon saving lives and prolonging mortality. Yet the distinction between providing comfort and hastening death is a fraught one, thus the repudiation of euthanasia by many countries. It is perhaps this dark area of contradictions that piqued American journalist and former doctor Sheri Fink’s interest when she learned about the allegation that several medical practitioners carried out euthanasia on terminally ill patients in the aftermath of Hurricane Katrina.
Using the hospital’s reaction to the disaster as a launchpad for her investigation, Fink unravels contemporary debates on the nature of life and mortality, the ethics surrounding the highly contested practice of euthanasia, and the effectiveness of state response systems to emergencies. An extrapolation of a Pulitzer Prize-winning article that was published in the New York Times Magazine in 2009, the result is searing reportage that offers a blow-by-blow account of the events that unfolded in the Memorial Medical Centre in New Orleans on the back of the hurricane and the subsequent investigation of second-degree murder allegedly perpetrated by doctor Anna Pou and two nurses, Lori L Budo and Cheri Landry.
The first section of the book, ‘Deadly Choices’, focuses on five days when emergency plans collapsed due to the hospital losing power and its back-up generators failing – leaving it without lights, air-conditioning, sewer systems and essential medical equipment. Awaiting evacuation by boat or helicopter, thousands of staff, patients and family members were trapped and living in squalor equivalent to a war zone as levees were breached and floodwaters enveloped the premises.
Fink’s meticulous storytelling is effective as she fosters an inescapable sense of foreboding; her slow-paced chronicling of the abject despair bringing to life a bleak picture of the hopelessness that must have been felt at the time:
The sounds of the wind stealing through invisible crevices added to the aura of terror, a moaning, like a ghost, up and down the musical scale.
The situation was further exacerbated by the withdrawal of national guardsmen and local policemen, as well as by the red tape tangles that stood in the way of getting anything done. Delving deeper into the medical emergency systems adopted, Fink explores the aberrant triage and medical rationing system implemented by staff – where the sickest were prioritised last for rescue – and the subsequent crisis of faith that forever cast a pall over the rescue efforts at the Memorial Medical Centre due to a ‘sense among the doctors that they would not be able to save everyone’.
He could rationalize what he was about to do as merely abbreviating a normal process of comfort care – cutting corners – but he knew that it was technically a crime. It didn’t occur to him then to stay with the patients until they died naturally. That would have meant, he later said he believed, risking his life.
The second section of the book, ‘Reckoning’, investigates the ensuing criminal proceedings against the medical professionals accused of ‘hastening the death’ of their patients, the thorough efforts of prosecutor-investigator team Virginia Rider and Butch Schafer, and the wellspring of community support that Pou subsequently garnered.
Five Days weaves together interviews with people who were at the hospital, families of dead patients, hospital executives, law-enforcement officials, attorneys, researchers and ethicists, to paint an incisive portrait of the events leading up to the much-contested deaths of the patients and their repercussions. Scanned copies of emails, weather reports, architectural floor plans and quoted dialogue – reproduced exactly as it was recalled in interviews – lend the book verisimilitude.
Fink frames each person involved by providing readers with a historical narrative, lifting deceased patients, in particular, from the annals of statistically recorded casualties into three-dimensional entities who allegedly died at the hands of medical practitioners. We learn about Jannie Burgess, who worked as a nurse through the integration of New Orleans, Merle Largasse who was a 76-year-old rescuer, collector and lover of feral cats and many other patients who met an untimely end.
Although the book has since attracted the ire of Anna Pou, Fink prefaces Pou’s crucial role in the unfolding story by detailing her ‘compassion for her patients’ and her reputation for being ‘the kind of cancer surgeon who fought to give patients with poor prognoses the latest treatments and every last possible chance to survive’. Fink’s appraisal of Pou’s behaviour is harsh and unflinching, but her real censure is reserved for the lack of consultation with patients on the very pivotal matter of their lives, for the not-for-profit company who owned the hospital (which Fink hints had more to do with the deaths than appeared to be the case), and an ill-adjudicated legal trial where insufficient evidence was provided to the jury.
The book discusses questions of state emergency response capabilities and moral culpability, but for the most part, offers no definitive answer to the political and ethical considerations of euthanasia, or to the dichotomy between murder and medical care. Perhaps it is a testament to Fink’s even-handed reportage that readers are left with no clear-cut answers about what actually transpired in the Memorial Medical Centre. Despite the multitude of accounts that comprise Fink’s reportage, the absence of Pou’s first-hand account means the events of September 1, 2005 will never be fully explained.
Any critique of this book must reference its colossal size. At 576 pages, the narrative drags in parts, but the minutiae of the pulsating events that characterise the first section and the deep insight Fink offers in the second make for an absorbing read.
Sheri Fink Five Days at Memorial: Life and death in a storm-ravaged hospital Atlantic 2014 PB 576pp $29.99
Sonia Nair is a Melbourne-based business journalist and freelance arts writer. She tweets at @son_nair
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