Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

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by Sheri Fink
     
 

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One of the New York Times’s Best Ten Books of the Year

Winner of the National Book Critics Circle Award for Nonfiction


Winner of the 2014 J. Anthony Lukas Book Prize, the PEN/John Kenneth Galbraith Award, the Los Angeles Times Book Prize, the Ridenhour Book Prize, the 2014 American Medical Writers Association

Overview

One of the New York Times’s Best Ten Books of the Year

Winner of the National Book Critics Circle Award for Nonfiction


Winner of the 2014 J. Anthony Lukas Book Prize, the PEN/John Kenneth Galbraith Award, the Los Angeles Times Book Prize, the Ridenhour Book Prize, the 2014 American Medical Writers Association Medical Book Award (Public/Healthcare Consumers), a 2014 Science in Society Journalism Award, and the SIBA 2014 Book Award for Nonfiction

An ALA Notable Book, finalist for the NYPL 2014 Helen Bernstein Award, shortlisted for the PEN/E.O. Wilson Award and the ALA Andrew Carnegie Medal

An NPR “Great Reads” Book, a Chicago Tribune Best Book, a Seattle Times Best Book, a Time Magazine Best Book, Entertainment Weekly’s #1 Nonfiction Book, a Christian Science Monitor Best Book, and a Kansas City Star Best Book

Pulitzer Prize winner Sheri Fink’s landmark investigation of patient deaths at a New Orleans hospital ravaged by Hurricane Katrina – and her suspenseful portrayal of the quest for truth and justice.

In the tradition of the best investigative journalism, physician and reporter Sheri Fink reconstructs 5 days at Memorial Medical Center and draws the reader into the lives of those who struggled mightily to survive and maintain life amid chaos.

After Katrina struck and the floodwaters rose, the power failed, and the heat climbed, exhausted caregivers chose to designate certain patients last for rescue. Months later, several of those caregivers faced criminal allegations that they deliberately injected numerous patients with drugs to hasten their deaths.

Five Days at Memorial, the culmination of six years of reporting, unspools the mystery of what happened in those days, bringing the reader into a hospital fighting for its life and into a conversation about the most terrifying form of health care rationing.

In a voice at once involving and fair, masterful and intimate, Fink exposes the hidden dilemmas of end-of-life care and reveals just how ill-prepared we are for the impact of large-scale disasters—and how we can do better. A remarkable book, engrossing from start to finish, Five Days at Memorial radically transforms your understanding of human nature in crisis.

Editorial Reviews

The New York Times - Jason Berry
Although she had the material for a gripping disaster story, Dr. Fink has slowed the narrative pulse to investigate situational ethics: what happens when caregivers steeped in medicine's supreme value, preserving life, face traumatic choices as the standards of civilization collapse. This approach is a literary gamble, demanding more of readers than a standard-issue medical thriller would. But Dr. Fink…more than delivers. She writes with a seasoned sense of how doctors and nurses improvise in emergencies, and about the ethical realms in which they work…Sheri Fink has written an unforgettable story. Five Days at Memorial is social reporting of the first rank.
The New York Times Book Review - Sherwin B. Nuland
Though not present during the disastrous days, [Fink] interviewed more than 500 participants, from hospital executives to family members, prosecutors and ethicists, recording their comments and descriptions so meticulously that her gripping narrative captures not only the facts of the situation, but the thoughts of her witnesses and the feverishly unfolding disorder, confusion and tragedy. Her choice of sentence structure, the almost staccato voice, and the starkness of style and language reflect the circumstances so well that the reader cannot help being pulled into the discordant rhythms of those chaotic hours…The tone is…visceral and very appropriate to the atmosphere created by the storm and its consequences. What we have here is masterly reporting and the glow of fine writing.
Publishers Weekly
“They were in a war zone,” Fink (War Hospital: A True Story of Surgery and Survival) writes of those stranded inside New Orleans’ Memorial Medical Center in the calamitous wake of Hurricane Katrina. In this astonishing blend of Pulitzer Prize–winning journalism (Fink, who also has an M.D. and Ph.D., won the award for the investigative reporting on which this book is based) and breathtaking narration, she chronicles the chaotic evacuation of the hospital and the agonizing ethical, physical, and emotional quandaries facing Memorial nurses and doctors, including a nightmarish triage process that led to the controversial decision to inject critically ill patients with fatal doses of morphine in order to refocus attention on those with a chance of surviving. An alarming 45 bodies were recovered from the crippled hospital, nine of which were deemed suspected victims of euthanasia. Yet investigators realized that unraveling the tragedies was “as impossible as collecting fragments of a fractured mirror and then, somehow, inferring what image had once appeared there.” Some members of the medical staff were charged with murder, but a grand jury acquitted them. Plenty of hard-earned lessons were learned from the stunningly mismanaged response to the disaster, yet Fink acknowledges that for the families of those who never made it out of Memorial, the “war against nature” could only be considered a loss. (Sept. 10)
Kirkus Reviews
Pulitzer Prize–winning medical journalist/investigator Fink (War Hospital, 2003) submits a sophisticated, detailed recounting of what happened at Memorial Medical Center in New Orleans during and after Hurricane Katrina. Under calamitous, lethal circumstances, the staff at Memorial did a remarkable job of saving many lives in the wake of Hurricane Katrina--though others would point out they didn't have the street smarts of the staff at Charity Hospital, whose creativeness resulted in far fewer deaths. Fink draws those few days in the hospital's life with a fine, lively pen, providing stunningly framed vignettes of activities in the hospital and sharp pocket profiles of many of the characters. She gives measured consideration to such explosive issues as class and race discrimination in medicine, end-of-life care, medical rationing and euthanasia, and she presents the injection of some patients with a cocktail of drugs to reduce their breathing in such a manner that readers will be able to fully fashion their own opinions. The book is an artful blend of drama and philosophy: When do normal standards no longer apply? what if doing something seems right but doesn't feel right? In the ensuing investigation of one doctor, who is clearly the fall guy (or woman, as it were), Fink circles all the players, successfully giving much-needed perspective to their views. The obvious villains are the usual suspects: nature, for sending Katrina forth; big business, in the guise of Memorial owner Tenet Healthcare, for its failure to act and subsequent guilty posturing; and government, feds to local, for the bungling incompetence that led to dozens of deaths. The street thugs and looters didn't help much, either. With apparent effortlessness, Fink tells the Memorial story with cogency and atmosphere.
From the Publisher
New York Times Bestseller

MSNBC's Morning Joe Book Club

Wall Street Journal Bestseller

NPR Bestseller

New York Times Book Review Editor's Choice

"A" – Entertainment Weekly

#1 September Book – Christian Science Monitor

One of USA Today's "Coolest Books" for Fall

One of People magazine's "Great Reads" in New Nonfiction

"What we have here is masterly reporting and the glow of fine writing.” – Sherwin B. Nuland, New York Times Book Review

“Dr. Fink more than delivers. She writes with a seasoned sense of how doctors and nurses improvise in emergencies, and about the ethical realms in which they work. The first half of this book, which is well paced, covers the five days of the title. Then the viewfinder shifts to an entwined legal and political story in which state authorities pursue a homicide investigation. That so many people, starkly divided over the question of whether crimes had been committed, come off as decent and appealing makes this book an absorbing read. Dr. Fink brings a shimmering intelligence to its many narrative cul-de-sacs, which consider medical, legal and ethical issues…. By reporting the depth of those gruesome hours in Memorial before the helicopters came, and giving weight to medical ethics as grounded in the law, Sheri Fink has written an unforgettable story. Five Days at Memorial is social reporting of the first rank.” – Jason Berry, New York Times

“The journalist and doctor Sheri Fink published a meticulous investigation of these deaths in the New York Times Magazine and on the Web site of ProPublica, in 2009. Her work won a Pulitzer Prize.  And now comes the book. In “Five Days at Memorial,” the contours of the story remain the same, yet Fink imbues them with far more narrative richness, making the doctors seem both more sympathetic and more culpable. Fink also expands on the ethical conundrums, which have festered over time and seem to gain fresh urgency.” – TheNewYorker.com

"A triumph of journalism...Fink re-creates this world with mastery and sensitivity, revealing the full humanity of each character. Unlike post-storm commentary that jumped to black and white conclusions, painting the doctors as heroes or villains, Fink’s narrative wades through the muck and finds only real people making tough choices under circumstances the rest of us, if we’re lucky, will never experience." – Houston Chronicle

"Every page gives evidence of meticulous research, thousands of hours spent interviewing, prowling the halls at Memorial, reviewing legal documents and transcripts...[Fink] offers no easy answers, no rush to judgment. But she does deliver an amazing tale, as inexorable as a Greek tragedy and as gripping as a whodunit."– Dallas Morning News

"Fink, a Pulitzer Prize-winning journalist who trained as a physician, writes powerfully of the investigation into the Memorial deaths and, in her epilogue, of subsequent disasters: the earthquake in Haiti, Hurricane Sandy in the Northeast, an influenza pandemic in India.” – Radhika Jones, TIME

“Powerful…Fink, a trained physician turned journalist, is able to re-create in minute detail the sights, smells and sounds of Memorial in the days following the storm. It’s safe to say that her medical background gave her a unique perspective, which, coupled with her fine writing, offers the reader an evocative narrative of how the hospital staff and patients struggled to cope with the lack of electricity, climbing temperatures, and a sense that they might not make it out alive.” – USA Today

“This isn’t just a policy brief ornamented with characters. It is, like all great journalism, a document unto itself, an artifact of what we thought about ‘life and death’ issues in the early twenty-first century… Magnificent.” Bookforum

“An important book… Fink, an M.D. and Pulitzer-winning journalist, certainly knows how to craft a nonfiction page-turner.” – Laura Miller, Salon
 
“[Fink] has shaped her research into an elegant narrative, Five Days at Memorial, with all the page-turning pull of a novel, no easy feat given the complexity of the story… riveting." – Entertainment Weekly

“Pulitzer Prize-winning journalist Sheri Fink spells out the story of Memorial – and its consequences – in a book that is as excellent as it is alarming.” – Christian Science Monitor

"Fink’s descriptions of the flooded hospital, her extensive interviews with those who were there, profiles of investigators and study of the history and ethics of triage and euthanasia come very close to a full airing of how a disaster can upset society’s usual ethical codes, and how that played out at New Orleans’ Memorial Medical Center....Fink has written a compelling and revealing account." – Seattle Times

"Five Days At Memorial unfolds in two parts—an impeccably researched reconstruction of the events inside the hospital during the disaster, and a gripping account of the investigation and trial that followed. Pulitzer-Prize-winning Sheri Fink, who is also a physician and a former relief worker in combat zones, lays out every shred of evidence, but leaves the final judgment to the reader. Five Days at Memorial treats the chain of events at the hospital as a microcosm that raises vital and increasingly relevant questions about end-of-life care, and the ethics of euthanasia in extraordinary circumstances." – Macleans

“Fink's reporting is stellar…[the] book is first-rate: riveting reading, morally probing, scrupulously fair. Anyone interested in Hurricane Katrina, human behavior in times of crisis, or medical ethics should read it.” – Milwaukee Journal Sentinel

 “Meticulously researched… Throughout this horrifying, fascinating book, Fink, a physician, maintains the highest journalistic standards. Her reporting is detailed, nuanced and far-reaching, yet it is never biased--a stunning accomplishment in a story with this kind of moral complexity.  [Fink] gives voice to all sides–the doctors, nurses, families, and patients themselves–and leaves the conclusions and judgments, none of which can or ever will be easily reached, to the reader. This is a book not to be missed. It is, quite simply, required reading.” – Shelf Awareness (starred)

“[Fink] offers a stunning re-creation of the storm, its aftermath, and the investigation that followed…She evenhandedly compels readers to consider larger questions, not just of ethics but race, resources, history, and what constitutes the greater good, while humanizing the countless smaller tragedies that make up the whole. And, crucially, she provides context, relating how other hospitals fared in similar situations. Both a breathtaking read and an essential book for understanding how people behave in times of crisis.” – Booklist (starred)

“In this astonishing blend of Pulitzer Prize–winning journalism (Fink, who also has an M.D. and Ph.D., won the award for the investigative reporting on which this book is based) and breathtaking narration, she chronicles the chaotic evacuation of the hospital and the agonizing ethical, physical, and emotional quandaries facing Memorial nurses and doctors, including a nightmarish triage process that led to the controversial decision to inject critically ill patients with fatal doses of morphine in order to refocus attention on those with a chance of surviving.” – Publishers Weekly (starred)

“Pulitzer Prize–winning medical journalist/investigator Fink (War Hospital, 2003) submits a sophisticated, detailed recounting of what happened at Memorial Medical Center in New Orleans during and after Hurricane Katrina. Fink draws those few days in the hospital’s life with a fine, lively pen, providing stunningly framed vignettes of activities in the hospital and sharp pocket profiles of many of the characters. She gives measured consideration to such explosive issues as class and race discrimination in medicine, end-of-life care, medical rationing and euthanasia, and she presents the injection of some patients with a cocktail of drugs to reduce their breathing in such a manner that readers will be able to fully fashion their own opinions. The book is an artful blend of drama and philosophy [and] with apparent effortlessness, Fink tells the Memorial story with cogency and atmosphere.”  Kirkus Reviews (starred) 

“Fink’s six years of research and more than 500 interviews yield a rich narrative full of complex characters, wrenching ethical dilemmas, and mounting suspense. General readers and medical professionals alike will finish the book haunted by the question,'What would I have done?'”  – Library Journal (starred)

“[Fink] raises important ethical questions in this fast-paced reconstruction of heart-wrenching events.” – Ms. Magazine

"In a high speed world that reduces reality to black and white, Sheri Fink slows down to examine every achingly tough decision made by medical responders to Hurricane Katrina. The riveting result  is nuanced and leaves you asking, 'Well, what would I have done?' Wow."  Laurie Garrett, Pulitzer Prize-winning writer and author of I Heard the Sirens Scream

"Sheri Fink is one of the best medical journalists working in the United States today and Five Days at Memorial stands as evidence of her ability to tell a can't-put-down story, and also her ability to delve into the troubled and sometimes heart-breaking state of medical care in this country today. Read it because it's a compelling look at a hurricane-driven medical catastrophe - and read it because it matters." – Deborah Blum, author of The Poisoner's Handbook

“Sheri Fink has once again revealed the necessity of honorable journalism:  to show us, precisely, why intelligence and information are of critical use.  She respects the reader by her labor—gathering the details, earning our engagement as she unfolds the complexity of this story, fact by painstaking fact.  Fink invites us into a fuller understanding of five days at Memorial Hospital, the deeper dynamics of which are much in play in America, today.  The stakes couldn’t be higher.” –Adrian LeBlanc, author of Random Family

Library Journal
★ 09/01/2013
Journalist Fink (War Hospital: A True Story of Surgery and Survival) won the 2010 Pulitzer Prize for Investigative Reporting for her work on the harrowing events at New Orleans's Memorial Hospital during and after Hurricane Katrina, reporting that became the basis for this book. Two thousand patients, staff members, and their family and friends sought safety at Memorial as Katrina approached on Monday, August 28, 2005. Without power, running water, air-conditioning, or standard high-tech medical equipment, conditions quickly deteriorated, particularly for the oldest and most critically ill patients. It wasn't until Friday, September 1, that everyone was finally rescued, and, by that time, there had been 45 patient deaths—18 of them deemed suspicious by the New Orleans coroner. A legal hurricane followed, and one doctor and three nurses were accused of second-degree murder. Fink devotes half of her book to the criminal investigations and ensuing grand jury inquiry, guiding readers through the concepts of triage, euthanasia, and end-of-life care that made the cases so controversial. VERDICT Fink's six years of research and more than 500 interviews yield a rich narrative full of complex characters, wrenching ethical dilemmas, and mounting suspense. General readers and medical professionals alike will finish the book haunted by the question, "What would I have done?" [See Prepub Alert, 6/24/13.]—Kathleen Arsenault, St. Petersburg, FL

Product Details

ISBN-13:
9780307718969
Publisher:
Crown/Archetype
Publication date:
09/10/2013
Pages:
576
Sales rank:
184,888
Product dimensions:
6.72(w) x 9.48(h) x 1.71(d)

Read an Excerpt

NOTE TO THE READER
This book recounts what happened at Memorial Medical Center during and after Hurricane Katrina in August 2005 and follows events through the aftermath of the crisis, when medical professionals were arrested and accused of having hastened the deaths of their patients. Many people held a piece of this story, and I conducted more than five hundred interviews with hundreds of them: doctors, nurses, staff members, hospital executives, patients, family members, government officials, ethicists, attorneys, researchers, and others. I was not at the hospital to witness the events. I began researching them in February 2007 and wrote an account of them in 2009, co-published on the investigative news site ProPublica and in the New York Times Magazine: “The Deadly Choices at Memorial.”

Because memories often fade and change, source materials dating from the time of the disaster and its immediate aftermath were particularly valuable, including photographs, videotapes, e-mails, notes, diaries, Internet postings, articles, and the transcripts of interviews by other reporters or investigators. The narrative was also informed by weather reports, architectural floor plans, electrical
 
PROLOGUE
At last through the broken windows, the pulse of helicopter rotors and airboat propellers set the summer morning air throbbing with the promise of rescue. Floodwaters unleashed by Hurricane Katrina had marooned hundreds of people at the hospital, where they had now spent four days. Doctors and nurses milled in the foul-smelling second-floor lobby. Since the storm, they had barely slept, surviving on catnaps, bottled water, and rumors. Before them lay a dozen or so mostly elderly patients on soiled, sweat-soaked stretchers.

In preparation for evacuation, these men and women had been lifted by their hospital sheets, carried down flights of stairs from their rooms, and placed in a corner near an ATM and a planter with wilting greenery. Now staff and volunteers—mostly children and spouses of medical workers who had sought shelter at the hospital—hunched over the infirm, dispensing sips of water and fanning the miasma with bits of cardboard.

Supply cartons, used gloves, and empty packaging littered the floor. The languishing patients were receiving little medical care, and their skin felt hot to the touch. Some had the rapid, thready pulse of dehydration. Others had blood pressures so low their pulses weren’t palpable, their breathing the only evidence of life. Hand-scrawled evacuation priority tags were taped to their gowns or cots. The tags indicated that doctors had decided that these sickest individuals in the hospital were to be evacuated last.

Among them was a divorced mother of four with a failing liver who was engaged to be remarried; a retired church janitor and father of six who had absorbed the impact of a car; a WYES public television volunteer with mesothelioma, whose name had recently disappeared from screen credits; a World War II “Rosie Riveter” who had trouble speaking because of a stroke; and an ailing matriarch with long, braided hair, “Ma’Dear,” renowned for her cooking and the strict but loving way she raised twelve children, multiple grandchildren, and the nonrelatives she took into her home.

In the early afternoon a doctor, John Thiele, stood regarding them. Thiele had taken responsibility for a unit of twenty-four patients after Katrina struck on Monday, but by this day, Thursday, the last of them were gone, presumably on their way to safety. Two had died before they were rescued, and their bodies lay a few steps down the hallway in the hospital chapel, now a makeshift morgue.

Thiele specialized in critical care and diseases of the lungs. A stocky man with a round face and belly, and skinny legs revealed beneath his shorts, friends called him Johnny, and when he smiled, his eyes crinkled nearly shut. He was a native New Orleanian, married at twenty, with three children. He golfed and watched televised sports. He liked to smoke a good cigar while listening to Elvis.

Like many of the hospital staff around him, his association with what was now Memorial Medical Center stretched back decades. He had rotated at the hospital as a Louisiana State University medical student in 1977. A classmate would later say that Johnny Thiele had turned into the sort of doctor they all wished to be: kind, gentle, and understanding, perhaps all the more so for having struggled over the years with alcohol and his moods. When Dr. Thiele passed a female nurse, he would greet her by name with a pat on the back and sometimes call her “kiddo.”

Thiele had pursued part of his training at the big public Charity Hospital, one of the busiest trauma centers in the nation, where he learned, when several paramedics burst into the emergency room in close succession, to attend to the most critical patients first. It was strange to see the sickest here at Memorial prioritized last for rescue. At a meeting Thiele had not attended, a small group of doctors had made this decision without consulting patients or their families, hoping to ensure that those with a greater chance of long-term survival were saved. The doctors at Memorial had drilled for disasters, but for scenarios like a sarin gas attack, where multiple pretend patients arrived at the hospital at once. Not in all his years of practice had Thiele drilled for the loss of backup power, running water, and transportation. Life was about learning to solve problems by experience. If he had a flat tire, he’d later say, he knew how to fix it. If somebody had a pulmonary embolism, he knew how to treat it. There was little in his personal history or education that had prepared him for what he was seeing and doing now. He had no repertoire for this.

He had arrived here on Sunday. He brought along a friend who was recovering from pneumonia and was too weak to com- ply with the mayor’s mandatory evacuation order for the city, which had exempted hospitals. Early Monday, Thiele awoke to shouts and felt his fourth-story corner office swaying. Its floor- to-ceiling windows, thick as a thumb, moved in and out with the wind gusts, admitting the near-horizontal rain. He and his colleagues lifted computers away and sopped up water with sheets and gowns from patient exam rooms, wringing out the cloth over garbage cans.

The hurricane cut off city power. The hospital’s backup generators did not support air-conditioning, and the temperature climbed. The well-insulated hospital turned dank and humid; Thiele noticed water dripping down its walls. On Tuesday, the floodwaters rose.
Early Wednesday morning, Memorial’s generators failed, throwing the hospital into darkness and cutting off power to the machines that supported patients’ lives. Volunteers helped heft patients to staging areas for rescue, but helicopters arrived irregularly. That afternoon, Thiele sat on the emergency room ramp for a cigar break with an internist, Dr. John Kokemor, who told him doctors were being requested to leave last. When Thiele asked why, he later recalled, his friend brought an index finger to the crook of his opposite elbow and pantomimed giving an injection. Thiele caught his drift.

“Man, I hope we don’t come to that,” Thiele said. Kokemor would later say he never made the gesture, that he had spent nearly all his time outside the building loading hundreds of mostly able- bodied evacuees onto boats, which floated them over a dozen blocks of flooded streets to where they could wade to dry ground. He said he was no longer caring for patients and too busy to worry about what was going on inside the hospital.
Wednesday night, Thiele heard gunshots outside the hospital. He was sure people were trying to kill each other. “The enemy” lurked as near as a credit union building across the street. Thiele thought the hospital would be overtaken, that those inside it had no good way to defend themselves. He lost his footing in an inky stairwell and nearly pitched down the concrete steps before catching himself. Panicked and convinced he would die, he reached his family by cell phone to say good-bye.

Thiele felt abandoned. You pay your taxes and you assume the government will take care of you in a disaster, he thought. He also wondered why Tenet, the giant Texas-based hospital chain that owned Memorial, had not yet sent any means of rescue.

Finally, on Thursday morning, the company dispatched leased helicopters, while other aircraft from the Coast Guard, Air Force, and Navy hovered overhead awaiting a turn to perch on Memorial’s helipad. Airboats came and went with the earsplitting drone of airplane engines.
The pilots would not allow pets on board the aircraft and watercraft, creating stressful choices for the staff members who had brought them to the hospital for the storm. A young internist held a Siamese cat as Thiele felt for its breastbone and ribs and conjured up the anatomy he had learned in a college dissection class. He aimed the syringe full of potassium chloride at the cat’s heart. The animal wriggled free of the doctor’s hands and swiped and tore Thiele’s sweat-soaked scrub shirt. Its whitish fur stuck to him. They caught the animal and tried again to euthanize it, working in a hallway perhaps twenty feet away from the patients in the second-floor lobby. It was craziness.

A tearful doctor came to Thiele with news she had been offered a spot on a boat with her beautiful twenty-pound sheltie. She had quickly trained it to lie in a duffel bag. Several of the doctor’s human companions were insisting they would not leave without her. The doctor had been sick to her stomach and continuously afraid. She wanted to go while she had this chance, but she felt guilty about abandoning her colleagues and the remaining patients. “Don’t cry, just go,” Thiele said. “An animal’s like a child.” He reassured her: “We gonna get by without you. I promise you.”

Thiele walked back and forth through the second-floor lobby multiple times as he journeyed between the hospital and his medical office. As the hours passed, the volunteers fanning the patients on their stretchers were shooed downstairs to join an evacuation line snaking through the emergency room.

Thiele knew nothing about the dozen or so patients who remained, but they made an impression on him. Before the storm, the poor souls would have had a chance. Now, after days in the inferno with little to no medications or fluids, they had deteriorated.

The airboats outside made it too loud for Thiele to use a stethoscope. He didn’t see any medical records, didn’t feel he needed them to tell him that these patients were moribund. He watched a doctor he didn’t know direct their care, a short woman with auburn hair. He would later learn her name: Dr. Anna Pou, a head and neck surgeon.

Pou was among the few doctors still caring for patients inside the stifling hospital. Some physicians had left; those who hadn’t were, for the most part, no longer practicing medicine—they were carrying patients or deciding which people to load onto boats and helicopters outside, where it was somewhat cooler. But Pou looked to Thiele like a female Lone Ranger. After four nights of little sleep, she remained determined to tend to the worst-off. Later, he would remember her saying that the patients before them would not be moved from the hospital. He did not know who had decided that.

Hospital CEO L. René Goux had told Thiele that everyone had to be out by nightfall. A nursing director, Susan Mulderick, the designated disaster manager, had given Thiele the same message. The two leaders later said they had meant to focus their exhausted colleagues on the evacuation, but the comments left Thiele wondering what would become of these patients when everyone else left.

He also wondered about the remaining pets, which he’d heard would be released from their kennels to fend for themselves. They were hungry. And Thiele was sure that another kind of “animal” was poised to rampage through the hospital looking for drugs they were addicted to and craved. He later recalled wondering at the time: “What would they do, these crazy black people who think they’ve been oppressed for all these years by white people . . . God knows what these crazy people outside are going to do to these poor patients who are dying. They can dismember them, they can rape them, they can torture them.”

What did the patients’ family members want Thiele to do? There was no one left to ask; they had all been made to leave, told their loved ones were on their way to rescue.

The first thing, he thought, was the Golden Rule, do unto others as you would have them do unto to you. Thiele was Catholic and had been influenced by a Jesuit priest, Father Harry Tompson, a mentor who had taught him how to live and treat people. Thiele had also adopted a motto he had learned in medical school: “Heal Frequently, Cure Sometimes, Comfort Always.” It seemed obvious what he had to do, robbed of control over almost every- thing except the ability to offer comfort.

This would be no ordinary comfort, not the palliative care he had learned about in a weeklong course that certified him to teach how to relieve symptoms in patients who prioritized this goal of treatment above all others.

There were syringes and morphine and nurses in this make- shift unit in the second-floor lobby. An intensive care nurse he had known for years, Cheri Landry, the “Queen of the Night Shift”—a short, broad-faced woman of Cajun extraction who had been born at the hospital—had, he believed, brought medications down from the ICU. Thiele knew why these medications were here. He agreed with what was happening. Others didn’t. The young internist who had helped him euthanize the cat refused to take part. He told her not to worry. He and others would take care of it.

In the days since the storm, New Orleans had become an irrational and uncivil environment. It seemed to Thiele the laws of man and the normal standards of medicine no longer applied. He had no time to provide what he considered appropriate end- of-life care. He accepted the premise that the patients could not be moved and the staff had to go. He could not justify hanging a morphine drip and praying it didn’t run out after everyone left and before the patient died, following an interval of acute suffering. 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.

He offered his assistance to Dr. Pou, but at first she refused. She tried repeatedly to convince him to leave the area. “I want to be here,” he insisted, and stayed.

With some of the doctors and nurses who remained, Thiele discussed what the doses should be. To his mind, they needed to inject enough medicine to ensure the patients died before every- one else left the hospital. He would push 10 mg of morphine and
5 mg of the fast-acting sedative drug Versed and go up from there as needed. Versed carried a “black box” warning from the FDA, the most serious type, stating that the drug could cause breathing to cease and should only be given in settings where patients were monitored and their doctors were prepared to resuscitate them. That was not the case here. Most of these patients had Do Not Resuscitate orders.

It took time to mix the drugs, start IVs, and prepare the syringes. He looked at the patients. They seemed lifeless apart from their breathing—some hyperventilating, some gasping irregularly. Not one spoke. One was moaning, delirious, but when someone asked what was wrong, she did not respond.

He took charge of four patients lined up on the side of the lobby closest to the windows: three elderly white women and a heavyset black man.

It had come to this. Dr. Thiele’s mind began to form a question, perhaps in the faint awareness that there might be alternatives they had not considered when they set this course. Perhaps he realized at the moment of action that what seemed right didn’t feel quite right; that a gulf existed between ending a life in theory and in practice.

He turned to the person beside him, the nurse manager of the ICUs who also served as the head of the hospital’s bioethics committee. Karen Wynn was versed in adjudicating the most difficult questions of treatment at the end of life. She, too, had worked at the hospital for decades. There was no better human being than Karen. At this most desperate moment, he trusted her with his question.

“Can we do this?” he would later remember asking her. “Do we really have to do this?”

Meet the Author

SHERI FINK is the author of the New York Times bestselling book, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (Crown, 2013) about choices made in the aftermath of Hurricane Katrina. She is a correspondent at the New York Times, where her and her colleagues' stories on the West Africa Ebola crisis were recognized with the 2015 Pulitzer Prize for international reporting, the George Polk Award for health reporting, and the Overseas Press Club Hal Boyle Award. Her story "The Deadly Choices at Memorial," co-published by ProPublica and the New York Times Magazine, received a 2010 Pulitzer Prize for investigative reporting and a National Magazine Award for reporting. Her coverage of Hurricanes Sandy and Isaac in 2012 received the Mike Berger Award from Columbia University and the Beat Reporting Award from the Association of Healthcare Journalists. A former relief worker in disaster and conflict zones, Fink received her M.D. and Ph.D. from Stanford University. Her first book, War Hospital: A True Story of Surgery and Survival (PublicAffairs), is about medical professionals under siege during the genocide in Srebrenica, Bosnia-Herzegovina. Five Days at Memorial was the winner of the National Book Critics Circle Award for nonfiction, the PEN/John Kenneth Galbraith Award for nonfiction, the Ridenhour Book Prize, the J. Anthony Lukas Book Prize, the Los Angeles Times Book Prize, the Southern Independent Booksellers Alliance Book Award, the American Medical Writers Association Medical Book Award, and the NASW Science in Society Journalism Book Award. Find her on Twitter at @sherifink, Facebook at sherifinkbooks or visit her website at www.sherifink.net.

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Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital 4 out of 5 based on 0 ratings. 64 reviews.
MdExTx More than 1 year ago
This book lives up to the hype it's getting. I received an advance copy of this and found it fascinating reading. I remember hearing about this hospital and the people trapped there in the New Orleans flooding after Katrina, but Sherry Fink's description of the conditions in the hospital really brings home to me how awful it must have been. The author apparently researched the subject intensively and provides details about the hospital and the people who spent 5 days in the hospital during and after Katrina. She draws no conclusions about what happened, just presents the facts and lets the reader decide for him or her self. The book lived up to my expectations in that it was well written and almost read like a novel. Even though I knew what had happened at Memorial Hospital after the storm, I found the book compelling reading. She fleshes out the personnel so the reader gets to know the doctors, nurses and patients. The only objection I had to the book was the amount of time the author spent on the history of euthansia and the debates about it in the past. It was near the end of the book, and I really just skimmed those few pages. Otherwise it is a great read, and thought provoking as well. I recommend it to anyone who is interested in Katrina, disaster medicine and medical ethics.
Anonymous More than 1 year ago
We have provided certain classes of people with authority to perform acts and direct actions. What happens to these people when you turn the power off and move them out of their usual bubble? Fink has opened a door on this question in a well researched and well presented look at Memorial Hospital during Katrina. There are no heroes here, just people asked to accept an elevated level of personal discomfort and risk to care for others. The success and failures to do makes clear that "question authority" should be frontmost in times of crises.
linhug More than 1 year ago
I found this book fascinating as it told about Katrina and the horrible "side effects" of misinformation, confusion and poor management on the part of the hospital's leaders. I have watched documentaries on TV about how so much out-and-out wrong information was given out by the news and then by the elected officials as they repeated the mistakes. I liked especially how the author did not draw conclusions, but just stated the events and let you make up your own mind about things. Obviously, there are lessons to be learned from the way that the different hospitals handled themselves. Charity simply continued their regular daily plan, and did pretty well. Memorial didn't, and ended up with euthanasia accusations. The lesson I learned is that when in an emergency situation, do not trust other people in institutional settings to do the right thing. Stay by your loved ones no matter what they tell you about how you "have" to leave. Question decisions that are made that do not seem right.
marystwin More than 1 year ago
The material presented in this book was so provocative that I read it twice. Imagine being a health care provider stranded in a hospital with a full house of patients with no direction or help from the corporation who owns the hospital. During the five days depicted, the environmental conditions were worsening within the hospital - floodwaters were rushing into the streets and hospital after a 200 ft. section of the levee was breached during Hurricane Katrina - no electricity, no elevators, no air conditioning, temperatures reaching 110 degrees in the building and inadequate & poorly located emergency generators; the power available to the patient units was insufficient to support the ventilator usage. In short, there was no emergency plan in place for evacuation in the event of a disaster. To further complicate matters, the only way to evacuate patients was to hand carry them up & down dark stairways, to a helipad in the hopes of being rescued by air. This is a book that has no happy ending. It will haunt you as you wrestle with the ethics of what happened in the five days of the aftermath of Hurricane Katrina in Memorial Hospital. It begs the question of who is really responsible, who takes charge, when a massive disaster strikes?
Anonymous More than 1 year ago
As a Red Cross volunteer who helped during Hurricanes Rita, Gustuv, Sandy and other disasters, this book captures the chaos, feelings of desperation, and horrible conditions that exist during disasters and their aftermath. Everyone should read this book ...govt officials, those in the medical field, students, the elderly, law enforcement, public safety...I mean EVERYONE. It brought back memories for me when I worked the Red Cross shelters with no electricity, toilets clogged, no AC etc etc...Excellent journalism and hopefully this will win some awards..forces you to ask yourself what would you do in a similar situation...I will be buying more copies as gifts.
norway_girl More than 1 year ago
Reading it is living it. I could not put it down for the first half of the book, in fact I had to google some pictures of New Orleans and the hospital to understand the location and how everything was connected geographically.  This book is well researched and carefully crafted.  The reason it slows in the second half is only to do with the mind-boggling facts of the first half.  It surely gives us all pause as to what we would do in the same situation.  After being here in New Jersey after Sandy, this book really hit much closer to home than it would have before.  
Anonymous More than 1 year ago
This story captured the horror of dealing with the events surrounding Katrina along with the legal and moral issues involving a medical situational crisis. The end of life issues are broader than this country seems willing to face. Most depressing is that no action has been taken to learn and take action to prevent much of what came to light in this investigation. It would cost too much money to plan and train for further disasters. Fink is a great journalist and the book moves right along. +
pw38 More than 1 year ago
The details of the five days are so real that you feel you are there living in that moment. It's so full of details that you can't put the book down, and sometimes have to read over a few lines to make sure you didn't miss a single thing. Well written, well documented. It should get more than 5 stars!
Hootie31 More than 1 year ago
I've been a nurse in a variety of settings for almost 40 years. During my Master's degree program ( Holistic Spirituality and Health ) I studied medical ethics. I really wish the author had been able to get into the heads of those convicted. You definitely understand the conditions in the hospital during Katrina. I would not be so quick to condemn the actions of the staff without having walked in their shoes. Self preservation must kick in at some point regardless of your position. I also believe in the dignity of assisted suicide.
Anonymous More than 1 year ago
While the detail can overwhelm at times, the author is grappling with a complex and fraught subject where too little detail would be worse. As we become increasingly dependent on organizations for our care, this book is a compelling read for the questions it raises. How will care be handled in extreme circumstances? How able will people and organizations be at adapting to extreme circumstances when the system fails? Well written, and thoughtfully presented.
Anonymous More than 1 year ago
Really well written & does a good job at not just reflecting the situation at Memorial but raising some VERY good questions that most of us have never had to really consider. I lived through Katrina, albeit on the "Northshore, with a 72 year old grandfather suffering from Alzheimers. VERY VERY difficult with no running water or electricity. How much more difficult for Doctors watching even older patients struggle with no hope?
Anonymous More than 1 year ago
A very even-handed approach to a disturbing story. I'm not one to praise reporting but this is a highly credible work. Very well done. Brings a great many issues to light. We should all rethink our preparedness and reexamine our personal and corporate priorities. The lack of communication at every level (from federal to state to city and even among the caregivers) was astounding. As a former caregiver I was shocked to realize that what I thought was a common vocabulary for end-of-life issues is in fact anything but common even without the overlay of a catastrophic category 5 hurricane.
Anonymous More than 1 year ago
As a medical person, I read this book with a knot in my stomach. I could sympathize with both patient and care giver. And given the situation, being merciful ,I feel , was an act of kindness.
Anonymous More than 1 year ago
The Pulitzer Prize winning non-fiction novel Five Days at Memorial is a chronological recap of the events that occurred at Memorial Hospital during the aftermath of hurricane Katrina. The descriptions that Sheri Fink composed captivated me, making me experience an atmosphere as though I personally had been at Memorial Hospital. Her descriptive citation of the story gave me the opportunity to perceive events through the eyes of doctors, patients, investigators, and prosecutors. Although the mood of the events taking place was disheartening, I could not help but to be intrigued by the details of the event. Growing up during events such as 9/11 and Katrina, our generation’s undeveloped and innocent minds were only capable of acknowledging the event, not comprehending the details and stories of the aftermath. Personally, I felt obligated to finally take the initiative and inform myself on the true devastation that was a result of hurricane Katrina. In saying this, I would highly recommend this book for those who grew up only seeing Katrina as a storm.  For a quick description of the plot, Memorial Hospital was struck by hurricane Katrina and due to breaks in a nearby levee, 15 foot flood water surrounded the building. The hospital staff soon found out when evacuations were moving quickly enough that the hospital was ill prepared to take care of patients. With multiple situations such as looters, power outages, and supply shortages, questions about euthanasia arose as terminally ill patients who seemed would not be leaving the hospital in time were suffering. The novel goes on to discuss the aftermath and investigation of what truly happened inside of Memorial Hospital. A majority of the story revolves around Dr. Anna Pou, but a mix of stories from numerous sources gives the reader multiple pathways to take their opinion of the story and build a foundation of evidence to support it. Fink’s mass research of this story paid off with the quality and quantity of material that was included in the novel. Depictions of the novel were perfectly described by giving the reader a picture of how truly awful the setting was while not being overly graphic with details that could be applied to the situation. Overall, Fink’s coverage of the complete story and the investigation afterwards answers every question that the reader could have. It accomplishes the purpose of informing the reader of a piece of American history that most of us have now long forgotten, and reminds us of the complex situations that Americans overcame in life altering circumstances.
The_Book_Wheel_Blog More than 1 year ago
Imagine this scenario: You’re stuck in a hospital without electricity, food, or proper resources to care for your patients. Some are going to die and there’s nothing you can do about it. Would you help ease their pain by euthanizing them, or hold out hope that help will arrive? And how would you decide which people to give the drugs to and which ones to rescue? These are, on the surface, the questions that the doctors at Memorial Hospital in New Orleans asked themselves while they waited out Hurricane Katrina. But what if there was more to the story than that? What if, in actuality, the patients weren’t about to die? These questions are exactly what author Sheri Fink set out to do when she started interviewing the hundreds of witnesses that helped recreate their five days in hell. Their choices would affect them forever, and for some would result in criminal charges. When I first started reading this book, I couldn’t decide what side of the ethical line I stood. On the one hand, killing someone without their consent is wrong, but on the other hand, I can’t even imagine being put in a situation that requires even thinking about such a thing, so who am I to judge? But as I started reading the book, or more accurately, as I started taking this journey, I found myself feeling every possible emotion a person can feel when reading a book. I started out sad, then turned sympathetic, followed immediately by horror, and ending with anger. As the facts unravelled, I found myself completely shocked by the utter breakdown in communication and both the hospital and government’s failure to prepare for such an event. Five Days At Memorial is an important and difficult read. Hurricane Katrina blew in to New Orleans and the city is still recovering, and so this book is an important part our American history. While it shines a light on our government and corporate failures, it also highlights the resiliency of the human spirit and will to survive. I highly recommend this book, but I do so with the warning that it addresses some very important and controversial issues involving end-of-life care and, in all honesty, will leave you a bit outraged.
Anonymous More than 1 year ago
I was intrigued by thestory itself which is what led me to purchase this book.I am a medical person and was curious to see how everything played itself out in this type of circumstance. Besides the constant repetition I still found myself looking for more info as to what led to the decisions made. That never happened. I found the writing itself to be rather poor and lacking a good flow. It felt like someone had written pages and pages of notes, threw them up in the air and however they were picked up was how the pages were placed. Sorry to go on, but I hardly ever write reviews and am just trying to save you some money. Try Wikipedia. You'll get the answers you want much quicker.
Autismwriter More than 1 year ago
As a former resident of New Orleans, I was hoping for more detail about the city and the storm. What I got instead, was, a detailed account of all the administrative blunders at Memorial Hospital. This book has a lot of names and characters to keep up with, and almost all of them are administrators at the hospital. I would rather have read about the patients and their lives instead. if you are a hospital administrator, this is probably a great read. For the rest of us, not so much.
RebeccaScaglione More than 1 year ago
Five Days at Memorial by Sheri Fink tells the story of Memorial Hospital in New Orleans during and after Hurricane Katrina hit.  While many doctors and nurses did all they could to save patients as the flood waters filled the hospital and shut off the electricity, a few were accused of something horrific: euthanizing patients. Sheri Fink investigates and shares this amazing tale. I loved Five Days at Memorial, but it was a tough read.  This book is not for the casual reader or for someone who doesn't read a lot of nonfiction. But if you are a fan of reading nonfiction, then this book really should be added to your list.  Five Days at Memorial is a compelling read that causes you to look deep inside yourself, put yourself in the doctor's and nurses shoes, to find out what your thoughts are on the idea of euthanasia. What nonfiction read did you find super compelling? Thanks for reading,  Rebecca @ Love at First Book
Tangen More than 1 year ago
I left NOLA only 5 days before Katrina arrived. My daughter-in-law worked at Childrens. I have been an RN for a good many years. I found it easy to feel the reality of the situations people found themselves in: exhaustion, without a sense of hope, morally challenged, wanting to place blame but knowing that it was a useless exercise, totally overwhelmed. The realities are portrayed starkly and with the persistence of an anger that will never go away, and with the sense that the self blame will never go away either. Everyone needs to become immersed in this tale. Those horrors could happen anywhere, but for differing causative factors. Nowhere are we as a people ready to avoid the sequelae of being transformed from a 21st century hospital setting to a primitive one in hours or days without a lot more awareness and preplanning. And how can we continue to believe in rescue by governmental agencies when budget cuts have made their resources impotent. It is impossible to read/listen to this book without becoming personally affected.
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Loved it, felt very immersed in the events and connected with the people, and then I found myself wondering how anyone could have considered euthanasia in this situation. It was a very real feeling of confusion and judgment on my part as a reader, and it only hints at what those in the midst of it felt. Very real human drama!
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