Here's a book to bring you down at the holidays. Or any day. Just when you think you've heard everything bad that happened after Hurricane Katrina, Sheri Fink comes out with the story of five days of misery and ethically difficult decisions at Memorial Hospital. Including discussion of euthanizing patients who have DNR requests and aren't doing well.
The first part of the book is an exhaustively researched account of the five days following the hurricane, as staff and patients wait for help and evacuation. Power goes out, generators fail, someone pretending to be a military evac leader actually is a thief, and the sound of gunshots and rumors of riots outside the hospital walls, combined with the intense heat and humidity no longer handled by central air, understandably take their toll on patients and staff alike.
But the problems are deeper than that. In spite of the fact that Memorial Hospital, opened in 1925 and flooded in 1926 and 1927, has no serious evacuation plan. It doesn't appear the city of New Orleans nor the state of Louisiana have one regarding medical facilities either. Spotty communication, as cell phones die off, is made worse by erratic and contradictory reports from the outside: "Yes, we're evacuating you today. No, not today. Sickest patients first. No, only those able to walk first."
An example of the mess of events:
"Other Tenet [Memorial's parent company] executives attempted to convince government officials to prioritize the evacuation of Memorial adn the company's other marooned hospitals. Staff at every agency seemed happy to nudge another agency. Someone from a senator's office offered to appeal to Gov. Kathleen Blanco and the Centers for Medicare & Medicaid Services. But people at the Centers for Medicare & Medicaid Services directed Tenet to contact the head of the appropriate hospital association. That association, the Federation of American Hospitals, appealed to the US Department of Health and Human Services, which appealed back, on behalf of patients in general, to the Federation, the American Hospital Association, the nation's hospitals, and the Federal Emergency Management Agency. Billionaire Ross Perot, whose son was a Tenet contractor, appealed to the Coast Guard and the Navy. There was no locus of responsibility. Fingers pointed every which way, much as they had when New Orleans flooded in the 1920s"
What a clusterf!ck.
It should come as no surprise, then, that one staffer's comment that "We will leave no living patients behind" eventually became the crux of legal action and accusations of murder and euthanasia.
This is not a book for the faint of heart. I was frustrated and outraged while reading it--how could they be so poorly prepared? How could New Orleans and LA not have better plans in place? Hurricanes are not exactly unknown quantities in that part of the country.
Five Days also explores the gray area of euthanasia, including how it's handled in other countries. The story at Memorial is very complex and very cloudy.
I give Sheri Fink many thumbs up for going so indepth to explore this frightening piece of recent history. That said, the second part of the book, which documents the legal battles that happened later, tends to drag. Fink frequently brings up things she's already discussed in the first part of the book, things that could have been summarized rather than fully examined for a second time. How many times do we need to be reminded of the quote about "No living patients"? Not this many.
It's a quibble. It's not an easy read, but it's an important one, and I can only hope all hospitals take its message about the necessity of disaster planning to heart.