By Sheri Fink, MD, PhD; Crown Publishers 2013
Five Days at Memorial is an account of how the staff at one New Orleans medical center dealt with Hurricane Katrina and its aftermath in August of 2005. The devastating storm flooded eighty percent of the city, and exposed a tragic lack of preparedness, communication and leadership at both the local and national level.
The small number of doctors and staff who remained at Memorial Hospital in those few days were left to fend for themselves with no clear plan from hospital administration or from the hospital’s parent corporation. As a result, a couple of people stepped up to make decisions and try to work a little order into the chaos. The outcome was far from ideal.
Bioethical challenges arose immediately. From over 500 hours of interviews Fink provides an intimate look at the challenges the staff faced. Everything from loss of electricity and plumbing, to creating a triage system which would dictate who would be rescued first, last, or not at all.
When rescue helicopters came the staff had to carry patients up and down several levels of the building because the elevators weren’t functioning. They feared that the sickest patients wouldn’t survive all the jostling so those patients weren’t moved. They feared they themselves might not have the strength to carry morbidly obese patients all that way and up and down dark stairwells, so those patients weren’t moved. Issues arose around triage status for patients who had DNRs (Do Not Resuscitate orders), and around the fact that the DNRs were misinterpreted by one physician, which set a tragic chain of events in motion.
Coupled with that, the Doctrine of Double Effect was at best misinterpreted; at worst, abused. The Doctrine of Double Effect is the concept that some measures commonly used for the terminally ill may ease discomfort but, unintentionally, may also hasten death. These measures are allowed because the intent is only to ease discomfort. But the measures used - such as increasing doses of morphine, which is known to suppress breathing - may cause death to occur sooner than it might have otherwise. The intent behind such palliative measures is key.
The book highlights critical moments of decision-making and the effects of those decisions. It places the reader in the middle of what has been referred to by those who were there as a ‘war zone’. Five Days at Memorial is a well-written, well-documented and intense book which clearly lays out governmental, corporate and individual errors of judgement that increased the misery of Hurricane Katrina for those who survived and those who did not.