Interview with Sheri Fink, author of 'Five Days At Memorial'

For five long days during and after hurricane Katrina struck New Orleans in 2005, patients and medical workers were trapped in a nightmarish scenario in the city's Memorial Hospital. Then, as the floodwaters receded, a shocking story began to circulate – that at least 20 of Memorial’s most fragile patients had been euthanized as an emergency measure.

Pulitzer Prize-winning journalist Sheri Fink, the author of the newly released Five Days At Memorial, recently spoke with Monitor Books editor Marjorie Kehe about the story and its implications for emergency workers everywhere. Here are excerpts of their conversation.

Q. What drew you to this story?

Before journalism, I had worked doing medical aid work in conflict zones. Then as a journalist I had written about hospitals in war zones. But I had never heard these types of allegations coming out of any of the places where I had worked.

So it drew my attention because I thought, whether or not this thing happened, the very fact that people who worked at the hospitals thought that it might have happened meant that something terrible had happened there. And having worked in many of these situations I also felt – and do feel – that disaster can strike anywhere, absolutely anywhere. And so there must be lessons for us. There must be some relevance for other people and other places.

Having worked in disasters, I have seen that, in those critical first few hours, those first few days – so much ends up riding on you and your neighbor and whoever is around. The official response always comes later and it always feels like it comes too slow.

Q. Why does it seem that the government, the hospital, and the hospital’s corporate parent were all so ill prepared for what – given geography and past experience – was not really that unlikely of a scenario?

I asked that same question after hurricane Sandy last year in New York City, when we saw very sick and vulnerable people being carried down staircases in the dark for days out of dozens of nursing homes and hospitals, which weren't evacuated in advance, because their backup power systems weren't protected against flooding. We don't know how many excess deaths occurred in the days and weeks after those stressful events, because the state of New York has so far kept data from the public and from researchers who wish to study the issue.

We need to know the stakes, the human costs, of failing to prepare. Only then can we make informed decisions about what is essentially another form of triage – how we balance the need to address everyday priorities against the need to invest in preparing for unlikely but foreseeable, catastrophic events. It is human nature to be short sighted and to lose momentum to make changes once the story is out of the headlines and there aren't financial incentives or political rewards. We owe to ourselves to learn from the past so we can try to do better.

Q. At a certain point the workers at Memorial Hospital seem to have felt utterly abandoned by the outside world, and this may have contributed to panic. Could this feeling have been prevented?

What [workers at Memorial] lacked was something that is very important in a disaster and that is situational awareness: the ability to see the larger picture. They became very helpless and very dejected. Communications weren’t good; [even] within the hospital, people weren’t sure when the next meeting would be. And then certainly the communications with the world outside the hospital were very spotty.

That’s one of the key things that I hope people will take away [from the book]. It’s so hard to maintain mental flexibility when you are tired and feeling hopeless and not having the use of the usual things that we’re so accustomed to. There are places in the world that, the power goes out in hospitals and there isn’t clean water and it’s horrific. It’s wonderful that we don’t usually have that situation here but it also makes it much harder for our health care professionals and all of us to cope with the situation when suddenly it does occur.

Q. Yet at Charity Hospital, a public hospital in New Orleans, things were, if possible, perhaps worse during Katrina. Yet the staff stayed calmer and patients fared better. Why?

One of the things that they did was that they kept people in their rooms and kept providing the same services, as much as they could. In disaster situations that I’ve worked in I’ve learned that to the extent that you can restore normalcy and have some kind of routine, that can be really helpful to keep people’s spirits up.

Another thing that they did [was to] realize the very negative power of rumor. At Memorial, these stories were going around about looters attacking the city and people were so so frightened. At Charity they tried to enforce this rule: If you didn’t see it yourself, you can’t say it. And perhaps that helped to keep panic at a lower level.

The third thing was that [at Charity] they were very used to dealing with resource shortages. They were a public hospital. They didn’t always have the latest technologies and as many resources to work with. So they were more used to being creative in dealing with shortages.

Q. Has anything changed since Katrina?

Yes and no. In the epilogue I looked at some of the disasters that we experienced in this country and in others since Katrina. There is certainly a great awareness of the suffering in the hospitals and the nursing homes. On the positive side, there’s been a great attention to the need to think about how we will deal with resource shortages if we face them, and there have been a number of protocols drawn up to help guide health-care professionals and to help them deal with questions like: Who do we put on the helicopter first? Who gets a ventilator if those should be in short supply? And in a way that could be a positive thing.

On the negative side, those discussions are being carried out in very small communities – the administrators of hospitals and other health-care professionals – and the larger public isn’t weighing in on them. And I think that there’s a larger conversation needed there.

Some of the things that haven’t changed: Unless you’re in New Orleans, your hospital probably hasn’t thought about (if you’re in flood location which many parts of the country are) the location of the backup power system and its elements – the generators, the transfer switches, the fuel pumps – are they really fortified against flooding? Or are they vulnerable, as we saw in NY to an incredible extent?

Q. The doctor and two nurses charged with euthanizing patients were never prosecuted. Do you feel that justice was done?

I really prefer to let the people who were involved in these events give their opinions on that, and they have very strong opinions about it in all directions. What I can say is that American medical ethics are very clear on this question of whether it is ever appropriate to hasten death in the case of a crisis, and the answer is no.

The families, for the most part, are very upset about what happened. I think the medical professionals may have thought that the families would [have wanted their loved ones] to be given comfort and helped to die in that situation. But you can’t just presume what people would feel in that situation.

Different people had different opinions and they are represented in the book. A lot of people did focus their anger on the hospital corporation and look to some compensation for the lack of preparedness.

There was a class action lawsuit that was settled for $25 million on behalf of anybody who either was in the hospital, lost a loved one, and a lot of people are very upset about the amount they received, especially after it had been strung out for so many years. They didn’t get their money till this year.

I think that there are a lot of families who feel that justice was not done. But what the form of that justice was, it’s certainly not just that they all wanted one doctor to go to jail. It’s much more complex and much more varied than that.