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Five Days at Memorial

Rebecca Foster

Sheri Fink
Atlantic Books, 576pp

Nine years later, the scale of the destruction wrought by Hurricane Katrina still seems staggering. At Category 5, it was the third strongest storm ever documented in America, with a six-metre storm surge and winds up to 175 mph. The devastation covered 90,000 square miles, caused $80 billion in damages, and took 1,800 lives.

The events of late August 2005 hit some facilities especially hard, including New Orleans' Memorial Medical Center, officially named Southern Baptist Hospital. Pulitzer Prize-winning journalist Sheri Fink (whose first book, War Hospital, also examined doctors under pressure - that time in Bosnia-Herzegovina) considers Katrina and its ethically-compromised aftermath through a painstakingly detailed account of Five Days at Memorial.

'If I'm in trouble at Baptist Hospital, if Baptist Hospital falls, it means the entire city would be destroyed,' one nurse had pronounced, in a moment of prescient irony. As it happens, 2005 was not the first time the hospital battled floodwaters. During a 1927 storm, 14 inches of rain fell within 24 hours. With eight feet of standing water in its basements, the hospital had to suspend operations. The media complained that there was 'virtually a complete failure of city authorities to provide relief.' Something sounds awfully familiar there. Eight decades should have been plenty of time for New Orleans to bolster its drainage systems, but even so, the levees were only designed to withstand a Category 3 storm. No one predicted Katrina's intensity.

Day One: August 28, 2005. The National Weather Service issued a sobering warning: 'Most power poles will be down and transformers destroyed. Water shortages will make human suffering incredible by modern standards.' That strongly-worded prophecy was soon to come true at Memorial. When the generators failed, the building was without lights or air conditioning. After four days, the hospital had become a stifling, sewage- reeking swamp. Even worse, patients on electric ventilators started to struggle for breath. As one doctor noted, it seemed 'the laws of man and the normal standards of medicine no longer applied.'

The National Guard began evacuating Memorial and other flooded medical facilities, but a plan of action was not entirely clear. According to emergency triage protocol, Memorial's patients were divided into three groups: those labelled 1 were healthy enough to walk themselves to an evacuation point; 2's needed assistance; and 3's, many of them in the special LifeCare unit, were the most gravely ill, in some cases with a Do Not Resuscitate (DNR) order - they would be evacuated (along with their doctors) last, if at all. 'The idea of indicating somebody's destiny by a number struck [some] … as expeditious but distasteful.' Yet there had to be some system to the hospital's emptying, and the (somewhat Utilitarian) aim was to do 'the greatest good for the greatest number of people,' as Dr Anna Pou insisted.

Here, after nearly 200 pages of what can feel like preamble, is where the book really starts to get interesting. Among the hospital staff there started to be mur-murings. 'Maybe the world was ending,' some thought, especially with the city erupting in rioting and violence. There was no guarantee that patients and staff would be rescued soon, or ever. Would it actually be the most humane decision to euthanize the DNR patients, as had already been done for any distressed pets who found their way to the hospital? Some staff members were horrified by the mere suggestion, but others, including Pou, began preparing vials of morphine and benzodiazepine, a sedative. The doctors' logic went that there was little that could be done for these terminally ill patients, apart from making them comfortable - and avoiding the stress of an evacuation.

Was this a compassionate decision intended to reduce suffering, or was it murder? One Memorial doctor texted his friends to warn that 'evil entities' were planning to kill the very people they were duty-bound to save. 'Moral and legal culpability for the deaths rested on the wisps of contrast between wanting, foreseeing, and intending death,' Fink writes. As bioethicist Arthur Caplan opined, 'you might be able to make a defence of a mercy killing … under very, very extenuating circumstances.' Would Memorial's desperate situation fall under those criteria?

Fink devotes nearly half of the text to tracking the legal battle that ensued after post-mortem investigations revealed that four LifeCare patients died with lethal doses of morphine and other sedatives in their bloodstream. Pou and two LifeCare nurses, Lori Budo and Cheri Landry, were arrested in July 2006. Around Pou, especially, a huge support campaign arose, both in the local community and nationwide. Pou's television appearances convinced viewers of her trustworthiness and essential goodness. In the end, a grand jury failed to indict the three defendants.

The sheer scope of this book is both its triumph and its downfall. Fink has, without a doubt, given the definitive account of the Memorial crisis. In her quest for balanced reporting, she scrutinises every plot thread, every minor player, every tiny moment that may have led to the climactic decisions made over those five days. Yet this means the resulting chronicle is unwieldy: packed full of details, both relevant and irrelevant, and swarming with an enormous cast of characters (it takes six pages, in small print, just to list them all at the book's start). It is a challenge to the reader to keep all the facts in mind whilst following a narrative arc.

For the most part, Fink maintains impressive neutrality. But at times she paints Pou as something of a pantomime villain, stalking hospital halls with a bouffant hairdo and a syringe, poised to strike. It is almost as if Fink was disappointed by a verdict of innocence.

As far as readable, eye-opening accounts of Katrina go, Dave Eggers's Zeitoun, with its compact storyline, is the better book. But as a study of the deeply divisive ethical issues at work in the Memorial case, as well as an exposé of the woeful unpreparedness of local and national disaster relief agencies, Fink's magnum opus is worth tackling.