"Five Days at Memorial"

It's time for another book review.  Hurricane Katrina, a Category 5 hurricane (the highest category on the Saffir-Simpson scale, with sustained winds documented over 157 mph) that made landfall on the Gulf Coast of Florida and Louisiana in August, 2005 was one of the most destructive hurricanes in the history of the United States.  According to the U.S. National Weather Service, Hurricane Katrina was the fourth strongest Atlantic hurricane to make landfall in the contiguous United States (preceded by the 1935 Labor Day hurricane, Hurricane Camille in 1969, and Hurricane Michael in 2018).  It was also the deadliest hurricane in the United States, causing at least 1,836 deaths and over $125 billion (in 2005 USD) worth of damage.  A lot of the damage (in fact, the majority of it) caused by Hurricane Katrina came after the initial landfall.  There were over 50 levee breaches around the city of New Orleans, and eventually 80% of the city and surrounding parishes flooded. 


The local, state, and federal governments' response to this natural disaster have received a lot of criticism and led to the highly publicized resignations of the Federal Emergency Management Agency (FEMA) director, Michael D. Brown and the New Orleans Police Department Superintendent, Eddie Compass.  New Orleans Mayor Ray Nagin, Louisiana Governor Kathleen Blanco, and President George W. Bush were also highly criticized.  Conversely, the United States Coast Guard, the National Hurricane Center, and National Weather Service were commended for their response.  Russel Honoré, now a retired Lt. General in the U.S. Army served as commander of Joint Task Force Katrina and was highly commended for his leadership during the relief efforts following Hurricane Katrina. 


Unfortunately, the government was not alone in being criticized for their response.  The book, Five Days at Memorial by Sheri Fink (who won the 2009 Pulitzer Prize for Investigative Reporting) tells the story of what happened at the New Orlean's Memorial Medical Center (now Ochsner Baptist Medical Center) over the course of five days (August 28, 2005 to September 1, 2005) following Hurricane Katrina's landfall.  Basically, the hospital flooded and its generators failed.  Thousands of hospital employees, patients, and in some cases, family members (of both staff and patients) were trapped inside the building waiting to be evacuated by either boat or helicopter. 


The book is divided into two parts - the first part, "Deadly Choices" tells about how the hospital's medical staff prioritized the ambulatory patients for evacuation first, keeping the most critically ill patients or those with active "Do Not Resuscitate" orders last on the evacuation list.  In most cases of triage, the most critically ill patients are attended to first and the ambulatory patients ("walking wounded") are treated last.  The evacuation of patients did not start until day number 3 (again, recall that the initial response to this disaster was entirely inadequate and poorly organized) - there were actually fights over whose jurisdiction the hospital fell under for evacuation!  Evacuation was proceeding so slowly, that at some point between day 3 and day 5, hospital medical staff made the decision to hasten the deaths of some of the patients who they felt would not survive, administering lethal injections of morphine (essentially, active euthanasia). 


The second part of the book - "Reckoning" - discusses the ramifications of the decisions that were made in the heat of the moment.  Three hospital employees - one physician and two ICU nurses were charged with second-degree murder.  The charges against the two ICU nurses were eventually dropped, and a grand jury chose not to indict the physician nearly 2 years later.


It's hard for us to say if we would have acted differently.  Fink does a very good job discussing the ethics of these kinds of decisions, and I won't go into any further specifics on these discussions.  The take-home message, for me (notwithstanding these ethical decisions, which I also found very interesting and thought-provoking), was that hospitals absolutely need to be better prepared for any and all contingencies with which they may be faced in the future.  During any mass casualty or natural disaster, individuals and groups will fall back to their training.  If they haven't been trained to deal with the kinds of issues that arise in these events, then they will be forced to "make it up" and improvise.  If there was any failure at Memorial Medical Center, it was on the part of the hospital administration.  There should have been a set of policies and procedures to follow, specifically addressing what to do in an emergency (specifically addressing the what, when, who, and how of an evacuation).  There's an old saying that I remember from my military days, "The more we sweat in training, the less they bleed in war" - it's actually true.  Hospitals should run evacuation drills and train their staffs so that they won't be left "making things up."  Would that have changed what happened during those "Five Days at Memorial"?  I don't know, but I suspect that it would have made a difference.