Book Review: Five Days at Memorial

Kilian de Lacy

(Atlantic Books Ltd, London, 2013)

This Pulitzer Prize winning book attempts, in over 500 pages, to give as accurate an account as possible of the devastating effect of Hurricane Katrina on New Orleans in August 2005, and in particular of events during and after the crisis, when medical professionals were arrested and accused of having hastened the death of some of their patients.
The prologue paints a dramatic picture of the scene within the hospital when some patients were being evacuated, and the horrendous choices which loomed in the consciences of the dedicated medical staff who had stayed at the hospital to care for their seriously ill patients.
The first chapter gives an overview of previous similar, though less devastating, natural events which should have made authorities aware of what they needed to do in preparation for future natural disasters and from which, as is painfully evident in the ensuing chapters, they had failed to learn, with tragic results.
The author, Sheri Fink, has been the recipient of several journalism awards and was a former relief worker in disaster and conflict zones, so her personal experience of such events is considerable. She conducted hundreds of interviews with doctors, nurses, family members, staff and others involved. She visited the hospital and other sites depicted in the book, and made use of source materials dating from the time of the disaster and its immediate aftermath. All in all, her research was thorough and extensive.
The style of writing is conversational and this brings to life the many characters who played lead roles in the disaster, especially those faced with the prospect of having to help dangerously ill patients who had been placed on Category 3 lists for evacuation, i.e. those who were to be taken out last or, more likely under the circumstances, not at all.
The disaster is painted in all its dreadful detail, the recurring theme being the lack of preparedness of the authorities to deal with the crisis. For instance, despite prior experience of flooding in the basement of the hospital, the power generators were still there, making it inevitable that the power went off as the water from the breached levees in the city flooded the lower parts of the building. Efforts to provide respirators, to keep patients comfortable and cool when the air conditioning failed, to preserve life and hygiene were maintained under increasingly challenging conditions. The inconsistency of communication between those on the ground and authorities elsewhere made painful reading.
Then there were the people: the medical staff, the patients, the families of the patients, the people who had sought refuge from the flood in the hospital, many bringing their pets along with them and expecting the animals to be rescued even before patients. Prominent among the medical staff were Dr Anna Pou and nurses Cheri Landry and Lori Budo, later to be charged with second-degree murder for intentionally killing four of the patients at Memorial Hospital.
When the floods receded, 45 bodies were found at Memorial Hospital, more than in any other rest home or hospital in the city. Nine patients, all in the Life Care unit and seriously ill, had died under suspicious circumstances. All nine had unusual amounts of morphine in their systems, some in combination with sedative drugs.
The book makes gripping reading. The author's detailed research is evident and the reader is drawn into the moral dilemmas which had beset those doctors and nurses charged with the care of these patients. It poses the questions:
• If you were caring for seriously ill patients without any of the normal backup systems a hospital offers and knowing that some authority had decreed that the most debilitated patients were to be evacuated last, if at all, what would you do?
• Is it ever permissible to administer to such patients a drug which may cause their death but would prevent their dying in agony and distress because of the lack of life support or other fundamental medical resources?
• Who was responsible for altering the triage priority for evacuation from sickest first (which is normal practice) to sickest last?
As the story moves into the post-Katrina phase of investigation, arrests, media exposure, accusations and legal proceedings, we are given a fascinating picture of the background agendas behind the moves against the three medics and the ever-intriguing play of American politics.
This is a book which will challenge those who think that euthanasia is only a black and white issue. Many of the leading characters implicated in the administration of allegedly lethal doses of morphine are Catholics working out of a moral tradition that holds to the maxim always to cure, not kill. At the same time, by highlighting the influence of systemic failure, the book also carries a warning to those in authority who fail to learn from history and are therefore doomed to repeat it. I strongly recommend it.

Kilian de Lacy is a writer and a nurse (now retired) who specialised in the care of the elderly and the dying. She continues to work with the elderly and other vulnerable individuals through her involvement in Grey Power and Agape Budgeting Services. She is an active member of Holy Family Parish, Porirua.