Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (ALA Notable Books for Adults)

Simplistically, this is a story of how a hospital full of doctors, family and patients dealt with and sustained through Hurricane Katrina. However, the story that focuses mainly on Dr. Anna Pou is a moral conundrum that is as divisive a subject as I can imagine. Sherri Fink treads through public files, personal testimonies and witness accounts to bring us a wide look at what took place at a New Orleans hospital as chaos ensued and governmental and corporate response languished. This lack of emergency response seems to be caused by a deadly combination of negligence and incompetence by the staff of the hospital and everyone they seemed to reach out to. Consequently, important decisions had to be made under stress , exhaustion and unbearable heat: Who among us gets to leave/receive critical care first? The oldest? The sickest? The ones with the best chance to survive? The ones with best quality of life chance? Triage was set up and days passed by slowly as people's lives hung in the balance. Thus enters Dr. Anna Pou. Fink goes into incredible detail of her background and character and gives us a sympathetic/ hard working, no-nonsense type of doctor who delegates authority amongst the nurses and charges at Memorial. Ultimately, it seems according to the book, that Dr.Pou would make important decisions to euthanize certain patients in what seems like a badly-kept secret that morally divided the staff. This is the central focus of the book and how you feel about Dr. Pou's actions will polarize the reader and have you second-guessing your original feelings. I must say, immediately I felt that euthanasia was completely acceptable. I believe that if somebody is to the point where pain and suffering renders somebody to the point that they are alive in the most basic definition only, I feel it acceptable for them to want to end their life. And, I did indeed feel this way throughout the book about Dr. Pou until you realize that these particular patients never consented. And there in lies the rub: euthanasia should never be put in the hands of the doctor without consent of the patient or family. Furthermore, in the case of Mrs. Burgess and Emmett Everett, not only did they not wish to die, they very much wanted to live. The fact that they were killed on the same day the mass evacuation was taking place only makes it more the tragedy. The second half of the book focuses on gathering evidence , the politics of prosecuting staff that risked their lives and otherwise behaved heroically during a disaster that most , including myself, got to watch from a distance. It's riveting and I think Fink presents every possible ethical possibility on what happened and what COULD have happened. I feel like she was objective and fair and if anything, only really painted LA attorney general in a negative light. It's no doubt controversial and there seems to be two camps: those that think that Dr. Pou is an amazing doctor who appears to have killed (with help of other staff, mind you) patients, even if ending their suffering was paramount in her mind. The other half is those that take Fink's reporting as factual. Perhaps the truth lies somewhere in between , but to those who deride Fink as trying to make a buck by sensationalizing , you have to consider both sides. Dr. Pou obviously has a lot to lose, including her freedom, if these accounts are accurate. She would literally have gotten away with murder. I don't, however, think she meant to kill with malice but rather with compassion. What does make me lose respect for her , though, is her continuing to lie about small details to exaggerate the conditions of the hospital ( lack of water, food, helicopters not being able to fly at night). If there was more of a consensus, or even if there was a moral consensus taken before she made the injections, I'd sleep better. Unfortunately for the victims, it seems like their deaths were carried out clandestinely. Meanwhile, their was an equal conspiracy of disapprovers who did nothing but express outrage over the possible euthanasia amongst themselves while not lifting a finger to stop it. I could go on and on about this with points both for and against all parties involved and not come within a mile of satisfaction. It's an astounding read that will test your preconceived notions of right and wrong and I'm not quite sure I'm qualified to judge anybody during a situation as hellish as this.

I do feel the novel was well researched and well written. The author leaves the reader to draw his/her own conclusion, having been presented with the hospital scenario, as well as the research results. I hesitate to say "facts", because - are they really? One thing for sure - most everyone involved had their own agenda. Who is to say which of the personages in this book had the purest motivations? It seemed most everyone had at least something to lose or at least some motivation to be less than fully revealing in the investigation. And how about those with a political axe to grind? Whose testimony or interview could the reader really trust? And perhaps that is one of the author's intentions for her audience. An aura of suspicion.... I learned quite a bit about the hospitals, post Katrina operations. I did lose a lot of respect for the corporations or public bodies owning them. Where were the evacuation and emergency operation plans - at the very least, those should have been in place, even if they would not have worked. And what about Nagin's mandate for the hospitals to remain open while everyone else had to evacuate - how shortsighted. Why would Gov Blanco refuse to declare martial law? But that seems to be the tale of the Katrina fiasco -people improperly prepared, shortsighted and downright negligent in many instances. Did the book help me decide how I felt about the guilt of the medical personnel involved? Yes, it did. I will leave readers to draw their own conclusions. It is sad that so many peoples' lives were damaged - those that died at the hospital as well as those investigated.And now that this book is out, it opens the wound afresh for them. The book serves a purpose but exacts a cost - again. Update: After checking out some additional websites, and becoming a bit more enlightened, I withdraw my first comment about the book being well researched. Perhaps I should have asked "Are we even sure the author had pristine motives?"

I had not followed Dr Pou's case when it was occurring, but I was aware that there was a female MD being investigated for practicing euthanasia during Katrina. When this was published, I wanted to learn the story. I have read two other books about medical care during Katrina- the first was CodeBlue, the second a collection of nurse's stories about working during the storm and its aftermath. Both were interesting, but not challenging in the way Five Days at Memorial has been. First, let me say that Ms Fink writes very well. Her excellent prose made the story very clear. I was horrified to learn just how dreadful the conditions became at Memorial hospital. This despite reading the two previous books. Reading this, I could smell the fetid odors, feel the heat and humidity and actually imagine myself in the nurse's shoes. I could clearly understand the terrible dilemma the staff faced as DAYS passed in 100 degree heat with no electricity and the chaos of no plan for rescue of patients, staff and family members stuck in Memorial hospital. I have been an RN for 37 years, and thankfully have never experienced a disaster. What Fink's excellent book has done is shocked me into the awareness that a disaster could occur at my hospital. It would most likely be an earthquake here; all our disaster drills focus on an earthquake. I have never before considered what would we do for our patients after we got them out of a presumably badly damaged building? I work in a free standing psychiatric hospital; fortunately none of our patients are on life support. But all our medical records are computerized. The medicines are dispensed through a electronic computerized dispensing machine. We would not be able to even give anyone a Tylenol, let alone their regular meds. We are on a hill; water is pumped uphill to us, so we wouldn't have much water. I was just informed there's some drinking water stored for the patients but none for the staff. The upshot of my reading this superb book is I am going to ask our upper administration to read Five Days at Memorial. Then I plan to be nosey and find out what are the plans for care for our emotionally fragile patients after the shaking stops. I am feeling very passionate right now about making certain there is a plan for the care of our patients afterwards, and that there is an organized well worked out evacuation program prepared now, before we need it. Where will we go? How? How will we get meds? How will we tell families where their loved one is? What will we do with the few patients who are dangerous? I thank Ms Fink for opening this nurse's eyes to the potential for horrific things happening to my patients. Because of this book, I am getting involved to prepare as best I can for what I hope never happens. I HIGHLY recommend this book to hospital nurses and their administrators everywhere. It is also an invaluable eye opener for those who have loved ones with chronic illness, who could face the same fate as the poor souls in LifeCare or Memorial hospital. This book is a life changer. I will say I was surprised by the legal findings. But I understand how they came to be. I will do my very best to protect my patients from a similar fate, by preparation.

I think everyone should read this book. This raises important questions about morals and ethics that prevail in current medicine and society that are as true today as they were present in the aftermath of Katrina. This book does a wonderful job presenting all sides of what occurred and demonstrates how crucial every step that was taken before and after the storm was to the outcome of how the public perceived these events. I really felt for everyone affected by the storm and everyone who was a part of putting together the pieces to understand the actions that occurred. My heart is broken for the patients, healthcare professionals, families, and those who couldn't make it out of the city. We so often want the world to be black and white, especially in medicine, where the outcomes of what happens to a patient is not as simple as a single treatment, where the repercussions of actions to patients can create a ripple effect not only years into their lives but into their loved ones lives and even the country. But the reality is far from black and white and is even more grey than I had realized. It really makes you understand how ill-prepared we are to face extremes, that most agencies we trust to look for answers in distaster are often as clueless as those facing its consequences head on. Even when thought goes into disaster planning, resource guarding—can it truly be done in a way that is fair and equitable? And how do you begin to define what is deemed fair or equitable when it comes to medicine in such circumstances? This book is highly thought provoking and I cannot recommend it enough to everyone.

This book, concerned with the handling and care, or lack thereof, of patients at Memorial Medical Center in New Orleans in 2005 during Katrina, is both a jumbled account of what transpired over five days at the hospital and thought provoking commentary regarding end-of-life issues. After days of chaos, deprivation, and the failure of medical technology and orders on the fifth day to completely evacuate the hospital, some last remaining, very ill patients were given large doses of palliative medications, resulting in their deaths. The big question of the author is whether a rather zealous attorney general was justified in placing under arrest a well-respected female cancer surgeon and two nurses for homicides allegedly committed on that last day. Context is all important in this story. The author does not avoid it, but her coverage is either insufficient or far too disjointed. The simple fact is that the hospital was criminally unprepared for Katrina, and it could have been. Pure neglect found supplies and key elements of the electrical system in the basement where anyone could predict flooding could occur. Evacuation plans were virtually nonexistent including the use of the helipad. The physical layout of the facility with its multiple stairs and passageways was a nightmare to navigate in deplorable conditions. And the author’s coverage of the medical personnel trying to deal with this mess is as chaotic as what was experienced on the ground. It’s impossible to keep track of what person is doing what; whether helicopters are coming or going with or without patients; etc. Although mentioned, the author does not hammer home the sheer ineptitude of the corporate giant who owned this hospital and could have invested in making it safe and offered far more help during the crisis. Secondly, the author devotes almost no time to the utter failure of various levels of government and agencies to make sure that the flood control systems of New Orleans would not break down under strong storm conditions. And this is in a city where large segments of it are below the water levels of huge bodies of water. The residents of New Orleans and Louisiana most definitely share in the blame. Where is their political willpower in ensuring their own safety and the safety of the vulnerable, like those in hospitals? In short, the medical personnel of Memorial Medical Center were essentially abandoned to operate in nightmarish conditions. The care of all patients was terrible by normal standards, not just for those who perished. After five days of hellish conditions there was tremendous uncertainty about how to end this horrendous situation. Under extreme duress, perhaps some made poor decisions at the end, but it is a large leap to claim murder in this situation. In the last of the book there are inconclusive discussions about what should be permitted under dire circumstances in regard to deciding how various groups of patients should be handled. Overall, the book sheds light on a very trying situation, but in many ways misses the mark, suggesting blame in the wrong places.

If this were fiction, it would seem so far fetched that an editor would probably tell the author to tone it down. No government is THAT inept! This book is one that needed to be written and the author has put it together chronologically and in such a way that even though you know the outcome, it still seems unbelievable. This is a story about government's failure to plan for an emergency that was bound to happen and its inability to react once it did and the "trickle down" blame from those who weren't there to those who were. For those medical professionals and patients marooned for five days as the water breached the levees of New Orleans after Hurricane Katrina with no power to operate essential machinery and no way to get out, common sense would dictate that they all did the very best they could under the worst possible circumstances. If these dedicated health professionals had simply left when evacuation was ordered, then what would have happened to the patients who could not leave as they needed medications, were not ambulatory, and/or were dependent on equipment for survival? Obviously, what would have happened is that these patients would have died, many in great pain and alone. Perhaps they would have starved to death, lying in their own waste? The hospital employees had no direction nor help from the corporate entity that owned the hospital and were left to do the best they could in the worst imaginable circumstances. Then, the very City that had no plan in place to deal with major hurricanes even though much of that City is below sea level, decided to accuse physicians of murder when patients who could not possibly be rescued and were dying anyway were given large doses of morphine to ease the process. Thankfully, the jury who heard the evidence, agreed with almost everyone on the planet except the authorities in New Orleans and understood that these physicians did something we would hope they would do for us if we were left in the middle of a disaster in great pain and the alternative was to go peacefully into the night or spend many hours or days in agony with the end result the same. The official failure of the government at every level to have any plan in place to deal with disaster is evident, as is the pathetic waste of resources building a case for murder against physicians? If the truth were told, there were probably dozens of violent crimes committed in the midst of all that chaos that were never pursued, either because the victims were dead or the evidence was destroyed. If you aren't angry after reading this book, you should be. Kudos to this author for a truly outstanding account of the wretched situation at Memorial Hospital in the aftermath of Katrina.

After seeing the recent TV series based on this book, I decided to buy and read it. On the plus side, the author Sherri Fink writes very well, and gives readers a compelling account of the "Five Days" as hospital staff struggled to deal with an impossible situation during Hurricane Katrina. Largely abandoned by City, State, and Federal officials, as well as by Tenet (owner of the hospital), the staff had to make agonizing decisions about survival, including which patients could be saved. Fink focuses much of her attention on one doctor, Anna Pou, who euthanized a number of seriously ill patients (at least according to this book). Although I admire this book, I do have some criticisms: 1) About half of the book is devoted to the aftermath of the "Five Days," with extensive reporting about the efforts of the local DA to investigate and later prosecute Dr. Pou. I wanted to see a shorter section on this, but additional discussion (to what is given) at the end of the book about the ethical issues and implications for future disasters. 2) Although Fink does provide at the beginning o the book some historical context, there should have been more information provided about the multiple failures in planning and decision-making by officials at all levels of government in the last 10 or so years prior to Katrina. 3) I found it difficult to understand how the hospital could have been given such low priority for evacuation. I wanted to see more information about the Governmental response during Katrina. Overall, I still learned much of value from reading this book, which offers powerful lessons for disaster planning and response.

When I bought this book I was wondering whether it would be a story of an embattled medical staff serving their patients under horrific conditions, or a story of murder and injustice. Surprise; it's both. Life is complicated. Is Dr. Anna Pou a dedicated surgeon who has done wonderful things for patients disfigured by head and neck cancer? Without question. Did she murder several patients, even as the evacuation of the hospital was finally moving into high gear? Unquestionably, and so did at least one other popular and respected doctor. Dr. John Thiele, now deceased, told Sheri Fink that he also killed patients on Thursday. I won't say "euthanized", because when the patient is a human rather than a pet, "euthanasia" implies consent. A hurricane is never a good thing, but Katrina was uniquely awful. Fink writes that there was a tradition of staff members almost making an adventure of working through a hurricane at Memorial. Staff members scheduled to work during a hurricane would bring their family members, pets and plenty of food. This tradition turned into a nightmare during Katrina, with spouses, children or elderly parents trapped with the staff in a world of darkness, 100 degree temperatures, gunshots in the night and toilets that no longer flushed. Many of the medical staff realized that they were dehydrating because they were trying not to drink water because they didn't want to use the bathrooms. Trying to evacuate patients was a nightmare, because they had to be carried down dark stairways to the 2nd floor by flashlight in 100 degree temperatures, then up several more flights of stairs to the heliport on the garage roof. Yes, it was a nightmare, and there's plenty to be said about lack of planning by the hospital's owners and by differing levels of government. But what stands out to me are the multiple ethically suspect decisions made within the hospital itself. There really should have been legislative hearings to air the dirty laundry and place the responsibility for those decisions, but the abortive attempt to prosecute Dr. Pou showed that New Orleans collectively wanted to put their hands over their ears and avoid looking at the horror show at Memorial. First, the triage system stated that the sickest patients would leave last. I'm not a doctor, but it stands to reason that the sickest patients will lose ground the fastest in a hospital where the air conditioning is gone, and where the backup generators are at risk. (Yes, the backup generators eventually failed). This seems to signal a mindset that the sickest patients were expendable. Of course, many of these patients deteriorated rapidly under the appalling conditions and ended up being killed because "they won't make it", an outcome that could have been avoided if the triage system had put them first, as Charity Hospital did, for example. The seventh floor of Memorial was leased by LifeCare, an acute care health system whose patients, on the average, were older and sicker than Memorials. That means that they were doubly discounted in the eyes of Susan Mulderick, Memorial's nursing director and the incident commander. Mulderick shocked a Coast Guard dispatcher by stating that she wanted all of Memorial's patients evacuated before any LifeCare patients. The Coast Guard dispatcher challenged her, but of course he had no real control over who was sent up to the helipad. The killings took place on Thursday, day five of the "five days." Sheri Fink states that the most tragic thing about the Memorial saga was that the killings started just as the evacuation was really moving into high gear. But that was because *someone*, never identified in the book, had decreed that the evacuation had to be completed on Thursday, and many doctors and nurses interpreted the deadline to be so firm that they believed patients not evacuated by Thursday evening were to be abandoned or killed. Who gave this order? Susan Mulderick? One of the Tenet managers in the hospital? Tenet's national management? The City or State? This order was the root cause of the killings, and it's profoundly frustrating that Fink was not able to get to the bottom of this despite her exhaustive research. Dr. Pou told Dr. John Thiele on Thursday that the very sick patients in the second floor holding area "won't be leaving the hospital." I'll give Pou the benefit of the doubt and assume that she didn't make this unconscionable decision, but who did? Thiele then began helping her kill them, thinking that if they were abandoned they might be brutalized by looters or eaten by the many pets stored in the hospital, who were to be released from their cages to fend for themselves. Reading Thiele's confession to Fink, it's easy to believe that felt that he was doing the best he could for the patients under these horrendous circumstances. But who was the monster who created those circumstances? Why not just allow the evacuation to continue until all living patients were gone? By Thursday, helicopters chartered by Tenet were showing up and joining the military helicopters who had been there all along. It was finally decided that 20 of the dead were victims of homicide. How much longer would have it taken to evacuate just 20 more patients, with more helicopters becoming available? Of course, there's an alternative explanation for the Thursday deadline (no pun intended): Maybe the doctors and nurses at Memorial were just done. If the rescue had stretched into Friday or Saturday, that would be another 24 or 36 or 48 hours that the medical staff would continue to be stuck in the filth, the stench, and the blast furnace heat. Disgracefully, there was never any mention of Tenet sending in rested doctors and nurses to relieve them. Maybe a critical mass of the staff had just reached the limit of their willingness to sacrifice for others under the worst possible conditions. The fact that many of the remaining patients were, by that time, so very ill, made the killing far easier to rationalize. But to quote one doctor I saw quoted in an essay on euthanasia, "We're never entitled to put a patient out of our misery."

Sehr interessantes Buch, stellenweise ein bisschen zuuu detailliert und langgezogen. Trotzdem lohnt es sich

Very well written, heartbreaking

I found this book compelling. As a Registered Nurse practising on the Gulf Coast for forty years I know the system and the terrain and the weather risks. As a Nursing Administrator I had to make decisions about evacuation of patients, transportation and the care of staff during these conditions. I must say I cried and found the situation harrowing. I thank God that I never had to make the ultimate decision these Nurses and Doctors had to contemplate. I have thought long and hard about this and I seriously believe, that in this world of severe weather issues, infectious epidemics and terrorism all over the world, we the healthcare providers must have urgent dialogue about the final triage. Don't leave it to the desperate people left on site to make these decisions. God Bless the patients and staff involved. God help those people at the corporation who failed to act!!

Excellent book. Amazon is awesome too. 😀

I found this book so interesting. It's a story about how life can unfold in a crisis, and the choices people are faced with. Also, I saw that values can differ, according to occupation and the current circumstances. How do we apply one 'value' lens to the other? And how do we learn from extreme events, or do we? Fascinating stuff. The story was told in a clear, readable manner with compassion and humanity.