(Audio)Book Talk: FIVE DAYS AT MEMORIAL, by Sheri Fink


Audiobook read by Kirsten Potter
Crown (September 2013), Hardcover (ISBN 0307718964 / 9780307718969)
Nonfiction (social science/health), 576 pages
Source: Purchased audiobook (Random House Audio (September 2013) ISBN 978-0-8041-2810-0; Audible ASIN B00EF870X8)
Reason for reading: Personal interest

From the Prologue: “For certain New Orleanians, Memorial Medical Center was the place you went to ride out each hurricane that the loop current of the Gulf of Mexico launched like a pinball at the city. But chances are you wouldn’t call it Memorial Medical Center. You’d call it ‘Baptist,’ its nickname since it had existed as Southern Baptist Hospital. Working a hurricane at 317-bed Baptist meant bringing along kids, parents and grandparents, dogs, cats and rabbits, and coolers and grocery bags packed with party chips, cheese dip, and muffulettas. You’d probably show up even if you weren’t on duty. If you were a doctor and had outpatients who were unwell, you might check them in too, believing Baptist to be a safer refuge than their homes. Then you’d settle down on a cot or an air mattress, and the hurricane, which always seemed to hit at night, would rage against the hospital and leave. The next day, the sun would rise and you would help clean up the debris and go home.”

Book description, from the publisher’s website 

In the tradition of the best investigative journalism, physician and reporter Sheri Fink reconstructs 5 days at Memorial Medical Center and draws the reader into the lives of those who struggled mightily to survive and to maintain life amid chaos.          

 After Katrina struck and the floodwaters rose, the power failed, and the heat climbed, exhausted caregivers chose to designate certain patients last for rescue. Months later, several health professionals faced criminal allegations that they deliberately injected numerous patients with drugs to hasten their deaths. 

Five Days at Memorial, the culmination of six years of reporting, unspools the mystery of what happened in those days, bringing the reader into a hospital fighting for its life and into a conversation about the most terrifying form of health care rationing. 

In a voice at once involving and fair, masterful and intimate, Fink exposes the hidden dilemmas of end-of-life care and reveals just how ill-prepared we are in America for the impact of large-scale disasters—and how we can do better.  A remarkable book, engrossing from start to finish, Five Days at Memorial radically transforms your understanding of human nature in crisis.

(Thanks to Kim for our brief e-mail exchange about Sheri Fink’s Five Days at Memorial, which we both read–unplanned–around the same time. I’m using it as the basis for my comments on this remarkable book, which I hereby designate “The Most Important Book I’ll Read This Year.” UPDATED 11/10/2013 to link to Kim’s review, which also draws on our discussion.)

Comments: What made Hurricane Katrina’s encounter with the city of New Orleans so memorably destructive was not so much the storm itself as the flooding from the levee collapse that followed it, which wasn’t anticipated (despite decades of infrastructure neglect) and further confused the emergency response. I knew this in general terms before I read Five Days at Memorial, but I didn’t know a lot of the details, and I don’t recall hearing much about what happened at Memorial and other hospitals at all.

What happened at Memorial Medical Center between August 27 and September 1, 2005 is a story of heroism and tragedy. The five-day process of evacuating staff, patients, and visitors from the flooded, blacked-out hospital is a chronicle of difficult decisions made under terrible conditions; while some had fortunate outcomes, they were overshadowed by the choices that turned out spectacularly badly. While administrators and physicians managed to ensure that “no living patient (was) left behind,” more than 40 bodies, including nine patients from LifeCare, a separate acute-care hospital occupying Memorial’s seventh floor, were found inside the building following the evacuation.

The medical staff’s decision to get patients with the best prognosis out first was based on a “survival mode” mindset–and not just patients’ survival, as rumors of martial law, abandonment by the authorities, and neighborhood violence caused members of the hospital staff to fear for their own lives. But the survival of those in the worst condition became increasingly precarious as time went on, and post-mortem examinations determined that most of the deaths occurred during the last twenty-four hours before evacuation was complete. Those findings raised questions–of medical malpractice and misconduct at least, criminal behavior at worst–which coalesced around cancer surgeon Anna Pou and two Memorial ICU nurses.

The medical/legal drama inherent in this story make Five Days at Memorial compelling reading, but what elevates the book to Important is the way that the incidents it relates provide an intense, concentrated perspective on larger issues; it presents potential case studies on medical ethics, disaster management, socioeconomic class and community relations. The focus it gives to questions relevant to the current national health-care debate is particularly notable. It’s impossible to ignore that health-care rationing essentially became standard operating procedure under these admittedly extreme conditions; does that set precedent for medical decisions made in non-crisis mode…or are these literally life-and-death questions always crisis choices, by their very nature?

Sheri Fink originally reported on what happened at Memorial, and the legal and medical fallout from those events, in 2009, and builds from there in this book. There are many sides to this complex story, as this much-expanded account makes clear. In some instances Fink is (deliberately?) vague about identifying people, and in others she offers detailed biography; I assumed that when participants weren’t named it was probably because she hadn’t been able to use them as primary sources, or that they wanted to be off the record if she had. I didn’t really get a strong sense of her own interpretation of events–and as an M.D. as well as a journalist, I can’t imagine she doesn’t have one–but I think that’s appropriate. Fink’s presentation is strikingly–perhaps frustratingly–even-handed, and I appreciated that she didn’t editorialize.

Although I read this in audio, I don’t know whether I’d recommend that format over print; it is a complex story, and it can be easier to stay on track in heavy fact-based narrative nonfiction when you can flip back through pages (or screens, in e-book format) to check on things–but it’s also a chunkster, and I seem to find long books easier to digest in audio lately. That said, I was surprised by how well this big, complicated book worked in audio format, and I think I got a stronger appreciation of just how Fink constructed all of this into a narrative from listening to it–from hearing it as story–than I might have from reading it. There was repetition of identifying details in the audio that might have annoyed me in print–at times I felt like telling my iPhone “Yes, I know who that is”–but there really were a lot of people to keep straight, so that was ultimately more helpful than irritating. It seems to me that the audio narrator of non-memoir nonfiction has a particular challenge to make the material hold the listener’s attention without really “performing” it; Kirsten Potter did an excellent job of staying out of the story’s way.

Decide for yourself what format would work best for you, but decide to read Five Days at Memorial. It’s fascinating, aggravating, heartbreaking, eye-opening, thought-provoking…and Important.

Rating: Book 4.25 of 5; Audio 4 of 5

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