Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, journalist Sheri Fink's probing account of the deaths of several gravely ill patients inside New Orleans' Memorial Hospital, opens with an apocalyptic scene.
It's four days after Hurricane Katrina and the once-thriving, orderly hospital stinks of human excrement. Hospital staff euthanize beloved pets abandoned by desperate owners. Dehydrated, nearly pulseless patients cling to life. The few remaining doctors anguish over what to do with these most vulnerable of invalids who are fighting liver failure, mesothelioma and other fatal diseases. An order comes down that the hospital must be vacated by nightfall, although rescue boats and helicopters have been slow in coming for days.
What happens next, allegedly, is that a small group of nurses and doctors collaborate to inject the weakest patients with a lethal dose of morphine and the sedative Versed. Some of the patients are clearly within days, if not hours, of death; others might have had decent odds of survival. The dramatic lead-up to this moment makes up the first half of Five Days at Memorial, while the long legal fallout is detailed in the second half of the book.
Fink, a reporter for ProPublica.com who is a doctor herself, won the 2010 Pulitzer Prize in investigative reporting for her work covering events at Memorial.
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Her reporting is stellar given limited access to some of the protagonists, including Anna Pou, the doctor accused with two nurses of mercy killing. Pou sat for one interview and declined to comment on details of the deaths.
The book presents a dizzying and contrasting array of perspectives and stories, taking readers inside the minds of doctors who thought they had no choice but to hasten patients' inevitable deaths, colleagues who sharply disagreed with that fatal action, and the heartbroken relatives of victims left to wonder exactly what happened. For readers who come to the book with an open mind, the account will — admirably in my estimation — raise more questions than it answers: When, if ever, should a doctor's urge to alleviate intense suffering outweigh a patient's right to live out his or her life? Should those who work during disasters be granted some degree of immunity for questionable actions committed under intense stress? And who, given the failures at all levels of government in the wake of Katrina, ultimately should be held to account for the deaths that occurred inside Memorial?
Fink's overarching structure is effective. The build-up to the apparent mercy killings is slow and tortuous, packed with excruciating details of anguished nurses and doctors watching patients suffer, sometimes die, for want of basic supplies such as oxygen. The second half is more analytical, as Fink describes the legalities of the case against the health care professionals, and the history and ethics of euthanasia.
Whether by design or accident, the reader sometimes feels at sea given the large number of characters and an occasional lack of factual grounding: More than 100 pages into the book, Fink has yet to tell us how many doctors and patients remain at the hospital. More problematic is the uneven, and occasionally shallow, character development. Fink sometimes recounts highly intimate details (describing the increasingly distant marriage of the lead prosecutor in the case against Pou and the two nurses, for instance). But there are so many characters introduced (a glossary of "selected" individuals at the start of the book lists more than 100) that we get to know few of them in much depth. Fink could have been more judicious in choosing which characters to feature yet still have included the range of perspectives and experiences a book of this kind requires.
I especially wanted to know more about the victims and their families. It's unclear whether Fink's access to some families was restricted given ongoing civil suits or her interest lay more with the hospital workers and investigators.
Despite the limitations in character development, Fink's book is first-rate: riveting reading, morally probing, scrupulously fair. Anyone interested in Hurricane Katrina, human behavior in times of crisis or medical ethics should read it.
'Five Days at Memorial'
By Sheri Fink
Crown. 576 pp. $27.