Sept/Oct/Nov 2013

First, Do No Harm

A harrowing reconstruction of triage gone wrong at a post-Katrina medical facility

Jeff Sharlet


At one point in Five Days at Memorial, Sheri Fink's elaborately researched chronicle of life, death, and the choices in between at a New Orleans hospital immediately following Hurricane Katrina, hospital staffers begin, inevitably, to imagine how the made-for-TV movie of their ordeal would be cast. A nurse named Budo, "dark-haired with a heart-shaped face and thick eyebrows, said she wanted Demi Moore to play her. Her longtime colleague on the night shift, Cheri Landry, short and stout, with hooded eyes, arched brows, and an air of wisdom, would be portrayed by Kathy Bates."

As things turned out, though, both women would play themselves. Memorial Medical Center's TV star turn would come via the attentions of Anderson Cooper, 60 Minutes, and Nancy Grace, who with eyes aglitter would speculate on "an angel of death" said to have "stalked" Memorial's halls, using lethal doses of morphine and other drugs to shoot up patients deemed too sick to evacuate. There'd be fiction, too: an episode of Boston Legal that would take the hospital's side—if, that is, the case for euthanasia committed and then denied can be called a side. There has not, to my knowledge, been a movie; and while I wish this devastating book a wide readership, I hope Fink never lets it be optioned. Her great accomplishment lies in the ways in which her relentless account resists narrative. There is no overriding arc to the story here—only dozens of little boats scattering.

Seen through a telescope, what happens is this: On the eve of Katrina, local residents, hospital staff and their families, and the patients and staff of a nearby small private hospital run by a company called LifeCare take shelter in New Orleans's Memorial Medical Center. Memorial, known by many as "Baptist" for its former religious affiliation, has become a private hospital, too, acquired by the massive Tenet Healthcare Corporation.

The storm strikes, windows shatter, but everyone survives. Then relief gives way to flooding. Rescue is intermittent. Tenet doesn't have a plan, or, apparently, a clue: One top executive mistakes a volunteer on the phone for FEMA; another concerns himself with granting Fox News the access to produce a story on Memorial, "a huge PR play for Tenet." The "cavalry" arrives: police and other unidentified armed officials who force a daughter at gunpoint to abandon her mother and otherwise seem to stand around with shotguns, helping no one and warning of gangs. There is talk of looters—a lot of talk—even though, at Memorial, there appears to be no looting. Doctors arm themselves. Boats come and go. There are tear-inducing rescues, there are prayers—a lot of prayers—and there are bodies piling up before the altar of the hospital chapel, now converted into a morgue. Later, a disaster mortuary team would find fifty-two rotting corpses in the empty hospital. Many of them—how many we'll never know—had been euthanized.

What begins, in Fink's telling, as standard you-are-there stuff—the daughter of a gravely ill mother "flew to her bedside"; a heroic doctor "worked and played with gusto"—grows more fascinating, and horrifying, as the water rises then stagnates, as the power fails and even the walls sweat, as "heroism" becomes an entirely relative question. And yet Fink does nothing so simple as switch from life-affirming courage to muckraking scandal. Her questions are always harder. We know what to think of the Memorial doctor who hand-pumps oxygen into the lungs of premature babies—but what, crucially, do we make of those who, with the best of intentions, invert the code of triage, evacuating the able-bodied first on the principle that they have the likeliest chance of survival? Or of the doctor who, disgusted by what he believes to be unethical—maybe even murderous—choices, abandons the hospital? Or of the nurse who sedates—and inadvertently endangers—patients "to the point they would no longer care that they were smelling the feces they were lying in"?

What would you do? Don't answer. This book is not a choose-your-own-adventure story. It is not an ethical puzzle. What's important, it slowly emerges, is that despite Fink's painstaking re-creation—based on five hundred interviews and mountains of documents—we weren't there. We cannot know. Five Days is a seemingly conventional book, paced like a thriller, that is subtly dedicated to what John D'Agata, champion of the "lyric essay," has described as the ever-shrinking "lifespan of a fact." But where so many lyric essayists take fact's half-life as a justification to fabricate symmetry, Fink, under the guise of third-person journalistic objectivity, drives us toward a kind of uncertainty so great that it's revelatory. Five Days at Memorial is journalism in the same way that the observations Walt Whitman recorded in the "blood-smutch'd little note-books" he carried through Civil War hospital wards were journalism. Whitman's method was subjectivity, and Fink's is the obsessive accumulation of detail, but the result is oddly similar, sweeping us through an institution over and over again, making rounds like a doctor, alighting on this case or that, searching for answers and finding questions.

"Help was coming too slowly," Fink writes, describing the view of Dr. Ewing Cook, the chief medical officer at Memorial. "There were too many people who needed to leave and weren't going to make it. It was a desperate situation and Cook saw only two choices: quicken their deaths or abandon them." Or one could do both: A nurse walks away from a patient cut off from oxygen because, as Fink writes, "she couldn't stand to watch this lady die on the ground, in a parking garage, in an American city, because nobody came to get her. She didn't want to know this lady's name." Or one could do neither: "I can't be a part of anything like that," one doctor declares of the triage plan. As Fink goes on to explain: "The idea was stupidity itself. [The Katrina victims at Memorial] had only been there two days since the floodwaters rose, and they were dry and had water."

There are conclusions to be drawn from Fink's collection of dilemmas. It's a shame, for example, that no Tenet executive faced criminal charges, and whatever one thinks of euthanasia, it's clear that "mistakes were made," to adopt the famously self-serving passive phrasing of Nixon's press secretary Ronald Ziegler. Toward the end of the book, Fink, a physician herself, seems to indicate through her juxtaposition of testimonies that she believes "a crime had occurred." The scope of that crime—not just a legal trespass but a moral and ethical one as well—is the true subject of this book. This isn't just a policy brief ornamented with characters. It is, like all great journalism, a document unto itself, an artifact of what we thought about "life and death" issues in the early twenty-first century.

While Five Days at Memorial may be "as engrossing as the best novel" (so its marketing claims), it is not like a novel. Characters emerge and fade, more like a cloud of witnesses than a cast. Nor is it like history. Analysis comes in the form of asides—in a passage on opposition to rationed health care, Fink writes, "To handicap the race for new treatments that might prolong life would be to call off the eternal search for the elixir of immortality. Plus it would be bad for capitalism."

The book of Lamentations might be the most relevant model, but Fink's tone is cooler than that. The book is divided into two parts: "Deadly Choices," an ever-darkening re-creation of the five days, and "Reckoning," an even thornier account of the investigation that followed. As nearly everyone involved lawyers up—one doctor hires an attorney who worked on an appeal by Lieutenant William Calley, infamous for commanding the 1968 My Lai massacre—the second half of the book necessarily deconstructs the first. An investigator's job, writes Fink, "was as impossible as collecting fragments of a fractured mirror and then, somehow, inferring what image had once appeared there."

And yet the investigator tries. Fink tries. Even the many doctors and nurses and patients and relatives who were, in fact, there try. A few claim certainty; more suffer nightmares and doubts. They take counsel with lawyers and priests. Some want to keep themselves out of prison, yes, but there is little sense of “getting away with it”—except, perhaps, with regardto Tenet Healthcare, which laid off its employees, sold the hospital, and settled a class-action suit in 2011 for $25 million, chump change for a corporation that in 2006 agreed to pay $900 million to settle charges of unlawful billing from the US Justice Department.

The numbers don’t add up. But then, they never do; history is not an algebraic equation. As Fink shows us in this magnificent and awful work of documentary prose, facts are not to be solved; they are to be collected and collected, arranged and rearranged, pondered and presented for what they are: all that we have to go on, terrifyingly incomplete. Such is journalism.

Jeff Sharlet teaches literary nonfiction at Dartmouth College. His most recent book is Sweet Heaven When I Die (Norton, 2011), a collection of essays.

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