Five Days at Memorial by Sheri Fink - Excerpt

7/30/2019 Five Days at Memorial by Sheri Fink - Excerpt

1/18


2/18
https://play.google.com/store/search?q=9780307718983&c=bookshttp://click.linksynergy.com/fs-bin/stat?id=VD9*lkiWNd8&offerid=146261&type=3&subid=0&tmpid=1826&u1=Five+Days+at+Memorial-EL--CrownScribd-9780307718983&RD_PARM1=http%253A%252F%252Fitunes.apple.com%252Fus%252Fbook%252Fisbn9780307718983%253Fmt%253D11%2526uo%253D4%2526partnerId%253D30http://www.indiebound.org/product/info.jsp?affiliateId=randomhouse1&isbn=0307718964http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?EAN=9780307718969&cm_mmc=Random%20House-_-Five+Days+at+Memorial-HC--CrownScribd-9780307718969-_-Five+Days+at+Memorial-HC--CrownScribd-9780307718969-_-Five+Days+at+Memorialhttp://www.amazon.com/gp/product/0307718964?ie=UTF8&tag=randohouseinc5813-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0307718964


3/18

sheri ink

ive days at memoriallie and death in astorm-ravaged hospital

C r o w n P u b l i s h e r s


4/18

Copyright 2013 by Sheri FinkAll rights reserved.

Published in the United States by Crown Publishers, an imprint o the Crown PublishingGroup, a division o Random House, Inc., New York.www.crownpublishing.com

crown and the Crown colophon are registered trademarks o Random House, Inc.

The Deadly Choices at Memorial, by Sheri Fink. Copyright 2009 by Pro Publica,Inc. All rights reserved. Portions reprinted by kind permission o Pro Publica, Inc. Firstpublished in the New York Times Magazine.

Flu Nightmare: In Severe Pandemic, Ocials Ponder Disconnecting Ventilators FromSome Patients, by Sheri Fink. Copyright 2009 by Pro Publica, Inc. All rights reserved.Portions reprinted by kind permission o Pro Publica, Inc.

Rationing Medical Care: Health Ocials Struggle With Setting Standards, by SheriFink. Copyright 2009 by Pro Publica, Inc. All rights reserved. Portions reprinted bykind permission o Pro Publica, Inc. First published on MinnPost.com.

Preparing or a Pandemic, State Health Departments Struggle with RationingDecisions, by Sheri Fink. Copyright 2009 by Pro Publica, Inc. All rights reserved.Portions reprinted by kind permission o Pro Publica, Inc. First published in the New York

Times.

Doctors Face Ethical Decisions in Haiti and Rationing Health in Disasters, by SheriFink. Copyright 2010 by Sheri Fink. All rights reserved. First broadcast on PRIs TheWorld.

In Hurricanes Wake, Decisions Not to Evacuate Hospitals Raise Questions, by SheriFink. Copyright 2012 by Sheri Fink. All rights reserved. First published on ProPublica.org.

Beyond Hurricane Heroics: What Sandy Has to Teach Us All About Preparedness,by Sheri Fink. Copyright 2013 by Sheri Fink. All rights reserved. First published in

Stanford Medicine Magazine.

Endpapers: Memorial Medical Center complex, viewed rom the south side, on ThursdaySeptember 1, 2005. Brad Loper /Dallas Morning News

Library o Congress Cataloging-in-Publication Data is available upon request.

ISBN 978-0-307-71896-9eISBN 978-0-307-71898-3

printed in th e united states of america

Maps by Jeffrey L. Ward

Jacket design by Chris Brand

10 9 8 7 6 5 4 3 2 1


5/18

[blank]

ORIGINAL 1926

HOSPITAL BUILDING

INTENSIVE CARE UNIT

LIFECARE

ER RAMP

MAGNOLIA ST.

CLARA ST.

NAPOLEON

AVENUE

JENASTREET

J E N

A S

T R

E E T

S. ROBERTSON STREET

water level on north side

DOCTORS OFFICES

NEW ORLEANS SURGERY

AND HEART INSTITUTE

NEW ORLEANS

CANCER INSTITUTE

PARKING LOT

LIFECARE

CORE PLANT BUILDING

WITH GENERATORS

COVERED TUNNEL

CLARA STREET

BRIDGE FROM NOSHI TO SOUTH WING

DOCTORS OFFICES

SHORTCUT OVER ROOF TO

PARKING GARAGE AND HELIPAD

SECOND-FLOOR LOBBY

BRIDGE

BRIDGE

SMOKING BALCONY

SOUTH WING

S

WE


6/18

CLARA WING

HELIPAD

MAGNOLIA STREETCADIZSTREET

GARAGE

DOWN RAMP

South to Mississippi River

PARKING GARAGE

BRIDGE

METAL STAIRCASE

MEMORIAL MEDICAL CENTER HOSPITAL COMPLEX

CHAPEL

HATCH TO GARAGE

SECOND-FLOOR LOBBYSTAGING AREA

PARKING GARAGE AND

STAIRS TO HELIPAD

MACHINE ROOM

GENERATOR ROOM

PHARMACY

SECOND-FLOOR PLAN

AND ROUTE TO GARAGE


7/18

note to the reader

THIS BOOK RECOUNTS what happened at Memorial Medical

Center during and ater Hurricane Katrina in August 2005 and ol-

lows events through the atermath o the crisis, when medical proes-

sionals were arrested and accused o having hastened the deaths o theirpatients. Many people held a piece o this story, and I conducted more

than ve hundred interviews with hundreds o them: doctors, nurses,

sta members, hospital executives, patients, amily members, govern-

ment ocials, ethicists, attorneys, researchers, and others. I was not at

the hospital to witness the events. I began researching them in February

2007 and wrote an account o them in 2009, copublished on the inves-

tigative news site ProPublica and in the New York Times Magazine: TheDeadly Choices at Memorial.

Because memories oten ade and change, source materials dating

rom the time o the disaster and its immediate atermath were particu-

larly valuable, including photographs, videotapes, e-mails, notes, dia-

ries, Internet postings, articles, and the transcripts o interviews by other

reporters or investigators. The narrative was also inormed by weather

reports, architectural foor plans, electrical diagrams, and reports pre-pared by plainti and deense experts in the course o civil litigation;


8/18

xviii note to the reader

Dialogue rendered in quotation marks is reproduced exactly as it was

recalled in interviews, or is taken directly rom transcripts and other pri-

mary sources. I one person recounted an important conversation, I gen-

erally attempted to contact all participants, but some declined to speak,

and at times memories were at odds. The main text and Notes highlight

areas o signicant dispute and indicate the sources o quotes when they

do not derive rom interviews with me. Typographical mistakes are pre-

served in quoted e-mails to give the reader a sense o the urgency in-

volved in their production.

This book relates the thoughts, impressions, and opinions o the

people in it, perhaps the most raught aspect o narrative journalism.

Attributed thoughts or eelings refect those that a person shared in an

interview, wrote down in notes, a diary, or a manuscript, or, less com-

monly, expressed to others whom I interviewed. As any book refects

the interwoven interpretations and insights o its author, I have tried to

make these distinct. All errors are mine.


9/18

PART I

deadly choices

Blindness was spreading, not like a sudden tide ood-

ing everything and carrying all beore it, but like an

insidious infltration o a thousand and one turbulent

rivulets which, having slowly drenched the earth,

suddenly submerge it completely.

Jos Saramago, Blindness


10/18

PROLOGUE

AT LAST THROUGH the broken windows, the pulse o helicop-ter rotors and airboat propellers set the summer morning air throbbing

with the promise o rescue. Floodwaters unleashed by Hurricane Katrina

had marooned hundreds o people at the hospital, where they had now

spent our days. Doctors and nurses milled in the oul-smelling second-

foor lobby. Since the storm, they had barely slept, surviving on catnaps,

bottled water, and rumors. Beore them lay a dozen or so mostly elderly

patients on soiled, sweat-soaked stretchers.In preparation or evacuation, these men and women had been lited

by their hospital sheets, carried down fights o stairs rom their rooms,

and placed in a corner near an ATM and a planter with wilting greenery.

Now sta and volunteersmostly children and spouses o medical work-

ers who had sought shelter at the hospitalhunched over the inrm, dis-

pensing sips o water and anning the miasma with bits o cardboard.

Supply cartons, used gloves, and empty packaging littered the foor.The languishing patients were receiving little medical care, and their skin


11/18

4 sheri fnk

Others had blood pressures so low their pulses werent palpable, their

breathing the only evidence o lie. Hand-scrawled evacuation priority

tags were taped to their gowns or cots. The tags indicated that doctors

had decided that these sickest individuals in the hospital were to be evac-

uated last.

Among them was a divorced mother o our with a ailing liver who

was engaged to be remarried; a retired church janitor and ather o six

who had absorbed the impact o a car; a WYES public television vol-

unteer with mesothelioma, whose name had recently disappeared rom

screen credits; a World War II Rosie Riveter who had trouble speak-

ing because o a stroke; and an ailing matriarch with long, braided hair,

MaDear, renowned or her cooking and the strict but loving way she

raised twelve children, multiple grandchildren, and the nonrelatives she

took into her home.

In the early aternoon a doctor, John Thiele, stood regarding them.

Thiele had taken responsibility or a unit o twenty-our patients aterKatrina struck on Monday, but by this day, Thursday, the last o them

were gone, presumably on their way to saety. Two had died beore they

were rescued, and their bodies lay a ew steps down the hallway in the

hospital chapel, now a makeshit morgue.

Thiele specialized in critical care and diseases o the lungs. A stocky

man with a round ace and belly, and skinny legs revealed beneath his

shorts, he answered oten to Dr. T or, among riends, Johnny, andwhen he smiled, his eyes crinkled nearly shut. He was a native New

Orleanian, married at twenty, with three children. He was a goler and a

Saints ootball an. He liked to smoke a good cigar while listening to Elvis.

Like many o the hospital sta around him, his proessional asso-

ciation with what was now Memorial Medical Center stretched back

decades, in his case to 1977, when he had rotated at the hospital as a

Louisiana State University medical student. A classmate would later saythat Johnny Thiele had turned into the sort o doctor they all wished to


12/18

fve days at memorial 5

struggled over the years with alcohol and his moods. When Dr. T passed

a emale nurse, he would greet her by name with a pat on the back and

sometimes call her kiddo.

Thiele had undergone part o his training at big, public Charity Hos-

pital, one o the busiest trauma centers in the nation, where he learned,

when several paramedics burst into the emergency room in close succes-

sion, to attend to the most critical patients rst. It was strange to see the

sickest here at Memorial prioritized last or rescue. At a meeting Thiele

had not attended, a small group o doctors had made this decision with-

out consulting patients or their amilies, hoping to ensure that those

with a greater chance o long-term survival were saved. The doctors

at Memorial had drilled or disasters, but or scenarios like a sarin gas

attack, where multiple pretend patients arrived at the hospital at once.

Not in all his years o practice had Thiele drilled or the loss o backup

power, running water, and transportation. Lie was about learning to

solve problems by experience. I he had a fat tire, he knew how to x it.I somebody had a pulmonary embolism, he knew how to treat it. There

was little in his personal history or education that had prepared him or

what he was seeing and doing now. He had no repertoire or this.

He had arrived here on Sunday. He brought along a riend who was

recovering rom pneumonia and was too weak to comply with the may-

ors mandatory evacuation order or the city, which had exempted hos-

pitals. Early Monday, Thiele awoke to shouts and elt his ourth-storycorner oce swaying. Its foor-to-ceiling windows, thick as a thumb,

moved in and out with the wind gusts, admitting the near-horizontal

rain. He and his colleagues lited computers away and sopped up water

with sheets and gowns rom patient exam rooms, wringing out the cloth

over garbage cans.

The hurricane cut o city power. The hospitals backup generators

did not support air-conditioning, and the temperature climbed. Thewell-insulated hospital turned dank and humid; Thiele noticed water


13/18

6 sheri fnk

Early Wednesday morning, Memorials generators ailed, throwing

the hospital into darkness and cutting o power to the machines that

supported patients lives. Volunteers helped het patients to staging areas

or rescue, but helicopters arrived irregularly. That aternoon, Thiele

sat on the emergency room ramp or a cigar break with an internist,

Dr. John Kokemor, who told him doctors were being requested to leave

last. When Thiele asked why, his riend brought an index nger to the

crook o his opposite elbow and pantomimed giving an injection. Thiele

caught his drit.

Man, I hope we dont come to that, Thiele said. Kokemor would

later say he never made the gesture, that he had spent nearly all his time

outside the building loading hundreds o mostly able-bodied evacuees

onto boats, which foated them over a dozen blocks o fooded streets to

where they could wade to dry ground. He said he was no longer caring

or patients and too busy to worry about what was going on inside the

hospital.Wednesday night, Thiele heard gunshots outside the hospital. He was

sure people were trying to kill each other. The enemy lurked as near

as a credit union building across the street. Thiele thought the hospital

would be overtaken, that those inside it had no good way to deend them-

selves. He lost his ooting in an inky stairwell and nearly pitched down

the concrete steps beore catching himsel. Panicked and convinced he

would die, he reached his amily by cell phone to say good-bye.Thiele elt abandoned. You pay your taxes, he thought, and you as-

sume the government will take care o you in a disaster. He also won-

dered why Tenet, the giant Texas-based hospital chain that owned

Memorial, had not yet sent any means o rescue.

Finally, on Thursday morning, the company dispatched leased heli-

copters, while other aircrat rom the Coast Guard, Air Force, and Navy

hovered overhead awaiting a turn to perch on Memorials helipad. Air-boats came and went with the earsplitting drone o airplane engines.


14/18


creating a predicament or the sta members who had brought them

to the hospital or the storm. A young internist held a Siamese cat as

Thiele elt or its breastbone and ribs and conjured up the anatomy he had

learned in a college dissection class. He aimed the syringe ull o potas-

sium chloride at the cats heart. The animal wriggled ree o the doctors

hands and swiped and tore Thieles sweat-soaked scrub shirt. Its whitish

ur stuck to him. They caught the animal and tried again to euthanize it,

working in a hallway perhaps twenty eet away rom the patients in the

second-foor lobby. It was craziness.

A tearul doctor came to Thiele with news she had been oered a

spot on a boat with her beautiul twenty-pound sheltie. She had quickly

trained it to lie in a duel bag. Several o the doctors human companions

were insisting they would not leave without her. Since the foodwaters

had surrounded them, the doctor had been sick to her stomach and con-

tinuously araid. She wanted to go while she had this chance, but she

elt guilty about abandoning her colleagues and the remaining patients.Dont cry, just go, Thiele said. An animals like a child. He reassured

her: We gonna get by without you. I promise you.

Thiele walked back and orth through the second-foor lobby mul-

tiple times as he journeyed between the hospital and his medical oce.

As the hours passed, the volunteers anning the patients on their stretch-

ers were shooed downstairs to join an evacuation line snaking through

the emergency room.Thiele knew nothing about the dozen or so patients who remained,

but they made an impression on him. Beore the storm, the poor souls

would have had a chance. Now, with the compounding eects o days in

the inerno with little to no medications or fuids, they had deteriorated.

The airboats outside made it too loud or Thiele to use a stethoscope.

He didnt see any medical records, he didnt eel he needed them to tell

him that these patients were moribund. He watched a doctor he didntknow direct their care, a short woman with auburn hair. He would later


15/18

8 sheri fnk

Pou was among the ew doctors still caring or patients inside the

stifing hospital. Some physicians had departed; those who hadnt were,

or the most part, no longer practicing medicinethey had assumed the

roles o patient transporters or were overseeing the evacuations outside

where it was somewhat cooler. But Pou looked to Thiele like a emale

Lone Ranger. Ater enduring our stressul days and our nights o little

sleep, she retained the strength and determination to tend to the worst-

o. Later, he would remember her saying that the patients beore them

would not be moved rom the hospital. He did not know i she had de-

cided that, or i she had been told that by an administrator.

Hospital CEO L. Ren Goux had told Thiele that everyone had to be

out by nightall. A nursing director, Susan Mulderick, the designated di-

saster manager, had given Thiele the same message. The two leaders later

said they had meant to ocus their exhausted colleagues on the evacua-

tion, but the comments let Thiele wondering what would become o

these patients when everyone else let.He also wondered about the remaining pets, which hed heard would

be released rom their kennels to end or themselves. They were hun-

gry. And Thiele was sure that another kind o animal was poised to

rampage through the hospital looking or drugs. He later recalled won-

dering at the time: What would they do, these crazy black people who

think theyve been oppressed or all these years by white people . . . God

knows what these crazy people outside are going to do to these poorpatients who are dying. They can dismember them, they can rape them,

they can torture them.

What would a amily member o a patient want Thiele to do? There

was no one let to ask; they had all been made to leave, told their loved

ones were on their way to rescue.

The rst thing, he thought, was the Golden Rule, do unto others as

you would have them do unto to you. Thiele was Catholic and had beeninfuenced by a Jesuit priest, Father Harry Tompson, a mentor who had


16/18


he had learned in medical school: Heal Frequently, Cure Sometimes,

Comort Always. It seemed obvious what he had to do, robbed o al-

most any control o the situation except the ability to oer comort.

This would be no ordinary comort, not the palliative care he had

learned about in a week-long course that certied him to teach the prac-

tice o relieving symptoms in patients who had decided to prioritize this

goal o treatment above all others.

There were syringes and morphine and nurses in this makeshit unit

on the second-foor lobby. An intensive care nurse he had known or

years, Cheri Landry, the Queen o the Night Shita short, broad-

aced woman o Cajun extraction who had been born at the hospital

had, he believed, brought medications down rom the ICU. Thiele knew

why these medications were here. He agreed with what was happening.

Others didnt. The young internist who had helped him euthanize the

cat reused to take part. He told her not to worry. He and others would

take care o it.In the days since the storm, New Orleans had become an irrational

and uncivil environment. It seemed to Thiele the laws o man and the

normal standards o medicine no longer applied. He had no time to pro-

vide what he considered appropriate end-o-lie care. He accepted the

premise that the patients could not be moved and the sta had to go. He

could not justiy hanging a morphine drip and praying it didnt run out

ater everyone let and beore the patient died, ollowing an interval oacute suering. He could rationalize what he was about to do as merely

abbreviating a normal process o comort carecutting cornersbut

he knew that it was technically a crime. It didnt occur to him then to

stay with the patients until they died naturally. That would have meant,

he later said he believed, risking his lie.

He oered his assistance to Dr. Pou, but at rst she reused him. She

tried repeatedly to convince him to leave the area. I want to be here,he insisted, and stayed.


17/18

10 sheri fnk

what the doses should be. To his mind, they needed to inject enough

medicine to ensure the patients died beore everyone else let the hos-

pital. He would push 10 mg o morphine and 5 mg o the ast-acting

sedative drug Versed and go up rom there as needed. Versed carried a

black box warning rom the FDA, the most serious type, stating that

the drug could cause breathing to cease and should only be given in set-

tings where patients were monitored and their doctors were prepared to

resuscitate them. That was not the case here. Most o these patients had

Do Not Resuscitate orders.

It took time to mix the drugs, start IVs, and prepare the syringes. He

looked at the patients. They seemed lieless apart rom their breathing

some hyperventilating, some gasping irregularly. Not one spoke. One

was moaning, delirious, but when someone asked what was wrong, she

was unable to respond.

He took charge o our patients lined up on the side o the lobby clos-

est to the windows: three elderly white women and a heavyset AricanAmerican man.

It had come to this. Dr. Ts mind began to orm a question, perhaps

in the aint awareness that there might be alternatives they had not con-

sidered when they set this course. Perhaps he realized at the moment o

action that what seemed right didnt eel quite right; that a gul existed

between ending a lie in theory and in practice.

He turned to the person beside him, the nurse manager o the ICUswho also served as the head o the hospitals bioethics committee. Karen

Wynn was versed in adjudicating the most dicult questions o treat-

ment at the end o lie. She, too, had worked at the hospital or decades.

There was no better human being than Karen. At this most desperate

moment, he trusted her with his question.

Can we do this? he would later remember asking her. Do we

really have to do this?


18/18
https://play.google.com/store/search?q=9780307718983&c=bookshttp://click.linksynergy.com/fs-bin/stat?id=VD9*lkiWNd8&offerid=146261&type=3&subid=0&tmpid=1826&u1=Five+Days+at+Memorial-EL--CrownScribd-9780307718983&RD_PARM1=http%253A%252F%252Fitunes.apple.com%252Fus%252Fbook%252Fisbn9780307718983%253Fmt%253D11%2526uo%253D4%2526partnerId%253D30http://www.indiebound.org/product/info.jsp?affiliateId=randomhouse1&isbn=0307718964http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?EAN=9780307718969&cm_mmc=Random%20House-_-Five+Days+at+Memorial-HC--CrownScribd-9780307718969-_-Five+Days+at+Memorial-HC--CrownScribd-9780307718969-_-Five+Days+at+Memorialhttp://www.amazon.com/gp/product/0307718964?ie=UTF8&tag=randohouseinc5813-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0307718964

Five Days at Memorial by Sheri Fink - Excerpt

Documents

Transcript of Five Days at Memorial by Sheri Fink - Excerpt