Five Days at Memorial: A different lesson

Sheri Fink says, "Emergencies are crucibles that contain and reveal the daily, slower-burning problems of medicine and beyond--our vulnerabilities; our trouble grappling with uncertainty, how we die, how we prioritize and divide what is most precious and vital and limited; even our biases and blindnesses."  This is part of her conclusion in Five Days at Memorial, the story of how one hospital's staff dealt with the chaos surrounding Hurricane Katrina in New Orleans.  She clearly believes that the staff intentionally killed patients, persuaded that in so doing they would be helping people avoid unnecessary suffering.  (The methods employed were qualitatively different from removing life support.)

My correspondent Budd Shenkin offers his views on the book here.  I think maybe he and I both disagree on a view expressed by Sherwin Nuland, the great Yale doctor.  Says Budd:

He would have voted to pass [the doctor involved] and not indict, he says.  Not me.  After all, the staff at Charity, the big public hospital, seems to have done much better.  Apparently, they didn’t kill anyone.

But I am not a doctor and so perhaps don't have the depth of experience to judge the clinicians on the floors.  I am not the least hesitant, though, in judging the administrators of the hospital.  By all accounts, they were incompetent--whether in preparing contingency plans for natural disasters or in carrying out their responsibilities during this storm.

As I read this book, I was sickened by what was going on.  I actually had to stop reading it at night because it was disturbing my sleep.  While the clinicians' action were troublesome, what made me most distressed was the fact that the administrators were truly missing in action.  Whatever you think might have been ethical lapses by doctors and nurses, they paled in my mind to those of the hospital's executive leadership.  Fink's statement above is way too complex vis-a-vis the responsibilities of executives.  They should conduct risk assessments and plan for contingencies; conduct simulations and practice and learn; be there to lead the troops when things develop; learn and modify as events unfold; and then debrief and learn even more.  Those steps did not occur at Memorial.  What a disgrace.