58 pages • 1 hour read
Sheri FinkFive Days at Memorial: Life and Death in a Storm-Ravaged Hospital
Nonfiction | Book | Adult | Published in 2013A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
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BetaChapters 5-7 Chapter Summaries & Analyses
Chapter 5 Summary
Early on the fourth day, August 31, the Coast Guard offers to fly out more patients, especially “the seven LifeCare patients on ventilators” (110), but Dr. Deichmann asks them to wait till daybreak. He believes at night it’s “too dangerous to reopen the helipad. The staff needed rest” (110).
A man walks through the hospital, shouting: “The boats are here! Get down there! You can take one bag! No animals!” (112). Patients and family members shuffle sleepily downstairs, only to learn that there aren’t any boats. They trudge back upstairs, where some discover their extra belongings have gone missing.
The backup generators begin to fail. Attempts to repair them prove inadequate. At 2 a.m., the last of the three generators fails. Only battery power remains. Without power, moving LifeCare patients is a lengthy and tedious process. They must be taken on stretchers down the stairs to the second floor, where they are passed through a maintenance-room delivery hole to the garage; trucks then drive them up the spiral driveway to the helipad, where they await rescue. Nurses and staffers are exhausted by the effort.
Many of the elderly patients, some portly, some dehydrated, overheat in the stifling air. They may be suffering heatstroke. Several die while awaiting rescue. A few are picked up by Coast Guard helicopters, but confusion remains over whether the aircraft should arrive at all during the night.
The morning sun heats the hospital, where “toilets were backed up, and the stench of sewage mixed with the odor of hundreds of unwashed bodies” (127). Armbands are issued: “Patients who could walk would be given green bands, those who needed assistance would get yellow bands, and those who depended completely on care given by others would get red bands. Patients with DNR orders were to get a black band” (127).
LifeCare patient Vera LeBlanc’s daughter, Sandra, is an EMT trainer. With her husband, Mark, she drives from Northern Louisiana to a staging area near downtown New Orleans. She finds two pilots of airboats—flat-bottomed machines, propelled by giant fans, that can move quickly across flooded areas—and gets them to take the LeBlancs to Memorial. They arrive at the hospital and are stunned to see the conditions there. Vera is alive but “in a mess” (133).
Patients are carried to the second-floor lobby: “The airboat flotilla was beginning to make runs to dry ground” (136). Armbands run out, and the staff establish a new I.D. system for patients, taped to or marked on their clothing: “1” for those who can walk, “2” for those who need assistance, and “3” for the worst cases. The “1” patients will be evacuated first.
“Pou and her coworkers were performing triage,” which “came to be used in accidents and disasters when the number of those injured exceeded available resources” (136). The controversial practice focuses efforts on those who most need medical attention, but it excludes those who are relatively well and those who are likely to die despite efforts to save them. Pou is troubled: “To her, changing the evacuation order from sickest first to sickest last resulted from a sense among the doctors that they would not be able to save everyone” (139).
One patient with a “Do Not Resuscitate” (DNR) designation is ordered left behind. A nurse, angry at this, “informed the woman’s daughter of her right to request that the DNR order be discontinued” (142). The daughter does so, saying: “When I made my mother a DNR, I did not know it meant ‘do not rescue’” (142). Another DNR patient’s daughter makes the same request but is told “there were no doctors available to do it” (142).
Chapter 6 Summary
Wednesday morning and afternoon, a few helicopters arrive at Memorial to evacuate patients:“Some of the pilots seemed to be under the mistaken impression that only a handful of patients remained” (147). One helicopter lands, intending to drop off patients. Supplies arrive by air, but flights are fewer overall on Wednesday.
The two airboats shuttle patients, three or four at a time, to dry ground:“They glided slowly to avoid hitting debris. The round-trip took more than an hour” (150). A much bigger boat joins them, but hundreds of people remain at the hospital, lined up and waiting; progress is slow.
“Pets weren’t being allowed on the boats and helicopters” (155), so critical care doctor Ewing Cook euthanizes some of them. Cook also looks in on ICU patient Jannie Burgess, who is comatose but comfortable. She weighs 300 pounds and, given the situation in the hospital, cannot be moved. He directs the nurses to increase Burgess’s morphine drip “until she goes” (157).
The DNR patients lie on cots in the second-floor lobby. The other patients are ahead of them in line for evacuation. Sandra and Mark LeBlanc, who had brought the boats, find Vera and carry her out of the lobby and onto one of the boats, despite protests from doctors.
Most communication systems are down, but a Tenet executive gets a message through that rescuers will arrive at 7 a.m. At City Hall, emergency manager Cynthia Matherne tries to coordinate rescue efforts, but the Coast Guard air station is damaged and communication is spotty, so the helicopters are “setting their own priorities, often rescuing people as they saw them” (167).
Tenet tries to formulate a rescue plan but is stymied by the disorganized actions of various agencies: “There was no locus of responsibility. Fingers pointed every which way, much as they had when New Orleans flooded in the 1920s” (168). Memorial hospital is ranked at the top of the priority list by some agencies and at the bottom by others. The response of federal agencies is equally disorganized.
Tenet completes arrangements to send helicopters to Memorial by early morning but learns that the situation is dire: “They have 115 pts. in-house, 30 bed bound and 40+ wheelchair bound. Expect up to 60 are fragile and may die within the next 24 hours” (172).
Chapter 7 Summary
Late in the evening on Wednesday, a police boat pulls up to the emergency ramp and twenty officers pour into the hospital. They are there to check on a report of looting, discover it’s a false alarm, and leave.
Belatedly, plant operations staff find and repair two small generators, one of which powers a few lights and fans. Critical patients receive limited doses of drugs to counteract pain, high blood sugar, and high blood pressure, but more advanced care is long gone.
Thursday morning, rescue crafts haven’t yet arrived. Linens and gowns have long since run out, and sweating critical patients develop new bedsores. Some moan in pain. The stench of overflowing toilets is overpowering. Nursing director Mulderick wants to ease patients’ pain with increased doses of morphine and asks to know if doctors will consider it, but this message is interpreted by Dr. Deichmann as a suggestion that euthanasia should be undertaken: “Deichmann said no. The idea shouldn’t even be considered” (190).
Many elderly critical patients are suffering, lying in their own filth, bedsores growing. One doctor wonders if the patients will ever be rescued, and whether they should be put out of their misery: “Somebody had already made that choice for the dogs. Why, she wondered, should we treat the dogs better than we treat the people?” (193).
Dr. Pou, similarly concerned, talks to Dr. Cook, who explains to her how to administer a drug cocktail that would “help the patients ‘go to sleep and die’” (195). Pou “wrote out large prescriptions for morphine” (195).
Dr. Kathleen Fournier is troubled by the talk of euthanasia and protests strenuously. She is widely disliked for her loud, curse-filled gripes: “She didn’t filter” (196). She talks to other doctors: some agree with her and some are on the fence. One who agrees is Dr. Bryant King: “He sent text messages to his sister and his best friend telling them that ‘evil entities’ were discussing euthanizing patients” (199). King asks his sister to contact the media or the military.
Patients still remain on the LifeCare seventh floor. A few of them are watched over by relatives; finally, they are told to leave their bedridden parents behind. LifeCare staffers learn that Memorial staffers “had arrived and were taking over the care of their patients” (208). LifeCare assistant administrator Diane Robichaux, in tears, tells her staff: “Our patients aren’t going to be evacuated. They aren’t going to leave” (208). Staffers are forced to abandon their patients and depart.
Rescue operations begin again by boat and helicopter. Police guard the hospital but will leave at 5 p.m. to respond to reports of civil unrest elsewhere; officers urge patients and staff to move quickly.
Dr. Pou and Dr. Thiele oversee administration of morphine, Versed, and Ativan to DNR patients. Some of the nurses aren’t aware of what’s going on and become alarmed when patients begin to look weird or whitish. They are shooed away by Dr. Pou. DNR patients begin to die; their bodies are moved into the chapel, now used as a temporary morgue.
“Throughout the day, boats and helicopters drained the hospital of nearly all of its patients and visitors” (221), and some patients die while waiting near the helipad. At least one is given morphine and Versed and carried back downstairs, where she dies.
Rodney Scott, 300 pounds, mistaken for dead yesterday, is finally airlifted out. One ICU nurse is injured during Scott’s load-in to the aircraft and is also helicoptered out: “Scott was the last living patient to leave Memorial” (224).
Chapter 5-7 Analysis
Doctors are trained to save lives and prevent suffering. Usually these two values are not in conflict; at Memorial hospital during the Katrina disaster, the values clash.
Lapses in rescue operations, spotty communication with the outside world, building temperatures reaching 105 degrees, high humidity, inadequate sanitation, and inoperable critical-care machinery push Memorial physicians into an ethical corner. They come to believe they must choose, not whether some patients can be saved, but which patients must die.
Their reasoning begins with the realization that the critical patients—who have suffered for days in extremely hot and humid conditions with little in the way of medical care—may be too far gone to survive an evacuation that will likely take hours or longer to reach functioning hospitals. It’s certainly not the doctors’ fault that the damaged city is unable adequately to extract these patients in a timely manner, but now it is the doctors’ responsibility to do something about it.
The decisions they make are based on the concept of triage, which divides scarce resources in accord with three groupings of patients: those who can live without help, those who can’t, and those who will die either way. In this case, the scarce resource is seats on rescue vehicles. Memorial doctors elect to hold back from evacuation those patients too critical, in their estimation, to survive the rescue trip. Strangely, they rank first for rescue the most able-bodied patients, who, in a normal triage system, would not receive benefits until others are served.
The system draws into question what will become of the most critical patients who are not going to leave the building. The staff can’t simply pack up and leave them to suffer and die alone. By the doctors’ logic, the only choice left is to put the patients out of their misery.
Some critical patients already have died, basically from exposure in the sweltering hospital; others begin to exhibit agonal breathing or Cheyne-Stokes respiration, which often signal impending death. Some experts believe that people who breathe in these ways are unconscious; others aren’t so sure. After all, comatose patients, who are supposed to be unconscious, often report later that they were aware of their surroundings.
In an excess of caution, Memorial doctors choose to assume that their critical patients are suffering, and that something must be done to alleviate the pain. That something—massive injections of morphine and sedatives—will also kill them.
Fink’s account also raises other questions: Is it possible these decisions emerge naturally from a hospital culture, unique to Memorial, that favors heavy sedation and pain relief? Is lethal palliative care already the go-to method for dealing with critical patients? For ICU nurse Karen Wynn, the practice was not unreasonable: “Withdrawing life support was something Wynn had grown extremely comfortable with from her work in the ICU under the tutelage of Dr. Ewing Cook” (214). Cook has delivered “so many times” the message: “We’ve done everything possible for her. Now the only option is to make her comfortable” (215). ICU Nurse Cathy Green, who publicly champions her Memorial cohorts, later works at other hospitals where palliative drug administration rules are much more strict.
