Book SummaryFive Days at Memorial, by Sheri Fink

1-Page Summary1-Page Book Summary of Five Days at Memorial

Hospitals face considerable challenges in readying for emergencies and handling catastrophic events, which includes allocating resources and determining the order in which patients receive treatment.

This part of the book examines the significant challenges hospitals face in preparing for and managing emergencies, particularly in relation to the allocation of limited resources and the complex ethical and logistical decisions regarding the prioritization of patient care. The situation at Memorial Medical Center worsened due to a lack of adequate preparation, unclear goals, and communication failures amid Hurricane Katrina's onslaught.

The hospital's susceptibility to the devastating effects of Hurricane Katrina was heightened due to the inadequate measures taken at Memorial prior to the storm's arrival.

Fink argues that Memorial Medical Center's insufficient preparation for emergencies significantly increased its vulnerability to the difficulties brought on by Hurricane Katrina. The hospital's location in a flood-prone zone, together with the lack of sufficient emergency power and the choice to keep patients in place before the storm hit, resulted in a cascade of challenges that overwhelmed the medical staff and contributed to the ensuing calamities.

The hospital's backup power infrastructure was insufficiently prepared for flooding, and prior to the storm's arrival, there was no evacuation of patients.

Despite their familiarity with extreme weather conditions, Memorial Medical Center and many other healthcare facilities in New Orleans found it challenging to manage the catastrophic flooding brought on by Hurricane Katrina. The hospital, built in a region prone to flooding, was established in 1926 and had experienced significant water damage in its lower floors, especially during the particularly rainy year of 1927. The area surrounding the hospital remained susceptible to flooding, despite considerable advancements in the city's flood protection measures during the twentieth century, including improvements to its water removal and pumping systems.

The situation, already unstable, worsened due to the design of the emergency power system, which was shaped by the location of Memorial. The hospital's emergency power system was engineered to withstand flood conditions, yet key components for distributing electricity, including transfer switches and pumps, were situated at or just above the underground level. Eric Yancovich, responsible for overseeing the facility's operations, identified a critical weakness when he examined the hurricane surge predictions in 2004. He warned that even a small amount of flooding might jeopardize the power system of the facility, but financial limitations left this problem unresolved before Hurricane Katrina struck. Prior to the hurricane's arrival, Memorial made the decision to keep its patients in place despite the evident risk of flooding.

The situation worsened due to the unclear and constantly shifting guidelines for medical evacuation, resulting in delays and confusion.

Fink highlights the considerable disarray and postponements that arose due to the constantly changing and ambiguous priorities for evacuation at Memorial. The initial plan was to first evacuate the patients who were in the most critical state. However, this strategy was modified to prioritize individuals who could move on their own or who could be moved without difficulty. The circumstances deteriorated, leading to a prolonged state of suffering for those who remained trapped under deteriorating conditions, as individuals with Do Not Resuscitate orders were designated to be evacuated last.

At first, the evacuation efforts concentrated on those in dire medical states, yet as circumstances changed, attention turned to evacuating patients with milder ailments, leading to heated discussions about the sequence of departure for patients who had chosen not to undergo resuscitation.

The initial evacuation plan at Memorial focused on ensuring that individuals in critical condition, including those in intensive care, infants in the nursery, and patients in need of dialysis, were the first to be evacuated. The approach aligned with medical norms that prioritize treatment for those in immediate need of care. As water levels increased, attention shifted to the transfer of individuals who could walk and were more easily moved. The adjustment in protocol, driven by the need to make the most efficient use of available transportation methods, led to an extended wait for many patients who were previously given precedence due to...

Five Days at Memorial Summary Choices pertaining to end-of-life medical care bore substantial ethical and legal implications.

This section delves into the ethical and legal repercussions stemming from the decision to administer lethal doses of medication to certain patients at Memorial Medical Center during Hurricane Katrina. Fink explores the complex justifications for these decisions, which the medical staff characterized as measures to alleviate suffering, and scrutinizes the challenge of understanding their intentions amidst rapidly deteriorating conditions, legal factors, and the ethical standards of delivering end-of-life medical treatment.

The doctors held discussions and decided to give certain DNR patients [restricted term] and [restricted term] to ease their suffering, even though they were aware that this could hasten death.

In the final moments before evacuation, the medical staff at Memorial engaged in discussions that culminated in the decision to administer lethal doses of [restricted term] and [restricted term] to certain patients who had Do Not Resuscitate orders. The involved parties insisted that their administration of injections aimed to ease patient suffering and offer comfort, despite knowing that it could hasten death. During the disaster, the decision led to intense...

Five Days at Memorial Summary The disaster was influenced by societal and infrastructural factors, encompassing the dynamics of racial interactions, the structure of social hierarchy, and the accessibility of medical resources.

This segment explores the intricate social and structural obstacles intertwined with disparities in race, class, and access to healthcare, which shaped the strategies employed to handle the emergency when Hurricane Katrina wrought havoc on New Orleans. Fink highlights the challenges linked to racial prejudice in times of emergency, particularly the tension between Memorial and LifeCare, which was exacerbated by the unequal allocation of resources and the differences in the demographics of their patients, as well as the deep-rooted disparities in healthcare that laid the groundwork for the adversity experienced by those trapped in the hospital during the hurricane.

As the hospital began evacuating, worries intensified regarding potential racial bias, given that a large number of self-mobile patients were white, in contrast to the predominantly African American patients who were severely ill and classified as "2"s and "3"s.

The investigation by the author uncovered that the planning of evacuations at Memorial Medical Center was shaped by underlying racial prejudices, reflecting broader societal issues that intensified Katrina's disproportionate effects on New Orleans' African...

Five Days at Memorial Summary The investigations and legal proceedings that followed were a direct consequence of the events that took place at Memorial Medical Center when Hurricane Katrina struck.

This section describes the events that followed Memorial's evacuation, focusing on the investigations and legal proceedings surrounding patient deaths, as well as broader societal responses. Fink explores the scrutiny or disregard by the legal system, medical professionals, and the broader community of the moral quandaries, as well as the lasting consequences of the occurrences at Memorial during that time.

The focus of public and media scrutiny centered on the possibility that the patients had been intentionally administered life-ending drugs.

The arrest of Anna Pou, Cheri Landry, and Lori Budo sparked intense public debate and led to a comprehensive scrutiny by the press of the ethical quandaries present. While some commended the medical staff for providing comfort-focused treatment amid an untenable scenario, others condemned them for allegedly adopting a god-like position and hastening the end of patients' lives without consent. Opinions on the motivations of the attorney general differed; some believed he was seeking attention and political advancement, while others saw him as an advocate for the underrepresented and neglected.

Advocates for Dr. Pou highlighted...