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Book Fox

Oh you know, long time reader, first time blogger...just a place to throw out some ideas, be a little snarky, give some honest opinions about books and the book industry.

Here's my dillemma..

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital - Sheri Fink

How do you review a book that you believe is important--as in, everyone who even hopes to call themselves a concerned citizen, anyone running for public office, and any one who ever expects to be hospitalized at some point in their life should read--but by the last page you kinda went, 'Meh'?


After starting, deleting, and restarting this review several times, I realized what the problem was. This is really two books. One I was fascinated by, and the other I didn't really care about.


The five days of the title refers to the five days of Katrina and it's immediate aftermath, at a for-profit hospital in New Orleans (why the 'for-profit matters later). Memorial was surrounded by floodwaters, lost power, had no concrete plan for rescue, and at the end of those five days had a larger than average death-rate. After investigation, many of the dead, who had largely been patients of an independent hospice-program within the bounds of Memorial, were discovered to have been injected with morphine and sedatives in much higher than normal doses.


The second half of the book was essentially a true crime story (though with the added nuance of discussing the prickly topic of euthanasia & and the culpability of medical personnel in emergency situations), detailing the investigation of Memorial, it's staff, and it's corporate overlords. In the end a doctor and two nurses were arrested for second-degree murder. 


I will admit that I was bored by this. The workings (or failings) of the legal system do not really interest me, and Fink's efforts to show all sides left me not even caring about the actual people involved. I would have welcomed more commentary about medical ethics, but since this was a book about a particular event and not about the issue itself, I suppose the insights of any but those involved would have been out of place.


What I do find fascinating is the psychology of crises--who lives, who dies, who fails, who thrives, who rises to the occasion, and who...takes hits of oxygen in a functioning part of the building while elsewhere in the hospital patients gasp for breath because there is no power for their ventilators.


Fink only briefly covers it, but there was another hospital in New Orleans that lost only 3 patients.  They were a charity hospital with twice the patients (incluiding psychiatric patieints), used to improvising with somewhat substandard equipment. That staff understood that just because it was a crisis didn't mean that the rules changed. Their primary mandate was to care for their patients, and to that end, they took care of themselves. They kept a regular sleep schedule. They kept up with all care--even non-essentials like physical thereapy. They organized morale boosters like a talent show by flashlight. Instead of going to their cars to sit in the air conditioning for a few minutes, they siphoned gas to keep their generators going. They never surrendered to the situation. They never believed that anyone--even the sickest--weren't going to get out alive.


So the first part of Five Days at Memorial is a play by play (more or less) of those five days. Do not doubt that there were heroes working at Memorial (just like there were probably cowards and troublemakers at Charity Hospital). But what comes across is a complete lack of leadership.


Their owner, Tenet, who owns many for-profit hospitals in the US, made only the most cursory attempts at any disaster preparedness plan before Katrina, and (much like the government) failed to react to the scale of the situation fast enough. And when they did, this huge corporation decided to rely on the government for rescue, despite offers from within their own family of hospitals to send helicopters and take patients.


On the ground, Memorial staff chose to triage their patients in such a way that the most fragile and vulnerable would be slated for rescue last. It was the opposite of what Charity Hospital decided. It might have made sense in other situations--a sinking ship with only so many lifeboats--but not in a time and place where rescue might be slow, but it was coming. There wasn't a shortage of food or supplies. The pharmacy ran low, but a shipment made it through early on. There was even a working generator in another part of the building. 


But they gave up. They assumed there was nothing they could do but wait for rescue, and so they tried nothing. And in the end, because though without sense they were not without compassion, several doctors and nurses made the choice to 'ease the suffering' of some of their patients in an unfortunately irrevocable way.


So it's an important book. It's just not exactly what I wanted it to be.