In the early days of my day job, an older coworker told me: "Whenever
you see a group study a situation and make recommendations, one of those
recommendations will always be, 'We need better communication.'"
It
has amused me over the years to see just how often this happens. But I
thought of it again, in a deadly serious context, as I read Sheri Fink's
Five Days at Memorial, an account of Hurricane Katrina's effect
on a Louisiana hospital. Throughout the tragedy, there were
miscommunications, conflicting and contradictory information, and
confusion about what decisions had been made, when, and by whom. It can
perhaps be best summed up by this quote from the book: "... since the
storm, government agencies, private organizations, and journalists had
churned out reports that analyzed and found fault with actions and
inaction at nearly every level of every system."
What is clear is
that after the power and running water and infrastructure failed--even
with the continued presence of food, bottled water, pharmaceuticals, and
ongoing rescues by boat and helicopter--it did not take long for the
hospital to become its own world, a world that felt divorced from normal
life. As Fink writes about one doctor's feelings during the emergency:
"She was no longer able to envision what would happen when life returned
to normal; many people seemed to be wondering whether that would ever
happen. Having an end would give them a reference point for their
options. Yes, she had heard they would all get out that day, but she
couldn't see it, couldn't believe it, wasn't convinced ..." It took less
than a week for the hospital to go from "normal" to this beyond-normal
state. Those lines reminded me of the way I have felt during
multiple-day emergencies (e.g., hurricane, ice storm) when power was
lost and roads were impassable. It only takes a few days for "normal" to
feel long lost, almost unimaginable. And I have never been in a
situation of the magnitude of Katrina. Katrina was horrific enough to
watch from the safe distance of my living-room TV.
The book
raises many ethical questions about the treatment of the ill and injured
during such emergencies, including: Who should be evacuated first, the
most critically ill or the most ambulatory? If medical resources are
limited, how should they be rationed? Do different ethical standards
apply during emergencies? Should euthanasia ever be on the table? Who
has the right to make such decisions? It's an utterly gripping and
haunting read.
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