Five Days at Memorial

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.