Last weekend I finished Five Days at Memorial, by Sheri Fink, for our work book club. Let's just say it's going to make for a fascinating discussion. In her investigation, Fink delves into what happened during and directly following Hurricane Katrina at Memorial Medical Center in New Orleans. The hospital faced destruction during the actual storm, but even more so when the levies broke and their humongous institution was partially flooded. The city had lost power and eventually the generator in the building that housed the patients who were not evacuated failed as well.
This book poses a series of critical questions, the first being "who gets to leave, and who has to stay?" As the city became more dangerous (supposedly; there is some debate about the rumors that ran rampant about snipers and looters) and communication between the hospital, its owner Tenet, and various sources of transportation (Coast Guard, private companies, etc...) became less reliable, the doctors and nurses in charge, including Dr. Anna Pou, had to decide the priority list for evacuating patients. Ultimately, they created a haphazard triage system that allowed healthier, walking people and sick, but possibly saveable people, to go first (like neonates). Those with DNRs, including many in a sort of "hospital within a hospital" called Life Care, were kept to the end (as well as an obese man who they weren't sure how to move). Many of the DNRs were elderly and lacked the ability to speak for themselves. Their statuses deteriorated rapidly, due to of course their illnesses, but also because of the horrific hospital conditions that led to extreme heat, dehydration, and lack of hygiene.
Eventually, doctors and nurses arrived at the conclusion time was running out and rescue for the remaining patients was not going to happen in the near future, meaning they themselves had to stay. The patients' conditions were deteriorating rapidly and they were suffering severely. It was decided, by someone, that those who seemed hopeless would be given a cocktail of morphine and benzodiazepine (like Ativan) to reduce their pain and anxiety... or kill them, considering the combination and dosage. It is unclean who exactly executed- it seems like a small core group (others knew and refused). Of the forty-five found dead in the hospital, twenty-three had elevated levels of these medication; twenty were labeled "homicides." Eventually, after much investigation, a doctor and two nurses were arrested for their role in the deaths (despite it seeming like others took part as well, such as Dr. John Thiele).
And now I'll shut up because I don't want to spoil the outcome for anyone who plans to read it (and you should).
So, the million dollar questions: was it flat-out murder? Euthanasia? Justifiable? Inexcusable? It's such a delicate, sensitive topic that can so easily lead to passionate, defensive responses. I wasn't expecting it to be so thought-provoking, and a catalyst for examining my own mortality. I, of course, have an opinion, but am almost hesitant to share as it may not be the popular one. First of all, I am a supporter of physician-assisted suicide (i.e. the Jack Kevorkian special). I feel that as humans we have the right to terminate our own lives, especially when one is facing a tortuous, terminal, medical illness. While I don't have a DNR, and don't plan to make one any time soon, I would not want to be kept in a vegetative state on ventilators. If I found myself facing lung cancer at the age of ninety- five I'd spend all my money and pay someone to carry me Half Dome and push me off The Visor. I believe in quality of life.
Those at Memorial were not given a choice; they were patients that were very sick but could have possibly regained some sort of quality of life if they were rescued and properly cared for. No one asked their family members. Patients didn't request to be medicated.
That being said, is it humane and ethical to watch someone slowly die in front of you? To drop into the tell-tale Cheyne-Stokes breathing pattern that precedes death? And to not be confident that a relocation will even bring life-saving care? At what point is enough enough?
If what the staff at Memorial did was done out of reasons of convenience- they were tired of caring for these patients or they were in a hurry to leave themselves, then it was straight-out murder. I'm hoping that wasn't the case, though, and that's when it gets a bit murkier, for me. I truly don't think it should have been done. But do I understand? I can at least try to. First of all, these doctors and nurses had gotten very little sleep in five days and were literally running around the hospital trying to save lives and evacuate people. They were scared for their own families and selves. Also, they have a duty to comfort, to make people feel whole again, and they couldn't. They were helpless and these people were a hop, skip, and a jump away from dying. There are no easy decisions during disaster.
It's so easy to judge others, whether it's how they spend their money or how they do their jobs. But until we're there, in that moment, experiencing what they've gone through, we really don't always have the right. Sure, the man who murders a little old lady only to rob her for his next hit of meth can rot in jail (or was he molested and beat for his entire childhood and has turned to drugs? Does that make it any better than the man who is just an asshole?), but the medical professionals who stayed at a destroyed hospital with no electricity, running water, or working sewage systems, trying to save person after person? Does intent matter? To me it does. These people did something wrong, and the consequences that resulted weren't what I have sanctioned, but to claim their are cold-blooded killers just doesn't work for me.
I could go on and on, but I'll stop there. Just read it.