A Conversation with Sheri Fink

The author of Five Days at Memorial on writing, reporting, and lessons learned

Five Days at Memorial
Five Days at Memorial is Pulitzer Prize winner Sheri Fink’s landmark investigation of patient deaths at a New Orleans hospital ravaged by Hurricane Katrina. It is a gripping, suspenseful portrayal of the quest for truth and justice.

In the tradition of the best investigative journalism, physician and reporter Sheri Fink reconstructs 5 days at Memorial Medical Center and draws the reader into the lives of those who struggled mightily to survive and to maintain life amid chaos.

Q. You have reported on health, medicine, and science in the United States and internationally, and have received a Pulitzer Prize and a National Magazine Award in investigative reporting for your story “The Deadly Choices at Memorial” published in The New York Times Magazine in 2009. That story, which chronicles decisions made by the medical staff of Memorial Medical Center, is the basis for this book. Why did you want to expand and elaborate on this story?

A. Many important aspects of what happened at Memorial couldn’t be included even in an article of 13,000 words. Certain mysteries needed more time to unravel. The events called for a deeper examination of triage and end-of-life issues as they resonated with the ongoing health reform debate, with its tension between expanded coverage and “death panels.” I kept reporting as new disasters occurred at home and abroad—earthquakes, hurricanes, tornadoes—what had the story of Katrina and Memorial taught the medical and nursing professions? Are hospitals better prepared for the next disaster? What’s changed?

Q. You are uniquely qualified to report on Memorial as both a medical doctor with a Ph.D. in neuroscience as well as your work delivering aid in combat zones. How did this help you write the book?

A. Medical school teaches the art of nonjudgmental listening, helpful for any reporter who wants to elicit real experiences, not just what fits into preconceived notions. Lab-based science training is all about pursuing the truth, testing theories, trying to disprove them, triangulating evidence—again, useful skills for an investigative journalist deciphering tantalizing but sometimes conflicting clues. As for having delivered aid in crises, it gave me empathy for the caregivers in this disaster and an understanding of the profound effects of sleep deprivation, stress, and trauma on human performance and thinking.

Q. Few forms of writing are more difficult than the reconstructive narrative. And yet, you’ve tackled this compelling story head-on. How did you assemble this narrative?

A. Out of many years and many sources! Interviews were crucial, but the limitations of memory and some people’s reticence to talk made it important to search for every available bit of documentation. I kept a running time line while researching the events—a way to see causation and connections that otherwise wouldn’t have been apparent. Because so many people possessed pieces of the truth of what happened, the story necessarily had to float between perspectives. Sticking to the cleanness of a mostly chronological retelling was the most straightforward organizing principle.

Q. Was there anything you discovered that surprised you during your research?

A. There were surprises to the end. The story’s many layers and mysteries kept me constantly interested. One of the most surprising discoveries was that different medical professionals, working side by side, injecting the same drugs into the same group of patients with the same effect (those patients’ deaths) could describe the rationale for their actions in radically opposite ways. The response to the crisis unfolding at other New Orleans hospitals also surprised me, stories that haven’t before been told.

Q. In the book you examine triage and end-of-life issues. How do you hope your book will further this discussion of these issues?

A. The question of who should get precious medical resources or slots on medical evacuation helicopters when they’re in short supply is a question of values as much as it is of medicine, and what happened at Memorial shows we need a much more inclusive conversation about it as plans are being adopted around the country. Should care be rationed on a random basis, like a lottery? Or be based on chances of survival? Should age ever be a factor, or “usefulness” to society? Should end-of-life preferences be a factor, and how? It’s hard for any of us to imagine what we might want for ourselves or a loved one until we’re in a specific situation—end-of-life decision making is much more complex than checking off boxes on an “advance directive” form. What happened at Memorial shows that doctors may misinterpret end-of-life choices or use them in ways patients never intended. We all need advocates in the hospital who really know us, particularly at a time of disaster. And we need to do more to help prevent terrible choices like the ones at Memorial from ever having to be made. I hope people who read Five Days at Memorial will think about these subjects in a new way and make their voices and opinions heard.

Q. What has the story of Katrina and Memorial taught the medical and nursing professions?

A. The influential Institute of Medicine released a report that said “neither the law nor ethics support the intentional hastening of death, even in a crisis,” and it discouraged the use of DNR orders in making triage decisions. The doctor who was arrested (but ultimately not prosecuted) has helped pass laws to protect colleagues who volunteer in future disasters against civil suits and criminal prosecution. Other professionals have helped improve disaster planning at their own hospitals. One doctor who worked at a New York City hospital during Superstorm Sandy was faced with losing all but a few backup power outlets within an hour. She quickly drew up a system for deciding which of her very sick patients, who relied on life support, would get access to six plugs. She told me that thoughts about Memorial and Katrina made her prioritize transparency and having solid reasons for the decisions that everyone could understand after the disaster. She even contemplated what the tabloid headlines would be the next day! Fortunately, she knew about draft plans created a few years ago for this type of situation. Most important, the specter of losing power led to creative, quick thinking that saved the backup power supply (a chain of volunteers passed fuel up to the day tank of the backup generators after the fuel pump failed)—this saved her from having to implement those life-and-death decisions. Memorial should teach us the importance of being creative in a disaster, always alert to new possibilities that allow a change in plans.

Q. Have hospitals made better plans for disaster preparedness? How can they improve?

A. Some hospitals in New Orleans have made better disaster plans and investments—they’ve dug wells for their own water supply, raised the various elements of their backup power systems above flood level, and established more robust evacuation plans. We still have to worry about hospitals in the rest of the country. Hurricane Sandy showed that New York City’s medical infrastructure wasn’t protected against the expected local hazards—we saw the same awful images of hospital patients being carried down multiple flights of stairs in the dark after floodwaters took out backup power systems. Improvements are only being made after the disaster. Does your hospital have generators, transfer switches, or fuel pumps in the basement in a flood zone? Is it up to earthquake code, if you live near a fault line? Is it fortified to withstand tornadoes, if you reside in Tornado Alley? Is the hospital’s backup power system designed to power air-conditioners and heating and ventilation systems? If not, do private investments or taxpayer dollars have a role in supporting these improvements to protect the most vulnerable before the worst occurs?

Q. Do emergencies sometimes make it necessary to break ethical rules?

A. In response to what happened at Memorial, Dr. Lachlan Forrow, a Harvard professor who directs ethics and palliative care programs at Beth Israel Deaconess Medical Center in Boston, eloquently asked: Do we need exceptional moral rules for exceptional moral situations, or do exceptional times almost always call for exceptional commitment to our deepest moral values? This is one of the essential questions this story raises. When a group of policemen shot and killed unarmed civilians on a bridge in New Orleans after Katrina and then covered up the events, people defending those policemen said that they should be excused because of the extraordinary, scary, chaotic circumstances. Others strongly disagreed, and a federal judge sent the policemen to jail. There’s been a big push recently for health departments and hospital systems to draw up a different set of standards to apply to medical care in crises. While that may be necessary to some extent, we have to make sure these choices are ones we can all live with after the disaster passes. We have to make sure they aren’t choices that will undermine a fundamental societal trust.

Q. We seem to be living in an era of extreme weather and a multitude of external threats, from environmental disasters to terrorism. What does Five Days at Memorial have to teach us?

A. Disasters anywhere in the country could cause medical needs to outmatch usual resources—whether in an infectious disease pandemic, a sudden drug shortage, a mass casualty event like a bombing, or more frequent and severe coastal flooding. Reading about those five days in New Orleans can help us prepare, including thinking through tough decisions before we ever have to make them.

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