I also co-wrote an article with Steve Few, which he has just published and that I hope you will check out — simply click on the title below:
Variation and Its Discontents
Funnel Plots for Fair Comparisons
I made the good mistake of starting to read Sheri Fink, M.D.’s, book Five Days at Memorial this past weekend. I call it a “good mistake” because it was a book that I literally could not put down (it is that fine), and as a result got absolutely nothing on my “to-do list from hell” done (a mistake I am still paying for).
It is hard to believe that it’s been eight years since Hurricane Katrina hit New Orleans. Even so, who can forget the images on television and in the newspapers of the complete devastation it caused? Flood waters surrounded and covered just about everyone and everything, including Memorial Medical Center, where hundreds of people slowly realized that they were marooned and for a time abandoned as rescuers were overwhelmed by the complete and utter devastation Katrina had wrought. The hospital’s power went out; backup generators failed; toilets overflowed; stench-filled corridors and stairwells were in complete darkness. Hospital employees smashed windows to let in fresh air — only to make the sound of gunshots echoing through the city sound that much closer.
By day four of the disaster, when the generators finally gave up the ghost, fifty-two patients in the hospital’s intensive care unit lay in sweltering, suffocating darkness. These patients were the sickest of the sick (only a few could walk) and the doctors and nurses, who were beyond exhaustion, wondered how many could and would survive.
As horrific as this part of Dr. Fink’s book was, the most troubling and indelible details were yet to come. When the final evacuation at Memorial was completed, 45 patients had not made it out alive. The State of Louisiana opened an investigation into the situation there. Among other findings was a determination by forensic consultants that 23 of those patients’ bodies had elevated levels of morphine and other drugs. Twenty of these deaths were categorized as homicides.
Based on this investigation, seven months after the hurricane, Louisiana attorney general Charles Foti announced at a news conference broadcast live the arrest of three members of Memorial’s medical staff: Dr. Anna Pou, and two intensive care nurses, Cheri Landry and Lori Budo, for “plain and simple homicide.”
Before rushing to judge these dreadful events, it is important and worthwhile to carefully follow Dr. Fink’s story — her exploration and presentation of the excruciating struggle of medical professionals as they decided to administer fatal injections to patients on the brink of death. At this point in her narrative, Fink slowed down and took me on a journey where situational ethics kicked me right in the head. What she wrote obliged me to re-examine everything I believed about end-of-life issues. When caregivers schooled in medicine’s supreme value –“First, do no harm”– face traumatic choices, and the standards of civilization collapse, I had to ask myself, “Does seeing their actions through the lens of a disaster like Katrina change my opinion of them?”
Being compelled by Fink’s book to think about these hard questions was a good challenge all the same — and a useful one, since Hurricane Sandy, the recent tornadoes in Kansas, and other natural disasters remind us that these questions must be addressed. Such scenarios no longer reside in the realm of the unthinkable; they are real and present. By reporting the story of the gruesome events at Memorial before rescuers arrived — carefully, evenly, and in the context of medical ethics and the law-Sheri Fink has produced an unforgettable, thought-provoking, value-challenging story. This book was worth every minute lost to checking one more thing off my never-ending to-do list, and I recommend it highly to healthcare professionals and lay people alike.
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