58 pages • 1 hour read
Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital
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The Failure of Planning
Memorial hospital has practiced for a hurricane-like disaster, but the rehearsals had failed to consider the most extreme situations. Part of the problem is money. The hospital needs upgrades to its emergency power supply, which depends on electric motors located in the basement. However, these motors will likely flood during a huge storm. These upgrades will be expensive, and Memorial puts off implementing them.
Another problem is that an emergency, by its very randomness, tends to surprise everyone with the shape and extent of its destructive course. Survivors often must abandon old plans and improvise new ones. These new plans are experimental and don’t always solve the problem but sometimes worsen it.
Yet another problem is that it’s nearly impossible to conduct a coordinated rehearsal among the many agencies that will respond in a disaster, much less stage a simulation that anticipates every eventuality. During the Katrina emergency, communications are disrupted and confused; rescuers often work at cross purposes, disagree on the chain of command, and misinterpret information they receive. This causes delays in rescuing people, including those trapped at Memorial hospital.
Whether these lessons are learned by the nation at large is up for debate, as a similar situation erupts in New York City, in 2012, when Hurricane Sandy causes outages and flooding at Bellevue hospital. Fortunately, the hospital comes through the storm better than did Memorial, but only nearly.
Life-and-Death Decisions
Rescue is slow to arrive at Memorial hospital; supplies, electric power, and potable water are scarce. Staffers do everything they can to care for patients under grueling circumstances, but eventually they must make complex decisions regarding those patients.
First, they must allocate scarce evacuation seats on boats and helicopters. The doctors decide on a form of triage that divides patients into those well enough to walk out on their own, those in need of care who can safely be rescued, and those too critical to survive the transit out of the hospital.
Memorial workers fear that the most critical patients will decline into pain, even agony, during their final hours awaiting a rescue that may not come in time. A group of doctors decide that their duty to these patients now consists of minimizing their pain, essentially by shutting down their nervous systems. This means they will die. Dr. Anna Pou volunteers to take the necessary actions, including injecting more than a dozen critical patients with enough morphine and sedatives to ease them into death.
The decision amounts to an act of euthanasia conducted without consulting the patients or their loved ones. It is a drastic measure whose arbitrariness, not to mention its probable illegality, leads to a government investigation and the arrest of Dr. Pou and two nurses.
Troubling discoveries later cast doubt on Dr. Pou’s work. The first is that evacuation could have been greatly speeded had Memorial staff moved upstairs patients across the seventh-floor roof instead of laboriously down to the second floor and then all the way back up through the garage to the rooftop helipad. The second discovery is that a nearby hospital is able to evacuate all of its critical patients during the emergency.
Controversy swirls through the city for months; a grand jury declines to indict the medics involved. Dr. Pou campaigns for legislation that would indemnify emergency medical professionals against criminal charges, such as the ones she has faced, that arise from future emergencies
The Controversy Over Euthanasia
Doctors’ duty of care is to prolong life and reduce suffering. Euthanasia, then, is a violation of those duties. In recent decades, however, voices have been raised that question this black-and-white ban on doctor-assisted death. Are there circumstances, including the Memorial hospital disaster, where doctors may consider relief of suffering through means that induce death?
The doctors at Memorial face such a dilemma and decide that their duty to the dying patients is to hasten their deaths and thereby relieve them of the agonies of their final hours.
Much of the controversy over euthanasia circles around the right of families and patients to consider all options. As a practical matter, end-of-life care involves many decisions—“Do Not Resuscitate” orders, delivery of extra pain killers, and simply stopping care at the judgment of the attending physician—that have effects similar to euthanasia. These decisions are always difficult, and doctors find they must walk a fine line between their duty to protect life and their obligation to prevent pain and suffering.
A chief problem with the Memorial deaths is that the doctors do not consult either the patients or their families, a process required in end-of-life situations. The Memorial emergency, however, involves ethical issues nearly impossible to settle to everyone’s satisfaction, and time and resources are leaking away rapidly, forcing the doctors’ hands.
Post-Katrina, many states have adopted laws that ease up on doctors and nurses who sometimes must take drastic steps during an emergency. The question of euthanasia, the most serious of measures, still lingers and may never be completely resolved.
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