Sunday, January 17, 2016

Five Days at Memorial by Sheri Fink

How the mighty have fallen.

Memorial Hospital in New Orleans used to be Baptist Hospital until a conglomerate bought it. My mother worked there; I was born there. It had a good name in the city.

Nobody prepared very well for a hurricane, either before the conglomerate or afterwards. Not just generators but the whole electrical plant needs to be above the high-tide flood level, especially in a city like New Orleans. Nobody had evacuation plans, and the two businesses sharing the facilities didn't coordinate. Disaster, here we come. Once the lake came through the levees (after Katrina had mostly passed the city), water rose too high for ambulances, and the hospital was out of power and crowded with refugees. Ventilators tend not to work very well without electricity, nor do monitors or oxygen pumps or automated drug infusion systems. There were quite a few very sick and frail there; some couldn't take the strain and died.

The city itself was not as violent during the flooding as the infamous first reports claimed, but neither was it as peaceful as later stories made out. Everyone was worried about attacks, and the gunfire at all hours didn't ease tensions.

It got worse. In ad hoc triage DNR orders translated to DoNotEvacuate (or Evacuate Last) regardless of patient condition. The left hand didn't know what the right was doing. Even after the generators failed there was some power in another wing, and at least one caregiver took refuge from the heat in the AC by running the car AC in the parking garage--nobody realized this might be useful for frail patients who were suffering badly in the heat. Communications with the Coast Guard were confused--at one point the hospital stopped evacuating patients because they were afraid it was too dark to fly (guardsmen were using night vision goggles). (And it turned out that nobody had thought through the next step after transporting city patients to evacuation points--many sick stayed there for days.)

And it got worse. Whether the problem was doctors who didn't want to be bothered (the author didn't think so) or a combination of the spirit of the age and exhausted and mis-communicating doctors, at least 9 patients were deliberately killed, by at least 2 doctors and 2 nurses--and probably nearer 20 patients.

The latter half of the book is the story of an attempt to charge Dr Pou with homicide. It failed. Her attorney did a marvelous job of smokescreen and PR misrepresentation, and (since Dr Pou was a state employee) the taxpayers coughed up over $400K for the privilege of being lied to.

I've opposed lethal injection as a method of execution because it involves doctors or nurses in killing (I don't mean killing in self-defense), and having amateurs do it seems cruel. The spirit of the age loves "euthanasia," and it looks like doctors were buying into it that day, even as the evacuation vehicles were coming. It is a very ugly change in medicine.

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