Book Reviews and Recommendations - Entry #4

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

by Sheri Fink

          This is the story of one of the hospitals in New Orleans that flooded during the Katrina disaster.  Ultimately a number of patients died in the hospital before everyone could be rescued and, in fact, one doctor and two nurses were charged in the deaths of some of the patients, but ultimately not convicted of any crime.  The first half of the story details what happened in the hospital during and after Katrina, and the second half of the story deals with the legal process afterward.  Personally, I found this story very fascinating and I could understand the difficult decisions that everyone faced.  I feel that the author was very even-handed in reporting the story and it makes you ask yourself “what would I have done in that situation?”  I highly recommend it.

          Though I am not a medical professional, I work in a hospital and interact with patients.  I can see how all of the problems that happened at the flooded hospital can develop.  So much of a hospital’s (or any organization’s) operational strategy is dependent on the existing infrastructure, and when that infrastructure fails, there really is chaos.  I remember working in my office at the hospital once when the power went out.  Since my office had no windows, it was suddenly pitch black.  But when I opened my office door into the hallway, I could easily see where I was going because there was emergency lighting all over.  If anything needed to remain powered up, it just needed to be plugged into the plentiful red outlets which are connected to backup power.  There was no panic – in fact there are regular tests of the process where the power is briefly switched off to verify that the backup power is working.  In the operating rooms and on the floors, business can really go on pretty much as usual.  That operational strategy works great.

          But what happens when the emergency power fails?  At Memorial hospital in New Orleans, the main power was, of course, knocked out by the storm.  No problem really – that was expected.  But when the floods came…well, it shouldn’t have been a problem.  The generator was above the flood level, so it should have been fine.  Unfortunately, the switching system was apparently below the flood level, so it failed.  There was no backup power.  That situation alone is hard to imagine.  Suddenly, everything that you totally rely on is gone.  How many things in a hospital do not require power?  The consequences are far-reaching.  Starting at that point, every patient on a ventilator had to be hand-ventilated 24 hours a day by someone.  That alone is just awful to consider.  Further, do you know of any big hospital buildings that have windows that open?  There is no air-conditioning, no ventilation at all.  The temperature soared inside.

          The problem was really complicated by the loss of communication.  First, of course, the hospital was flooded and no one could get in or out through the flooding.  Whatever staff was in the hospital at the time was suddenly on a 24 hour a day shift that was going to continue until they could be rescued.  How do you send an overhead code?  You can’t – you just have to take care of it yourself.  Communication was cut-off with the outside to a great extent (there was some communication – I can’t remember all of the details).  The hospital did have a helicopter pad, but it hadn’t been used in decades and no one knew if it could still be used.  And how do you get patients on beds up to the helicopter pad when the elevators don’t work.  There are no easy decisions and everything is difficult.  The more you think through the situation, the more you realize just how bad it is for the patients and staff.  Just awful.

          I believe the book is written clearly enough that anyone can put themselves in the situations that the staff, patients, and families faced and can think about what they would do in a similar situation.  Of course, the natural tendency is to say that this should never have happened – steps should have been taken long before to prevent the worst aspects of the disaster (like moving the generator controls above the flood level) – but that is not the situation people found themselves in.  This book is worth reading, whether you work in a hospital or are a medical professional or not.