Sunday’s New York Times Magazine has a haunting account of events in Memorial Medical Center in New Orleans in the days after Hurricane Katrina. The piece is about the deaths that lead the the murder arrest of Dr. Anita Pou and two others, and the failure of that prosecution. The story recounts a passage through hell; as the situation gets more and more starkly grim, I became torn as a reader between thinking whether it’s possible to judge or second guess people in these circumstances and left with the unmistakable conclusion that, if this story accurately recounts the events at that hospital, murders actually did occur. The story was written by a journalist who is also an MD, Sheri Fink.
The story is an account of the events at the hospital, partciularly surrounding patients on the seventh floor, where LifeCare Hospitals ran a hospital-within-the-hospital, along with an account of the murder investigation. There is some discussion of a debate about whether health-care workers caught in a situation such as this should be given immunity from second-guessing their decisions. The article’s conclusion is that murders did occur at the hospital. I’m not sure I’d say I recommend the story; it is very difficult and painful reading, but it seems to me an important one. I’d be curious of the reaction from medical professionals.
The Times described the genesis of the piece in an editor’s note:
Fink is an M.D. as well as an experienced reporter, and she brings a unique perspective to the story, having aided refugees in the aftermath of wars and disasters around the world for 10 years and taught a course two years ago at Tulane University on public health issues in crisis situations. Her reporting is unusual in another way for us: it was undertaken not on direct assignment but with financing from the Kaiser Family Foundation and then while she worked as a staff reporter for ProPublica, the independent, nonprofit newsroom that produces investigative journalism and distributes it in an array of ways, including through mainstream media outlets like The Times. This is not the first collaboration between ProPublica and The Times, but it is the biggest such undertaking.
The picture, above, is the hallway of the seventh floor of the hospital; this is where the patients died who were the focus of the murder investigation. The picture below is the stairs to the helipad where patients were being evacuated.
Is there such a thing as a Freudian typo? Perhaps a Freudian Tip? I’m referring to the sentence: “This is where the patience died.” Too true.
yes there is such a thing, meander. I’m going to fix it though
“Father John F. Tuohey, regional director of the Providence Center for Health Care Ethics in Portland, Ore., said that there are dangers whenever rules are set that would deny or remove certain groups of patients from access to lifesaving resources. The implication was that if people outside the medical community don’t know what the rules are or feel excluded from the process of making them or don’t understand why some people receive essential care and some don’t, their confidence in the people who care for them risks being eroded. “As bad as disasters are,” he said, “even worse is survivors who don’t trust each other.”
Father John’s statement could be applied to the current health debate.
I read this the other day. All I remember of the time after Katrina was Jackson being a total mess. It was so hot – too hot to do anything. No electricity for a week. My main goal every morning was locating a cold diet coke. It had to have been even hotter and more humid in New Orleans and it must have felt like the world had abandoned them. I don’t know how anyone could second guess what these doctors and nurses did.
If there is a Hell, it cannot be as bad as conditions in Memorial Medical Center during that post-Katrina period. Anything that the medical staff may have done to ease the suffering of those poor patients is, in my limited opinion, beyond review. They were there. Ecclesiastes 3.
Before I even look at the article, hypotheticals: I am there with my multiple medical problems (real in my case) including some that would put me at higher risk of dying in such a place than many reading this (without my meds working in high temps). I leave my patient to save myself. I am abandoning them, Am I required (legal and/or moral)to put myself at very high risk to care for someone that might live, will live , someone dying. Similar scenario: patient with AIDS has a cardiac arrest while vomiting blood- am I required (legal or ethically) to perform CPR and likely get AIDS? If he is my patient, if he is not. DIscuss.
Ill read this but the nuances I can imagine are so difficult before jumping into the fray that I suspect that all I will get is a headache and the clear notion that anyone that believes that all ethical issues are black and white and not shaded has lost his/her mind.
NL
I remember on the Tuesday after the storm seeing those searchers spray paint the number of dead inside the homes–and not even fully comprehending their jobs at the time. Every time the dogs drank water it would take 4 bottles to fill their bowls back up and I remember counting incessantly the number of bottles left each time. The first days going out to try to find water and ice, not realizing that the gas we were wasting was at least as important as the water. The heat so hot it was cooler to stay outside at night, no working toilets, absolutely no wind, no noise except an occasional gun shot and all the time wondering if you were going to have to use your gun on someone trying to rob you. Without alcohol, I do not know how we would have made it. This was the Coast–not New Orleans–so I consider those doctors heroes. What I dealt with was 1/100th of what those doctors and nurses saw and dealt with. I truly believe that those shoes will never be walked in again and that their actions cannot be fairly judged by people who could not possibly experience again or understand those surreal hours and days in that hospital.
As I read the article I was startled to read about Dr Cook(my hypothetical #1 above with an ill MD) It is interesting that he appears to a priori reject the rationale of ‘double effect’ used to justify giving ‘necessary’ doses of Morphine to minimize suffering knowing full well they cause respiratory depression:
“If you don’t think that by giving a person a lot of morphine you’re not prematurely sending them to their grave, then you’re a very naïve doctor,” Cook told me when we spoke for the first time, in December 2007. “We kill ’em.”
After finishing the article, it is clear that this is actually more than I posited above as the core of the story. Clearly the euthanasia issue is at the forefront. I am inclined to lean towards NMC’s take. Having said that and putting myself in the situation, as I suspect I can more than most here, I do not think I would have injected. That said what would have been my duty? What are the answers to my questions above? Was Dr Cook remiss in leaving? Clearly the hospital was not only staffed by the people described. Are they others at risk legally or to be condemned morally for not staying?
In the letters to follow the article, many sides seem to be well aired out. It is clear I signed up with higher risks and responsibilities than many occupations with similar educations (lawyer,economist,PhD prof, ethicist, preacher), biohazards scientist excluded. I did not sign up to the same level of risk and responsibility as a member of our Armed Forces or even a Trauma surgeon. If circumstances throw me into this situation- am I to act more like a 9-4 Dermatologist or a Trauma surgeon??
No answers only questions
NL
Pertinent column by Bill Kristoff in today’s NYT:
http://www.nytimes.com/2009/08/30/opinion/30kristof.html
Ben,
That article is most certainly not written by Bill Kristol – a reflexive opponent of any health care reform – but instead by Nicholas Kristof.
WHAT a boner! We have a houseful of grandkids for the weekend … I am experiencing sensory overload. I think I need one of Dr. Cook’s morphine cocktails.
You can’t Monday Morning Quarterback the situation unless you were there. They did the best they could with what they had. I experienced Camille 1st hand just north of the coast. in 191. I evacuated for Katrina came back home to Bay St. Louis on Thursday morning (Katrina struck on Monday morning). Nothing I experienced in Camille prepared me for what I saw and experienced when I returned home. Many of those who stayed in Bay St. Louis and Waveland had a “thousand yard stare”. Some still do. Some didn’t make it. Most who did still suffer from some form of PTSD. I do. How can anyone try to judge what those health care providers went through unless you were there? And if you had been, I doubt that you would say anything, other than sit and stare and cry when you thought about it. Those poor souls at Baptist Hospital in New Orleans were utterly abandoned. Walk in their shoes. . . then talk to me.
NL: “If circumstances throw me into this situation- am I to act more like a 9-4 Dermatologist or a Trauma surgeon??”
You act / perform as the compasionate human being that you are and you move on. Hopefully there is the cathartic in the form of a therapist, a blogg or a well aged single malt to help you cope.