Sheri Fink's new book, "Five Days At Memorial" details the horrors visited upon patients and staff at New Orleans hospitals after Katrina. But it culminates in a remarkably honest, frank, and blood curdling assessment of the standards for triage in emergencies, and a similarly honest, frank and blood curdling discussion regarding euthanasia in America.
What happened in some New Orleans hospitals and nursing homes during and after Hurricane Katrina was a travesty. It was unnecessary, heartless in many ways, and just plain wrong. Yet, Pulitzer Prize winning physician-journalist Fink puts the reader in the moment, allowing us to feel the panic, the heat, the fear, the fatigue. She forces the reader to think about that question none of us ever want to face: what would I do?
These were not monsters. They were caring, trained professionals. They were doctors and nurses and respiratory therapists and hospital administrators. During and after Katrina so many of them were revealed as absolute heroes. What could have brought a very few of them to even consider needles full of versed (a paralytic) and morphine (a pain reliever that can inhibit a patient's ability to breath)? Could I ever reach the conclusion that killing a patient was the best option?
I worked for years as a paramedic until my back gave out. I was trained to deal with mass casualty disasters, where many people are injured or ill at the same time (and participated in several). Because resources are so limited in the initial stages, we were trained to triage, meaning to determine the order in which care is provided. I was trained to leave the dead or dying to their fate, provide care for the critically injured or ill who I believed had a possibility of survival first, make those less critically injured or ill wait until the critical patients received care and transport to a hospital, and make the walking, talking wounded sit down and wait even longer. But I never witnessed triage within a hospital during an emergency. It is an entirely different animal. And I never knew that what I was taught was not standard of care everywhere. As Fink reveals, triage guidance and standards can be different from hospital to hospital, region to region, state to state, and country to country.
If you had twenty patients dependent on ventilators to breath, but the hospital was telling you that within hours backup generators would only be capable of running six of the ventilators, what would you do? This happened in NYC after Hurricane Sandy. Who would you pick? Old? Young? Sickest? Most likely to survive? Please, let me never have to face that decision.
Most importantly, Fink points out that most of the standards and guidelines being established in hospitals, regions, states and countries are being made almost entirely without public input - without the voices of the patients. She admits that these truly are death panels - and death panels without input from patients and their families.
One of the clearest examples Fink provides, involving one of the few groups of non-medical people involved in such a discussion, included a young man who said that if a triage panel decided to keep him on a ventilator and not the four year old beside him, that would make him very sad. And yet a young mother at the same panel wanted to know, if only the youngest were saved, who would care for them? Teach them? Nourish them?
When you check into a hospital, do you ask if they are in a flood prone area? Do you ask if their backup generators are located in the flood prone basement? Do you ask to see their emergency preparedness and prevention plan? Do you want to know if they have a triage plan, or guidelines discussing who lives and who dies in an emergency?
And beyond triage, when does compassion and concern for a patient who is suffering justify euthanasia? When does such action actually become murder? Those not in the medical field are generally not participating in these conversations. And we should be.