Cover image for Five days at Memorial life and death in a storm -ravaged hospital
Title:
Five days at Memorial life and death in a storm -ravaged hospital
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Publication Information:
[S.l.] : Crown, 2013.
ISBN:
9780307718983
Physical Description:
1 online resource (576 p.)
Language:
English
Awards:
National Book Critics Circle Award for General Non-Fiction, 2013
Abstract:
a-- In the tradition of the best investigative journalism, physician and reporter Sheri Fink reconstructs5 days at Memorial Medical Center and draws the reader into the lives of those who struggled mightily to survive and to maintain life amid chaos. -- Five Days at Memorial From the Hardcover edition.
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Accelerated Reader Grades 9-12 8.8 30 Quiz 164626 English non-fiction.
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Summary

Summary

One of the New York Times 's Best Ten Books of the Year

Winner of the National Book Critics Circle Award for Nonfiction

Winner of the 2014 J. Anthony Lukas Book Prize, the PEN/John Kenneth Galbraith Award, the Los Angeles Times Book Prize, the Ridenhour Book Prize, the 2014 American Medical Writers Association Medical Book Award (Public/Healthcare Consumers), a 2014 Science in Society Journalism Award, and the SIBA 2014 Book Award for Nonfiction

An ALA Notable Book, finalist for the NYPL 2014 Helen Bernstein Award, shortlisted for the PEN/E.O. Wilson Award and the ALA Andrew Carnegie Medal

An NPR "Great Reads" Book, a Chicago Tribune Best Book, a Seattle Times Best Book, a Time Magazine Best Book, Entertainment Weekly 's #1 Nonfiction Book, a Christian Science Monitor Best Book, and a Kansas City Star Best Book

Pulitzer Prize winner Sheri Fink's landmark investigation of patient deaths at a New Orleans hospital ravaged by Hurricane Katrina - and her suspenseful portrayal of the quest for truth and justice.

In the tradition of the best investigative journalism, physician and reporter Sheri Fink reconstructs 5 days at Memorial Medical Center and draws the reader into the lives of those who struggled mightily to survive and to maintain life amid chaos.

After Katrina struck and the floodwaters rose, the power failed, and the heat climbed, exhausted caregivers chose to designate certain patients last for rescue. Months later, several health professionals faced criminal allegations that they deliberately injected numerous patients with drugs to hasten their deaths.

Five Days at Memorial , the culmination of six years of reporting, unspools the mystery of what happened in those days, bringing the reader into a hospital fighting for its life and into a conversation about the most terrifying form of health care rationing.

In a voice at once involving and fair, masterful and intimate, Fink exposes the hidden dilemmas of end-of-life care and reveals just how ill-prepared we are in America for the impact of large-scale disasters--and how we can do better. A remarkable book, engrossing from start to finish, Five Days at Memorial radically transforms your understanding of human nature in crisis.
 




From the Hardcover edition.


Reviews 5

Publisher's Weekly Review

"They were in a war zone," Fink (War Hospital: A True Story of Surgery and Survival) writes of those stranded inside New Orleans' Memorial Medical Center in the calamitous wake of Hurricane Katrina. In this astonishing blend of Pulitzer Prize-winning journalism (Fink, who also has an M.D. and Ph.D., won the award for the investigative reporting on which this book is based) and breathtaking narration, she chronicles the chaotic evacuation of the hospital and the agonizing ethical, physical, and emotional quandaries facing Memorial nurses and doctors, including a nightmarish triage process that led to the controversial decision to inject critically ill patients with fatal doses of morphine in order to refocus attention on those with a chance of surviving. An alarming 45 bodies were recovered from the crippled hospital, nine of which were deemed suspected victims of euthanasia. Yet investigators realized that unraveling the tragedies was "as impossible as collecting fragments of a fractured mirror and then, somehow, inferring what image had once appeared there." Some members of the medical staff were charged with murder, but a grand jury acquitted them. Plenty of hard-earned lessons were learned from the stunningly mismanaged response to the disaster, yet Fink acknowledges that for the families of those who never made it out of Memorial, the "war against nature" could only be considered a loss. (Sept. 10) (c) Copyright PWxyz, LLC. All rights reserved.


Kirkus Review

Pulitzer Prizewinning medical journalist/investigator Fink (War Hospital, 2003) submits a sophisticated, detailed recounting of what happened at Memorial Medical Center in New Orleans during and after Hurricane Katrina. Under calamitous, lethal circumstances, the staff at Memorial did a remarkable job of saving many lives in the wake of Hurricane Katrina--though others would point out they didn't have the street smarts of the staff at Charity Hospital, whose creativeness resulted in far fewer deaths. Fink draws those few days in the hospital's life with a fine, lively pen, providing stunningly framed vignettes of activities in the hospital and sharp pocket profiles of many of the characters. She gives measured consideration to such explosive issues as class and race discrimination in medicine, end-of-life care, medical rationing and euthanasia, and she presents the injection of some patients with a cocktail of drugs to reduce their breathing in such a manner that readers will be able to fully fashion their own opinions. The book is an artful blend of drama and philosophy: When do normal standards no longer apply? what if doing something seems right but doesn't feel right? In the ensuing investigation of one doctor, who is clearly the fall guy (or woman, as it were), Fink circles all the players, successfully giving much-needed perspective to their views. The obvious villains are the usual suspects: nature, for sending Katrina forth; big business, in the guise of Memorial owner Tenet Healthcare, for its failure to act and subsequent guilty posturing; and government, feds to local, for the bungling incompetence that led to dozens of deaths. The street thugs and looters didn't help much, either. With apparent effortlessness, Fink tells the Memorial story with cogency and atmosphere.]] Copyright Kirkus Reviews, used with permission.


Booklist Review

*Starred Review* As the floodwaters rose after Hurricane Katrina, patients, staff, and families who sheltered in New Orleans' Memorial Hospital faced a crisis far worse than the storm itself. Without power, an evacuation plan, or strong leadership, caregiving became chaotic, and exhausted doctors and nurses found it difficult to make even the simplest decisions. And, when it came to making the hardest decisions, some of them seem to have failed. A number of the patients deemed least likely to survive were injected with lethal combinations of drugs even as the evacuation finally began in earnest. Fink, a Pulitzer Prize winner for her reporting on Memorial in the New York Times Magazine, offers a stunning re-creation of the storm, its aftermath, and the investigation that followed (one doctor and two nurses were charged with second-degree murder but acquitted by a grand jury). She evenhandedly compels readers to consider larger questions, not just of ethics but race, resources, history, and what constitutes the greater good, while humanizing the countless smaller tragedies that make up the whole. And, crucially, she provides context, relating how other hospitals fared in similar situations. Both a breathtaking read and an essential book for understanding how people behave in times of crisis.--Graff, Keir Copyright 2010 Booklist


New York Review of Books Review

"THE JUROR WAS CONVINCED - and, she believed, all of her fellow jurors were too - that a crime had occurred on that fifth day at Memorial." So concludes Sheri Fink's harrowing and minutely detailed description of the hellish events that took place at a New Orleans hospital during Hurricane Katrina and its aftermath in late August and early September 2005. The members of the special grand jury convened two years after those desperate days were in agreement that the state of Louisiana should not indict Dr. Anna Pou for the murder of four patients during the disaster . Why then, did they nevertheless continue to believe that a "crime had occurred"? The only crime they had been assembled to investigate was homicide, the evidence for and against which they had been studying for weeks. If they thought the 51-year-old surgeon was guilty, why did they let her go free? There will never be a satisfactory answer to that or to many of the other questions raised since it became public knowledge that 45 corpses , "the largest number of bodies found at any Katrina-struck hospital," were found in the debris-strewn remnant that had been the interior of Memorial Medical Center. The forensic pathologists consulted by the authorities had unequivocally found that sufficient morphine and a sedative were present in the tissues of the patients Dr. Pou was suspected of killing ; witnesses had described seeing the accused in the presence of these patients , carrying syringes of the drugs ; at least one of the deceased was in no danger of imminent death before the time he was almost certainly injected ; and circumstantial evidence galore suggests that euthanasia was the most likely cause of at least some of the deaths. And yet, no indictment was brought . Should facts conflict with a decision that ought logically to proceed from them, an explanation is needed. When personal moral codes clash with professional ethics; when the heart clashes with the mind; when empathy clashes with religious doctrine; when inner convictions clash with law - it is then that the muddle of surrounding circumstances tends to blur the perception of even the most obvious evidence, and to mitigate its influence. Duty becomes a matter of interpretation, and crime is in risk of being extenuated. And thus it was with the medical and nursing staffs of Memorial during Hurricane Katrina, and it was almost certainly thus with the emotions of the grand jury in this case. Though hospital personnel have been faulted for making insufficient preparations for a major disaster, and municipal and federal authorities attacked for their disorganized and inadequate responses - both of which assessments have merit - the culprit behind the poor decisions that were made and the offenses that may have been committed in the name of mercy was simply the magnitude of the disaster. The city of New Orleans was in the grip of a whirlwind of catastrophes. The hospital became a quagmire of ever-rising contaminated water; human waste; the rotting bodies of pets that had been brought there for shelter; and the soaked rubble of shattered equipment. The stench was unimaginable . There was justifiable concern that looters would target the hospital's drug caches . Rescuers and professional personnel were in constant fear for their lives, as gunshots periodically pierced the air . The rumor spread that a nurse had been assaulted. Working in these tumultuous surroundings day after day, without electricity and often in the dark, sleep-deprived doctors and nurses labored determinedly and often in vain to help the patients entrusted to them, amid their own concern for family members at home and the danger to their possessions posed by the inundating waters. Decisions were made and actions take n with utmost haste and uncertainty, and no doubt sometimes with the poor judgment characteristic of the most extreme forms of stress. When many of the citizens of New Orleans later called the members of the hospital's staff, including Dr. Pou, heroic in their attention to duty, there was good reason. It is in the description of these events that Fink, a Stanford-educated physician and a health and science writer , is at her best. Though not present during the disastrous days, she interviewed more than 500 participants , from hospital executives to family members, prosecutors and ethicists, recording their comments and descriptions so meticulously that her gripping narrative captures not only the facts of the situation, but the thoughts of her witnesses and the feverishly unfolding disorder, confusion and tragedy. Her choice of sentence structure, the almost staccato voice, and the starkness of style and language reflect the circumstances so well that the reader cannot help being pulled into the discordant rhythms of those chaotic hours. These are not the even-tempered literary cadences of her Pulitzer Prizewinning article about the crisis at Memorial that appeared in The New York Times Magazine in 2009, on which this book is based . The tone is different, visceral and very appropriate to the atmosphere created by the storm and its consequences. What we have here is masterly reporting and the glow of fine writing. In Fink's telling, the villain of this story is the storm; the heroine, albeit a flawed one, is Anna Pou. According to her colleagues, she was as close to a healing angel as a physician ever gets. She had a reputation for hovering over her patients, even long after they had lefther immediate care. A woman of deep religious faith, she prayed with them and with their families , asking that her skills be guided by the benevolent power to which she was so firmly committed. Those skills were plentiful, as confirmed by those she worked with and by her impressive academic credentials . But healing is not always synonymous with curing; it may have been that Dr. Pou's compassion for her fellow human beings already so close to death and in acute danger of worsening got the better of her; it may be that emotion overwhelmed rationality; it may be that the personal overwhelmed the professional. If so, it may be that she did indeed euthanize patients, as prosecutors maintained (and which she has consistently denied). Even the most unbending of ethicists, the most rigid of physicians and the most punitive of prosecutors must on some level understand such motives. The grand jury certainly seemed to, and that may well explain why it voted not to indict. I would have done the same. But I am leftwith a lingering burden of unease, the same burden that should weigh on the American conscience every time race rears its head in a judicial proceeding - as, for another example, in George Zimmerman's acquittal in the death of Trayvon Martin . Would the New Orleans grand jury have ruled as they did had all the patients been middle-class whites ? We can only guess. FIVE DAYS AT MEMORIAL Life and Death in a Storm-Ravaged Hospital By Sheri Fink 542 pp. Crown. $27. Circumstantial evidence galore suggests that euthanasia was the most likely cause of some of the deaths. Yet, no indictment was brought. SHERWIN B. NULAND is the author of "How We Die," winner of the 1994 National Book Award for nonfiction. He is a faculty member at the Yale Interdisciplinary Center for Bioethics.


Library Journal Review

Fink's (War Hospital) meticulous and extensive research is apparent in this detailed description of a large New Orleans hospital in crisis during Hurricane Katrina. Memorial Hospital was seen as shelter from the pending storm and even had patients transferred there from other facilities. When the woefully unprepared facility lost power and seemed under siege, the doctors made some difficult and controversial decisions about evacuation and triage, with the most physically able people leaving first. As a result of this policy, a doctor and two nurses were charged with injecting some patients with drugs to hasten their deaths. The first half of the book vividly describes the situation in the hospital, and the equally engrossing second half covers the legal cases resulting from the storm's aftermath, a situation that took years to play out. Reader Kristin Potter narrates professionally and even-handedly. -VERDICT Highly recommended for all listeners. ["Fink's six years of research and more than 500 interviews yield a rich narrative full of complex characters, wrenching ethical dilemmas, and mounting suspense," read the starred review of the Crown hc, LJ 9/1/13; an LJ Best Book of 2013, see p. 26.]-Mary Knapp, Madison P.L., WI (c) Copyright 2013. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.


Excerpts

Excerpts

NOTE TO THE READER This book recounts what happened at Memorial Medical Center during and after Hurricane Katrina in August 2005 and follows events through the aftermath of the crisis, when medical professionals were arrested and accused of having hastened the deaths of their patients. Many people held a piece of this story, and I conducted more than five hundred interviews with hundreds of them: doctors, nurses, staff members, hospital executives, patients, family members, government officials, ethicists, attorneys, researchers, and others. I was not at the hospital to witness the events. I began researching them in February 2007 and wrote an account of them in 2009, co-published on the investigative news site ProPublica and in the New York Times Magazine: "The Deadly Choices at Memorial." Because memories often fade and change, source materials dating from the time of the disaster and its immediate aftermath were particularly valuable, including photographs, videotapes, e-mails, notes, diaries, Internet postings, articles, and the transcripts of interviews by other reporters or investigators. The narrative was also informed by weather reports, architectural floor plans, electrical   PROLOGUE At last through the broken windows, the pulse of helicopter rotors and airboat propellers set the summer morning air throbbing with the promise of rescue. Floodwaters unleashed by Hurricane Katrina had marooned hundreds of people at the hospital, where they had now spent four days. Doctors and nurses milled in the foul-smelling second-floor lobby. Since the storm, they had barely slept, surviving on catnaps, bottled water, and rumors. Before them lay a dozen or so mostly elderly patients on soiled, sweat-soaked stretchers. In preparation for evacuation, these men and women had been lifted by their hospital sheets, carried down flights of stairs from their rooms, and placed in a corner near an ATM and a planter with wilting greenery. Now staff and volunteers--mostly children and spouses of medical workers who had sought shelter at the hospital--hunched over the infirm, dispensing sips of water and fanning the miasma with bits of cardboard. Supply cartons, used gloves, and empty packaging littered the floor. The languishing patients were receiving little medical care, and their skin felt hot to the touch. Some had the rapid, thready pulse of dehydration. Others had blood pressures so low their pulses weren't palpable, their breathing the only evidence of life. Hand-scrawled evacuation priority tags were taped to their gowns or cots. The tags indicated that doctors had decided that these sickest individuals in the hospital were to be evacuated last. Among them was a divorced mother of four with a failing liver who was engaged to be remarried; a retired church janitor and father of six who had absorbed the impact of a car; a WYES public television volunteer with mesothelioma, whose name had recently disappeared from screen credits; a World War II "Rosie Riveter" who had trouble speaking because of a stroke; and an ailing matriarch with long, braided hair, "Ma'Dear," renowned for her cooking and the strict but loving way she raised twelve children, multiple grandchildren, and the nonrelatives she took into her home. In the early afternoon a doctor, John Thiele, stood regarding them. Thiele had taken responsibility for a unit of twenty-four patients after Katrina struck on Monday, but by this day, Thursday, the last of them were gone, presumably on their way to safety. Two had died before they were rescued, and their bodies lay a few steps down the hallway in the hospital chapel, now a makeshift morgue. Thiele specialized in critical care and diseases of the lungs. A stocky man with a round face and belly, and skinny legs revealed beneath his shorts, friends called him Johnny, and when he smiled, his eyes crinkled nearly shut. He was a native New Orleanian, married at twenty, with three children. He golfed and watched televised sports. He liked to smoke a good cigar while listening to Elvis. Like many of the hospital staff around him, his association with what was now Memorial Medical Center stretched back decades. He had rotated at the hospital as a Louisiana State University medical student in 1977. A classmate would later say that Johnny Thiele had turned into the sort of doctor they all wished to be: kind, gentle, and understanding, perhaps all the more so for having struggled over the years with alcohol and his moods. When Dr. Thiele passed a female nurse, he would greet her by name with a pat on the back and sometimes call her "kiddo." Thiele had pursued part of his training at the big public Charity Hospital, one of the busiest trauma centers in the nation, where he learned, when several paramedics burst into the emergency room in close succession, to attend to the most critical patients first. It was strange to see the sickest here at Memorial prioritized last for rescue. At a meeting Thiele had not attended, a small group of doctors had made this decision without consulting patients or their families, hoping to ensure that those with a greater chance of long-term survival were saved. The doctors at Memorial had drilled for disasters, but for scenarios like a sarin gas attack, where multiple pretend patients arrived at the hospital at once. Not in all his years of practice had Thiele drilled for the loss of backup power, running water, and transportation. Life was about learning to solve problems by experience. If he had a flat tire, he'd later say, he knew how to fix it. If somebody had a pulmonary embolism, he knew how to treat it. There was little in his personal history or education that had prepared him for what he was seeing and doing now. He had no repertoire for this. He had arrived here on Sunday. He brought along a friend who was recovering from pneumonia and was too weak to com- ply with the mayor's mandatory evacuation order for the city, which had exempted hospitals. Early Monday, Thiele awoke to shouts and felt his fourth-story corner office swaying. Its floor- to-ceiling windows, thick as a thumb, moved in and out with the wind gusts, admitting the near-horizontal rain. He and his colleagues lifted computers away and sopped up water with sheets and gowns from patient exam rooms, wringing out the cloth over garbage cans. The hurricane cut off city power. The hospital's backup generators did not support air-conditioning, and the temperature climbed. The well-insulated hospital turned dank and humid; Thiele noticed water dripping down its walls. On Tuesday, the floodwaters rose. Early Wednesday morning, Memorial's generators failed, throwing the hospital into darkness and cutting off power to the machines that supported patients' lives. Volunteers helped heft patients to staging areas for rescue, but helicopters arrived irregularly. That afternoon, Thiele sat on the emergency room ramp for a cigar break with an internist, Dr. John Kokemor, who told him doctors were being requested to leave last. When Thiele asked why, he later recalled, his friend brought an index finger to the crook of his opposite elbow and pantomimed giving an injection. Thiele caught his drift. "Man, I hope we don't come to that," Thiele said. Kokemor would later say he never made the gesture, that he had spent nearly all his time outside the building loading hundreds of mostly able- bodied evacuees onto boats, which floated them over a dozen blocks of flooded streets to where they could wade to dry ground. He said he was no longer caring for patients and too busy to worry about what was going on inside the hospital. Wednesday night, Thiele heard gunshots outside the hospital. He was sure people were trying to kill each other. "The enemy" lurked as near as a credit union building across the street. Thiele thought the hospital would be overtaken, that those inside it had no good way to defend themselves. He lost his footing in an inky stairwell and nearly pitched down the concrete steps before catching himself. Panicked and convinced he would die, he reached his family by cell phone to say good-bye. Thiele felt abandoned. You pay your taxes and you assume the government will take care of you in a disaster, he thought. He also wondered why Tenet, the giant Texas-based hospital chain that owned Memorial, had not yet sent any means of rescue. Finally, on Thursday morning, the company dispatched leased helicopters, while other aircraft from the Coast Guard, Air Force, and Navy hovered overhead awaiting a turn to perch on Memorial's helipad. Airboats came and went with the earsplitting drone of airplane engines. The pilots would not allow pets on board the aircraft and watercraft, creating stressful choices for the staff members who had brought them to the hospital for the storm. A young internist held a Siamese cat as Thiele felt for its breastbone and ribs and conjured up the anatomy he had learned in a college dissection class. He aimed the syringe full of potassium chloride at the cat's heart. The animal wriggled free of the doctor's hands and swiped and tore Thiele's sweat-soaked scrub shirt. Its whitish fur stuck to him. They caught the animal and tried again to euthanize it, working in a hallway perhaps twenty feet away from the patients in the second-floor lobby. It was craziness. A tearful doctor came to Thiele with news she had been offered a spot on a boat with her beautiful twenty-pound sheltie. She had quickly trained it to lie in a duffel bag. Several of the doctor's human companions were insisting they would not leave without her. The doctor had been sick to her stomach and continuously afraid. She wanted to go while she had this chance, but she felt guilty about abandoning her colleagues and the remaining patients. "Don't cry, just go," Thiele said. "An animal's like a child." He reassured her: "We gonna get by without you. I promise you." Thiele walked back and forth through the second-floor lobby multiple times as he journeyed between the hospital and his medical office. As the hours passed, the volunteers fanning the patients on their stretchers were shooed downstairs to join an evacuation line snaking through the emergency room. Thiele knew nothing about the dozen or so patients who remained, but they made an impression on him. Before the storm, the poor souls would have had a chance. Now, after days in the inferno with little to no medications or fluids, they had deteriorated. The airboats outside made it too loud for Thiele to use a stethoscope. He didn't see any medical records, didn't feel he needed them to tell him that these patients were moribund. He watched a doctor he didn't know direct their care, a short woman with auburn hair. He would later learn her name: Dr. Anna Pou, a head and neck surgeon. Pou was among the few doctors still caring for patients inside the stifling hospital. Some physicians had left; those who hadn't were, for the most part, no longer practicing medicine--they were carrying patients or deciding which people to load onto boats and helicopters outside, where it was somewhat cooler. But Pou looked to Thiele like a female Lone Ranger. After four nights of little sleep, she remained determined to tend to the worst-off. Later, he would remember her saying that the patients before them would not be moved from the hospital. He did not know who had decided that. Hospital CEO L. René Goux had told Thiele that everyone had to be out by nightfall. A nursing director, Susan Mulderick, the designated disaster manager, had given Thiele the same message. The two leaders later said they had meant to focus their exhausted colleagues on the evacuation, but the comments left Thiele wondering what would become of these patients when everyone else left. He also wondered about the remaining pets, which he'd heard would be released from their kennels to fend for themselves. They were hungry. And Thiele was sure that another kind of "animal" was poised to rampage through the hospital looking for drugs they were addicted to and craved. He later recalled wondering at the time: "What would they do, these crazy black people who think they've been oppressed for all these years by white people . . . God knows what these crazy people outside are going to do to these poor patients who are dying. They can dismember them, they can rape them, they can torture them." What did the patients' family members want Thiele to do? There was no one left to ask; they had all been made to leave, told their loved ones were on their way to rescue. The first thing, he thought, was the Golden Rule, do unto others as you would have them do unto to you. Thiele was Catholic and had been influenced by a Jesuit priest, Father Harry Tompson, a mentor who had taught him how to live and treat people. Thiele had also adopted a motto he had learned in medical school: "Heal Frequently, Cure Sometimes, Comfort Always." It seemed obvious what he had to do, robbed of control over almost every- thing except the ability to offer comfort. This would be no ordinary comfort, not the palliative care he had learned about in a weeklong course that certified him to teach how to relieve symptoms in patients who prioritized this goal of treatment above all others. There were syringes and morphine and nurses in this make- shift unit in the second-floor lobby. An intensive care nurse he had known for years, Cheri Landry, the "Queen of the Night Shift"--a short, broad-faced woman of Cajun extraction who had been born at the hospital--had, he believed, brought medications down from the ICU. Thiele knew why these medications were here. He agreed with what was happening. Others didn't. The young internist who had helped him euthanize the cat refused to take part. He told her not to worry. He and others would take care of it. In the days since the storm, New Orleans had become an irrational and uncivil environment. It seemed to Thiele the laws of man and the normal standards of medicine no longer applied. He had no time to provide what he considered appropriate end- of-life care. He accepted the premise that the patients could not be moved and the staff had to go. He could not justify hanging a morphine drip and praying it didn't run out after everyone left and before the patient died, following an interval of acute suffering. He could rationalize what he was about to do as merely abbreviating a normal process of comfort care--cutting corners--but he knew that it was technically a crime. It didn't occur to him then to stay with the patients until they died naturally. That would have meant, he later said he believed, risking his life. He offered his assistance to Dr. Pou, but at first she refused. She tried repeatedly to convince him to leave the area. "I want to be here," he insisted, and stayed. With some of the doctors and nurses who remained, Thiele discussed what the doses should be. To his mind, they needed to inject enough medicine to ensure the patients died before every- one else left the hospital. He would push 10 mg of morphine and 5 mg of the fast-acting sedative drug Versed and go up from there as needed. Versed carried a "black box" warning from the FDA, the most serious type, stating that the drug could cause breathing to cease and should only be given in settings where patients were monitored and their doctors were prepared to resuscitate them. That was not the case here. Most of these patients had Do Not Resuscitate orders. It took time to mix the drugs, start IVs, and prepare the syringes. He looked at the patients. They seemed lifeless apart from their breathing--some hyperventilating, some gasping irregularly. Not one spoke. One was moaning, delirious, but when someone asked what was wrong, she did not respond. He took charge of four patients lined up on the side of the lobby closest to the windows: three elderly white women and a heavyset black man. It had come to this. Dr. Thiele's mind began to form a question, perhaps in the faint awareness that there might be alternatives they had not considered when they set this course. Perhaps he realized at the moment of action that what seemed right didn't feel quite right; that a gulf existed between ending a life in theory and in practice. He turned to the person beside him, the nurse manager of the ICUs who also served as the head of the hospital's bioethics committee. Karen Wynn was versed in adjudicating the most difficult questions of treatment at the end of life. She, too, had worked at the hospital for decades. There was no better human being than Karen. At this most desperate moment, he trusted her with his question. "Can we do this?" he would later remember asking her. "Do we really have to do this?" Excerpted from Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital by Sheri Fink All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.