‘Five Days at Memorial’, by Sheri Fink

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, by Sheri Fink, Atlantic, RRP£14.99 / Crown, RRP$27, 576 pages

September 11 2001 is remembered as a time when Americans faced a harrowing attack in their streets with grit and resolve. Four years later, televised reports from another calamity offered up a very different America: a superpower unable to cope with a ferocious storm on its southern shores.

Hurricane Katrina left behind death and destruction and a lingering stench of acrimony among policy makers over a lack of preparedness. Rescue and relief in Louisiana, which suffered the most deaths of any state in the colossal natural disaster, was neither bold nor efficient. Its showcase city of New Orleans – known as the Big Easy for its amiable ways – was a crucible of bad planning in late August 2005. And one hospital, rendered nearly helpless as levees around the city crumbled, stood as a sobering vision of the consequences.

As floodwaters rushed in, Memorial Medical Center turned into a theatre of heartbreak for the doctors and nurses marooned with about 240 patients. Five Days at Memorial is the story of what happened until the last living patient was evacuated on September 1. When mortuary workers arrived days later, they found 45 bodies, more than at any hospital in Katrina’s path.

This is a riveting account of medical decisions made in the worst of times and the unhappy trail of allegations, prosecutions and recriminations that followed. It also reads as a demand, years on, for personal accountability from a few doctors and nurses who, with syringes and sedatives in hand, apparently helped some sick, but arguably not dying, patients draw their last breaths.

Sheri Fink, a medical doctor and journalist who won a Pulitzer Prize in 2010 for her reporting on the deaths at Memorial, has culled public records, plumbed legal files and interviewed some of the doctors, nurses and families caught up in the storm to pose important questions of care and responsibility. She draws on rare experience: she has worked in and studied disaster zones. Fink based a previous book on the tales of doctors in Bosnia who worked, in the 1990s, under siege in Srebrenica.

In this narrative, infused with historical insight, she presents good people making decisions that become grist for murder allegations. Fink begins as a sympathetic chronicler. Individual doctors and nurses are introduced as compassionate, selfless, everyday heroes. But as floodwaters engulf the hospital’s lower floors, as electricity fades, as gunshots are heard in the distance, as sick babies and frail grandmothers wail without running water, cool air or much-needed oxygen, decisions must be made.

Fink’s account of what follows makes for uneasy reading. Doctors at Memorial set moral priorities – babies first – as the first rescue helicopter appears. As hours pass, they decide, without consulting families, that evacuations for patients with standing do-not-resuscitate orders will be deferred. A small group of doctors privately decides help isn’t coming soon enough. Powerful doses of morphine and sedative are injected to patients deemed weak or unlikely to survive rescue. In less than a week, their ordeal is over.

The medical staff would later describe themselves as pursuing the best care under terrible circumstances. Their decisions would rattle New Orleans, outrage some families who believe their loved ones were in line to be rescued, and stir the medical profession to support them and then to advocate for laws to protect health workers from being sued for work during disasters.

Fink offers a complex narrative with many threads, including a deeply relevant exploration of end-of-life standards and guidelines. She considers moral and philosophical debates in other countries and explains the stakes in New Orleans. Some families did not fully comprehend the power that the physicians could wield in dire straits – or how do-not-resuscitate orders could or would be interpreted in an evacuation.

The Louisiana attorney-general would eventually arrest one doctor and two nurses on murder allegations related to four patient deaths. None went to trial. A grand jury was called in New Orleans to investigate. Behind closed doors, 10 women and men heard facts, considered the circumstances, and declined to issue indictments.

Fink’s instinct in this vast account is to look past those legal perimeters and continue to press some basic questions of fairness. What were the standards in determining who should be moved out first? Could some patients have survived if moved, and why not try? Couldn’t the doctors and nurses have coped or waited a few more days – at least through a full week? What happened in the minds of the medical professionals in five days that made them move towards death rather than life?

Five Days at Memorial can only prompt reflection on how we cope with disasters. Government planners should have done better; corporate owners could have prepared more. But individuals, too, have great powers, Fink points out, in resisting compromise in moments of crisis. Individual medical choices and triage choices sometimes “are less a question of science than they are of values”.

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Christine Spolar is the FT’s investigations editor