Five Days at Memorial by Sheri Fink

I have been wanting to read this book since I learned of it being published.  I started and could not put it down, reading last night until way past 11 and just finishing now once the duck was in the oven and the vegetables pared for dinner.  I am watching a looming snow storm outside, maybe getting nine or ten inches by tomorrow.  Thankfully that does not qualify as a disaster, nothing like the seven feet of snow that lambasted Buffalo last week.

This book is wonderful,  The fact is that 19 people were injected with morphine and other drugs at Memorial Hospital in the aftermath of Hurricane Katrina.  The author presents unbiased renditions of everyone's memories, impressions and concerns.  Factually, these people were injected as the hospital was being finally evacuated after five days of no power, little food, overworked staff and rioting neighborhoods.  Fink does a marvelous job of describing the horrific conditions and the mental strain not only of dealing with weather related realities but also the bureaucratic and corporate mishandling of the process.

The second section of the book hits too close to home as Fink details federal investigations, criminal charges, grand jury deliberations and both the tactics of lawyers for both sides and the denial of hospital owners.  The lack of single point of clarity or responsibility, the mix of best intentions versus changing or nonexistent procedures or plans is my world.  I work for the NYS Department of Health.  After Fink recounts how various oversight organizations tried to learn from Katrina on how to respond to complete failure of power, to limited medicine, etc etc, she finds herself in the midst of Hurricane Sandy and the hospitals and nursing homes in New York City and Long Island that were subject to equally harrowing conditions.  At DOH, my team oversees the distribution of federal grants to many of the healthcare providers mentioned in the book.  Fink's descriptions of their damages are even more graphic than those they sent us in their application for funds.  I am sort of living a post-disaster situation almost as frustrating as Sandy:  other bureaucracies are placing burdensome requirements to document expenses claimed for grant reimbursement; all contracts and payments are reviewed by multiple agencies, both State and federal.  To date, only about 15% of the funds my team controls have been paid out.

I also deal with many of the people Fink mentions who work in NYS DOH and many others who are the backbone and heart and soul of our emergency preparedness and response group.  How these folk and the top executives can cope with the issues that seem to occur with more and more frequency amazes me.  I was recently on a conference call where one woman was informed it would be her fault if more than a dozen people needing dialysis deaths if she did not find a way to get them out of their snow bound homes in Buffalo and to treatment.

Finally, Fink devotes the last part of the book to the ethical issues involving the triaging and distribution of scarce or diminishing medical treatments during a crisis.  Fink compares New York's establishment of standards against Maryland's where much more public involvement informed the regulations.  I am all for the wisdom of the crowd, but Fink's book does not circle back to the vested interests that seep into public forums.  These are decisions that must evolve.

I plan on buying several copies of this book to give to my team as Christmas presents.  Read it, it is a thoughtful, valuable "retreat-like" discussion of issues anyone in public health has to face.