Friday, December 13, 2013

Five Days at Memorial

I have just read “Five Days at Memorial,” by Sheri Fink.  How a great book can be written by a lady who ends her first name with an “i” I don’t know, but this is really a great book.  Sheri seems to have been a journalist, and writes like a great one, with precision and detail and facts that are presented to be suggestive, but not overwhelming in judgment.  The fact that she is also a doctor, and specialist in disaster medicine, makes her understanding superlative.  You are left to draw your own conclusions – but of course you aren’t, you are drawn along with her on her path, and then have the illusion you have drawn your conclusions.  But it’s a path I was delighted to take.

She follows what happens during Katrina at Memorial Hospital, still called “Baptist” from it’s name before the Tenet Corporation took it over 10 years prior, yet it is filled with Catholics for some reason, I guess because it is New Orleans.  What happened was, in brief, the hospital was extremely poorly led, and there was panic among the doctors and other hospital personnel that they would not be rescued and evacuated and that they would all die there.  They knew they couldn’t leave patients behind to fend for themselves, so they prayed a lot, and then killed a bunch of patients with morphine and Versed and then got out of there.  Then there was an investigation and there were some heroes (I was rooting!) who saw the truth and pursued it – but in the end were defeated by local politics and a thoughtless, clueless, evil medical establishment closing of the ranks nationally to protect a prime miscreant, a murderer, a constant pray-er.  Wow, what a story.

I have always thought that euthanasia was sometimes the most humane procedure appropriate for a situation.  (It might even someday be the best road for me, although I can’t say that yet.  I’m still at the stage where I don’t want to die, ever.  But I’ve always been slow to mature; that’s me.  But that’s a diversion; I’m talking in general.)  But now I’m not so sure.

It seems the Belgians and the Dutch have euthanasia institutionalized pretty well, at least that’s what I hear.  Of course you never know until you see it up close, and when you see it up close, you sometimes lose perspective.  So it’s always hard to know anything; it’s an epistemological question.

So, let’s turn to the usual source of wisdom I consult, my Dad.  He said that every generation needs to have a doctor in a family, if for nothing else to protect the family against all the lousy doctors out there.  I think this is true.  I’m used to a certain level of doctoring, a certain level of ethics, a certain level of objectivity, a certain level of intelligence.  But then I remember what happened around 1980 when I started in practice.  I was at Merritt Hospital in Oakland, not the Harvard hospitals and UCSF where I trained.  I was getting into the local thick of things.  One day I was in the OR and a baby came out asphyxiated, and even though at that time I didn’t have great skills, I was able to resuscitate the baby and take the baby down the hall pumping oxygen into his lungs on the way to the nursery.  Trailing behind me was Vlad, th delivering obstetrician known for inducing labor and producing premature infants.  As I helped the nurse push the crib and kept up the pumping on the ET tube down the baby’s trachea, Vlad announced loudly, “God saved this baby!  You didn’t save this baby, God saved this baby!” 

“What an idiot,” I thought.  I was right; he was an incompetent nut.  From what I read, he would not have been totally out of place at Memorial.  The prime euthanist at Memorial was a surgeon named Anna Pou (pronounced “poe,” not “poo”,) who was a very, very dedicated surgeon for difficult facial cancer surgeries, and as far as we know was competent at that.  She went over the top in at least one case we know, where she kept in personal touch with a patient and the family through thick and thin even unto death.  She was admirable, devoted, and she seemed humble enough.  But with all her praying, she apparently got into the God complex and made some mistakes.  She wasn’t Vlad, but on the other hand she gave me enough perspective to rethink my opinion that we should to the way of Belgium and the Netherlands with euthanasia.

Anna is not the only villain in the piece.  Other doctors, many nurses, and the nurse who led the hospital administration are revealed as incompetent and in some cases despicable.  The Attorney General, Foti, who is not the most competent person in the world, and who is politically hobbled by controversy, actually comes out positively.  He realizes the evil that was done and seeks to get it prosecuted.  The local DA, however, is the one in charge, and he succumbs to political pressure and assigns to the case a young lawyer six years out of law school.  This guy could have been a hero, young lawyer rises to the occasion – but he craps out and vitiates the great efforts of an investigative team from the state that ferrets out the facts, gets the witnesses, presents the case, only to have this young guy present a biased case to the grand jury, ensuring that no one with the relevant facts testifies, and the case is dismissed.  No one was enthusiastic about pursuing the case, is his comment.  Jesus.  Maybe every family needs a lawyer, too.

When it’s time for me to go, please have someone attending to me who doesn’t pray to ask for guidance. 

Here’s a review more sympathetic to the personae than I am, by Sherwin Nuland, the great Yale doctor:  He would have voted to pass Dr. Pou and not indict, he says.  Not me.  After all, the staff at Charity, the big public hospital, seems to have done much better.  Apparently, they didn’t kill anyone.

Budd Shenkin

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