Arts December 16, 2015
The Other Side of Disaster
A Conversation with Pulitzer Prize-Winning Author Sheri Fink

Disasters, both natural and man-made, have a tendency to become crucibles of humanity. In an instant, ordinary and extraordinary people alike are thrust into situations in which vital resources—things as basic as oxygen, water, food and shelter—fall precipitously short of need. Lives fall into jeopardy, all the while time advances, forcing decisions and action. 

How exactly do we respond?

It is in our response—the other side of disaster—that the panoply of human values, systems, competency, wit, selflessness and bravery are tested. 

Five Days at Memorial by author Sheri Fink | Sun Valley, IdahoAuthor and reporter Sheri Fink knows a lot about disasters and how people respond to them. The Pulitzer Prize-winning author—she has two to her name—and correspondent for The New York Times, earned M.D. and Ph.D. degrees from Stanford University. She has been on the ground and has reported in the aftermath of some of the more wrenching human disasters of our time: the genocide at Srebrenica, Bosnia-Herzegovina (about which she wrote the book “War Hospital”), Hurricane Katrina (documented in “Five Days at Memorial”) and the Ebola outbreak in West Africa (reported in a seven-part series called “The Ebola Ward” in the The New York Times.) 

All three bodies of work explore the dilemmas faced by healthcare workers when needs far outstrip resources. In her most recent book, “Five Days at Memorial,” which she discussed at the 2015 Sun Valley Writers’ Conference, Fink reports on how that quandary reached its ultimate endpoint during Hurricane Katrina on the floors of the Memorial Medical Center in New Orleans. It was alleged by healthcare workers there that in a hospital without power or running water, in temperatures exceeding 100 F., and isolated by floodwaters with an, at least, perceived inability to evacuate a number of extremely ill patients, one doctor and two nurses euthanized several patients with high doses of morphine and Versed, a sedative. 

 

“Disasters help us see these larger issues that are with us all of the time … of how resources in the healthcare field get distributed.”

 

How people and events even got to such a point, as well as the legal accounting that took place in their aftermath, comprise the narrative arc of “Five Days at Memorial.” The intensity, chaos and direness of the situation are palpable in the retelling, as is the weight of the decisions people faced each day of five harrowing days. 

The task of reconstructing events that transpire in the chaos of a natural disaster requires preternatural skill and doggedness. Fink’s experience as a scientist and doctor clearly informs her work as a journalist. As she told me during a long conversation at the 2015 Sun Valley Writers’ Conference, “Science is very much like journalism in that it is a search for truth. If you do it well, you are challenging your theories, rather than trying to prove them. It is about listening and paying attention to evidence, triangulating and replicating.” 

At the center of Fink’s book is the concept of triage. Triage in medicine is a system for prioritizing patients when the number of patients exceeds the available resources to treat them. Though there are sundry protocols nationwide, they typically call for the sickest patients to be treated first. However, as Fink explained, “There is this concept in medicine that if you reach a certain level of disaster … would there be some point at which the normal standards of medicine do not apply? There are some people who agree with this. There are other voices out there that say it is very dangerous to go down that route.”

Author Sheri Fink leads a discussion about the events recounted in her book, “Five Days at Memorial,” during the 2015 Sun Valley Writers’ Conference.

Some doctors and nurses at Memorial did just this; they categorized the healthiest patients as “ones,” those who needed more care were “twos,” and those who were very ill or who had “do not resuscitate” (DNR) orders were categorized as “threes.” In addition, these numbers represented the order in which patients would be evacuated. The category three patients included nine patients who some on the staff felt were too sick or heavy to be carried down five flights of stairs, through a narrow passageway into a garage structure, then up fire escape stairs to an out-of-service heli-pad for helicopter evacuation. The implication was clear: some patients would be left behind.

This so-called “reverse triage,” while utilitarian—some argue it saves the most people over time—is predicated on assumptions about future events and outcomes. As Fink points out in her book, “Predicting how a patient will fare is inexact and subject to biases.”

Sun Valley Writers' Conference | Sun Valley, Idaho | Sun Valley MagazineThere are still other, more complex protocols for distributing healthcare resources, such as those for organ donation. But, Fink explained, “For me, … coming out of this book, my conclusion is that there is not one right way to distribute these things. But we can have the process of deciding how it’s done be open, transparent and inclusive, so, at least, we can justify what is being done. And then, try to increase the supply because then we don’t have to make these choices.” 

A similar mismatch between supply and demand plays out on the macro level of healthcare every day, only on a slower time scale. As Fink noted, “Disasters help us see these larger issues that are with us all of the time … of how resources in the healthcare field get distributed.” 

The events reported in “Five Days at Memorial” also underline the ongoing tension society tolerates between preparedness and triage. Regarding the latter, Fink said, “A point that has been driven home to me with every disaster I’ve studied is the real importance of flexibility in implementing solutions and to be constantly reassessing. Triage is all about reassessment.”

The fact remains, however, that preparedness, as complicated and expensive as it can be, goes a long way in obviating the need for triage when disaster does strike. “We need to think as a society … how much do we want to invest in preparing for these rare but foreseeable and potentially catastrophic events,” she added. “And as a species, I think, we are not wired to do that.” 

This article appears in the Winter 2015-2016 Issue of Sun Valley Magazine.