Five Days at Memorial
When hospitals choose who lives
Description
On the morning of August 29, 2005, Hurricane Katrina made landfall in Louisiana, and at Memorial Medical Center in New Orleans, the staff thought they had come through the worst of it. The building was standing. The windows had held. There were more than two thousand people inside — patients, doctors, nurses, families who had come to ride out the storm, and their pets. For a few hours it looked like the hospital had done what hospitals are supposed to do in a crisis: hold. Then the levees failed, and the water that had spared the roof began climbing the ground floor from below.
By the second day the electricity was gone. The backup generators, wired low in a city built below sea level, drowned. Without power there was no air conditioning in the Louisiana heat, no working elevators to move patients down eight floors, no reliable way to run the machines keeping the sickest people alive. The temperature inside pushed past a hundred degrees. Toilets stopped working. Rescue, when it came, came in trickles — a helicopter here, a few boats there — and someone had to decide who went first. Someone also, it would later be alleged, decided who would not go at all.
Sheri Fink, a physician turned reporter, spent six years reconstructing what happened inside those walls across five days, and the reckoning that followed. Her account moves between the sweltering hallways and the courtrooms where doctors and nurses were later accused of injecting patients to hasten their deaths. It is a book about a building losing its fight, and about the conversation nobody wants to have until it is far too late to have it calmly.
The question we’re asking : When a hospital runs out of power, cooling, and time, who gets to decide which patients are saved — and by what rule?What we’ll see : We follow Memorial through the flood into the choices its staff made in the dark, the criminal case that followed, and the uncomfortable questions it left behind.
Table of contents
01Chapter 1 — The water rose faster than the plan
Memorial had a disaster plan, the way most hospitals do — a binder, procedures, an assumption that help would arrive within a reasonable window. What it did not have was a plan for the specific thing that happened, which was total failure of infrastructure over multiple days with no clear rescue on the way. Fink's reporting keeps returning to this gap between the disaster imagined and the disaster that came. The generators were the first betrayal. They were positioned where flooding could reach them, and once the water rose, the power went, and everything downstream of power went with it.
Inside the hospital were also patients from LifeCare, a separate long-term acute-care facility that leased the seventh floor. These were among the most fragile people in the building — dependent on ventilators, on constant medication, on machines that needed electricity. When the power died, keeping them alive meant hand-ventilating them, carrying them, improvising in a way that could not be sustained for days in hundred-degree heat. The staff were doing physical labor most had never trained for, on no sleep, with the smell and the noise of a city drowning outside the windows.
02Chapter 2 — The order of the living
Triage is an old idea in medicine — sort the wounded so that effort goes where it does the most good. On a battlefield or in an emergency room, that usually means treating the most urgent cases first. What happened at Memorial inverted the logic in a way that still unsettles anyone who reads Fink's account. As helicopters and boats offered limited capacity, the staff had to rank patients for evacuation, and a decision took shape that the sickest patients — those with Do Not Resuscitate orders, those least likely to survive the ordeal of being carried down darkened stairwells and out to a landing pad — would go last.
The reasoning was not indefensible on its face. If you can only move so many people, and some are ambulatory while others need to be hand-carried on stretchers by teams of exhausted staff through flooded corridors, prioritizing those most likely to survive the journey has a brutal internal logic. But Fink shows how a DNR order — a statement about not wanting heroic resuscitation at the end of life — quietly got reinterpreted as something else entirely: a marker that a patient's life mattered less in the queue for rescue. That slippage is one of the book's most disturbing threads.
03Chapter 3 — A crime, or a mercy, or neither
Months after the water receded, Louisiana authorities alleged that a physician, Dr. Anna Pou, along with two nurses, had injected a number of the remaining patients with morphine and the sedative midazolam in doses that hastened or caused their deaths. In July 2006, the state attorney general's office arrested the three on allegations related to second-degree murder. The charge transformed the Memorial story from a tragedy of infrastructure into a national argument about what caregivers may do when there is no good option left.
Fink lays out both readings without flattening either. In one account, these were exhausted clinicians who believed, rightly or wrongly, that certain patients could not be evacuated and would suffer terribly if simply abandoned — and who chose to ease their passage. In the other, they crossed the oldest line in medicine, deciding on their own authority that some patients would die and acting to make it so, without consent, without oversight, in conditions that made any such judgment unreliable. The drugs involved can relieve suffering and can also kill; the intent behind a dose is nearly impossible to reconstruct after the fact.
04Chapter 4 — What a hospital is for when the grid fails
Step back from Memorial and the individual choices, and Fink's larger argument comes into view: the United States asks caregivers to make impossible decisions in disasters while giving them almost no framework for making them. Triage in an extreme emergency — deciding who gets the ventilator, the helicopter seat, the last dose of a scarce drug — is not something most doctors are trained for, and it is not something the public has been asked to think about in advance. So when catastrophe hits, exhausted individuals improvise rules in the dark, and society judges them afterward by standards no one had agreed on beforehand.
The book documents how little had changed even after well-known warnings. Hospitals in flood zones still placed critical equipment where water could reach it. Evacuation plans still assumed timely rescue. And the deeper question — how a facility should ration care when there is genuinely not enough to go around — had been left largely unaddressed, precisely because it is so uncomfortable that no institution wants to be the one to write it down. Fink argues that this avoidance is itself a choice, and that its cost is borne by patients and by the staff left holding the decision.
05Conclusion
Memorial Medical Center reopened years later under a different name, its generators moved, its assumptions revised. Dr. Pou returned to practice and became an advocate for legal protections for medical workers acting in disasters. The patients who died on the upper floors during those five days remain, in Fink's telling, both individuals with names and stories and also a kind of collective question the country never quite answered. Six years of reporting did not produce a culprit. It produced a fuller picture of how ordinary competence unravels when the conditions competence depends on disappear.