Book Club. Five Days at Memorial

[balancedlife]

Jul 18, 2016 12:12:41 GMT -5 coffeequeen63 said:

Memorial just seemed to be in chaos mode from early on.

But I realize I probably came across as judgy in my first thread. I understand that this was an unprecedented disaster and I don't presume to know how I would have dealt with it. I'm thankful that I was not in that situation.

Chaos from the get-go!  And I do sense that Pou stepped in to try to help.  The trouble seemed to me that she was consulting mostly with those who would agree with her or were not in a position to find it easy to disagree with her.  And she proceeded to tell others what to do even though she wasn't familiar with the patients involved and she really didn't consult with the staff who had been working with those patients. 

Yep, I am judgy even though I have never been in any sort of similar situation (and that surgeon kind of got under my skin!).  Feel free to correct me.  But I kind of feel that there are some real lessons to be learned here about disaster management and that probably involves doing some judging, eh?

[balancedlife]

Jul 18, 2016 12:21:26 GMT -5 MonkeyTwirl said:

Thank you for bringing that up. I wanted to discuss it here.  I thought this was a major part of the story, yet the author did not mention it 'til well into the book, after she was done narrating the events at Memorial and has moved on to the legal issues afterwards.  This confused me greatly.  She mentions it like an afterthought, but it seems super extra major to me.  How could the execs be so clueless? Didn't the staff see the lights at the Cancer Institute and know there was power?  Power was out everywhere else. Wouldn't it be obvious?  And even if it wasn't, wouldn't there have been several people on staff who found out, and then word would get around, and DUH, let's move patients there!  I can't wrap my head around this part of the story, and the author just totally shoved it aside like it was a footnote.  No staff ever mentions it?  Can anyone help me understand this?

The author did, if I remember correctly, mention in one --one! -- quick sentence earlier in the first section.  Something about one staff member seeng a light over there.  And that was it!  Nothing about the staff doing anything other than seeing it.  I don't understand why the Memorial people didn't follow up on this and I certainly fault the author for not pursuing it!

I really would like to know that the execs who abused their power in this way were vilified in all the media!

[gemster]

Jul 18, 2016 12:51:05 GMT -5 balancedlife said:

Jul 18, 2016 12:21:26 GMT -5 MonkeyTwirl said:

Thank you for bringing that up. I wanted to discuss it here.  I thought this was a major part of the story, yet the author did not mention it 'til well into the book, after she was done narrating the events at Memorial and has moved on to the legal issues afterwards.  This confused me greatly.  She mentions it like an afterthought, but it seems super extra major to me.  How could the execs be so clueless? Didn't the staff see the lights at the Cancer Institute and know there was power?  Power was out everywhere else. Wouldn't it be obvious?  And even if it wasn't, wouldn't there have been several people on staff who found out, and then word would get around, and DUH, let's move patients there!  I can't wrap my head around this part of the story, and the author just totally shoved it aside like it was a footnote.  No staff ever mentions it?  Can anyone help me understand this?

The author did, if I remember correctly, mention in one --one! -- quick sentence earlier in the first section.  Something about one staff member seeng a light over there.  And that was it!  Nothing about the staff doing anything other than seeing it.  I don't understand why the Memorial people didn't follow up on this and I certainly fault the author for not pursuing it!

I really would like to know that the execs who abused their power in this way were vilified in all the media!

Because I was speed reading I completely missed where it was mentioned in the first section, when it was mentioned in the second section I was confused as to what/where it was in relation to memorial.

I didn't actually pay that much heed as the author just seemed to mention it in passing, I'll have to re-read that part again.

I think it's strange that more wasn't made of it in the first part of the book, and the execs should have been pilloried in the book and the media.

[OwlGreen68]

Do you think she placed some of the details primarily in the legal consequences part of the book in order to enhance the details that were revealed?

I can't think of a good way to put that...  It was more dramatic saving some of those things for the second half, maybe?

[rangersma1]

Hi book clubbers, I posted earlier today but my posts are gone.  I have an uneasy feeling that I didn't log in.  Slow learner, that's me!

Just about everything I said has been covered by others and was so much better than mine, so I'll just say ditto to all that's been said.  Just one thing I learned that "agonal" has to be the ugliest word in the English language.

[honeybzzzs]

Finally home and I get a chance to read the replies. So many good insights.

To answer the questions.
I listen to a lot of audiobooks because of my commute. I picked this book up on a whim, "Oh, this looks interesting". Glad I did. It sparked many a discussion at work as each day I came in with a new part of the story to talk about.

I had no idea this was going on during the Katrina crisis. It just didn't seem to be covered by the news. Just the news of the looting and shootings.
I was interested to see if anyone reading the book had better coverage on this if they lived closer to New Orleans.

I thought the author did a good job of informing us of the conditions the hospital staff had to work under. I smiled at Fairazz's remark about "I live in Texas. I get that it was HOT". Since I live in Camelot, and we don't get those weather conditions, it was a eye opener for me. I do realize that New Orleans is hot and muggy. I felt it was a good reminder for me to know just how awful it was. Things like the fact that windows couldn't be opened and had to be broken to get a bit of a cross breeze.
That generators weren't working, that people planned on being there only a couple of days and they didn't bring enough supplies with them...food, clothes, etc.

Thank you Balanced for mentioning the CEO's in the cancer-center. Listening to the book while driving I sometimes miss details. I was confused when this was mentioned during the reading. My thoughts were "where is this happening?" "Is it across the street?" "Did I miss something important?"
I wish this had been covered better. The author could have given us more detail on this subject.

Others have mentioned that "the sickest patients should have been evacuated first"
If I remember correctly, that was what was attempted first. However, other hospitals didn't have a place for these very sick people either. Or they didn't have the equipment needed to help these people. Plus, nursing staff needed to go with the patients so they were losing a staff member each time a patient left. Also, the helicopter pilots weren't taking on the very ill as they had trouble getting them, and their supplies (gurneys and such) into the helicopters.
Remember the pilots didn't want to take the neonates because it was difficult to get the incubators into the helicopters. The pilots only had so much time to land and fly to the next hospital. It was only because the doctor insisted that the neonates were taken that those babies were saved.
I believe at this point they decided to evacuate the healthier patients. At least they could walk, didn't need life saving equipment, etc. With the thought that "we can move 50 healthier patients for each very sick patient. Let's get them to safety. Surely the National Guard will be here in a day or two to help evacuate the sickest patients."
I understand how this train of thought could have happened.

Looking forward to tomorrow's discussion. Good night all.

[moosishun]

Hey! Do we start another thread for the 2nd day or continue here?

I am cornfused.

[gemster]

Jul 19, 2016 6:25:32 GMT -5 moosishun said:

Hey! Do we start another thread for the 2nd day or continue here?

I am cornfused.

I was just going to ask the same thing!

some of the group threads have daily posts, others just do a long continuous thread - I don't mind either way, one thread may be better as we can see what we/others have already said but will go with whatever works best for you Moosi, book club is your baby 

[moosishun]

I'm all for keeping it in one place! We might even get people who post here weeks after! Wouldn't that be fun?

I asked honey to continue with the good work, but perhaps I was too late, so here are a few little bitty questions:

1. What do you think of the behavior and decisions made by the medical staff at Memorial? Where you shocked by the lethal injections of morphine? According to Dr. Ewing Cook, "It was actually to the point where you were considering that you couldn’t just leave them; the humane thing would be to put ’em out.’’ What do you think?

2. What shocked, or disturbed, you the most? The actions of the staff? The unpreparedness (short-sightedness?) of the hospital? The horrific conditions everyone operated under?

3. How would you have fared under the conditions at New Orleans' Memorial?

I'll get back to this later!

[gemster]

1. What do you think of the behavior and decisions made by the medical staff at Memorial? Where you shocked by the lethal injections of morphine? According to Dr. Ewing Cook, "It was actually to the point where you were considering that you couldn’t just leave them; the humane thing would be to put ’em out.’’ What do you think?

Yes I was shocked by that - more so than I was by Dr Pou and the nurses who were actually charged as I don't think they were ever so blatant about what they were doing. I am also puzzled as to why Dr Cook wasn't charged along with Pou (and some others, I think Dr Thiele was of them) why did they single her out? Sorry if this was explained and I missed it with my speed reading

2. What shocked, or disturbed, you the most? The actions of the staff? The unpreparedness (short-sightedness?) of the hospital? The horrific conditions everyone operated under?

All three but I think I was most shocked by the unpreparedness & the conditions now that I know more about what happened at Memorial and about Katrina in general. Dr Cook's statement above is very callous taken out of context but I think most of the staff genuinely thought they were doing the best by their patients given the circumstances.  The hopelessness and feeling that they wouldn't be rescued was for the most part proved to be unfounded but I think they were genuinely acting based on the horrendous situation confronting them at the time.  

3. How would you have fared under the conditions at New Orleans' Memorial?
I'd have been beyond useless, I don't do well with illnesses/medical stuff or being around sick people. I think I would actually have coped better as a patient myself, as I wouldn't have had the 'obligation' to help others and then feeling guilty/pathetic/useless because I am so bad at it. I don't know how I would have coped with being a visitor, especially to a seriously ill patient - I like to think I would have kept it together enough to care for them even if I wasn't helping with anything else, but I honestly don't know.

[Deleted]

I have a few minutes before I leave for work so this will be hurried.

I think the decisions to administer the lethal cocktail was the result of groupthink in a horrible warlike situation. I am shocked. But I see that they thought no help was coming and that the patients would die there without any care at all. The timing was so bad. Help was freaking finally on the way. I kept waiting for a hero to step up and say, you all go, send back a helicopter with suppies. I'll stay with these people. YOU DONT HAVE TO DO THIS.

Shocked and disturbed by the total knowledge that those levies were in their condition and no one wanted to part with the money to fix them. Ugh.

How would I have fared? Not well. The conditions, the confusion, the fear. But, I know I would have tried to help. And, I know I would not have helped administer those meds.

Sorry so quick. I need to catch a train. I;ll be back later.

[gemster]

I agree with Fair that they thought they were operating in a situation like a warzone and were not sure if they (never mind the very sick patients) would make it out alive. They didn't know the cavalry were coming over the hill.

I think a lot of this was because there was no 'hero' - they didn't even have to be a hero as such just someone who kept calm and carried on, like in the other hospital where the staff carried on working to their normal shift rotas - someone must have been 'in charge' enough to organise this, and that just didn't seem to exist in Memorial.

I don't think I would have helped administer the meds but if I was told to do so by a doctor or senior member of staff then who knows. It's kind of hard for someone like me who knows nothing whatsoever about the medical profession and has never been a carer of any kind to imagine myself in this kind of position. But for example if I was there visiting my mum who was seriously ill/DNR and medical professionals were telling me she was in agony and would never make it out alive I may well have consented for them to give her the meds.

[rangersma1]

I was shocked by Emmet Everett's death. He was obviously not near death, I think he was considered by staff as inconvenient. The unpreparedness of the entire city, state and hospitals was not surprising, considering the Let the Good Times Roll attitude of the area. I would have been useless at the hospital, and I would never judge a person who stayed and went along with decisions which h were abhorrent to their beliefs.

[Deleted]

Jul 19, 2016 7:42:47 GMT -5 rangersma1 said:

I was shocked by Emmet Everett's death. He was obviously not near death, I think he was considered by staff as inconvenient.

Amen to that Rangers.

[honeybzzzs]

Oh Moosi, I'm sorry. I didn't see that you wanted me to continue with the questions. Thank you for getting us started today.

What did I think of the decisions made?
While reading, all I could think about was the Fall of Saigon. The pictures of people trying to get on those helicopters. The military with their machine guns. I remember when that was happening. This seemed so similar to me. There were men with guns in the hospital telling people to leave. The staff had no idea if this was the first of many helicopters to come or the one and only.
It was such a warlike atmosphere.

What shocked and disturbed you the most?
I was surprised, in a city that floods at the drop of a hat, that emergency plans weren't in better working order. To have the generators in the basement. To not practice evacuation. To only be prepared for a few days of inconvenience.
Mostly shocked at the lack of help from the "higher ups". Where was the "Calvary"?

How would I have fared?
I was raised military. I have a real sense of "oh, this is the situation we are in now...this is what needs to be done" Also, I have a "follow orders" but also a "I'll take charge" mentality.
So many factors play into the "what would I do..how would I fare" question. This has gone round and round in my head since I read the book. I do know that I would be as kind and helpful as possible.

[coffeequeen63]

Good morning!

1. Let's see..... Where to start? First, I think there was an appalling lack of leadership. As Gemster mentioned, there was no calming presence in the face of this disaster to keep the care of the patients going. It seemed like no one was really sleeping. Miscommunication was rampant. Treatments of the patients stopped early on. Dr. King was the only one who seemed to want to continue to care for the patients as they should be. I mean, they discontinued IV fluids on Tuesday when they thought the patients would be evacuated. On Thursday, the patients had not been evacuated, but IVs had never been restarted. What the actual fuck? That alone probably contributed to the deterioration of the patients to near death status. The patients were not being turned, were developing bed sores, were dehydrated. I think the "groupthink" mentality as Fairazz called it took hold early on and there was this sense of oh, well. They are all going to die anyway and maybe us too.

2. The most shocking thing to me was again the mob mentality. Like no one stepped up and said "Hell no you will not euthanize Emmett who is alert and oriented and just happens to be a big man who is paralyzed. We will find a way to get him to the helicopter." The Lifecare manager never said, "So who exactly says we have to euthanize these patients and who gave them the authority to make that call?" The Lifecare nurses just abandoned their patients to Dr. Pou and the Memorial nurses. They were clearly upset about it, but again it was like this sense that a higher authority was calling the shots when really it was just these sort of fragmented conversations that had taken place and some things taken out of context that led some of the doctors and nurses to this conclusion. Like one person would say that the Lifecare patients looked really bad and it became this truth that none of them would make it. Dr. king said he was more afraid of the people inside the hospital than out. Like he might get shot if he disagreed. But again, this was no government decision or military decision. The freaking helicopters were landing "one after another" Thursday morning as the patients were being euthanized. Sorry. That was kind of bloggy.

3. How would I have fared? I honestly don't know. I like to think that I would have been taking better care of the patients. I know from experience that a horrifically busy night in an ER or ICU can be adversely swayed by negative personalities. If some of the staff are complaining and making conditions seem worse than they are, they can bring morale and energy down in a heartbeat. As in the case of Memorial, that certainly leads to a decrease in care for the patients. As for the euthanization? I feel very conflicted. For patients who were in the apparent death throes with agonal breathing, Morphine may have been the kindest thing to do. I am doubtful that anyone would survive that state with any kind of meaningful recovery. But I think that was only a few patients. Not twenty!!! And not Emmett!!!! I can't stop thinking about him. That really haunts me. Did he know they were killing him?

[balancedlife]

Pretty much echo everything that CoffeeQueen has written!

[balancedlife]

Let's see here. I think that I have some further thoughts about euthanasia in general and its use at Memorial in particular.

Releasing those who are at the end of life and who are suffering and who have made it known that they want to be helped in this way should be given this assistance. To me, it is akin to helping our pets go when the time has come.

And therein lies the difference. At Memorial, it did seem premature to me and the rush seemed so much based on misinformation and miscommunication. And there is a hint of convenience, too, ugly thought though that is. Anyway, it would have been so much better to continue doing all the proper medical treatments that were possible, while awaiting further and accurate information about the situation. Sometimes one should make haste slowly.

And I keep coming back to "sickest out first." Then there would have been more time to calmly assess what was happening and what needed to be done.

[balancedlife]

Ha! In discussions like these, I always find myself torn. I have strong opinions, but I don't want to upset my GDT pals. It's a conundrum! Plus, I'm a Libra and always end up trying to see the other point(s) of view. Even though I am pretty sure that I am right in every way!

Gotta dash off. BBL and I am looking forward to reading more here!

[gemster]

Well you are called Balanced, Balanced 

I'm like you though and can see both sides (and I'm not even a Libra!) I think what they did was wrong but that's with hindsight. They were in a terrible situation - which they presumed was even more terrible due to the mass panic, no-one taking control etc - and I don't think their intentions were bad in most cases. Emmett Everett causes me the most concern too, and I feel that he did know what was happening 

Honey made a good point about the 'sickest first' yesterday  - that the helicopter pilots didn't want to or couldn't take them.  If I'd witnessed very sick patients being turned away with pilots saying they couldn't take anyone on gurneys or who needed specialist equipment then I may have come round to the way of thought that there was going to be no way to get those people out of there.

[balancedlife]

Yes, the situation, especially at the beginning, was awful beyond belief. And the people who did rather take control were perhaps not the best people to be entrusted with all that power. Better to have let the LifeCare people call the shots for their patients rather than the Tenant folks?

I do see Honey's POV about sickest first, but, in my mind, I keep coming back to the neonatal staff and those very, very sick babies. Those nurses just kept treating those tiny creatures all the way down all those stairs and, when the pilots said it was a no-go, the staff would not be denied and eventually a way was found. A way was found. I wonder if the same could have happened with the 7th floor patients.

Then there would have been somewhat healthier patients left. Fewer staff needed to care for them. Fewer resources needed to support them. And there would have been time. Time to consult, discuss, allocate, sleep, organize, seek more information, craft work-arounds to solve some of the problems. Ha! Time to send someone over to see why there was a light on over in the Cancer Institute!

[MonkeyTwirl]

Jul 19, 2016 6:37:10 GMT -5 moosishun said:

1. What do you think of the behavior and decisions made by the medical staff at Memorial? Where you shocked by the lethal injections of morphine? What do you think?  As a proponent of euthanasia, I was more sympathetic to the staff than many are.  This book and our discussion has helped me better understand the complexities of medical ethics, and the slippery slope of being pro-euthanasia - where do you draw the line?  Who draws the line?

2. What shocked, or disturbed, you the most? The actions of the staff? The unpreparedness (short-sightedness?) of the hospital? The horrific conditions everyone operated under?  The overall magnitude of the clusterfuck at every level and dimension.  It's despairing and makes me ashamed of my country.  My housemate is a new employee of FEMA.  We discussed this book.  She said that many lessons were learned from Katrina and that many improvements have been implemented as a result.  This gives me hope.

3. How would you have fared under the conditions at New Orleans' Memorial?  I have not been tested in this way.  I would like to think that I would do my best to be of help.  As a lay person, I cannot imagine what I would have done if I was a medical professional.  If my loved one was a terminal patient, suffering, with little quality of life to look forward to, and I knew their wishes were like mine, I would advocate for the highest level of comfort care and possibly euthanasia.

I'll get back to this later!

[gemster]

They did find a way with the babies but it was touch and go, it was wonderful that Baby S survived but it could have turned out badly and the doctor who saved him could have found himself facing charges or a lawsuit. I think in situations like that you do what you think is right at the time and it's only with hindsight you know for sure you've made the right decision or not.

I do agree that the medical staff caring for their babies did a much, much better job advocating for their charges. But I do think in general people tend to value the lives of babies and children more highly (not saying that is right or wrong it just seems to be part of human nature to want to save children first) and that may have swayed the pilots too - they would take risks for a baby that they wouldn't take for an adult or elderly patient.

[honeybzzzs]

When Emmett Everett's name was mentioned on this board my thought was "they got the big guy out...I remember that". So off to look it up..

They got Rodney Scott out! "Obese ICU patient who was recovering from surgery and heart trouble, at last felt himself being hoisted up the open metal steps to the helipad. Weighing more then 300 pounds and unable to walk, Scott was the last living person to leave the hospital grounds." Pages 223 and 224

So why couldn't Emmett be saved? Oh, that is soooo upsetting. Obviously they were able to move this man, and Emmett was in a similar condition. Were only LifeCare patients euthanized? Was Rodney Scott a LifeCare patient? I'll have to look that up too.

Back to work I go.

[Deleted]

I think they were all Lifecare who were euthanized. That seemed odd to me. And Emmet being euthanized really made me mad. And not get out ahead but these families settled for pennies in class action suit. While I understand the worry of "if we compensate and find guilty, will med staff react in future emergencies". It kind of reminded me if the Henrietta Lacks book. They way these patients were treated.