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Originally published Sunday, September 8, 2013 at 5:09 AM

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‘Five Days at Memorial’: 45 patient deaths in Katrina’s wake

In Sheri Fink’s “Five Days at Memorial,” the Pulitzer Prize-winning journalist attempts to get to the bottom of what happened at a New Orleans hospital in the days after Hurricane Katrina, when 45 patients died.

Special to The Seattle Times

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“Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital”

by Sheri Fink

Crown, 448 pp., $26

After he failed to get indictments against a doctor for her role in patients’ deaths at a New Orleans hospital during Hurricane Katrina, the prosecutor said he feared there would never be an open debate about what really happened.

Sheri Fink’s book “Five Days at Memorial” may fill that role.

Fink’s descriptions of the flooded hospital, her extensive interviews with those who were there, profiles of investigators and study of the history and ethics of triage and euthanasia come very close to a full airing of how a disaster can upset society’s usual ethical codes, and how that played out at New Orleans’ Memorial Medical Center.

A criminal trial might have pinpointed how death occurred for some of the 45 bodies found at the hospital after the storm in 2005.

The 50,000 pages of documentation compiled by investigators might reveal more.

But that evidence has been sealed by Louisiana courts.

The doctor most directly involved in the deaths, the one who avoided indictment, won’t discuss her actions on Sept. 1, 2005, when morphine and midazolam, a nervous- system depressant, were administered.

Dr. Anna Pou, who was arrested under Louisiana’s second-degree murder statute concerning four of the deaths, has refused to give details, citing civil suits.

Despite all this, Fink has written a compelling and revealing account of what happened at Memorial. A medical doctor and former relief worker in disaster zones, Fink won a Pulitzer Prize for her 2009 New York Times Magazine article about Memorial.

The longer book format allows Fink to give more context and details about the circumstances in which the deaths took place.

The storm and levee rupture left the hospital in a lake, the city without power and Memorial’s mechanical and emergency systems flooded. Without power and air conditioning, the hospital sweltered in August heat, sewer systems failed, machines monitoring and keeping patients alive switched off and help from the government or corporate owners was late in arriving.

While Fink makes clear that doctors at Memorial, including Pou, gave compassionate care under difficult conditions, she also frames ethical choices raised by the challenging logistics for the evacuation on the fifth day at Memorial. Some patients had “Do Not Resuscitate” orders. Many were in the last stages of terminal diseases.

Getting them to the helipad meant the exhausted staff would have to carry patients — some weighing more than 300 pounds — down and up flights of stairs and maneuver them through a hole in the hospital’s machine-room wall (flooding barred easier access). If left behind, the patients might wake up alone, terrified and in pain. Perhaps morphine was most merciful.

Fink says that Pou realized some of the sickest patients might not make it out. What Pou — and other doctors — did isn’t easy to categorize. Is injecting patients with large doses of morphine and other drugs murder? Euthanasia? Giving them something to make them comfortable, as Pou is quoted as saying?

Was there “a specific intent to kill” in the mind of the doctor, as required under Louisiana’s definition of second-degree murder?

In the case of Anna Pou, it’s still a matter for debate.

John B. Saul is an editor at The Seattle Times and has taught journalism and writing at four universities and colleges.

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