Recent events in seemingly every branch and generation of my family, as well as in the families of friends, have had me thinking a lot about medical care in the United States, and about end-of-life ethical issues. And when I’m thinking about stuff, I tend to want to read about it. Two excellent books wandered across my reading radar of late, and while they are a departure from what I usually review here they have both challenged my preconceptions and given me new perspectives.
I didn’t actually chose Sheri Fink’s book, Five Days at Memorial: Life and Death in a Storm-ravaged Hospital (Crown Publishing Group, 2013), because I was looking to explore the above issues, though. I chose it because I have a fascination with New Orleans coupled with a borderline voyeuristic interest in stories about Hurricane Katrina and its aftermath. The fact that this volume was a National Book Critics Circle Award winner, as a well as a New York Times Book Review Ten Best Books of 2013, made me feel nominally more comfortable with wanting to learn about how the disaster played out in one hospital. What I got was a book I could scarcely put down, and one that challenged me to think differently about pretty much all of my previous assumptions.
As the floodwaters rose in New Orleans, the generators at Memorial Medical Center failed, plunging the hospital into darkness and threatening the survival of patients who depended on modern medical equipment. As the exhausted and frightened staff worked to evacuate the building, they designated the sickest patients, and particularly those with Do Not Resuscitate orders, as the last to be rescued. At some point, the decision was made to hasten the seemingly inevitable death of these patients by injecting them with morphine and other drugs. Five Days at Memorial reflects six years of investigation by Fink, an MD herself, into the events leading up to that decision, as well as the legal ramifications in the days, months, and years after the disaster.
Like most Americans, I watched the heartbreak of Hurricane Katrina unfold on my television, unable to understand how the wealthiest country in the world could leave thousands of its citizens to drown or die from lack of food, water, and shelter. Fink’s book paints a frightening picture of how ill-prepared we are across the country for large-scale disasters. It also challenges the decisions made by some of the staff, and reveals deeper issues about end-of-life care. I started it inclined to think that perhaps, if someone were going to die anyway, hastening that end so that they weren’t forced to die in a highway clover leaf or airport terminal was the more humane option. I finished it wondering what, exactly, made the doctors and nurses involved feel they had the right to make that decision, without the input of families or even adequate knowledge of the patient’s medical history.
Five Days at Memorial is investigative writing at its finest. Fink portrays all the people involved as real human beings, with real personalities and motivations. She tries (without wholly succeeding) to conceal her own judgements. And in the tradition of the very best writing, she leaves the reader pondering “what would I have done?”
After finishing Five Days at Memorial, I found myself really wondering about end-of-life issues, especially given events and developments in my own family. I had been wanting for a while to read a book I had first heard about through an interview on The Daily Show, Being Mortal, by Atul Gawande (Henry Holt and Company, LLC, 2014), and decided now was the time to seek it out. This ended up being another one of the best books I have read in a very long time, so much so that I started and finished it in one day, unable to put it down!
Subtitled Medicine and What Matters in the End, Being Mortal explores exactly the issues and conundrums I have been struggling with. Gawande writes with the authority of a professor at Harvard Medical School, but also with the gentleness of a doctor who genuinely wants to help people, and who thinks deeply and carefully about what that REALLY means. He does not spare himself, freely admitting to his doubts and mistakes, which sets him somewhat apart from my personal experience with many doctors. Exploring the classic American nursing home, the “Assisted Living” trend, and the hospice movement, at its core this is actually a book about the death of Dr. Gawande’s own father. As such, it makes the topic both universal and particular. It gave me a lot to consider, and is a book I think pretty much everyone should read, since sooner or later we are ALL going to face the issues of how our loved ones, and we ourselves, want to die.
Which is not a very pleasant way to end this post, I admit! The real genius of Gawande’s book, though, is that despite its premise it is actually a very hopeful and life-affirming approach to a topic most people, Americans in particular, avoid. It has changed the way I think about many issues, and isn’t that what the very best books accomplish?
I received the book Five Days at Memorial from Blogging for Books for this review.