Audiobook Review: Five Days at Memorial by Sheri Fink

Five Days at Memorial by Sheri Fink (read by Kirsten Potter; 17 hours, 33 minutes) recounts the tragedy of Hurricane Katrina from the perspective of inside the walls of the city of New Orleans's large downtown hospital. Caring for many of the city's most vulnerable, those at the hospital made fateful decisions amidst the chaos following the hurricane - decisions for which some of the physicians and nurses faced criminal charges in the aftermath of the storm. A physician and investigative journalist, Sheri Fink takes the reader right into the hospital during the storm and tells the stories of the doctors, nurses, administrators and patients caught in the frantic deterioration following the devastation of the storm.

 The book opens a few days prior to the storm as the city prepares for the forecasted hurricane. Inured to the rituals of hurricane prep, many took the warnings less than seriously and didn't heed all the warnings. At Memorial, they arranged to have staff on hand but otherwise additional precautions were not taken. In addition, many of the staff and those that lived near the hospital used it to shelter during the storm. As the storm bore down on New Orleans, the hospital was bustling but everyone felt the hospital would ride out the storm without issue. Of course, the storm was stronger than expected and the breaking of levees with the resulting flooding was not anticipated. As conditions worsened at Memorial in the days following the hurricane, the shortcomings of the city and the hospital's disaster planning became increasingly evident. With power out over the city, the hospital was dependent on back-up generator power. The generators, however, were on lower levels below the flood line; very quickly, the hospital had no power. With patients on ventilators and other equipment, the situation soon became dire. The hospital staff had to figure out how to get patients evacuated from the hospital.

At this point, the lack of coordinated effort between the hospital, its corporate ownership and government became obvious. Messages were going out from the hospital but either not being heard or responded to with inaccurate information that drove some bad decisions. Ultimately, doctors in the hospital triaged patients for evacuation by making judgement calls on the likelihood of surviving the evacuation but they were not operating with the best information about the conditions and timing of any evacuation. Based on where they were triaged, some patients were essentially sentenced to death. Faced with patients they believed were not going to be able to leave the hospital and increasingly deteriorating conditions outside, some doctors and nurses made decisions to hasten the deaths of patients with lethal injections.

 My Thoughts
This story was gripping and read with the pacing of a thriller - the narrator was new to me but kept me gripped throughout without overdoing the drama.  Although the outcome of the storm and the fact that some patients were euthanized was known at the start of the book, I found myself anxiously listening to hear the details and the analysis that was not well understood outside of this book. The author tells the story from a neutral viewpoint and didn't demonize the doctors, nurses or officials but let the facts speak for themselves.

One statement that really stayed with me was that the lack of planning on so many levels is actually the failure of morality in the situation - not necessarily the actions of any individual. During Hurricane Sandy in NYC, seven years after Hurricane Katrina, I watched on television as they evacuated patients from NYU Hospital because the storm waters flooded the lower levels of the hospitals which is where the generators were located - the same situation faced by Memorial. I hope our government and public health officials commit themselves to adequate disaster planning so patients never have to face what was faced at Memorial.

Review: One Doctor : Close Calls, Cold Cases and the Mysteries of Medicine by Brendan Reilly, MD

In One Doctor: Close Calls, Cold Cases and the Mysteries of Medicine, Dr. Brendan Reilly brings readers to the front lines of medicine today and exposes it's fractured, ailing state. A distinguished internist  at a major academic medical center in Manhattan, Dr. Reilly sees the spectrum of patients as they are admitted to his service and he navigates the healthcare system in trying to provide the best care to each patient. By weaving together his thoughts on the healthcare system, the mysteries of some of his most challenging patients and the very personal story of caring for his own parents at end of life, Dr. Reilly has created an informative but also gripping look at medicine today.

Dr. Reilly began his career as a primary care physician in small town New England and practiced medicine in a way one imagines it was practiced years ago - with house calls and an in-depth knowledge of each patient. This experience, though not without its own challenges and during which he encountered his most mysterious case which haunts him to this day, informs Dr. Reilly's approach to treating patients. In this quote he reveals his philosophy as a doctor:

For many doctors, the purpose of medicine is to cure disease. For these "curing" doctors, if you don't have a definable disase - panic attacks is not a disease - then you've come to the wrong place. But, for other doctors, the purpose of medicine is the same today as it has been for centuries: to relieve human suffering - sometimes by curing disease (when we can) but always by empathizing with, understanding, and trying to comfort the sufferer.

He laments the fact that the vocation of being a doctor and comforter to patients has been devalued in the current business culture of medicine with healthcare as a "commodity" and patients as "consumers" and "customers" while the doctors are "providers".

Although Dr. Reilly provides his opinions on the state of healthcare today, the book is not merely an examination of healthcare policy from within the industry. Perhaps it's greatest offering is in bringing the reader to the bedside as Dr. Reilly and his team of colleagues, interns and residents see patient after patient and try to solve their medical mysteries. In each case,  the doctors use a mix of basic physical examination, patient interviews and more advanced medical technologies like CT Scans to get to the source of the symptoms presented by the patient and land on a diagnosis. The reader sees the process used in diagnosis, the challenges of managing not just the patient but their families, and the inevitable race against time as patients begin to worsen and the narrow window of time to diagnose and treat successfully narrows.

The counterbalance to the doctor at work is the doctor trying to doctor his own parents. His father, also a physician, has metastatic bladder cancer which has significantly impacted his quality of life while his mother is suffering from dementia and also needs significant daily care. With their care, Dr. Reilly experiences first hand what many of his own patients' families grapple with including challenging end of life decisions. How much intervention is enough or too much? It is interesting to watch him practice the same deductive approach to medicine without the benefit of distance - he is obviously emotionally invested in his parents and it complicates his care for them.

My Thoughts
I could not get enough of this book - it is fascinating on so many levels. With the health care debate so front and center now with the launch of the Affordable Care Act, it is interesting to explore, on a less superficial level than offered by the media, the many drivers of our issues in healthcare today. It also confirms my belief that there is no silver bullet to our healthcare challenges today and each solution will have some sacrifice with its own downsides.

More than that, however, I loved the front row seat to the practice of medicine and watching the doctor at work. It was like watching an episode of Gray's Anatomy or ER - gripping and emotional. In each case, you see the doctors struggling with their own issues - there is actually quite an exploration of regret in medicine and how it is not well understood or discussed - and juggling multiple patients and a plethora of information as they try to both cure and comfort each patient. At the core of each case is a patient looking to the doctor and the healthcare system for relief and a doctor trying to solve a mystery in order to do just that.

This book is definitely a top read for me in 2013 - highly recommend!