Five Days at Memorial by Sheri Fink

After Hurricane Katrina struck and power failed, amid rising floodwaters and heat, exhausted staff at Memorial Medical Center designated certain patients last for rescue. Months later, a doctor and two nurses were arrested and accused of injecting some of those patients with life-ending drugs.


Five Days at Memorial, the culmination of six years of reporting by Pulitzer Prize winner Sheri Fink, unspools the mystery, bringing us inside a hospital fighting for its life and into the most charged questions in health care: which patients should be prioritized, and can health care professionals ever be excused for hastening death?

Transforming our understanding of human nature in crisis,
Five Days at Memorial exposes the hidden dilemmas of end-of-life care and reveals how ill-prepared we are for large-scale disasters—and how we can do better.

Why I Picked It Up

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This year, I've been reading a ton about explorers and the body's limits, in what started as a curiosity about stamina and what you can push past, and that curiosity's spiraled into a few different threads. I've had the privilege of reading a lot of gorgeous meditations on nature, in one direction, and landed on some survivalist picks in the opposite direction. I've always had that curiosity (see: Extreme Medicine, Endure) because one of my favorite professors in school taught exclusively history of science classes—and I was a history major who (realistically) should have majored in psych instead.

Recently, that's shifted into more medicine and trauma. My family and I basically always have Grey's Anatomy on in the background while at home. While on the plane home from the Tour du Mont Blanc, I ended up watching The Pitt, which is a medical drama fashioned as if Grey's met 24: each episode covering one hour in a chaotic ER. After finishing it, I wanted to read something that had a similar feel.

And then we have the hurricane bit. Over the last year, storms have been on my mind more than normal. I'd never considered myself truly afraid of a natural disaster until last year because the models had Milton set to basically destroy Tampa, and my family was not evacuating; considering Helene had just, days earlier, destroyed my aunt's house and wrecked another of my favorite places—Asheville—I was really high-strung and freaked out about it. Not to get too personal, but I was deeply worried for loved ones' safety, and basically did not sleep that entire week. So last year's hurricane season was not fun, and this year marks the twenty-year anniversary of Hurricane Katrina hitting New Orleans.

It felt right and distinctive to read about the tragedy, both because I think it's good to read about tragedies that scare me, and because it feels like a good way of honoring the devastation. I think distilling down to crisis mode has a certain clarity to it, but I also don't want to feed into "tragedy porn." Right now, I'm just gravitating towards heavy reads in some ways.

Finally, I love a microhistory with a complex cast, which is why surprising picks like The Warrior Elite or Black Hole Blues win me over. From insights of books like Cultish and even Steinbeck's phalanx, I've always been fascinated by large group organizations, especially with blurry work/life identity lines. A sense of loyalty and camaraderie.

About 'Five Days at Memorial'

Five Days at Memorial details the—obvious—five days at Memorial Medical Center in New Orleans, where doctors, staffers, and their families both dealt with the care of existing patients and usually rode out the storm. Nothing seemed all that different from previous years, at first, so they were prepared with cots, food and water, generators, etc. (People in other states, for the record, can also be extremely condescending and shitty towards the South in regards to evacuation time, warnings, etc. but that's a separate tangent.)

The book starts with a flash to what the crux of the narrative is about: triaging the final patients, those who wouldn't be able to be evacuated, and the extreme measures taken to "keep them comfortable." Euthanasia? And if so, were those healthcare operators in the right? Who made which calls, and how were they authorized? In the blur of the storm and its aftermath, it's hard to get a straight answer.

Voice & Tone

Overall, I liked Five Days at Memorial and the way it set up the story, although I do think the pacing felt a little shoddy to start. The beginning of the book often has what's essentially a promise for tone—by reading the first few chapters, you get a feel for its speed, voice, etc. Whereas Five Days can't always decide whether it wants to zoom in on a particular moment or detail or keep a more omniscient feel, which makes the transitions hard to follow; you'd assume based on the beginning that each day unfolds in a certain way, but the way it hops around—and eventually just zooms out entirely once the storm is over and the hospital emptied—is a bit disorienting.

Basically, the entire back half of the book deals with the emotional reactions, legal battles, etc. that then characterize the core moral dilemma of what happened at the hospital. I hadn't been expecting that, and so the second half did ultimately feel repetitive and much harder to get through too. I'm not sure what would have been a better way of organizing the book, but I'm just not sure how I feel about its clarity and execution. I'll give some grace to the pacing in regards to the storm itself—maybe it "mimics the choppy, contradictory, repetitive way things happened" too—but the overall impression of the last fifty percent of the book was muddied.

And then voice-wise, descriptions are sometimes vivid to the extent that they ring a little false or extraneous, but that's me being a tremendous brat about what I perceive as an affected voice or not. I thought the investigation and curiosity were great. I thought moments of attempted description or poeticism fell flat and that Fink's storytelling was better when she aimed to be straightforward rather than elegant. Of course, I'm reading for the story, but when dealing with subject matter like this, writing that feels like it's perhaps "trying harder" to be cinematic generally gives me a sense of sensationalism I don't like in combination.

The Core of the Book

The book successfully captures murky areas in which values clash within people, which I appreciated. For example: you'd read about someone who's angelic on a medical front but racist or money-hungry, so you see areas in which multiple people are morally icky in different ways. It's pick your poison, in that sense.

Who do you side with, which intention is better (in this sense, abandonment vs. euthanasia), what biases exist in triage, when to omit info vs. be entirely transparent with relatives, for example. Few figures emerge reputationally intact from this narrative (if not unscathed, at least unflattered), and readers will likely cast judgment unevenly based on their individual value systems.

Essentially, when the skies clear and everyone's out of the hospital, people realize that there were far more deaths at Memorial than anywhere else, and started to investigate what happened. It turns out that there were drugs administered near the end of evacuations that likely sped up the deaths. So was that intentional? Who issued the orders? Was that justified in the context of any suffering and pain, and should doctors be allowed to make those calls for patients?

And then there's a lot of atmosphere built around the dignity of death. Within Dacher Keltner's analysis of what provokes awe, encounters with life and death is one of them. Hospice care is a unique precipice of sorts, and I still think frequently to taking care of my grandmother in her final days. End-of-life care has a certain black-and-white quality to it, and conversations around DNR orders and similar set everything else in stark contrast. Comfort matters too, which is part of what makes the dilemma depicted in this book so startling to many.

The best parts of the book are when it goes wide to introduce lots of context and questions across disciplines; when it goes too narrow, it feels more like it's repeating information. I appreciated that I felt subtle shifts in my thoughts and opinions over the course of the book about intention vs. outcome, responsibility, how to determine triage, etc. That, to me, signals an effectiveness in conveying the thorny complexity of the issue.

Sheri Fink also repeatedly emphasizes how field of vision narrows during crisis and how careers taught to triage, react, be decisive, etc. can make poor choices based on limited information—but how there's not a fantastic solution either. Nobody can hold all the information at once, so how do you decide what individual people can be responsible for in the midst of a tragedy?

As the conclusion eventually gets around to, the best way to avoid tragedies like what happened at Memorial is to consider worst-case-scenarios before they happen instead of banking that they won't, so that those individuals can make broader, more informed decisions without the heat of the moment clouding their judgement.

Overall Thoughts

Five Days at Memorial was an informative, fascinating, and occasionally heavy book. There's no doubt that the situation depicted was a messy, disorganized, terrible one in which a lot of people got caught in the crossfire, and Five Days also does a great job showing how everyone was operating from an incomplete picture. The businessmen involved in the hospital administration look absolutely terrible (predictably) in how they deflected the suffering of those stuck inside.

Primarily, this is a book about medical ethics and how to apply them during times of crisis, especially when decisions go beyond the scope of what someone is "normally" authorized to do. That's where the group vs. individual tension comes in, especially because memories are flawed and hindsight bias is too real—so nobody can precisely identify when or where specific shifts happened; instead, you're going to get some scapegoats so that people can put a tragedy behind them.

The book itself feels less clear than I expected, but again: I'm not entirely sure what is Fink perhaps biting off more than she could chew as a storyteller versus what is the genuine chaos of the situation. In this sense, I know writers who are capable of this balance—which is why I love Dick Couch, for example—but can't identify what is the author vs. the storm here. I didn't love her way of adding color to her descriptions; it felt at best a little awkward and, at worst colorful to the extent that it sounded fictional regardless of whether or not it was. I suppose I'm just curious as to whether or not this one got a Pulitzer Prize for its subject matter or for its execution too, because I could see it being the former.

I think the second half could have been handled better, as the first half was infinitely more compelling—and I say that knowing the first half is during the storm and the second is legal battles. Separate from the events themselves. I did often get the sense that she wrote herself into a corner at some points and had to repeat herself to transition. I've never lived in New Orleans (although it's on my wishlist at some point), so can't speak to whether it's done respectfully or too sensationally. The book has its pros and cons, but the topics were worth mulling over.

For fans of:

What Have We Done by David Wood; The Pitt (show); Dopesick by Beth Macy; Extreme Medicine by Kevin Fong; Columbine by Dave Cullen; etc.