The ndeasy thing to say about this book is that it is remarkable. I can’t even begin to imagine how Fink found the information necessary to put together this compelling narrative. There’s material here for two books – first, what happened during those five days at Memorial and then what happened as a consequence of decisions made during those five days. Even the Epilogue – a focus on what we have and have not learned about emergency preparation and procedures – could, itself, be the seeds of another book (and is certainly required reading for those who make policy. Though I am not overly reliant or impressed by awards, I am not at all surprised that this book was a National Book Critics Circle Award Winner and a winner of the Pulitzer Prize.

Fink wisely omits discussion of the human and natural causes of Hurricane Katrina’s devastation. That is not her subject. Instead, she focuses on what happened at one hospital (though there are useful peeks at what happened at others – they are present for the purposes of comparisons) and the decisions made by, well, that’s part of the problem – it’s unclear who made some of the decisions. But there were plenty of decisions made – by everyone from architects, to doctors and nurses, to helicopter pilots, to people sitting far away at corporate offices, but not too many – and this is part of Fink’s point – by patients and their advocates.

This book raises an incredible number of questions. How much time and money should be spent on emergency equipment, procedures, personnel and training that we hope to never use? Could we have really been ready for Hurricane Katrina (and Rita)? What can, realistically, be done to improve central issues like communication? How can procedures be streamlined so that significantly less time is spent on turf battles during a time of crisis? What is the best way to conduct triage at a time like this?

And then, afterwards, how can we evaluate and learn from such a disaster in order to improve our response the next time? To what extent should we judge (in a court of law) decisions made in such times – times that those of us outside the situation cannot possibly understand?

Someone (Eisenhower?) once said, “Plans are worthless, but planning is everything.” I think that applies here. Find good people – and there are plenty on display here – give them what they need (training, materials, checks & balances, etc.) and then get out of their way. Do I agree with every decision made during those 5 days? No, but I wasn’t there, so my judgment means little. The conduct of some the key players after those five days – including a doctor at the center of the situation – does deserve serious scrutiny. Decisions made ‘on the ground’ can be understood, if not always supported. I think we should have very little tolerance for pre-meditated efforts to alter the narrative, no matter whose interests those alterations serve.

http://www.nola.com/katrina/#/0

http://www.sherifink.net/

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