Late August Reading
Sep. 3rd, 2023 08:40 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
aseFive Days at Memorial: Life and Death in a Storm-Ravaged Hospital (Sheri Fink) (2013): Presenting in two parts and an epilogue a chronicle of events, during and after Hurricane Katrina, at Tenet Memorial Medical (sold by Tenet as part of a post-Katrina divestment from Louisiana, currently Ochsner Baptist Medical Center); legal investigation into rumored patient euthanizations; and lessons learned (or not learned). An expansion of a 2009 New York Times article, "The Deadly Choices at Memorial".
The persons, motivations, and actions at play in the book incidentally or deliberately hit on trends that continue to bloom and bear fruit now, almost 20 years later. Emergency preparedness and assigning patient acuity during a crisis. The devastation of the 2005 Atlantic hurricane season ties into climate change and other hurricane disasters, such as Sandy in 2012 (whose New York City impact is touched on in the epilogue); Harvey and other major 2017 hurricanes; or the misery of the 2020 season, which started early, generated a record-breaking number of storms, ended late, and incidentally broke some of the records set by the 2005 (Katrina) hurricane season, during the first year of the COVID pandemic. The encroachment of profit motives on the healthcare sector. The interaction of race and perceived guilt, or perceived intention.
The first half of the book, "Deadly Choices" does a fantastic job communicating to the reader that on-the-ground decisions were made in relentless heat and tropical humidity, in a brick building with failed air conditioning, so forget about nighttime temperature recovery, on a background of shifting and sometimes contradictory information.
Fink makes some good incidental points that other hospitals struggled with the patient care and evacuation issues Memorial was challenged by, including a case where one patient was left for dead and later picked up, quite alive. She also touches on Charity Hospital being in the same floodwaters as the rest of the New Orleans hospitals, but somehow Charity Hospital seemed to avoid the patient mortality and possibly the worst of the morale problems Memorial suffered.
She also makes clear that the healthcare response to New Orleans' inundation was just as overwhelmed as any other part of the humanitarian disaster that followed Katrina.
The second half of the book, "Reckoning", focuses on the legal and social ramifications of two doctors' choices to euthanize a number of patients, as well as the ethical underpinnings. The MD ultimately put on trial had several things going for her: the chaos of events; being a second generation MD, the daughter of a doctor well-connected in New Orleans health care social circles; and being an upper-class white woman in the South. Fink highlights how this MD benefited from social connections and a snazzy media campaign, when it came time for a grand jury to find her innocent or guilty of second-degree murder.
(I will never, ever not be salty about the tidbit that the cancer center's generator maintained power, so the C-suite used the cancer center, with its working generator, as a break room, while patients with thermoregulation problems and dehydration were lying on mattresses on the floor one functional skyway away.)
Another thread of Memorial's messy outcomes was the AMA* recommendations for triaging critical patients when resources get limited, and limiting doctor liability in times of crisis. It seems to me that once you've opened the door to crisis compromises, it becomes a lot easier to find or manufacture a crisis, especially in settings that require skilled, in demand workers. There's a line right from Memorial and Katrina to the healthcare staffing of 2023.
*American Medical Association, not "against medical advice".
Wiki tells me that Fink received a PhD and MD from Stanford, and embarked on humanitarian work before or while getting into journalism. This is the sort of resume that makes one reconsider one's life choices.
Desiring a palate-cleanser, I reread a great deal of Captain Vorpatril's Alliance (Lois McMaster Bujold) (2012). The overall plot is: Ivan accidentally gets married, his wife's family turns out to be of Jacksonian-Cetagandan extraction,Nazi gold Cetagandan occupation historical artifact shenanigans ensue. There's a clear pivot at Ivan's realization he is, in fact, quite in love with his wife, where suddenly Tej's family appears to put outside pressure on Ivan and Tej to sort out their fake marriage. The pivot doesn't do great things structurally, and also takes some of the wind out of a small-scale novel focused on Ivan and Tej. Bujold's used the juxtaposition of character work, sweeping plot arc, and theme to good effect in Mirror Dance and Memory, but for me it didn't line up as neatly in CVA. I think the theme in this one was supposed to be "reconciling family and legacy" or something along those lines, mirroring Ivan and Tej as successful adults who are not the adults their parents wanted, but it gets a little obscured in the stop-start plot speed.
I see my original comments ended, At some point I'll appreciate CVA for what it is, rather than what I'd like it to be, which I find unintentionally amusing in light of above thoughts on theme.
The persons, motivations, and actions at play in the book incidentally or deliberately hit on trends that continue to bloom and bear fruit now, almost 20 years later. Emergency preparedness and assigning patient acuity during a crisis. The devastation of the 2005 Atlantic hurricane season ties into climate change and other hurricane disasters, such as Sandy in 2012 (whose New York City impact is touched on in the epilogue); Harvey and other major 2017 hurricanes; or the misery of the 2020 season, which started early, generated a record-breaking number of storms, ended late, and incidentally broke some of the records set by the 2005 (Katrina) hurricane season, during the first year of the COVID pandemic. The encroachment of profit motives on the healthcare sector. The interaction of race and perceived guilt, or perceived intention.
The first half of the book, "Deadly Choices" does a fantastic job communicating to the reader that on-the-ground decisions were made in relentless heat and tropical humidity, in a brick building with failed air conditioning, so forget about nighttime temperature recovery, on a background of shifting and sometimes contradictory information.
Fink makes some good incidental points that other hospitals struggled with the patient care and evacuation issues Memorial was challenged by, including a case where one patient was left for dead and later picked up, quite alive. She also touches on Charity Hospital being in the same floodwaters as the rest of the New Orleans hospitals, but somehow Charity Hospital seemed to avoid the patient mortality and possibly the worst of the morale problems Memorial suffered.
She also makes clear that the healthcare response to New Orleans' inundation was just as overwhelmed as any other part of the humanitarian disaster that followed Katrina.
The second half of the book, "Reckoning", focuses on the legal and social ramifications of two doctors' choices to euthanize a number of patients, as well as the ethical underpinnings. The MD ultimately put on trial had several things going for her: the chaos of events; being a second generation MD, the daughter of a doctor well-connected in New Orleans health care social circles; and being an upper-class white woman in the South. Fink highlights how this MD benefited from social connections and a snazzy media campaign, when it came time for a grand jury to find her innocent or guilty of second-degree murder.
(I will never, ever not be salty about the tidbit that the cancer center's generator maintained power, so the C-suite used the cancer center, with its working generator, as a break room, while patients with thermoregulation problems and dehydration were lying on mattresses on the floor one functional skyway away.)
Another thread of Memorial's messy outcomes was the AMA* recommendations for triaging critical patients when resources get limited, and limiting doctor liability in times of crisis. It seems to me that once you've opened the door to crisis compromises, it becomes a lot easier to find or manufacture a crisis, especially in settings that require skilled, in demand workers. There's a line right from Memorial and Katrina to the healthcare staffing of 2023.
*American Medical Association, not "against medical advice".
Wiki tells me that Fink received a PhD and MD from Stanford, and embarked on humanitarian work before or while getting into journalism. This is the sort of resume that makes one reconsider one's life choices.
Desiring a palate-cleanser, I reread a great deal of Captain Vorpatril's Alliance (Lois McMaster Bujold) (2012). The overall plot is: Ivan accidentally gets married, his wife's family turns out to be of Jacksonian-Cetagandan extraction,
I see my original comments ended, At some point I'll appreciate CVA for what it is, rather than what I'd like it to be, which I find unintentionally amusing in light of above thoughts on theme.
(no subject)
Date: 2023-09-09 07:56 pm (UTC)Sometimes the best answer to deadly seriousness is a little lightening the mood!