Leadership Decisions During an Unimaginable Crisis: 5 Days Underwater
Impossible decisions were made at Memorial Medical Center
When the hurricane known as Katrina, first hit Memorial Medical Center in New Orleans, the hospital’s Incident Commander was told by the facilities manager that even though the hospital had survived hurricanes in the past, the biggest risk this time was flooding. He told her that flood waters of more than four feet would result in a power outage and a potentially catastrophic outcome.
This was the beginning of the story about the hospital’s traumatic experience during Hurricane Katrina, as told in Apple TV’s narrative series Five Days at Memorial.
In the next scene, we see the Incident Commander ripping through the hospital’s thick Policies and Procedures Manual, specifically the Crisis Procedures section looking for the emergency procedure for flooding. It didn’t exist. There was no plan or procedure for a flood.
A hospital that was three feet below sea level had no plan for flooding.
The Incident Commander asked the facilities manager what they would need to do if it did flood. He told her the only option would be to evacuate.
She called together the management team who put their heads together to begin planning for the worst.
They soon found out that they would need to make decisions on the fly and develop procedures as they implemented them. See my essay Leaders Have a Plan: When They Don’t They Create One on the Fly where I discuss the skills needed for unanticipated crises.
Leadership & Decision-Making
The hospital administrators had to make extremely tough decisions. They made their decisions under unimaginable conditions within a tight time frame. They were sleep-deprived, hot, hungry, thirsty, dirty, physically exhausted, and emotionally overwhelmed. Their patients experienced the same challenges while also suffering from their medical conditions.
Every possible scenario can’t be predicted or prepared for, and the healthcare providers at Memorial were in a nightmare that continued to get worse.
The hospital received intermittent assistance from National Guard helicopters and boats, but that assistance was limited and unpredictable because of the dire needs of the entire region.
On the fifth day of hell, police officers showed up unexpectedly and told management that everyone had to be out of the building by 5:00 pm.
The reality they faced under police orders, was that there wasn’t enough time, staff, boats, or helicopters to evacuate every person in the building.
The providers had to decide who to evacuate and who to leave behind.
The Apple TV series was not a documentary but a narrative based on the 2010 investigative piece The Deadly Choices at Memorial by Sheri Fink and her 2013 book Five Days at Memorial.
No narrative film is ever 100% accurate, and many that are based on true stories are criticized for the “artistic license” taken in telling the story. There are always parts added or removed. Though unintentional, a narrative series will contain the unconscious bias of the filmmaker, as well as the bias of the author of the book.
Documentary films are considered to be more accurate but they also display the bias of the filmmaker. While some are far more neutral than others, the filmmaker’s interpretation is always apparent in their editing decisions and the time they allot to each aspect as well as what is not included in the final cut.
Throughout the series, we watch the hospital staff make heroic efforts to evacuate patients, while simultaneously still providing treatment.
The helicopter pad was on the roof and without electricity, getting patients up there required carrying each person up several long sets of steep rickety metal stairs that were outside of the building. Getting the larger patients up those narrow stairs was quite a feat.
Then there were additional circumstances that added complexity to the situation. The 52 patients on the seventh floor were part of LifeCare, a separate long-term, acute care system for elderly patients with multiple medical problems. LifeCare had its own separate administrative body and medical staff.
During the crisis, LifeCare administrators seemed to be missing in action.
From the ProPublica article:
“LifeCare’s medical director, Dr. John Wise, who had stayed at the hospital for previous hurricanes, was not present during Katrina. He had notified the company in advance and arranged coverage for his patients. Some patients’ family members as well as doctors I interviewed questioned whether his presence might have improved the outcomes for LifeCare patients. Memorial’s physician chief of staff also happened to be out of town when Katrina struck.”
With almost no LifeCare administrators, and as far as I know, zero assistance from corporate headquarters in Texas, the staff of Memorial Medical Center was left with the burden of helping to care for and evacuate an extra 52 patients who were not their responsibility. This article explains:
While a number of LifeCare patients were clearly in their last days regardless of the storm, there was one patient who seemed healthier than the others and certainly more lucid. He was quite ill but the main thing working against him was his size, and as many would argue, also his race.
He was a Black man who must have weighed at least 400 pounds. It would have been extremely difficult, if not impossible, to move him up and down stairs to a boat or helicopter.
Impossible Decisions
Rather than letting him, and dozens of other patients die a slow excruciating death all alone, one doctor in the final moments administered two painkillers in high doses.
She had either intended to medicate them or to purposely euthanize them. It seemed that either way, she was trying to relieve the suffering of those patients.
We will never know every detail of the decision but the man who seemed a bit healthier was Black and the physician who administered the medication was a white woman.
If she had not intervened and had instead left patients to die a slow agonizing death all alone because evacuating every last one of them was impossible, their deaths likely would have been chalked up to the storm, and the horrendous conditions.
One of the most fascinating aspects of this story was the range of opinions of the doctors and nurses who worked at Memorial and who were present for at least some of that disaster. There was clear polarization.
One camp thought that not enough was done to save and evacuate every last patient regardless of the fact that it was impossible. Those same people believed that it was immoral to euthanize patients under any circumstances.
The second camp saw the situation as impossible and while they were hesitant to state it directly they were of the belief that medical intervention that euthanized patients who were surely going to die was an acceptable option since it immediately relieved patients’ suffering and did not leave them in the emotional agony of dying slowly and completely alone.
Many were interviewed. Some made strong accusations which resulted in charges being brought against the doctor who administered the medication. She went to trial but was acquitted by a jury.
“The Five Days at Memorial true story confirms that an internist at Memorial Medical Center named Bryant King told CNN that “the discussion of euthanasia was more than just talk.” Based on conversations he had with other workers at the hospital, he publicly asserted that one or more employees had killed patients.
King said that when he learned that they were going to kill patients, he boarded a rescue boat and left. “I’d rather be considered a person who abandoned patients than someone who aided in eliminating patients,” he told CNN’s Nancy Grace.” — History vs Hollywood
Impossible decisions were made during each of the fives days. Those decisions became increasingly more difficult to make.
If we could put every great leader in that exact same situation under those conditions, no doubt some would have made the same decisions and some would have made decisions that were dramatically different.
Some will argue this but there are many complicated and nuanced situations that require leadership decisions, but because the situation is so complex, there is no definitive right or wrong choice.
How do we judge the decisions of professionals in a worst-case scenario on steroids?
Perhaps we don’t.
Yes, some sort of investigation was needed.
It was horrifying that so many dead bodies were found carefully (perhaps respectfully) placed in one room, but to view that reality out of context of the unimaginable situation is not only unfair but likely difficult to avoid.
How could the jurors possibly understand the trauma and hardship experienced by the healthcare providers and the complexity of the situation? How could the jurors judge the decisions that were made under such excruciating conditions?
No doctor should ever find themselves in the kind of situation that forces them to make impossible decisions but if they do and if they acted decisively, we can see them as leaders who did something.
We can see them as a committed professional who did not freeze, flee or remain passive, but who reached deep into their conscience and used their experience to make what they believed to be the best choice from a menu that had no acceptable choices.
