The harrowing account of the life and death decisions made in the midst of chaos following Hurricane Katrina, including government incompetence, official inaction, incredible stupidity, dedicated medical professionals, and questionable ethical decisions.

I won this book through GoodReads First Reads program and was thankful for the opportunity to read it. Not an easy read or a fast one, but very thought-provoking.

This is a book that is almost impossible to review with complete objectivity, much like the events discussed within it. I am thankful for the opportunity to read the book and to ponder so many issues and incidents that will haunt me for a long time just from having read about them.

I was interested in reading this book for several reasons: I am an attorney who deals with medical issues and claims regularly; the best and most difficult class in my law school experience was a seminar on bioethics and the law; and I visited New Orleans less than a year post-Katrina and was appalled by the remaining ravages of the storm and horrified by how much worse the conditions must have been during the crisis itself. I had already had some knowledge of the cases involving Memorial and St. Rita's and this book was on my radar screen from the beginning. The interview with the author on The Daily Show reinforced my fascination.

And then the book arrived and I was set to start reading and reviewing it just as the Great Shutdown Showdown of 2013 began -- and I am a government employee working in Washington DC, so I had a front row seat to the madness. Reading about the madness and stupidity and official ineptitude and lack of forethought associated with Katrina in that atmosphere was too much. I had to put the book down.

Once the government was officially open for business, I picked it up again. Unfortunately, the disaster of Hurricane Katrina and administrative stupidity and poorly coordinated efforts awaited within. Reading more than 10 or 15 pages at a time was painful and horrifying. The fact that a mock disaster drill for a massive hurricane resulting in widespread destruction, flooding, and power outages including at hospitals had been held within the month preceding Katrina and the very people who fumbled the ball in the real crisis had participated in (and clearly learned nothing from) the drill was a revelation that nearly made my head explode. The image of hospital executives leaving behind squalor and suffering, dying patients in an overheated crippled hospital to cross to the cancer institute and sit in the air conditioning microwaving meals and chatting on their cell phones and, even after being evacuated and knowing how many people died while they shunned all responsibility, seeing nothing odd about those choices -- words fail me! The first portion of the book is difficult to get through.

The second portion deals with the investigation and the aftermath. You get to know more about the wider city and the other choices being made and specific feelings of the family members (which, by the way, was somehow never presented to the grand jury!). You learn that there were -- and to a large extent still are -- no real guidelines for how to triage patients for evacuation or provision of scarce resources to critical patients or determine who should control between the military and the police and the government and the medical personnel. You saw how the corporate structure of Tenet clearly had some bearing on how things were handled -- both on a larger scale for the executives outside New Orleans and a smaller scale in terms of how the staff was used to thinking about the choices for care available to them -- in that they eventually sold all their properties in the area in order to pay the fines for millions of dollars of Medicare and insurance fraud on a huge scale. You saw how the staff at Charity Hospital, with fewer resources than Memorial, but more practice at caring for people with little or none of the expensive options, the loss of which flummoxed Memorial staff, were able to maintain order and structure and improvise solutions that saved the majority of their patients.

And you get to learn about how, even more than in most places, Louisiana is governed by money and political connections in everything it does. The amount of time the coroner spent dithering about cause and manner of death even as he solicited expert opinions from all side -- and then proceeded to ignore them. The political grand-standing of the State Attorney General which undermined his own case and sacrificed the work put into it by the staff. The politicking and raising of money for defense funds and the demonizing of those who questioned the events at Memorial. I could appreciate the legal strategies employed by the defense and the hard work of the investigators and attorneys developing the case. And I could appreciate the frustration of the families of the patients/victims and the number of cases that were swept aside to pursue the headliners. And in the end, I am still left with all of the questions about what would I have done and what would I have wanted done for me and my loved ones in that situation.

This book was incredibly well-written. The tension and desperation of those days at Memorial is palpable as you read the first section of the book. You get the perspectives of all of the people -- patients, family, nurses, doctors, and even executives -- presented as objectively as possible but with enough of their point of view that you don't think of any of them as demons or angels. You are given all of the facts and background and allowed to draw your own conclusions, even while the conclusions drawn by the author are clear. In the end I concluded that Mr. Everett's death had definitely been murder and that the others were questionable, especially given that help had at last arrived -- although it was unclear whether there was a larger intent by those outside to rescue the sickest of the sick. And yet I still concluded that Dr. Anna Pou is a devoted surgeon who cares deeply about her patients and their well-being. And the larger blame for much of the tragedy of Katrina remains with the values of society being placed on the here and now and saving money while not thinking of all the things that could go wrong!

"A book is a mysterious object, I said, and once it floats out into the world, anything can happen. All kinds of mischief can be caused, and there's not a damned thing you can do about it. For better or worse, it's completely out of your control." -- Paul Auster

This book is going into the Medicine Chest Book Box, which is off to Florida and azuki.

Came home in the Medicine chest IV. Looks interesting.

Wow. I cannot better 6of8's review. This is a must read about diaster preparedness, corporate greed, excellent non-fiction writing, and human frailty.

After reading this book, I felt for all the actors, top to bottom. I abhor many of the decisions made, the justifications, the explanations, but I agree with 6of8:

"And yet I still concluded that Dr. Anna Pou is a devoted surgeon who cares deeply about her patients and their well-being. And the larger blame for much of the tragedy of Katrina remains with the values of society being placed on the here and now and saving money while not thinking of all the things that could go wrong!"

Sad. Very sad. Yet Dr. Pou's failure is an indictment to us all at not standing up in uncomfortable times and saying "no."

One result of this book; my husband and I will NOT be filing care directives. Instead we will sign them and give them to each other to be used as a last resort if ever necessary.

Put in the Medicine Chest V Bookbox.

Chosen from the Medicine Chest V book box.

What better place to leave this than the ICU Waiting area. Interesting book.