Aug 21, 2016

Playing God

When people are dying and you can only save some, how do you choose? Maybe you save the youngest. Or the sickest. Maybe you even just put all the names in a hat and pick at random. Would your answer change if a sick person was standing right in front of you?

In this episode, we follow New York Times reporter Sheri Fink as she searches for the answer. In a warzone, a hurricane, a church basement, and an earthquake, the question remains the same. What happens, what should happen, when humans are forced to play god?

Produced by Simon Adler and Annie McEwen. Reported by Sheri Fink. 

In the book that inspired this episode you can find more about what transpired at Memorial Hospital during Hurricane Katrina, Sheri Fink’s exhaustively reported Five Days at Memorial

You can find more about the work going on in Maryland at: www.nytimes.com/triage

Very special thanks to Lilly Sullivan. 

Special thanks also to: Pat Walters and Jim McCutcheon and Todd Menesses from WWL in New Orleans, the researchers for the allocation of scarce resources project in Maryland - Dr. Lee Daugherty Biddison from Johns Hopkins University School of Medicine, Howie Gwon from the Johns Hopkins Medicine Office of Emergency Management, Alan Regenberg of the Berman Institute of Bioethics and Dr. Eric Toner of the UPMC Center for Health Security.

Support Radiolab by becoming a member today at Radiolab.org/donate.    

THE LAB sticker

Unlock member-only exclusives and support the show

Exclusive Podcast Extras
Entire Podcast Archive
Listen Ad-Free
Behind-the-Scenes Content
Video Extras
Original Music & Playlists

Jad Abumrad:

Let's just start it from the top. Okay, you ready?

 

Robert Krulwich:

Mm-hmm (affirmative).

 

Jad Abumrad:

All right. So for reporter Sheri Fink, who works at the New York Times and is author of the book Five Days at Memorial, you could say it all began with two tents.

 

Sheri Fink:

So this was back I 1999. The US and other, I think NATO, allies were involved in a bombing campaign in Serbia.

 

Jad Abumrad:

This is basically like the last gasps of war in the former Yugoslavia. You had Serbia attacking ethnic Albanians in Kosovo. NATO was trying to protect them, bombing Serbia, which was creating a huge exodus of refugees. Now Sheri at the time was not yet fully a reporter. She was fresh out of med school, volunteering at a human rights organization, working on a book about a war hospital in Bosnia. And since she knew the landscape, she was able to convince this organization to let her go to Macedonia to document what was happening, to document potential war crimes.

 

Sheri Fink:

So I remember I went to the border of Kosovo and Macedonia and, like, a hundred thousand refugees had shown up. They were trying to cross the border into Macedonia but the Macedonian government had closed its border with Kosovo, so people who were fleeing got trapped. They got stuck in this muddy no man's land between the two borders.

 

Jad Abumrad:

She said police in riot gear were basically lining the Macedonian side. So you had all of these people crammed into this muddy channel.

 

Sheri Fink:

And the Macedonian Red Cross and this one charity had gotten permission to set up a makeshift medical station in that border area between these two countries.

 

Jad Abumrad:

It was this sort of frumpy, brown medical tent. Now, Sheri was there to conduct interviews, nothing to do with medicine.

 

Sheri Fink:

I was there to collect information but when I got there I literally remember walking up to this border, and a doctor who I had interviewed previously, this really tall Albanian, Kosovo-Albanian doctor, looked out and he told the Macedonian border guards, "Let her in, we need her. She's a doctor."

 

Jad Abumrad:

They just grabbed you and pulled you into this tent?

 

Sheri Fink:

Yes.

 

Jad Abumrad:

What, so you were just out of med school when this happened?

 

Sheri Fink:

I had just finished med school, yeah.

 

Jad Abumrad:

Suddenly, she says, she was tossed in with all these war doctors. And here's the key, eventually she gets posted at the door of the tent.

 

Sheri Fink:

And what I ended up doing, or what they put me in charge of, was triage.

 

Robert Krulwich:

Now, triage. It's a French word.

 

Jad Abumrad:

Nice accent.

 

Robert Krulwich:

Yes, thank you. It means to sort or to sort for quality. Originally it was a reference to sorting coffee beans, actually, sorting different kinds of coffee. But a few hundred years ago, the word started being applied to people, to actually sorting different kinds of casualties on a battlefield. And that suddenly was her job.

 

Sheri Fink:

Literally, I stood outside of this makeshift medical station and every minute, every couple of minutes, there would be another patient brought to the door of our medical tent. And so my job was to stand outside that door and decide who gets in and who doesn't.

 

Jad Abumrad:

And like, how did you do that? How did you make that choice?

 

Sheri Fink:

Well, I don't remember having guidelines. I remember just having to wing it.

 

Jad Abumrad:

She says she just went on instinct.

 

Sheri Fink:

And so the people who seemed like they might be having a heart attack or a seizure, those were the ones that went into that tent.

 

Jad Abumrad:

But, you know, people with physical disabilities, no.

 

Sheri Fink:

People who have chronic conditions-

 

Jad Abumrad:

No.

 

Sheri Fink:

Psychiatric issues?

 

Jad Abumrad:

No.

 

Sheri Fink:

Everybody else I had to direct to this other tent and someone ended up calling it The Tent of the Damned. I remember appealing for help from the Macedonian Health Ministry, saying, you know, take these people into Macedonia, they're not a threat. Open your border, take them in. They need care. And the health ministry kept refusing and so they stayed in this tent day after day.

 

Jad Abumrad:

Sometimes for four, five, six days.

 

Sheri Fink:

And several of the people in this tent, they died.

 

Jad Abumrad:

Sheri says this experience haunted her. And years later, when she was a full-blown reporter and traveling all around the world looking at triage in different scenarios, she would return to this memory again and again and wonder, how do people in that situation make that decision? How should they?

 

Robert Krulwich:

Today a collaboration with the New York Times. We're going to follow reporter Sheri Fink through the ins and outs of triage in three different situations, three different places in the world, as she tries to understand what it means to play god.

 

Jad Abumrad:

I'm Jad Abumrad.

 

Robert Krulwich:

I'm Robert Krulwich.

 

Jad Abumrad:

This is Radiolab. Stay with us.

 

Jad Abumrad:

Are we rolling?

 

Robert Krulwich:

Yeah.

 

Jad Abumrad:

Okay.

 

Sheri Fink:

Oh, I think he was going to get...

 

Jad Abumrad:

Oh, is he going to get you some water? Okay. By the way, you know, we're going to start with Kosovo, but when did you as a writer become obsessed with all of this?

 

Sheri Fink:

Well, this obsession about triage came about when I was working on my last book, Five Days at Memorial, which was about triage in an emergency, in Hurricane Katrina.

 

Jeff Morrow:

This is the scenario that people in New Orleans have been fearing for a long time. A category five hurricane headed right toward the city. I'm Jeff Morrow, on the Riverwalk in New Orleans [crosstalk 00:06:36]

 

Jad Abumrad:

Okay, so this is going to be our first stop. We all have heard the story of Katrina told and retold, and certainly it's hard not to think about now with what's happening in Baton Rouge. But in this story the hurricane is really just a backdrop. Really, we're going to focus in on one building.

 

Sheri Fink:

This hospital, Memorial Medical Center, built in 1926 in one of the lowest parts of that city, which is really like a bowl.

 

Jad Abumrad:

It was a sturdy brick building, eight stories tall, stretching over two city blocks.

 

Sheri Fink:

It had served in every storm until that point. It was really seen as somewhere safe.

 

Male:

The city of New Orleans is under mandatory evacuation. Everyone is advised to leave the area.

 

Robert Krulwich:

And this hospital became for Sheri a kind of portal into these questions about triage. She ended up spending six and a half years interviewing doctors at the hospital, patients, nurses, family members, government officials, ethicists, hospital administrators. In all, she conducted over 500 interviews to reconstruct moment for moment what happened at the hospital during Hurricane Katrina.

 

Male:

Get ready. The most intense part of the storm is getting ready to come across.

 

Jad Abumrad:

Day one. Monday, August 29th, 2005.

 

Sheri Fink:

Around 6:00 AM Katrina hits.

 

Female:

It turned [inaudible 00:07:57] and we all right.

 

Male:

I've never seen anything in my life like this.

 

Sheri Fink:

And...

 

Male:

Oh man, this is going to be [inaudible 00:08:06]

 

Sheri Fink:

They get through the storm okay. The city power is gone but they've got their backup power. But this hospital had a vulnerability a lot of American hospitals have, which is that they had moved the generators to the second floor.

 

Jad Abumrad:

So that they would be higher up, in case of flooding.

 

Sheri Fink:

But electricity is all about circuits. And they had elements of that backup power system that were below flood level. Things like switches and other electrical material.

 

Jad Abumrad:

But they got through the first day okay. And it seemed at that point that the worst was over.

 

Sheri Fink:

And then-

 

Male:

Stop. You haven't heard about that water coming over that levy from the lake?

 

Male:

No.

 

Male:

When did It start rising?

 

Male:

Actually, after the storm. And it cleared up...

 

Sheri Fink:

The levees failed.

 

Female:

Sweet lordy.

 

Sheri Fink:

Water surrounds this hospital. It fills New Orleans and, as the water started to rise around the hospital, that is the moment that the people in charge knew they were in big, big trouble. They knew what their vulnerability was.

 

Robert Krulwich:

How many patients were in the hospital at this point?

 

Sheri Fink:

There were 250 patients. There were about 2,000 people, because you had so many staff-

 

Jad Abumrad:

Wow.

 

Sheri Fink:

... and then all the visitors who had come with the staff members and with the patients.

 

Jad Abumrad:

So, Sheri says, mid-morning on that second day... this is Tuesday, August 30th... just as the waters were starting to rise...

 

Sheri Fink:

A group of doctors got together and they did come up with a system, which evolved a little bit over the crisis. But they decided, first, get the babies out, get the critical care patients out. And they knew that they had two high-water trucks from the National Guard and the water wasn't so, so high yet.

 

Jad Abumrad:

At that point it was only part-way up the sloping emergency room ramp.

 

Sheri Fink:

And they decided to put patients who could walk on those trucks. So helicopters start to arrive.

 

Jad Abumrad:

Medical staff start to bundle tiny babies in incubators, ICU patients in wheelchairs, onto the elevator and up to the helipad.

 

Robert Krulwich:

How many patients can a single helicopter take?

 

Jad Abumrad:

You know, like the ones that were landing. How many can they do?

 

Sheri Fink:

One or two.

 

Jad Abumrad:

Wow, so this is slow going.

 

Sheri Fink:

Yeah. It was late evening before they got all of the intensive care unit patients out.

 

Jad Abumrad:

Did they get all the babies and the...

 

Sheri Fink:

They got all the babies.

 

Jad Abumrad:

All in all, on that second day they evacuated about 60 people. These are 60 of the most critical patients. Although we should also say that if a patient had signed a DNR, a Do Not Resuscitate order, the doctors decided those patients should not go first and they were held back. We'll sort of explain their thinking on that in just a second. Okay, so darkness falls on day two. The doctors and nurses are exhausted.

 

Sheri Fink:

They'd been working really, really hard carrying patients in the heat.

 

Jad Abumrad:

Many of them lay down on cots in vacant beds.

 

Sheri Fink:

To rest for the night. And then before the sun rises, a few hours before, about 2:00 AM, the buzz of the generators suddenly just...

 

Jad Abumrad:

Stopped.

 

Sheri Fink:

It was quiet.

 

Jad Abumrad:

The water had reached those electrical switches in the basement.

 

Sheri Fink:

Dr. Cook, Ewing Cook, a longtime ICU doctor, he was lying not far from where those generators were and he said to me it was "the sickest sound of his life."

 

Robert Krulwich:

The sound of absence.

 

Jad Abumrad:

Yeah.

 

Sheri Fink:

And that is when it became an absolute emergency in this hospital. It's pitch blackness, some of the medical equipment, they have backup batteries, they started beeping to warn that the electrical power had stopped. You still had nine patients who relied on ventilators to breathe.

 

Sheri Fink:

It became a hive of activity. We've got to get everyone out. Everybody was running around with flashlights, these beams in the blackness, trying desperately to move those patients down the stairs now there's no elevators, that's the other big thing. Fortunately somebody found a hole in the machine room wall on the second floor, that led directly to a parking garage. So they figured out they could pass patients through this roughly 3x3 ft hole onto the back of a pickup truck, drive them up to the eighth story of that parking garage, and then carry them up three rickety flights of steps to this formerly unused helipad. And five of the nine patients on ventilators died, just right then.

 

Gina Isbell:

It's just like I said, I've been trying to put it away.

 

Sheri Fink:

Yeah.

 

Gina Isbell:

But I want to make this as accurate as I can for you.

 

Robert Krulwich:

This is tape of an interview that Sheri did back in 2008, when she was doing research for this story.

 

Sheri Fink:

Okay, well why don't we just start [crosstalk 00:13:04] introduce yourself.

 

Gina Isbell:

My name is Gina Isbell.

 

Sheri Fink:

Isbell, okay.

 

Gina Isbell:

Mm-hmm (affirmative). Just like it's spelled.

 

Robert Krulwich:

Gina was a nursing director working on the seventh floor of the hospital that day.

 

Jad Abumrad:

She'd actually been attending to those nine patients that didn't make the first helicopter ride.

 

Robert Krulwich:

And she described to Sheri that, right after the power went out and after the ventilators shut down, one of her patients flat-lined.

 

Gina Isbell:

And we brought him back. We had run out of oxygen, the whole hospital.

 

Robert Krulwich:

That's what she'd been told.

 

Gina Isbell:

And he needed oxygen, so we brought him down the stairs to the second floor...

 

Robert Krulwich:

They brought him down in the dark and then got in line to wait for their turn to go through the hole in the wall up to the heliport. She says that since his ventilator wasn't working anymore, the whole time they were standing there they had to hand squeeze this ventilator bag to keep air going into his lungs.

 

Gina Isbell:

You know, he kept twitching and I knew he needed oxygen. And [inaudible 00:14:00] I was in line and it was my turn at the window. I kept bagging him and bagging him. One of the physicians came over and said, "You do know that he needs oxygen." I said, "Yes, sir." And he said, "We don't have any oxygen and we can't get any. You have to let him go." And at that point, you know, I'm standing there and I'm like, how do you do this? How do you just let him go? But he was right.

 

Gina Isbell:

I mean, I knew it was neurological and that he needed oxygen and that he wasn't going to make it without it. So I just hugged him and stroked his hair. I waited and just kind of held him. He died in my arms and, you know, you're not prepared for that.

 

Gina Isbell:

I had to take him out of the boiler room so I rode him out and the morgue was full. The chaplain came over to me and he says, "Come on with me." We took the body into the chapel and I just stood there and I just busted up crying. He just held me and we prayed. When he left I just sat in the chapel for a few minutes and tried to compose myself a little bit. You're prepared to help people and to save people, you know. It's just not enough. Everything you've done is just not enough.

 

Jad Abumrad:

Day three. Wednesday, August 31st, 2005.

 

Sheri Fink:

The sun rises and that's when they're expecting all the helicopters to come back. And they wait, and they wait, and they wait. An occasional helicopter comes but this concerted rescue effort that had taken place the evening before has stopped.

 

Jad Abumrad:

Now, we know now looking back, that on that Wednesday-

 

Sheri Fink:

The helicopters were doing their own triage.

 

Reporter:

... the Coastguard rescuing people...

 

Sheri Fink:

And looking at people on rooftops waving rags.

 

Reporter:

The entire family is on that roof right now [crosstalk 00:16:49]

 

Male:

[crosstalk 00:16:49] these people need to go.

 

Sheri Fink:

But the people inside the hospital, most of them had no idea. All they knew was, we're in this horrific situation, where are the helicopters?

 

Jad Abumrad:

At this point there's still nearly 200 patients at the hospital.

 

Sheri Fink:

And some of the staff, they're panicked because it takes them so long to move the patients to the top of the parking garage just below that helipad.

 

Jad Abumrad:

So she says, on that third day at about 7:00 in the morning, a bunch of doctors and hospital administrators...

 

Sheri Fink:

Maybe a dozen, dozen and a half.

 

Jad Abumrad:

They got together and they decided that they needed a system, a way of organizing their patients, so that when those helicopters started to show up again they wouldn't waste any time at all. They'd know exactly who to evacuate, in what order.

 

Sheri Fink:

In other words, who are we going to get out first? That was the question. And that's the moment where they come up with the ones, twos, and threes. This is triage. There are a limited number of resources, in this case helicopters and few boats, and we have to decide which people get access to those resources. There are a couple of ways to look at this.

 

Jad Abumrad:

Sherry says if you go back to the very beginning of triage...

 

Sheri Fink:

... the first conception of it.

 

Jad Abumrad:

1790s.

 

Sheri Fink:

Napoleon's chief surgeon. Baron Larrey, I think.

 

Jad Abumrad:

He made a rule on the battlefield...

 

Sheri Fink:

... that you take the people who are in the acute need first. So the sickest are going to be treated first and with the most resources. This is the way it works in most emergency rooms. There's a long waiting line of fevers and cuts, but if you got a heart attack you get right to the front of the line.

 

Sheri Fink:

Another way to look at is the utilitarian concept.

 

Jad Abumrad:

This got its start with some philosophers in the 18th and 19th centuries.

 

Sheri Fink:

The core of this idea seems simple, try to do the greatest good. You want to maximize some sort of good outcome amongst a population.

 

Jad Abumrad:

So rather than think about what one individual needs, you think, how can I save the most number of lives or the most number of years of life?

 

Sheri Fink:

If we want to maximize years of life we might want to pick people who have a better chance of surviving or younger people.

 

Jad Abumrad:

And this method of triage is what you often see in a war zone where, say, there's a bombing and you have more injured victims than there are ambulances or medics.

 

Sheri Fink:

So one, two, three. Imagine a lobby area in a hospital, a waiting area.

 

Jad Abumrad:

Sherry says, in this case, what the doctors did...

 

Sheri Fink:

They asked the staff to get everyone out of their rooms...

 

Jad Abumrad:

... bring them down to that second-floor lobby...

 

Sheri Fink:

... and then some doctors, including one whose name might be relevant for later, Dr. Anna Pou...

 

Jad Abumrad:

She was a head and neck surgeon.

 

Sheri Fink:

She and another doctor, they stationed themselves on the landing where the patients were brought down to on that second floor. And as the nurses would bring them, they would look quickly at the patient's chart, look at the patient, and decide on a number. And the nurses would take a magic marker and a piece of paper and writer either "one," "two" or "three" on that paper.

 

Jad Abumrad:

And then she says they would tape that number...

 

Sheri Fink:

... onto the patient's gown. So the ones were your relatively healthy patients, a patient maybe who had an appendicitis and their appendix out but they're looking good, they could even be discharged. The ones would be rescued by boat, presumably among the first. The twos were your more typical hospital patients. A patient maybe who had a heart attack, who wasn't fully recovered, who would need ongoing care. They would go by helicopter, presumably second. And then the threes were those super-sick patients or anyone with a Do Not Resuscitate order.

 

Jad Abumrad:

Those patients would go last.

 

Sheri Fink:

One of the doctors... when I said, "Why did you choose the sickest patients to go last?"... one of them said, "Well, I figured anyone with a Do Not Resuscitate order would have a terminal or irreversible condition," which, by the way, isn't always the case. And he said, "I thought that that patient would have 'the least to lose.'"

 

Jad Abumrad:

So it sounds like in some way they went to more of a utilitarian way of thinking.

 

Sheri Fink:

Yeah.

 

Jad Abumrad:

And you could see everything that follows as flowing from that utilitarian decision. And actually, they made it at a few different points, to prioritize the healthiest people first and the sickest people last.

 

Sheri Fink:

These choices ultimately did become very consequential.

 

Jad Abumrad:

In any case, all three groups were placed in different parts of the hospital.

 

Sheri Fink:

And the threes were kept in the lobby, the second-floor lobby.

 

Jad Abumrad:

To just wait.

 

Sheri Fink:

So as the day goes on, the area started to get really full, patient next to patient on these cots.

 

Jad Abumrad:

In one corner, she says, you had about 18 people lined up side-by-side. And these were people with heart conditions, symptoms of pneumonia, stroke.

 

Sheri Fink:

There were nurses standing around fanning people. It just... It was so, so hot.

 

Jad Abumrad:

Some people guessed that the temperature inside the building must have been a hundred degrees.

 

Dr. Anna Pou:

I don't know if there's any way for me to describe to you how intense the heat was.

 

Jad Abumrad:

This is Dr. Anna Pou in an interview with 60 Minutes. She was one of the doctors who did the numbering.

 

Dr. Anna Pou:

It was relentless, it was suffocating, it made it extremely difficult to breathe. And with the heat came the terrible smell.

 

Sheri Fink:

It just started to smell really bad.

 

Gina Isbell:

And oh, the bathrooms were so bad.

 

Jad Abumrad:

That's Gina Isbell again.

 

Sheri Fink:

She said the sewage was sort of backing up in the toilets.

 

Gina Isbell:

I mean, they just had sewage everywhere. On the grounds, everywhere. You just... Personally, I didn't want to eat or drink anything because I didn't want to have to use the bathroom.

 

Jad Abumrad:

As the day went on...

 

Sheri Fink:

Some people started really feeling abandoned. Like, why aren't they here? Why aren't they helping us?

 

Male:

We have... We opened an attic. We bust a hole in the [crosstalk 00:22:57].

 

Reporter:

We're in a war zone here. It looks like a war zone.

 

Sheri Fink:

On the seventh floor, there was this radio that was playing in the corridor...

 

Radio host:

Eight minutes past six o'clock here on WWO.

 

Sheri Fink:

... the local talk station. And the radio was...

 

Male:

Is this radio station-

 

Sheri Fink:

... one of the only ways they were getting information from the outside.

 

Reporter:

The mindset, the needs, the hunger, the anger, the rage, is growing among people-

 

Sheri Fink:

Some of the nurses have carts that they would roll around and they'd have the little radio on the cart and they'd be listening.

 

Reporter:

Basic jungle, human instincts are beginning to creep in.

 

Sheri Fink:

And there were tales on the radio that were alarming the staff.

 

Male:

Someone is breaking into businesses and looting merchandise. These people should be shot.

 

Sheri Fink:

Things that turned out not to be true.

 

Male:

You know, we're under martial law here.

 

Sheri Fink:

That they had declared martial law. There was literally a deputy sheriff who got on air and told people that-

 

Deputy Sheriff:

We even both commented and said, "Oh, it looked likes a shark's fin."

 

Sheri Fink:

... he saw a shark swimming around a hotel.

 

Reporter:

They're walking like zombies, like Nights of the Living Dead.

 

Sheri Fink:

Just imagine how that would feel if you were in this hospital and that was the only word you were having about what was going on outside.

 

Gina Isbell:

One of our employees was like, having a breakdown, freaking out in the garage. And...

 

Jad Abumrad:

By the afternoon of that third day, that Wednesday, some of the staff were having nervous breakdowns.

 

Sheri Fink:

Morale is really, really low because all these patients are still there, basically.

 

Gina Isbell:

Patients were so hot, you know. They would just kind of drift off to sleep and you'd have to wake them up and make them take sips of water, sips of whatever we had, you know.

 

Reporter:

The City of New Orleans will never be the same.

 

Gina Isbell:

You know, some of them were crying for their mama.

 

Reporter:

People are dying-

 

Sheri Fink:

One of the nurses told me she was worried that there could be brain damage or lasting effects of this severe overheating.

 

Jad Abumrad:

Wow.

 

Sheri Fink:

So there's this level of panic.

 

Jad Abumrad:

What happened?

 

Sheri Fink:

Well, so there is also the situation of the pets. And this may make no sense to most people, but they would offer staff members... they could bring their pets if they were coming in to work a storm. They turned medical records over into a kennel and people started to worry about their pets.

 

Jad Abumrad:

Apparently on that Wednesday, one of the larger dogs, a Newfoundland, started having seizures from the heat.

 

Sheri Fink:

So some of the staff chose to have doctors euthanize their pets. And then, just try to imagine if you can...

 

Reporter:

Looters are running free.

 

Reporter:

... residents trying to shatter windows and climb into stores. [crosstalk 00:25:34].

 

Sheri Fink:

It's hot, people are dying, you're hearing gunshots in the neighborhood, you're afraid.

 

Male:

It's total chaos.

 

Sheri Fink:

You don't know if there's real violence breaking out in the city.

 

Reporter:

There are bodies floating in the water there.

 

Sheri Fink:

You don't know how many rescue resources are going to come, it's night time. Your colleague walks up to you and says, you know, "We're euthanizing the pets to put them out of their misery. What about these suffering patients? Shouldn't we put some of them out of their misery?"

 

Sheri Fink:

And I interviewed all these people and I'm trying to figure out, like, where did this idea come from, and tracing it back. There were a these little informal conversations and this starts just going around the hospital, this sort of idea of putting patients out of their misery.

 

Gina Isbell:

I don't know who told me that but that's what I heard. And, you know, in those circumstances, what do you do? If you're at war and you have someone that's not going to be picked up and you can't carry them to safety and they're bleeding to death, what do you do? Do you let them suffer? Do you let them? I don't know.

 

Jad Abumrad:

Sheri says that, as this idea spread around the hospital, people fell into different camps. Some people thought this was the most humane thing they could do, it would be criminal to let people suffer more. Other people, when they heard about it, were outraged.

 

Sheri Fink:

For example, Dr. Bryant King, whose colleague, Dr. Fournier, she walks up to him and says, "There's this discussion going on and," you know, "What do you think?" And he says, "You got to be (beep) kidding me, that you actually think that that's a good idea."

 

Jad Abumrad:

This is Dr. King in an interview on CNN.

 

Dr. Bryant King:

I mean, how could you possibly think that that's a good idea?

 

Jad Abumrad:

Day four. Thursday, September 1st. Here's what ends up happening. Accounts here are a bit vague and in dispute, but according to Dr. King, who spoke about this on CNN, he says... and other people say they saw this as well... he says he saw one of the doctors we talked about earlier...

 

Sheri Fink:

Dr. Anna Pou.

 

Jad Abumrad:

Who is still there that Thursday morning.

 

Sheri Fink:

Caring for patients. These patients on the second floor who were chosen to go last.

 

Jad Abumrad:

He says he saw her talking to patients while holding a handful of syringes.

 

Dr. Bryant King:

Anna's standing over there with a handful of syringes, talking to a patient. And the words that I heard her say were, "I'm going to give you something to make you feel better." And she had a handful of syringes. I don't... And nobody, nobody walks around with a handful of syringes and goes and gives the same thing to each patient. That's just not how we do it.

 

Jad Abumrad:

To jump forward for a beat, after this whole ordeal was over and the rescue teams and the mortuary teams arrived...

 

Sheri Fink:

Many bodies were found in this hospital, about 45 bodies found. And so there was an investigation launched. They found these bodies, they tested these bodies for drugs, and what they found was that nearly two dozen patients had received either morphine or Versed, a powerful sedative, or a combination of the two in a very short time period on that Thursday, September 1st 2005. So again-

 

Jad Abumrad:

Wait, now many?

 

Sheri Fink:

It was, I think, 21 in the end.

 

Jad Abumrad:

But it's complicated. In medicine, what is comfort and what is murder depend to a large degree on the intentions of the doctor.

 

Sheri Fink:

It's called the Principle of the Double Effect. It's sometimes credited to St. Thomas Aquinas, and it's this idea that an act that can cause harm, but if your intention is to do good, then that's ethical.

 

Jad Abumrad:

And Dr. Anna Pou?

 

Reporter:

Did you murder those patients as the attorney general alleges?

 

Dr. Anna Pou:

No, I did not murder those patients. And I want everybody to know that I am not a murderer, that we are not murderers.

 

Jad Abumrad:

In that 60-Minutes interview, Dr. Pou flatly denies euthanizing anybody. And at various points in the interview she is clearly distraught at the accusation

 

Dr. Anna Pou:

It completely ripped my heart out because my entire life I have tried to do good. My entire adult life I have given everything that I have within me to take care of my patients.

 

Jad Abumrad:

But Sheri did talk to one doctor, Dr. Ewing Cook. We mentioned him earlier when we were talking about the generators. He's a doctor who deals a lot with end-of-life care, and he was very open with her about the decisions he made.

 

Sheri Fink:

He had gone upstairs, visited Mrs. Burgess-

 

Jad Abumrad:

Cancer patient.

 

Sheri Fink:

... to see how she was doing. And he was just thinking to himself, she's so, so sick. She's got advanced cancer, I can't imagine she would have more than maybe a week to live at the best of circumstances. She is weighted down with fluid, which can happen toward the end of life, so she weighs a lot. She's on the eighth floor, so we'd have to carry her downstairs. Plus there's four nurses up here taking care of her. Couldn't we use them somewhere else?

 

Sheri Fink:

So he literally turned to one of the nurses and said, "Can you give her enough morphine till she goes." And that nurse charted huge increase in morphine for her and she died. And that was his thought. So he made this decision and, to this day or at least the last time we spoke, he felt he did the right thing.

 

Sheri Fink:

He said to me he thought it was desperate. He saw only two choices, quicken their deaths or abandon them. I mean, if that was the real situation, there's some ethicists would say either of those choices would be, you know, not justified, but excusable.

 

Jad Abumrad:

But one of the arguments you could make is that when you give up on one person, it then becomes a little bit easier to give up on the next person, and then the next person, and then suddenly you're on a slippery slope. And Sheri did tell us about this one case.

 

Sheri Fink:

His case was very haunting. Emmett Everett, a 61-year old doting grandfather. Very, very heavy.

 

Jad Abumrad:

He weighed 380 pounds and he was up on the seventh floor of the hospital.

 

Sheri Fink:

He was conscious, alert, fed himself breakfast, asked his nurses, "Are we ready to rock and roll?" He said to one nurse, who never forgot it, "Cindy, don't let them leave me behind. Don't let them leave me behind." But he had had a spinal cord stroke, he couldn't walk, he was on the seventh floor of a hospital with no working elevators. The staff told me they couldn't imagine how they would carry him down those flights of stairs, let alone would a helicopter take a man of his size. And he was one of the patients who was found with this drug combination in his body.

 

Jad Abumrad:

And he died?

 

Sheri Fink:

He died. His body was found. And by the way, the other tragedy was, just as those injections took place, was when the helicopters finally were focused on this hospital.

 

Robert Krulwich:

Did a judge or jury find anyone guilty of manslaughter or murder or second-degree murder or...

 

Sheri Fink:

No, nobody ended up getting convicted. And again, just to remind you how quickly a hospital can go from a normal, American, well regarded, functioning hospital to a place where this was even considered and discussed, was so short. Monday morning the storm hits, Tuesday morning the water rises, early Wednesday morning all power goes out, and this is Thursday.

 

Jad Abumrad:

Wow. That's kind of chilling to think. God, if all that began with a triage decision about which patient should go first... I'm trying to put myself in the position of the people at that hospital and I'm thinking to myself, god, it would be really nice to have like, a checklist. Like a checklist on a wall that says here's how you do this, so that I can just check the boxes. Because, god, I wouldn't be able to think my way through that.

 

Sheri Fink:

Yeah.

 

Robert Krulwich:

So that's where I go next. I wonder whether this story you've just told us leads us anywhere. The first place it would lead me would be to ask, is there a system that people could set up? People who are reasonable and who have the expectation that something like this is going to happen again. Somehow, somewhere, maybe in my town, my hospital, my place. So what could we do to make this not happen?

 

Sheri Fink:

Well, it's interesting you ask because, of course, after Katrina there have been efforts since then to come up with a protocol.

 

Robert Krulwich:

Oh.

 

Jad Abumrad:

According to Sheri, the experience in Katrina was basically a wake-up call for doctors and hospitals and state governments to think about triage. Like how should we ration medical resources? Like if something bad happens again, which patients do we prioritize first? Which patients don't we prioritize? How do we do this?

 

Sheri Fink:

One of the interesting things was that the State of Maryland decided, we're going to throw this open to our population and have what they call deliberative democracy. So pull people together in a room from all walks of life and have them grapple with this. I was there.

 

Jad Abumrad:

Oh, you went to the very first one?

 

Sheri Fink:

I did.

 

Jad Abumrad:

I'm imagining like, a town hall meeting. Was it like that? Or no.

 

Sheri Fink:

Yeah. So just imagine a church basement in inner-city Baltimore or a conference room in wealthy Howard County.

 

Speaker:

Thank you for coming, for giving up this gorgeous Saturday to have what we think is a really, really important conversation.

 

Sheri Fink:

There's refreshments.

 

Female:

At about 12:15 we'll take a break for you all to get lunch, bring it back to your tables...

 

Sheri Fink:

People have been recruited to be a part of this. And when I say people, it's just regular folks.

 

Female:

You want to switch seats?

 

Sheri Fink:

So the researchers, let's call them that, they get people together and-

 

Dr. Lee D.:

We're going to get started. Good morning.

 

Sheri Fink:

The sort of scenario is laid out.

 

Dr. Lee D.:

So my name is Lee Daugherty. I am an intensive care doctor just down the road at Johns Hopkins. What we're going to be talking about today is how we make decisions about who gets life-saving resources in a situation where we literally cannot take care of everyone. Today the scenario we'll talk about is pandemic influenza.

 

Jad Abumrad:

They basically tell people, okay, imagine a flu is sweeping the country. Millions of people are sick, coughing, some are dying. The only way that folks are going to get better, they say, is if they have a ventilator to help them breathe. But the problem is there just aren't enough.

 

Speaker:

This is horrible stuff. This is a terrible situation we're talking about.

 

Sheri Fink:

So here you have too many patients, too few resources. How do we choose? Who gets those ventilators?

 

Speaker:

What are the acceptable options? What might be the right answers? What-

 

Jad Abumrad:

The researchers then essentially lay out three different kinds of options.

 

Sheri Fink:

Number one.

 

Jad Abumrad:

Try to save the most lives or years of life by picking...

 

Sheri Fink:

... people with the best chance of surviving the pandemic.

 

Jad Abumrad:

Such as giving the ventilators to young people or healthier people.

 

Sheri Fink:

Number two.

 

Jad Abumrad:

Picking people who will be the most helpful during the pandemic.

 

Sheri Fink:

So first responders, healthcare providers, vaccine workers, et cetera.

 

Robert Krulwich:

I'm [inaudible 00:37:03] staying with you [crosstalk 00:37:03].

 

Sheri Fink:

Or number three.

 

Jad Abumrad:

Leave it up to fate. Something like first come, first serve or-

 

Sheri Fink:

A lottery.

 

Speaker:

I'm seeing people nod. Does that make sense? Okay.

 

Sheri Fink:

And then they say, we're here to answer your questions, talk amongst yourselves.

 

Speaker:

Right, go ahead. Thank you.

 

Jad Abumrad:

You know, pick.

 

Male:

If we talked about something and like-

 

Female:

Those protocols will be black and white.

 

Female:

I've never seen any situation in life where it was black or white.

 

Female:

Some things are black or white.

 

Female:

I'm saying it shouldn't be black or white.

 

Female:

Well, my immediate reaction to the lottery was, it's a leveler. It's all the same.

 

Female:

Oh, I think it is the scientifically least responsible way to go.

 

Female:

If somebody's going to live but be very sick, should that go into the decision?

 

Female:

If we've set up guidelines, then yes.

 

Female:

Is every kind of doctor, you know what I mean, going to be essential?

 

Female:

No.

 

Female:

Let them say that.

 

Female:

No. No.

 

Sheri Fink:

Now, the good news is...

 

Male:

I would get a ventilator and a four-year old wouldn't? I just think that would be the saddest thing.

 

Sheri Fink:

People were willing to engage in this question. And this was right at the time... You guys remember all the death panel discussions?

 

Male:

We should not have a government program that determines you're going to pull the plug on grandma.

 

Jad Abumrad:

Yeah.

 

Robert Krulwich:

Yeah.

 

Sheri Fink:

Sarah Palin.

 

Sarah Palin:

It's in black and white. Of course there are death penalties in there.

 

Sheri Fink:

This started at that time.

 

Male:

If they have a better chance at [inaudible 00:38:27], they should definitely take that.

 

Jad Abumrad:

And there weren't any fist fights?

 

Sheri Fink:

But as you can also hear...

 

Female:

I'm all for the first come, first serve.

 

Female:

Then nobody has to put that on their conscience.

 

Female:

Would you get it first because you there and I got there a half a second and I entered through a wall?

 

Female:

Probably.

 

Sheri Fink:

There wasn't a lot of agreement.

 

Female:

I respect your opinion but I'm just dealing with-

 

Female:

No, you don't.

 

Female:

Yes, I'll [inaudible 00:38:48].

 

Female:

I think in a time of crisis there's no room for emotions. Because if you're trying to say, oh, we got to judge it by person to person, there's exceptions to the rule, that's emotion talking and there's no room for that.

 

Female:

I don't think it's emotion.

 

Female:

It is.

 

Female:

I think if you're looking at everything that's going on, you're judging it on that.

 

Female:

And that's why we have those set up already.

 

Male:

The reality is, some people going to have to die.

 

Sheri Fink:

So one of the big findings was that-

 

Speaker:

There are certain ways in which we will not make these decisions.

 

Sheri Fink:

There were things that the researchers wanted to be off the table, like not even come into the discussion.

 

Speaker:

We're not going to make decisions based on gender, race, socio-economic status.

 

Sheri Fink:

Like people's jobs and incomes and...

 

Speaker:

... citizenship status...

 

Sheri Fink:

You know, whether they had a criminal history or were they upstanding members of society.

 

Speaker:

Those things are out of bounds. I just want to say upfront, that's not up for grabs.

 

Sheri Fink:

But those things kept popping up.

 

Female:

You're going to have like, a young pastor. And you might have a reprehensible, alcoholic, criminal type person and he might have more years to live. Well, the years of the pastor are going to be more beneficial to society than the years of this... a criminal, reprehensible alcoholic bad person.

 

Female:

Whoa, you are straying into iffy territory there. Wow [crosstalk 00:40:07]

 

Female:

... we know. It's like.

 

Female:

That is a personal value judgment.

 

Sheri Fink:

There were people who thought that undocumented immigrants shouldn't get ventilators. Alcoholics, smokers...

 

Female:

And the world will be a better place in the end.

 

Male:

In the most brutal terms possible they are saying, do you deserve to survive? Not can I save you, but should I try and save you?

 

Jad Abumrad:

What's interesting is that people were really comfortable making utilitarian choices. Like saying, yeah, that person should get the ventilator because they're going to benefit the greater good in some way. But if that ever got formulated in a slightly different way, which is to say, that person should get the ventilator because they deserve it more than another because their life has more value than another person, well then people were like, we're not cool with that. And yet you would hear people say it that way again and again, then immediately be repulsed when they heard someone else say it that way.

 

Female:

I don't think you can determine who's done what in their life and how that's valuable. I might think my hairdresser's more important. I might. They're important, right? I want to look good during my pandemic situation. So...

 

Sheri Fink:

And this was particularly acute when participants were asked the second-

 

Female:

Can we move to an even more controversial topic?

 

Sheri Fink:

... really hard question. Would it be acceptable to you... Do you think it's acceptable to ever remove a ventilator from one patient to give it to somebody else?

 

Male:

This one I definitely don't have a clear answer myself.

 

Sheri Fink:

Some people said, well, of course.

 

Male:

If it doesn't seem like someone is going to make it through the treatments, then maybe we need to cut it and cut their treatment short and pass that ventilator on to someone else.

 

Sheri Fink:

But-

 

Male:

You're going to murder my father?

 

Sheri Fink:

... there were other people who said no.

 

Male:

You take my father off that ventilator and you are going to-

 

Female:

I will sue you.

 

Male:

... be sued-

 

Female:

Yeah, that's what I mean.

 

Male:

... for the rest of your life. I'm never going to sign off for that.

 

Female:

It's a terrible thing to think about.

 

Female:

But it's necessary.

 

Male:

I don't know how I feel about anybody [crosstalk 00:42:06].

 

Female:

It's so complicated.

 

Jad Abumrad:

Did they come to a conclusion? Did the public-

 

Robert Krulwich:

Jad, did you hear a conclusion? Like, I listened to this, here's what I heard. I heard thoughtful people struggling with a problem that is so hard to struggle with, that what they end up doing is going, I don't know how, I don't want to do this, I'm paying no attention to your guidelines because I can't deal with-

 

Sheri Fink:

Well, this is what I loved about it. The number one response was to try to get out of the situation and find ways to avoid having to ration. That's the most important part of this. Let's not just-

 

Jad Abumrad:

Wait, wait, wait. Before we pre-judge this, what is it the researchers are going to take away from all this?

 

Sheri Fink:

Well, a couple of things that they got out of it. Number one... Remember we talked about the different ways of deciding that they put out for people to discuss? Well, it turns out they wanted to combine some of those different perspectives and they wanted-

 

Jad Abumrad:

According to Sheri, a lot of people thought, sure, let's start out utilitarian. Let's try and save the most lives by picking the people who are most likely to survive.

 

Sheri Fink:

If they're likely to survive and they need it. But chances are, there's going to be a lot of people who fit in that category, so if everybody's just about the same... and we don't have like, great science that allows us to know which patient is going to survive and which one's not going to... so for that second tier, let's do it randomly. Let's just be really, really fair and give everyone an equal chance.

 

Jad Abumrad:

So it's like you introduce a little bit of fate to keep things honest.

 

Sheri Fink:

Exactly. And the researchers said, you know what, this is a good idea. Let's see if we could maybe put this concept into the protocol.

 

Jad Abumrad:

Am I right in thinking that these guidelines, whatever they end up being, are designed to avoid that sort of, like, sorting based on who deserves it and who doesn't?

 

Sheri Fink:

Yeah. I mean, there's some fairness in having guidelines, especially guidelines that were developed with the input of lots of people. So even if we don't like the choices that are made... we don't end up getting the ventilator or our loved one doesn't... overall, if you know that there's a protocol out there and this is the rule... here's why we had to adopt this rule, it's being applied to everybody and you're not going to be advantaged or disadvantaged over money or over all of these other things... it sort of helps you accept it.

 

Jad Abumrad:

Yeah.

 

Robert Krulwich:

Well, in theory that sounds, you know, plausible. But when you put theory to practice, which we're going to do right after the break, things get very hard.

 

Jad Abumrad:

That's coming up.

 

Jad Abumrad:

Hey, I'm Jad Abumrad.

 

Robert Krulwich:

I'm Robert Krulwich.

 

Jad Abumrad:

This is Radiolab. And returning now to our collaboration with the New York Times and reporter Sheri Fink. This is our final stop, in many ways our hardest stop, because it's the closest we're going to come to sort of the heart of the issues we've been talking about. And you realize that when you get up close, as Sheri's about to, sometimes what's a success and what's a failure are kind of hard to measure.

 

Sheri Fink:

Test.

 

Female:

You're going to have to [inaudible 00:46:38] here.

 

Male:

If we can't even do the tip-fibs, then we won't evaluate-

 

Sheri Fink:

I remember being in Haiti after the Haiti earthquake in 2010.

 

Male:

I've got a 20-year old female. I don't know what's going to happen there.

 

Sheri Fink:

I was embedded with a group of US disaster responders, the International Medical and Surgical Response Ream, IMSuRT.

 

Male:

What's your name again?

 

Sheri Fink:

Sheri.

 

Sheri Fink:

We were in this tent hospital and at this point, maybe about a week and a half after the earthquake, there were so, so many casualties.

 

Reporter:

More than a hundred thousand people could be dead.

 

Sheri Fink:

There was patient after patient kind of lined up in a row.

 

Male:

Most of the things we've had are dehydration, sepsis, festering wounds, open fractures...

 

Sheri Fink:

And they didn't have enough resources and they were running out of oxygen tanks. Then they were also trying to use these oxygen concentrators, which pull oxygen from the environment, but rely on power and they were running out of diesel for the generators.

 

Male:

... logistics. We're at a critical level with our diesel supply and oxygen for the OR, so I'm freaking today. I mean, I am freaking. Pray for us in logistics today.

 

Sheri Fink:

Okay.

 

Female:

Do we have respiratory [crosstalk 00:47:50]

 

Sheri Fink:

This was a hospital that had set up to do surgery. They needed oxygen, they didn't have enough. So the question became, who were they going to give it to and who were they not? And at one point-

 

Male:

[inaudible 00:48:03] to ICU, please.

 

Male:

Need you in ICU?

 

Sheri Fink:

I was following a couple of the doctors. We walked into this tent and we met this woman.

 

Sheri Fink:

Hi.

 

Sheri Fink:

She had braided hair, a white nightgown on and this tube running into her nose.

 

Sheri Fink:

[foreign language 00:48:21]

 

Translator:

Her name is Natalie.

 

Natalie LeBrun:

Natalie LeBrun.

 

Translator:

Natalie LeBrun.

 

Sheri Fink:

And how old are you? [foreign language 00:48:26]

 

Translator:

  1. She's 38 years old.

 

Sheri Fink:

Oh, okay. Tell her we're almost the same age. [foreign language 00:48:33]

 

Sheri Fink:

How are you feeling today? [foreign language 00:48:37]

 

Translator:

She's feeling better [crosstalk 00:48:41]. They gave her a lot of medicine and she's doing all right.

 

Sheri Fink:

That's good. [foreign language 00:48:46]. In speaking to her, I found out that she was from Port-au-Prince, the capital, and that during the earthquake her house had collapsed. And everyone inside it, she said... which was most of her extended family... they died. [foreign language 00:49:02]

 

Translator:

They were all staying together, like, you know, nieces, nephews, cousins and everything.

 

Sheri Fink:

I'm so sorry. [foreign language 00:49:09]

 

Sheri Fink:

She told me that, amazingly, she had survived because she wasn't at home when the earthquake hit. She'd checked into this hospital-

 

Translator:

... in the main hospital, downtown-

 

Sheri Fink:

... very shortly before the earthquake happened. Because she had had chronic lung problems, so she was there to get treatment. After the earthquake she was transferred to this American hospital.

 

Sheri Fink:

How do you feel about the treatment that you got here? [foreign language 00:49:37]

 

Translator:

Oh, they treat me well. Way better than anywhere that she's been. [foreign language 00:49:43] She thank god for the American people because they're the one that's in charge right now. Because god is really using them and put them in charge of all the things that's going on. [foregin language 00:49:57]

 

Natalie LeBrun:

I love Obama. I love Obama. God bless Obama.

 

Sheri Fink:

I'm happy to see a smile on your face. [foreign language 00:50:05]

 

Sheri Fink:

I started to speak with the staff about her.

 

Sheri Fink:

You've been taking care of her, part of the unit?

 

Female:

Yeah. Yeah, basically-

 

Sheri Fink:

And I found out that Natalie had just won the hearts of the surgical staff there. People loved her. She was so thankful...

 

Female:

But she has a chronic illness, which is severe heart failure and hypertension and... It's very hard for us to see her leave.

 

Sheri Fink:

They told me they had plans to take her off oxygen. They were going to turn down the oxygen slowly to try to make it more comfortable and they were going to send her off to a Haitian facility that didn't have oxygen but where she would presumably die. And if you're thinking in terms of cold, hard triage theory, you know, this makes sense because they were trying to save oxygen. She has a chronic problem that probably won't get better, so that's, like, the theory of it. But the practice of it was quite different. She had absolutely no idea that they were about to do this. She had all this hope for her future.

 

Translator:

Hopefully when she get well, she pray to god that she will have an opportunity to earn a living. [foreign language 00:51:20] She wants to know, once she gets to the hospital, is there any way possible that the people would give her, like, somewhere to stay, like some kind of shelter.

 

Sheri Fink:

I mean, I'm a journalist and I don't know that answer to that, but I... I don't know what to say. It's such a hard situation right now. [foreign language 00:51:41]

 

Sheri Fink:

And I remember the nurse who was doing the triage, who'd made that decision to cut off her oxygen...

 

Patrick Kadilak:

I'm Patrick Kadilak. I'm the commander for the IMSuRT team.

 

Sheri Fink:

... had never met her.

 

Patrick Kadilak:

No, I never met the patient but that's the role that I'm at. We're running out of oxygen, the country itself doesn't have oxygen, so I have to make the decision. No, she can't have the oxygen, turn it off. I have to look at the greater good that we can provide with the limited resources we have.

 

Sheri Fink:

And so then I followed that woman. I wanted to see this on a human level as well as on the abstract level. The transporters came a few hours later...

 

Male:

All right, stop looking around. Go ahead, get them up here.

 

Sheri Fink:

I think it was the 82nd Airborne, actually, who were providing that service. They were amazing. And they came to pick her up.

 

Female:

And she needs to travel with O-2? Or does she need to travel with her-

 

Sheri Fink:

They saw she was on oxygen. They said, okay, we're going to put her on their portable oxygen tanks. And the representative from the hospital said...

 

Male:

No, she does not.

 

Sheri Fink:

Oh, no. No. She doesn't get oxygen. So they yanked the oxygen...

 

Male:

All right. Ready?

 

Sheri Fink:

... strapped her onto a stretcher...

 

Male:

Get up here. One, two, three...

 

Sheri Fink:

... lifted her up, stuck her in the back of this Humvee ambulance.

 

Sheri Fink:

Careful. Watch your head.

 

Male:

You coming with?

 

Sheri Fink:

Yes.

 

Male:

Okay, we're going to hop in the cargo Humvee, that one pulling up.

 

Sheri Fink:

I rode with her.

 

Male:

Bumps coming up.

 

Sheri Fink:

Okay, bump. Bump, bump, bump.

 

Natalie LeBrun:

Oxygen.

 

Sheri Fink:

She started getting short of breath.

 

Natalie LeBrun:

Oxygen.

 

Sheri Fink:

Oxygen?

 

Natalie LeBrun:

Oxygen. Oxygen. Oxygen.

 

Jad Abumrad:

Oh, my god.

 

Sheri Fink:

She's asking for oxygen.

 

Sheri Fink:

She put this asthma inhaler in her mouth and she kept hitting it over and over again.

 

Natalie LeBrun:

Oxygen.

 

Sheri Fink:

She thought it was oxygen. It was horrific to watch her start to suffer. I felt complicit. I was doing a story and I knew very well that they had chosen for her to die. And just watching, it didn't feel right. And so...

 

Sheri Fink:

Sorry, but I just can't watch that anymore.

 

Sheri Fink:

The Humvee had stopped at this hospital and I nodded over toward her and some of the medical staff went to look at her.

 

Female:

Parlez-vous Anglais? No.

 

Sheri Fink:

They could see she was in distress. They brought her inside. She was really struggling to breathe, but then...

 

Doctor:

Yeah, she's [inaudible 00:54:33].

 

Sheri Fink:

I saw one of my medical school professors, an emergency doctor, and I told him about her.

 

Doctor:

Is it... Who's is this?

 

Sheri Fink:

It's hers.

 

Doctor:

Is that hers?

 

Sheri Fink:

Yes.

 

Doctor:

Here. I need this. Mama, I want you to sit up. Okay, mama. No, slide back a little bit, slide back. A little bit more, there you go.

 

Sheri Fink:

And he improvised.

 

Doctor:

Give here 16mg of [inaudible 00:54:59], write it out.

 

Sheri Fink:

He used, like, all these diuretics to get fluid off her lungs.

 

Doctor:

We got any nitrates or anything?

 

Sheri Fink:

And he found one tank of oxygen that had a teeny bit left in it.

 

Doctor:

There...

 

Male:

This'll make you breathe better, okay?

 

Doctor:

Keep it in your nose, in your nose.

 

Male:

Okay? Breathe in [inaudible 00:55:21]

 

Sheri Fink:

And he was able to extend her life.

 

Doctor:

All right. Good night. See you tomorrow.

 

Sheri Fink:

All right.

 

Sheri Fink:

Ultimately I actually felt a responsibility for her that outlasted the story that I did. And so after that came out I did attempt to help her.

 

Jad Abumrad:

Really?

 

Sheri Fink:

Yeah.

 

Jad Abumrad:

How?

 

Sheri Fink:

Well, I found a charitable group that was willing to bring her to the US under a certain type of visa program that allowed for humanitarian... like a medial treatment. The cardiologist who had examined her in Haiti had thought she had a rheumatic heart disease that was causing her lung problems and that it could be surgically corrected. But when she came to the US, in fact, it was found that she had a much more serious condition. She really needed a transplant and she didn't make it.

 

Jad Abumrad:

Oh.

 

Robert Krulwich:

Does this make you wonder... So here you've got a rule and maybe in some broad way it's helping, but in that vehicle, looking at this woman, you wanted to break the rules for very moral and decent reasons. In these extreme circumstances, where life and death are wrestling with each other, can you make rules? I mean, I...

 

Jad Abumrad:

Yeah. Because it's, like, you can't fault the people for taking her off the oxygen. And you can't fault you for trying to get her on the oxygen. So what's the conclusion to draw?

 

Sheri Fink:

Well, let's not give up, you know. The conclusion is, let's not give up. It turns out there were options for this woman. It turns out that somebody was able to extend her life. Now you could very well argue that she should have died in that moment, because look at all the resources that were spent, but I just feel like there was some value in her existence. There was so much value.

 

Sheri Fink:

She came to the US and, my god, she took up a collection for all the patients back in the Haitian hospital who she was friends with. She contributed till the day she died. She changed my life, too, so I don't know how to do the math on this one.

 

Jad Abumrad:

This is the problem though.

 

Simon Adler:

Well, don't... Real quickly... Guidelines require, like, a lack of compassion, the cold, hard rigidness of it, and everything you're talking about has to do with compassion...

 

Jad Abumrad:

This is Simon Adler, by the way, our producer.

 

Simon Adler:

And how do you make compassion work on that large of a scale without caring out people? And then you care about some people more than other people. And then, oh shit, now we're hurting people.

 

Sheri Fink:

Right. That's a very good point. If you don't systematize it, you risk choosing people based on factors that are really not fair.

 

Jad Abumrad:

Exactly. Because part of me does wonder, like, what if Natalie weren't such a nice person? Would that have changed things?

 

Sheri Fink:

Well, you know, if Natalie was a mean person, I don't think I would have felt any better watching her suffer. It's just about the person in front of you. I think that the more unbearable it is, so the more you have to look someone in the eyes, the more it makes us try to figure out creative ways to avoid doing it.

 

Robert Krulwich:

Okay, but I do feel you somehow refusing to acknowledge the subject when it really, really gets tough. You say let's avoid that toughness, over and over again, let's-

 

Sheri Fink:

No, I'm facing the real problem, which is that it's a problem to have to ration.

 

Robert Krulwich:

But what... But-

 

Sheri Fink:

And, you know what, we're not going to figure out the best way to ration, because there is no one best way. Because everyone in society will have a different view on that.

 

Jad Abumrad:

I think that that's, in some way, unimpeachable. I think you're absolutely right, we should always strive to not have to make the choice. But if we do have to make the choice, how do we do it?

 

Sheri Fink:

Well, that's a very tough question.

 

Robert Krulwich:

Let me tell you that I think what you've hit upon here is an impossible piece of human business. Rationing, triage, whatever you call it, is an inhuman act which humans are trying to do, but the fact of their humanity makes it impossible. So what we've got here is we've got a real deep problem. We have a god role and nobody fits it.

 

Jad Abumrad:

We have so many people to thank for this hour. Let's start with Lilly Sullivan and Pat Walters, for really getting us thinking about all of this. Thank you, Lilly. Thank you, Pat. Thank also to PRI's The World. A version of the Haiti story first appeared on that show. And a huge thanks to New York Times correspondent Sheri Fink. All the stories you heard in this hour came as a result of her reporting for the book Five Days at Memorial. Sheri has an article that coincides with this podcast about the the Maryland project. We will link to it from radiolab.org or you can read it at nytimes.com/triage.

 

Robert Krulwich:

And thank you, New York Times, for lending us Sheri for a bit of time.

 

Jad Abumrad:

Yes. This story was produced by Simon banned-for-life Adler, Annie there-can-be-only-one McEwen. We had original music from both Simon and Annie. Also from Taylor DuPreez and Kenith Kershner. I'm Jad Abumrad...

 

Robert Krulwich:

I'm Robert Krulwich.

 

Jad Abumrad:

Thanks for listening.

 

Recording:

Message one.

 

Mel:

This is Mel, calling from Brooklyn. Radiolab is produced by Jad Abumrad. Dylan Keith is our Director of Sound Design. Soren Wheeler is our Senior Editor. Jamie York is our Senior Producer. Our staff includes, Simon Adler, Brenda Farrel, David Gebel, Matt Kielty, Robert Krulwich, Annie McEwen, Andy Mills, Latif Nasser, Malissa O'Donnell, Kelsey Padgett, Arianne Wack, and Molly Webster. With help from Alexandra Leigh Young, Jackson Roach and Sharon [Zina 01:02:10]. The fact checkers are Eva Dasher and Michelle Harris.

 

Copyright © 2019 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.