CHICAGO — At first blush, you might mistake Sheri Fink's book "Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital" for simply a disturbing and deeply engrossing play-by-play of the horrors that occurred at Memorial Medical Center in New Orleans during Hurricane Katrina in 2005.
But once you get past the terrifying details about what happens when a hospital that serves predominantly low-income and minority patients runs out of electricity, water and hope, it's much more.
In giving readers an insider's look at how Memorial Hospital emerged from Katrina with 45 casualties — "the largest number of bodies found at any Katrina-struck hospital" — and with one doctor being accused of murdering four of the patients (the charges were later dropped), the author does several things.
Fink touches on the perils of letting a major metropolitan area's infrastructure crumble at the hands of politics, racial bias and corruption. She discusses, at length, the international and domestic post-9/11 disaster preparedness protocols that have given public institutions a false sense of security about their ability to adequately respond to large-scale crises.
And there are indictments of for-profit corporate medicine and of the ways that mass media aggravate tragedy by transforming catastrophic news into nationally televised kangaroo courts that deliver ratings gold.
But at its heart, "Five Days at Memorial" confronts our societal distaste for considering the last days of our lives with as much diligence as we do all that comes before — and what happens when the end comes unexpectedly.
As Fink summarizes in her exhaustive retelling of one small part of what the Federal Emergency Management Agency called "the single most catastrophic natural disaster in U.S. history," we are made to consider that such anomalies serve as a reminder that life-and-death decisions about dignity, medical resources and survival are painfully commonplace.
"Emergencies are crucibles that contain and reveal the daily, slower-burning problems of medicine and beyond," Fink writes. "Our vulnerabilities; our trouble grappling with uncertainty, how we die, how we prioritize and divide what is most precious and vital and limited; even our biases and blindnesses."
It's stunning how a book about a nearly decade-old tragedy can be so painfully relevant today.
I couldn't help but make a connection between Fink's study about how the poor fare in life-and-death medical decisions to how hard the family of Jahi McMath — who was declared legally dead after complications from tonsil surgery at a California children's hospital late last year — had to fight to keep her on a ventilator.
The 13-year-old girl's devoutly religious parents are going through the unimaginable. Who could watch their beautiful girl still warm, still breathing and moving sporadically, and see only a corpse?
But this is how it goes when you live in the country with the highest medical costs in the world. A country where generous health care coverage is practically passed from parent to child, almost always pivoting on whether the parent has a job that provides good medical insurance.
And that's also how it goes in a society that won't engage in serious debate about, as Fink puts it, "how and whether to inform and involve viable, aware patients or the family members of patients when potentially lifesaving resources are being denied."
Granted, it's different in McMath's case because the medical community defines brain-dead as truly, fully dead.
But ultimately the medical decisions that surround these cases come down to the cost of allowing a patient with hopeless odds for survival to take up scarce resources — whether during a natural disaster or in day-to-day life.
Fink notes: "In normal times, it is easier to avoid acknowledging that some patients don't get access to needed care and refrain from engaging in an inclusive search for solutions.
"Sometimes individual medical choices, like triage choices, are less a question of science than they are of values." We must decide "what the goals of dividing resources should be for the larger population — whether maximizing number of lives saved, years of lives saved, quality of life, fairness, social trust or other factors."
It's a call to action for us all to consider the life-and-death decisions that our health care systems require us to face — and to pipe up about what outcomes we ultimately value most.