The Real Story Behind ‘Five Days at Memorial’

Real Stories is an ongoing column about the true stories behind movies and TV shows. It’s that simple. This installment focuses on the true story behind the upcoming Apple TV+ series Five Days at Memorial.

Hurricane Katrina remains one of the deadliest and most destructive storms in the history of the United States. The hurricane hit the Gulf of Mexico in August of 2005, impacting states around the region. Katrina devastated the city of New Orleans in particular. As chaos ensued, first responders and medical professionals faced every challenge imaginable.

In 2013, journalist Sheri Fink, herself a medical doctor, published a book, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. The book, based in part on a long feature she published in the New York Times and ProPublica in 2009, details five days at Memorial Medical Center in New Orleans. As the storm raged, the hospital went without power for days. Among the events detailed in the book was the controversial decision by doctors to inject patients, many of whom the doctors believed were near death, with fatal drugs.

Fink’s book serves as the inspiration for the upcoming miniseries of the same name, Five Days at Memorial, from Apple TV+. Here is a look at the true story behind the series.

The Storm Hits

The topography of New Orleans makes it particularly prone to hurricanes. A large portion of the city sits below sea level. This was not always the case. As the city expanded in the 19th and 20th centuries, developers began draining swampland to make room for more people. But by pumping water out of the city, it began to shrink and continues to do so to this day. This, plus rising sea levels due to climate change, makes storms and subsequent flooding that hits the region particularly deadly.

Since the 1920s, Memorial Medical Center had served as a shelter during storms. Fink notes:

For generations, the hospital’s sturdy walls served as a shelter when hurricanes threatened: employees would bring their families and pets, as well as coolers packed with muffulettas.

And so, when Katrina hit, many naturally sought refuge in the building. According to Fink, about 2,000 people were inside the hospital when the storm hit, including more than 200 patients and 600 staff. When the storm hit during on the morning of August 29, the city’s power failed. The hospital’s generators took over and many, Fink writes, believe they had “seemed to have weathered one more storm.”

The Flooding Begins

One of the key figures in Fink’s reporting is Anna Pou. Described as a “surgeon whose strong work ethic earned respect from doctors and nurses alike,” Pou is played by Vera Farmiga in the miniseries. Fink reports that on the second day, a nurse called for Pou to look out the window. What they saw: “water gushing from the sewer grates.” The deadly flooding had only just begun.

Knowing the danger that flooding posed to the hospital and their patients, senior staff immediately began making plans for evacuation. The director of nursing, Susan Mulderick (played by Cherry Jones) was in charge of hospital operations during a crisis. She had been a member of the group responsible for writing the hospitals 246-page emergency plan. But no part of the plan detailed what to do in the event of “a complete power failure or for how to evacuate the hospital if the streets were flooded.” They were in uncharted territory.

Doctors began to gather and discuss how the evacuation would work and who would be given priority. Fink writes:

The doctors quickly agreed that babies in the neonatal intensive-care unit, pregnant mothers and critically ill adult I.C.U. patients would be at great risk from the heat and should get first priority. Then [Richard Deichmann, the hospital’s soft-spoken medical-department chairman] broached an idea that was nowhere in the hospital’s disaster plans. He suggested that all patients with Do Not Resuscitate orders should go last.

Other doctors agreed with the decision, one that would come to be one of the defining moments of the evacuation.

LifeCare

Fink also notes that one important group was left out of hospital discussions. LifeCare operated as a kind of “hospital within a hospital” at Memorial. LifeCare treated critical ill or injured patients who needed intensive, around-the-clock care. And, Finks reports:

LifeCare was known for helping to rehabilitate patients on ventilators until they could breathe on their own. LifeCare’s goal was to assist patients until they improved enough to return home or to nursing facilities; it was not a hospice.

There was debate within the hospital about the treatment of some of these patients. Fink writes:

LifeCare deployed the full array of modern technology to keep alive its often elderly and debilitated patients. Horace Baltz, one of the longest-serving doctors at Memorial, told me of spirited debates among doctors over coffee about what some of his colleagues considered to be excessive resources being poured into hopeless cases.

Generators Fail

Evacuations at the hospital began in the afternoon on day two. Coast Guard and private medical helicopters landed at the top of the building. Hospital staff carried patients up flights of stairs as part of the evacuation. Diane Robichaux (played by Julia Ann Emery), served as LifeCare’s own “incident commander” during the hurricane. Robichaux, Fink reports, remained in touch with officials throughout the evacuation. As the hours continued, it became clear that the “government’s rescue efforts and communications were in chaos.”

Then, on the morning of the third day, the hospital’s generators failed. Fink describes the scene in the immediate aftermath:

Alarm bells clanged as life-support monitors and ventilators switched to brief battery reserves while continuing to force air into the lungs of seven patients. In about a half-hour, the batteries failed and the regular hiss of mechanical breaths ceased. A Memorial nurse appeared and announced that the Coast Guard could evacuate some critical patients if they were brought to the helipad immediately. Volunteers began carrying the LifeCare patients who relied on ventilators down five flights of stairs in the dark.

Patients who relied on ventilators began to die. As the day went on, the temperature rose to above 90 degrees. Water stopped flowing. The hospital, one administrator said, “was in survival mode, not treating mode.” Doctors then divided patients into three priority categories to speed up evacuation. Pou took the lead.

Outside the Hospital

As staff struggled to treat patients inside the hospital, many other people tried to make their way to the hospital in boats and makeshift rafts. Some wanted to take family members from the hospital. Others were seeking treatment of their own. Dr. Bryant King (played in the series by Cornelius Smith Jr.) was among the hospital staff who witnessed people seeking treatment be turned away, including a couple with small children. Fink reports:

‘‘You can’t do this!’’ King shouted at [René Goux, the hospital’s chief executive]. ‘‘You gotta help people!’’ But the family was turned away.

“The humane thing”

In her reporting, Fink describes the physical challenges of the evacuation: the heat, the stairs, the smoke, and the exhaustion of the staff. As the evacuation continued, tough decisions had to be made. Fink writes:

Help was coming too slowly. There were too many people who needed to leave and weren’t going to make it, [Ewing Cook, one of the hospital’s most senior physicians] said, describing for me his thinking at the time. It was a desperate situation and he saw only two choices: quicken their deaths or abandon them. ‘‘It was actually to the point where you were considering that you couldn’t just leave them; the humane thing would be to put ’em out.’’

Fink describes the back and forth between members of the hospital staff. The thinking brought the doctors into a discussion of “euthanasia,” which was illegal at that time. Many doctors at first rejected the idea.

“Chronically Deathbound”

On September 1, the fourth day, the evacuations took a turn for the better. Boats and helicopters began to arrive. But as the evacuation continued, senior hospital staff continued to face tough choices, including how to evacuate the patients they had placed in category three. Exhausted hospital staff could not carry these patients down several flights of stairs, the doctors reasoned. While evacuations continued, no one arrived to help with that specific task.

Fink reports that Cook believed many of these patients were “chronically deathbound.” The report continues:

Cook said he told Pou how to administer a combination of morphine and a benzodiazepine sedative. The effect, he told me, was that patients would ‘‘go to sleep and die.’’ He explained that it ‘‘cuts down your respiration so you gradually stop breathing and go out.’’ He said he believed that Pou understood that he was telling her how to achieve this. He said that he viewed it as a way to ease the patients out of a terrible situation.

Fink goes on to describe how the policy was implemented within the hospital. How some felt as though LifeCare patients in particular were targeted. How some wrongly assumed that the hospital had been taken over by martial law. And how some “had never seen a physician look as nervous as Pou did.”

According to Fink:

Patients were hot and uncomfortable, and a few might be terminally ill, but [King] didn’t think they were in the kind of pain that calls for sedation, let alone mercy killing. When he saw Pou with the syringes, he assumed she was doing just that and said to anyone within earshot: ‘‘I’m getting out of here. This is crazy!’’ King grabbed his bag and stormed downstairs to get on a boat.

Karen Wynn (played by Adepero Oduye), the I.C.U. nurse manager defended the decision. Fink reports:

Wynn told me that at that point all the staff could offer was ‘‘comfort, peace and dignity.’’ She said: ‘‘We did the best we could do. It was the right thing to do under the circumstances.’’

She added: “But even if it had been euthanasia, it’s not something we don’t really do every day — it just goes under a different name.’’

The Fallout

By 9 p.m. that day, the hospital was evacuated. Then, on September 11, 2005, mortuary workers entered the hospital. There, they discovered 45 bodies. Investigations ensued, centered on “allegations of patient abandonment and euthanasia.” Fink reports that one of the people who called the authorities was a lawyer for LifeCare, who said that a possible nine people had been “given lethal doses of medicines by a Memorial doctor and nurses.”

Autopsies quickly followed. Once they were finished, morphine was found in the bodies of those same nine people named by LifeCare. Investigations continued. And on July 17, 2006, Pou was arrested. Two nurses, Cheri Landry and Lori Budo were also arrested. Carrie Everett, the widow of Emmett Everett, also filed a lawsuit. Fink reports:

“Who gave them the right to play God?” Mrs. Everett demanded. “Who gave them the right?”

The story made its way into national headlines. Medical experts weighed in. The public, Fink notes, supported Pou and the other doctors’ heroic efforts. A grand jury convened in March 2007. Dr. Frank Minyard, who performed autopsies, testified. Fink reports:

Minyard told me that in the end, he decided that four of the nine deaths on the seventh floor were homicides, including Emmett Everett and Rose Savoie. Until now, he has never publicly revealed that conclusion. He also said of Pou, “I strongly do not believe she planned to kill anybody, but it looks like she did.”

Pou faced 10 potential charges, including second-degree murder. The jury had to decide whether Pou, Fisk writes, had a “specific intent to kill” and thus should be indicted. On July 24, 2007, the jury opted not to indict on any of the ten counts.

Fink, through both her book and subsequent reporting, has continued to tell the story of those five days.  In the years that have followed, the events of that day have sparked debates among members of the medical community, ethicists, and the public at large.

Five Days at Memorial debuts on Apple TV+ from August 12, 2022