Falling Into The Fire and Five Days At Memorial

I mentioned I’ve been reading some harrowing medical books recently… And in the way of these things, there are some commonalities between the first two, so I thought I’d cover them together. There are a few more books focusing on mental health in particular still in my ‘to be read’ pile but I think there’s probably only so much harrowing that one post can hold.

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First up, I finished Sheri Fink’s Pulitzer winning Five Days At Memorial, which covers the devastating period immediately before, during and after Hurricane Katrina for the people sheltering in the New Orleans Memorial Medical Center. The ‘after’ covers both the aftermath, as hospital workers and volunteers worked to evacuate the patients who remained as floodwaters rose, and the arrests and litigation that marked the years that followed. In particular, the book follows the case of Dr Anna Pou, charged with murder for allegedly helping to euthanize some of the sickest patients in the hospital.

There’s no point pulling any punches. This is a distressing read. It’s impossible not to put yourself in pretty much everyone’s shoes; doctors, patients, volunteers, pets brought in during the storm. Terrible medical and ethical decisions were forced on individuals as a result of a pretty catastrophic failure of both business and government to plan for and respond to an emergency on this scale. Fink’s approach is journalism at its best: extremely balanced, detailed without overwhelming and structured in such a way that is both pacy and nuanced without overtly leading the reader to any particular conclusion. I feel like I know what Fink – a trained physician herself – felt about the actions of key decision makers and I’d certainly made my own mind up by the end of the book.

But ultimately this isn’t a book about blame or recriminations. It’s about forcing people to think the unthinkable so they’ll be prepared when the stakes are at their highest. It’s about asking the right questions in the metaphorical calm before the storm and putting people ahead of budgets. It’s about the questions that don’t have answers and how we want to approach them as a society. It’s a true ‘what would you do?’ cautionary tale and it reminded me that we’re not as far from the unimaginable as we might think.

18686094Straight off the back of Fink’s book, I read Christine Montross’ elegaic Falling Into The Fire: A Psychiatrist’s Encounters with the Mind in Crisis. On the surface, the only similarity between them was the hospital setting but I almost immediately stumbled on some interesting connections. Montross writes in the opening chapter about the presence of uncertainty in both her medical and psychiatric training,  as well as how she’s come to uneasy terms with it in her practice:

‘But as a doctor, I have emerged from my training with a shaken faith. If I hold my trust in medicine up to the light, I see that it is full of cracks and seams. In some places it is luminous. In others it is opaque. And yet I practice. At times this doubt is disillusioning. More often, however, I’ve come to view the questions that arise as a vital component of the work of medicine.’

It’s too easy to see doctors as infallible and medicine as full of definitive truths. We are vulnerable in our dealings with our doctors so we want a degree of certainty that is unattainable. Sick/well, life/death, right/wrong – there are too many polarisations, when the truth is that almost every part of medical practice is a sliding scale. I found Montross’ position thought-provoking and it shed light on some of the decisions taken in the aftermath of Katrina where decisions were perhaps not questioned or reevaluated as regularly as they should have been.

Montross also discusses ethical dilemmas that arise where, as in the case of the Memorial doctors, there is no consensus or ‘correct’ approach and where opinions may be divergent and charged. For example, can a doctor who has sworn to ‘first do no harm’ amputate the perfectly healthy limb of a patient suffering with body integrity identity disorder (BIID) – a condition whereby people believe a part of their body does not belong to them and needs to be removed – in order to bring them relief from their often profound psychic suffering?

Montross’ book is also at times pretty upsetting and she openly accepts the difficulty of dwelling with her patients on the brink of the ‘chasm’. But what makes it ultimately such a redemptive and heartfelt read is how beautifully she brings it back to a shared idea of what it means to be human, what it means to suffer and how we all live with the daily knowledge that we are all always potentially a second or two away from life-altering disaster. Drawing on simple anecdotes of her life with her partner Deborah and their two children, Montross avoids this ever being a book about the strange ‘other’ that the mentally ill are often portrayed as and encourages the reader to empathise in a really meaningful way. I loved her style of writing and would certainly seek out her other book.

While neither of these books could ever be viewed as an easy read, they are both rewarding and enriching, and I’d heartily recommend them both.

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