As Sheri Fink recalls it, she heard about the events at Memorial Hospital the way most of us probably did, among the news stories coming out of New Orleans after the devastation caused by Hurricane Katrina in August 2005. The staff at the underprepared hospital, where the generators failed after two days, worked around the clock, struggling amidst chaos and confusion to keep patients fed and hydrated until they could be evacuated. In June of the next year, a doctor and two nurses from the hospital faced criminal allegations of having hastened the deaths of several elderly and critically ill patients with injections of sedatives.
Fink, a trained doctor who also has a Ph.D. in neuroscience as well as experience delivering aid in combat zones, recognized the significance of the story. She had previously written a book, War Hospital: A True Story of Surgery and Survival, about a group of young doctors trapped in Bosnia and the professional and ethical dilemmas they faced there. Working as a freelance journalist, she headed to New Orleans to try to conduct an interview with the doctor under indictment. Eventually, her efforts led to a story, co-published by ProPublica and the New York Times, which was awarded a Pulitzer Prize. Some writers might have moved on, but Fink stuck with the story, interviewing everyone she could—hospital staff, patients and their family members, relief workers, and others. The result of six years of reporting was a book, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, which not only reconstructs the events at the hospital during those critical five days after the storm struck, but also explores vital questions of policy, not to mention truth and justice: Who bears responsibility in disasters? And how can we prepare for calamity?
Five Days at Memorial has been justly acclaimed, winning numerous awards, including the National Book Critics Circle Award and the Los Angeles Times Book Award. In a phone conversation with CNF earlier this year, Fink talked about how her medical training informs her work as a reporter, the importance of “vacuuming up” information, and the six years of work she put into researching the events of five days. —CNF
GUTKIND: Surely there were times when you decided you would just walk away and find something else to write about. Or were you just kind of committed?
FINK: No, I was writing about a lot of different things in the interim; I wasn’t just doing that story. There are stories that I follow—even now there are a couple of things I’ve been following for well over a year; it’s not like I stop everything else. Particularly if you’re an independent journalist or a freelancer, it may be typical that you’re going to be working on kind of juggling different things, and I think that can be an advantage. Over time, sometimes someone who’s not willing or able to talk at first will be able to later, and, of course, through the incredible amount of litigation in this particular case, certain documents became available in the court record that were very helpful at reconstructing what happened—at giving facts and data and test results and whatnot, which was all very helpful in piecing things together. But I was certainly doing other things along the way.
GUTKIND: Are there two different ways you piece a story together? Do you piece together the basic information of the story while at the same time you have a narrative that you’re trying to piece together? How does that work, and how do you keep them separate and together, and how do you do that kind of research simultaneously?
FINK: I think one of the most helpful things is to keep a timeline. If you’re intending to tell a narrative story, that can be very, very helpful.
Basically, when I did an interview, I would go back and kind of plug the relevant pieces into my running timeline, which was just a Word document. So, if I interviewed somebody and I learned that he went to medical school in 1974, and this and that, I’d just find that spot in my document in 1974. You find connections that way, things that you wouldn’t realize maybe if you had just done different interviews and you weren’t looking for those connections. I think it can be really helpful to keep a timeline like that, and then when you’re constructing your narrative, obviously chronology is one of the most useful organizing principles, particularly with a complex story. It can be a way of helping the reader not get confused, so I think timelines are very helpful.
GUTKIND: There are also many spots in the book and in your story where you take us inside the hospital. You’re investigating a flight of stairs, for instance, and you describe the stairs and certain details of what the hospital looked like. When do you do that reporting? Do you do that in the end? Do you do it in the beginning? How do you know you’re even going to need that information?
FINK: I think that with a deep-dive narrative story you’re really becoming the world’s expert on your topic, and so I’m always vacuuming up pretty much every detail I can find. If there’s a detail that really interests you, chances are it’s going to interest your readers (or, if you’re working in other media, whoever is consuming that media). I guess I follow my own curiosity, and I know that to reconstruct a scene, I’m going to need those kinds of details. And because I wasn’t there collecting those videos, asking people about what it was like, collecting pictures, I would ask everybody I met: Did you have a cell phone camera? Did you take pictures? Can you send me those? Can you show me those? I just collected those over the years, and then when I went to write, I would have those materials that I needed, and that’s when I would really look at them as I was writing particular sections. So I had a file in my computer that was all photos and videos, and I would turn to those as well as the descriptions of the people. Because I tried to tell each part of the story through the eyes of a different person, I would go back to their interviews and look at how they [responded] when I asked them what a particular thing was like, what it was like through their eyes.
GUTKIND: You seem to be very careful about being as objective as you possibly can be about the situations.
FINK: Yeah, one of the fascinating parts of this particular event is that it is so nuanced. It was a hospital that was two city blocks long, and people really did have different experiences, depending on where they were at a point in time in a point in space. And also, these discussions of euthanasia and end of life—they’re often spoken of in not very direct terms, kind of euphemistically, and people can interpret them different ways, and it is entirely possible that that’s what occurred here. I mean, I think the truth of what happened is quite clear: there were quite a few patients who were given drugs and then died, and some of the people who were involved in that felt it was an intentional hastening of death. There are others who felt it was a form of comfort, but who were still willing to say it was maybe not what we do every day. So I just felt that, with this particular case, it was important to have those perspectives, but I can see doing it the other way for a different kind of story.
GUTKIND: You are two different people—a physician and, also, a writer. I’m wondering if you had a difficult time balancing those perspectives.
FINK: I think there can be advantages and disadvantages of having an expertise in a particular area. On the advantage side, it can be a head start; it can give you a sense of what might be most relevant, and it’s also a link to the people you’re speaking with, because they know that there are certain commonalities in your training or background and in the way that you might look at the world. On the other side, I think it’s very valuable to come from the outside of a field. You can bring a fresh perspective; you aren’t inculcated in a particular profession. (There’s a whole process of professionalization that occurs in training to become a physician or a lawyer or any other field. A journalist.) I think it’s just like the advantages of having a foreign correspondent be in a country for a very long time and develop that expertise and background, versus having somebody come in with new eyes every few years and really have a different perspective on things. I don’t think there’s one right way to go about this, and I certainly don’t think that having a medical background or a nursing background is a prerequisite to report on topics of health. Not at all. There are very many people who don’t have that background, who do a great job at it, and vice versa. There’s a role for both the specialist and the non-specialist, and you develop. . . . As you well know, and as anybody who’s been in journalism knows, while you cover topics, you do develop quite an expertise. As reporters, we’re so fortunate to be able to go right to the leaders in a particular field and to get to speak with them. They might spend an entire career building up a particular type of knowledge—or a research scientist who works for years and years to find one small discovery—and we get to capture that whole background, compressed for us as we interview that person and learn about their work.
SAREWITZ: Do you have a different view of truth as a narrative writer versus in your identity as a scientist? Do you see “scientific truth” and “narrative truth” as different things?
FINK: That’s really interesting because I’ve actually always thought of them as very linked. The very fact that I went through a basic science training program gives me a sort of skepticism—a need to triangulate bits of evidence as well as distrust of a simple single truth—and I think I really learned all of that in the lab, so I see it as more similar than dissimilar. I feel like I bring that same investigative approach that I did to the lab to investigative journalism. I see them as very similar.
SAREWITZ: What about in terms of the outcome? I have the sense that there’s something different in the way objectivity and truth manifest in science versus in a narrative, where there seems to be a tension in how different characters in your story view the truth, but it sounds like you’re saying you don’t think there really is a difference.
FINK: No, because I think it’s true with science, too. You have to have replication, and we’re always changing our understanding, and there’s very little that we. . . . Particularly with medical studies: let’s say that every few years, a new study is showing us something different and leading us in a slightly different way. I worked in molecular biology, partly, for my Ph.D. (as well as in more cell-based and larger system-based studies), and even in a carefully controlled experiment, you get lots of different results. You see that the truth is not easy to find and that science is an evolving process. It’s not like you state one truth in the science paper that you publish and that truth stands forever, and I feel like narrative is very similar in this way. Maybe that’s why I write the way I do: that I am (as you pointed out) loath to, in this particular story, state one point of view and say that’s the absolute truth from all perspectives. I think that comes from that background of knowing that truth is complicated and wanting to be skeptical of it.
SAREWITZ: Quite wonderful and, yet, I would also say, very different from the public persona of science as often portrayed by scientists.
FINK: Well, no, this is a problem, actually: scientists do realize these things, and sometimes this long-standing tension between the news media, who want to cover science, and scientists themselves maybe not being. . . . There’s been a long-standing problem between scientists and news media communicating scientific results to the public, and so, no, I think scientists do understand this. Maybe it’s just that the way their findings get reported is more definitive than the science would actually suggest, or maybe there are pressures on scientists (as in many fields) to show that they’ve discovered something to get more funding or get their names out there. I don’t know; I wouldn’t say I know. But I think scientists do realize this.
SAREWITZ: You said that part of your motivation in undertaking the New Orleans story was to create an awareness of the situation so it wouldn’t happen again. But, of course, there was actually nothing surprising about Katrina in that the meteorological vulnerability of the city was perfectly well known and kind of excruciatingly well predicted through advances in climatology and meteorology as well as the understanding of natural disasters and so forth.
FINK: And in journalism, too.
SAREWITZ: And journalism, as well. One of the things that often frustrates me in my effort to work across this boundary between science and decision-making is how often we say we know lots of things, but they’re somehow not accessible to decision-makers. Is narrative a tool that ought to somehow be mobilized more effectively by the scientific community as a way of getting complex, important ideas out there so that they are more fully appreciated and absorbed in the public sphere? There’s no lack of communication of science to the public and policy makers, yet there does somehow seem to be an inability to get big insights that ought to be obvious to be taken seriously—like, New Orleans is going to get hammered by a hurricane someday. So do you see narrative, in part, as something that the scientific community ought to find more ways to engage in as a better way of avoiding what happened in New Orleans?
FINK: I want to answer that in three ways. First of all, yes: certainly, I think one of our most important tasks is that we need to figure out how to tell the stories better. How do we tell these stories in a way that will engage the public and that editors will see as a good story? I think it’s very challenging; I’ve certainly tried to pitch a lot of risk stories (or preparedness stories), and how to tell a story about a risk of something that hasn’t yet happened is always challenging. So figuring out ways to do that better … I think that’s a challenge, and it’s a great challenge, and we should do more of that. That’s one thing.
The second thing is that even when we know about the risks, still—when it comes to knowledge of risk versus action—there are these policy questions and resource questions. In other words, how much do we as a society, and as governments, as individuals, as corporations, all along the line … how much do we want to invest in preparedness to be able to handle things that could be potentially catastrophic but that are relatively unlikely? And how do we balance that investment against our everyday needs and concerns and places where we need to put our resources, when, in some cases, resources might be not ample at a time of financial difficulties. That’s a valid question: there are plenty of things we know about and that we’re not preparing for, and it may be for a variety of reasons. It’s not because we don’t know necessarily, but maybe it’s because this particular policymaker will be out of office by the time this thing might occur, or because business cycles—planning cycles—are more short term than long term, or. . . . Whatever the reason, I think human beings tend to be more shortsighted, and so maybe probing why that is would be another set of stories, and how we make these decisions about preparedness and balance of risks is a whole separate question.
The third thing I’ll say is that even though we may know what the risks are—there were questions about the larger infrastructure, and we knew that hurricanes could hit New Orleans, that it was under sea level, and maybe some people appreciated the levee vulnerabilities—I feel, having worked in a lot of disasters around the world and seen a lot of calamitous things, that the one thing which is always certain is that individuals will be in these circumstances. Official help may not come; preparedness may not be good—likely won’t be so good—and what tends to happen (at least, what I’ve seen) is that the people in the immediate vicinity of a crisis are the ones on whose shoulders these events fall, and who have the power really to save lives in the immediate aftermath. That’s why Five Days at Memorial, I think, focuses in very closely on individual decision-making: that is something we all have control over. We can all prepare mentally—almost as if you’re somebody who plays a sport and you are going to be practicing a play or you’re going to be visualizing it before you ever have to perform it. I think that’s the value of thinking through these types of situations that could occur in our hospitals, in our towns, in our homes, and which I think we have control over.
SAREWITZ: That’s incredibly insightful and interesting.
GUTKIND: I’m curious what’s going to happen next. What are you working on? Or what’s the next crisis project that you’re going to look into?
FINK: I’m going to write about lipstick and wedding cakes from now on, and small puppies. No more of this heavy stuff. [Laughs.] I’ve just taken a job at The New York Times, and so I’m in the process of figuring out what the next stories will be right now.