Sep 30, 2022

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 right in front of you?

In this episode, first aired back in 2016, 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?

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.

Episode Credits:

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


You can find more about the work going on in Maryland at:
The book that inspired this episode about what transpired at Memorial Hospital during Hurricane Katrina, Sheri Fink’s exhaustively reported Five Days at Memorial, now a series on Apple TV+.

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LULU MILLER: Hey there. Lulu Miller here with an intense episode. We're gonna play one today that is from the archives. We made it back in 2016 in collaboration with the New York Times, where we take on the concept of triage—a word that at its core means sorting the value of lives. This topic is really tricky. Do you save the oldest, the youngest, the people with the most medical training? Do you pick it randomly? These questions are obviously just as relevant and unanswered today, and we thought it would be a good time to take a listen back. Produced by Simon Adler and Annie McEwen with reporting from Sheri Fink. Playing God.


JAD ABUMRAD: By the way, you know, we're gonna start with Kosovo, but when did you as a writer, become obsessed with all of this?

SHERI FINK: Well, this—this—this obsession of—about triage came about when I was working on my last book.

ROBERT KRULWICH: This is Sheri Fink, reporter from the New York Times. She's the author of the book Five Days at Memorial.

SHERI FINK: Which was about triage in an emergency. In Hurricane Katrina.

ROBERT: We brought Sheri in to tell us a series of stories that grew out of the reporting she did for that book, but we actually are gonna start with some tales before she wrote the book, when she was at the border of Kosovo and Macedonia.

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

JAD: 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.

SHERI FINK: I remember I went to the border of Kosovo and Macedonia and, like, 100,000 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. And the Macedonian Red Cross and this one charity had gotten permission to set up a makeshift medical station in that border area. I was there to collect information, but when I got there, the doctor who I had interviewed previously, this really tall Albanian—Kosovo Albanian doctor looked out and he told the Macedonian border guard "Let her in. We need her. She's a doctor."

JAD: They just grabbed you and pulled you into this tent?


JAD: What? So wait, you were just out of med school when this happened?

SHERI FINK: I had just finished med school. Yeah.

JAD: But 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: Now, "triage" is a French word. It means to sort for quality. And a few hundred years ago, the word began to be applied to 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 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: 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: 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 who went into that tent.

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

SHERI FINK: People who have chronic conditions.

JAD: No.

SHERI FINK: Psychiatric issues.

JAD: Nope.

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 board or take them in, they need care." And the health ministry kept refusing. And so they stayed in this tent day after day.

JAD: Sometimes for four, five, six days.

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

JAD: 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?

[NEWS CLIP: 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.]

JAD: Okay, so this is gonna be our first stop. We all have heard the story of Katrina told and retold. But in this story, the hurricane is really just a backdrop. Really, we're gonna 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: 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.

[ARCHIVE CLIP: The city of New Orleans is under mandatory evacuation. Everyone is advised to leave the area.]

ROBERT: 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.

[NEWS CLIP: Get ready. This is the most intense part of the storm. It's getting ready to come across.]

JAD: Day one. Monday, August 29, 2005.

SHERI FINK: Around 6:00 AM, Katrina hits.

[NEWS CLIP: I've never seen anything in my life like this.]

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

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

SHERI FINK: And then ...

[ARCHIVE CLIP: Stop. You haven't heard about that water coming over that levee from the lake?] 


[ARCHIVE CLIP: When did it start rising?]

[ARCHIVE CLIP: Actually after the storm. It had cleared up.]

SHERI FINK: The levees failed.

[ARCHIVE CLIP: Good Lord!]

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: 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 ...

JAD: Wow.

SHERI FINK: ... staff. And then all the visitors who had come with the staff members and with the patients.

JAD: So Sheri says, mid-morning on that second day, this is Tuesday, August 30, 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: 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: The medical staff start to bundle tiny babies in incubators, ICU patients in wheelchairs, onto the elevator and up to the helipad.

ROBERT: How many patients can a single helicopter take?

JAD: Yeah. Like the ones that we're landing. How many can they do?

SHERI FINK: One or two.

JAD: Wow. So this is slow going.

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

JAD: They get all the babies, and—and the ...

SHERI FINK: They got all the babies.

JAD: 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. And 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've been working really, really hard carrying patients in the heat.

JAD: Many of them lay down on cots and vacant beds.

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

JAD: Stopped.

SHERI FINK: It was quiet.

JAD: The water had reached those electrical switches in the basement.

SHERI FINK: Doctor—Doctor Cook, Ewing Cook, a long-time ICU doctor, he was lying not far from where those generators were. And he said to me, it was quote, "The sickest sound of his life."

ROBERT: Sound of absence.

JAD: 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. It became a hive of activity. They gotta 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. And so they figured out they could pass patients through this roughly three-by-three foot 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.

[ARCHIVE CLIP, Gina Isbell: It's just like I said, I've been trying to put it away.]

[ARCHIVE CLIP, Sheri Fink: Yeah.]

[ARCHIVE CLIP, Gina Isbell: But I wanna make this as accurate as I can for you.]

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

[ARCHIVE CLIP, Sheri Fink: Okay, good. Introduce yourself.]

[ARCHIVE CLIP, Gina Isbell: My name is Gina Isbell.]

[ARCHIVE CLIP, Sheri Fink: Isbell. Okay.]

[ARCHIVE CLIP, Gina Isbell: Just like it's spelled.]

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

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

ROBERT: And she described to Sheri that right after the power went out and after the ventilator shut down, one of her patients flatlined.

[ARCHIVE CLIP, Gina Isbell: And we brought him back. We had run out of oxygen, the whole hospital.]

ROBERT: That's what she'd been told.

[ARCHIVE CLIP, Gina Isbell: And he needed oxygen. And so we brought him down the stairs to the second floor.]

ROBERT: 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.

[ARCHIVE CLIP, Gina Isbell: Out this window.]

ROBERT: And she says that since his ventilator wasn't working anymore, the whole time they were standing there, they had to hand squeeze his ventilator back to keep air going into his lungs.

[ARCHIVE CLIP, Gina Isbell: You know, he kept twitching and I knew he needed oxygen. And so 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. And 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. I mean, I knew it was neurological, and that he needed oxygen and he wasn't gonna make it without it. So I just hugged him and stroked his hair, and I waited and just kind of held him and—and he died in my arms. And, you know, you're not prepared for that. 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: Day three. Wednesday, August 31, 2005.

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

JAD: Now, we know now, looking back that on that Wednesday ...

SHERI FINK: The helicopters were doing their own triage.

[NEWS CLIP: Coast Guard rescuing people.]

SHERI FINK: And looking at people on rooftops waving rags.

[NEWS CLIP: Entire family is on that roof right now. You're seeing ...]

[NEWS CLIP: 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: 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: So she says on that third day, at about seven in the morning, a bunch of doctors and hospital administrators ...

SHERI FINK: Maybe a dozen, dozen and a half.

JAD: ... 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 gonna 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 a 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: Sheri says if you go back to the very beginning of triage ...

SHERI FINK: The first conception of it.

JAD: 1790s.

SHERI FINK: Napoleon's chief surgeon ...

JAD: 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 gonna be treated first and with the most resources. And 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. Another way to look at it is the utilitarian concept.

JAD: 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: 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 are—have a better chance of surviving. Or younger people.

JAD: 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: Sheri says in this case what the doctors did ...

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

JAD: ... 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: 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 write either one, two, or three on that paper.

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

SHERI FINK: Onto the patient's gown. So the ones were your relatively healthy patients. 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. 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: 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 quote 'the least to lose.'"

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


JAD: 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: 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: 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: 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—it just—it was so, so hot!

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

[ARCHIVE CLIP,  ANNA POU: I don't know if there's any way for me to describe to you how intense the heat was.]

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

[ARCHIVE CLIP, 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.

[ARCHIVE CLIP, Gina Isbell: And the—oh, the bathrooms were so bad.]

JAD: That's Gina Isbell again.

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

[ARCHIVE CLIP, Gina Isbell: I mean, they just had sewage everywhere.]

[ARCHIVE CLIP, Sheri Fink: Mm-hmm.]

[ARCHIVE CLIP, Gina Isbell: On the ground. Everywhere. You—you just—personally, I didn't want to eat or drink anything 'cause I didn't wanna have to use the bathroom.]

JAD: 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?"

[NEWS CLIP: 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 Quarter.

[NEWS CLIP: Eight minutes past six o'clock here on WWL.]

SHERI FINK: The local talk station and the radio was ...

[NEWS CLIP: Is this radio station ...]

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

[NEWS CLIP: 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.

[NEWS CLIP: Basic jungle, human instincts are beginning to creep in.] 

SHERI FINK: And there were tales on the radio that were alarming the staff.

[NEWS CLIP: Someone is breaking into businesses and looting merchandise. These people should be shot.]

SHERI FINK: Things that turned out not to be true, like ...

[NEWS CLIP: 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.

[NEWS CLIP: We even both commented and said "Oh, it looks like a shark's fin."]

SHERI FINK: He saw a shark swimming around a hotel.

[NEWS CLIP: They're walking like zombies, like Nights of the Living Dead. That hall ...]

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.

[ARCHIVE CLIP, Gina Isbell: One of our employees was, like, having a breakdown, freaking out in the garage, and ...]

JAD: By the afternoon of that third day that Wednesday, some of the staff are having nervous breakdowns.

SHERI FINK: Morale is really, really low because all these patients are still there, basically. So there's this level of—of panic.

JAD: 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, and they turned Medical Records over into a kennel and people started to worry about their pets.

JAD: 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 ...

[NEWS CLIP: Looters are running free.]

[NEWS CLIP: Residents trying to shatter windows and climb into stores.]

SHERI FINK: It's hot. People are dying. You're hearing gunshots in the neighborhood. You're afraid.

[NEWS CLIP: It's total chaos.]

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

[NEWS CLIP: There are bodies floating in the water there.]

SHERI FINK: You don't know how many rescue resources are gonna come. It's nighttime. And 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?" And I interviewed all these people and trying to figure out, like, where did this idea come from? And tracing it back, and there were all these little informal conversations. And this starts just going around the hospital, this—this sort of idea of putting patients out of their misery.

[ARCHIVE CLIP, Gina Isbell: I don't know who told me that, but that's what I heard.]

[ARCHIVE CLIP, Sheri Fink: Mm-hmm.]

[ARCHIVE CLIP, Gina Isbell: And, you know, in those circumstances, what do you do? And if you're at war and you have someone that's not gonna be picked up and you can't carry them to safety and they're bleeding to death, what do you do? You let 'em suffer. Do you let 'em? I don't know.]

JAD: 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 ...

[ARCHIVE CLIP, Bryant King: You gotta be [bleep] kidding me that you actually think that that's a good idea.]

JAD: This is Dr. King in an interview on CNN.

[ARCHIVE CLIP, Bryant King: I mean, how could you possibly think that that's a good idea?]

JAD: Day four. Thursday, September 1. Here's what ends up happening—and 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: 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: He says he saw her talking to patients while holding a handful of syringes.

[ARCHIVE CLIP, Bryant King: Anna standing over there with a handful of syringes, talking to a patient, and the—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—that's just not how we do it.]

JAD: 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 1, 2005.

JAD: Wait, how many?

SHERI FINK: It was, I think, 21 in the end.

JAD: 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—that can cause harm, but if your intention is to do good, then that's ethical.

JAD: And Dr. Anna Pou ...

[ARCHIVE CLIP, 60 Minutes: Did you murder those patients as the attorney general alleges?]

[ARCHIVE CLIP, 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: 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.

[ARCHIVE CLIP, Anna Pou: It completely ripped my heart out because my entire life I have tried to do good, and my entire adult life I have given everything that I have within me to take care of my patients.]

JAD: 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: 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. And plus there's four nurses up here taking care of her. Couldn't we use them somewhere else?" So he literally turned to one of the nurses and said, "Can you give her enough morphine 'til 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. He said to me, he thought it was desperate. He saw only two choices: quicken their deaths or abandon them. And 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: 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: 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."

JAD: Hmm.

SHERI FINK: But he had had a spinal cord stroke. He couldn't walk. He was on the seventh floor of the hospital with no working elevators. And 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: And he was—and he—he died?

SHERI FINK: He died. Found—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: Did a judge or jury find anyone guilty of manslaughter or murder or—or second degree murder or …? 

SHERI FINK: No. Nobody ...


SHERI FINK: 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: Wow. That's kind of chilling to think.

JAD: After Katrina, as we hear after the break, people started paying all kinds of attention to triage, thinking about it in new ways and, as you'll hear, some surprising new places. That's coming up.


JAD: Hey, I'm Jad Abumrad.

ROBERT: I'm Robert Krulwich. This is Radiolab. And this hour we are talking about triage.

JAD: And before the break, we were talking to reporter Sheri Fink about what happened in one hospital in New Orleans during Hurricane Katrina and the consequences of some of the decisions made there.

ROBERT: But now we shift focus.

JAD: God, if all of that began with a triage decision about which patients 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. 'Cause God, I wouldn't be able to think my way through that.


ROBERT: 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 gonna 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 asked because, of course, after Katrina, there have been efforts since then to come up with a protocol.

JAD: Oh.

JAD: 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: And one of the interesting things was that the state of Maryland decided we're gonna 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 ...

JAD: Really?

ROBERT: Really?

SHERI FINK: ... and have them grapple with this. And I was there.

JAD: Oh, you went to the very first one?


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


[ARCHIVE CLIP: To get started, there's just a ...]

SHERI FINK: So just imagine a church basement in inner-city Baltimore. Or a conference room in wealthy Howard County.

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

[ARCHIVE CLIP, woman: Do you wanna switch seats?]

SHERI FINK: So the researchers, let's call them that, they get people together and ...

[ARCHIVE CLIP: We're gonna get started. Good morning. Good morning.]

SHERI FINK: The sort of scenario is laid out.

[ARCHIVE CLIP, Lee Daugherty: So my name is Lee Daugherty. I am an intensive care doctor just down the road at Johns Hopkins. And what we're gonna be talking about today is how we make decisions about who gets life saving resources in the—in a situation where we literally cannot take care of everyone. Today, the scenario we'll talk about is pandemic influenza.]

JAD: 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 gonna get better," they say, "is if they have a ventilator to help them breathe. But the problem is there just aren't enough."

[ARCHIVE CLIP, Lee Daugherty: This is horrible. 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?

[ARCHIVE CLIP, Lee Daugherty: What are the acceptable options? What might be the right answers? What ...]

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

SHERI FINK: Number one ...

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

SHERI FINK: People with the best chance of surviving the pandemic. 

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

SHERI FINK: Number two ...

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

SHERI FINK: So first responders, healthcare providers, vaccine workers, etcetera. 

ROBERT: Oh, interesting. [mumbling]

SHERI FINK: Or number three.

JAD: Leave it up to fate. Something like first come for serve or ...

SHERI FINK: A lottery.

[ARCHIVE CLIP, Lee Daugherty: I'm seeing people nod. Does that make sense? Yeah. Okay.]

SHERI FINK: And then they say, 'We're here to answer your questions. Talk amongst yourselves."

[ARCHIVE CLIP, Lee Daugherty: All right. Go ahead.]

JAD: You know ...

[ARCHIVE CLIP, Lee Daugherty: Thank you.]

JAD: ... pick.

[ARCHIVE CLIP, man: You talk about something ...]

[ARCHIVE CLIP, woman #1: Those protocols, those protocols will be black and white.]

[ARCHIVE CLIP, woman #2: I've never seen any situation in life where it was black or white.]

[ARCHIVE CLIP, woman #3: Some things are black and white.]

[ARCHIVE CLIP, woman #2: I'm saying it shouldn't be black and white.]

[ARCHIVE CLIP, woman #4: Well, my immediate reaction to the lottery was it's a leveler. It's all the same.]

[ARCHIVE CLIP, woman #3: I think it is the scientifically least responsible way to go.]

[ARCHIVE CLIP, woman #5: I think ultimately it's fair.]

[ARCHIVE CLIP, woman #4: If somebody's gonna live, but be very sick. Is that—should that go into the decision?]

[ARCHIVE CLIP, woman #1: If—if we've—if we've set up guidelines, then yes.]

[ARCHIVE CLIP, woman #6: Is every kind of doctor, you know what I mean, gonna be essential?]

[ARCHIVE CLIP, woman #3: I didn't say that. No. No.]

SHERI FINK: Now the good news is ...

[ARCHIVE CLIP, man:  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.

JAD: And there weren't any fist fights?

SHERI FINK: No. But as you can also hear ...

[ARCHIVE CLIP, woman #1: Well, I'm all for the first come first served, and nobody has to put that on their conscience.]

[ARCHIVE CLIP, woman #2: If you get it first because you're there and I got there half a second and I entered ...]

SHERI FINK: ... there wasn't a lot of agreement.

[ARCHIVE CLIP, woman #3: I respect your opinion, but I'm just feeling ...]

[ARCHIVE CLIP, woman #4: No you don’t. [laughs]]

[ARCHIVE CLIP, woman #3: Yes, I do!]

[ARCHIVE CLIP, woman #2: I think in a time of crisis, there's no room for emotions.]

[ARCHIVE CLIP, man: The reality is some people are gonna have to die.]

SHERI FINK: So one of the—the big findings was that ...

[ARCHIVE CLIP, Lee Daugherty: 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 coming into the discussion.

[ARCHIVE CLIP, Lee Daugherty: We're not gonna make decisions based on gender, race, socioeconomic status.]

SHERI FINK: Like people's jobs and incomes and ...

[ARCHIVE CLIP, Lee Daugherty: Citizenship status and their ...]

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

[ARCHIVE CLIP, Lee Daugherty: Those things are out of bounds. I just wanna say upfront that's not—that's not up for grabs.]

SHERI FINK: But those things kept popping up.

[ARCHIVE CLIP, woman: You may have, like, a young pastor and you might have a—a reprehensible alcoholic, criminal type person, and he might have more years to live. Well, the years of the pastor are gonna be more beneficial to society than the years of this—a criminal, reprehensible, alcoholic, bad person.]

[ARCHIVE CLIP, woman #2: Whoa. You are straying into iffy territory there. Whoa! That is a—that is a personal value judgment.]

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

[ARCHIVE CLIP, woman#3 : And the world will be a better place in the end.]

[ARCHIVE CLIP, man: 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: What's interesting is that people were really comfortable making utilitarian choices, like saying, "Yeah, that person should get the ventilator because they're gonna 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, like, were not cool with that. And yet you would hear people say it that way again and again, and then immediately be repulsed when they heard someone else say it that way.

SHERI FINK: And this was particularly acute when participants were asked the second ...

[ARCHIVE CLIP, woman #1: Can—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?"]

[ARCHIVE CLIP, man: This one, I definitely don't have a clear answer myself.]

SHERI FINK: Some people said, "Well, of course."

[ARCHIVE CLIP, man #2: If it doesn't seem like someone is gonna make it through the treatments, then we need to cut it—cut their treatment short and pass that ventilator on to someone else.]


[ARCHIVE CLIP, man #3: You're gonna murder my father?]

SHERI FINK: ... there were other people who said no.

[ARCHIVE CLIP, man #3: You take my father off that ventilator and ...

[ARCHIVE CLIP, woman: I will sue you.]

[ARCHIVE CLIP, man #3: You are going to be sued.]

[ARCHIVE CLIP, woman: Yeah. That's what I mean.]

[ARCHIVE CLIP, man #3: For the rest of your life. I'm never gonna sign off on that.]

[ARCHIVE CLIP, woman #2: It's a terrible thing to think about.]

[ARCHIVE CLIP, man: Right.]

[ARCHIVE CLIP, woman #3: But it's necessary.]

[ARCHIVE CLIP, man #3: I don't know how I feel about anything.]

[ARCHIVE CLIP, woman #3: It's so complicated.]

JAD: Did they come to a conclusion? Did the public ...

ROBERT: Did you—Jad, did you hear a conclusion?

SHERI FINK: 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: Wait, wait, wait, wait. Before we prejudge this, what is it that the researchers are gonna 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?

JAD: Mm-hmm.

SHERI FINK: Well, it turns out they wanted to combine some of those different perspectives. And they wanted ...

JAD: 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 gonna be a lot of people who fit in that category. So if everybody's just about the same and we can't—we don't have, like, great science that allows us to know which patient is gonna 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: So it's like you introduce a little bit of fate to keep things honest.

SHERI FINK: Exactly. And the—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: 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, and especially guidelines that were developed with the input of lots of people.

JAD: Yeah.

SHERI FINK: 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 gonna be advantaged or disadvantaged over money or over these other things, it sort of helps you accept it.

JAD: Yeah.

ROBERT: Hmm. In theory that sounds, you know, plausible, but when you put theory to practice, which we're gonna do right after the break, things get very hard.

JAD: That's coming up.


JAD: Hey, I'm Jad Abumrad.

ROBERT: I'm Robert Krulwich.

JAD: 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 gonna 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.


[ARCHIVE CLIP, medic: Yeah, we—we can't even do the tip fibs that we wanna evaluate.]

SHERI FINK: I remember being in Haiti after the Haiti earthquake back in 2010.

[ARCHIVE CLIP, medic: I got a 20-year-old female. I don't know what's gonna happen here.]

SHERI FINK: I was embedded with a group of US disaster responders: the International Medical and Surgical Response Team, IMSuRT.

[ARCHIVE CLIP, medic: What's your name again?]

[ARCHIVE CLIP, 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.

[NEWS CLIP: More than a hundred thousand people could be dead.]

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

[ARCHIVE CLIP, medic: 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. And then they were also trying to use these oxygen concentrators which pull oxygen from the environment, but they rely on power and they were running out of diesel for the generators.

[ARCHIVE CLIP, medic: Logistics. We're at a critical level with our diesel supply and oxygen for the OR, so it's—I'm freaking today. I mean, I am freaking. Pray for us in logistics today.]

[ARCHIVE CLIP, Sheri Fink: Okay.]

[ARCHIVE CLIP, medic: Do we have respiratory to major for ...]

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 gonna give it to, and who were they not? And at one point ...

[ARCHIVE CLIP, medic: ... ICU, please.]

[ARCHIVE CLIP, medic: Meet you in the ICU?]

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

[ARCHIVE CLIP, Sheri Fink: Hi.]

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

[ARCHIVE CLIP, translator: Comment tu t'appelles?]

[ARCHIVE CLIP, Natalie Le Brun: Natalie Le Brun.]

[ARCHIVE CLIP, translator: Natalie Le Brun.]

[ARCHIVE CLIP, Sheri Fink: And how old are you?]

[ARCHIVE CLIP, translator: [To Natalie, in Creole.] Quel age as tu?]

[ARCHIVE CLIP, Natalie Le Brun: Trente-huit.]

[ARCHIVE CLIP, translator: [in English, to Sheri] 38. She's 38 years old.]

[ARCHIVE CLIP, Sheri Fink: Oh, okay. Tell her we're almost the same age.]

[ARCHIVE CLIP, translator: [To Natalie, in Creole.]]

[ARCHIVE CLIP, Sheri Fink: How are you feeling today?]

[ARCHIVE CLIP, translator: [To Natalie, in Creole.]]

[ARCHIVE CLIP, translator: [in English, to Sheri] She's feeling better.]

[ARCHIVE CLIP, translator: [To Natalie, in Creole.]]

[ARCHIVE CLIP, translator: [in English, to Sheri] They give her a lot of medicine and she's doing all right.]

[ARCHIVE CLIP, Sheri Fink: That's good.]

[ARCHIVE CLIP, Natalie Le Brun: [In Creole]]

SHERI FINK: 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—they died.

[ARCHIVE CLIP, Natalie Le Brun: [In Creole]]

[ARCHIVE CLIP, translator: [in English, to Sheri] They were all staying together like, you know, nieces, nephews, cousins and everything.]

[ARCHIVE CLIP, Sheri Fink: I'm so sorry.]

[ARCHIVE CLIP, Natalie Le Brun: [In Creole]]

SHERI FINK: She told me that, amazingly, she had survived because she wasn't at home when the earthquake hit.

[ARCHIVE CLIP, Natalie Le Brun: [In Creole]]

SHERI FINK: She checked into this hospital ...

[ARCHIVE CLIP, translator: [in English, to Sheri] 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. And after the earthquake, she was transferred to this American hospital.

[ARCHIVE CLIP, Sheri Fink: How do you feel about the treatment that you got here?]

[ARCHIVE CLIP, Natalie Le Brun: [In Creole] Oh!]

[ARCHIVE CLIP, translator: [in English, to Sheri] Oh, they treat me well. Way, way better than anywhere else that she's been.]

[ARCHIVE CLIP, Natalie Le Brun: [In Creole "C'est les Americains qui sont responsable...."]]

[ARCHIVE CLIP, translator: [in English, to Sheri] She thank God for the American people cause they're the one that's in charge right now 'cause God is really using them and put them in charge of all the thing that's going on.]

[ARCHIVE CLIP, Natalie Le Brun: [In Creole] Merci. Merci beaucoup. I love, I love Obama. God bless Obama.]

[ARCHIVE CLIP, Sheri Fink: Okay. I'm happy to see a smile on your face.]

[ARCHIVE CLIP, Natalie Le Brun: [In Creole] Merci.]

SHERI FINK: I started to speak with the staff about her.

[ARCHIVE CLIP, hospital staff: You've been taking care of her? Part of the ...]

[ARCHIVE CLIP, Sheri Fink: 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.

[ARCHIVE CLIP, hospital staff: 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 then they were gonna send her off to a—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.

[ARCHIVE CLIP, translator: [in English, to Sheri] Hopefully when she get well, she prayed to God that she will have an opportunity to earn a living.]

[ARCHIVE CLIP, Natalie Le Brun: [In Creole]]

[ARCHIVE CLIP, translator: [in English, to Sheri] She wants to know, once she's at the hospital, is there any way possible that the people would give her, like, somewhere to stay, like some kind of shelter?]

[ARCHIVE CLIP, Sheri Fink: I—uh, I mean, I'm a journalist and I don't know the answer to that, but I-—I don't know what to say. It's such a hard situation right now.]

[ARCHIVE CLIP, translator: [in Creole]]

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

[ARCHIVE CLIP, Patrick Cadillac: I'm Patrick Cadillac. I'm the commander for the IMSurT team.]

SHERI FINK: ... had never met her.

[ARCHIVE CLIP, Patrick Cadillac: No, I never met the patient, but that's the rule 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.

[ARCHIVE CLIP, hospital staff: Stop looking around. Go ahead, get him up there.]

SHERI FINK: It was an 82nd Airborne actually, who were providing that service. They were amazing. And they came to pick her up.

[ARCHIVE CLIP, transporter staff: Does she need to travel with O2? Or does she need to travel with her ...]

SHERI FINK: They saw she was on oxygen. They said, "Okay, we're gonna put her on—" their portable oxygen tanks. And the representative from the hospital said ...

[ARCHIVE CLIP, hospital staff: No, she does not.]

SHERI FINK: Oh, no. No. She doesn't get oxygen. So they yank the oxygen.

[ARCHIVE CLIP, transporter staff: All right, Ready?]

SHERI FINK: Strapped her onto a stretcher.

[ARCHIVE CLIP, transporter staff: Get up here. One, two, three. Go.]

SHERI FINK: Lifted her up. Stuck her in the back of this Humvee ambulance.

[ARCHIVE CLIP, transporter staff: Careful.]

[ARCHIVE CLIP, transporter staff: Watch your head.]

[ARCHIVE CLIP, transporter staff: Coming with?]

[ARCHIVE CLIP, Sheri Fink: Yes.]

[ARCHIVE CLIP, transporter staff: We're gonna hop in the cargo Humvee. Pulling up.]

[ARCHIVE CLIP, transporter staff: What do you ...]

SHERI FINK: I rode with her.

[ARCHIVE CLIP, transporter staff: Bumps coming up.]

[ARCHIVE CLIP, Sheri Fink: Hey, bump, bump, bump.]

[ARCHIVE CLIP, Natalie Le Brun: Oxygen?]

SHERI FINK: She started getting short of breath.

[ARCHIVE CLIP, Natalie Le Brun: Oxygen!]


[ARCHIVE CLIP, Natalie Le Brun: Oxygen. Oxygen. Oxygen!]

JAD: Oh my God!

SHERI FINK: She's asking for oxygen. She put this asthma inhaler in her mouth. She kept hitting it over and over again.

[ARCHIVE CLIP, Natalie Le Brun: 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—to die. And just watching didn't feel—it didn't feel right. And so ...

[ARCHIVE CLIP, 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—to look at her.

[ARCHIVE CLIP, Sheri Fink: 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 ...

[ARCHIVE CLIP, emergency doctor: Yeah, she's definitely big time CHF.]

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

[ARCHIVE CLIP, emergency doctor: Is it—whose is this?]

[ARCHIVE CLIP, Sheri Fink: It's hers.]

[ARCHIVE CLIP, emergency doctor: Is that—is that hers?]

[ARCHIVE CLIP, Sheri Fink: Yes.]

[ARCHIVE CLIP, emergency doctor: Here, I need this. Mama. I want you to sit up. Okay, mama. Slide. No. Slide back a little bit. Slide back.]

SHERI FINK: And, he improvised.

[ARCHIVE CLIP, emergency doctor: Give her 60 Milligrams of [inaudible]. Write it out.]

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

[ARCHIVE CLIP, emergency doctor: We got any nitrates or anything?]

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

[ARCHIVE CLIP, emergency doctor: There. This will make you breathe breaths better, okay? Keep it in your nose. In, through your nose. Okay. Breathe in.]

SHERI FINK: And he was able to extend her life.

[ARCHIVE CLIP, emergency doctor: All right. Good night. See you tomorrow.]

[ARCHIVE CLIP, 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—I did attempt to help her.

JAD: Really?


JAD: How?

SHERI FINK: Well, I found a—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 medical treatment. And the—the cardiologist who had examined her in Haiti had thought she had a—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 and she really needed a transplant. And she didn't—didn't make it.

JAD: Huh.

ROBERT: 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: 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. Like, it turns out there was—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—like there was some value in her existence. There was so much value. 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 'til the day she died. I don't know how to do the math on this one, you know?

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

SIMON: And how do you make compassion work on that large of a scale without caring about people? And then you care about some people more than other people.


SIMON: ...and [bleep]. And now—now—now we're hurting people.

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

JAD: Exactly. 'Cause part of me does wonder, like, what if Natalie weren't such a nice person? Would her—would that have changed things?

SHERI FINK: Well, you know, if Natalie was a mean person, I don't think I would've felt any better watching her suffer. It's—it's just about the person in front of you, and 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: Okay. But—but I do feel you somehow refusing to acknowledge the subject point when it really, really gets tough. You say, "let's—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 and ...

ROBERT: But what—But at some point ...

SHERI FINK: You know what, we're not gonna 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: I think that that's, and 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?

ROBERT: 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. We have a God role. and nobody fits it.

JAD: We have so many people to thank for this hour. Let's start with Lily Sullivan and Pat Walters for really getting us thinking about all of this. Thank you, Lily. Thank you, Pat. Thank you 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.

ROBERT: Which is, by the way, a very fine book and you should check it out.

JAD: Sheri has an article that coincides with this podcast about the Maryland Project. We will link you to it from, or you can read it at

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

JAD: 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 Deupree and Kenneth Kirschner. I'm Jad Abumrad.

ROBERT: I’m Robert Krulwich.

JAD: Thanks for listening.

LULU: Hey, Lulu again. In the years since we released this episode, we've made another piece about triage. During the pandemic, we worked on a piece with disability activists and author Alice Wong about the guidelines that actually were put in place in New York State that ended up allowing for the taking of someone's personal ventilator to give to someone deemed to be a higher priority of saving. Alice, who uses a BiPap machine herself, called this quote, "breath stealing," and put together a truly amazing audio essay for us as part of our Breath show. You can find it at or right here in the liner notes to this episode. Thanks so much for listening.


[LISTENER: Radiolab was created by Jad Abumrad and is edited by Soren Wheeler. Lulu Miller and Latif Nasser are our co-hosts. Suzie Lechtenberg is our executive producer. Dylan Keefe is our director of sound design. Our staff includes: Simon Adler, Jeremy Bloom, Becca Bressler, Rachael Cusick, Akedi Foster-Keys, W. Harry Fortuna, David Gebel, Maria Paz Gutiérrez, Sindhu Gnanasambandan, Matt Kielty, Annie McEwen, Alex Neason, Sarah Qari, Anna Rascouët-Paz, Sarah Sandbach, Arianne Wack, Pat Walters and Molly Webster. With help from Andrew Viñales. Our fact-checkers are Diane Kelly, Emily Krieger and Natalie Middleton.]


[LISTENER: Hi, this is Finn calling from Storrs, Connecticut. Leadership support for Radiolab science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, Science Foundation Initiative and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.]



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