Wait, you're listening to Radio Lab from WNYC. Let's just start from the top. Okay, you ready? Alright, so for reporter Sherry Fink, who works at the New York Times and is author of the book Five Days of Memorial, you could say it all began with two tents.
So this was back in 1999. The US and other, I think, NATO allies were involved in a bombing campaign in Serbia. This was basically like the last gasp of war in the former Yugoslavia. She had Serbia attacking ethnic Albanians and Kosovo.
NATO was trying to protect them bombing Serbia, which was creating a huge exodus of refugees. Now Sherry, 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, to document potential war crimes.
So I remember I went to the border of Kosovo in 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.
She said police and riot gear were basically lining the Macedonian side. So you had all of these people crammed into this muddy channel. And the Macedonian Red Cross and this one charity had gotten permission to set up makeshift medical station in that border area between these two countries. This is sort of frumpy, brown medical tent.
Now Sherry was there to conduct interviews. Nothing to do with medicine. I was there to collect information, but when I got there, I literally remember walking up to this border and a 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.
They just grabbed you and pulled you into this tent? Yes. So you just got to med school in the center? I had just finished med school.
Yeah. 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.
And what I ended up doing, they put me in charge of, was triage. Now triage, it's a French word. Nice accent. Yes, thank you.
It means to sort or to sort for quality. Originally it was a reference to sorting coffee beans, actually, sorting different kinds of coffee. But a few hundred years ago, the word started being applied to people, actually sorting different kinds of casualties on a battlefield. And that suddenly was her job.
Literally I stood outside of this makeshift medical station and every minute, every couple of 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. And like, how did you do that? How did you make that choice?
Well, I don't remember having guidelines. I remember just having to wing it. She says she just went on instinct. 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. But you know, people with physical disabilities, no. People who have chronic conditions, psychiatric issues? Nope.
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. When your border take them in, they need care. And the health ministry kept refusing.
And so they stayed in this tent day after day. Sometimes for four, five, six days. And several of the people in this tent, they died. Sherry says this experience haunted her.
And years later, when she was a full blown reporter and traveling all around the world, looking at triage and 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? Today, a collaboration with the New York Times where then a follow reporter Sherry think through the ins and outs of triage in three different situations, three different places in the world as she tries to understand what it means to play God. I'm Jan Aben-Ran.
I'm Robert Bowersch. This is Radio Out. Stay with us. Are we rolling?
Yeah. Okay. I think he's going to get. Oh, he's going to get some water.
Okay. By the way, we're going to start with Cosmo. But when did you as a writer become obsessed with all of this? Well, this obsession about triage came about when I was working on my last book, Five Days at Memorial, which was about triage and an emergency in Hurricane Katrina.
This is the scenario that people in New Orleans have been fearing for a long time. A Category 5 hurricane headed right toward the city. Okay. So this is going to be our first stop.
We all have heard the story of Katrina told and retold. Certainly, it's hard not to think about now with what's happening in Baton Rouge. But in this story, the hurricane is really just a backdrop. Really, we're going to focus in on one building.
This hospital at Memorial Medical Center built in 1926 in one of the lowest parts of that city, which is really like a bull. It was a sturdy brick building, eight stories tall, stretching over two city blocks. Served in every storm until that point. It was really seen as somewhere safe.
And this hospital became for Sherry 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. Get ready.
This is the most intense part of the storm is getting ready to come across. Day one, Monday, August 29th, 2005. Around 6am. Katrina hits.
I've never seen anything in my life like this. 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 so that they would be higher up in case of flying. 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. But they got through the first day, okay. And it seemed at that point that the worst was over. And then...
I've heard about that water coming over the left, coming over the lake. No. Went to the sunrise. Actually, after the storm, it would be clear.
The 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.
How many patients were in the hospital at this point? There were 250 patients. There were about 2,000 people because you had so many staff and then all the visitors who had come with the staff members and with the patients. So Sherry says, mid-morning on that second day, this is Tuesday, August 30th, just as the waters were starting to rise.
A group of doctors got together and they did come up with the 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. At that point, it was only part way up the sloping emergency room ramp.
And they decided to put patients who could walk on those trucks. So... Helicopters start to arrive. Medical staff start to bundle tiny babies and incubators, ICU patients and wheelchairs onto the elevator and up to the helipad.
How many patients can a single helicopter take? Like the ones that were landing. How many can they do? One or two.
Wow. So this is slow going. They got all the intensive care unit patients out. And they got all the babies and...
They got all the babies. All in all in that second day, they evacuated about 60 people. They said 60 of the most critical patients. Although we should also say that if a patient had signed a DNR, 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. They've been working really, really hard carrying patients in the heat.
Many of them lay down on cots and vacant beds. Two rests for the night. And then before the sun rises, a few hours before. About 2 a.m.
The buzz of the generators suddenly just... The water had reached those electrical switches in the basement. Dr. Cook, Ewing Cook.
Long time I see you, doctor. He was lying not far from where those generators were. And he said to me, it was the sickest sound of his life. The sound of absence.
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. I got to get everyone out. Everybody was running around with flashlights.
These beams in the blockness. 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 skin floor that led directly to a parking garage. And so they figured out they could pass patients through this roughly 3x3-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.
It's just like I said, I've been trying to put it away. But I want to make this as accurate as I can for you. This is a tape of an interview that Sherry did back in 2008 when she was doing research for the story. My name is Gina Estelle.
Estelle. Okay. Just like it's spelled. Gina was a nursing director working on the seventh floor of the hospital that day.
She'd actually been attending to those nine patients that didn't make the first helicopter run. And she described to Sherry that right after the power went out and after the ventilators shut down, one of her patients flatlined. And we brought him back. We had thrown out an oxygen, a hospital.
That's what she'd been told. And he needed oxygen. And so we brought him down the stairs to the second floor. 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 helipoid.
And she says that since his ventilator wasn't working anymore, the whole time they were standing there, they had to hand-squeeze this ventilator bag to keep air going into his lungs. You know, he kept twitching and un-you needed oxygen. So I was in line and it was my turn out the window. I kept begging him and begging him.
The physician came over and said, you do know that he needs oxygen? I said, yes sir. 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 what I'm standing there. I'm like, how do you do this? I just let him go. But he was right.
I knew it wasn't neurological. And he needed oxygen and he wasn't going to make it without it. So I just hugged him and stroked his hair. I waited and just kind of held him in.
He died in my arms and you know you're not my pan for that. So I had to take him out of the boiler room. So I rode him out and the board was full. And the chaplain came over to me and he says, come on with me.
And we took the body into the chapel. And I just stood there and I just busted up crying. And he just held me and we prayed. And when he left, I just sat the chapel for a few minutes.
I tried to compose myself a little bit. I prayed to help people and to save people. You know, it's just not enough. Everything I've done is just not enough.
Day three, Wednesday, August 31st, 2005. Sunrise is. 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.
Now, we know now looking back that on that Wednesday, the helicopters were doing their own triage. Coast guard rescuing people and looking at people on rooftops, waving rags. The entire family is on that roof right now. 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? At this point, there's still nearly 200 patients at the hospital. And some of the staff, they're panics because it takes them so long to move the patients to the top of the parking garage just below that helipad.
So she says, on that third day at about seven in the morning, a bunch of doctors and hospital administrators. Maybe a dozen, a dozen and a half. 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 one order.
In other words, who are we going to 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 in 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. She already says if you go back to the very beginning of triage.
The first conception of it. 1790s. Napoleon's chief surgeon, Baron Larry, I think. He made a rule on the battlefield.
That you take the people who are in the acute need first. So the sickest are going to 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. This got to start with some philosophers in the 18th and 19th centuries. 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. 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?
If we want to maximize years of life, we might want to pick people who have a better chance of surviving or younger people. And this method of triage is what you often see in a war zone, where I say there's a bombing and you have more injured victims than there are ambulances or medics. So one, two, three. Imagine a lobby area in a hospital waiting area.
Sherry says in this case what the doctors did. They asked the staff to get everyone out of their rooms. Bring them down to that second floor lobby. And then some doctors, including one whose name might be relevant for later, Dr.
Anna Poe. She was a head and next surgeon. 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 in a piece of paper and write either one, two, or three on that paper. And then she says they would tape that number. Onto the patient's count. So the ones where you're 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. Those patients would go last. 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. So it sounds like in some way they went to more of a utilitarian way of thinking. Yeah. And you could see everything that follows as flowing from that utilitarian decision and actually made it a few different points to prioritize the healthiest people first and the sickest people last.
These choices ultimately did become very consequential. In any case, all three groups were placed in different parts of the hospital. And the threes were kept in the lobby, the second floor lobby. To just wait.
So as the day goes on, the area started to get really full patient next to patient on these cots. 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. There were nurses standing around fanning people. It just, it was so, so hot.
Some people guessed that the temperature inside the building must have been 100 degrees. I don't know if there's any way for me to describe to you how intense the heat was. This is Dr. Anna Poe in an interview with 60 Minutes.
She was one of the doctors who did the numbering. It was relentless. It was suffocating. It made it extremely difficult to breathe.
And with the heat came the terrible smell. It just started to smell really bad. Oh, the bathroom was so bad. That's Gina Isbelligan.
She said sewage was sort of backing up in the toilets. I mean, they just ate sewage everywhere. On the ground, everywhere. You just, personally, I didn't want to eat a drink anything because I didn't want to have to use the bathroom.
As the day went on. Some people started really feeling abandoned. Why aren't they here? Why aren't they helping us?
We're at a war zone here. It looks like a war zone. On the seventh floor there was this radio that was playing in the quarter. It's an infinite passage of the clock here.
Don't be dumb about it. The local talk station and the radio was one of the only ways they were getting information from the outside. The mindset, the needs, the hunger, the anger, the rage is growing among people. 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.
Basic jungle human instincts are beginning to creep in. And there were tales on the radio that were alarming the staff. Someone is breaking into businesses and looting merchandise. These people should be shocked.
Things that turned out not to be true like this. You know, run a martial law here. That they had declared martial law. There was literally a deputy sheriff who got on air and told people that.
We even both commented and said, oh, it looked like a shark spin. He saw a shark swimming around a hotel. They're walking like zombies, like knights are the living dead. Just imagine how that would feel if you were in this hospital.
That was the only word you were having about what was going on outside. One of our employees was like having a breakdown, freaking out in the garage. By the afternoon of that third day, that Wednesday, some of the staff were having nervous breakdowns. Morale is really, really low because all these patients are still there, basically.
Patients were so hot, you know, they were just kind of drugged off the sleeping, had to wake them up and make them take sips of water and sips of whatever we had, you know. The city of New Orleans would never be the same. You know, except I would look right for their mom. One of the nurses told me she was worried that there could be brain damage or lasting effects of this severe overheating.
So there's this level of panic. What happened? 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 into work or storm, and they turned medical records over into a kennel, and people started to worry about their pets.
Apparently on that Wednesday, one of the larger dogs in Newfoundland started having seizures from the heat. So some of the staff chose to have doctors euthanize their pets. And then just try to imagine if you can. Lutors are running free.
Residents try to shatter windows and climb into stores. It's hot, people are dying. You're hearing gunshots in the neighborhood. You're afraid.
You don't know if there's real violence breaking out in the city. There are bodies bloating in the water there. You don't know how many rescue resources are going to come. It's nighttime.
And your colleague walks up to you and says, 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 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 sort of idea of putting patients out of their misery. I don't know who told me that. But that's what I heard.
And in those circumstances, what do you do? And if you at war and you have someone that's not going to be picked up and you can't carry them to safety and I believe in the death, what do you do? You let them suffer. Do you let them?
Cherry 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.
For example, Dr. Bryant King, who's colleague, Dr. Fornier, she walks up to him and says, there's this discussion going on and what do you think? And he says, you've got to be kidding me.
Did you actually think that that's a good idea? This is Dr. King in an interview on CNN. How could you possibly think that that's a good idea?
Day four, Thursday, September 1. Here's what ends up happening. And accounts here are a bit vague and indisputable. 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. Dr. Anna Poe. Who was still there that Thursday morning.
Caring for patients. These patients on the second floor, who were chosen to go last. He says he saw her talking to patients while holding a handful of syringes. Anna standing over there with a handful of syringes, talking to a patient.
And 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 walks around with a handful of syringes and goes and gives the same thing to each patient.
That's just how we do it. To jump forward for a beat after this whole ordeal was over and the rescue teams and the mortuary teams arrived. 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 1st, 2005.
So yeah. Wait, how many? It was, I think, 21 in the end. But it's complicated.
In medicine, what is comfort and what is murder depended to a large degree on the intentions of the doctor. 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 can cause harm, but if your intention is to do good, then that's ethical. And Dr. Annapau. Did you murder those patients as the attorney general alleges?
No. I did not murder those patients. And I want everybody to know that I am not a murderer, that we are not murderers. In that 60-minute interview, Dr.
Poe flatly denies euthanizing anybody. And at various points in the interview, she is clearly distraught at the accusation. It completely ripped my heart out. Because my entire life, I have tried to be good.
And my entire adult life, I have given everything that I have within me to take care of my patients. But Sherry 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. He had gone upstairs, visited Mrs. Bridgette's cancer patient 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 circumstances. She is weighted down with fluid, which can happen for 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 till 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 did the right thing. He said to me, he thought it was desperate. He saw only two choices, quickened their deaths, or abandoned them.
And I mean, if that was the real situation, there's some ethicists would say either of those choices would be not justified but excusable. 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 Sherry did tell us about this one case. His case was very haunting. And at Everett, a 61-year-old doting grandfather, very, very heavy. He weighed 380 pounds.
And he was up on the seventh floor of the hospital. 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.
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 upstairs, 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. And he died? He died. He 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. Did a judge or jury find anyone guilty of manslaughter or murder or a second to be murder? No, 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. Wow. That's kind of chilling to think, God, if all of that began with a triage decision about which patient should go first, I'm trying to put myself in the position of the people at that hospital.
I'm thinking to myself, God, it would be really nice to have a checklist on a wall that says, here's how you do this so that I can just check the boxes because God, I wouldn't be able to think my way through that. Yeah. 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 going to happen again, somehow, somewhere, maybe in my town, my hospital, my place? So what could we do to make this not happen? Well, it's interesting you asked because, of course, after Katrina, there have been efforts since then to come up with a protocol. Oh.
According to Sherry, the experience in Katrina was basically a wake-up call for doctors and hospitals and state governments to think about triage. 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? And one of the interesting things was that the state of Maryland decided, we're going to 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 and have them grapple with this. And I was there.
Oh, you went to the very first one. I did. I imagine like a town hall meeting, was it like that? Or no?
Yeah. So just imagine a church basement in inner city Baltimore or a conference room in Waupe Howard County. Thank you for coming. We're giving up this gorgeous Saturday to have what we think is a really, really important conversation.
There's professionals. At about 1215, we'll take a break for you all to get lunch and bring it back to your table. People have been recruited to be a part of this. And when I say people, it's just regular folks.
So the researchers, let's call them that. They get people together. And where are they going to get started? Good morning.
The sort of scenario is laid out. So my name is Lee Darden. I am an intensive care doctor. Just remember what it sounds like.
And what we're going to be talking about today is how we make decisions about who gets life-saving resources in a situation where we literally cannot take care of everyone. Today, the scenario we'll talk about is pandemic influenza. They basically tell people, OK, imagine a flu is sweeping the country. Millions of people are sick, coughing.
Some are dying. The only way that folks are going to get better, they say, is if they have a ventilator to help them breathe. But the problem is, they're just aren't enough. This is horrible stuff.
This is a terrible situation we're talking about. So here you have too many patients, too few resources. How do we choose? Who gets those ventilators?
What are the acceptable options? What might be the right answers? The researchers then essentially lay out three different kinds of options. Number one.
Try to save the most lives or years of life by picking. People with the best chance of surviving the pandemic. Such as giving the ventilators to young people or healthier people. Number two.
Picking people who will be the most helpful during the pandemic. So first responders, health care providers, vaccine workers. It's interesting. Me, I'm sure that's true.
Or number three. Leave it up to fate. Something like first come for serve or? A lottery.
People nod. Does that make sense? OK. And then they say we're here to answer your questions.
Talk amongst yourselves. Right. OK. You know, pick.
Can we talk about something you want? Those protocols. Those protocols. We'll be right and right.
I've never seen any situation in life where it was a lack of one. Some things are black and white. I'm saying it shouldn't be black and white. Well, my immediate reaction to the lottery was it's a leveler.
It's all the same. I think it is the scientific, the least responsible way to go. I think ultimately it's big. If somebody's going to live with you very sick, is that should that go into the decision?
If you set up guidelines, then yes. If every kind of doctor, you know what I mean? It's going to be essential. So I don't think that.
No. Now the good news is. I would give a ventilator. And a four-year-old wouldn't.
I just think that would be the saddest thing. People are willing to engage in this question. And this was right at the time. You guys remember all the death panel discussions?
No, no, no, no. My program. Let me turn this to the romping of the tongue. Yes.
Sarah Palin. It's in black and white. Where's your death panels in there? This started at that time.
If they have a better chance, you probably should definitely take that. And they're wearing any fistwights? No. But as you can also hear.
All for the first time for a certain point, nobody has to put that in their conscious point. That's going to burst because you there and I got there half a second and not in a travel. There wasn't a lot of agreement. I respect your opinion, but I'm just the only one who you don't.
Yes, I do. I think in a time of crisis, there's no room before emotions. Because if you're trying to say, oh, we've got to judge it by a person, the first person that's accepting the rule, that's emotion-topping. There's no intervention.
It is. If you're looking at everything, it's going on. And that's why I have those set up for everybody. The reality is, some people are going to have to go.
So one of the big findings was that? There are certain ways in which we will not make these decisions. There were things that the researchers wanted to be off the table, like not even come into the discussion. We're not going to make decisions based on gender, race, socioeconomic status.
Like people's jobs and incomes and citizenship status, whether they had a criminal history or were they upstanding members of society. Those things are out of bounds. They just want to say upfront that's not a progress. But those things kept popping up.
You're going to have it like a young pastor and you might have a reprehensible alcoholic criminal type person and you might have more years to live. Well, the years of the pastor are going to be more beneficial to society than the years of this criminal reprehensible alcoholic bad person. Whoa, you are straying into me. If you're territory there.
Whoa. That is a personal value. There were people who thought that undocumented immigrants didn't get ventilators, alcoholics, smokers. In the most brutal terms possible they're saying, do you deserve to survive?
Not can I save you, but should I try to save you? What's interesting is that people were really comfortable making utilitarian choices, like saying, yeah, that person should get the ventilator because they're going to 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 were like, we're 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.
I don't think you can determine who's done that in their life and how that's valuable. I might think my hairdress is more important. I might. I might.
They're important, right? I want to look good during my pandemic situation. And this was particularly acute when participants were asked the second, can we move to an even more controversial topic? 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? This would not definitely come up with a clear answer myself. Some people said, well, of course, if it doesn't seem like someone is going to make it through the treatments, then maybe we need to cut their treatments short and kind of ventilator on someone else.
But you're going to murder my father? There were other people who said, no, you take my father off the ventilator and you're going to be sued for the rest of your life. I'm never going to shut up. I don't know how I do that.
It's so complicated. Did they come to a conclusion to the public? Did you hear a conclusion? Like, I listened to this.
Here's what I heard. I heard thoughtful people struggling with a problem that is so hard to struggle with that what they end up doing is going, I don't know how I don't want to do this. I'm paying attention to your guidelines because I can't deal with it. This is what I loved about it.
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. Before we prejudge this, what is it that the researchers are going to take away from all this? 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? Well, it turns out they wanted to combine some of those different perspectives. According to Sherry, 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.
If they're likely to survive and they need it. But chances are, there are going to be a lot of people who fit in that category. So if everybody's just about the same and we don't have great science that allows us to know which patient is going to 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. So it's like you introduce a little bit of fate to keep things honest. Exactly. 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. 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? Yeah, I mean, there's some fairness in having guidelines and especially guidelines that were developed with the input of lots of people. 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 going to be advantaged or disadvantaged over money or over these other things. It sort of helps you accept it. Yeah, in theory, that sounds plausible.
But when you put theory to practice, which we're going to do right after the break, things get very hard. That's coming up. This is Jerome calling from Silver Spring, Maryland. Radio Labs supported in part by the Alfred P.
Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at www.slone.org. Hey, I'm John Abbom-Rod. I'm Robert Krowich.
This is Radio Lab and returning now to our collaboration with the New York Times and reporters, Sherry Fink. This is our final stop, many ways are hard to stop because it's the closest we're going to come to sort of the heart of the issues we've been talking about. And you realize that when you get up close, that's where he's about to, sometimes what's a success and what's a failure are kind of hard to measure. Test.
We can't even do the tip-tip to the right. I remember being in Haiti after the Haiti earthquake back in 2010. I was embedded with a group of U.S. disaster responders, the International Medical and Surgical Response Team, ImSert.
What's your name again? I'm Sherry. 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. More than 100,000 people could be there.
There was patient after patient kind of lined up in a row. Most of the things we had are dehydration, sepsis, festering, wounds, open fractures. 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.
Logistics, we're at a critical level with our diesel supply and oxygen for the OR. So I'm freaking today. I mean, I am freaking brave for us and we'll just give it. Can we have respiratory and major support?
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 going to give it to and who were they not?
And at one point. We're just being senior in justice. We're going to find you and I see you. I was following a couple of the doctors.
We walked into this tent and we met this woman. She had braided hair, a white night gown on and this tube running into her nose. It's not her. We're almost the same age.
How are you feeling today? It's good. 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 died. She told me that amazingly she had survived because she wasn't at home when the earthquake hit.
She checked into this hospital 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. How do you feel about the treatment that you got here? I'm happy to see a smile on your face.
I started to speak with the staff about her. Even taking care of her part of the time. I found out that Natalie had just won the hearts of the surgical staff there. People loved her.
She was so thankful. But she has a chronic illness which is severe heart failure and hypertension and it's very hard for us to see her leave. 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 going to send her off to 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, this makes sense because they were trying to save oxygen. She has a chronic problem that probably won't get better so that's 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.
Hopefully when she gets well she brings the guard she will have an opportunity to earn a living. But I'm so glad that she wants to go there. She wants to go there anyway possible that the people would give us somewhere to stay like some kind of shelter. I'm a journalist and I don't know the answer to that but I don't know what to say.
It's such a hard situation right now. And I remember the nurse who was doing the triage who made that decision to cut off her oxygen. I'm Patrick Hadalac and I'm the commander for the insert team. I never met her.
No, I never met the patient. But that's the role at a minute. 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 oxygen. Turn it off. I have to look at the greater good that we can provide with the limited resources we have. 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. It was an 80 second airborne actually who were providing that service. They were amazing and they came to pick her up.
She needs a travel window too. She needs travel. They saw she was on oxygen and they said okay we're going to put her on their portable oxygen tanks and the representative from the hospital said oh no no she doesn't get oxygen. So they yanked the oxygen.
Stop it. Stop it. Stuck her onto a stretcher. Give me a one.
Lift her up. Stuck her in the back of this Humvee ambulance. Watch your head. We're going to have to park a Humvee down for one.
I rode with her. Okay. Okay. She started getting short of breath.
She started getting short of breath. She put this asthma inhaler in her mouth. She kept hitting it over and over again. 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 die and just watching didn't feel right. And so.
You guys go. Hey. Sorry to watch that anymore. It stopped at this hospital and I nodded over toward her and some of the medical staff went to look at her.
I like a way of lace. No. She was in distress. They brought her inside.
She was really struggling to breathe. But then. Yeah. She's definitely a big time CHF.
I saw one of my medical school professors, an emergency doctor and I told him about her. Is it? Is it? Is that her?
Yes. I need this. Mama? She stood up.
Okay. Mama. Just like my other side back. He improvised.
He was just a couple of grams of cool. He used like all these diuretics to get fluid off her lungs. He got a nitrate for anything. And he found one thing of oxygen that had a teeny bit left in it.
This makes you breathe breath better. Keep it in your nose. Okay. Breathe in.