FIVE DAYS AT MEMORIAL: Life and Death in a Storm-Ravaged Hospital. By Sheri Fink. Crown. 576 pages. $27.

Hurricane Katrina hit New Orleans in August 2005, and many people believe that the city and its residents will never be the same. Who can forget the faces of those stranded on rooftops after the levees breached? Who can forget the stories of chaotic looting and violence and the "Lord of the Flies"-like atmosphere that took hold of the city during those dark days?

Memories have faded with time, but author Sheri Fink wants us to remember what went wrong during those five days at Memorial Medical Center.

In 2009, Fink wrote a gripping expose about the 45 deaths at the hospital in the wake of Hurricane Katrina called "The Deadly Choices at Memorial."

In it she described an investigation of the doctors and staff at Memorial that resulted in "wrongful death" arrests involving Dr. Anna M. Pou and two surgical intensive care nurses, Cheri Landry and Lori Budo.

Fink thought a deeper examination of triage and end-of-life decisions at the hospital after Katrina was needed, so she wrote "Five Days at Memorial."

The book begins on the morning of August 28, 2005, Day One of the storm. "Katrina's huge, Technicolor swirl filled the Gulf of Mexico on television screens throughout Memorial Medical Center," Fink writes.

By 10 a.m. (some have argued it was already too late), Mayor Ray Nagin signed a mandatory evacuation for the entire city, but hospitals and their employees were exempted. Inside the hospital, people gathered to say goodbye to family members too sick to leave. At the end of the day, approximately 2,000 people remained inside the hospital: 183 Memorial patients and as many staffers, 55 long-term "LifeCare" patients and 600 staffers and hundreds of family and community members seeking shelter. Surgical staff hunkered down and prepared for the ravages of the storm.

By Day Two, Katrina's winds had dwindled, and it appeared the city had "dodged a bullet." Memorial had sustained damage, but remained functional with backup power. Within hours, a National Guardsman reported to hospital staff that the levees protecting the city were breached, and flooding was certain. Nearly 200 high-risk patients including newborns, ICU patients, pregnant women, patients undergoing dialysis and bone marrow patients needed to be evacuated.

Memorial and LifeCare staff went into high gear as the power was lost, the heat began to climb, the toilets backed up and water stopped flowing from the taps. Panic escalated, yet doctors and nurses thought only of their patients.

By Day Five, 45 patients were dead. Large quantities of morphine were found in the bodies of these patients. Many, but not all, were DNR (do not resuscitate).

Emmett Everett was not DNR. A 60-year-old, 380-pound paraplegic awaiting colostomy surgery, he was too heavy to remove from the hospital, medical staff decided. The elevators weren't working and the helicopters had trouble landing on the roof of the hospital, so staffers were carrying patients down five flights of stairs through a hole in the wall and out to the helipad.

Pou and several other doctors decided to evacuate the sickest patients last. Fink reports that one of the doctors said only the strong could survive this and, "Mother Nature's course would have to be hastened."

But who is sickest? Who stays and who is left behind? And who decides?

Fink works hard to paint a clear and unbiased view of the unthinkable conditions inside the hospital walls, and the selfless dedication of the staff. She breathes life into the characters under investigation.

We learn that Pou is a New Orleans native, a doctor's daughter, a Catholic, a wife and an excellent doctor. The nurses are hardworking people with families doing their best to care for their patients under horrible circumstances, Fink writes, even as she describes evidence of euthanasia.

She wants readers to struggle with the moral questions and with casting blame. She wants to get us as close as possible to the inner workings of Memorial during those five days so such mistakes are not made again.

Fink says she wanted the book to open a discussion about disaster preparedness at hospitals in the U.S. and the ethical rules that govern these decisions. The importance of such a discussion is obvious: New York's devastating Hurricane Sandy revealed in 2012 a similarly fragile medical system of disaster preparedness. We need to be able to live with the choices we make after disaster, choices that don't undermine a fundamental social contract, she writes.

The first half of the book is gripping, and while the pace slows in the second half, Fink's measured examination of the aftermath keeps the reader's attention to the end.

Not surprisingly, her account was met with great backlash from Pou and her supporters who refer to Fink's writing as "deceptive" and fictitious. They tell their own story at

The frustrating reality is that the truth is not black and white, and even with Fink's careful reporting, questions remain.

Reviewer Amy S. Mercer is marketing manager of the Gibbes Museum of Art.