Some worthwhile commentary on the Katrina subject:
Katrina’s Triage
It is a grim but inescapable fact that not everyone in New Orleans could be saved.
By Marc Gellman
Newsweek
Updated: 6:56 p.m. ET Sept. 2, 2005
The term triage migrated from the coffee trade to the battlefield, and from the battlefield to the hospital. Now it has moved into the fetid swamp that is New Orleans in the aftermath of Hurricane Katrina. The term is being used at this very moment by doctors and Homeland Security officials; by police and by relief workers; and we often don’t even hear it as it flits by on the news reports. In this catastrophe we are able to see something we never have the chance to see unless we have been in a battlefield MASH unit or a hospital after a massive influx of injured patients. We are seeing triage work.
The allocation of scarce resources to an overwhelming number of needy people is one of the most daunting ethical conflicts a healer or protector can face. Who is to be saved when not all can be saved? This is not just an ethical question, it is an ethical nightmare, and we are watching the nightmare on television every night. Still inside the nightmare, there are choices that must be made and watching triage work may give all of us hope that even in the depths of chaos and death, moral virtue is still possible. What looks like unfeeling cruelty on the TV screen is most likely the result of hard but decent choices made by people who see exactly what we see, but who, unlike us, are charged with facing the chaos and turning it into hope. The triage of the city of New Orleans, and the other Gulf Coast towns is at one and the same time both heroic and nauseating, both morally inspiring and infuriating.
The reason for triage decisions is the fact of limited resources. Now there is much to say about why lifesaving resources are limited in this catastrophe, but only a fool or an abject ideologue cannot grasp the fact that when the strongest possible storm hit the most vulnerable possible city, death, devastation and chaos were sure to follow in its wake no matter what the preparations for the storm. Yes, more could have been done, and nothing I say or believe ought to be construed in any way as justifying any possible malfeasance of what public officials could have or should have done ahead of this killer storm. I am particularly bewildered and outraged at the length of time it has taken to get food and water to the starving, suffering people in the convention center. As I write this on Friday, they are still in harm’s way and still suffering from the lack of the only lifesaving resource that should never be rationed and that is hope. It is a disgrace that even in the context of necessary triage decisions, they still wait in fear, hunger and thirst way too long for the time of triage to end.
However, in the end I simply refuse to blame the rescuers more than the storm that caused the need for rescue. It is not merely naive but profoundly foolish to have expected that 100,000 troops with water and food and patrol vehicles and helicopters and busses and trains and showers and shelters and electricity and bulldozers and levee-repair crews and mobile kitchens and tent cities and psychological services and identity checkers and employment services and construction crews and electrical linemen and mechanical and structural and civil engineers and architects and water-control experts and animal-removal experts could have all been set up somewhere out of the storm path but close enough to swoop in and pluck the soaking victims out of harm’s way despite the collapsed bridges and levees the minute the winds stopped blowing and minute the tide subsided without missing a heartbeat. Where have we gleaned the arrogant belief that if we suffer from a natural disaster, it must always somebody’s fault? We must all face the grim but inescapable fact that there are some times and some places where the need you face is simply greater than the resources you have at that moment or even days after that moment or even weeks after that moment, and thus agonizing decisions must be made. Triage is a way to make those decisions on the allocation of scarce lifesaving resources that does not stop the tears, but at least it stops the feeling that you did not just throw up your hands and give up.
Triage is not a way to decide whom to kill. Triage is a way to decide whom to save so that in the end the most people can be saved. Triage choices are tough, but they are necessary because doing nothing is a choice, and because following the loudest scream is a choice, and because only helping those on television is a choice, but all those choices are driven by impulse and are not supported by coherent moral values. If the resources were unnecessarily limited, and if the triage decisions were made in error we will know in time. The point now is that any finger-pointing must be mollified by a good dose of trust, humility and patience. Just because we see a helicopter on the news flying over a group of victims here does not mean that the helicopter is not following a triage decision to save a group of more needy victims there. Triage is where morality meets reality. It is precisely at times of chaos that morally informed but tough-minded triage decisions must be made, otherwise morality is simply a dilettante’s luxury and a mere intellectual puzzle for the philosophy classroom, but irrelevant on the street.
COHow are triage decisions made? In general, triage requires the splitting of the affected population into three groups. The first group is the group that is suffering fatal injuries and will probably not live no matter what is done to help them. The second group is the group of people who are affected but who are not suffering any life-threatening injuries. The third group is the group of people whose lives are at risk, and who will die soon if they are not treated right away but who will live if they are treated. The moral thrust of triage is to identify the third group as soon as possible and give them the first claim on the scarce resources that are available. That’s how triage works in a hospital overwhelmed by patients in need, and that is how it is working in the streets of New Orleans now.
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In Katrina’s aftermath these triage decisions are being made every hour of every day, and they will continue to be made until the satisfied needs intersect with the increasing resources. In the early hours, much was made about the warehousing of thousands of people in the convention center and the Superdome. As awful as those conditions were and are, and as deeply tearful was their plight, this was precisely the right triage decision. The people in those centers were miserable, but in the Superdome at least, there was water and shelter from the blazing sun. The people there would vomit and suffer but they would live. They needed help but they did not need help immediately. They were in the second triage group. The people in the third group had to be helped immediately. These were the people clinging to rooftops in the broiling sun with no water and no shelter or wandering trancelike through the deadly toxic swamp of the engorged streets. They would die within hours if all the limited resources were not sent to rescue them. That was done. It seemed cruel to those suffering on the ground, and to those of us watching triage work on TV, but it was a moral choice to save the suffering and dying before tending to the suffering but not yet dead.
On the rooftop of one of the hospitals, triage decisions had been made and because of those decisions neonatal babies were taken from their mothers and airlifted to safety before their mothers were saved, and because those babies were saved some dying people were left to die. In the midst of these gruesome but morally heroic triage decisions, the nurse on the roof said, “We made our triage decisions and we got three out last hour. We will get them all out as soon as we can, but we’re going to be all right. We are going to make it.” Hers was the heroic and hopeful face of triage. Hers were the courageous decisions that no flood can wash away.
We can say what we want, and we can accuse whom we want, but I believe we are at least compelled to pray that these suffering people and their rescuers will find each other in time. If you are not religious, then hold them in your thoughts and wish them well. They are using triage to try to keep mere chaos from becoming total annihilation.
Finally, I believe we are compelled to acknowledge that no possible scenario of human existence will ever free us from more than occasionally having too much need and not enough help. Killer storms, wars, famines and other natural catastrophes will test us forever. That is the most sad fact of life here on planet earth. And in the face of temporarily scarce lifesaving resources, there will always be those whose idea of helping is to scream, accuse and point fingers at people they hated before the storm. Thank God, however, there will also be people like the smiling nurse on the hospital rooftop. I am glad I am not in New Orleans now, but if I were there, I would want to be standing right next to her.
© 2005 Newsweek, Inc. |
