Free Five Days at Memorial by Sheri Fink Page A

recent eugenic and Nazi subversions of science and medicine—their
     conceptions of “lives not worth living” and the sick logic of ridding society of certain
     of its members to enhance the perceived health of the larger body—had ingrained in
     Americans an aversion to assigning lower values to certain lives.
    On the other side, with drug and device developers figuring out how each organ that
     threatened to quit could be repaired or replaced, the practice of life support surged
     ahead of the practice of relieving pain, both physical and existential. Patients weren’t
     given much of a say in how much of this new medicine they really wanted if they became
     critically ill and unable to speak for themselves.
    And there were deeper, more unsettling questions. How now todefine death? When was it permissible, even right, to withhold or, more wrenchingly,
     withdraw life-sustaining care? For a few weeks after a reporter cast Lamm’s remarks
     before them, regular Americans looked these questions in the eye.
    They quickly looked away.

    BALTZ LEARNED of Anna Pou soon after her arrival at Memorial in the fall of 2004.
     One of his patients had developed a pouch in the esophagus that trapped food and caused
     problems eating and swallowing. It was Pou’s turn to do ear, nose, and throat consultations,
     and Baltz asked some of the nurses about her. Who was she? What was she like? They
     raised their eyebrows. From what little they volunteered, Baltz guessed that they
     considered Pou a loose cannon, someone to avoid.
    When Pou came to see Baltz’s patient, she didn’t merely offer her opinions. From Baltz’s
     perspective, she took over like a commander and failed to discuss important aspects
     of his patient’s care with him. Baltz judged her competent, but lacking in finesse.
     After the incident, he took it upon himself to give her some constructive criticism.
     He made it a practice to improve the work of those around him, especially younger,
     newer doctors. Pou seemed to listen to him.
    After having spent seven years in Galveston, it would have been a challenge adjusting
     to the culture, etiquette, tools, and systems of any new hospital. When Pou was passionate
     about something, whether or not she was right, she stated her beliefs as unequivocally
     as a partisan talk-show host. Projecting surety was a defensive skill some doctors
     developed during their training, when attendings “pimped” them, barraging them with
     tough questions before their peers during rounds. Often, too, patients and families
     wanted clear answers when there weren’t clear answers to give.
    One day, Pou cornered the nurse in charge of her postsurgical patientsat Memorial. “We can’t have this!” she said. The previous night, one of her patients
     had become confused after surgery. Nurses caught him trying to get out of bed and
     pulling at the breathing tube in his neck. A nurse had paged the medical resident
     on duty to order a set of soft, loose cuffs with long straps. The nurses tied the
     straps to the bed and placed the soft cuffs on the man’s wrists. This would limit
     his movements and keep him safe until he was less agitated. When Pou arrived the next
     morning and saw her patient restrained, she was unhappy. She told the head nurse to
     ask a hospital risk manager for workers who would sit at the patient’s bedside twenty-four
     hours a day and watch him to make sure he was safe without the restraints. It was
     an unusual request. It earned Pou respect from the nurse in charge. To her, it meant
     that Pou had compassion for her patients.
    Unlike many surgeons who manifest their authority by getting ugly or impatient in
     the operating theater, Pou was methodical and explained things carefully to residents
     and nurses. She had a way of speaking like a schoolteacher, enunciating her words
     to draw out each syllable and nodding her head for emphasis.
    Perhaps more than anything it was the type of patients Pou cared