Free Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital by Sheri Fink

go.”
    “You have no right to decide who lives and who dies,” Baltz would answer. Through these conversations, he learned that some of his fellow doctors adhered to what Baltz thought of as the “Governor Lamm philosophy.” In 1984, at a time of growing budget deficits and ballooning medical costs, Colorado governor Richard Lamm criticized the use of expensive, high-tech medicine to keep some patients alive almost indefinitely, regardless of their age or prognosis. At a meeting of the Colorado Health Lawyers Association, Lamm bolstered his argument by citing a recent critique of antiaging research penned by the prominent Universityof Chicago bioethicist Dr. Leon R. Kass. “We’ve got a duty to die,” Lamm said, “and get out of the way with all of our machines and artificial hearts and everything else like that and let the other society, our kids, build a reasonable life.”
    Lamm’s words were picked up by an attentive Denver Post reporter and caused a nationwide furor.With the appearance of crash carts and the expansion of intensive care medicine in the 1960s and ’70s, hospitals had become adept at keeping sick people alive longer. Medicare covered the new technologies regardless of cost, and by the 1980s some policymakers worried about the projected growth in medical spending. Lamm’s comments awakened the public to the problem and demonstrated the tension between the “business motive” and medicine’s burgeoning end-of-life dilemmas.
    Lamm’s rationing directive rankled for many reasons. To limit life-saving care would be to deny the human impulse to rescue individuals in extremis. To handicap the race for new treatments that might prolong life would be to call off the eternal search for the elixir of immortality.
    Plus it would be bad for capitalism. At the time, the US-Soviet war urge was sublimated into battles for technological innovation. We were going to the moon. Why not also cure cancer or raise the dead?
    Also the relatively 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