Border area. I was there to collect information but when I got there. The doctor who I had interviewed previously this really tall being in Kosovo Albanian doctor looked out and he told the Macedonian border guard let her in we need her she's a doctor. They just pulled into this tent yes was where you're just out of the South and I had just finished med school suddenly she says she was tossed in with all these were doctors and here's the key Eventually she gets posted at the door of the tent and what I ended up doing or what they put me in charge of was tree Osh now is a French word it means to sort for quality and a few 100 years ago the word began to be applied to 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 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 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 know people who have chronic conditions psychiatric issues you know. Everybody else I had to direct to this other tent and someone ended up calling it the tent of the damned. I remember but peeling for help from the Macedonian health ministry saying you know take these people into Macedonia they're not a threat open 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 456 days and several The people in this tent they died. Cherry says this experience haunted her and years later when she was a full blown reporter and traveling all around the world looking at 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. 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 because it's going to be our 1st stop we all have heard the story of Katrina told and retold But in this story the hurricane is really just a backdrop really we're going to focus in on one building this hospital the Memorial Medical Center built in 1926 in one of the lowest parts of that city which is really like a bowl it was a sturdy brick building 8 stories tall stretching over 2 city blocks that had served in every storm until that point it was really seen as somewhere safe. And this hospital became for Sherry a kind of Port. These questions about tree Irish she ended up spending 6 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 even the most intense part of the storm is getting ready to come across day one Monday August 29th 2005 around 6 am. This. I've never seen anything like it and. They get through the storm OK. The city power is 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 2nd floor so that they would be higher up in case of flooding 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 1st day OK and it seemed at that point that the worst was over and then . Actually after the. Levees failed. Surrounds the. 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. The hospital at this point there were 250 patients there about 2000 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 2nd day it is Tuesday August 30th just as the waters are starting to rise a group of doctors got together and they did come up with a system which evolved a little bit over the crisis but they decided 1st get the babies out get the critical care patients out and they knew that they had to high water trucks from the National Guard in 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 tracks so. Helicopters start to arrive and medical staff start to bundle tiny babies in incubators I.C.U. Patients in wheelchairs on to the elevator and up to the help at how many patients can a single helicopter take the ones that were landing How many can they do one or 2 while so this is slow going yeah it was late evening before they got all the intensive care unit patients out in the you know the babies and they had all the babies all in all in that 2nd day they evacuated about 60 people there 60 of the most critical patients although we should also say that if a patient has signed a D.N.R. Do Not Resuscitate order the doctors decided those patients should not go 1st and they were held back. Sort of explain their thinking on that in just a 2nd. Darkness falls on day 2 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 bacon beds rest for the night. And then. Before the sun rises few hours before. The buzz of the generators suddenly just. Stopped. By. The water had reached those electrical switches in the basement Dr Dr cook cook long time I see a doctor he was lying not far from where those generators were and he said to me it was quote the sickest sound of his life absence you know and that is when it became an absolute emergency in this hospital. It's pitch blackness some of the medical equipment they have backup battery so they started to warn that the electrical power had stopped you still had 9 patients who relied on ventilators to breathe it became a hive of activity and began to get everyone out everybody was running around with flashlights. Blackness 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 2nd floor that led directly to a parking garage and so they figured out they can pass patients through this roughly 3 by 3 foot hole onto the back of a pickup truck drive them up to the story of that parking garage and then carry them up 3 flights of steps to this formerly unused tell a pad. And 5 of the 9 patients on ventilators died just right then it's just like us that have been trying to get away. But I want to make this is accurate as I can for you and this is tape of an interview that she did back in 2008 when she was doing the research for this story which is money that is a genius found is just like it's you know it was a nursing director working on the 7th floor of the hospital that day she'd actually been attending to those 9 patients that didn't make the 1st helicopter ride and she described to Sherry that right after the power went out and after the ventilator shut down one of her patients flatline and. We brought him back we had fun oxygen cost that's what she'd been told and he needed oxygen. And so who brought him down . The stairs to the 2nd 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 helicopters and she says that since his ventilator wasn't working anymore the whole time they were standing there they had to hand squeeze his ventilator back to keep air going into his lungs you know he kept twitching and I knew he needed oxygen in town always in line and it was my turn at the window so I kept begging him to day. One of the physicians came over and say you do know that he needs oxygen so just he said he doesn't have any US citizen to be heat get any. Yes to let him go. At that point you know I'm Day 3 Wednesday August 31st 2005 sun rises and that is when they're expecting all the helicopters 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 tree a Coast Guard rescue people and looking at people on rooftops waving rags Heights higher family is on that roof right next to it. 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 there panics because it takes them so long to move the patients to the top of the parking garage just below that Hella Pad So she says on that 3rd date about 7 in the morning bunch of doctors and hospital administrator maybe a dozen dozen and a half they got together and they decided that they need 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 what order no other words who are going to get out 1st. That was the question and that's the moment where they come up with the ones twos and threes. This is tree I wish 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 couple of ways to look at this she says if you go back to the very beginning of the 1st conception of a 790 S. Napoleon's chief surgeon he made a rule on the battlefield that you take the people who are in the acute need 1st so the sickest are going to be treated 1st 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've 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 flaws. 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 going to maximize years of life we might want to pick people who are have a better chance of surviving who are younger people and this method of Korea is what you often see in a war zone where say there's a bombing and you have war injured victims then there are ambulances or medics so 123. Imagine a lobby area and 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 2nd floor lobby and then some doctors including one whose name might be relevant for later Dr Anna Polk she was the head neck surgeon she and another doctor they stationed themselves on the landing where the patients were brought down to on that 2nd 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 and a piece of paper and write either 12 or 3 on that paper and then she says they would tape that number on to the patient's gown 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 1st the to use where you're 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 2nd 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 a few different points to prioritize the healthiest people 1st and the 6 people last all 3 groups were placed in different parts of the hospital and the Threes were kept in the lobby the 2nd floor lobby to just wait. So as the day goes on the area started to get really full patient next patient on these cots in one corner she says yet about 18 people lined up side by side these are 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 there's any way for me to describe to you how intense the heat was this is Dr Ann Apollo in an interview with 60 Minutes she was one of the doctors who did the number and it was really glad. It was suffocating and made it extremely difficult to breathe and with the hate came the terrible smell started to smell really bad and the gas was so bad that's Gina Isabel again she said sewage was sort of backing up in the toilets in a just a sewage everywhere on the planet everywhere it just personally I didn't want to eat or drink anything because I didn't have to use faster and as the day went on Some people started really feeling abandons. Why are they here why aren't they helping us you know what I'm going to have you. Here looks like a war zone on the 7th floor there was this radio that was playing in the corridors . Of. The local talk station and their radio was. One of the only ways they were getting information from the outside the mindset the needs to hunger the anger the rage. Among 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 they were tales on the radio that were alarming the staff someone is breaking into businesses and the merchandise these people should be shot things that turned out not to be true like you know one of much more near that they had declared martial law there was literally a deputy sheriff who got on told people that common and said. He saw a shark swimming around a hotel they're walking like zombies of 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 live on toys just like right freaking out in the garage. That 3rd day that Wednesday some of the staff are having nervous breakdowns really really low because all these patients are still there basically. So there's this level of 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 a storm and they turned medical records over into a kennel and people start 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 looters are running very strong shattered windows and climbing the storms it's hot people are dying you're hearing gunshots in the neighborhood you're fraid. You don't know if there's real violence breaking out in the city there are body floating in the water there you don't know how many rescue resources are going to comments night time and your colleague walks up to you and says you know. We're euthanizing the pets to put them out of their misery. What about the suffering patients shouldn't we put some of them out of their misery . And I interviewed all these people and trying to figure out like where did this idea come from and tracing it back and there were all these little informal conversations. And were in the starts just going around the hospital this sort of idea. Of putting patients out of their misery. But that's what I heard. And you know in those circumstances with. All our A.F. Someone that's not going to be picked up and you can carry him to safety believing that. He did. You know a lot of stuff on. The. 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 Forney a she walks up to him and says there's this discussion going on and you know what do you think and he says you know if you actually think that that's a good idea this is Dr King in an interview on C.N.N. With you possibly think that that's a good idea. Day for Thursday September 1st here's what ends up happening. And accounts here are a bit vague and in dispute but according to Dr King who spoke about this on C.N.N. He says and other people say they saw this is well he says he saw one of the doctors we talked about earlier doctor and a pope who is still there that Thursday morning caring for patients these patients on the 2nd floor who were chosen to go last he says he saw her talking to patients while holding a handful of syringes and us standing over there with a handful of the Ranters talking to a patient the words that are heard her say were I want to give you something to make you feel better they say had a handful of syringes I don't and nobody nobody would handle is the way just goes and gives the same thing these patients that this is not we do it. To jump forward for after this whole ordeal is over and the rescue teams in the mortuary teams arrived many bodies were found in this hospital. About $45.00 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 2 dozen patients had received either morphine or versed said a powerful sedative or a combination of the 2 in a very short time period on that Thursday September 1st 2005 how many it was I think 21 in the end but it's complicated in medicine what is comfort and what is murder depend 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 that can cause harm but if your intention is to do good then that's ethical. And Dr Anna pope 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 Minutes interview Dr Post 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 taught 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 earlier 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 Burr Jess 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 of circumstances she is weighted down with fluid which can happen toward the end of life so she weighs a lot she's on the 8th floor so we'd have to carry her downstairs and plus there's 4 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 and 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 felt he did the right thing he said to me he thought it was desperate he saw only 2 choices quick in their deaths or abandon them and I mean if that was the real situation there some at this would say either of those choices would be you know not justified but excusable but one of the arguments you could make is that when you give up on one person then becomes a little bit easier to give up on the next person and then the next person then suddenly you're on a slippery slope and Sherry did tell us about this one case his case was very haunting and that Everett 61 year old doting grandfather very very heavy he weighed 380 pounds and he was up on the 7th floor of the hospital he was conscious alert fed him self breakfast asked his nurses are we ready to rock N roll he said to one nurse who never forgot it Cindy don't let him 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 7th floor of a hospital with no working elevators and the staff told me they couldn't imagine how they would carry him down those flights of stairs let alone what a helicopter take a man of his size and he was one of the patients who was found with this drug combination in this body and he was and 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. Or. Did a judge or jury find anyone guilty of manslaughter or murder or 2nd murder nobody stopped 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 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. Kind of chilling to think. After Katrina as we're after the break people started paying all kinds of attention to. Thinking about it in new ways and as you'll hear some surprising new places that's coming up. This is Max calling from Berlin Germany supported by transfer which is built to make it easier to send money internationally. And receive and convert currencies in more than 70 countries more lies dot com. This is from Long Island New York radio ordered by new yellow green and red approach to categorize food is designed to help people make a meal choice with the goal of losing weight. Colorado Public Radio News is on Twitter. For a fast take on the news of the day insights from C.P.R. News reporters and the photos you can't see on the radio find C.P.R. News on Twitter. Support for Colorado Public Radio comes from Rocky Mountain Repertory Theater a musical theater in Grand Lake introducing their fall show always Patsy Cline based on a true story of the artist playing through September Rocky Mountain Rep dot com. I'm Jesse Witten from indie one or 2. Fronts the wildly successful. Alabama. But the current musical project for Howard is her own. This year Howard releases. It's called after her older sister who taught her how to. Write poetry and who died of cancer when they were still young. Well Howard says the album title is in more. About her sister it's about herself. Which is why she felt she had to shed her band members. Get to know the ladies from discover more new music to 3. I'm Robert Krulwich This is Radio Lab And this hour we're talking about tree ouch and before the break we were talking to reporters Sheri Fink about what happened in one hospital New Orleans during Hurricane Katrina and the consequences of some of the decisions made there but now we shift focus all of that began with a tree house decision about which patients should go 1st. I'm trying to put myself in the position of the people of that hospital and I'm thinking to myself it would be really nice have like a checklist like 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 you know that's where I go next I wonder whether this story you've just told us leads us anywhere the 1st place that 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 ask because of course after Katrina there have been efforts since then to come up with a protocol going to Sherry the experience of Katrina was basically a wake up call for doctors and hospitals and state governments to think about. Like how should we ration medical resources like if something bad happens again which patients do we prioritize 1st 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 1st one I did I mention 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 Wealthy Howard County thank you for giving up this quarter this Saturday to have we think it's a really really important conversation that they're still fresh friends people have been recruited to be a part of this and when I say people it's just regular folks act so the researchers let's call them that they get people together and everybody is starting to take. The sort of scenario is laid out so ready to leave already and as your doctor just heard it turns out in the air and we're going to be talking about today is how we make decisions about. Yes life saving resources in the in a situation where we literally you know take care of everything today is an area we're talking about is going to 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 breathed. The problem is. There just aren't enough this is stuff this is a terrible situation so here you have too many patients too few resources how do we choose who gets those ventilators what. Might be the right answers The researchers then essentially lay out 3 different kinds of. Number one try to save the most lives or years of life by picking people the best chance of surviving the pandemic such as giving the ventilators young people or healthier people Number 2 picking people who will be the most helpful during a pandemic so 1st responders health care providers vaccine workers that are often. Number 3 leave it up to fate something like 1st come 1st serve or a lottery. So you will not does that make sense OK and then they say we're here to answer questions talk amongst yourselves and then you know. There was no other car no thought of it will be like and what does that mean that the translation and the life where you know that some things are black and say in the last letter I quote My immediate reaction to the lottery was it's a level or that's all they see on T.V. At least from the scientific lease irresponsibility I think ultimately it's a failure if somebody is going to live with the various There is that should back away into the decision and if we if you set of guidelines that yes that we have that we are you know what I mean going to meet other things to say I didn't say that. Now the good news is that I would be a ventilator 4 year old wouldn't I just think that would be the sense that people were willing to engage in this question and there were any fistfights you know but as you can also hear the 1st come 1st Certainly nobody has to put that they are close to that if 1st week was a day and I got there hey if the 2nd night is right and there wasn't a lot of agreement or state your opinion but I'm just doing what you do I guess I think the time of crisis there's no room for emotion the reality is some people are going to have to go it's one of the the big findings was that there were 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 to make decisions based on gender race socioeconomic status like people's jobs and incomes and citizenship status and you know whether they had a criminal history or where they upstanding members of society those things are out of bounds I just want to say up front that's not that's not up for grabs but those things kept popping up he was like a young pastor and you might imagine. Reprehensible the alcoholic terminal type person and he might be calling the nurse. Of the year is the pastor I was interviewing one beneficial to society isn't the use the 1st is a criminal record a simple well know what one person well you are sharing if it tears are there well the only good of it that is a. Personal. There were people who thought that undocumented immigrants didn't get ventilators alcoholic smokers and the world will be a better place because it is the most brutal terms possible they are saying do you deserve to survive or not can I say to you but should I try to save. What's interesting is that people 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 or life has more value than another person well then people 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. And this was particularly acute when participants were asked the 2nd camp can we move 10 even more controversy on 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 one I definitely don't have a clear answer myself and some people said well of course if it doesn't seem like someone is going to make it through the treatments. Or if we need to cut it cut their treatment sure that cars are going to later on it's on the House but you're going to murder my father there were other people who said no you take my father off sooner or later. I was going to be true friendship that's in English to your right but like never going to spend a few years I can't think I'll write 1st let's just say I was. It's so complicated. Did they come to a conclusion did you publish or did you hear a conclusion 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 like they want to do it before we prejudge this what is it 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 and they recorded 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 they're going to be a lot of people who fit in that category so if everybody is just about the same and we can't really we don't have like great science that allows us to know which patient is going to survive and which one is not going to so for that 2nd tier let's do it randomly let's just get a really really fair and give everyone an equal chance so it's like you introduce a little bit of faith to keep things honest Exactly and in the research he said you know what this is a good idea let's see if we could maybe put this concept into the protocol in my writing 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 yeah so even if we don't like the choices that are made it 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 advantage or disadvantage over money or over these other things it's sort of helps you accept it yeah. That sounds you know plausible but when you put theory to practice which you can do right after the break things get very hard That's coming up. This is calling from sober Spring Maryland Radiolab supported in part by the Alfred P. Sloan Foundation and hissing Public Understanding of Science and Technology in the modern world more information about Sloan and W.W.W. Dot Sloan. Hi this is Andrew Sade's from Pittsburgh Pennsylvania Radiolab are supported by noon offering a personalized weight loss program based on a cognitive behavioral pro-choice with the goal of losing weight and keeping it off for good learn more and new an M dot com. Its jewel in Nova Scotia Radiolab is supported by Progressive Insurance offering its film called Explorer designed to provide information about available home insurance options in one place more information a progressive dot com. I remember my 1st gift to public radio I had never donated taking a little pennies from the grocery store but never giving one back it was actually a story that I heard that hooked me in I had been listening for a number of years and I felt an obligation to do after I made my 1st I remember I felt like I was part of a community like I had taken to make your 1st gift right now and you listen differently it's really easy at C.P.R. Dot org catch all the latest stories in business education and the environment on C.P.R. News you can stay informed throughout the day with Morning Edition Colorado matters the take away here and now and all things considered and the news doesn't stop when you turn off your radio find more in-depth coverage any time at C.P.R. Dot org And for a closer look at the issues affecting Colorado you sign up for our e-mail newsletter the lookout at C.B.R. Dot org. I'm Robert Krulwich This is Radio Lab And returning now to our collaboration with The New York Times and reporter Sherry think 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 as Sherri's about to. Sometimes what's a success what's a failure kind of hard to measure. Test please we can't even do the chip right I remember being in Haiti after the Haiti earthquake back in 2010 was a was the access that I was in bedded with a group of us disaster responders the international medical and surgical response team in search treating at least here 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 a 100000 people took that was patient after patient kind of lined up in a row most of the things we can agree to. That's. Coming back 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 which used the word political level with the usual supply their oxygen for the water. For their. Ready for work I am right here this is 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. At one point. I was following a couple of the doctors we walked into this tent. And we met this woman. She braided hair a white night gown on and. Running into her notes. She . Said Jim you're. In 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 the money isn't way she had survived it. Because she wasn't at home when the earthquake hit doesn't mean that 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. Everyone's. God is really using. Love about. Happy to see a smile on your face. I started to speak with the staff about her. And I found out that and had only had just one of the hearts of the surgical staff there people loved her she was so thankful. Hard pressed 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 cooled hard tree Amish theory you know this makes sense because they were trying to save oxygen she has a chronic problem that probably won't get better so that's like 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 similar to live. She prayed to God. Living but others at the settlements put it. Down. Anyway because the people were given somewhere to stay show. A. Journalist. To tell them. What to say in such a hard situation. And I remember the nurse who was doing the trash who'd made that decision to cut off her oxygen Patrick Cadillac commander for the insurer had never met her I never let the patient. But that's the rule. Of oxygen in the country that song. Doesn't a box of the soul have to make the decision no she can't switch and 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 an on the abstract level. The transporters came a few hours later. Where he was the 82nd Airborne actually who were providing that service the remains and they came to pick her up and she gets. It they saw she was on oxygen and they said OK 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 yank the oxygen. Structure onto a stretcher. And lifted her up stuck her in the back of this Humvee ambulance. I rode with her. She started getting short of breath that. Asked him how in her mouth over and over. That it was oxygen. This 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. To die and just watching didn't feel it didn't feel right. And so I'm. Going to be it stopped at this hospital and I put over toward her and some of the medical staff went to look at her. To see she was in distress the frogger in science. And she was really struggling to breathe but then. Seizure I saw one of my medical school professors and emergency doctor and I told them about her. That is it yes I need this moment to. Look at me. Like that but. She improvised it was. Right and she used like all these directs to get fluid off for longer. And she found one thing of action that headed to the last minute. For me. To. See and. Was able to extend her life. Ultimately I actually felt a responsibility for her that outlasted this story that I did and so after that came out I I did attempt to help her. Well I found a charitable group that was willing to bring her to the U.S. Under a certain type of visa program that allowed for humanitarian. Like a medical treatment and the cardiologists who had examined her in Haiti had thought she had a rheumatic heart disease that was causing her lung problems and that it could be surgically corrected but when she came to the U.S. In fact it was found that she had a much more serious condition and she really needed a transplant and she didn't didn't make it. So here you've got a rule and maybe in some Broadway it's helping but in that vehicle looking at this woman you wanted to break the rules for very. Moral and decent reasons in these extreme circumstances where life and death are wrestling with each other. Can you make rules I mean yeah because it's like you can't fault the people for taking her off the oxygen and you can't fault you for trying to get her on the oxygen so what's the conclusion to draw well let's not give up you know the conclusion is let's not give up like it turns out there was there were options for this woman it turns out that somebody was able to extend her life now you could very well argue that she should have died in that moment because look at all the resources that were spent but I just feel like like there was some value in her existence there was so much value she came to the US and by God she took up a collection for all the patients back in the Haitian hospital who she was friends with she contributed to the day she died I don't know how to do the math on this one is the problem though well they don't really guidelines require like a lack of compassion the cold hearted rigidness of it everything you're talking about has to do with compassion this is Simon Adler by the way our producer and how do you make compassion work that largescale without caring about people that you care about some people what other people and I don't know you know we're hurting that's a very good point if you don't systematize it you you risk choosing people based on factors that are really not fair exactly it's just about the person in front of you and I think that the more unbearable it is so the more you have to look someone in the eyes the more it makes us try to figure out creative ways to avoid doing it OK but I do feel you somehow refusing to acknowledge the subject when it really really gets tough. You see let's let's avoid that toughness over and over again let's know I'm facing the real problem which is that it's a problem to have to ration but I'm not but it's no no what we're not going to figure out the best way to ration because there is no one best way because everyone in society will have a different view on that I think that that's in a somewhat unimpeachable I think you're absolutely right we should always strive to not have to make the choice but with we do have to make the choice how do we do it let me tell you that I think what you've hit upon here is an impossible piece of human business rationing whatever you call it is an inhuman act which humans are trying to do but the fact of their humanity makes it impossible you have a god role and nobody fits it. Thanks to New York Times correspondent Sheri Fink I'm Jad Abumrad I'm Robert Krulwich takes for listening. This is C.P.R. News K.C.'s fire at them Denver K C F C and Boulder and on H.D. At 90 point one F.M. . C.P.R. News welcomes how I built this with Guy Ross to Denver for a live show Nov 13th a conversation with author products Kurt Richardson about his entrepreneurial journey tickets on sale now at Paramount Denver dot com. Support comes from the vineyard wine shop a destination for fine wine in Cherry Creek north since 1971 featuring wine of the month clubs educational in-store tastings and a curated selection of wine beer and spirits learn more at Vineyard wine shop dot com This. Is the TED Radio Hour. Each week groundbreaking TED talks to. TED Technology Entertainment Design design is a really rich term for a chicken liver no. TED conferences around the world gift of the human imagination we've had to believe in the impossible this true nature of reality beckons. Just beyond those talks those ideas dad did for radio. From N.P.R. . I'm Guy Raz Coming up what is a thought really is it just the brain or is it something more you know it's like this with us looks through your mind what it's gone ready that's kind of amazing how can you use your very brain to understand how your brain works how does the brain do that with the biggest mystery in the universe this episode the unknown brain 1st the news. Live from N.P.R. News in Washington I'm Janine Herbst hurricane Dorian is now approaching the northern Bahamas as a powerful Category 4 storm with top sustained winds of 150 miles an hour N.P.R.'s Greg Allen reports the islands are expected to begin getting the 1st impact from that storm Sunday hurricane Dorian has slowed down as it's begun turning west that means it will spend hours over the Bahamas pummeling the island chain with winds over 140 miles per hour 15 to $20.00 inches of rain is possible in some places in a Facebook Live post the head of the National Hurricane Center can Graham said while it's over the Bahamas Dorian may slow down even more when you're moving that slow That's a lot of rain that's a lot of people on wind and it's really devastating for some of the analysts in the northern Bahamas we really want to get that out to those folks to be prepared so it's a significant situation authorities in the Bahamas have ordered residents on low lying islands to evacuate shelters are being set up on Grand Bahama in churches and schools Greg Allen N.P.R. News Miami tens of thousands of pro-democracy demonstrators in Hong Kong defied a ban on protests and clashed with riot police N.P.R.'s Emily fan reports it's one of the most violent days in 3 months of demonstrations protesters wearing gas masks and carrying umbrellas uprooted from.