Writing out the storm

April 22, 2010, 12:52 a.m.

In the early 90s, Sheri Fink, a medical student studying neuroscience, was sitting with about a hundred other Stanford undergrads in a HumBio course about healthcare in the Nazi period. Professor Tom Raffin, then-co-director of Stanford’s center for biomedical ethics, was describing the horrifying role that physicians played in the Final Solution in Germany in the 1940s. The class listened raptly as Raffin spoke of systematic German euthanasia campaigns against children born with congenital defects.

Writing out the storm
Sheri Fink M.D. ‘98, PH.D. ‘99 found her calling in journalism after years of studying medicine. Her “Deadly Choices at Memorial,” a long form feature published last year in The New York Times Magazine won her the 2010 Pulitzer Prize for investigative reporting. (AMI VITALE/MCT Info Services)

At her seat, Fink shook her head, shifting her mop of dark curls. A human rights firebrand with a bent for medicine, Fink was both horrified and fascinated at what motivated the Nazi doctors to do what they did. How could physicians in the Third Reich euthanize thousands in the name of science?

Asking the medical ethics questions was the aim of the class, but it soon became more for Fink. At the time, Sheri Fink, M.D. ’98, Ph.D. ‘99 watched the horrors unfold in the Bosnian War in the early 90s from her position at Stanford and asked herself what she could do. Nearly a decade later, she would ask herself the same question, but in a different country and with a new context. After hearing allegations of ‘mercy killings’ by a cohort of  New Orleans doctors marooned at a hospital in the wake of Katrina, Fink set out to see how and if the physicians had hastened the deaths of elderly patients they thought weren’t going to make it to evacuation.

The answer to that question led Fink, a social justice-minded med student turned investigative journalist, through a traumatic path that earned her the 2010 Pulitzer Prize for investigative reporting early last week.

“Deadly Choices at Memorial,” Fink’s gripping 13,000-word exposé published in The New York Times Magazine in 2009 on the fourth anniversary of Katrina was an up-close reconstruction of the life-or-death decisions that beset a team of health professionals in a New Orleans hospital after the disaster. The story, which took two years of reporting, hundreds of interviews and extensive evidence examination, kicked off a national dialogue on the ethics of “mercy killings” in disasters and a debate about the culpability of medical professionals put into these crisis-mode decisions.

“I wanted to appreciate some aspect of their experience, having worked in disaster myself,” said Fink, in a phone interview from her home in Washington, D.C. “I think it was an opportunity for them to tell their stories and give their perspectives and to help Americans understand what happened there, with the hopes, perhaps, that that could help situations like this from arising in the future.”

So in February 2007, more than two years after the levees broke and floodwaters pummeled New Orleans, Fink headed to Louisiana. A young freelance reporter at the time, she had secured a grant from Kaiser Media Fellowship in Health to report on the story. After two intense years conducting more than 140 interviews, Fink was ready to publish. She sold the idea of the story both to Steve Engelberg, the managing editor of online investigative powerhouse ProPublica, and The New York Times Magazine. They liked it.

Fink’s “Deadly Choices at Memorial” piece was just one instance of a long career on the “medical crisis beat” that had its roots in her time at Stanford.

Working on her Ph.D. research under Robert Sapolsky throughout the 90s to design gene therapy to protect brain cells from various neurological diseases, Fink became more concerned by what she read in the newspapers than what she saw under her microscope. The ethnic cleansings in Bosnia deeply disturbed her, leading her to co-found Students Against Genocide to spread awareness of the conflict in 1993.

Then, in 1997, just two years after the end of the Bosnian War, Fink decided to go to Bosnia as part of a conference put on by Bosnian medical students titled “Medicine, War and Peace” to study how the students practiced medicine in crisis.

She floated the idea to Raffin, who was initially skeptical.

“I was worried that she would be hurt,” Raffin, now an emeritus professor, remembered. “There was a lot of violence in Bosnia at the time.”

But Fink pressed him for funds and he eventually conceded. Fink headed to Sarajevo.

“I decided to take a year off after med school and go there and try to understand what my colleagues in Bosnia who were in med school were going through,” Fink said.

To prep for that experience, Fink decided to educate herself about journalism, and completed a reporting fellowship through the American Association for the Advancement of Sciences, aimed at giving reporting experience to grad students with a science bent. As part of the program, she did a three-month stint at a newsroom in Portland and “fell in love with journalism.”

From then on, she abandoned the lab coat for a notepad, following in the footsteps of her father, a journalist in her home state of Michigan.

Triage: The process of determining medical priority in order to increase the number of survivors in times of crisis.

It’s a word that Fink knows well. She encountered it in her reporting on Katrina, but fresh out of medical school at Stanford, Fink actually practiced it.

As a researcher for Physicians for Human rights and background for her book “War Hospital: A True Story of Surgery and Survival,” Fink went to Kosovo. Then, as upwards of f 100,000 people showed up at the medical camp, which was underequipped, Fink was asked to pitch in with medical services.

“I was helping out with that right after med school working under the direction of the more experienced doctors,” she said. “And I was doing triage, deciding who would get into the tents for care first and who could wait, whose injuries were not so serious.”

Fast forward to Katrina and the choices of physicians at the Memorial Medical Center. It was miles removed from Kosovo, but it was triage all over again, of an entirely different scale.

And Fink knew what the doctors were going through.

“I realized that these people in New Orleans hadn’t had that opportunity because this was it for them,” she said. “It was hitting their city, which was a very different thing. And even having had a little taste of that, I realized that people don’t make the best decisions when they haven’t slept for days, and that they might make decisions differently if they were rested and if they had better preparedness.”

That nuance and the desire to shed light on the human dilemma characterizes Fink’s work and led her to pen an emotional, illuminating portrait of New Orleans Medical Center.

“This type of disaster, horrific as it was, had the potential of occurring in many places in America as in many places around the world,” Fink said. “I felt like there might be some larger importance to the story than just the specifics of what occurred.”

Raffin agreed.

“Journalists have a critically important role to play in illuminating ethical issues for people who aren’t normally exposed to them,” Raffin said. “I think we need to nurture people like Sheri Fink who will go out and research and do important pieces of journalism that shed light on the issues we really need to consider.”

CORRECTION: In the original version of this story, it was reported that doctors in Bosnia during the war euthanized thousands of patients. Doctors in Bosnia did not euthanize people in the name of science. It was also reported that Fink was required to write a book in order to travel to Bosnia with Stanford funds. The Stanford funds, in fact, carried no such stipulation.

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