Carlton Cuse had been waiting years to develop Sheri Fink’s Pulitzer Prize-winning investigation into the deaths at a New Orleans hospital leveled by Hurricane Katrina. But he had to wait.
The project went to Scott Rudin, and then to Ryan Murphy for adaptation as part of FX’s “American Crime Story” series. When that fell through, Cuse finally was able to snag the rights to the story and, along with John Ridley, transform it into a gripping television show starring Vera Farmiga and Cherry Jones.
“I read the book shortly after it was published, and it blew me away,” Cuse told TheWrap of the project. “It just stuck in my brain.”
“Five Days at Memorial” follows the medical staff at Memorial Hospital in the aftermath of Hurricane Katrina, as rising flood waters cut the staff and patients off from access to water and electricity, making care nearly impossible. As authorities at the local and federal level scrambled to organize aid for New Orleans, the doctors were left to make some impossible decisions about their patients’ care.
When Cuse began to see the project become a reality, the world was facing the COVID-19 pandemic. Production came to a halt before eventually continuing, though the ramifications of the coronavirus continue to make an impact on a global scale.
“So as we really were thrust into the main part of our creative work, suddenly, we were all living in the middle of a medical crisis and [it] really had resonances,” he said, adding that he hopes the series could “help prevent something like this from happening in some future disaster.”
“There’s also a cynical part of me that says, ‘Well, it just doesn’t seem to be our nature as a society.’ We tend to keep repeating the same mistakes,” Cuse said.
In our new Q&A with Cuse, the showrunner breaks down how he finally managed to tell the story, and how recreating a past medical disaster became even more poignant amid the pandemic.
TheWrap: This project has been floating in development for a while. Can you catch me up on how it landed with you?
Carlton Cuse: I read the book shortly after it was published, and it blew me away. I mean, I thought I knew about Hurricane Katrina, and then I realized I really didn’t know and Sheri Fink’s exhaustive research and incredible storytelling skills were on full display. This book is just a fantastic piece of nonfiction writing. And even though it’s just about what happened to these 2,000 people trapped in this hospital in New Orleans during this hurricane — one of the largest hurricanes ever in the United States, and then the flooding that follows — that examination also speaks to what happened in New Orleans in general, and I think that’s kind of the brilliance of the book. It’s burrowing down and examining one event, but through that one event, we really come to understand what that tragedy of Katrina and the aftermath was like for New Orleans in general. And it just stuck in my brain. But unfortunately, Scott Rudin was on the book for a long time and then Ryan Murphy on the book for a long time, and I just had to wait. Finally, unfortunately, those guys were not able to get it made. And then I was fortunately able, along with John Ridley, to convince Sheri Fink that we were the guys to tell her story. I didn’t know John, but I was a huge fan of his work. I thought [his show for ABC] ‘American Crime’ was just a genius show and I love working in collaboration. He felt like just the perfect person. Fortunately, John responded to the material. So, with Sheri’s blessing, we jumped in and started figuring out how to best tell the story.
I really was impacted by the use of archival footage throughout the series. How did you sift through all of that and nail down what worked best?
We had some really good archivists who spent months looking for everything that could be found. Obviously there were limitations in terms of the quality [of] stuff that was being shot on video, because it was low grade video, 4×3 [aspect ratio]. I mean, there was a lot of stuff that was just hard to use, and it was hard to find, but we exhaustively searched for everything that we could find about it. When John and I started talking about the story we realized that a lot of the story took place in this hospital and it was pretty insular. We felt it was important to contextualize what was going on in this hospital with some understanding of what, at the same time, was going on outside the hospital. What were the events that were happening surrounding the hospital while these characters were going through what they were going through? So this archival footage became a way to root the story in kind of a larger context. We just wanted the story, even though it was a dramatic adaptation, to feel authentic and to have this fidelity to the emotional truth of what people experienced in New Orleans and certainly what these characters experienced in this hospital.
There are a lot of perspectives here, and a lot of blame being thrown around. Of course you have the source material, but how did you adapt this story in a way that felt the most objective?
I think that was one of our fundamental decisions that John and I had to make. We felt like if we took a side and tried to impose one set of views that that would actually ruin the story. The best way to tell the story and the most important way to tell the story was to try to show all sides of the story and try to advocate for all the different characters and really try to understand why they made the decisions that they made. We really wanted to leave it to the audience to make their own judgment about those decisions and what happened. In the best version, this story would provoke conversations and discussions. We started it in the fall of 2019, before the pandemic happened. So as we really were thrust into the main part of our creative work, suddenly, we were all living in the middle of a medical crisis and [that] really had resonances. We were telling this story about a Southern medical crisis. And John said to me early on [that] history rhymes. That became such a keystone for us as we went forward because these medical professionals at this hospital in New Orleans had to make almost impossible decisions about who got care, who got prioritized to be rescued, how each patient was going to be treated relative to other patients. And then we found ourselves shooting this in a pandemic where those exact same decisions were having to be made: who gets a ventilator, who gets monoclonal antibodies. What kind of medical treatment do you get if you’re in a poor inner city hospital versus a rich, suburban hospital? I think that it’s unfortunate that we as a society don’t seem to learn as many lessons as we should from these kinds of situations and hopefully, ‘Five Days at Memorial’ will provoke some further discussions about that and maybe, in my most optimistic part of my brain, it will help prevent something like this from happening in some future disaster. There’s also a cynical part of me that says, ‘Well, it just doesn’t seem to be our nature as a society.’ We tend to keep repeating the same mistakes.
The series gets very dark and often incredibly sad. I’m wondering how you grappled with the realities of the situation without making it too upsetting? How do you grip audiences with the dreadful parts of the series without making them want to turn it off?
Fair enough. The show is harrowing, and the story is, but I think it’s also important and timely and gripping. You really will get involved in these characters and in the narrative, and even though some of the things are harrowing, I think that it’s fundamentally a very humanistic story. There is also a lot of heroism on display and we’re telling a story about a group of people, most of whom volunteered to be there. They didn’t have to be in the hospital. They were trying to do their best to help the other patients, the staff members, and I think there’s something fundamentally really uplifting and positive about how hard these characters work to behave altruistically and help their fellow humans during this horrible crisis. But there were difficult moments. That’s just part of the storytelling. I don’t think that John and I consciously thought too much about you know, ‘What was the right level? What was the wrong level?’ I think it was more about just trying to feel like we were being honest and truthful in the story that we wanted to tell and in trying to balance the various elements and really show the pressures that these characters were under. It led us to what you see on the screen and I think it’s pretty good and gripping, and we hope the audience feels the same way.
How much of the series was practical vs. visual effects? I really couldn’t tell how much of the flooding was practical.
We worked really hard. We spent thousands of hours discussing the technical challenges of replicating New Orleans — a giant city that 80% of it was under 10 feet of water. So how do we do that? We built a 4 million gallon tank in Hamilton, Ontario, and it was big enough to put multiple boats in it and drive the boats up and down the streets around the hospital. That created a lot of verisimilitude. Then we combined [that] with visual effects. We did a lot of things that were practical, and then we enhanced them with visual effects. The helipad was another really tricky thing. We really wanted to show how perilous and dangerous and vertiginous it was to go up to that top of that thing, especially if you’re trying to carry an unconscious patient. It included building a replica of the helipad to full scale. It was a complicated process and I’m very happy to hear you [weren’t able to] figure out how we did it because that’s kind of the magic trick of cinema. You want to make the audience feel it was real and we worked really hard to try to convince you it was real.
Four million gallons. Wow.
Yeah. I mean, we’re lucky. Right from the get go, Apple supported the vision of making this show very cinematic. I think there’s another version of the show, which would have been much more contained in the hospital. But absent the context of really what was going on in the hurricane with the flooding, I don’t think the story would have been as powerful. It felt really important to John and I that you’d be able to experience the disaster on the scale that the characters were experiencing the disaster.
