Producer/Director/Writer Carlton Cuse on Telling the Story of ‘Five Days At Memorial’ With Integrity and Fidelity

Veteran producer/director/writer Carlton Cuse may be most known for working on sci-fi and horror shows like Lost, The Strain, and Bates Motel, but in taking on Five Days at Memorial, a true-life depiction of one hospital’s impossible circumstances in the wake of Hurricane Katrina, Cuse has revealed that truth can be much stranger than fiction.

In our conversation, Cuse and I go through the grueling nature of creating the project, as well as the horrible decisions hospital staff were forced to make when federal, state, and local governments left them to their own devices. It’s an eye-opening discussion about the nature of health care in America, and the systemic failures that exacerbated a natural disaster by adding a human one on top of it.

Awards Daily: What drew you to this challenging project?

Carlton Cuse: I had read Sheri Fink’s book shortly after it was published. I thought I knew about Hurricane Katrina, because I had watched a fair amount of the coverage, but I realized I knew almost nothing about what had transpired. Sheri, in such meticulous and detailed fashion, told the story of what happened to these two thousand people who were trapped inside this hospital and also, in doing so, really told the story of what was happening in New Orleans at large during probably the largest natural disaster in the history of our country. It was just an incredible story. Unfortunately, I got beaten to the punch by Scott Rudin who had the option and tried to make it for a bunch of years. After that Ryan Murphy had the option for a few years. I was just fortunate that those guys weren’t able to get the movie, or the TV show, made. Then I finally convinced Sheri Fink to let me have an option on the property and then I brought in John Ridley to work on it with me, who was my first choice – a filmmaker who I did not know but who I had admired from afar for a long time. We both had deals at Disney. Even though I didn’t know him, it felt like that was a helpful element. Most importantly, John read the book and felt the same way that I did that there was really an incredible story there. So, we started working on it and trying to figure out how to take it and adapt it, and what to keep and what to lose, and how to tell the story with integrity and fidelity. 

Awards Daily: In John’s case, many of his projects have this great commitment to a painful level of authenticity and reality. Which I think was perfect for this project. I think a lot of people who know your work might think of you as a person who’s worked in sci-fi a lot, which you have, but you’ve worked in other areas too. There were times when I was watching this that it felt like science fiction, like how is this even possible. I imagine the more you learned about it, the more you were bowled over by what occurred. 

Carlton Cuse: That was what was incredible about the story, it just seems hard to believe that in America in 2005 we were in a situation where an entire city — 80% of that city was under water — where you had a couple thousand people trapped in a hospital for days on end with no information, no plan for how to get them out, no systematized organized way to rescue them, and failure of the institutions that owned the hospitals, and failure of the local government, failure of the state government, FEMA. It’s just incredible. These poor people were put in the position of having to make completely untenable decisions. As a writer, we strive to find ways to examine stories about people put in really difficult circumstances, and this was that but it was also true. It wasn’t even a fiction story. It was interesting because I think what really hooked John, which I connected to so deeply, was that he had sent the original article, for which Sheri FInk won the Pulitzer prize, to his father who was a retired physician. His father’s comment was “I’m glad I wasn’t the one having to make those decisions.”

That sentiment along with almost a kind of immediate decision to not write something that was going to pass judgment on the people involved were very important operative principles for us as we figured out how to tell the story. I think from the standpoint of the first one I was really like “How is it that we have put people in a position to make impossible decisions?” And in the case of our second operative principle, I said to John I think the best version of this is at the end of the series; it’s like the spinning top at the end of Inception. People can debate and discuss – so I guess there was a science fiction connection – what they think about the events that transpired. It’s really been interesting because I have discovered that people have widely different thoughts about the events and really land in very different places about what they think should or should not have happened to Dr. Pou, or the other people involved in the incidents in the story. 

Awards Daily: I think the failures of the local, state, and federal government have become perhaps more obvious to us through news coverage, but the nature of the corporate failure I thought was particularly fascinating here on two levels. 1: from the standpoint of having no evacuation policy for a place that can easily come under water if there’s a hurricane. It just seems so obvious that you would need this. The other factor: having the hospital within the hospital that was treated like a real second class citizen to a large degree throughout the process of evacuation and care.

Carlton Cuse: That was definitely something that we wanted to dramatize. Tenet was the company that owned the hospital at the time. They didn’t have a plan to get everybody out of there. Neither did Lifecare, the company that owned the long term care facility that was the hospital within the hospital. It was just compounding, the fact that there was no one to help these poor people. Mainly these were health care workers who by and large volunteered to stay there to take care of patients. They did this out of altruism and then found themselves in this horrible position. John and I started writing this in September of ‘19, and then as we were getting deep into it, in late February is when the pandemic struck. It really had a lot of resonance. Here we were writing about people who were trying to decide who was going to get on a boat, who was going to get rescued in a helicopter at the same time that we were living in a world where people were deciding who gets a ventilator, who gets a vaccination. The resonance of that story was something that was really meaningful to all of us involved. It was even more intense because we went to Toronto to film the show, and there were much lower levels of COVID there and it just felt safer. Particularly in a show where there were a lot of elderly people, a lot of people crammed into confined spaces. When we were there, the whole city was in lockdown so really the cast and John and myself only had each other to hang out with and we were all inside of our bubble. 

It was a very intense experience both onscreen and offscreen, but really a beautiful one. Everyone involved was so committed to telling the story. People commented to me “How did you get these actors to not look glamorous, to have their hair matted and be covered in sweat?” No one batted an eye. No one said a thing except for we want to be committed to telling this story with a great degree of accuracy, and not tell it in a Hollywood style or a sensational style. There’s nothing wrong with those. I wrote a disaster movie called San Andreas, which has a very different tone and leaned into the popcorn movie kind of construct for that. This couldn’t be that. This was a story that had to honor the real-life heroes that were working in that hospital and trying to do their best to help and save people, and from that, explore the decision making process that led to a bunch of people dying and how that all came about. A good story gets stuck in my brain and rattles around in there, and I was just fortunate that I had the good luck to get the option on this book and be able to tell the story. It was just such an incredibly rewarding experience to be able to bring this to the screen and to get Apple to support us and to give us the resources that we needed to make this with the scale and scope that it required in order to feel authentic. I think the bad version of this would have been to just be in the hospital and never go outside and never understand the context of what was going on in there. But we had the money that we could actually put you in the shoes of those people who were in there and try to affect rescue and survival even during this difficult time. 

Awards Daily: The show doesn’t tell you what to think or feel. It really is about presentation largely. You do a great job of presenting all angles and the disagreements that people have, not only about what happened but about what to do about what happened. It almost gets a little bit Rashomon-y. I know that’s such an overused phrase at this point. There is that commitment to not passing judgment on anything anyone does and just presenting it and allowing the viewer to decide for themselves. I love that about it. There’s a place for stuff that does try to influence you and tell how to feel. I don’t think this show needed it. You trusted the audience to sort it out themselves.

Carlton Cuse: Very much. I don’t know that I can say anything more than what you said. You said that very well. You captured what our intentions were. We tried very hard to not take sides, to just present the story, to let people make their own judgments about it. The story was powerful enough without having to editorialize on it. In fact, it would have been wrong to editorialize on it. I think the ethical questions involved are so profound, I think it would do a disservice to the story to take a side. It’s a situation where you have to present the facts and let everybody walk in the shoes of these characters and make their own decision about “What would I have done?” That’s it. It’s a really tough question. For all of us involved we were hoping that maybe this show is a small step towards preventing this from happening in another situation, so that health workers in future disasters aren’t put in the position of having to say “What do I do?” Anytime you’re dealing with these issues and rationing care or making decisions about who gets some lifesaving advantage over someone else. There’s just absolutely no right answer. There’s only just a series of bad choices really.

Awards Daily: In this case, when the evacuations were happening they actually prioritized healthier people over sicker people. Some of that was because moving the sickest patients was going to be so difficult. Was that eye opening to you? I think we’ve always lived in this world where we thought the sickest go first, the weakest go first, we take care of them first, but that wasn’t what happened here.

Carlton Cuse: The whole process of how this story unfolded in this hospital was incredibly eye opening to me, because mainly, there just wasn’t an organized plan. These health care workers had to make decisions on the fly, they were exhausted. You would think if you worked in a hospital there would be some rigid set of rules about protocols but there aren’t – at least in this hospital there weren’t. So they were kind of making it up as they were going along. There was a cascading series of decisions that led to the unfortunate circumstances of a bunch of people dying. It was really interesting for John and me to explore that and to try to understand how you get to that place where a doctor is making a decision to administer injections of drugs that could potentially be lethal. Something like that doesn’t come out of the blue. It comes out of a series of decisions that precede it. 

Awards Daily: I think a lot of moments in the series are going to be hard to get out of my mind, but what I would call the Sisyphusian walk up to the helipad was just staggering. To think of these health care workers carrying human bodies, drenched in sweat, dehydrated themselves, in this horrendous heat, and unsanitary conditions, going up this layered walk up to the helipad and then going down and doing it over again. It’s incredibly heroic, but it’s also staggering to think that this was the only option. 

Carlton Cuse: One of the things that I remember thinking about as we first started to put the story together, is that one thing you can do in a movie that is kind of better than a book is you can really dramatize and really show the audience how bad something is. Sheri Fink is a wonderful writer and she described the conditions in this hospital, but it’s another thing to actually dramatize those things and see them on screen. It was very hard to in any way outdo her book because it’s so good. But in the execution of the physical environment and the circumstances they were in, movie making is great for that. So a lot went into that. Obviously we didn’t have any access to the existing hospital. The existing hospital wasn’t flooded. We had to reconstruct this journey. It’s very rewarding to hear you say that you felt every bit of the peril of it. That was the intention. 

We built this helipad in a field outside of Hamilton, Ontario. Then the stairs were a separate element that were precipitously rising just up to nowhere. They were their own element. We then had other pieces of the staircase on certain sets. We had to combine all of these things through the magic of visual effects to create the sense of what that real helipad was like. That it was built on these spindly poles, that it hadn’t been used in eighteen years – no one knew if it would actually take the weight of a helicopter. We really worked hard and we had an incredible production design team led by Matthew Davies, our production designer, to figure this all out. It was on a wing and a prayer that we were shooting all these disparate elements and just believing that we would be able to stitch them together and make it believable. It was an important part of the storytelling because it was really important to make you feel what it felt like to be trying to take these people up these stairs, because it was an important part of the decision making about whether certain patients could be rescued. How many patients could be rescued, how arduous it was to get patients down seven flights of stairs in the dark and the heat, across the hospital, through a hole in the wall, up the parking garage, and then up this precipitous set of stairs. Every decision to take someone that route was really challenging. 

Awards Daily: I want to make sure that we get to some of the performances. It’s hard to start anywhere other than Vera Farmiga, who’s just a remarkable actor on any given day, but this is such a great role and a great performance. What fascinated me in large part about Anna Pou, is that she is both a woman of science and faith. A lot of times in our lives we tend to separate those two things. For her, both things were driving her to the same decision, oddly enough. I think people on the science side could see why you might make the choice to relieve someone’s pain through an ultimate end. But people on the religious side I think it’s a harder struggle because to them, it’s taking a life on some level. I thought it was fascinating how Vera was able to get across this idea that she could be a woman of faith and a woman of science and reach the same conclusion, not a conflicting conclusion, but the same conclusion from both ends.

Carlton Cuse: Vera was always my first choice. I had worked with her for five years on Bates Motel. Every day when I watched dailies, I would marvel at the choices that she made and the brilliance that she brought to that role. I feel like she was underappreciated for how good she was in that part. So, the opportunity to get her to do this show was really fantastic. The first thing she became was a fierce advocate for her character and I think that that went beyond my imaginings of how well she did that with believability, with restraint, and with compassion for this woman. I think Vera really understood how important the spiritual component was, in fact we talked about it and I actually put more of that in the last speech. All those words had come from various things that Anna Pou said in various places, at various times, in letters, in speeches. It was very important for Vera to lean on the spiritual side of the character. You articulate that well, the idea that characters usually do align on one side or the other. This character was driven by both her really strong faith, she’s catholic, one of eleven children, but also she was a doctor, a very humanistic doctor. I think she truly believed she was doing the right thing for her patients. The twin drives of her spirituality and her scientific medical empiricism compelled her. Vera did an incredible job of finding both those sides of the character. 

Awards Daily: In the hospital itself there are characters who play the other side, who don’t see this as a good moral choice. The person that I thought was the true other side of the coin was Michael Gaston, his character. By the way, what a knockout performance, just stunning throughout. The grief he was carrying over his own loss and then this desire to find a way to make things right regarding Memorial. He actually reminded me a little bit of the Ian Holm character in The Sweet Hereafter, who had his own sadness in his life with his daughter being a drug addict and he wanted to fix this bus accident in Canada. Both Holm and Gaston’s characters wanted something to fix. Different people can look at the same thing and come to a different conclusion and be good people and have the right intent. I thought he really captured that.

Carlton Cuse: Michael is such a beautiful actor and I think he got under the skin of Butch Schafer in such an incredible way. It’s kind of hard to believe that that was the true story. You have a guy who was tasked with investigating these murders who was doing this in the wake of his own daughter dying from medical malpractice, from being prescribed an overdose of drugs. If you fictionalize that some executive might say, eh, that’s a little too on the nose, right? But he did it with such restraint and with such authenticity. It’s just such a great performance and you feel for him at every moment. It changes the entire nature of that performance from being just a straight up investigator who’s trying to assemble facts. We’re all compelled by those kinds of crime stories. Where does the evidence lead us, what happened? But in this case, it really was almost a personal journey of recovery, an attempt to reconcile this thing that had happened to him. It’s under the skin of every scene that he does and then eventually, obviously, it comes to the front when he experiences the frustration of where the investigation is leading. It was a brilliant performance and I really hope he gets recognized for it.

Awards Daily: There are times when I’ve watched shows where a character or two characters are so enjoyable that you almost wanted them to have a spinoff. I think that’s what I would say about Gaston and Molly Hager. It doesn’t make any sense to have them have a spinoff, but I would love to watch another show about the two of them working together. 

Carlton Cuse: The thing about it, Molly was just incredible. She works mainly in theater in New York. She’s not had a lot of lead roles. But she sent us a brilliant audition tape. We really applaud the fact that Apple was willing to go with her even though she didn’t have the type of credits that normally somebody would expect you to have to take on this kind of role. She was fantastic. She was the person who we wanted and the universe delivered her to us. She and Michael immediately clicked and they became fast friends off screen. They developed this incredible friendship and comradery and this kind of chemistry, which is fully there in their relationship on screen. By the way, it was very much, according to Sheri Fink, a part of Butch and Virginia’s relationship when they were working together – their dynamic. It was both delightful to watch and very authentic how they bonded. You may be dealing with something really difficult and tragic, and maybe because of that you find ways to connect and sort out your more humanistic side of yourself in those situations. They found that and I agree it was really fun and delightful.

We very much wanted the second part of the last three episodes…we sort of divided the thing. Again one of our initial decisions was we saw this in two pieces—the first piece was the first five days. We actually made the decision to make them a little bit differently too and make them feel a little bit like each was its own movie. The first five days was that descent into the events of what happened across those five days. We wanted to dramatize that with real authenticity and in an unsparing way. Then we wanted to do this investigation from the comfort of hindsight. We introduced these two new characters. We had a different DP who shot that. We hired this wonderful director, Wendey Stanzler, to direct it. It has its own color timing, its own different approach to the music. Everything about it was different. We wanted it to feel different because we wanted that investigation to feel different. All of a sudden, you have Molly and Michael wonderfully carrying their own little mini movie for three episodes.

Awards Daily: I imagine it feels incredible to have pulled this off, to have seen it be so well received, and to know that it’s out in the world as this long term document. 

Carlton Cuse: Thank you. It really makes me happy to hear you say all that. I’m really proud of it. I worked really hard on it. It was very difficult to make it, particularly in the middle of COVID, and I’m just glad it’s meeting with a good response. It was such a great experience to work with all the people. All of my creative collaborators on the show were so wonderful and so talented. It was truly a highlight experience in my career. I’m glad that it’s getting the reception that it is.