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Cross Genre Storytelling and Emotional Translation onto the Screen with ‘Five Days at Memorial’ Showrunner, EP, and Director Carlton Cuse

Carlton Cuse shares with Script the decisions behind breaking up the mini-series into two parts, not taking a narrative point of view, departing from the literal narrative, out of dramatic necessity, and so much more. Plus, Cuse shares his process when tackling an adaptation.

Based on actual events and adapted from the book by Pulitzer Prize-winning journalist Sheri Fink, “Five Days at Memorial” chronicles the impact of Hurricane Katrina and its aftermath on a local hospital. When the floodwaters rose, power failed and heat soared, exhausted caregivers at a New Orleans hospital were forced to make decisions that would follow them for years to come.

Five Days at Memorial is emotionally gripping from the first to last episode. The role as an audience member and a happenstance bystander in this scenario, is to listen and watch different angles of one incredibly horrific event, that was the 2005 Hurricane Katrina, and how these stories unfold and converge over the course of five days at Memorial Hospital. The second part of the story leads us to the investigations of what was morally and ethically "correct" and criminal, due to the hard decisions made over those last days of the evacuation. 

It's a heavy task to approach and adapt, but it was in the best of hands with the even keeled and fervidly receptive creative collaborators Carlton Cuse and John Ridley, and their creative team in front and behind the scenes. And as Cuse mentions of author Sheri Fink's work on her book, "Sheri spent six years working on this book, she conducted over 500 interviews, it was so thorough and so well researched," all pieces were in place for Cuse and Ridley to create a strong emotionally character driven visual narrative.

Cuse at this point in his career is a master of authentic character driven narratives, from Lost to Bates Motel to adaptations like Tom Clancy's Jack Ryan, it's very safe to say, he knows what he's doing. And it's not ego driven, it's driven by passion. After a brief conversation with Cuse, you're left in awe of how raw his intentions are behind his storytelling and the importance of clear and communicative collaboration. He shares that and more during this interview, plus the decisions behind breaking up the mini-series into two parts, not taking a narrative point of view, departing from the literal narrative, out of dramatic necessity, and so much more. Plus, Cuse shares his process when tackling an adaptation.  

This interview has been edited for content and clarity.

Vera Farmiga as Dr. Anna Pou in Five Days at Memorial. Courtesy of AppleTV+.

Vera Farmiga as Dr. Anna Pou in Five Days at Memorial. Courtesy of AppleTV+.

Sadie Dean: I’m very curious about the development process behind adapting this book of the same name with John Ridley. How did it all start for you two?

Carlton Cuse: It basically started with me reading the book, I can't remember exactly when it was, but it was not long after it had originally been published. And I thought that I knew about Hurricane Katrina, but once I read the book I realized there was so much more about everything that happened that I didn't know, and specifically this story of what happened in this hospital while it was covered, and obviously we show that in the series with Anderson Cooper and all sorts of people commenting. I think it was really obscured by the focus on what was going on in the convention center and at the Superdome and it just was an incredible story.

I love cross-genre storytelling, and that's kind of my sweet spot as a writer and where I love to live. And the idea that this was sort of a disaster thriller crossed with the medical ethics drama – it really is a disaster/thriller, 2,000 people trapped in a hospital with rising floodwaters and diminishing resources. And then it evolves because of those circumstances into a medical ethics drama where characters have to make profound decisions about who gets treatment, what kinds of treatment, and then ultimately, difficult decisions about how to care for patients or whether we administer drugs to patients and all the kinds of dilemmas that we try to explore in the story.

Carlton Cuse

Carlton Cuse

I just fell in love with it, unfortunately, [laughs] a little producer named Scott Rudin had optioned it. So, I was living in the shadow of Scott Rudin at first who had an option for a number of years, and then when that option expired, Ryan Murphy got the option. And then I had to kind of wait out that option. And then finally, after Ryan Murphy's option expired, I was able to convince Sheri Fink to option the book to me. And at that point, I made really the single most important decision in the entire course of the project, which was to send it to John Ridley. I love working in tandem with another showrunner - that's sort of is something that has developed across my career, and it's just the way I like to work. For me, as a writer, the thing that gets me up in the morning, and it makes me the most excited, is working hand in hand with a like-minded person to figure out how to tell a story the best way we can tell it. John really was the first person who really popped into my mind as, ‘OK, who's the ideal person to do this with?’ And I had been a huge fan of American Crime. I felt that John was an incisive, disciplined, and deeply humanistic filmmaker and that those qualities were exactly right for the telling of this story.

Fortunately, John read the book, and also was captivated by it. And we had this kind of common thread -John's father was a doctor, and my grandfather was a doctor, one of my uncles was a doctor, my cousin was a doctor, and my mom wanted me to go to medical school. [laughs] And John had shared with his dad kind of what the story was about. And his father said, 'I'm glad that I didn't have to make those decisions.' And that was just something that I think was really profound and it really stuck with both of us. It had this resonance, this idea that what happens when medical professionals are put in the position of having to make untenable decisions? And that was something we were really interested in exploring right from the get-go.

John and I started talking about how we best wanted to tell this story, and I think one of the first things we landed on was the idea of not taking a point of view, in terms of what happened in this narrative. And the metaphor for us was the spinning top at the end of Inception; if we did our job right, that when the show was over, people would debate and discuss, and probably have different opinions about what went down. And whether people thought that what Anna Pou did was right, or whether it was wrong, or whether it was justified or whether it wasn't justified, or whether we were capable of sort of passing judgment on those actions, from the comfort of hindsight, those were all really interesting questions to put on the table and give people the opportunity to make their own judgment about them.

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Sadie: Yeah, it's a lot as a viewer to take in and sit with but you do think about the morality and the ethics behind those difficult decisions that were made. I think generally, in broad terms, most of the world knows what happened during and the aftermath of Hurricane Katrina – but how did you and John approach building tension off of something already so heightened? The tension builds and builds so masterfully, yet in a very grounded way.

Carlton: I think so much of this is rooted in John - he is just a brilliant writer who writes from a place of authenticity, and really deep in the human heart. And so right from the get-go in our collaboration, he was so inside these characters in a way that was so inspiring. And we talked about what we wanted to do. And then John wrote the pilot, it was so good - and I think he did so much heavy lifting in terms of finding the right tone in his execution of the first script, and it became a template for us.

We decided that the more we dove into Sheri Fink's book, the more we recognized the genius of it. I mean, Sheri spent six years working on this book, she conducted over 500 interviews, it was so thorough and so well researched and so well told that we also decided that we really didn't need another source. And what we wanted to do in this case was, Sheri had done the heavy lifting, and we were going to do an adaptation of her story. And in the places where we're going to depart from the literal narrative, out of dramatic necessity, we were going to strive to maintain a very exacting level of emotional truthfulness. And because we had the book, and because we had spent so much time talking about it, and because John laid out such a great path in the first episode, we decided that the two of us would just write it all together - we didn't have a room. And so, that's really how it came about.

I think that the things that really informed it, were trying to deeply advocate for each of our characters. Characters who some people might judge as being antagonists, we didn't choose to judge them as antagonists, we sort of viewed everyone as a protagonist in their own story, and sort of advocating vigorously for each of the characters on the page, I think allowed us to attract Vera Farmiga and Cherry Jones and the incredible actors that were all a part of our show. Julie Ann Emery and Cornelius Smith Jr. and Adepero Oduye, I mean, we got so lucky. And I think we also felt so well supported by Apple in allowing us to cast the actors who we felt were best for the part, not casting actors who were in some abstract way, the best for somebody's idea of what the marquee should be. We were given the creative freedom to just really cast the people we wanted. And we cast people we felt were going to make the story feel authentic. 

Adepero Oduye as Karen Wynn in Five Days at Memorial. Courtesy of AppleTV+.

Adepero Oduye as Karen Wynn in Five Days at Memorial. Courtesy of AppleTV+.

Even though it is an adaptation and a dramatization, being authentic was also something that we were constantly aware of, as we were scripting the show. And not only was Sheri's book an incredible resource, but Sheri herself had all sorts of voluminous research beyond the books in the forms of pictures and videos and details about characters and inner relationships and things that didn't even make it into her book.

Anyone as a writer, you have to construct an iceberg. And that iceberg is the world of your story. And at the end of the day, maybe only 15% of that iceberg is going to be above water, but to have your story feel truthful and authentic and for you to feel like you've done the process of exploration thoroughly, you have to construct the whole iceberg. Sheri had constructed a massive iceberg. [laughs] That was a great jumping-off point for us. And so, she remained involved, she was attached as a producer, and was really an invaluable resource throughout the entire production, particularly as we were trying to rewrite things and come up with like, 'Oh, was there something else that you have about this character? And what this character did between this point and that point?' Or just even small little details like, ‘Did Karen Wynn have a wedding ring? And what did it look like?’ And boom, she had that information - from small production items to larger narrative elements.


I think the story was so powerful. It wasn't a massive invention, the real tough decisions were, ‘What are the most salient elements that we need to tell the story?’ And it was a winnowing process in a way to go through everything in the book and really try to figure out, ‘OK, what are the things that are most important? And what are the things that really emotionally land for the two of us?’

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Sadie: While going through that process, did you two have the theme set in place as North Star?

Carlton: I think that there was - it was a combination of both. The first overriding decision we made was that we wanted to try to maintain kind of some measure of objectivity and try to write the story without taking sides and try to illuminate everyone's point of view. I think the second biggest decision that we made was to divide the story into two parts, and that the first five episodes would each be a day in the life of the characters in the hospital. The book was called Five Days in Memorial, and so we thought, well, that lends itself well to a long-form television show, we'll do days 1,2,3,4,5 and then we'll do Part B, which will be the investigation. So now suddenly, we'll come in and we'll reexamine a lot of these same events, we'll keep some stuff closed, and we'll kind of follow these investigator characters, who now are tasked with trying to evaluate what happened and allow everyone to sort of make a decision about what they want to do about it.

[L-R] Michael Gaston as Arthur 'Butch' Schafer, Cornelius Smith Jr. as Dr. Bryant King, and Molly Hager as Virginia Rider in Five Days at Memorial. Courtesy of AppleTV+.

[L-R] Michael Gaston as Arthur 'Butch' Schafer, Cornelius Smith Jr. as Dr. Bryant King, and Molly Hager as Virginia Rider in Five Days at Memorial. Courtesy of AppleTV+.

One of the things that we felt that we could do on screen that you can't do as well in a novel was really show the misery in this hospital. A lot of decision making was influenced by the horrible conditions. The fact that they were stuck there for five days...there was a failure of corporate leadership, local leadership, state leadership, FEMA, and government leadership, and these characters were in increasingly desperate circumstances - the power went out, the temperature was over 100 degrees in the hospital, it was dark. They were getting very little sleep. And those things you can really convey that on screen, you can really show the character's misery and really paint that kind of hellish world that they were inhabiting. And that was something that we really wanted to do. Because obviously, those conditions informed the decision making that the characters made. And so that was something that we really wanted to emphasize. And then I think we just sort of felt our way along from there.

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Obviously, there's some things, if you read the book closely, we conflated some of the events from day five onto day four, just for dramatic purposes, and again, that's what you do in an adaptation, it would be way too didactic to hew to the facts with tremendous fidelity - your show might feel didactic, and if the audience wants that, they can read the book. We again chose in our dramatization to try to maintain an emotional truth and a high degree of factual truth. But really, the core for us was, what is the emotional truth of these characters and all the facts in the world as compelling as they are, in the screen adaptation, don't mean anything if they don't translate into some sort of an emotional translation onto the screen that invests the audience in those characters journeys.

Sadie: Right, it’s a lot of heavy lifting. It feels like this big puzzle set that your team was piecing back together through all these episodes. And I'm curious about the decision to split up the writing duties of the first half, and you taking more of the procedural part of it, and not directing those episodes. But also, your collaboration with one of the best TV directors out there right now, Wendey Stanzler.

Carlton: Yeah, originally John and I were going to split the scripts, we each have our name on four of them. But I said to John, at a certain point, ‘Look, you're deeply ensconced in the writing of part one, and so for me to kind of drop in and do one of those, I think would be less good, than you kind of carrying all of the emotional substance of what you've done forward. And so you should do all part one, and then I'll write part two.’ But all of that was based on a lot of collaborative discussions beforehand.

So, even though that's how we divvied it up, we had really talked a lot about what we were going to do in each part, but we wanted part two to be distinct and separate. And we wanted part two to have a distinct and separate look. It felt like the best way to divide things were for John and I to direct the episodes in part one, and then have an entirely different director do part two so that in this case, Wendey could come in and bring her point of view to that telling of the story. And also part two has a different DP - the first one is Ramsey Nickell and part two is Marc Laliberté - it has its own look, it has its own color palette.

While we wanted to make sure that there was a measure of unity between the two parts, we did want them to feel distinct from each other. And Wendey was a phenomenal choice for us. She is an amazing director and a wonderful human being. And she started as a documentarian, and I think this project was one that she kind of tapped herself into in a way that was extraordinary. I just couldn't be happier with the work that she did in bringing part two to life and it was a wonderful collaboration. We had also talked a lot about kind of what we wanted to do narratively, and what our sort of intentionality was directorially - that worked out really well, because I think we were both confident that we had really a common vision of how we wanted to tell the story. And then Wendey came in and then she added her special sauce to the second part and just did an incredible job with it.

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Sadie: Any advice for writers who are interested in adapting a non-fiction book?

Carlton: I think when you're doing an adaptation, what I think is important is to read and reread and reread the work, and then put it aside and then try to think about what are the three or four or five things - what are the operative things that that matter to you about this story, and that you think are central to it? When Graham Roland and I created the Tom Clancy Jack Ryan series for Amazon, I read about, I think, eight of the Tom Clancy books, just as a reader and someone who liked those kinds of stories. And I think having absorbed those stories and read a lot of them, I was able to say, ‘OK, here are some common elements to the Tom Clancy books that we need to do in our story.’ And even though we told in seasons one and season two, two wholly original stories that were not a part of any Tom Clancy books, they were rooted in this sort of understanding of the DNA of what we felt made Tom Clancy books work. And I think that to me is useful exercise is trying to say, ‘Well, what are the things that make this work as a book?’ And I think once you have those as operative principles, then I think they become kind of guideposts that allow you to decide what to take and what to leave from the book, and I think they help really shape the way that you dramatize the story. 

That's my process - really try to think about what are those elements that really made this book feel special to me, and then knowing those things, extract that DNA and then rebuild it in the form of scripts.

Watch all episodes of Five Days at Memorial on AppleTV+.

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