Dr. David Ansell came to Chicago's Cook County Hospital right out of medical school. County had once been an institution that boasted some of the finest doctors and most competitive internships in the country. But Chicago's black population quadrupled between 1930 and 1960, and thanks to racial segration, County Hospital became the de-facto hospital for black Chicagoans. ("Racial segregation was actively enforced and many Chicago hospitals refused to serve black patients until laws like the Hill-Burton Act and Medicare-mandated desegregation.") Additionally, County became the default dumping ground for private hospitals who didn't want to accept only $500 for Medicare patients. Political corruption (particularly bad in Chicago at this time) and a lack of public will to provide free care to the uninsured meant that funding was scarce.
By the time Ansell arrived at County in 1978, it was a run-down, deeply dysfunctional institution that nevertheless treated hundreds of thousands of patients a year. Patients waited for an average of 8 hours in the emergency room, or weeks to get medications filled. Months passed between a breast cancer diagnosis and treatment. To get a CAT scan, doctors had to personally wheel their patient to the nearby private hospital, and wait with them for hours to get the scan. The private hospital doctors wouldn't treat the public patients, so County doctors had to bring all medications and equipment they might need (including everything they needed if their patient coded, because even then the Presbyterian doctors couldn't/wouldn't help). Attending physicians were rarely actually on the floor; nurses slept during the night instead of tending to patients; there were never enough chairs, beds, space, medication, or x-ray equipment. Everything had to be double-checked, because tests would be ordered but never done, medications were never delivered. And meanwhile, funding for County was perpetually in doubt, even though it was clear that even the existing system wasn't enough to satisfy Chicagoans' health care needs. Ansell and his collegues continually fought to get funding for their programs and get better care for their patients.
The anecdotes that Ansell shares are haunting and arresting. His tales of blatent corruption and cronyism, racism, classism, homophobia and sexism are clearly just the tip of the iceburg--there are many more lurking beneath the surface. His calls for a single-payer health care system are passionate and well-informed. The history of Chicago and County are equally well-researched, and he tells their stories in a clear, easy-to-follow manner. The only arena he falters in is when he talks about himself; his writing comes across as a little braggy, even though he's clearly fought for and accomplished a lot. It's not that he hasn't earned respect, it's just that his writing is a little too blunt for my taste.
The story of County is so fascinating and infuriating that no matter who told it, it would be a ripping book. Ansell's passion for social justice, and the long, hard struggle (that continues to be necessary) to achieve it, come through perfectly, needing no authorial flourishes or polish.