“You’ d never want to wake up and find yourself in Cook County Hospital, the nation’s first and oldest public hospital. The building looks as huge, grey and battered as a vanquished and abandoned old battle ship run aground on the shattered streets just west of Chicago’s Loop. The hallways and waiting rooms—there’s no nicer way to put this—are thick with sick people who have also run aground and seem abandoned to waiting, limping, straining, coughing, sighing and sweating, bleeding, crying.”
— Scott Simon, Weekend Edition, National Public Radio, 1994
A Black man on the south side of Chicago will live 8 years less than the average white man in the US. Much of this life expectancy gap is due to excess heart disease and cancer among Black men compared to whites. This gap could be reduced with prevention, early detection and access to primary care. The failures of the health care system in Chicago and in particular the gaping holes in the public health safety-net are partly to blame. This is why I wrote "COUNTY." To tell a story about health care in America through the lens of my experiences at Chicago's public hospital.
COUNTY is the tale of one of America's oldest and most unusual urban public hospitals and the patients it serves. From its inception as a "Poor House" dispensing free medical care to indigents, Chicago's Cook County Hospital has been both a renowned teaching hospital and the healthcare provider of last resort for the uninsured.
COUNTY covers more than thirty years of its history, beginning in the late 1970s when I began my internship, to the "Last Rounds" when hundreds of former trainees gathered to bid the enormous, iconic, Victorian hospital building an emotional farewell when it was closed to make way for a new facility.
I write of the hundreds of doctors who went through the rigorous training process with me, many sharing my vision of health care as a human right and resurrecting an embattled hospital in critical condition. County is about people, from my mentors including the legendary Quentin Young, to the multitude of patients whom he and County's medical staff labored to diagnose and heal under battle-field conditions. It is a story about politics, from contentious union strikes and demonstrations to battles against "patient dumping" and public health, depicting epidemics including the AIDS crisis and the opening of one of Chicago’s first HIV/AIDS clinics. It depicts the cruel unfairness of a health care system that perpetuates health care inequality for poor people.
Finally, it is about my medical and political education in urban America, a coming-of-age story set against a backdrop of race, segregation and poverty.
Dr. David A. Ansell is Vice President, Clinical Affairs, and Chief Medical Officer at Rush University Medical Center.
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