The New York Times reviews County
July 28, 2011
By ABIGAIL ZUGER, M.D. Published: July 25, 2011
“Man down in the men’s washroom!” This cry is not part of the usual hospital soundtrack, but when Dr. David A. Ansell heard it as he sped down a corridor in the old Cook County Hospital in Chicago, he barely broke stride. He veered into the men’s room, tried the locked door of the stall where a crumpled body lay, hoisted himself up over the fetid contents of the adjacent toilet, balanced on the metal divider and prepared to descend and administer CPR.
That was when the disheveled corpse on the floor roared to life, a lighted cigarette dangling from one hand, and requested with vigorous profanity that Dr. Ansell remove himself from the premises.
Dr. Ansell did just that. “Call security,” he muttered to the few onlookers paying any attention to the drama, and continued on his way.
This anecdote may help explain why some people who take jobs in large urban public hospitals escape as soon as possible, while others stay on forever, bound to these deeply flawed, impossibly colorful institutions with a devotion as passionate, as long-lasting and as illogical as the kind generally directed at flawed and colorful human beings.
Superlatives flood these hospitals: They have the poorest and sickest patients; the longest-suffering, most inefficient and occasionally most corrupt administrations; the most disengaged nurses in the world, and the most dedicated; the cruelest and kindest doctors. These players stage a hundred Dickensian morality plays an hour, for a panorama that calls out to would-be writers and would-be reformers alike.
Dr. Ansell is both, which makes his account of almost two decades at Cook County more than the usual collection of medical war stories. He arrived at the hospital as an intern in the late 1970s, a low point for the hospital and medical residency training in general. The hospital, built in 1914, was bursting at the seams, a filthy, unventilated, mismanaged horror. Today’s methodical protocols for educating young doctors had yet to evolve: The newbies were pretty much left to train one another back then, inmates running the asylum.
As it turned out, the residents at Cook County were an unusually energetic group, schooled in the activism of the late ’60s, deeply committed to a liberal agenda and prepared to go mano a mano with Chicago’s entrenched political machine. And so, to the hospital’s history of medical firsts, which include America’s first blood bank and first trauma unit, Dr. Ansell and his peers added a few of their own.
They were the among the first in the country to expose the all-too-common practice of “dumping,” in which uninsured patients who turned up at a private hospital were cheerfully bundled into an ambulance and sent to a public facility, no matter how sick they were. In a large review published in The New England Journal of Medicine, the Cook County group outlined the unnecessary deaths that resulted. Dr. Ansell subsequently testified before a Congressional committee on the subject, and a 1986 law made the practice illegal without substantial safeguards.
Those were the days when an uninsured Chicago woman who found a lump in her breast had only one alternative: a trip to the Cook County emergency room, where, after waiting for hours, she would be referred to the hospital’s breast clinic, with an appointment generally some three months off. “Take it or leave it,” clerks told their largely African-American clientele. Dr. Ansell and his colleagues grappled with administrators to loosen a hogtied budget and open one of the first breast cancer screening programs in the country, with suitably prompt appointments and follow-up.
Did their accomplishment change Chicago’s giant racial gap in breast cancer mortality? Not one whit. Fairy tales seldom come true in places like Cook County, where Dr. Ansell (who left the hospital in 1995) found on a visit back that despite a major reorganization and the opening of a brand-new facility, the “crammed, tense” waiting rooms of 2006 looked just like the ones of 1978. “If anything, things had gotten worse.”
Three decades’ worth of herculean efforts to reorganize health care delivery in Chicago, he concludes, simply applied a few dingy Band-Aids to our fundamentally flawed national system. Indeed, as an advocate of a single-payer national health insurance, he sees the health care overhaul of 2010 as just another, larger Band-Aid.
Public hospitals seem to bring out the writer in many of their young doctors, with fairly uniform results. In “The Making of a Surgeon” (1970), Dr. William A. Nolen told stories like Dr. Ansell’s about Bellevue Hospital in New York in the 1950s, while Dr. Fitzhugh Mullan waged a political struggle much like Dr. Ansell’s at Lincoln Hospital in the Bronx, then told his story in “White Coat, Clenched Fist” (1976). Dr. Ansell is not as proficient a writer as either of these two; his chapters move at a herky-jerky pace, full of redundancies and loose ends.
But when it comes to the stories of his patients, many of whom he cared for over decades, from clinic to hospital to funeral, Dr. Ansell soars. These sketches are, to be sure, the standard-issue material of a good doctor trying to do right by a set of immensely beleaguered fellow citizens. But unlike fairy tales, we cannot have too many of these stories in circulation, to bear witness, to inform and to inspire.
A version of this review appeared in print on July 26, 2011, on page D5 of the New York edition with the headline: Their Zeal Changed Lives, if Not The System.