The New York Times
County: Life, Death and Politics at Chicago's Public Hospitalby David A. Ansell
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The amazing tale of County” is the story of one of America’s oldest and most unusual urban hospitals. From its inception as a poor house” dispensing free medical care to indigents, Chicago’s Cook County Hospital has been renowned as a teaching hospital and the healthcare provider of last resort for the city’s uninsured. Ansell covers more than thirty years of its history, beginning in the late 1970s when the author began his internship, to the Final Rounds” when the enormous iconic Victorian hospital building was replaced. Ansell writes of the hundreds of doctors who underwent rigorous training with him. He writes of politics, from contentious union strikes to battles against patient dumping,” and public health, depicting the AIDS crisis and the Out of Printening of County’s HIV/AIDS clinic, the first in the city. And finally it is a coming-of-age story for a young doctor set against a backdrOut of Print of race, segregation, and poverty. This is a riveting account.
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Life, Death, and Politics at Chicago's Public Hospital
By David A. Ansell
Chicago Review Press IncorporatedCopyright © 2011 David Ansell
All rights reserved.
1989: You Should Write That Book
"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 battleship 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
I bolted down the steps from the General Medicine Clinic at Cook County Hospital. My scuffed, brown Rockports smacked the concrete stairs as my right palm skimmed the handrail, its blue paint, once bright and cheery now worn to its steely base by thousands of hands, perhaps as tardy as mine. I was late. I was always late. A major weakness and character flaw — one I am still trying to mend years later. Late, because I stuffed my life, like the overflowing shopping carts of the scavengers who loitered on Madison Street. A victim of both my idealism and impatience. The cacophony and chaos of County Hospital made a perfect setting for my appetite. It was an "all you can eat" kind of place. It was barely 1:00 p.m. and I was gorged.
I spent the morning seeing patients in the clinic; the door was full of charts; the waiting room stuffed as tight as a stockyard cattle car. The last patient had taken me longer than I hoped and after I packed her off with her prescriptions and laboratory orders, I wrote a hasty note in the chart, looked at my watch and cursed. I grabbed my stethoscope from the desk, shoved it into the front pocket of my corduroys and raced to the stairwell.
I punched open the door at the bottom of the stairs and was whisked into a vortex of patients traversing the hallway, a whirring of sounds and the vaguely pungent and familiar odor of musk and oiled hair. If I was going to make it to my meeting, I needed to do my best Walter Payton impression and slice through this gauntlet without being thwarted by the doctors, staff and passersby who bustled past the waiting room of the sprawling Ambulatory Screening Clinic. Every day, 200 to 300 unscheduled patients swarmed through its doors seeking medical attention. Today, like every other day, it was more mosh pit than clinic. The cumulative body heat of the masses overwhelmed the air conditioning system's attempt to cool the room.
As I began my cut through the winding corridor, my final dash to the meeting, a voice intercepted me, the clipped Arabic-tinged English of a colleague, Iraqi-born kidney specialist, Dr. Asad Bakir, an island of calm amidst the erupting first floor of Fantus Clinic. I turned. His hair was combed in a neat part, each strand obedient and in place on his head in contrast to my roiling mop of curls. His starched grey laboratory coat and Armani-style trousers were pristine, their creases sharp as a razor's edge. I sighed. My shoulders slumped. I'd never make the meeting. I stopped and shook his hand. I liked Bakir. Eight years earlier I had worked with him when I was a resident in training and he wrote on my evaluation that I should be considered for a spot as an attending physician at County, perhaps the highest endorsement a resident could receive. We were both distracted by a crushing assemblage of patients and doctors and we gawked like sightseers.
"You know, David," he said in the British public school accent and rolled r's so typical of Iraqis of his age, as his eyes darted across the crowd in the waiting area in awe, "someone should wrrr-ite a book about this place." The conditions at Cook County Hospital were so appalling and the suffering of such magnitude that we often felt that if the outside world knew about it, there would be more outcry to end or improve it.
"Actually," I replied, "I plan to write a book, I'm just not sure anyone would believe it." My assertion was interrupted by a registration clerk's frantic call.
"Dr. Ansell! There's a man down in the men's washroom!" I hesitated before I pounced into action. And not only because I would now surely miss my meeting. The men's washroom was about thirty feet away. Its reputation for filth was legendary at County; with just two stalls to accommodate the thousands of patients and staff who waited or passed by every day. Add to that a spotty cleaning schedule, the semi-sweet odor of ancient urine deposits left by a multitude of bladder-challenged Chicagoans and the tags of competing West Side gangs carved on every available surface, and you had one place I never deigned to enter in all my years at County.
Bakir and I exchanged a "let's roll" glance. I tore past the vending-machine-lined back wall of Fantus accompanied by the drum roll clickety-clack back beat of Bakir's loafers on the linoleum. I pushed through the swinging door of the bathroom and was jolted by an aromatic blend of urine, feces and sweat. My heart thumped. On the floor, visible under the closed door of the first stall was the limp body of a man, in the fetal position. I seized the stall door and shook it. Locked from within. No time to waste. I slammed open the adjacent stall and scaled the toilet seat, careful not to plunge my feet into the murky water of the bowl below. I grabbed onto the top edge of the divider between the two stalls with both hands, stretched myself up on my tippy toes and peeked over. My stethoscope dangled out of my pants pocket.
"There's a guy down on the floor. He's out cold. Maybe a seizure. I'm gonna climb over and try to get to him," I said to Bakir below. With my right foot, stretched as far as it could go on the edge of the toilet seat, I dragged myself up over the partition: my left foot and leg flailed and banged on the metal divider between stalls as I grunted to maneuver over the top. At thirty-seven, I pondered I just might be a little old for this. Too late. I was committed. Just then, I saw the man twitch. A sign of life. Good news. My foot caught the top of the divider. As I leaned to thrust myself into the other stall, the lifeless lump on the floor roared alive, like an outtake from The Exorcist. He whipped around towards me, face contorted in fury. A lit cigarette stub with a quarter inch of grey ash dangled between his fingertips. A curlicue of smoke ascended in a lazy waltz up towards me. The man aimed a nicotine stained brown finger at me, as he pried himself up to rest on one elbow.
"Get the fuck out of here!" the homeless man barked, defending his territory. Hanging atop the stall, I struggled to catch my breath. My eyes darted back to Bakir, as I mumbled, "Call security."
I hopped off the toilet and skipped out of the bathroom, brushed my hands together several times, placed them on my thighs and tried to press the crinkles out of my corduroys. Bakir eyed me and shrugged his shoulders as we parted ways.
"You know, David, you should wrr-rite that book."
Twenty-two years have passed since that moment in the bathroom. The same homeless still called County Hospital home. Health reform passed in 2010 to much fanfare. But to many of us grizzled and skeptical veterans of the health-care battles fought on Chicago's West Side, first to save and then transform Cook County Hospital, health reform looked like more of the same. It perpetuates the inequities in our health care system; the very issues we came to County Hospital to challenge. Some things have improved at County Hospital in the thirty-plus years since I came to Chicago, wide-eyed, wild-haired and newly graduated from medical school. On the other hand, many of the problems that I encountered when I arrived there have persisted. And yet County remains a necessary component of the health care safety net because the U.S., unlike most other industrialized nations, does not value equal access to health as a human right.
I owe a big debt to County Hospital. It is where I learned to be a doctor. To diagnose and treat conditions that I had only known as words in a medical school textbook. Taught by other young doctors, as young as I, but also taught by my patients, some of whom still see me so many years later. Most of all, County Hospital is where I first witnessed how unfairness wreaked havoc on my patients' bodies and on their families. How the triad of racism, poverty and lack of insurance conspired to kill my patients and their family members before their time. It is a form of injustice that continues to this day.CHAPTER 2
1964–1978: Wounded Pigeon Syndrome
"You know what's wrong with you?" my dad said, in his east London accent. Here it comes, I thought. My dad had a certain way of berating me and my brothers, able to reduce us to nothing with a word or a glance. However, even his most unkind criticisms reflected a bit of truth. We sat on opposite sides of the kitchen table. The morning light spilled through the windows. It was 1973. I was twenty and home from college. At issue were the bricks I put in all the toilets in my family's house, as a way to reduce water consumption. I didn't tell him. He discovered it weeks later, when he investigated why it was taking multiple flushes to clear his business. He was not happy.
"You've got the wounded pigeon syndrome," he said. Earlier in the year, I had nursed a sick pigeon back to health, an episode that helped my father crystallize what he thought was wrong with me. Wounded pigeon syndrome. He meant that I had a soft spot for the underdog, for farm workers, for the civil rights marchers, for the Vietnamese and for the environment. He did not understand. A generation gap. When I argued with him about some current injustice, he dismissed me with the phrase, "T'was ever thus." This made my blood boil.
I loved my dad, but we did not see eye to eye. He came from a poor East End family in London, the English equivalent to the Lower East Side of New York. And he immigrated with my mom to Binghamton, New York, a white-ethnic shoe factory town on the banks of the mud-colored Susquehanna River in an Appalachian mountain valley, 170 miles from New York City. Binghamton was a sad sack of a city in the midst of a slow death spiral of economic decline. But he found work there, as a doctor in a converted gas station in the country and so he settled. A child of the Depression, he had no time for activism or politics.
He was correct, though. I did have "the wounded pigeon syndrome." My mother's extended Polish family perished in the Holocaust a few years before my birth, and this fact hung over my childhood like the grey fog lingered over a Binghamton morning. I grew up haunted and perhaps even obsessed by the images of the Holocaust. I trace my interest in issues of social justice to my reaction to that horrific event. I was a sensitive kid — "overly sensitive," my mother said. And "weak-chested and knobby-kneed," she'd add if she had your attention. When my family took weekend trips to New York City and we consorted among the throngs along Broadway at night, my brothers and sister ogled the lights. I gaped at the beggars with their cans and signs, some legless on rolling platforms; others who hid in the shadows of alleys, or on the stoops of shuttered businesses, wrapped in layers of clothes. I wanted to help them, to empty my pockets of change and throw it into their tins.
The CBS Nightly News thrust 1960s America into our family den. The Kennedy assassinations, and the civil rights and anti-war movements exploded across the black-and-white screen. I was transfixed. Twelve years old during Freedom Summer in 1964, I read the paper in shock as the news of the murders of the three civil rights activists in Mississippi unfolded. The images of Bloody Sunday and the gassing and head-smashing of the civil rights marchers on the Edmund Pettus Bridge in Selma distressed me. By the time student activism burst out in Binghamton in the late 1960s, I was in the thick of it.
Julian Bond, a rising black civil rights leader and the first black person to be elected to the Georgia State Senate since Reconstruction, arrived in town when I was seventeen to lead an anti-war demonstration. I stood on the manicured lawn in front of the copper green-domed Courthouse on a spring day, with my high school posse, wearing an olive green military jacket I had purchased at the local Salvation Army for a few bucks. Bond held forth on racism and the war. Riveted, I listened to him speak as a warm feeling of pride rose from my stomach into my chest, and I realized that I was part of a larger movement that shared my beliefs. I finally had a way to express my feelings about the events in the larger world. We marched against the Vietnam War, winding our way through the working-class Binghamton neighborhoods to jeers and waving American flags. We chanted anti-war slogans in response.
I was asked to write a column in the Binghamton Central High School newspaper during my senior year. "Pa Central," as the column was titled, was supposed to be about school spirit, but in 1969 that was the last thing on my mind. "Expecting William Buckley?" was the sarcastic, antiauthoritarian introduction to my first column. It was not long before I was summoned to the principal's office to explain myself. I stood in front of his desk, hands by my side. He sat looking up at me through horn-rimmed glasses, my newspaper column in front of him, a frown on his face.
"Ansell, what does this mean?" His jowls shook like cow udders, as his index finger tapped in a staccato beat on the paper to make his point. His scalp, visible under his short, cropped hair, reddened from front to back like an ink spill on paper. He was a major in the army reserves. Big-boned and closed-minded, he had earlier in the year refused to allow the school to purchase Catcher in the Rye and Brave New World for a fiction elective I had arranged with some other seniors. In defiance, we bought our own copies. But he had no problem with our twelfth-grade English required reading of "A letter to my granddaughter about communism," a piece of propaganda by J. Edgar Hoover, the Director of the FBI.
Binghamton Central High School in the late 1960s still bore the remnants of the anti-communist frenzy of the Joseph McCarthy years. Binghamton was a backwater, a town of festering racism and anti-Semitism that seemed impervious to the world outside its mountainous boundaries. Woodstock had been held on a farm about fifty miles away the year before, but it might as well have been in another country.
William Buckley was the national spokesperson of the conservative right, the Glenn Beck of the time, and apparently one of the principal's heroes. My question, "Expecting William Buckley?" irritated him. "This won't do in the school newspaper," he said, and demanded I remove the line. I refused, jaw thrust forward. We argued. I don't know why he relented. I guess I convinced him that the words themselves were innocuous and the double entendre was not so sinister. In the months and weeks that followed, every column I wrote faced the same scrutiny.
The winds of change blasted across the country. Rules and norms were changing quickly. Even at Binghamton Central. The student council had a very strict dress code at my high school. No tee shirts. No sandals. No jeans. No shorts. No culottes. No miniskirts. So I helped organize a vote against the dress code at the student council. "I move we abolish the dress code," I said to the assembled students sitting at school desks in a classroom. "Second," another student chimed in as we had planned. "Any discussion?" The student council advisor blustered and wrung his hands. "You can't do this!" he said. "All in favor? Aye!" the students affirmed. "Against?" Silence. The room broke out in whoops. Gone was the dress code. The next day, Binghamton Central's hallways were a sea of students in tee shirts and jeans, miniskirts and culottes.
By the time I left Binghamton for college in 1970, I was ready to take on the world. College started with the anti-war movement at its peak and ended with the Watergate hearings and Nixon's impeachment. I joined the thousands of college students who marched on Washington in antiwar demonstrations. My friends and I watched the Watergate hearings every day on a flickering, beat-up, black-and-white Zenith, hanging on every revelation. Politics was our lifeblood. The threatened impeachment of Nixon felt like vindication. Like many of my generation, I saw — and still see — activism as a way to improve a flawed world. I chose medicine as a way to channel my altruistic desires to help others. I clung to the hope, naïve perhaps, that health and medicine were free from the conflicts that fractured our larger society.
Excerpted from County by David A. Ansell. Copyright © 2011 David Ansell. Excerpted by permission of Chicago Review Press Incorporated.
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Meet the Author
DAVID A. ANSELL, M.D., MPH is the vice president of Clinical Affairs and chief medical officer at Rush University. He lives in Oak Park with his wife of thirty-six years, Dr. Paula Grabler, who also trained at Cook County Hospital. They have two grown children. During his scarce leisure time, he enjoys reading, exercising and gardening.
For more info on the author and event listings visit: www.countythebook.com
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