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Prologue Four hospitals stand within a fifty-mile radius of a major American city. On the surface, they are as different from one another as fairy-tale sisters. Pines Memorial Hospital is a pleasant-looking cream-colored building with a sixteen-story tower and broad, welcoming windows overlooking a quiet tree-lined suburban avenue. After decades of independence, the neighborhood’s favorite hospital was bought out by Westnorth, a large healthcare corporation, which is slowly diluting the local flavor. With 190 beds, Pines Memorial serves a highly educated, wealthy population with a large percentage of academics, retirees, and nursing home residents. Because it is close to a major highway, Pines’ emergency room, which has approximately 60,000 visits per year, often treats victims of major-impact car accidents. Nurses joke that the hospital should be called Highway Memorial, because the risks of the highway are far more relevant to the medical staff than the quiet red pine forests outside of town. Several miles away, South General Hospital occupies a mostly gray edifice curved away from the road, as if to shield its inhabitants from the gang violence that occurs frequently nearby. The Level-1 trauma center— designated as such because it has the resources to treat every stage of injury, from prevention through rehabilitation—has 300 beds to serve one of the most indigent areas outside the city. South General’s ER sees 95,000 ER patients annually. The reputation of “The South” is like that of the proverbial kid from the wrong side of the tracks, hoping to keep up with her peers, but unable to overcome the disadvantages of living on the poverty-stricken south side of town. Forty-five minutes west, in a peaceful corner of the city, Academy Hospital, proud and prestigious, inhabits several white-pillared, brick structures that wind around courtyards and patios, reflecting the storied architecture of its surrounding university campus. With approximately 425 beds, Academy treats a ritzy demographic of young and middle-aged residents in the nearby million-dollar homes and the students at the elite university. The Academy ER treats fewer than 45,000 patients per year, partly because it simply does not have the building space to expand its emergency department walls. And Citycenter Medical, a longtime teaching hospital, is split between two dusty beige high-rises, perhaps representative of its dual personalities: a stalwart institution with top-notch doctors and an ER so poorly managed it is considered dangerous by many of its own staff. A 390-bed Level-1 trauma center, Citycenter has an emergency department that is crumbling beneath the weight of the 85,000 annual patients it does not have enough nursing staff to treat properly. While Pines Memorial treats more blunt force, multisystem traumas because of the car accidents, Citycenter’s traumas are typically isolated injuries, such as gunshot wounds. Easily reached by public transportation and in the heart of a densely populated city, Citycenter is a destination of choice for homeless people, drug-seeking addicts, and the uninsured. In each of these disparate institutions, pale blue curtains shroud pods of frightened people. In each, seasoned healers perform routine procedures and medical feats behind bleached sterile walls. And in each, tracking invisible undercurrents through hallway mazes, nurses connect doctors to patients, carrying out copious orders in synchronized steps, entwining themselves intimately in convalescents’ lives.
