Hospital: An Oral History of Cook County Hospital.

We all know what happened to the 1994 Clinton plan to reform U.S. health care, much discussed in the pages of Commonweal. In two new books--both excellent--a big-city medical center in the Midwest and a small-town hospital in New England illustrate the current state of U.S. health care.

Cook County, which serves as the model for the TV series "ER," is Chicago's only public hospital, and is spread out over thirteen buildings. In Hospital, Sydney Lewis, the daughter and granddaughter of nurses and former assistant to oral historian Studs Terkel, has assembled sixty-plus candid and poignant interviews with a diverse group from County: physicians, patients, nurses, maintenance staff, administrators, social workers, etc. (one person per chapter).

It's difficult to single out any one of them because they all are articulate in different ways and with different foci, but here's a sample: Surgeon John Barrett, a native of Cork, Ireland, who thought he would be a family practitioner in his own country, is now director of the trauma unit and president of the medical staff. Two of his thought-provoking observations are: "The short-term problem is that people have access to guns; the real problem is that they don't have coping mechanisms"; and "the ancient Chinese had it much better--they said, 'When you're well, you pay the doctor; when you're sick, the doctor pays you.'" His American-born wife, Kathy, is a nurse who has served in the medical admitting unit, the coronary care unit, the prison unit, the procedure room (a.k.a. the shock room), medical intensive care, and the department of quality assurance. She characterizes the physicians of the 1980s as "me me, I I, car phone, Brie cheese." And Jewell Jenkins, a college-educated housekeeper on the AIDS ward, begins the workday raising window shades with the words, "Let's see what God is doing out here today."

As one might imagine, the turf wars, red tape, and miscommunications in an institution of County's size are legion. These interviews reveal how extramedical issues affect patient care. A political patronage system in which people paid to get their jobs existed for far too long. We hear from workers who think certain directors are divine and others who consider those same directors incompetent or worse. In the 1970s, the physicians and nurses went on strike; squabbles over seniority versus ability and the fear of being "written up" drain the time, energy, and morale of employees. Lewis also points out the racial distinctions in occupational categories at County: most attending physicians are white, many M.D.s in training are foreign-born, nurses now tend to be Asian, and the staff members who keep the building up and running are black.

There are opportunists dealing drugs in the hospital, patients who will be released only to have their wheelchairs stolen where they live (or who will sell them on the street), and three-year-olds diagnosed with syphilis. Ethical dilemmas like treating arsonists burned in fires they've set and the cost of intensive care of high-risk neonates and the elderly (compared with the cost of immunizations) are also discussed. What saves the reader from being overwhelmed is the fact that Lewis has included interviews with people who seem to have a true spirtual calling to health care: a physician who was in the Jesuit novitiate and recognized that jobs as an orderly and ambulance driver were leading him into medicine; another doctor (a former seminarian) who first worked in County as a community service project required by his Catholic junior and senior high schools in Chicago. And then there's blessed Jewell Jenkins, the aforementioned windowshades-raising house-keeper, who defies categorization.

Susan Garrett, the former administrator of York (Maine) Hospital, has written Taking Care of Our Own based upon many years of experience in large and small hospitals. The "characters" in this memoir are composites, but the reader will have no trouble recognizing the truth in this narrative of how a small hospital struggles to stay afloat, compete with other medical institutions, and provide quality care to its community.

This author begins her book with a bit of poetry ("Postcards") from her husband, the wonderful writer George Garrett--"I know what happens in my neighborhood/By sounds, by heart." Many of the problems at a small hospital are the same as at a large one: government regulation; "patients" suspected of coming to the facility for companionship, a meal, and a roof over their heads rather than for treatment of actual medical problems; rising costs; lavish expectations by laypeople of what medicine can accomplish; physical plant and equipment obsolescence and breakdown. However, because of the scope of Garrett's position, she has a more comprehensive view of her institution than most of the folks interviewed in Hospital have of Cook County.

And some of the situations here seem unique to Maine: Dr. Art Seiler falls out of his boat and is rescued by lobsterman Big Scotty Milliken, only to have Big Scotty fall off the town dock an hour later, get carried upriver, and be cared for at the hospital by Dr. Seiler. Garrett constantly has to make plans for the hospital with a bifurcated view of her "clientele"--the small, year-round population, then the invasion of summer tourists. Further, the decision making that goes into building a new wing of the hospital must take into account the inherent frugality and modesty of the local trustees, who for the most part live in small houses despite their incomes and who tend to regard even required change as extravagance and enslavement to novelty. (Various unfamiliar parties who show up at a meeting regarding the bonds that will be used to fund the new-wing construction are referred to as "suits from New York.")

Garrett does a phenomenal job of interweaving into her short memoir some of the specific legislation and clinical advances that have made medicine almost ridiculously complex, even at a small hospital. She also shows that hospital administrators are not just number-crunchers, as when she completely loses patience with a pharmaceutical rep complaining about the cost of research and development, saying, "Your firm makes a gross profit over the diseased bodies of my neighbors."

These two books reveal what is right and what is wrong with the current health-care system; pick up either one (or both) and ponder what kind of health-care reform would realistically address our needs and be affordable. Those who think such decisions are better made by Washington officials might consider this passage from Taking Care of Our Own: "A grade school question: Isn't the government us?"