June 2015

County: Life, Death and Politics at Chicago’s Public Hospital, by David Ansell ★★
David Ansell offers his personal reflections as a resident and then junior attending in internal medicine at Cook County Hospital in Chicago, Illinois. This book was to complement another recent read by Dr. Guinan et. al. titled The History of Surgery at Cook County Hospital. Having been a resident in surgery at CCH from 1982 to 1989, this book was of great interest to me. I do not recall ever having encountered Dr. Ansell, but there was minimal contact between the surgical and internal medicine residents at the County. Part of the reason for that was the highly inconsistent care that our patients received under the internists at CCH, necessitating that we as surgeons care for most diseases that would usually fall in the realm of needing an internist.
I have very mixed feelings about this book. I appreciated DR. Ansell’s candor and honesty, which was not always seen in the History of Surgery. Ansell was willing to speak at length about the wantonly corrupt Chicago politics and how CCH was considered by the politicians as a nuisance rather than a necessity for the county. He spoke at length about a system completely overwhelmed, and yet ignored by the powers in public office. He gives a nice feel about the frustrations of a doctor in that system trying to do the best to provide for the patients that come under his care.
Unfortunately, Ansell is over-burdened by his ideology, and this has controlled his behavior as a CCH physician to an extreme degree. Ansell is at least honest about how his was a public agitator, and often acted against his superiors to promote his vision of “the good”. Yet, he remains completely blind to how his personal politics and behaviors have perhaps made matters worse rather than better for the poor of Cook County. He labors hard to expose the corrupt Democratic machine that runs Chicago, yet offers no alternative to that Democratic machine, speaking very demeaningly of the other political party. His oft repeated delusion that “health care is a right” (i.e., and not a privilege) suggests that Ansell will not be happy until at health care in the US is reduced to the quality found at CCH, so that there is an equalization of care among the “rich” and the “poor”. I’m sure that even then Ansell would be a dis-satisfied character.
I was particularly annoyed when Ansell spoke so disparagingly of my mentor, Dr. G. Dr. G. happened to be Bangladeshi in origin, probably one of the finest surgeons I had ever met in my life, and a role model of acting in a thoughtful and non-discriminatory manner. The entire episode of his interaction with Dr. G. suggests to me that Ansell was more a blind ideologue than a brilliant innovator. This is not unusual for the Chicago system, and we are now having to suffer under a community activist but now national Führer from this same corrupt Chicago  system.
That Ansell now sits on the Cook Country Board for the hospital is testimony that Stroger Hospital will be the same failure that its predecessor was.  I wish that Ansell could spend a lengthy amount of time working in a truly destitute health care system, such as I have done in Extrem Nord Cameroon or in Bangladesh, to see that a bleeding heart doesn’t solve the problem of disparity in health care. Ingenuity does allow for solutions that Ansell (and for the most part, the entire American health care system) will not allow. This has nothing to do with financial reasons, but rather for legal, sociological, political and ideological obstructions to providing for the poor.
I’ll mention just one example. Ansell heavily criticizes the large open wards that once were at Cook County Hospital. I’ve never had a patient complain about that, and we as physicians would work hard to preserve the privacy of our patients. Yet, the large ward allowed a nurse to quickly assess in a few glances if everything was ok. I would frequently ask a patient to watch out for the patient in the bed next to them if they were doing poorly, and to report that immediately to the nurse. A little care was able to prevent the spread of infection from one patient to another. The total cost of care was vastly less for the same quality as the private rooms that we now have throughout the US.
I read this book a bit frustrated and with great disappointment–Ansell seemed to care for the indigent patient of CCH, but allowed his personal ideology and obnoxious behavior to dominate his stay at the County. For that reason, this book would  be most fittingly titled “Clueless at County”.

A History of Surgery at Cook County Hospital, edited by Patrick Guinan, Kenneth Printen, James Stone, and James Yao ★★★
This book was of great interest to me, since I did my residency at Cook County Hospital during the years 1982 -1989. At that time, we were never given much of a history of the place. There was the operating amphitheater which was being used as a large storage area. There was Karl Meyer Hall, which was rarely used except as a place to grab some food at the 1st floor cafeteria, as we usually slept in unused beds at the hospital when on call. There was Karl Meyer’s residence, which was then being used as the trauma office. We were never really told much about Karl Meyer, or how Cook County Hospital created so many legends. Thus, I found the book of great interest, and since I prefer to read books on my iPad, that is how I purchased the book. I have mixed feelings about the book.
First, the book was exceptionally poorly edited. Spelling errors and other errors were everywhere. The organization of the book created multiple repetitions, and a clear linear timeline of history of CCH was never well developed. The most early history, being that before the 1915-2002 building was erected, are sketchy at best, and not well laid out. I don’t get a good feeling as to how surgery developed in Chicago, and since Cook County Hospital was so dependent on the rise and development of Northwestern, Rush, University of Illinois, and Loyola University, the history of those residency programs should have been better described. The book is written in a manner that if one never set foot in CCH, they would have no clue as to what was being talked about–the book’s value is primarily for former surgery residents of CCH.  I get the feeling that the book was haphazardly slopped together without much thought for the potential audience.
Secondly, I was left with the feeling that surgery training at CCH was rather haphazard and chaotic, that instruction came mostly from the chief resident, and that attendings were not often present, owing to the voluntary nature of the surgical leadership. To some extent, that actually was my experience at CCH, with a mixture of absolutely superb attendings (such as Dr. Abcarian and Dr. Jonasson) and absolutely horrid, possibly even incompetent attendings, whose names will go unmentioned, though some were mentioned with praise in the book. The attitude of the residents at the time of my residency was of pompous arrogance that the CCH residency in surgery was the greatest in the world, and  that it was one of the few that truly produced consistently great surgeons. I didn’t see that at all. Perhaps the punishment of the system led some residents into a minor form of Stockholm Syndrome, where the abused become attached and fall in love with the tormentor. This book hints at such a possibility. Unintentionally, the book does more to disparage the training one received at CCH rather than compliment it.
Thirdly, there were many historical inaccuracies (or, perhaps, incomplete truths) in the book, at least related to the years that I was a resident. The real reason for Dr. Baker’s departure goes (and should go) unmentioned. The cause for Dr. Jonasson’s departure was greatly misrepresented, since she was fired by the Cook County Board, as we were told at the time. I’m left wondering about the real cause for Freeark’s departure, since he never again set foot in CCH. The editors chose political correctness, rather than indicting the most politically corrupt city & county government in the United States for poor management of their hospital. The “dirty laundry” of Cook County Hospital was swept under the rug, leaving us only half a history of the place. Other details were minor errors. For instance,  I remember some of the windows of the operating room still being able to be opened, and battling flies in the operating room. (Even in the 1980’s, we still occasionally used the windows at X-Ray view boxes and as air-conditioning units!) There is a mention of contending with the AIDs problem in the 1970’s, yet it wasn’t until 1987 that we knew enough about the HIV epidemic to take any actions, such as actually wearing gloves in the trauma unit when doing procedures.
Fourth, there was much history that was glossed over. What about the county jail on the 8th floor of the A building? How did the A building come to be? How did the Fantus Clinic emerge to the place and character that it was throughout the 1970’s – 1990’s? Could one have elaborated more on Karl Meyer and his living arrangement in the hospital? Surely there were anecdotes about the highly quirky elevator operators and other employees of the hospital that formed a special characteristic of the place. Many people with great histories were glossed over, such as Dr. Lowe in trauma, and way-too-short  histories of certain individuals such as Dr. Abcarian, Dr. Walter Barker in thoracic surgery and Dr. Jonasson, all true giants in the world of surgery.
There was much good in the book that made it enjoyable to read. I appreciated the elaboration of the development of various departments of the hospital. Most relevant were the development of the trauma unit and blood bank, both being nation’s first. Having worked in many of the departments mentioned, such as the orthopedic, colon rectal, thoracic, pediatric, and burn services, I would have appreciated having a better understanding of the history of the department when I was still a resident. Thirty years later, it is still fascinating to read about how these departments came to be.
The personal stories at the end of the book were a total delight. These stories and vignettes of the old County hospital make for the best memories. When I started surgical residency, one of my first encounters was with Dr. Robert S., who had just graduated from the County residency, and was then doing a fellowship in Cardiothoracic surgery at the University of Illinois. He would spend countless hours with me, relating stories of the Greeks, of cases that he had done, and how things worked at CCH. I am sure that virtually every resident that graduated from CCH has a book full of stories, myself included, of unusual and interesting events that transpired while serving at CCH. For me, there were stories in the ER dealing with drug addicts and prostitutes, the trauma unit with famous (infamous) criminals, with survival tactics while working the floor or taking call, with various quirks of attendings (both good and bad), and with living an experience that nobody could ever repeat at this time, since there is no more CCH.
It was with great sadness that I learned that the old hospital was removed and a new, much smaller facility was built in its place. Many of the buildings needed to be removed or were completely obsolete, such as the nursing building and Karl Meyer hall, as well as the Children’s hospital and the “A” building. The Children’s hospital also held the burn unit, and was so run down during my time as a resident, that it was downright spooky to go into. The only thing good about that building were the elevators, which were fun to ride. But, it is only fitting that the new hospital be named Stroger Hospital, as it is no longer Cook County Hospital. Cook County Hospital has died, and a new beast has arisen in its place. It is unlikely that Stroger Hospital will generate any surgical giants, save for total happenstance. Thus, I am delighted that a history of the old Cook County Hospital, written by those that had a long experience with the place, has been produced. For all its faults, this is still a history worth reading by those who have spent a few years of their life within those halls.