County: Life, Death and Politics at Chicago’s Public Hospital

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”.