Book Review

Hospital: An oral history of Cook County Hospital

N Engl J Med 1995; 332:1242May 4, 1995

Article

Hospital: An oral history of Cook County Hospital
By Sydney Lewis. 349 pp. New York, New Press, 1995. $25. ISBN: 1-56584-138-7

Cook County Hospital of Illinois, founded in the 1860s, is one of the few great public hospitals that continue to survive and endure. Sydney Lewis, who studied with Studs Terkel, has captured the turbulent past and present of this institution in the interviews she conducted for her remarkable new book, an oral history of Cook County Hospital. Her book is a moving portrait of a troubled medical center seen through the eyes of the people who work there and the patients who enter its doors.

In this book, Cook County Hospital emerges as a lumbering, benevolent giant of an institution that treats patients by the thousands, tending as best it can to the sick and injured of the city. It is a refuge for the medically neglected and uninsured. It is a repository for the complicated problems of a large, urban, impoverished population: substance abuse, teenage pregnancy, sexually transmitted disease, tuberculosis, AIDS, violence, and homelessness. The imperfections of the hospital are laid bare for all to see: interminable waits for care, condescension and prejudice toward patients, an appalling lack of privacy, ethnic conflicts among the hospital staff, a pharmacy dispensing medicines at a snail's pace, an antiquated and dysfunctional computer system, and an administrative bureaucracy hamstrung by politics.

Some of the hospital's doctors, nurses, technicians, and clerks become so frustrated with the system that they quickly choose to move elsewhere; others are content to remain, only to sink comfortably to a level of passive mediocrity. Despite the predisposition to despair, Lewis uncovers admirable examples of perseverance and humanism in the midst of chaos. Most of the people in these pages are not consumed by the daunting challenges they face, but confront them willingly, resourcefully, and sometimes triumphantly. Many people at Cook County Hospital have a heartfelt commitment to the institution's mission to serve the poor and are determined to overcome obstacles to achieve that fundamental goal. They seem motivated by truly noble considerations. The compassionate statements Ms. Lewis has recorded are too frequent to be dismissed as disingenuous or calculated.

Lewis carried her microphone everywhere, and the voices we hear are diverse, insightful, and always interesting. They take us on a journey from the hospital's fabled past — when its reputation was golden and its residency positions were highly prized — to its more tumultuous present when a strike by the house staff in the 1970s threatened to close the hospital for good. This is by no means a narrow, doctor-centered history, but one of wide-ranging perspective. Like an engaging documentary, the intersecting oral narratives produce a rich, highly resonant, and unpredictable mixture.

It would have been helpful had Lewis begun with a concise history of the hospital, so that readers could easily place the stories that follow in context. Unfortunately, she did not include even one photograph of the hospital. I suspect that Lewis wanted the words to stand on their own and evoke individualized images, an understandable preference.

Whether or not Cook County Hospital or any other public hospital should continue to exist is the thought-provoking question underlying these oral histories. Lewis conducted these interviews during the debate over President Clinton's Health Security Act, when equal access to care seemed possible and public hospitals appeared to be ultimately unnecessary. With the demise of comprehensive health care reform and with further Medicare and Medicaid cuts looming, Cook County Hospital may not yet have met its maker. Lewis's work may help us decide whether the public hospital is an institution worth preserving.

Robert M. Kaiser, M.D.
University of Pennsylvania School of Medicine, Philadelphia, PA 19104