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

by David A. Ansell, Quentin Young (Introduction)

The amazing tale of "County" is the story of one of America's oldest and most unusual urban hospitals.

From its inception as a "Poor House" dispensing free medical care to indigents, Chicago's Cook County Hospital has been both a renowned teaching hospital and the healthcare provider of last resort for the city's uninsured. COUNTY covers more than thirty years of its history, beginning in the late 1970s when the author began his internship, to the "Final Rounds" when the enormous iconic Victorian hospital building was replaced and hundreds of former trainees gathered to bid it an emotional farewell.

Ansell writes of the hundreds of doctors who went through the rigorous training process with him, sharing his vision of saving the world and of resurrecting a hospital on the verge of closing. Radical Medicine is about people, from Ansell’s mentors, including the legendary Quentin Young, to the multitude of patients whom he and County’s medical staff labored to diagnose and heal. It is a story about politics, from contentious union strikes to battles against “patient dumping”, and public health, depicting the AIDS crisis and the opening of County’s HIV/AIDS clinic, the first in the city.

Finally, it is about a young man’s medical education in urban America, a coming-of-age story set against a backdrop of race, segregation and poverty.

Genres: Nonfiction, Medicine, Medical, History, Memoir, Health, Audiobook

221 pages, Hardcover

First published January 1, 2011

About the author

David A. Ansell (born 1952) is a Chicago-based physician, health activist and author whose efforts at both the national and local levels have advanced concerns about health inequities and the structure of the US health care system.

Reviews

[Phoenix Perpetuale · Rating 5 out of 5]

Why I liked this book is that real people and people are behind it—county hospitals for the uninsured in the USA from 1960 to 1990. It exhibited the actual life of ordinary and poor people. I have listened to this book on Audible; beautifully narrated.

[Wealhtheow · Rating 3 out of 5]

Dr. David Ansell came to Chicago's Cook County Hospital right out of medical school. County had once been an institution that boasted some of the finest doctors and most competitive internships in the country. But Chicago's black population quadrupled between 1930 and 1960, and thanks to racial segration, County Hospital became the de-facto hospital for black Chicagoans. ("Racial segregation was actively enforced and many Chicago hospitals refused to serve black patients until laws like the Hill-Burton Act and Medicare-mandated desegregation.") Additionally, County became the default dumping ground for private hospitals who didn't want to accept only $500 for Medicare patients. Political corruption (particularly bad in Chicago at this time) and a lack of public will to provide free care to the uninsured meant that funding was scarce.

By the time Ansell arrived at County in 1978, it was a run-down, deeply dysfunctional institution that nevertheless treated hundreds of thousands of patients a year. Patients waited for an average of 8 hours in the emergency room, or weeks to get medications filled. Months passed between a breast cancer diagnosis and treatment. To get a CAT scan, doctors had to personally wheel their patient to the nearby private hospital, and wait with them for hours to get the scan. The private hospital doctors wouldn't treat the public patients, so County doctors had to bring all medications and equipment they might need (including everything they needed if their patient coded, because even then the Presbyterian doctors couldn't/wouldn't help). Attending physicians were rarely actually on the floor; nurses slept during the night instead of tending to patients; there were never enough chairs, beds, space, medication, or x-ray equipment. Everything had to be double-checked, because tests would be ordered but never done, medications were never delivered. And meanwhile, funding for County was perpetually in doubt, even though it was clear that even the existing system wasn't enough to satisfy Chicagoans' health care needs. Ansell and his collegues continually fought to get funding for their programs and get better care for their patients.

The anecdotes that Ansell shares are haunting and arresting. His tales of blatent corruption and cronyism, racism, classism, homophobia and sexism are clearly just the tip of the iceburg--there are many more lurking beneath the surface. His calls for a single-payer health care system are passionate and well-informed. The history of Chicago and County are equally well-researched, and he tells their stories in a clear, easy-to-follow manner. The only arena he falters in is when he talks about himself; his writing comes across as a little braggy, even though he's clearly fought for and accomplished a lot. It's not that he hasn't earned respect, it's just that his writing is a little too blunt for my taste.

The story of County is so fascinating and infuriating that no matter who told it, it would be a ripping book. Ansell's passion for social justice, and the long, hard struggle (that continues to be necessary) to achieve it, come through perfectly, needing no authorial flourishes or polish.

[Esther · Rating 3 out of 5]

I liked this book well enough! Very easy read abt one doctors experience working in the cook county public hospital and the existing health disparities for Chicago’s Black population. Feel like it could have gone more in depth, and I didn’t rly get the organization of the book

[Lobstergirl · Rating 2 out of 5]

Ansell seems to be a terrific doctor, completely dedicated to the poor, uninsured, underserved populations of Chicago, but he's a terrible writer and should have had this ghostwritten.

Black women's faces are sometimes the color of "obsidian," sometimes "mahogany," sometimes "coffee." (No midnight? Rootbeer? Teak?) Eyes are "almond-shaped" and "coal-colored." One patient's complexion darkened from "cocoa" to "steel black." The whites of her eyes went from orange to "muddy ochre." Seriously, the book had an editor and was read through by one of the author's children, who is a writer - and no one raised a flag at this Crayola box of horrors? There is also a hideously high number of sentence fragments. "Mrs. Jones sat. Silent. Serene. Not a sprayed hair out of place."

It's too bad, because Cook County Hospital's history is interesting and important, not just to residents of Cook County but as a microcosm of much that was and is wrong with healthcare in America, and it deserves a thorough and absorbing treatment.

Ansell came to Cook County right from medical school in the 1970s. He and his young compadres were horrified by the conditions, the underfunding, and the damage being done to Chicago's poor. There were nurses who didn't give a shit, doctors who were undertrained and caused patient deaths, doctors who did care but were too inexperienced to save some lives. Mostly there was a hospital infrastructure with enormous delays, a crippling lack of equipment, a lack of privacy and dignity accorded to patients, and the corruption of Chicago's political machine which kept the hospital underfunded and doctors un-unionized.

Ansell and his colleagues worked hard to make the system better, and sometimes they succeeded spectacularly. They decided to do a study of 500 patients transferred from other area hospitals to County because they lacked insurance, known as "patient dumping." Patients would arrive at the hospital and a "wallet biopsy" would be done to figure out if they were insured and could or couldn't pay for services. If they couldn't pay, they would be immediately transferred to County, even if they were in dire condition - on ventilators, or women whose labor had already begun - they were moved in their unstabilized condition. Ansell tracked the outcomes of these patients. Over 20% ended up in the ICU; of those, 9% died. Almost none of these patients had given their consent for transfer. Although Ansell and his colleagues were only "amateur sociologists," their study published in the New England Journal of Medicine in 1986 drew national media attention and resulted in the Emergency Medical Treatment and Active Labor Act of 1986, which made it illegal to transfer patients without first performing a screening medical exam. Patients can now be transferred only with consent and for medical reasons.

Ansell obviously cares deeply about the plight of poor black people. But it's unclear why a book about Cook County Hospital needed a photograph of Black Panther Fred Hampton's assassination scene - bloody mattress, bullet perforated wall.

[Happyreader · Rating 4 out of 5]

Focused on a single Chicago hospital, I’m curious how this book would resonate with someone not familiar with County healthcare or Chicago politics. Most of the book takes place in the old hospital, which no longer exists, but it’s ultimately an indictment of our racist, inequitable national healthcare system which sadly does still exist. Best chapter in the book deals with the County patient dumping study, a hopeful example of how being brave enough to present the facts and dire consequences can effect positive policy change and save lives. Also loved reading about the crusaders, such as Ruth Rothstein, whose leadership led to the building of the new hospital and HIV/AIDS-focused Core Center. Something is lost, however, when you discuss the Cook County Health & Hospitals System in isolation. Once you get past the long lines, County is frequently able to provide better care for the uninsured than the insured simply because they’re not constrained by the crazy limitations imposed by health insurers. What many healthy insured Americans don’t realize is that once you become sick, you’re not as well protected as you had assumed. At the end of the day, an equitable healthcare system would benefit all Americans and cost us all less than the crazy and pricey system we currently suffer under.

[Tim Friese · Rating 2 out of 5]

The book deals with an excellent topic and has some interesting stories along the way, but overall I was put off by poor organization, less depth than I wanted in talking about the issues at hand, and a style that did not work for me - alternately rambling and preachy.

The worst part was that this book could have been so much better. There is material for a very good or even great book in there, material that I think the author didn't adequately make use of.

Still recommended for people interested in public health care, health care justice, etc.

[Deana · Rating 2 out of 5]

This subject has a lot of potential, but I wish it was written by a sociologist instead of a doctor. It was written like a 5th grade essay, took about an hour and a half to read, and was sprinkled with indications that the author thinks he's a serious rebel for having worn Birkenstocks at some point in his life.

[Emily Costello · Rating 5 out of 5]

Definitely not for everyone, but a must read for anyone interested in entering the healthcare field. Undoubtably apropos to read in the midst of a global pandemic and an incredibly turbulent time for race relations in the US. I am interested in seeking out similar books from the perspective of black americans.
As a young public health professional, it was really interesting to use the book as a comparison between pre and post ACA health outcomes (book was published in 2011). I really appreciated the overall candidness of the book.

[Molly · Rating 4 out of 5]

I really enjoyed this book the authors, obviously smart and passionate about what he does, but also surprisingly vulnerable about patients lost or harmed by the conditions under which he was treating them. It reads like a novel, which is sad because so many things in the book should not have happened . I’m looking forward to reading the author’s other book next. I recommend this to anyone in Chicago who is interested in learning more about the history of the city or anyone in healthcare.

[Stephanie · Rating 4 out of 5]

This is not the most well written book, but it graphically depicts the very real healthcare inequities in the the U.S. Having done a rotation at the new County hospital
and seen the ongoing challenges affecting patients' care, it was heartbreaking reading about the awful conditions in the first hospital.

[Haley Greer · Rating 4 out of 5]

This book was a viscerally difficult read. It addresses the systemic and structural racism that pervades access to healthcare for minority populations. Dr. Ansell is the special type of medical provider who refuses to become comfortable and complacent in patient care and instead believes it a moral obligation of his to combat systems that dehumanize patients.

[Icrea · Rating 4 out of 5]

This is a book club selection. I was interested in the topic and enjoyed it more than I thought.
I'm not particularly interested in medicine, but very interested in Chicago history and social injustice.
Anyone who doesn't think we need the ACA/universal healthcare/Obamacare needs to read this.
There is a mention of Obama and I wonder how much Cook County Hospital motivated him for change.
Everyone in Washington needs to read this.

This was published in 2011. So much has changed and stayed the same since then.

[umang]

I read this more for historical content than for style, so I'm not going to rate it. I was familiar with much of the County history already, but this was still a good discussion of the politics of public health care in Chicago. It was somewhat limited in scope due to the focus on the institutions with which the author has been affiliated.

[Allison Foster · Rating 3 out of 5]

Interesting journey of public health programming through the eyes of one doctor in Chicago. I would like to reemphasize to all authors and audiobook readers that changing the voice of your characters almost always results in micro aggressions. Just… don’t.

[Bree · Rating 4 out of 5]

Read a great review on NPR.

[Mimi Wolf · Rating 5 out of 5]

If only more health practitioners would expose the travesty of our health care system. This book will make you gasp and then break down crying.

[Nicole · Rating 4 out of 5]

Great read for anyone in the health care field, in health care policy, interested in social justice issues, or even just Chicago history.

[Sydney Ramicone · Rating 5 out of 5]

One of the greatest books I have ever read. Anyone going into healthcare should read this book. Reveals the inequalities/disparities in American healthcare.

[Rachael · Rating 5 out of 5]

https://www.nytimes.com/1975/11/14/ar...

"County Hospital became the defacto hospital for black people. Racial segregation was actively enforced and many Chicago hospitals refused to serve black patients. Ultimately, this legacy of segregated care in the underesourced public system contributed 50 years later to the gaping, black-white racial disparities in health outcomes for which Chicago is known for."

What is the best way to deliver healthcare to the poor and uninsured? Americans should not face early death or disability because they are uninsured.

The real lethal triad: racism, poverty, and lack of insurance kills patients before their time.

"Conditions were accepted, expected, and ignored."

In 1980, patient dumping was a routine practice that caused death and disability because patient care was delayed or deferred until the patient was transferred to County. Some had GSWs, were in active labor, etc. "It was a legal form of battery and manslaughter." 25% of patients ended up in intensive care and 9% died. Patients did not give consent or were lied to about why they were being transferred.

The patients with chronic illness in the ER waiting room were "sick and tired of being sick and tired."

"There was one thing patients at County had: time." The nurses recruited patients waiting hours for their appointments to sit in the twice-daily class on breast health. The women wanted to learn and were eager for health education.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” -MLK

"In 1982, life expectancy of black men in Chicago was 65, less than a man in Bangladesh."

At the walk-in clinic, over half the patients had untreated hypertension. Of the hypertension found, in 40% was new in male patients and 20% was new in female patients. They needed primary care, not a walk-in clinic but they were uninsured and there was no place to send them. The general medicine clinic had a waiting list of 10k patients! ^6 community care clinics were later established which gave options for physicians to continue care but the demand continued to skyrocket as numbers of the uninsured rose.

Frequent urinary tract infections can indicate a low immune response and HIV/AIDs.

Lack of basic nursing care + absolutely extreme wait times led to patients feeling humiliated because there was no privacy and no dignity.

"Was a system whose purpose was to serve the poor destined to perpetuate separate but unequal care despite our best efforts to transform it?"

A patient's anger about care does not equal aggression so don't get aggressive with them! Empathy and problem solving.

Last 15 minutes: great points about what contributes to the past and modern day health crisis in Chicago.

"Safety net programs were chronically underfunded."

[Charity · Rating 5 out of 5]

On the AIDS crisis in the early 1980's: It did not take long for AIDS to move from being a disease of gay white men to becoming a disease of minority populations in the most devastated neighborhoods in the city [Chicago]. Misinformation about AIDS prevention in the community, fanned by inept and ideologically driven public-health messaging by the Reagan administration that emphasized "just say no" over condoms and needle exchange programs, helped expand the epidemic.

This is an amazingly well-written book that spans decades of health/medical care/basic human needs inequity in the city of Chicago. David Ansell weaves hard data and facts effortlessly within the endless stories of HUMAN NEED he is clearly personally involved both professionally and emotionally.

Whenever I read information like this, it's so hard to believe that these things go on every day IN THIS COUNTRY. In inner-city Chicago, the life expectancy rate for a black male is LESS than it is for their counterparts in Bangladesh. Communities are ravaged by high blood pressure, diabetes and sickle cell anemia that goes undiagnosed until the affected persons end up in the emergency room for something severe; many times, by that time, it's far too late.

I'm tired of hearing "we don't have the money." We have a military budget that lines the pockets of contractors all over this world (I'm not opposed, of course, to the money spent to pay troops OR that that takes care of our veterans who return from conflict) but we throw up our hands at people lined up in lines that are several city blocks long before it's light out at a CHANCE to see a doctor. People DIE while waiting for basic care; there is blood on the hands of the people who think the uninsured should just be left to die. Again, how does this happen and how do we fix it? I think people who believe this country is a "Christian Nation" should be even MORE compelled to work on answering this question.

[Catherine · Rating 3 out of 5]

Dr. David Ansell, the author of County: Life, Death and Politics at Chicago's Public Hospital, attended medical school in the 1970s and knew early on that he wanted to provide care to underserved populations. He chose the Cook County health system for his residency, where he immediately found that the health care delivery system for the poor and for minorities, was in need of great reform.

It is important to note that this book is Dr. Ansell's memoir of his years of residency and beyond. As we read about his progress beginning with medical school through years as an experienced physician, his passion for the profession is very evident. He is a caring physician, one who treats all of his patients with the highest level of respect and dignity. His commitment to making positive changes to health services access for the poor is very admirable. Readers will be moved by the stories of his personal encounters with his patients.

Where the book fell short for me is in its "one-sidedness". Granted, it is a memoir, so I should have expected to read Dr. Ansell's perspective. The book does include some stories of individuals who appear to share the same point of view as Dr. Ansell. It does not, however, dive in with any depth to provide perspectives of individuals with differing points of view. There are entire groups of health care providers, from nurses to administrators, who are described as lazy, uncaring, and even crooked. Perhaps they were. But, all of them? I would have liked to read more about the challenges that these individuals were faced with. I realize that it would no longer be a memoir if the book expanded in this way. But, frankly, to hear nurses (who were working in challenging conditions), being described as lazy or lacking in knowledge, without reading at least a bit of their stories in their own voices, made reading portions of this book less enjoyable for me.

Overall, an interesting memoir on a critical topic.

[Liz · Rating 4 out of 5]

Very realistic description of the experiences of an idealistic, activist young doctor at one of the largest and most important public hospitals in the United States. He outlines the appalling conditions in the old Cook County Hospital, and the story is enlivened by the descriptions of the struggles of some of the individual patients he worked with over the years. When Blacks fled the South in the Great Migration, they encountered systems in northern cities that were just as afflicted with segregation and racism as the places they had come from. The legacy of that segregation is still with us today, and drags down the health and life opportunities for urban Blacks in many northern cities.

The author discusses health differences in terms of the medical system, with delays in diagnosis and treatment leading to patients presenting with advanced disease, it is clear that the larger problem is not the difference in medical care, but the difference in health in these disadvantaged communities. This is the very definition of structural racism, with poor housing, poor food, lack of open space, air pollution, and other larger, societal problems causing the early onset of diseases such as obesity, hypertension, and diabetes. The bigger challenge is not simply to fix the medical system (a heavy lift in itself) but to fix the discrimination and poverty which lead to disease in the first place.

FWIW, I felt Bronson Pinchot overacted in the audiobook narration, although I liked his narration of another book a great deal.

[John Gurney · Rating 3 out of 5]

Dr. David Ansell was passionate about healthcare. This manifested itself in positive ways such as moving from Syracuse to Chicago in 1978 for a residency at Cook County Hospital, specifically to serve poor and minority populations. He was disgusted by the racism widespread even in late 1970s Chicago, and by the abysmal care at Cook County. No question, he was a compassionate and engaged doctor, one who advocated for his patients. But, as some of the promo blurbs say, such as the Chicago Tribune, this is an "angry” book. Dr. Ansell seethes, even now, at many people, ranging from patronage bureaucrats to various supervisors and administrators (e.g. "Dr. O") to local politicians like former Cook County Board President George Dunn. Ansell writes vividly and this work is full of imaginative insults and he goes over-the-top, at times, comparing various Cook County health policies to "murder" and "institutional violence".

Dr. Ansell is at his best discussing the history of Cook County Hospital and stories about his real patients. "County" was the nation's first public hospital, treating the indigent for free. It trained generations of doctors and was an innovator, site of the first blood bank. But, the hospital was always short-funded and a healthcare provider of last resort. If you lacked insurance, you could get free care at County. If you had insurance, you would avoid the lines, which really meant waiting a day or more just to see a doctor, and the indignity of the facilities. Dr. Ansell was enraged by the lack of patient privacy and the indifferent 'customer service' often provided by careless nurses and administrators. The 1916 building became hopelessly overcrowded and functionally obsolete, though it remaining in service until the end of the century.

The doctor rose through the ranks himself, staying on after his residency and becoming an administrator. He describes yeoman efforts to improve the patient experience. He was highly active politically, fighting efforts to close the hospital, authoring a study against patient 'dumping' by other hospitals, etc.

As Chicago's black population surged after WWI, and racism fenced black residents into congested west- and south-side neighborhoods, County became the main provider of health care to Chicago's poor minority populations. Whether solely motivated by racism or not, the political leadership of Cook County did not want to increase its investment in health care for the poor. They did not much enjoy the idea of change. Dr. Ansell ably describes his fight to approve two nurses, yes two nurses, for breast cancer screening in the 1980s. He hit a bureaucratic brick wall and had to take it directly to a public Cook County Board meeting, where he was mocked by old-time Chicago pols. The issue wasn't the cost of the two nurses, but rather, Dr. Ansell wasn't working the 'proper channels', the way things are usually done in the "Chicago Way."

Though a self-described Leftist, Dr. Ansell is non-partisan, which is refreshing, and he readies his sharpest daggers for old school Cook County machine Democrats. He has nary a good word about the 2010 health care law ("ObamaCare"); he wants single payer, meaning doing away with traditional insurance and replacing it with a 'free' federal program, which he believes means health care "equality". Personally, I think this is hopelessly unrealistic- I suspect it is naive to think that, under single payer, the wealthy in Beverly Hills or Manhattan's Upper East Side or Chicago's Gold Coast would ever stand for the exact same level of care as the poor. The connected, rich and powerful will have better facilities, better doctors, etc.

He bravely takes on the issue of patronage. Patronage is a political system in old cities like Chicago where politicians put people on government payrolls in exchange for favors and political work. They also stuff their family, friends and neighbors into these jobs. Merit is not a factor, but rather, will the employee repay the politician with door-to-door campaigning come election time, with political contributions, and the like. While an inherently inefficient and immoral way to run a city, patronage workers as tollbooth collectors or garbage men are one thing, whereas applying patronage to health care workers in a hospital is potentially life-threatening. Dr. Ansell is highly critical of the patronage workers at County.

I think Ansell's idea of unionizing doctors- he co-led a push for one at Cook County- would make care worse and less responsive, though, to his credit, he speaks of it being more needed at a public hospital beholden to politicians. Do we want our doctors on strike? Ironically, in the strange world of Cook County politics, his unionization efforts were killed by... a union. Because his doctor group chose at out-of-state union to represent them, deeming the local AFSME affiliate as not sufficiently progressive, the Chicago union rep on the governing board personally killed their drive, out of spite.

Though he never speaks of it, he indirectly sheds light on the issue of voucher vs. direct service. A voucher is payment given to any provider who serves the patient, which is how Medicare and Medicaid work. The other possibility is to provide free-to-all-comer health care such as County hospital. The nightmare of local government meddling he describes- county board deciding abortion policy or whether to approve two nurses- and all the chronic problems of County and its obsolete facilities, suggest the County hospital way is inferior. Perhaps unaware of it, he never mentions economics, yet, simple supply and demand suggest a facility like County will always be overused. The service is free to patients and, as Dr. Ansell points out, the indigent have long used the County ER for routine medical primary care as well as emergencies. The demand outstrips supply.

One telling fault of the book is that it lacks even one word about paying for his reforms. While he certainly is correct Chicago has a long history of racism, I think he's too harsh on the Cook County taxpayers who, to their credit, have funded a public hospital for nearly two centuries. There certainly is more than just racism in the desire of local politicians to minimize the amounts spent on County hospital, which, as Dr. Ansell freely admits, has always been a strange mix of dysfunction.

[Joshua Debo · Rating 5 out of 5]

It's simple. Create a hospital that's "so far behind... [it's] ahead."

I loved this book, and while I gave it 5 stars, the last 100 pages or so had a lottttt of writing that, while probably necessary, was so personal to the author's political career that it lost my interest.

However, the first 100 pages were ferociously moving and further made me believe that single-payer health care might be the most important issue to push for in America in the near future. Some of the last 100 really brought me back to the random epidemiology lecture I decided to attend on Thompson Library's 11th floor Reading Room my freshman year that brought me to study global public health as a minor.

In all, Ansell's writing makes me thrilled to start training to become a physician, and I recommend this book to anyone interested in social disparities in healthcare.

[Quirky Shauna · Rating 4 out of 5]

Audio book. He's a young intern in the 1970s learning in the public Cook County Hospital where the poor and uninsured go to get treatment. There is little to no supervision or training but bonding with other interns to share what they've learned. He becomes an activist politicking to improve conditions, get more funding, and provide better care for patients.

Their research project about accepting all uninsured patients from outside hospitals led to the creation of EMTALA in 1986. Any patient who presents to an emergency department gets a screening medical exam and gets stabilized before transfer to another hospital. So if a woman presents in active labor, she is examined and stabilized not immediately transferred 5 minutes before her baby is born.

He's a proponent for a single payer medical system and her makes a compelling case.

[C G · Rating 5 out of 5]

As a native Chicagoan, I enjoyed the historical aspect of the book. It was incredibly interesting to read the first hand experience of a doctor who worked within the halls County. This was a required read during my undergraduate studies in Health Sciences. It was eerie to read about a once bustling hospital and see the vacant Gothic style building standing covered in graffiti (2014), now (2021) turned hotel and food court that serves the new County hospital building one street over.

Dr. Ansell brings to light the conditions and inequalities faced by the uninsured, undocumented, and minority residents in the past. How terrible is it that many of these issues discussed are still issues we face today? I plan to re-read this novel. A must read for all MD and public health students.

[Jay · Rating 5 out of 5]

“Tragedy & Triumph” are the two words Dr. Ansell used in the last chapter to describe the hallowed and horrifying encounters narrated in this book.

I think that description encapsulates the nuanced but charged history of Cook County Hospital. What I most took to heart were tales after tales of commitment, by past practitioners like Ansell and other names I recognize as a current student, frustrations and even humbly admitted failures, nevertheless intimately accompanying the hard realities facing those who need care most.

For those who dream of equitable, faithful healthcare to walk alongside the tragedies and to celebrate the triumphs of patients’ lives, this book is a testament to that possibility.

[Codes · Rating 4 out of 5]

The inequalities of the hospital system, and the set up of emergency rooms has always been a fascination of mine. So this book was on par for that topic. The author did a great job of telling his story while trying to be unbiased with the facts. As someone from New York and a union member, I enjoyed hearing about 1199s involvement in trying to help the physicians unionized. I love the fact that the author kept up with several of his patients over the decades. That kind of quality care is not taught in schools. The end of the book dragged out but I understand that he had to wrap up the information.

[Iva Velickovic · Rating 5 out of 5]

As someone with no medical background and a strong interest in public policy, I found this memoir extremely insightful. Ansell highlights the many ways public policy--where we put a highway, how we structure the hospital's board of directors, how many resources we devote and where we devote them--affects health outcomes through his and his patients' experience at County. He's clearly brilliant--and seems like a badass, activisty friend too. I listened to the Audiobook, and I may buy a hardcover to revisit in a few years' time.

[Josh Bodnar · Rating 5 out of 5]

The struggles of one doctor at Cook County hospital who describes how racism and the underfunding of public healthcare take the lives of his patients. Perhaps most powerful is his conclusion that these health disparities are worse today than when he first came to Chicago in the 1980s. His story of a patient with sickle cell and the mistreatment she received over the years in the emergency department is something I will never forget. This book makes you rightfully ashamed of the US healthcare system but excited to help make change.