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The House of Hope and Fear: Life in a Big City Hospital
Critically acclaimed author Audrey Young offers a real-life Grey's Anatomy set in Seattle's big city hospital. Opening with the view of an idealistic young doctor entering her first post-graduate job at the local county hospital, The House of Hope and Fear explores not only the personal journey of one doctor's life and career, but also examines the health care system as a whole. The county hospital setting provides Audrey Young with a second education. With clear, eloquent text, the author chronicles attempts made to treat those tossed aside by society along with the personal and ideological shifts that accompany this daunting task. All of the hospital politics are detailed in a gripping account of the hospital's inner workings, and a human face is expertly given to the health care crisis in America.
256 pages, Hardcover
First published August 1, 2007
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383 people want to read
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Displaying 1 - 30 of 43 reviews
January 2, 2019
Hospital vignettes by a Harborview doctor. I liked the patient stories and the background about the functioning of a public hospital, but she got way too into the weeds about some of the daily logistics. Even though the book was published less than 10 years ago, I was struck by how much has changed in the American health care system since then, particularly in terms of the ACA and the opioid crisis.
June 7, 2013
This book is more of a behind-the-scenes look at how a large public hospital is run than it is a collection of stories about the author's interactions with various patients while she worked there. The stories are here, but the author doesn't mine them for the full dramatic effect that she could have. The overall effect is tempered somewhat by the author's agenda, which is to present the difficulties of providing health care to the poor and uninsured. Since I agree with her that we need universal health care, I didn't find that annoying, but apparently some readers have.
As far as the writing goes, I thought the author's analytical skills were stronger than her narrative skills. That's not to say that the book was boring because it wasn't. But it was clear that her strengths lie in meticulous research and thoughtful analysis rather than in pure story-telling. In other words, this is a "smart" book, which I happen to like. I especially appreciated the Appendix where she suggests resources for those who would like to learn more about issues surrounding health care today. I've already put three of the books she recommends on hold at the library and I'm looking forward to delving into things like the history of public (or "charity) hospitals, unequal health care and the role of the pharmaceutical industry.
As far as the writing goes, I thought the author's analytical skills were stronger than her narrative skills. That's not to say that the book was boring because it wasn't. But it was clear that her strengths lie in meticulous research and thoughtful analysis rather than in pure story-telling. In other words, this is a "smart" book, which I happen to like. I especially appreciated the Appendix where she suggests resources for those who would like to learn more about issues surrounding health care today. I've already put three of the books she recommends on hold at the library and I'm looking forward to delving into things like the history of public (or "charity) hospitals, unequal health care and the role of the pharmaceutical industry.
November 12, 2016
Having worked at Harborview around the time that this book was written, most of the book felt like a summary of my own experiences there. It was a great reminder of how special a place Harborview is, but also how challenging and frustrating it can be as an employee there, and the many barriers there are to providing effective care to patients who lack so much in the rest of their lives. This book might be more eye opening to someone who isn't in healthcare--and I do recommend, if you aren't in healthcare, you learn a little bit more about our system and how truly ineffective our healthcare spending is and where your taxpayer dollars go.
The best part of the book is the last five pages. It summarizes, in a nutshell, what is wrong with our entire health care system and why we need to shift our focus to public health. Honestly....go read that part. It's amazing. If you're a nurse, the rest of the book is a story you already know.
The best part of the book is the last five pages. It summarizes, in a nutshell, what is wrong with our entire health care system and why we need to shift our focus to public health. Honestly....go read that part. It's amazing. If you're a nurse, the rest of the book is a story you already know.
September 1, 2009
I devoured this book in a day - it's a literal recount of my residency experience at Harborview, Seattle's county hospital! Right down to the the names of the "outsized personalities" that make Harborview what it is. The author was the year ahead of me in training.
Read this if you want to find out what it was my training was like. (a no brainer clue - it's nothing like gray's anatomy.) From running the medic one radios in the emergency room to sprinting for codes across 6 ICUs and 7 floors, the anecdotes seem as familiar as if they were my own patients - and some of them probably were, since the patients she describes are composite sketches of "frequent fliers" who were familiar to everyone who worked there.
Also read this if you want a window into how broken our current health care system is and why we need reform - more reform than what's on the table.
Read this if you want to find out what it was my training was like. (a no brainer clue - it's nothing like gray's anatomy.) From running the medic one radios in the emergency room to sprinting for codes across 6 ICUs and 7 floors, the anecdotes seem as familiar as if they were my own patients - and some of them probably were, since the patients she describes are composite sketches of "frequent fliers" who were familiar to everyone who worked there.
Also read this if you want a window into how broken our current health care system is and why we need reform - more reform than what's on the table.
June 6, 2013
It was interesting to note the similarities between public hospitals and public schools. Teachers and doctors have similar agendas in desiring compliant students/patients and preferring to focus on them instead of capacity and finances. It was heart breaking and enlightening to see how Harborview cares for the homeless and I am intrigued by the idea of a "wethouse" after her description. It's a good peek into public healthcare and an important platform for universal heath care.
September 16, 2018
This book was okay but not great. It was more like a short story group than one big story. The more interesting parts were learning how hospitals track the amount of work their interns perform. The story also included bits and pieces of patients.
September 28, 2019
Seattle's Harborview must be an exceptional facility. I love how Young has portrayed the hospital, staff and physicians and wonder if its still the same, how those who work so hard can maintain their empathy, sympathy and compassion.
November 22, 2019
Not very good writing or storytelling, but full of good and interesting information. Glad I read it.
December 13, 2019
An important look about the social aspects of modern healthcare.
August 29, 2023
An interesting look at the disparity between the haves and the have nots in health care.
November 29, 2009
Dr. Young worked at Seattle’s Harborview hospital for a time. Harborview is Seattle’s only public hospital; all the rest are private, for profit institutions. This means that pretty much all of the indigent and uninsured emergency cases end up at Harborview, the other hospitals declining to take them in, even if they are a shorter ambulance ride for the patient. This is the story of how Harborview manages to deal with the over crowding this can cause. Harborview’s emergency department is the place where every patient, no matter how poor or drug addicted, will be treated with dignity and to the best of the hospital’s ability.
The author blends patient stories with descriptions of how the hospital works, from the traffic control center (the people who coordinate incoming ambulances and where patients end up in the hospital -sometimes bunked in the cafeteria), the doctors, the social workers to the bean counters.
What emerges is a picture of a system in a lot of trouble. Harborview itself is surviving financially, but the other six public hospitals in the Seattle area have closed. The bigger problem is *why* there are so many people using Harborview’s emergency services: it’s mostly the homeless or those barely keeping a roof over their heads. These people, who live in the cold and wet and never know when or what they’ll have to eat next, are at a much higher risk for illness than people more fortunate than them. Because they can’t afford to go to a doctor or to buy their medications, they put off dealing with their health problems until they pretty much collapse. It costs more to treat a person in this condition than it does to keep them warm and fed, but those services are scarce to nonexistent in America. The most common public perception of the poor and homeless is that they deserve to be poor and homeless; that they are lazy, drug addicted (yes, sometimes they are drug addicted), less worthy members of the human race. Because of this, measures to give them what they need to keep healthy are very unpopular.
On top of this, there is the problem that the uninsured pay MORE for their services than insurance does. Medicare says “We will pay you X amount for this service, no matter what you bill” and hospitals and doctors accept this. Insurance companies do the same thing, ending up paying sometimes a *much* smaller amount for a given service. How to make up this shortfall? Well, bill those without insurance more. The don’t have the bargaining power of Medicare or insurance companies; they can’t do anything to negotiate the cost.
As a member of the vast uninsured – and a person with several chronic illnesses- I know well the problems with the health care system. But many people remain unaware of just how large the problems with the health care system are. This book is a great place to learn about it.
The patient stories were the most interesting parts of the book to me; some patients are followed for many months. Some unexpectedly live; some unexpectedly die. The patients range from drunks to the mentally ill, to the average person, to multimillionaires. These stories are vivid and immediate, and take place embedded in the business of the hospital bits. Recommended.
The author blends patient stories with descriptions of how the hospital works, from the traffic control center (the people who coordinate incoming ambulances and where patients end up in the hospital -sometimes bunked in the cafeteria), the doctors, the social workers to the bean counters.
What emerges is a picture of a system in a lot of trouble. Harborview itself is surviving financially, but the other six public hospitals in the Seattle area have closed. The bigger problem is *why* there are so many people using Harborview’s emergency services: it’s mostly the homeless or those barely keeping a roof over their heads. These people, who live in the cold and wet and never know when or what they’ll have to eat next, are at a much higher risk for illness than people more fortunate than them. Because they can’t afford to go to a doctor or to buy their medications, they put off dealing with their health problems until they pretty much collapse. It costs more to treat a person in this condition than it does to keep them warm and fed, but those services are scarce to nonexistent in America. The most common public perception of the poor and homeless is that they deserve to be poor and homeless; that they are lazy, drug addicted (yes, sometimes they are drug addicted), less worthy members of the human race. Because of this, measures to give them what they need to keep healthy are very unpopular.
On top of this, there is the problem that the uninsured pay MORE for their services than insurance does. Medicare says “We will pay you X amount for this service, no matter what you bill” and hospitals and doctors accept this. Insurance companies do the same thing, ending up paying sometimes a *much* smaller amount for a given service. How to make up this shortfall? Well, bill those without insurance more. The don’t have the bargaining power of Medicare or insurance companies; they can’t do anything to negotiate the cost.
As a member of the vast uninsured – and a person with several chronic illnesses- I know well the problems with the health care system. But many people remain unaware of just how large the problems with the health care system are. This book is a great place to learn about it.
The patient stories were the most interesting parts of the book to me; some patients are followed for many months. Some unexpectedly live; some unexpectedly die. The patients range from drunks to the mentally ill, to the average person, to multimillionaires. These stories are vivid and immediate, and take place embedded in the business of the hospital bits. Recommended.
September 23, 2010
The House of Hope and Fear: Life in a Big City Hospital is a memoir on Dr. Audrey Young’s experience at Harborview Hospital. Harborview Hospital is a public hospital located in Seattle Washington, where Dr. Young worked as a resident doctor in the emergency department. Her role in the hospital was not easy. Since Harborview Hospital is a public hospital, they depend on the government for funding. Dr. Young had to deal with indigents and uninsured emergency cases. She also had t deal with patients that were declined from other hospital in the city, which made her job even harder.
Harborview Hospital accepts patients no matter how poor they were. They also accept patients that were alcohol and drug addicts. Dr. Young highlights the biggest problem of the hospital, which was health care because they could hardly put the hospital together. Harborview Hospital was the only public hospital left in Seattle because six other hospitals had closed. Because Harborview Hospital accepts every patients at arrive in the emergency department, there was a point where the hospital had to go on divert. This was biggest challenge that Dr. Young and her fellow doctors had to face.
“The most charity care that any other hospital in metropolitan Seattle did in 2005 was $13million.” The main issue of the story was health care” pg. 96. There were so many uninsured patients in Seattle that Harborview Hospital could barely put its feet up.
This book was recommended to me by my friends that took the hospital course at The Johns Hopkins University and I read this book for my English class. I was truly amazed on how the amount of dying people that Dr. Young survived. I recommend this book to the people who are looking for an inspiration from a doctor.
Harborview Hospital accepts patients no matter how poor they were. They also accept patients that were alcohol and drug addicts. Dr. Young highlights the biggest problem of the hospital, which was health care because they could hardly put the hospital together. Harborview Hospital was the only public hospital left in Seattle because six other hospitals had closed. Because Harborview Hospital accepts every patients at arrive in the emergency department, there was a point where the hospital had to go on divert. This was biggest challenge that Dr. Young and her fellow doctors had to face.
“The most charity care that any other hospital in metropolitan Seattle did in 2005 was $13million.” The main issue of the story was health care” pg. 96. There were so many uninsured patients in Seattle that Harborview Hospital could barely put its feet up.
This book was recommended to me by my friends that took the hospital course at The Johns Hopkins University and I read this book for my English class. I was truly amazed on how the amount of dying people that Dr. Young survived. I recommend this book to the people who are looking for an inspiration from a doctor.
February 29, 2012
If I could give this book 27 stars, I would. I work at the hospital that Dr. Young describes with honesty and affection. In her stories about patients, doctors, families, and aspects of society, the reader gets a view inside a public hospital and the people who work and are treated there.
There are two reasons why I would recommended you read this book: First, it would help you understand why I choose to work at the county hospital and why I am so proud of the work I do. The other reason is more political: reading about the patients who end up at the county hospital seeking primary care - the homeless, the addicted, the mentally ill, the underinsured, the unemployed, the desparate - is the best argument I can think of for universal health care.
Just one fact pulled from the book: the United States spends more than twice as much on health care than any other country, and yet our health outcome and life expectancy statistics are nowhere near the best in the world.
There are two reasons why I would recommended you read this book: First, it would help you understand why I choose to work at the county hospital and why I am so proud of the work I do. The other reason is more political: reading about the patients who end up at the county hospital seeking primary care - the homeless, the addicted, the mentally ill, the underinsured, the unemployed, the desparate - is the best argument I can think of for universal health care.
Just one fact pulled from the book: the United States spends more than twice as much on health care than any other country, and yet our health outcome and life expectancy statistics are nowhere near the best in the world.
July 15, 2012
PROS: Dr. Young's narrative style is engaging and easy to read. She does a good job of presenting the struggle to balance cost and quality of care and the human side to the medical field. Her book is informative and well-rounded. For me, as a pre-nursing student and a Harborview volunteer, I found the details of patient care fascinating.
CONS: This is clearly intended to be a persuasive piece about health-care reform. Not that this is necessarily negative, but the book is not purely objective. I wished there were more details of patient care and less about the business side of the hospital, but this is purely my opinion. If I were not interested in the medical field, I probably would have found some of the details a little dry, but with my background, I did enjoy them.
CONS: This is clearly intended to be a persuasive piece about health-care reform. Not that this is necessarily negative, but the book is not purely objective. I wished there were more details of patient care and less about the business side of the hospital, but this is purely my opinion. If I were not interested in the medical field, I probably would have found some of the details a little dry, but with my background, I did enjoy them.
May 18, 2015
This is a well written book and is more about treating ALL patients with dignity than about Harborview itself. I think she does an excellent job of describing care for peeps that many consider "throw away" - those experiencing homelessness and those addicted to drugs and alcohol. While not explicitly condoning rationing of health care, she describes the decisions that were made during her time at the county hospital, and leaves the reader to draw conclusions. There are many good instances of what's broken about USA's health care system, and some commentary and examples about what can be done to improve it. I recommend it to everyone in the Seattle area, and everyone involved in making health care decisions.
December 18, 2013
I really liked the stories in this book. As someone who interfaces with HMC just about every day (and several other area hospitals), it was good to gain some insight into what goes on in the other floors of the hospital. I particularly enjoyed reading about her patients.
However, the end of the book was almost "preachy." Dr. Young strongly advocates a unversal health care system and she was trying to make her point here. I wish that she took some of the data that she put in her appendices and used that to make a rational argument for universal health care rather than the seemingly emotional argument she made here.
However, the end of the book was almost "preachy." Dr. Young strongly advocates a unversal health care system and she was trying to make her point here. I wish that she took some of the data that she put in her appendices and used that to make a rational argument for universal health care rather than the seemingly emotional argument she made here.
December 12, 2010
In a first-person narrative, Dr. Audrey Young shares her experiences working at Harborview Medical Center, the only public, not-for-profit hospital in Seattle, Washington. The result is a timely and compelling portrait of the current health care crisis. Young’s narrative centers around interactions with patients and the day-to-day operations of a busy county hospital. This title is especially recommended for students who are considering a career in a public hospital. An appendix provides further resources and information on how to advocate for health care reform.
December 10, 2009
Despite the many hours I've logged in hospitals, I've never been over to Harborview. From what I hear from the general public that's a good thing...I can't imagine having a crack addict (who threatens to kill the nurse or doctor every time they try to provide care) as a roommate! I don't know if my insurance would pay for a private room. Young provides a great series of vignettes, as well as a bit of history about this hospital.
September 6, 2009
It's my hospital!!! This book gives you a vivid sense of working at Harborview and reminds me why I do. It's definitely a "booster" book, but then again, I tend to think it's all true. Also some very timely discussion of how we treat the most marginalized folks in our society, very relevant to the current healthcare debate.
January 7, 2010
A riveting read -- straight from the mouth of a doc who worked the ER and a clinic @ Harborview. My dad worked there when I was little, so he enjoyed hearing snippets from the book. I loved reading about those who work to serve those who society often neglects, with respect and dedication. Highly recommended to all SPL folk.
February 25, 2010
Author Audrey Young was a staff physician at Harborview; the dust jacket biography indicates she is not now...not surprising since the stories she tells would doubtlessly lead anyone to anger, frustration, and burnout. Here's what's wrong with our health care system, made visible in the hard luck cases that walk into Harborview's ER as a place of last resort.
August 24, 2010
I love this book, and not only because i know and love Harborview Hospital. The book combines a tribute to Dr. Copass and others, a description of a hospital that combines care of the very poor and of the affluent (respectful to both), a personal memoir of the doctor, and reflections about the challenges facing health care today.
April 8, 2013
I loved this book - I found it equal parts a human interest piece with the personal stories of patient's she treated and a history piece on the politics surrounding the Seattle area hospital system. I had read her other book (What Patients Taught Me) first and had really enjoyed it, her second book did not disappoint.
December 19, 2015
This was a very gripping insider's perspective on what it truly means to care for the homeless, the addicted, the underinsured, and everyone else in the only public hospital in the city. It focused mainly on the challenges of keeping the emergency department open and running during big crises. There were happy endings and sad endings but that's what healthcare is.
February 14, 2010
I loved this book, and I learned so much from it. I cannot recommend it highly enough. It is very readable, it is full of information, it's about Harborview Hospital in Seattle, the major trauma hospital for a very larger area of the Northwest.
October 30, 2010
A book about Harbour View Medical Center. Very fascinating to me, but may not be interesting for everyone. Someone who doesn't also work in emergency services may not find the book as good. It's well written.
February 4, 2011
Loved the local angle and all the bigger than life personalitiies. She does a great job of starting with stories of individuals (both patients and doctors) and then broadening it out to include larger social issues.
Thought-provoking, well written and definitely worth the time.
Thought-provoking, well written and definitely worth the time.
April 19, 2011
I read true medical stories in the hope of learning more about the patients. This author is a doctor writing about Harborview Hospital which is in Seattle. There were too many statistics and criteria for shutting the doors of the hospital than case studies.
February 26, 2013
A really interesting look at the uninsured and the medical system in general. Written as a memoir, Dr. Audrey Young uses stories of patients in the ED of Harborview Hospital in Seattle to examine the condition of the homeless and uninsured.
November 18, 2013
I didn't like this one as much as her first book. I liked hearing about the inner workings of the hospital but it was also a downer. It's pretty clear that our health care system has major problems and this made me feel hopeless about it.
Displaying 1 - 30 of 43 reviews