Not long ago I was hospitalized for ten days.  Insurance paid for most of my expenses. The doctors, nurses and facilities were outstanding as was my post-hospitalization follow-ups by visiting RNs.  Now compare my experience with Dr. David Ansell’s County, about the seventeen years he worked at Chicago’s Cook County Hospital, a safety net hospital dubbed “County” by the poor and largely uninsured people of color it served.  It had once been praised for establishing the nation’s first blood bank and trauma unit.  By 1995, however, when Ansell left, it had become a dumping ground for the poorest of the poor, as he describes it in his gripping, angry and ultimately very sad chronicle.

In 1978 Ansell and a small group of five Syracuse University medical school graduates, all deeply influenced by the activism and accomplishments of the civil rights and anti-war movements, chose to launch their internships at Cook County Hospital.  “We came to County Hospital eyes wide open because of its troubles, not in spite of them,” writes Ansell. “We came to County because we believed that health care was a right, not a privilege.”  But it was, the five interns quickly learned, no better than “third-world patient care.”  In his introduction, the respected Dr. Quentin Young, County’s Chairman of Internal Medicine, says the hospital was “monstrous.”  

Third World?  Monstrous?  Ansell describes what he found during his years at County:  corruption, substandard management, political patronage, doctors learning on the job, rats, roaches and always, jammed waiting rooms (“The County Hospital lobby could have been mistaken for a Calcutta bus station, not a place of healing.”)  He describes one night in the ER when “the knife and gunshot wounds had priority.  They screamed in pain.  Blood and chaos.  The drunks and addicts on gurneys as well.”  It was Dante’s Inferno, American style.

CAT scans were unavailable.  Colonoscopies had huge waiting lists and lengthy appointments awaited women with suspicious lumps in their breasts.  Beleaguered doctors and nurses were inundated while patients found themselves lacking basic items like soap, towels and sheets.

After a while, the new doctors publicly denounced the infamous practice of “dumping,” where private hospitals shipped uninsured patients, many of whom were seriously sick, to County.  They also began a Breast Cancer Screening Program and prevention programs aimed at relieving stress and preventing HIV.

As his grim odyssey develops, Ansell recalls a patient suffering from hallucinations caused by his giving up alcohol.  “Hey Doc,” he called out to Ansell, “last night I thought I saw two large rats.”  A skeptical Ansell later learned that his patient was not hallucinating at all but that there really were rats in his room. County is replete with many such stories, the most poignant about his long friendship and care for Harriet, a woman with sickle cell anemia, among other problems. When she finally died after two years of dialysis, Harriet’s family asked Ansell to deliver her eulogy in a Baptist church on the city’s South Side.

The root of the problem, he is rightfully convinced, is not money—which remains sorely needed—but rather our two-tiered system of medical care, one for the impoverished and another for the rest of us. It is neither nothing more nor less than separate but unequal. In the years he was there, poverty was persistent as jobs increasingly vanquished.  Health problems, Ansell says about the racially segregated city, was caused by “the triad of racism, poverty and lack of insurance [which] conspired to kill my patients and their family members before their time. It is a form of injustice that continues to this day.”

Some years after he left County in 1995 for the renowned Rush Medical Center in Chicago where he is now Chief Medical Officer, a survey was taken of the city’s poorest people. Some one-third were found to be depressed, and with asthma and hypertension. One can add diabetes and obesity to the miserable plagues confronting Chicago’s largely black and Hispanic poor.  When he returned to visit County before it finally closed he found that in spite of many improvements “If anything, things had gotten worse.”

Today, no-one knows exactly how many safety net public hospitals have closed throughout the nation or may soon be closed by governments strapped for money. Despite our new if still contested federal health law, Ansell hopes for a system open to all and which does not discriminate between rich and poor and the insured and uninsured. But given today’s racial divide and mean-spirited political scene, that seems more and more an impossible dream.