HOSPITAL - An Oral History of Cook County Hospital, by Sydney Lewis; The New Press, New York, 1994, 350 pages, $25.

Review by Del Meyer, MD

One of the 36 Interns I rotated with at Wayne County General had finished at the Univ of Illinois and did his clinical clerkships at Cook County. We always enjoyed his stories about the front line of medicine on the near west side of Chicago with gang members and their victims as patients. The men and women in white were "off limits" to the gangs as they roamed the hospital grounds and adjacent streets and dives.

He recounted the night that horror struck when two people in white were attacked. Members of the house staff determined who the leader of the gang was, lay in wait and caught him. They took him to the nearest curb, broke all his long bones and a few ribs, heisted him above their heads and marched him into the emergency room, placing him on the trauma table. They gave him the finest medical and surgical care available. He had a chest tube expertly placed. Some of his fractures were openly reduced and internally fixed in the operating room, while others were casted. The patient was placed in traction on a bed on the orthopedic ward. Over the next few months as the "Gang leader" lay mending, his "troops" were seen quietly entering the hospital, observing their hero, and leaving pensively.

So when I saw Lewis' Oral History of Cook County Hospital, it caught my eye. I also noted the subtitle, "The Searing Portrait of the Urban Health Battlefield."

Sydney Lewis gives us a collection of stories and vignettes from doctors, nurses, patients, personnel, guards, maintenance and other employees. Sometimes current interns gave accounts of their family members who had interned there.

In the first chapter, Lewis recounts about an intern who had admitted a patient. This patient happened to have a girl friend on the psychiatric ward who paid him a visit and sliced his throat. Died right before the intern's eyes. Another intern freaked out ad started yelling orders at the nurses when a new patient in the ER had a blood sugar of 600. A resident had to calm him down telling him, "People come into the County two and three at a time with blood sugars of 800, 900. So ... it prepares you for anything." Breaking in an intern at a county hospital is trial by fire.

Cook County had 300,000 ER visits a year, 400,000 out patients a year and 960 beds. About half were medical. With a house staff of 160, it was one of the largest medical services in the country. Saving lives was a constant challenge and mending bodies and minds was a day and night process. In the midst of all this desperation, the County Director of Hospitals fired the Chief of Medicine, as well as some of his attending and house staff. The chill caused a sudden exodus of many of the attending, and a large number of the house staff. The hospital faced closure had it not been for the fortitude of one of the fired intern who stood up to the Director of Hospitals, told him what he was doing to the safety net for the indigent and sick, and the emergency measures he best institute to save the institution.

The Jail service was run by Mount Sinai Hospital. The Jail, a collection of people with alcoholism, STD's, drug abuse, contagious disease of all kind, who couldn't make bail, numbered 4800 inmates on any one day, but 50,000 during the course of one year. It was discovered that Sinai was offering inmates unnecessary operations to facilitate the training of residents in return for a week out of jail in a clean bed with good food. This expose couldn't be covered by any wallpaper, and the entire service was transferred to the County.

There are over sixty short chapters in this "Oral History" which can be sampled over time, as curiosity mounts or insomnia strikes, and need not be read in the sequence written. Despite the medical ugliness, humor comes through in many stories. Since County started in 1860 with a warden at its head, Lewis also gives us a running history of the poor and immigrants as they come through its doorways. Quentin Young who has three chapters, states in his last retrospective look, "...County is superior to any other arrangement that's been devised in the US...for care of the poverty sector of all races... it does a better job... There's a difference between having a neonatology unit for...six kids and having one for sixty. There's a difference between taking care of one burn and taking care of twelve...even though the private hospitals could absorb the patients, they won't..." Quentin Young, the Chief of Medicine who was fired three times and won reinstatement each time in court, describes the new County with community clinic outreach as the model for the future. He then concludes, " is absolutely true--that we have to break the back of hyper-specialism and change the ratio of 20% primary care, 80% specialist to 50/50. If we do a forced march we can do that in about ten years...the magnificent and huge trainer of specialists for the first half of this century, County can become the mass trainer of primary care docs with a proper balance between hospital experience and community-based care... County is one of the many shining examples of how public medicine... works."