Nursing Book Club
Hospital: Man, Woman, Birth, Death, Infinity.
Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids
Reviewed by Christine Contillo, RN, BSN
When I was a young girl back in the dawn of nighttime television drama, there was a weekly show whose main character was a handsome doctor named Ben Casey. Each week he faced a new medical dilemma; then, as the credits rolled, a hand slowly drew the following symbols on a board while a solemn voice gravely proclaimed each one: “man, woman, birth, death, infinity.” This was apparently what doctors had on their minds as they made their critical decisions.
In her book Hospital, best-selling author/reporter Julie Salamon tells us that hospitals have necessarily added to the list of criteria for successful operation. She throws “red tape, bad behavior, money, god and diversity on steroids” into the title, just so we can understand what is really going on behind the scenes.
Ms. Salamon spent a year following the operations of Maimonedes Medical Center, a 705-bed not-for-profit hospital located in Brooklyn, N.Y. Dedicated in 1919 as a community hospital for the Jewish population, Maimonedes has become a medical factory that serves an increasingly diverse immigrant population. The hospital generated $626 million in revenue in 2003 and trains 460 new doctors each year.
To stay current the facility strives to meet the needs of its patient group, which includes serving Chinese, Italian, Caribbean and kosher foods, and having a staff of translators and varied religious counselors available. Maimonedes also tries to find just the right blend of technology and services that will allow it to keep the local people from crossing the river into Manhattan for their medical care.
How can it keep each group happy without alienating another? As Ms. Salamon points out (with the wisdom of Solomon), it’s not easy.
The cast of characters is dizzying, and the author followed up with virtually anyone who would speak with her, including patients, while she wore a name tag designating her as “writer.” There are conversations with presidents, CEOs, chairmen, chiefs of staff, CFOs, directors, social workers, physicians (both residents and attendings), nurses, nursing assistants, environmental workers — the list goes on and on and, thank heaven, there are three pages listing the names and titles for reference.
The book tells how multi-million dollar decisions that affect thousands of people are made, how family matters can impact these decisions, how personalities and conflicts play into the dynamic, and what it takes to not lose sight of why it’s all being done — to improve patient care.
That is why we’re all here, right? Why cancer centers are built, fund-raisers held, employees promoted, diversity training conducted, technology and new medication developed and patient surveys taken — because we care about the patients. At least, I always thought that’s what hospitals are all about.
If you read Hospital you may begin to wonder if healthcare in America could be just a juggernaut that operates as all large industries do. Could there be a possibility that hospitals exist as a means of ongoing employment for millions of people? The majority of those working in direct patient care would disagree.
Either way, it is a fascinating read and allows you to draw your own conclusions about the purpose of hospital care.
Christine Contillo, RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.