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

Nursing Book Club

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

Changing the World

By David A. Ansell, MD, MPH (Academy Chicago Publishers, 2011)
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Reviewed By Christine Contillo, RN, BSN

Maybe it’s because I’m also from upstate New York and there just aren’t that many of us. Or it could be because I graduated from a nearby college in the same year as the author, Dr. David Ansell. Possibly it’s because I also worked in inner-city, poorly-funded public hospitals. No matter the reason, I read County: Life, Death and Politics at Chicago’s Public Hospital, the story of the author’s career in public health, and felt such empathy that with a change of location it could easily have been the story of my own nursing journey.

Dr. Ansell was in medical school in the 1970s at a time and in a politically charged place where young people believed that they could make a difference in the world. It’s hard to look back now and realize that then “separate and not even remotely equal” was the standard. The author served his residency and became an attending at one of the largest public hospitals in the country, and during that same time period I was doing something similar. I remember that clinic where obstetrical patients routinely delivered without insurance and without anesthesia, and then went to rooms with up to eight beds which afforded no privacy and no sleep.

As the night RN on a 60-bed unit, I spent most of the shift mixing and hanging the IV meds and hoping that the nursing assistants wouldn’t need me. Our staff often called Security to break up domestic disputes even during the late stages of labor. Once I had to search in the basement through all the hospital’s dirty linen when a tearful patient admitted to me that she’d hidden $400 in her pillowcase, all the money she had, to keep it from her boyfriend while she was in the hospital having his baby.

County Hospital in Chicago, where the poor patients believed they got the best care in the city, was admittedly far worse than what I experienced. Patients waited all day to be seen, and if their name wasn’t called they came back and waited again the next day. Dr. Ansell and six of his fellow medical students from Syracuse University took their residencies there believing that they would change all this, and in some ways they were instrumental in what followed. Even as witness to the beginning of the AIDS epidemic and breast cancer screening, the book is a valuable history. All of America was undergoing change at the same time, and the patients and staff at County were swept up in the wave.

Despite a few unnecessary references to lazy nurses, Dr. Ansell later acknowledges the importance of patient education in chronic disease prevention and care, and then hires nurses with grant money to help him open clinics across the city, offering patients medical services in their own environment and allowing the staff to better individualize their care.

Anyone who sees the practice and cost of medicine being tangled in the web of politics will be fascinated by the author’s accurate observations of this time period. He sees the relationship of race, poverty and mortality for what it is and doesn’t allow for it to be dismissed. His career is an amazing adventure and his commentary well worth the read. You will enjoy the book, as I did, if you believe that quality medical care is a right, not a privilege.  

Christine Contillo, RN, BSN is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.

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