At times, this book seems quite dated (it was published in 1994), with the lack of computers and cell phones, but at other times it seems as if it could be describing present day. Cook County hospital, as portrayed in this book, is a study in contradictions. It is an old, dirty building with old-fashioned, overcrowded wards; yet it provides excellent diagnosis and care. It has staff who are rude and uncaring, hired under political patronage and only marking time to get a paycheck; yet it has other staff who are dedicated, passionate, highly skilled, and loyal to patients. Patients will complain about long wait times, unpleasant staff, disorganization, and filth; then they will say they would never consider going to another hospital, that County is "their hospital." One interviewee in the course of a conversation will describe being cursed and threatened, overworked and underpaid, and then sing the praises of the hospital, stating that he or she is a "County person." The hospital has low funding, high volume, and outdated technology; it is also a coveted training site for physicians.

This book was written as the Clinton administration was working to develop healthcare reform, and there is some discussion of what type of reform might be needed or how changes would affect County. As a public hospital governed by the County Commissioners, Cook County Hospital got little funding but was expected not to turn any patient away; in spite of the EMTALA law, other hospitals routinely turned away patients and told them to go to County. Cook County's patients tended to be poor, with the attendant illnesses associated with poverty. Staff and administrators were not confident that any healthcare reform would have a great impact on their hospital; they'd heard too many times that a new building is coming or some other change will take place.

The format of the book is oral history, which in this case means each chapter is a direct quote from a staff member or patient, from environmental services, to security, to nursing, to maintenance, to physicians, with more interviews with physicians and nurses than other areas. Themes that recurred at every level included concerns about the age of the hospital building, poverty, lack of security, the perceived increase in violence inside and outside the hospital, and racial tension in the community and among the staff, as well as the pleasure of doing a job well and feeling that one makes a difference, providing dignity to patients, learning from the mixed cultures that come together at the hospital, and passion for improving healthcare.

Ultimately, this book paints a picture of healthcare in what is almost a war zone. Several of the interviewees mentioned the TV show M*A*S*H, with the alternating camaraderie, conflict, pressure, satisfaction, heartache, futility, and hope that healthcare workers under fire feel. It is clear that we need hospitals like County, who do not turn anyone away, and that these hospitals need support and renewal. I'd be interested to see a follow-up to this book to see where the specific interviewees are now and the current state of Cook County Hospital. I did take a brief peek online to see that it appears to be now part of a large health system with a pretty website and good branding; hopefully the culture, atmosphere, and quality of care have all improved as well.

Overall, this was an interesting read, a little peek into the experiences of a select few staff at one of the busiest hospitals in the country. It is a reminder that the poor are still with us and that there are people who make it their careers to get in the trenches and try to make lives better, and that we all should take the time to do our jobs with consideration for how our behavior affects those around us. ( )