In Twelve Patients: Life and Death at Bellevue Hospital (Grand Central Publishing/The Hatchette Group, 2013, 349 Pages, $9.99 Kindle edition) Dr. Eric Manheimer tells a story about the American health care system set in Bellevue Hospital, which is the oldest and
largest hospital in the United States. As a public hospital it serves
the needs of those populations not well-served by the huge
infrastructure of America's hospital and larger medical industries.
Through its vast doors come the immigrant and minority people who,
for hundreds of years, have gathered in New York City for its
challenging environment of work, wealth, and freedom, as well as
providing a home for all who come. Riker's Island, the largest prison
complex in the country provides a vast prison facility for those who
comit crimes or are waiting trial for offenses ranging from simple
drug arrests to the most horrendous of violent acts. The serial
killer known as Son of Sam was imprisoned there for several years
awaiting trial. The relationship between these two institutions and
the communities surrounding them provides the context for this
enormously engaging and challenging exploration of the American
health care system at the nexus where it is most challenged. Using
twelve patients, including himself, as examples, Manheimer explores
the nooks and crannies of an over-challenged system to provide care
for those most in need.
Bellevue Hospital
In what amounts to a series of
harrowing and inspiring case studies, he portrays the capacity of
this system to meet the physical and emotional needs of those most in
need of its powers. Skillfully using dialogue with his patients,
colleagues, and family to explicate the stories he has to tell,
Manheimer avoids the trap of jargon and stilted description bringing
the cases to life through his own humanity and turning what
might be cardboard stereotypes into people the reader cares about
caught in situations that become real and compelling. Beneath each
story lies the reality of grindingly difficult living conditions
experienced by many who have suffered to get to the United States
only to find themselves confronted by many of the same criminal
elements they encountered at home, a system fragmenting to a halt under
its own weight, and a country deeply divided about what to do with
both criminals and immigrants. Early in the book, Manheimer
comments, “PTSD (post traumatic stress disorder) was made an
official disease in 1980. That is 2700 years after Homer described
the effects of war on warriors in his majestic Iliad.”
In
many ways, Bellevue, and by estension our entire medical system, must
constantly seek to counteract the physical and emotional effects of
devastating medical system which cares little about the effects of
our society upon its least affluent members. Eric Manheimer, for
fourteen years the medical director of Bellevue, seems uniquely
qualified to tell this story. Along with his wife Diana, he has
travelled widely in Latin America and speaks Spanish fluently. He
takes the time to come to know his patients and colleagues beyond the
merely medical, seeking out the underlying pathology that leads to
both disease and desperation. Whether the patient is Tanisha, a
sixteen year old foster child who escapes her twelfth foster home
after being raped by her foster sister's boyfriend or Carlos Beltran,
a violent killer who has arrived from Guatamala with the skills of
special forces soldier put to use in service of the drug cartels and
paid for with training provided by the United States, his stories
bear the weight of a punishing reality yet are told in such a way as
to illuminate the essential humanity of each one.
Outside the Emergency Room at Bellevue
Through
these people, Manheimer tells the stories of the diseases
(tuberculosis, cancer, HIV/AIDS, drug addiction, obesity) and the
underlying causes of much disease (violence, rape, incest, parental
neglect and more) to make these articulate, and often attractive,
people come to life while illuminating the holes in our medical
delivery system and social matrix through which many of them have
fallen. The twelve patients, including himself, as he battles an
intractable throat cancer, each illuminate a part of the story. Put
together, they present a discouraging and inspiring set of problems
that bedevel and endanger our entire society.
At one
point, a Mexican doctor asks Manheimer why so many Americans who live
in a country which can offer the best and most innovative medical
care anywhere, are coming to Mexico for medical treatment, he comments, “The key players
in the health industy, from hospitals to insurance, to Big Pharma,
and the physicians groups have gotten so powerful that they can
distort and deform what happens in Washington.” He goes on to say,
“In a society that is increasingly mesmerized by efficiency,
measurement by numbers, and a bottom line mentality that extols
wealth over any other human value, the risk is clear....” It is
rare that a book manages to be instructive, enlightening, frightening
and entertaining all at once. Eric Manheimer, in taking his readers
into the world of Bellevue Hospital manages to do this
while introducing us to the world of public health and political
intrigues almost beyond imagining. In so doing he shows us how and
why the current battle over the Affordable Care Act (Obamacare)
places our society in a dilemma that will haunt us for decades as we
battle the efforts of corporate America to control us in the name of
freedom. In the picture he paints, we can't live with or without
universal health care, and haven't discovered a way to deliver it,
the valient efforts of dedicated doctors, nurses, and, yes,
bureaucrats notwithstanding.
Eric Manheimer, M.D.
Eric
Manheimer, M.D., is an internist with a focus on geriatrics and
palliative care. He was chief medical officer and patient safety
officer at Bellevue Hospital, part of New York City's Health and
Hospitals Corp., for 15 years, and is a fellow of the American
College of Physicians.
His administrative responsibilities spanned clinical care,
quality, care management, emergency preparedness, organizational
growth, graduate medical education and citywide programs with the
John Jay College of Criminal Justice, Planned Parenthood and the
Department of Health of New York City. Dr. Manheimer has worked
internationally in Haiti, Pakistan and Latin America. He is a
clinical professor of medicine at the NYU Langone Medical Center.
In
Twelve Patients ( Grand Central Publishing/The Hatchette Group, 2013, 349 Pages, $9.99 Kindle edition) Eric Manheimer shows respect for his patients, colleagues, the
police, and members of the communities he serves in ways that the political system from the White House to the local
precinct cannot manage. They respond to him in kind. The people we meet in the book are first of all
sick humans whose complex illnesses reflect the physical disease and
the psychological effects of our society. His ability to generalize
these real people into cases that illuminate both medical and social
issues lifts Twelve Patients
well above the ordinary in its ability to explore and explain our
current problems. As the book ends in the vice of being caught
between the hospital's capabilities and a political battle going on in Albany
and Washington, it suggests we are coming to a halt as a
nation. While there remains an essentail optimism to the book, it's a
thin thread. Twelve Patients was
recommended to me by my friend Bob Cook. I bought and read it on
my Kindle.
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