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Life, Death, and Dollars in a Small American Town
By Brian Alexander
The business of sickness is perverse. In too many instances, medical interventions are ineffective Band-Aids. Other factors, like where you stand in the social, racial and economic pecking order — and what ZIP code you were born in — determine far more about your health. As Bertolt Brecht said so well, in his “Worker’s Speech to a Doctor”:
When we’re sick, we hear
You are the one who will heal us.
When we come to you
Our rags are torn off
And you tap around our naked bodies.
As to the cause of our sickness
A glance at our rags would
tell you more. It is the same cause that wears out
Our bodies and our clothes.
In “The Hospital: Life, Death, and Dollars in a Small American Town,” Brian Alexander shares this reality from the perch of a struggling rural hospital, known to its Bryan, Ohio, community as the “Band-Aid Station.” While the nonprofit hospital fights to stay solvent and independent, each day brings new gut-wrenching stories. From the C-suite’s tension-filled strategic planning meetings to life-or-death moments at the bedside, Alexander nimbly and grippingly translates the byzantine world of American health care into a real-life narrative with people you come to care about.
Reporting over a period of two years, which only ended this past August, Alexander went into exam rooms, patients’ homes and pathology labs, and rode along with ambulance crews. He provides a deep investigative account that chronicles the staff of nurses, doctors, technicians and administrators trying to keep the patients of northwest Ohio alive.
You will root for the hospital C.E.O. who is tiptoeing around minefields, and for the immigrant doctors who are decidedly unwelcome in Trump country, even as they try their best. But the work is grueling and the lives are almost impossibly hard to save. In sensitive portrayals, Alexander shares how patients become sicker as care is delayed, costs spiral out of control and all too often patients die from preventable deaths. The entire mess is plagued by a malignancy of despair. Everybody in this story is drowning.
Just as Brecht captured in 1938, what often makes patients sick are conditions we don’t see — or choose not to see. Alexander identifies them with surgical precision, the underlying pathogens of pernicious poverty and the widening chasm of income inequality. Add in systematic racism, early childhood trauma and inequitable access to healthy food, healthy air and high-quality health care, and you have a perfect storm.