HOSPITAL, by Julie Salamon, The Penguin Press, 365 pages, $25.95

The author is a prolific journalist who has also written a number of books. In this election year when candidates are sparring about health-care reform, this book is "a warts and all" treatment of hospitals and health-care specialists in America.

Specifically, the author has traced a year in the life of Maimonides Medical Center in Brooklyn, studying it from an ethical, technological, sociological and cultural point of view. Salaman also analyzes the doctors, administrators, nurses, ambulance drivers, cooks and cleaners who make this facility run.

Finally, she has followed the patients who have been treated there.

She chose this facility partly because it is located in a multi-cultural community, where 67 different languages are spoken. Salamon follows the internal feuds, personal connections, egotism, greed, comedy, love and loss predictably experienced at such a major institution.

In her prologue, Salamon sums up the problems with high intensity: "Over the course of a year, I would become privy to many conversations and miscommunications, as well as the thoughts, interactions, successes, and failings of a remarkable confluence of compassionate and contentious people.

"They were ambitious, shortsighted, altruistic, selfish, foolhardy, and wise. They tried to respect themselves and their patients, a task that often appeared far more difficult than diagnosing illness or performing complex medical procedures or speaking one another's languages. They tried to remember — against the odds posed by a greedy and corrupted health-care system and by institutional and human frailty — that healing was the heart of the matter."

In rich conversations with doctors, Salamon heard that sometimes modern medicine may cause more disease than it cures — "that a spiritual or philosophical dimension to taking care of patients" was often missing. One doctor remembered interns drawing each other's blood and discovering in the process that he had Crohn's disease.

The quick declaration was made that it was caused by anxiety, which he soon discovered was not correct. But he did have abundant anxiety until he was prescribed sulfasalazine for a year and his inflamed intestines calmed down. From that he learned that merely "articulating a disease could disrupt a life."

The sense of these conversations was that hospital personnel are too often so busy that they don't spend the time necessary to properly care for individual illnesses well enough. Salamon also discovered that physicians and patients don't speak the same language, and that increased efforts need to be made in hospital settings to allow patients to comprehend what doctors say and are given the time to ask the right questions.

Oftentimes, physicians have feuds that have more to do with problems of personal interaction than they do with sound medical decisions. These are only a few of the many problems discussed in this terrific book. It ought to be required reading for anyone about to undergo surgery.


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