Review | A Texas hospital provides sad and hopeful lessons



“Healthcare remains linked to the question of worthiness.” This stark statement echoes throughout “The People’s Hospital: Hope and Peril in American Medicine,” Ricardo Nuila’s attempt to untangle the labyrinthine system of American hospitals and, more crucially, American medical insurance.

Ben Taub, a “safety net” hospital in Houston, created to help those without health insurance gain access to care, is not quite an aspirational model for how health care should be approached in the United States. Nor is it a cautionary tale, or a kind of map that can be used to understand the American health-care system at large. Or maybe it is all those things, just at different moments. But this facility, where physician Nuila has spent his career, is more than just his most readily available reference point when wading into the big questions that plague health care in the United States; it is a stage where some of the most troubling problems in the system are solved, and where patients continue to fall through the holes that are still present, even with a safety net.

The book pingpongs, sometimes dizzyingly, between Nuila’s personal history with medicine, the history of medicine more generally (focusing primarily on the United States in the last 200 years, but also stretching much further back) and the individual medical histories of a handful of his patients. Though there are times when it seems he is retreading ground he’s already covered, much of that repetition appears to be by design, echoing the endless cycles patients often must work through to find treatment.

It is the individual patients who bind the book together, helping Nuila chart a course through questions about a medical system that too often sees them as mere numbers — when they’re seen at all. And it’s not just their time and struggles at Ben Taub that preoccupy Nuila, but their almost always winding journeys to get there.

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There is Christian, a young man with chronic, debilitating knee pain who learns that going from being uninsured to having coverage doesn’t matter much if your coverage allows you to see specialists but won’t approve the diagnostic tests ordered by those specialists. Then there’s Roxana, an undocumented woman with no coverage who receives emergency surgery on a life-threatening tumor only to wake up with dry gangrene, leaving her arms and legs decayed and useless. That outcome alone is a horror story that seems fit for a prime-time medical drama. But while the TV patient would spend the hour coming to terms emotionally with this radical change, Roxana faces the possibility that without health insurance to cover another surgery, she might never rid herself of what were once her functioning limbs.

A patient’s story might end in tragedy or triumph, but most land somewhere in between at Ben Taub. Still, Nuila is careful not to equate even the most hopeful outcomes with happy endings. Not just because that might be trite, but because navigating an unforgiving health-care landscape isn’t a story that has anything like a definitive end for millions of Americans.

“The People’s Hospital” never shies away from the deep inadequacies of the American health-care system. Nuila admits that though there are some solutions that seem both feasible and necessary, there are other, more complex problems that have no simple answers. Still, it doesn’t seem accidental that the book ends on a distinctly hopeful note. A patient receives the surgery they need, and Nuila at last sees them in good spirits. The patient hasn’t been transformed into the healthy person she was before she got sick, but she’s improved enough to give herself, and those around her, hope. “The People’s Hospital” will leave you with just that: a hope that even if our health-care system will never become the shining beacon of equitable care all patients deserve, it can, at least, get better.

Molly Horan is the author of “Epically Earnest.”

Hope and Peril in American Medicine

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