1989: You Should Write That Book

"You'd never want to wake up and find yourself in Cook County Hospital, the nation's first and oldest public hospital. The building looks as huge, grey and battered as a vanquished and abandoned old battleship run aground on the shattered streets just west of Chicago's Loop. The hallways and waiting rooms — there's no nicer way to put this — are thick with sick people who have also run aground and seem abandoned to waiting, limping, straining, coughing, sighing and sweating, bleeding, crying."

— Scott Simon, Weekend Edition, National Public Radio, 1994

I bolted down the steps from the General Medicine Clinic at Cook County Hospital. My scuffed, brown Rockports smacked the concrete stairs as my right palm skimmed the handrail, its blue paint, once bright and cheery now worn to its steely base by thousands of hands, perhaps as tardy as mine. I was late. I was always late. A major weakness and character flaw — one I am still trying to mend years later. Late, because I stuffed my life, like the overflowing shopping carts of the scavengers who loitered on Madison Street. A victim of both my idealism and impatience. The cacophony and chaos of County Hospital made a perfect setting for my appetite. It was an "all you can eat" kind of place. It was barely 1:00 p.m. and I was gorged.

I spent the morning seeing patients in the clinic; the door was full of charts; the waiting room stuffed as tight as a stockyard cattle car. The last patient had taken me longer than I hoped and after I packed her off with her prescriptions and laboratory orders, I wrote a hasty note in the chart, looked at my watch and cursed. I grabbed my stethoscope from the desk, shoved it into the front pocket of my corduroys and raced to the stairwell.

I punched open the door at the bottom of the stairs and was whisked into a vortex of patients traversing the hallway, a whirring of sounds and the vaguely pungent and familiar odor of musk and oiled hair. If I was going to make it to my meeting, I needed to do my best Walter Payton impression and slice through this gauntlet without being thwarted by the doctors, staff and passersby who bustled past the waiting room of the sprawling Ambulatory Screening Clinic. Every day, 200 to 300 unscheduled patients swarmed through its doors seeking medical attention. Today, like every other day, it was more mosh pit than clinic. The cumulative body heat of the masses overwhelmed the air conditioning system's attempt to cool the room.

As I began my cut through the winding corridor, my final dash to the meeting, a voice intercepted me, the clipped Arabic-tinged English of a colleague, Iraqi-born kidney specialist, Dr. Asad Bakir, an island of calm amidst the erupting first floor of Fantus Clinic. I turned. His hair was combed in a neat part, each strand obedient and in place on his head in contrast to my roiling mop of curls. His starched grey laboratory coat and Armani-style trousers were pristine, their creases sharp as a razor's edge. I sighed. My shoulders slumped. I'd never make the meeting. I stopped and shook his hand. I liked Bakir. Eight years earlier I had worked with him when I was a resident in training and he wrote on my evaluation that I should be considered for a spot as an attending physician at County, perhaps the highest endorsement a resident could receive. We were both distracted by a crushing assemblage of patients and doctors and we gawked like sightseers.

"You know, David," he said in the British public school accent and rolled r's so typical of Iraqis of his age, as his eyes darted across the crowd in the waiting area in awe, "someone should wrrr-ite a book about this place." The conditions at Cook County Hospital were so appalling and the suffering of such magnitude that we often felt that if the outside world knew about it, there would be more outcry to end or improve it.

"Actually," I replied, "I plan to write a book, I'm just not sure anyone would believe it." My assertion was interrupted by a registration clerk's frantic call.

"Dr. Ansell! There's a man down in the men's washroom!" I hesitated before I pounced into action. And not only because I would now surely miss my meeting. The men's washroom was about thirty feet away. Its reputation for filth was legendary at County; with just two stalls to accommodate the thousands of patients and staff who waited or passed by every day. Add to that a spotty cleaning schedule, the semi-sweet odor of ancient urine deposits left by a multitude of bladder-challenged Chicagoans and the tags of competing West Side gangs carved on every available surface, and you had one place I never deigned to enter in all my years at County.

Bakir and I exchanged a "let's roll" glance. I tore past the vending-machine-lined back wall of Fantus accompanied by the drum roll clickety-clack back beat of Bakir's loafers on the linoleum. I pushed through the swinging door of the bathroom and was jolted by an aromatic blend of urine, feces and sweat. My heart thumped. On the floor, visible under the closed door of the first stall was the limp body of a man, in the fetal position. I seized the stall door and shook it. Locked from within. No time to waste. I slammed open the adjacent stall and scaled the toilet seat, careful not to plunge my feet into the murky water of the bowl below. I grabbed onto the top edge of the divider between the two stalls with both hands, stretched myself up on my tippy toes and peeked over. My stethoscope dangled out of my pants pocket.

"There's a guy down on the floor. He's out cold. Maybe a seizure. I'm gonna climb over and try to get to him," I said to Bakir below. With my right foot, stretched as far as it could go on the edge of the toilet seat, I dragged myself up over the partition: my left foot and leg flailed and banged on the metal divider between stalls as I grunted to maneuver over the top. At thirty-seven, I pondered I just might be a little old for this. Too late. I was committed. Just then, I saw the man twitch. A sign of life. Good news. My foot caught the top of the divider. As I leaned to thrust myself into the other stall, the lifeless lump on the floor...