The inner-city hospital is Memphis' chronically under funded Regional Medical Center, known as "the Med." Unlike the city's private hospitals, the Med has to take everybody, which means lots of non-paying patients, many of whom are addicts, people without family, the homeless, the mentally ill. British journalist Sandy Balfour spends a year walking its corridors and talking to its nurses, the backbone of the hospital.
The nurses at the Med are a proud, dedicated bunch. Many are black and most of the ones Balfour talks to have been there for years. One of the things he doesn't say is how much turnover there is; going by this book, not much. Pay is the same as at private hospitals and the nurses have greater autonomy and authority. "We work as a team," is a refrain that comes up again and again.
He spends much of his time in the trauma center, burn unit and HIV clinic. Nurses who work trauma (including airlift trauma nurses) are a special breed; people who thrive on the challenge of emergency, and the rush of adrenaline. Most of them wouldn't work anywhere else.
But then nurses who work the ever-depressing burn unit are a special breed too; people who can spend months with a patient in constant pain, whose best will never be as good as it was. Death is frequent. It's not one of the more popular specialties.
And it takes a special sort of person to work with HIV patients all day. Like many of these nurses Marye Bernard takes her faith as seriously as her responsibilities. Patients respond to her determined optimism. Her goal is to prevent HIV becoming AIDS. "What this means is I do everything. Pap smears, teeth, dietary advice, antibiotics. You name it. I do palliative care, symptomatic care, and preventative care. I give anti-retroviral drugs. I do education."
Money and race come into the story frequently: constant threats by the state to shut down a place that runs deeply in the red; the differences in ambiance between a place like the Med and the private hospitals where everyone has insurance; the chasm in general health between people who get regular care and people who don't have insurance; the color divide inherent in all those differences.
At the Newborn Center about 30 percent of the Med's newborn babies require intensive postpartum care. The infant mortality rate for white babies in Memphis is 5.8 per 100,000, a bit better than the national average. The rate for black infants is 18.7. Here too, the Med has a dedicated staff, run by 79-year-old Dr. Sheldon Korones who believes "health care is a right, not a privilege," and that the worst faults of our system stem from making medicine "a product." He raised the money himself to start the Newborn Center in 1968, his reaction to the assassinations of Martin Luther King and Robert Kennedy.
The nurses, many of them considerably more conservative than Korones, talk comfortably to Balfour, inviting him to watch them work. He meets FSAs (failed suicide attempts) MVAs (motor vehicle accidents), GSWs (gunshot wounds), watches an operation to reconstruct a girl's face after she was shot by her boyfriend, attends a three-hour church service with the head nurse.
Frustrating, depressing stats and monetary issues punctuate Balfour's anecdotal, informative and inspiring narrative. The nurses are wonderful people, with a heartening sense of the importance of their work. As fascinating as this material is, though, it doesn't go deep enough. Why does Marye Bernard refuse to sign off on disability for even very sick patients with AIDs? Why a 24 hour shift for some nurses (enabling them to run other businesses, including a farm and a pet cemetery)? What about that patient at the outset who complained about the rudeness of the nurses at the Med? Are they? Why?
However many questions you may have at the end, Balfour puts his heart into this celebration of a caring profession, while capturing the sad ironies of the system's inequities.