Taking Care of Our Own: 2a Year in the Life of a Small Hospital

Susan Garrett's story of a year in the life of rural (York, Maine) hospital, sets the daily crises, personality quirks and policy dilemmas against her own evolving quest for the hospital's ultimate survival - a matter of dollars, quality and image. Administrator of the non-profit hospital for six years, Garrett's approach is philosophical and humane, as into any discussion of cost/benefit come the patients, the doctors, the government, like a wrench into smooth working machinery. So, when the brilliant surgeon throws a temper tantrum in the operating room (after the operation) because two of his instruments were missing, and then insists the hospital hire a technician responsible solely for his instruments, hire the technician they do. Otherwise the brilliant surgeon will leave, diminishing quality. The fact that the nurse supervisor quit on the spot, caught between two grandstanding doctors, is accorded little more than a shrug. If Miss Jannsen, not quite "one of our own," stays in the hospital longer than the 11 days Medicare will pay for, the hospital will lose money. If she dies there, having refused treatment for cancer, hers will be cited as an "avoidable" death, harming the hospital's overall rating. Without resolving this dilemma, Garrett shifts to the genial give and take of the lunchroom where informal advice and consultation among doctors is frequent. She leads the reader with assurance into board meetings where future needs clash with present restraints and individual demands, then pushes on into housekeeping, physical therapy, the emergency room. Each place gives rise to anecdotes which illuminate the personalities - many heroic - of the people who keep the hospital going. Bev Tracey, the tireless nurse who crops up everywhere. It was she who discovered why Miss Jannsen refused surgery. Or Dr. Talley whose diagnostic ability is uncanny but whose penchant for drug abuse makes him a serious risk. Garrett progresses through the seasons from Maine's nonexistent (in her opinion) spring, through the overcrowded summer and the long days of winter when quiet may erupt into disaster with a storm. Forays into history offer just enough to help the reader share the tug-of-war between quality and cost. Garrett outlines the politics of medicaid, medicare, building grants and insurance contracts. The wrangling over new building, cost shifting to fit government requirements, more cost shifting onto the backs of the self-insured, the constant worry over litigation. One complaint - no index. But through all the stories - the proud pillar of the community who is forced to sell her house and her china collection to finance her cardiac care; the dirt-poor family who cannot or will not help themselves, the arrogance and uncertainties of doctors - run Garrett's own ruminations on care. What should a small hospital be? What can it be? Does it have a future? Vivid, thought-provoking, informative, often riveting, Garrett coaxes compassion from her