The House of Hope and Fear: Life in a Big City Hospital

Wow. I sought this book out mainly because a friend had been working night shifts in Emergency at Harborview. I came away from a fascinating read with a much better idea about just how precarious our healthcare system is. Young's ability to tell a story while educating should be honored. I can never figure out how a physician has time for a personal life. I still don't know. Young has given the non-medical reader a glimpse of carefully managed chaos. I don't know how anyone can oppose a change in our healthcare after reading this short, interesting peek into a working public hospital.

I recently finished The House of Hope and Fear and LOVED it. I was totally intrigued by the various patients' story lines--a bit like watching Grey's Anatomy (in the best, most gripping sense, not the sensational sense). And I liked how Dr. Young interwove excellent info about hospital policy, homelessness, health insurance, etc. throughout. A great way to explore complex issues about our nation's healthcare system. What I liked most was Dr. Young's openness about her frustrations with her patients and their challenges. She was honest about her own attitudes toward homeless drug addicts vs. well-healed drug addicts--surprisingly different, and I found myself nodding along, and then learning the same lessons she learned. She also recognized how myths of poverty affected patient care--sometimes in positive, sometimes negative ways. Fascinating. I found myself learning from the stories constantly along the way. It was a very human story written in layperson's terms. A very accessible and important book.

Audrey Young offers a compelling collection of vignettes that detail the inner workings of the Emergency Department at Harborview Hospital in Seattle. In doing so, she opens the reader's eyes to the medical plight of the city's homeless and underprivileged, and how the care they receive via the Emergency Room impacts us all. She makes a strong case for reform of our country's health care system and offers intelligent commentary on how things might be improved, all the while recognizing the difficulty of making wholesale changes in anything so important to each of us. Along the way, the reader will meet many fascinating characters on both sides of the stethoscope, and feel the compassion that care givers in urban situations often exhibit. The book is hard to put down and hard to forget. Few among us have constant contact with the indigent; their lack of medical care is one of the shames of the current medical system in this country, which is too often driven solely by profit motive. Dr. Young explains how Harborview balances the need to generate income with the need to serve everyone in the community, including those without means or insurance. It is a fascinating look at the way a hospital is run. At the book's conclusion, Dr. Young offers wisdom and insight on the ways we might improve the current situation. This book should be required reading for the folks in Congress who are shaping healthcare reform, and indeed for anyone with a serious interest in the outcome of this most important issue.

Dr. Young's new book is an engaging account of life at the large mission-driven county hospital in Seattle. I spent most of my 3rd year med school rotations there myself 12 years ago and am now working in a mission-driven community health center 18 miles away. My desire to serve the poor was a direct result of the dedication from the doctors and staff that I witnessed at Harborview. Now, I spend more than half my time educating and mentoring medical students and I plan on incorporating this book into our 2nd year curriculum. The stories are diverse: some are about incredible patients and their challenging situations - socially, medically, psychologically; some are really more about the ethical dilemmas faced by providers, and faced by patient's families; other stories point out the inequities in healthcare, while demonstrating how this institution has creatively found a way to thrive financially while serving the least able to pay. Most importantly to me - this book is hugely interesting, well written, easy to read, hard to put down and deserving of high praise. The reason this book is so good and the messages conveyed so well is that Dr. Young has incredible skill at portraying the humanity of her subjects. This is a book of true characters; unforgettable characters. The characters are patients, their loved ones and families, the infamous ER director, a remarkable specialist in nephrology, Dr. Young herself, and the staff of the hospital. I read their stories and can picture them on a gurney, in their offices, on the wards, in the ER; I can smell the smells again; and hear the sounds in the ICU. This text can easily and effectively (each chapter is pretty well able to stand on its own as a separate reading - though together it reads as a cohesive story) be used regularly with medical students and public health and policy students - the examples in it are perfect for igniting debate about healthcare inequality, social justice, medical ethics, professional development, difficult patients, allocation of resources and care for the underserved.