The Hospital: Life, Death, and Dollars in a Small American Town by Brian Alexander

American healthcare was an absurdist game of Jenga. 

~From The Hospital by Brian Alexander

The Hospital: Life, Death and Dollars in a Small American Town by Brian Alexander is the portrait of a Byran, Ohio hospital between 2018 and 2020. Alexander followed management, staff, and patients, investigating the complexities of healthcare in America in one small town. The news headlines we have all seen is presented in a personalized narrative that is deeply affecting; you want to rant, or cry. Likely both.

What America did have was a jumble of ill-fitting building blocks: the doctoring industry, the hospital industry, the insurance industry, the drug industry, the device industry. ~from The Hospital by Brian Alexander

Alexander follows the Bryan hospital's struggles to keep in the black when other small hospitals were being consolidated or put out of business by larger hospitals. And he shows how medical care has become a profit-making business. 

I was surprised to learn that deductibles were not always a part of health insurance. The rationale was that people would not abuse insurance if they had to pay a portion out of pocket. Affordable insurance comes with a high deductible, and people think twice before using it. Consequently, people go without preventative care and medications and treatment for illnesses. 

It could have been my family when we had to forward paid bills to the health care provider for reimbursement--after we met the deductible. Our baby suffered from continual ear and sinus infections and we often met the deductible by the end of January, which meant a huge decrease in available income for other bills and necessities at the start of every year.

The patients in the book exemplify the danger of skipping care. Those who can't afford medications pay a higher personal and economic cost when disease or illness progresses. Some pay with their lives, some become disabled and permanently lose jobs and income, and many are hopelessly mired in debt. 

Alexander writes that America has struggled with the crisis in medical care costs for a hundred years. Citizens resisted health insurance  a hundred years ago the way they resisted the Affordable Care Act later. Health insurance was, an is, considered unAmerican and socialist by some--even those who benefit from Medicare and other governmental programs.  

"Health...is a commodity which can be purchased," Alexander quotes the president of a utility company, and major employer, in 1929. "The difficulty now is its cost is beyond the reach of a great majority of people." 

Almost a hundred years later, it remains true.

In 1963, my dad sold the business his father had built in Tonawanda, NY, and came to Detroit to look for work in the auto industry. Mom had an autoimmune disease. They needed health insurance. My folks were very lucky. They went from struggling to a nice home, two cars, health insurance to treat mom's crippling rheumatoid arthritis and, later, dad's non-Hodgkins lymphoma, plus my folks paid for my first two years of college.

Today, my son has to purchase his own health insurance. He has to invest his own money in a retirement account. Of course, he has school loans, too. 

We have gone backwards. 

Alexander touched on Michigan hospitals, like William Beaumont Hospital, the Royal Oak, Michigan based hospital where my parents and grandparents were treated. A few years back they tore down an the aging shopping center of my youth and built a new one. It did seem strange to me that a hospital was in real estate. When Covid-19 hit and Michigan went into lockdown, hospitals lost elective surgery patients. Like my husband, who was considering shoulder replacement surgery a year ago. Beaumont laid off thousands and eliminated 450 jobs. During a pandemic. 

The book brought back a lot of memories of our seven years living along the Michigan-Ohio border. I had been to the towns Brian Alexander writes about.  

After fifteen years living in Philadelphia, we moved back to Michigan so our son could grow up knowing his extended family. Neither of us had lived in a small town before. There were under 9,000 people in Hillsdale, and about 40,000 in the entire county. There was a turnover of doctors; our first family doctor, one of the few who delivered babies, left family practice, demoralized after lawsuits. We did have a small hospital at the end of our street. When our son was three, he came down with pneumonia and we were glad the hospital was so close. 

Small town life was an adjustment. We left a racially eclectic city neighborhood for a county with five African Americans; one was my ob/gyn, one his nurse wife, and one his daughter who was in my son's class in grade school. I was surprised by rural poverty. Our son told us that half his kindergarten class did not have a phone and most had no books in their homes. We took took day trips antiquing in small Ohio towns like Pioneer and I took my Bernina sewing machine for cleaning in Bryan, OH. 

I am pleased that the publisher offered me a free egalley in exchange for a fair review. I found this to be an immersive, thought-provoking book.

read an excerpt at https://us.macmillan.com/books/9781250237354

The Hospital: Life, Death, and Dollars in a Small American Town
by Brian Alexander
St. Martin's Press
Pub Date March 9, 2021 
ISBN: 9781250237354
hardcover $28.99 (USD)

from the publisher

An intimate, heart wrenching portrait of one small hospital that reveals the magnitude of America’s health care crises.

“With his signature gut-punching prose, Alexander breaks our hearts as he opens our eyes to America’s deep-rooted sickness and despair by immersing us in the lives of a small town hospital and the people it serves. “ —Beth Macy, bestselling author of Dopesick

By following the struggle for survival of one small-town hospital, and the patients who walk, or are carried, through its doors, The Hospital takes readers into the world of the American medical industry in a way no book has done before. Americans are dying sooner, and living in poorer health. Alexander argues that no plan will solve America’s health crisis until the deeper causes of that crisis are addressed.

Bryan, Ohio's hospital, is losing money, making it vulnerable to big health systems seeking domination and Phil Ennen, CEO, has been fighting to preserve its independence. Meanwhile, Bryan, a town of 8,500 people in Ohio’s northwest corner, is still trying to recover from the Great Recession. As local leaders struggle to address the town’s problems, and the hospital fights for its life amid a rapidly consolidating medical and hospital industry, a 39-year-old diabetic literally fights for his limbs, and a 55-year-old contractor lies dying in the emergency room. With these and other stories, Alexander strips away the wonkiness of policy to reveal Americans’ struggle for health against a powerful system that’s stacked against them, but yet so fragile it blows apart when the pandemic hits. Culminating with COVID-19, this book offers a blueprint for how we created the crisis we're in.

Death in Mud Lick by Eric Eyre

Newspaper journalists were my heroes as a girl. My ten-year-old girlfriend and I spent hours planning to turn a falling down chicken coup into an office where we would write and publish our own newspaper. I was on the school newspaper in high school. I follow a number of journalists on social media who are my heroes, and now I have one more to add to my list.

You reminded me of how much a community depends on its newspaper to tell the truth and follow through finding the truth even if it's a little scary.~from Death in Mud Lick by Eric Eyre

Charleston Gazette-Mail reporter Eric Eyre won a Pulitzer Prize for his investigation into the massive opioid shipments to West Virginia. That story is presented in the book Death in Mud Lick.

I will admit this was one of those books I requested that looked interesting but when I received it I almost regretted it. I don't need to read another tragedy. We are in a pandemic already!

But I don't shirk my responsibilities and I sat down and read. I was soon immersed in the twisted history of how every safeguard failed to alert and stop the massive inflow of opioids into small towns, resulting in record overdose deaths. I looked forward to picking it up every day.

Everybody was making money--the pharmacies, doctors, patients, distributors, manufacturers. And nobody had the power to stop them.~ from Death in Mud Lick by Eric Eyre

This is one more story about people's lives sacrificed for money and governing authorities complicity in cover-ups. It is also the story of how a small town newspaper and one reporter prevailed to disclose the papertrail detailing responsibility.

Eyre does an amazing job marrying the personal side of the crisis and the struggle of the newspaper to keep afloat with his documentation of events. During the time of his investigation, Eyre was diagnosed with Parkinson's. It didn't stop him.

Today a Facebook friend shared a quip about shutting down the national media and watching 80% of the world's problems go away. Another Facebook friend responded, "It's your right to stay ignorant."

I am with that second friend. The media--particularly newspapers  still employing investigative reporters--are essential to a democratic society. We may not like what we are reading, we may find the news disheartening and frightening, but our alternative is ignorance.

I received a free ebook from the publisher on a Goodreads giveaway. My review is fair and unbiased.

Read an excerpt and listen to an audio excerpt at
https://www.simonandschuster.com/books/Death-in-Mud-Lick/Eric-Eyre/9781982105334

Death in Mud Lick: A Coal Country Fight against the Drug Companies That Delivered the Opioid Epidemic
By Eric Eyre
Scribner
Publication March 31, 2020
$18 hard cover; $12.99 ebook
ISBN 13: 9781982105310

from the publisher:

From a Pulitzer Prize–winning reporter from the smallest newspaper ever to win the prize for investigative reporting, an urgent, riveting, and heartbreaking investigation into the corporate and governmental greed that pumped millions of pain pills into small Appalachian towns, decimating communities. 

Death in Mud Lick is the story of a pharmacy in Kermit, West Virginia, that distributed 12 million opioid pain pills in three years to a town with a population of 382 people—and of one woman, desperate for justice, after losing her brother to overdose. Debbie Preece’s fight for accountability for her brother’s death took her well beyond the Sav-Rite Pharmacy in coal country, ultimately leading to three of the biggest drug wholesalers in the country. She was joined by a crusading lawyer and by local journalist, Eric Eyre, who uncovered a massive opioid pill-dumping scandal that shook the foundation of America’s largest drug companies—and won him a Pulitzer Prize.

Part Erin Brockovich, part Spotlight, Death in Mud Lick details the clandestine meetings with whistleblowers; a court fight to unseal filings that the drug distributors tried to keep hidden, a push to secure the DEA pill-shipment data, and the fallout after Eyre’s local paper, the Gazette-Mail, the smallest newspaper ever to win a Pulitzer Prize for investigative reporting, broke the story.
Eyre follows the opioid shipments into individual counties, pharmacies, and homes in West Virginia and explains how thousands of Appalachians got hooked on prescription drugs—resulting in the highest overdose rates in the country. But despite the tragedy, there is also hope as citizens banded together to create positive change—and won. A work of deep reporting and personal conviction, Eric Eyre’s intimate portrayal of a national public health crisis illuminates the shocking pattern of corporate greed and its repercussions for the citizens of West Virginia—and the nation—to this day. 

Visioning Human RIghts in the New Millenium: Quilting the World's Conscience

I was inspired to write this book because of my admiration for Eleanor Roosevelt and my belief that if women were fully empowered, they would transform the world into a peaceful place." Dr. Carolyn L. Mazloomi

Visioning Human Rights in the New Millenium: Quilting the World's Conscience exemplifies the legacy of quiltmaking as a political vehicle, how in the hands of artists, fiber and thread are employed to create powerful political and humanitarian statements. 

Dr. Mazloomi's preface begins, "Visioning Human Rights in the New Millenium is a call for action in the global struggle for human rights, Through artistic expression, utilizing the canvas of quilts, the artists here interpret the thirty articles of the Declaration of Human Rights." The Declaration grew out of the United Nations in 1948, a reaction to World War II, written by a committee led by Eleanor Roosevelt. It was her crowning achievement.

The 91 quilts interpret the thirty Articles in the Declaration ranging from "We Are Born Free and Equal" to "No One Can Take Away Our Human Rights." 

These are quilts that make us uncomfortable, that prick our conscience.

Article 19. Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to see, receive and impart information and ideas through any media and regardless of frontiers. Do You Know Me? By Peggie Hartwell 

Article 3. Everyone has the right to life, liberty and security of person. Cruelty Come for Us All, James Mardis, including images of a lynching tree, Rubin Stacey, Emmett Till, and Trayvon Martin.

Article 13. (1) Everyone has the right to freedom of movement and residence within the boundaries of each state. (2) Everyone has the right to leave any country, including his own, and to return to his country. The Monarch Butterfly by Deanna Tyson

On my first opening the book and glancing through the pages I learned one can't turn away from these images. Each quilt arrests attention; they tell a story that wants to be heard.

Many of the stories are heartbreaking.

There is an image of a woman pushing against a bull dozer's bucket, her teeth clenched in anguish and struggle. Behind her is a house, partly demolished, and a map of Hamtramck in Detroit Michigan. "Hamtramck, My Home" by Sharon Ray tells the story of a city governance determined to evict a black population and one woman who stood up to power. The city determined to tear down black residential neighborhoods to build new housing, but the displaced people would not be able to afford the new housing. Read about the 1971 ongoing court case here.

Article 17: (1)Everyone has the right to own property alone as well as in association with others. (2) No one shall be arbitrarily deprived of his property.

There are quilts that celebrate the enjoyment of the rights in the Declaration.

On This Special Day by Gwendolyn Brooks is a celebration. Thoughtful use of fabrics, embellishments, and painting illustrate the joy and pride of marriage.

Article 16 (1) Men and women of full age, without any limitations due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage, and at its dissolution. 

And you will find hope in these quilts.

Imagine a World by Nancy Cash exemplifies the kind of world we can choose to have. It is at once an ideal Utopia and an achievable goal. Education is the first step to equality in all its manifestations: equality under the law, in the distribution of wealth, opportunity, health, and access to clean water.

 Article 26. (1) Everyone has the right to education.

This remarkable book proves again the power of quilts. It is a wonderful testament to the ongoing struggle we wage to achieve the high standards set out in the Declaration.

I previously reviewed Dr. Mazloomi's book And Still I Rise, my review found here.

I received a free book from the publisher in exchange for a fair and unbiased review.

Visioning Human Rights in the New Millennium: Quilting the World’s Conscience
Carolyn L. Mazloomi
Schiffer Publishing
ISBN13: 9780764357404
$34.99 hardcover

Lighting the Fires of Freedom: African American Women in the Civil Rights Movement

Fifty years ago the Civil Rights Act of 1968 was signed into law.

Most know the name, legacy, and speeches of the Reverend Dr. Martin Luther King.

And most have heard of his wife Coretta Scott King and activist Rosa Parks. But what about the countless other women involved with the Civil Rights Movement? Those who did the grunt work, who put their lives on the line, who strove to achieve what the culture said they could not do?



Getting Personal

When I made my quilt I Will Lift My Voice Like a Trumpet I was inspired by the Abolitionists and Civil Rights who I encountered in reading Freedom's Daughters by Lynne Olson. My embroidered quilt includes an image and quote from women who made a difference but are not well known. The quilt appeared in several American Quilt Society juried shows.

I Will Lift My Voice Like a Trumpet at the Grand Rapids AQS show

When I saw Lighting the Fires of Freedom: African American Women and the Civil Rights Movement by Janet Dewart Bell on NetGalley I quickly requested it. I was interested in meeting more of these courageous, but lesser-known women.

Going Deeper

The author interviewed and collected oral histories of nine women for this book:

• Leah Chase, whose restaurant was a meeting place for organizers, was a collector of African American art and was commemorated by Pope Benedict XVI for her service.
• Dr. June Jackson Christmas broke race barriers to gain admittance to Vassar, spoke out against the internment of Japanese Americans during WWII, was the only black female student in her medical school class, and fought housing discrimination to change New York City Law. 
• Aileen Hernandez became an activist at Howard University in the 1940s, was the first female and black to serve on the EEOC in 1964, and was the first African American president of NOW.
• Diane Nash chaired the Nashville Sit-In Movement and coordinated important Freedom Rides. 
• Judy Richardson joined the Students for a Democratic Society at Swarthmore College before leaving to join SNCC. She founded a bookstore and press for publishing and promoting black literature and was an associate producer for the acclaimed PBS series Eyes on the Prize.
• Kathleen Cleaver was active in SNCC, the Black Power Movement, the Black Panthers, and the Revolutionary People's Communication Network.
• Gay McDougall was the first to integrate Agnes Scott College; she worked for international human rights and was recognized with a MacArthur Foundation Fellowship.
• Gloria Richardson was an older adult during the movement, with a militant edge; Ebony magazine called her the Lady General of Civil Rights.
• Myrlie Evers's husband Medgar was the first NAACP field secretary in Mississippi. She was officially a secretary, but she 'did everything' and later championed gender equality.

Diane Nash. "Problems lie not as much in our action as in our inaction."

I was familiar with Diane Nash, who appears on my quilt. I only knew Myrlie Evers-Williams by association to her martyred husband Medgar.

For me, Evers' statement was most moving, revealing more about her emotional life and feelings. Her husband Medgar, a war veteran, was the first African American to apply to Ole Miss when he was recruited to work for the NAACP.

Myrlie organized events, researched for speeches, and even wrote some speeches while raising their family and welcoming visitors such as Thurgood Marshall to her home for dinner. It was a lot for a young woman. She is quoted as saying,
"It was an exciting but frightening time, because you stared at death every day...But there was always hope, and there were always people who surrounded you to give you a sense of purpose."

Medgar knew he was a target and encouraged her to believe in her strength.

After her husband was murdered in front of their own home, the NAACP would call on her to rally support and raise money, with no compensation. Meanwhile, she felt anger and outrage at what had happened. Medgar had dreamt about relocating to California some day, so Myrlie and her children moved.

Thinking back on the movement, Myrlie recognizes the struggle women had to be recognized for their work. And she bristles at being pigeonholed as Medgar's widow instead of being recognized for her accomplishments. It is wonderful that Myrlie was asked to deliver the prayer before President Obama's inaugural address.

Faith and trust and believe she ends, possibilities await. Be open. Be adventurous. Have a little fun.

That is good advice to us all. But coming from a woman whose husband made the ultimate sacrifice, it is an affirmation of great importance.

I received a free ebook from the publisher through NetGalley in exchange for a fair and unbiased review.

Lighting the Fires of Freedom: African American Women in the Civil Rights Movement
by Janet Dewart Bell
The New Press
Pub Date 08 May 2018
ISBN 9781620973356
PRICE $33.99 (CAD)

The Leavers by Lisa Ko

Our son grew up with a boy born in Asia who, as an infant, was adopted by an American, middle class family. He had perfectly nice parents and a biracial adopted sister. Our son told us the boy felt sad, wondering why his mother gave him up, and about how he was conflicted by being different as the only Asian in school. There was always an air of sadness about the boy.

I thought of that boy, now a man, while reading Lisa Ko's debut novel The Leavers. The book is a moving journey into the lives of Deming/Daniel, a Chinese American child adopted by an American family, and his birth mother Pelian/Polly, bold and strong but whose fierce love of her child cannot save them from the forces--poverty and the law-- that inevitably separate her from her child.

Pelian/Polly Gao is an unforgettable character, born in rural China, daughter of a fisherman. She imagines possibilities of another life and will do anything to achieve her dreams. She could have settled for marrying the village boy who loved her, remained in China, taking care of her aging fisherman father. She could have had an abortion and stayed in the Chinese factory dormitory, working long hours. Instead, she takes out a loan to go to America.

Her son Deming was born in New York City. But Polly's debt meant long hours working for low wages. She sends her son to live with her father in China. After the death of his grandfather, Deming rejoins his mother, who is living with her boyfriend and his sister and nephew. Those years are Deming's happiest. He adores his mother and has a 'brother' for best friend.

One day Deming's mother disappears. He is placed in a foster home and is adopted by an educated and well-off family. Now called Daniel, the boy never feels at home in his new world, any more than his mother had felt at home in her rural village.

Daniel flounders in life. Then he is brought into contact with people from his past who led him on a quest to find his mother. And finally learns the harrowing events that led to their separation.

Illegal immigration, the immigrant experience, the love between a mother and a child, and the search for authenticity and a place to belong are all themes in the novel.

The novel has garnered much well deserved praise and I purchased it to read. The beauty of Ko's writing and the memorable characters made this an outstanding read.

Reading with Patrick: The Memoir of an Idealistic Teacher

Michelle Kuo is a Chinese-American who grew up in West Michigan. I've lived in West Michigan. I lived in an entire county with only a handful of African Americans. I don't think there was one Asian person out of the 40,000. So it is understandable that Kuo grew up feeling alienated, identifying with the African American experience.

I admire how Kuo struggled with her immigrant parent's dreams for her and her personal desire to dedicate her talent to human rights. And I appreciated her honesty in admitting her failures and steep learning curve about the limits of what she could accomplish. It recalled to mind the idealism my husband and I once held and the pain and disappointment when faced with reality.

Reading with Patrick is her story of two years teaching English in one of the poorest counties in America, working in a school for troubled students. Success was not immediate, but she persisted. Her kids realized she was a teacher who cared.

She leaves under pressure to continue her education, planning a career in law. Several years later one of her best students is in jail for manslaughter. Kuo puts her personal life on hold to be with Patrick. They start back at square one. He has to physically relearn how to write legibly and read with understanding. Over seven months he becomes a gifted creative writer.

The story of how she discovers how to awaken his mind and set his spirit free is heartwarming and also devastating. I thought of the old television commercials for supporting black colleges: A mind is a terrible thing to waste. But of course, these children born in poverty, with little opportunity, do lead wasted lives. Kuo discovers many of her students have also ended up in jail or pregnant and it makes her reconsider her own estimation of her legacy.

Patrick accepts a plea bargain and serves his time. And then discovers all the doors are closed to him. As Kuo points out, the justice system has moved from trials to settlements, but the jail sentences permanently impair futures. The justice system and public education, and the legacy of racism behind them are addressed with thoughtful insight.

It is Kuo's self-revelatory journey that sets this book apart.  And I loved reading how students, and in particular Patrick, responded to literature and poetry.

I won this book on a giveaway. Thank you to LibraryThings and the publisher.

Random House
Publication Date July 11, 2017
$27
ISBN: 978-0-8129-9731-6

Grace by Paul Lynch: The Story of a Girl Surviving The Great Hunger

2 million people died in The Irish Potato Famine when blight destroyed three years of potato crops between 1845 to 1851.

In his novel Grace, Paul Lynch recreates Ireland during the famine. The writing is gorgeous, the protagonist, Grace, memorable, the descriptions of what she experiences while on the road crushing.

Think of a journey story set in a Dystopian world, such as The Road by Cormac McCarthy. Consider that the story is history, that the starvation, despair, disease, and the ever-present threat of death are historical.

Realize that government and the wealthy could have alleviated the suffering. It is a disturbing realization of how those of means and comfort justify their selfish self-interest. Then consider the great need in the world today, in America, in your own hometown, and know that nothing has really changed. We still turn a blind eye and hold to 'truths' about self-reliance and just deserts.

Grace's mother provides a cottage for her children through an arrangement with Boggs, who visits her as payment for his largess. But as Grace nears puberty, Boggs notices the girl. One night Grace is roused and her mother shears off Grace's hair and orders her to dress in men's clothing. The next day her mother insists she eats a rare meal of meat and orders her out of the house to find work as a man, hopefully to return with full pockets.

Confused and unwilling, Grace hangs around and is joined by her younger brother Colly. Colly instructs Grace on manliness, how to smoke a pipe to damp the hunger, and his chatter fills the void. They seek out empty huts or animal sheds for shelter, shivering in the cold. After an accident takes Colly, his voice and comments are still heard by Grace, become a part of her, and she answers back in whispers.

Grace journeys from town to town, picking up work where she can. She mimics men's behavior while noticing the swelling of her breasts. She passes through villages where the starving hawk their shreds of clothing and emaciated children stand listless. She finds herself with rough company, thieves, men who have detected her sex and follow her, and finally Bart, who becomes her protector.

"This is no way to live."

Bart and Grace travel across the country, to people and places from his past, hoping to find work, to learn there is nothing left of the Ireland he had known.

"Don't you see what is going on around you? The have-it-alls and well-to-doers who don't give a fuck what happens to the ordinary people," Bart tells Grace. "The people are living off hope. Hope is the lie they want you to believe in. It is hope that carries you along. Keeps you in your place. Keeps you down. Let me tell you something. I do not hope. I do not hope for anything in the least because to hope is to depend on others. And so I will make my own luck. I believe there are not rules anymore. We are truly on our own in all this." And at the last, "The gods have abandoned us, that's how I figure it. It is time to be your own god."

Grace is nearly dead when she is rescued by a disturbed religious cult leader, then must find the strength to escape her rescuer. She returns to find her family home deserted. The book ends with Grace, age nineteen, the famine over, pregnant and living with a man she trusts, with hope for the future.

Lynch has accomplished something remarkable in this historical novel, for he not only has created a memorable protagonist and a story of growing up, not only a vivid picture of Ireland during The Great Hunger, but he has given readers a book that raises our awareness of suffering and how, in the past and in the present, every one of means who turns away is responsible.

I found this one of the most memorable novels I have read this year.

I received a free ebook from the publisher in exchange for a fair and unbiased review.

Grace
by Paul Lynch
Little, Brown & Company
Publication July 11, 2017
$26 hard cover
ISBN: 9780316316309