“The House of Hope and Fear” by Audrey Young, M.D.

I just finished reading another memoir, The House of Hope and Fear: Life in a Big City Hospital, by Audrey Young, M.D.  My book club is reading it for January. It was a quick read because once I got into it, I couldn’t put it down. The book follows the good doctor through her job as an attending physician at Harborview Medical Center in Seattle, WA. She describes the medical cases that walk through the door on a daily basis, none of which are sensational like on a television show. They’re simply real people arriving with standard issue diseases like diabetes, high blood pressure, and heart failure. What makes this book very different than a TV show is that it covers with greater detail the fact that our health care system is profoundly flawed.

Harborview is a public hospital, meaning it is one of the few that takes people that certainly can’t pay, while the other seven hospitals within a 5 mile radius accept only a small proportion of those with no insurance. If you’re homeless, poor, or otherwise downtrodden, Harborview is your only shot at health care.

Before reading this book, I had no idea how ambulance services decided to which hospital one should be transported. This book explains that both where you go and the level of care you receive are very dependent on your health insurance. For example, even at Harborview, but also more so at the other hospitals, the emergency room doors can be closed due to overcrowding, with people turned away or transported to a different hospital further from their homes, all while people sit in large private rooms on the upper floors because they have great insurance that pays for expensive surgical procedures. There are big rooms with space for beds, the hospital is just not putting beds or people in them.

According to Young, health care in the U.S. is still about making money, even at Harborview. Departments that make the most money, like surgery, have the most beds, the most space, and well laid plans for expansion and remodelling, while departments that cater to the homeless, even when they are at capacity on a daily basis, like detox and dialysis, have no plans for improvement.

Due to cutbacks at my husband’s work during the latest recession, I have had only catastrophic insurance for over a year. The idea that I could show up at a hospital and receive lower quality, or less heroic health care compared to someone else seems criminal.

I’ve been a socialist at heart for some time (since birth?), but this book reinforced my feeling that health care should not be allowed as a capitalist venture.

I definitely enjoyed this book, despite my frustrations with the reality of the subject. It often made me feel one of two emotions. I either felt like a) our health care system is screwed up and I am not doing enough about it or b) that it was too overwhelming for me to fix so I was tempted to put my head in the sand. I’m sure Young was hoping for the former.

Since reading this book I’m definitely planning to spend more time looking into single payer health care, which means that there is basically one insurance company that everyone pays into and fees come out of. If used properly, it would eliminate the idea that the quality of care is dependent on your insurance or socioeconomic status.

I also learned from this book as a writer. Young included technical descriptions of medical conditions and their diagnosis and treatment. In my memoir, I have included technical medical descriptions of procedures related to assisted reproduction including egg donation, artificial insemination, and in vitro fertilization. I noticed that my descriptions of medical procedures tend to include more detail or elaboration, but in a way that helps the lay person compare it to every day things, whereas Young simply states that she ordered a CT scan and blood cultures and hopes (or assumes) that the reader understands why or how those will help in her diagnosis and treatment. I am very comfortable with medical terminology and don’t need much explanation, but I’m curious to hear how the non-technical members of my book club feel about the technical medical aspects. Maybe TV shows like E.R., Grey’s Anatomy, and House have made it easier for the everywoman to understand this stuff?

This is Young’s second book on the subject, her first covering the life of a medical student. I’m very tempted to read her first as well. This book did a couple of things I aspire to: it kept me interested despite it’s technical nature and my desire to avoid reading about the travesty that is the U.S. health care insurance system, and it was written with a voice that would never be called literary. Sometimes I worry that my voice is not flowery enough because my background is in science instead of literature, but this book proved to me that not every successful book has to sound like it was written by an English poet.

There was one aspect of the book that I noticed so I’ll be careful in revising my own. Young uses (fake) patient names throughout the book and occasionally, because there were so many, I would forget who she was talking about. I’ve read and heard from other writers that characters should only be named if they are significant enough, if they are worth remembering. But now I’m wondering if those names need to be reinforced when they recur. Young occasionally would write something like, “Jason Smith, the patient with the blood clot in his leg,…” to jog the memory, but at other times she would leave off the condition, and for those I’d have a hard time figuring out the context for that person.

Reading this book made me want to investigate and possibly send my manuscript to her agent, Max Gartenberg. His web site says he only takes query letters, so I need to work on my query. Check!

Check out this book and let me know what YOU think.

Lorraine Wilde

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4 responses to ““The House of Hope and Fear” by Audrey Young, M.D.

  1. Thanks for the kind words about House of Hope & Fear, and yeah for book groups! I’m curious to hear what your fellow readers think.

    You mention flowery writing, but honestly I think it’s the clarity of the storytelling that carries the day. I’m always having to remind myself of Elmore Leonard’s so-called Most Important Rule of writing (from his 10 Rules of Writing): “If it sounds like writing, I rewrite it.”

    And I’m sad to say that my agent Max Gartenberg passed away last year after almost 50 years representing books. His daughter Anne Devlin represents medical narrative, so you might try her.

  2. Wrong info on that previous comment!

    • What a nice surprise to see you here Audrey! You made my day.

      My book club is this Friday so I’ll be writing a little more over the weekend about their response. Although, when I chose your book, I assumed that my group (including two veterinary technicians, a physician’s assistant, a zoologist, and a city prosecutor) would find a lot to relate to. But they might not be representative of your broader audience. 🙂

      I’ll have to check out Elmore Leonard’s books. Thanks for the support! I try to remember the wise words of my 10th grade English teacher who forever changed my writing style when she recommended, “Lorraine, just try to write like you talk and you’ll be fine.”

      Thanks for the update on Mr. Gartenberg’s agency. I’m not sure my memoir qualifies as medical narrative (will need to look at the genre more closely), but it certainly includes that element. I’ll add Anne Devlin to my query list.

  3. Book club was a blast and the discussion was wide ranging. We were philosophical about whether or not an author needs to feed their emotions into a story for it to be engaging, whether physician’s as people are more detached to spare their sanity in such a chaotic, dramatic work environment, and whether single payer health care really is the solution to our problems. Those that have worked in the medical and legal sectors agreed heartily that Dr. Young’s account of her patients, their issues, temperments, and lives, was spot on. One member said she’d actually met the famous Dr. Copass while her ER doc hubby was doing a rotation at Harborview, and she shared how the national approach to ER medicine was changing, without Copass. Overall, a stimulating discussion. Several said it was a book they might not have chosen on their own because of the subject, but all but those that are medically sensitive were glad they read it.

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