Review: The People's Hospital (2023)
“[This book] is a love letter to the hospital, my hospital, where people find healthcare and revere it like treasure. It is also a letter to those sitting in positions of authority, to alert them to the consequences of failing to act with immediacy.”
The People’s Hospital: Hope and Peril in American Medicine by Ricardo Nuila is a mostly frustrating — though at times lucid and gripping — work of nonfiction about the author’s experiences working in the Ben Taub public hospital, the centerpiece of Houston’s safety-net healthcare system for the poor.
“Work of nonfiction” is vague and I’m sorry about that. But the phrase captures one of this book’s core problems: Namely, that it’s never clear what kind of book People’s Hospital is intended to be.
In some ways, it is a memoir: It details Nuila’s own reasons for entering medicine, explores his relationship with his father (also a Houston-based doctor), and narrates anecdotes sourced from his career in medicine.
But it also tries to cram in so SO much more, including life stories of Nuila’s patients; a historical account of the development of private insurance; an indictment of the U.S. health care industry; and an exegesis of Jan de Hartog’s 1964 book The Hospital, which exposed the deplorable conditions in Jefferson Davis hospital, the precursor to Ben Taub.
I’ve seen other nonfiction works balance this many competing priorities. But People’s Hospital lacks a clear structure to carry the reader through. Many of the chapters are organized around vague concepts (“Beliefs” and “Misperceptions,” for example). Stories about patients are often split across many chapters, some very far apart; one chapter ends on a cliffhanger and then takes over 100 pages before it picks up the thread again!
It’s also never quite clear what Nuila’s goal is. He makes many important (and true) critiques of how insurance companies and warped financial incentives destroy people’s lives. He also has a lot of nuanced praise for the way Ben Taub, as a taxpayer-funded public hospital, provides better care than many for-profit and nonprofit institutions.
But he is vague about extrapolating from these points. Should we have Medicare for All? Should every county in America have a Ben Taub? I don’t demand that a nonfiction book answer every question that it raises, but it surprised me that a book so ambitious in other ways didn’t offer much of a vision for changing the system it critiques. At one point Nuila writes that his criticism of hospital and pharma companies’ practices isn’t “meant to disparage business or capitalism.” Maybe he should do some disparaging tho!!
All this is frustrating because some chapters are genuinely brilliant. Near the end, Nuila describes what it was like to work in Ben Taub during the height of the coronavirus pandemic in 2020 and 2021 and the results are captivating. It manages to convey both factual information and emotional reality — mostly, I think, because it had focus. I wish the rest of the book had that same clarity of purpose.
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