A looming menace lurks within the towers of American medicine. One young doctor is determined to uncover the truth. Follow him on a journey you will never forget.
Don Newman, a resident physician at the renowned University Hospital, awakens to the screams of his pager in a windowless call room in the middle of the night. He runs to a dark ward to attend to a dying woman strapped to a bed and realizes—despite working long and hard to become a doctor and having sworn to do no harm—harm has become his business.
So begins Dr. Newman’s quest to find true healing in a world that puts profits ahead of patients. He abandons his plans to become a cardiologist and enrolls in an Ivy League graduate program in health system science, where an unorthodox professor promises to guide him ever deeper into the dark secrets of the healthcare industry. Don joins fellow students—the alluring Frances Hunt, a sharp nurse practitioner, and Bruce Markum, a cocky, well-connected surgeon—on a journey through the medical underworld. When Dr. Newman unearths evidence of a conspiracy stretching from the halls of Congress to Wall Street and even to his small campus, his harmless course of study becomes deadly serious. Will he be silenced? Or will he find a way to save himself and the patients he has sworn to serve?
The End of Healing tells gripping story of a young doctor's journey through the healthcare underworld to confront his own demons, uncover the roots of corruption in American medicine, and find true healing. This remarkable novel will change your perspective on the U.S. medical system forever…and give you the insight you need to find real healing in today’s world.
Jim Bailey pulls back the exam room curtain to reveal a giant healthcare industry spiraling out of control. This literary tour de force resonates with core themes of classical literature, medical history, and science. The End of Healing gives voice to victims of our dysfunctional healthcare system and those launching a national movement to reclaim health care that heals.
JIM BAILEY is a physician and professor of medicine and preventive medicine at the University of Tennessee Health Science Center in Memphis, where he directs the Center for Health System Improvement, cares for the sick, and teaches doctors in training. His research appears in many peer-reviewed medical journals, including JAMA, Journal of General Internal Medicine, and Annals of Internal Medicine. Dr. Bailey has an abiding passion for the classics, medical history, and ethics, and believes that sharing our stories can heal.
To learn more, visit EndofHealing.com.
|Publisher:||The Healthy City|
|Product dimensions:||5.90(w) x 8.70(h) x 1.30(d)|
Read an Excerpt
The Dark Ward
In the middle of the journey of our life I came to myself within a dark wood where the straight way was lost.
Dante Alighieri, Inferno 1, 1-3
DR. NEWMAN DREADED the task ahead. Like countless others in these so-called halls of healing, Sibyl Bellamy was more victim than patient.
He'd been on the night shift three months earlier — the first time she was brought to the emergency room. He'd admitted her to the hospital and worked her up for the team that would care for her starting the next morning. He'd known at once she had suffered a very big stroke. It didn't take a genius to see that. She couldn't move anything on her right side, her mouth drooped and leaked drool from the right corner, and she couldn't speak or squeeze his fingers. Mucus rattled in her windpipe with every breath and she showed little inclination to cough it up. Her eyes were wide open and filled with fear. Cords of muscle in her good arm strained against the padded leather strap around her wrist.
Her panicked daughter had rushed into the room and launched a battery of questions: "What's going on, Doctor? What's wrong with my mother? Why can't she talk? Can you help her? Will she be okay?"
He took a deep breath before answering. "I'm Dr. Newman. Your mother is very sick. Could you tell me what happened?"
Words erupted in a breathless rush. "I found her this morning in her house on the floor and I don't know how long she was there but she was fine when I saw her yesterday morning — she had gone to the bathroom on herself and she couldn't move so I called the ambulance and they brought her to the emergency room about ten this morning — I've been in the waiting room ever since and no one has told me anything!" Tears filled the wells beneath her eyes and overflowed. "What's wrong with her, Doctor? Was it a stroke?"
The physical exam left no doubt — yes — she'd suffered a large middle cerebral artery stroke. The left half of her brain was dead. She would probably never walk, talk, or eat again. But he was trained never to give a diagnosis until the history was complete and all test results were in.
"Let me ask you a few questions first. Does your mother have high blood pressure or other medical problems?"
"Yes, she takes medicine for high blood pressure. It runs in our family."
"What medicine was she taking?"
"Well, she used to take a water pill, I think."
"Yes, that's it! She took it for years."
He nodded and noted it in the chart. Hydrochlorothiazide prevents strokes better than anything. "Go on," he encouraged.
"Mom stopped taking it when the doctor gave her free samples of a new medicine. Norvasc, I think it was. She didn't like the new medicine because she said it stopped her up but the doctor told her it didn't have any side effects."
"When did she last see her physician?"
"Four months ago. That's when the receptionist said the doctor couldn't keep seeing her since she didn't have insurance anymore. He was nice enough to give her those free samples but she couldn't go ask him for more after that lady told her not to come back and she didn't have the money to fill the prescription. The new drug cost over fifty dollars for a month's supply so she just quit. Her old pill had worked fine and it only cost five dollars."
"She lost her insurance?"
"We are not fancy people, Doctor. My mom has worked every day of her life, mostly two jobs. She's worked right here at the University Hospital as a housekeeper for years. You know they outsourced housekeeping five months ago, right? The new cleaning service company kept her on but dropped her health insurance."
He did know. The hospital had signed a management contract with New American Healthcare in July 2000, right at the beginning of his third and last year of specialty training in internal medicine. Contracting out the housekeeping service was one of the ways New American Healthcare was helping the University Hospital save a little money. Mrs. Bellamy might not have health insurance for a simple doctor's office visit, or a prescription to control her high blood pressure, but now she was so sick no hospital could legally turn her away. She'd be declared disabled, Medicaid would kick in, and the expensive hospital tab would get paid — courtesy of the American taxpayers.
The daughter's body shook with silent, heaving sobs. Dr. Newman put his hand on her shoulder and waited. She took a deep breath to steel herself, shook off his comforting arm, and looked him hard in the eye. "What is wrong with my mother?" she demanded again.
He'd tried to give her the straight scoop. Pulling two molded plastic chairs over alongside Mrs. Bellamy's gurney, he motioned for the daughter to sit down across from him. He reached out, took her hand in both of his, and spoke slowly. "I think your mother has had a very large stroke. I'm sorry to tell you this, but I'm afraid she will never recover no matter what we do. Your mother is dying."
The daughter's face was blank, flat, as if she hadn't comprehended a single word of what he just said. She wasn't ready to process the horrible news. After all, her mother was lying nearby, asleep and breathing on her own.
"There is a slim possibility that dehydration is a contributing factor," he offered. "Perhaps with fluids, feeding, and rehab, your mother might be one of the lucky few to partly recover."
He intended his words to comfort the daughter just enough to tide her over until she was ready to process the grim reality that her mom was essentially gone. Once the words were out, however, it was too late.
Mrs. Bellamy's daughter's eyes lit up and she clapped a hand to her chest. "Oh, Doctor, please, I want you to do everything possible to save my mama!"
Everything possible. The magic words. That was all it took to set the gears of the hospital machine in motion to grind out a whole slew of hopeless interventions and procedures, or — as Sibyl Bellamy would call them if she could speak — torture.
Mrs. Bellamy had fought against every intervention. The GI team hadn't inserted a PEG tube to funnel food directly into her stomach because she would have ripped it out with her good left hand. Instead, they had stuck a feeding tube down her nose, which she could pull out without really hurting herself. As expected, she had pulled the feeding tube out of her nose again and again. Each time, the team had shoved the greased tube back through her nose and down the back of her throat. They had alternated between drugging her up — a medical form of bondage politely termed "chemical restraints" — and tying her left hand to the side of the bed.
Her second week in the hospital, she regurgitated and inhaled some of the blue liquid nutrition formula they pumped through the feeding tube into her stomach. She had nearly drowned in the blue food, which damaged her lungs and resulted in a severe case of pneumonia. She had survived only with the help of powerful antibiotics. After fifteen more days in the hospital, she had been discharged to a nursing home, where they kept her alive with more artificial feeding and hydration. Three more times she had returned to the University Hospital for lung infections caused by breathing in the spit she couldn't swallow, and each time she was discharged on another round of antibiotics. Don had followed her course from afar, glad he was not responsible for her hopeless case.
Until today. It started like every other call day. He slept in until 6 a.m. On his way to the hospital he stopped at Caffe DiMartino for a double cappuccino at 6:25 a.m., as he did each fourth day when he was on call. The coffee bar on the Italian North End near Don's one-room apartment had served the best espresso in Boston since 1932.
The barista looked up and smiled. "Ciao Dottore. Buongiorno! On call today?"
Don smiled back as he leaned on the marble bar, "For the hundredth time, Giulio, call me Don. Yeah, on call. Every fourth night — the worst."
"Your mamma would want me to tell you that you have dark circles under your eyes, Dottore. How 'bout you sit down over by that window, and taste your latte for a change?"
"Not today, Giulio, gotta go," Don said.
"Okay, Dottore, just this time, I will give you the best cappuccino in Boston to go. But you must come back when you are ready to enjoy life."
"I'll do that Giulio. Grazie," he said, completing the charade Giulio always required before he'd allow Don to take his steaming espresso to go. Don grabbed the tall frothy drink and headed out the door.
By 6:45 he was walking into the hospital, and by 6:50 he was finishing his cappuccino as he scanned labs on the hospital computer for the fourteen patients on his service. He figured he could discharge at least three before the onslaught of new patients that evening.
His day was unremarkable — examining patients and writing notes from seven to ten, rounding with the attending and team from ten to twelve, noon conference with a drug company lunch, stabilizing a patient who crashed and had to be transferred to the ICU, dictating three of the five discharge notes for the day, aspirating a swollen joint. Before he knew it, it was already 5:00 p.m. and his team was on call for the night.
At 5:05 his pager went off — he glanced at the number — the emergency room. He wasted no time in getting there. In minutes his long strides brought him face-to-face with the automatic doors before they opened. He had to stop short.
Looking through the glass window across the crowded emergency department, he spotted Sibyl Bellamy strapped to a sheet-covered gurney in Exam Room 8. His heart sank. A quick review of her chart revealed the depressing details of the heroic measures the hospital staff had taken to keep her alive. The resident physician's notes from that first admission documented the daughter's insistence they "do everything possible." Apparently, the original care team hadn't been able to get the daughter to hear the hard truth, either.
Now she was back again, her congested lungs cultivating yet another crop of drug-resistant bacteria. Sibyl Bellamy was a spunky woman who might withstand the daily blood draws, intravenous lines, and tube insertions for months before being blessed by a resistant infection that antibiotics couldn't cure. Or maybe one time she would be lucky enough to arrive at the hospital too late to be forced back to this brutal reality. But on this night Dr. Newman was on call, she was still among the living, and he would do his job.
He was glad he didn't need to take a history. Sibyl Bellamy couldn't speak. As he walked up to her gurney he heard secretions rattling in her throat as she struggled to breathe. Her eyes locked on his.
Dear God! She recognized him. He was sure of it.
Her wide eyes accused him. Her irises disappeared, overmatched by her dilated pupils and the whites of her eyes, and she opened her mouth wide to scream.
AAAAAAAAAA! AAAAAAAAAA! AAAAAAAAAA!
He had committed no crime, but her stare and mandrake screams unnerved him as if he had.
Don managed to complete a brief physical without meeting her eyes again. The exam added nothing to what he already knew. The chest x-ray showed her lungs were cloudy where they should have been clear. Aspiration pneumonia again.
He couldn't reach the daughter and suspected the usual — the daughter thought she was doing the right thing keeping her mother on artificial feeding and was angry the greatest hospital in the world couldn't cure her. Who wouldn't be angry? People had come to expect the great hospital and its brilliant doctors to bring life from death. And no one, including Dr. Newman, had been honest enough to tell Mrs. Bellamy's daughter the whole, unvarnished truth: the help of the hospital in Sibyl Bellamy's case was a joke and no doctor possessed the power to make her well again.
It would have been kinder to tell the daughter everything, keep Mrs. Bellamy clean and comfortable, and allow her to die with dignity. Instead everyone strung her along, encouraging vain hopes of an impossible recovery as they rushed to accomplish the business of prolonging Sibyl Bellamy's death.
After admitting Sibyl Bellamy and seven more patients, Dr. Newman had finally crawled into the hard twin bed in his windowless call room at one-thirty in the morning. His body ached all over. Having worked up patients nonstop for nineteen hours, all he wanted was a good night's sleep. He was out the instant his head hit the pillow.
AAAAAAAAAA! AAAAAAAAAA! AAAAAAAAAA!
Her siren screams set his heart pounding before morphing into the earsplitting screech of his pager. He groped for it on the nightstand, silenced it, and hit the light switch on the wall above the narrow bed. The stark call room materialized in a buzz of artificial light.
He shielded his eyes and squinted at the clock. Three-fifteen. Less than two hours sleep, yet he felt a stab of guilt for indulging in the luxury when a pile of admission paperwork and progress notes from the previous day's parade of new patients awaited his attention. He forced himself upright and dialed the number on the pager.
A nurse picked up before the first ring. "Will you please come see Mrs. Bellamy right away? She's thrashing around so much I had to put her in restraints to keep her from falling out of bed. She lost her IV and I can't get it back in."
After four years of medical school and nearly three years of residency, Dr. Don Newman was annoyed to be woken up in the middle of the night to do medical student scut work. He started to tell the nurse to call his intern, Edward, but the reason she had skipped protocol was obvious. Don was the third-year resident physician in charge of the medicine service for the night. It would not be easy to get the needle back into Mrs. Bellamy's vein, and Edward — who was in the seventh month of first-year training — would end up calling him for help anyway.
He stepped out of bed right into his Nikes, splashed cold water on his face from the sink in the corner, and burst through the door into the hallway of the half-abandoned old hospital. Someone had removed the fluorescent tubes in every other fixture. He ran down the half-lit hall under the stripes of light and dark toward the new hospital, his ears still ringing with the screams of the pager.
AAAAAAAAAA! AAAAAAAAAA! AAAAAAAAAA!
He ran like Dr. Joe Gannon, the doctor in blue scrubs he had admired as a boy in television reruns of Medical Center. Dr. Gannon always ran and he always arrived just in time to rescue his patient from the brink of death.
Of course, this was the real world. Fewer than one in six CPR recipients survive to leave the hospital, and many of those survivors are pretty messed up. He knew that now. Nonetheless, from old habit he emulated Gannon's heroic dash to the bedside.
He ran into the unbearable bright light of the new hospital, following the painted blue line contrived by some diabolical Daedulus-architect to lure people into the maze. The blue line snaked through a labyrinth of hospital corridors, past countless procedure rooms and operating rooms, down the stairs and past the radiology suites and laboratories, through billing and administration, then past pharmacy and central supply. To anyone who saw him run by, he appeared to be a confident young doctor eager to get to the patient's bedside. Little did they know how he dreaded what he was expected to do to poor Mrs. Bellamy.
He considered the options. There were a couple of ways to get an intravenous line in without patient cooperation. He could give her a painful intramuscular shot of Demerol, but it would be tricky to administer enough to knock her out without impeding her breathing. Or, he could get the nurse to pin her down so he could stick the line into her arm, neck, or groin, while she fought and screamed and stared at him with her damning eyes.
Excerpted from "The End of Healing"
Copyright © 2017 The Healthy City, Inc..
Excerpted by permission of The Healthy City, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
1. The Dark Ward
2. The Choice
3. The Gates of Hell
4. Great Scientists Who Couldn’t Cure
5. The Beauty Industry
6. Institutionalized Gluttony
7. The Waste Land
8. The Arrogant Physician
9. The Marble Hospital
10. False Teachers
11. The Plan of Healthcare Hell
12. Medical Violence
13. High-Tech Suicide
14. Health Care Assassins
15. The Ambulance Chasers
16. Unnatural Law Makers
17. Insurance Salesmen
18. The Drug Pushers
19. Procedures for Profit
20. Snake Oil Salesmen
21. Swindler Bureaucrats
22. National Institutes of Sickness
23. White Coat Hypocrites
24. The Image Makers
25. The Sick Care Business
26. False Healthcare Counselors
27. The Lobbyists
28. Politicians Spreading Disease and Discord
29. The Alchemist
30. Counterfeit Care
31. Industrial Giants Whose Time is Past
32. Traitors to Family
33. Traitors to Country
34. The Betrayer Revealed
Diagram of Healthcare Hell
Health System Seminar Syllabus
The Fine Print
Reading Group Guide