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Book Review: Twelve Patients: Life and Death at Bellevue Hospital

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Book Review:
Twelve Patients: Life and Death at Bellevue Hospital
By Eric Manheimer, M.D. -- Grand Central Publishing 2012

Bellevue is one of 11 New York City public general hospitals. It is a municipal medical center that has cared for the city's poor and ill for 275 years. It is also one of the world's most famous hospitals. Not only is it our country's oldest hospital, Bellevue also has a record of many firsts -- first pediatric and maternity wards; first public health programs that were instrumental to controlling tuberculosis, typhoid and polio; the first cardiac pacemaker; and the first psychiatric hospital for children. Nobel prizes went to two Bellevue physicians for pioneering heart catheterization. Bellevue today has 380 psychiatric and substance use treatment beds which make for a large mental hospital in their own right within the walls of the massive general hospital. Bellevue also provides medical and psychiatric care to inmates transferred from Rikers Island (New York City's 15,000-person jail), and boasts the busiest emergency department in the city, attracting every imaginable variety of trauma, physical disease, and psychic disturbance.

This history sets the stage for the 12 stories told by Dr. Eric Manheimer, who was Bellevue's chief medical officer for almost 15 years, departing recently to take on medical quality and safety projects at New York University/Langone Medical Center, Bellevue's academic affiliate. Born in the Bronx, Manheimer trained in New York City but left for Dartmouth for 17 years, returning to enter the maw of municipal life and death, demonstrating that you can take a boy out of the city, but not the city out of a boy.

Manheimer mixes medicine with anthropology, sociology, psychiatry and a bit of politics and economics. Yet the essence of what we read is how disease, person and circumstance converge and present the most daunting challenges to those who are ill, their families and the medical staff of this remarkable municipal hospital. Through the medium of stories he achieves a book that is more than about Bellevue: It is about people, families, caregivers, culture, communities, desperation, despair, resilience and hope.

There are stories about a fallen Wall Street titan; a gang member almost murdered at Rikers Island for squealing; about the horrors of domestic violence and random street crimes; on organ donation (Bellevue is a major center); psychotic street people; abused and traumatized children who live a life of emotional chaos, also known as PTSD; about the undocumented and uninsured who comprise a sizable proportion of the people served at Bellevue; and how heart disease, tuberculosis, parasitic people and conditions, drug abuse, mental illness, HIV/AIDS, poverty, and cancer are as much a part of New York as are its residents and visitors.

Manheimer himself is the subject of one of his stories. In 2008, Manheimer fell ill with squamous cell cancer of the throat, a bad disease. After 30 years of caring for others, he became the patient. It was "three years of hell," with radiation, chemotherapy and surgery -- only to discover another cancer, melanoma, which itself can also be deadly. Remarkably, his treatment, his family and his indomitable spirit sustained him, and he went back to work at Bellevue, before finally taking down his shingle as chief medical officer. This was a tough chapter to read; I can only imagine what it was like to write, no less live.

There is unsparing honesty in this book about medical care. For example, we get an uncensored look at medical errors, the cause of so many preventable hospital deaths. If it can go wrong, it will, Manheimer reminds us. We see also how it takes leadership to contend with the resistance that powerfully and promptly coalesces when people and institutions are asked to do something different, even if it might mean saving lives. We also read about how doctors so often -- expensively and futilely -- chase after symptoms that have no physical basis since, it can be so hard to imagine that the causes of the pain and suffering are psychic in nature. We confront, like the staff at Bellevue does every day, how the poor are the last in line in the food chain of medical care.

Manheimer has range as a doctor, a writer and a social commentator. This book is tough medicine. But nothing less is apt to work when it comes to curing that which is the hardest to treat, including our torn social fabric.

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Lloyd I. Sederer, MD

www.askdrlloyd.com

The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.

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