Checking Into Doctor Hell : When You’re Really Sick, the Last Thing You Need Is a Health-Care System That Makes Things Worse
On August 2, 1990, Saddam Hussein sliced into Kuwait. On August 3, Dr. Edwin Kaplan of the University of Chicago Medical Center sliced into me, or more precisely, my right groin. He removed a couple of puffed-up lymph nodes and sent them to a pathology lab for analysis.
If everything that followed had gone as smoothly as Kaplan’s knife, I wouldn’t be writing this. He was gentle and considerate, pausing often to make sure that, fortified by local anesthetic and Demerol, I was feeling no pain. Afterward, when I was in the recovery room, he raided a refrigerator to perk me up with cookies and juice, and we sat around talking baseball for half an hour. As a surgeon, Kaplan proved quite deft, leaving me with an unusually unobtrusive scar.
Weeks later, lying on an examination table at another hospital, I was being looked over by two doctors of the female persuasion. After probing my body for telltale bumps, they turned their attention to the scene of the crime, my exposed groin area. “My, that’s a small one,” the junior of the pair cooed.
“I beg your pardon?”
She, of course, was referring to Kaplan’s handiwork. I, of course, was not.
Perhaps the sickest part about being sick has nothing to do with the malady itself. Suddenly, miscues and miscommunications can come to dominate your life even as you struggle to save it. A few might make you laugh. Considering what’s at risk, however, too many others can be terrifying.
Just a few weeks after my 39th birthday, a lump in my groin sent me to my internist, who sent me to Kaplan. The result--a cancer diagnosis--forced me into a crash course in both my illness and the shortcomings of the system deputized to deal with it. What I experienced, what all too many other patients have experienced as well, was truly a Doctor Hell. It’s a twilight zone of bureaucracy, nearsightedness and detachment that can defeat or at least complicate even the best efforts of the most sincere and dedicated medical professionals, of whom there are many. Even if it doesn’t end up harming patients, which it can--Doctor Hell produces needless anxiety, frustration and bitterness at a time when the last thing an ailing person needs is added stress.
Reviewing my case a year later as a reporter, I got a far more detailed look at behind-the-scenes hospital work than most patients ever get. With that perspective, the reason for some of the confusion and apparent missteps becomes clearer. No matter how many high-tech gizmos and wonder drugs have been developed, medicine remains more an art than a science--with few concrete answers.
But that doesn’t account for the avalanche of medical fallibility that should be preventable but often isn’t. Diagnoses are presented definitively, then suddenly reversed without any explanation. Tests are misread and treatments misapplied. Doctors can be arrogant and evasive, and patients are made to wait like supplicants, expected to pay exorbitantly, forced to navigate a stupefying bureaucratic maze and--cliche of cliches--are even misplaced on occasion. (More about this later).
“There are problems for patients in the form of a hassle every step of the way,” admits Washington internist Charles P. Duvall, immediate past president of the American Society of Internal Medicine.
Charles B. Inlander, president of the People’s Medical Society, a consumer group based in Allentown, Pa., agrees. “You (the patient) are helpless,” he says. “You’re in no physical condition to ask the right kind of questions, you’re sick, you’re feeling horrible, you’re scared, you’re grasping at straws for information. You’re dealing with a bunch of docs who treat you as a condition, not as a real person.” Little wonder that 69% of those questioned in a survey conducted for the American Medical Assn. agreed that “people are beginning to lose faith in their doctors.”
A woman named Barbara sure is. Two years ago, her father spent nearly two months in a major Chicago-area teaching hospital after suffering a serious heart attack. He recuperated for several days in intensive care after an experimental heart-regulating device was implanted in his chest. One time, Barbara’s mother came into the unit and found him gone. She was told he had been sent back to surgery, an ominous sign. For more than three hours, she sat in the waiting room, sobbing. Finally, a stranger waiting to see another patient took pity on Barbara’s mother and started asking questions. Barbara’s father, it turned out, was just fine and had been moved to a regular room hours earlier. The man sent to surgery was the next occupant of the intensive-care bed.
“When my father first went in there, I felt we were better equipped than most people, because we have doctors and nurses and lawyers in the family. We’re better educated, articulate and used to taking control,” says Barbara, an attorney, who asked that her full name not be used. “But that institution is so big, and it grinds on, and it’s so impersonal and such a hellhole that it really doesn’t matter what you bring into it as a person. You’re going to have the same lousy experience.”
IT WAS A SULTRY DAY IN AUGUST WHEN I LEARNED I HAD CANCER, but my first numbed thoughts took me back to a crisp April evening in 1977. I’d been with my father, then 67 and near the end of a long, losing battle with prostate cancer. It had turned a jolly, wisecracking fat man into a sullen, sunken-cheeked near-cadaver.
He was too weak to go out, so we tuned the TV to a movie called “Bang the Drum Slowly.” The program guide advertised it merely as a baseball film, but it became painfully clear that this was a film less about sport than the power of friendship in the face of tragedy. Most of all, however, it was about death, death from cancer--the fictional catcher Bruce Pearson was fatally stricken with Hodgkin’s disease.
Watching this, knowing my father was watching this, made my skin crawl. But to say anything or flip the dial would have been an admission that something was terribly wrong, that my ailing father, like Bruce Pearson, would die. I froze. We watched the whole movie in silence.
I have no idea what went through my father’s head that night. He never said a word. Maybe it didn’t bother him at all. He had been struggling with cancer for six years but, in my presence at least, hadn’t so much as hinted that he was scared, and he rarely talked about his treatments or his doctors. He didn’t offer, and I was all too happy not to ask. Now, years later, I was about to find out on my own what people meant when they said someone was “struggling” with cancer.
My descent into Doctor Hell began within weeks of the biopsy, when I returned to the University of Chicago Medical Center to meet for the first time with the oncologists assigned to my case. They tried their best to be helpful and understanding but bombarded me with jargon that seemed to reduce my illness to a scientific equation, not an intensely personal tribulation. I wanted to know how serious it was and how to get rid of it. They answered with terms like “protocols,” “morphology” and “multiple modalities.” Patients talk of cures. Doctors shun the word, preferring the more tentative “remission” or “partial remission” or “complete and lasting remission.”
I was told I had contracted something called non-Hodgkin’s lymphoma, a cousin of the better-known Hodgkin’s disease that killed the fictional Bruce Pearson. Both are somewhat rare cancers that affect the body’s immune system.
Once almost always fatal, Hodgkin’s, if caught early, is now among the most curable of cancers, thanks to chemotherapy and radiation. Non-Hodgkin’s, too, has a fairly decent cure rate, though not as good as Hodgkin’s. In a pernicious form called “indolent,” however, the cancer spreads like molasses, taking seven, 10, sometimes 15 years to pose a serious threat. But it also has proven nearly impossible to cure.
Of all the gray areas in cancer diagnosis, it was my dumb luck to contract a disease that is one of the grayest. In a study a few years ago, a nationwide panel of pathologists reviewed more than 100 biopsy slides from lymphoma patients. In 37% of the cases, the experts had significant disagreements on what form the disease had taken. James Vardiman, the sincere and respected pathologist who oversaw my diagnosis at Chicago, confessed to me later that he, too, had trouble pinpointing the precise form of my lymphoma when he first looked at samples back in August of 1990.
At first, I was told that my cancer was an “intermediate” non-Hodgkin’s, which is considered very treatable. Then 10 days later I was told that it had been reclassified indolent. Although chemotherapy would probably shock it into remission, it would almost certainly come back several years down the road. In short, I was going to die prematurely but probably enjoy a long stretch of relatively good health to contemplate it. The news brought on a gnawing depression. I was desperate to do something, but trying to get answers, let alone guidance, was like pulling teeth.
Compounding my anxiety, none of the lymphoma experts at Chicago seemed to agree on what to do. Some said do nothing until it gets bad. Some said try conventional chemotherapy, though chances of a cure were slim. “Your disease, I hate,” Dr. Robert Geller, my primary oncologist, told me later. “It doesn’t sit right with me because I don’t know what to tell people.”
Panicked, I sought a second opinion from a highly recommended lymphoma specialist at Loyola University Medical Center in the Chicago suburbs, only to stumble over my inexperience with hospital routine. Loyola, like most hospitals, wants patients coming from other medical centers to bring with them raw test materials such as biopsy slides and CAT scans. Nobody told me any of this, so I arrived at Loyola empty-handed. That could have proved cataclysmic had I not decided to later take the unusual step of seeking yet a third opinion.
Because of the missing materials, the Loyola expert was reluctant to make a firm recommendation on treatment. Still, based on the diagnosis made at Chicago, he suggested that my cancer might be so limited in area that radiation might work. It was the first time radiation had even been mentioned.
In late September, thoroughly confused, I headed to Stanford University Medical Center to see Sandra Horning, a renowned lymphoma specialist. This time, I brought the slides and scans. Stanford ordered a couple of new tests, analyzed Chicago’s material and then--a few days after I returned home--rendered a verdict.
Indeed, I had an indolent lymphoma, I was informed by Ivy Peterson, a Stanford resident who had assisted Horning. Peterson even faxed me a copy of a letter to my doctors at Chicago that confirmed their diagnosis and recommended radiation to the right side of my groin area as the sole mode of treatment. The Chicago doctors accepted that analysis and prepared to carry out Stanford’s recommendations. That’s when things really got weird.
Just days before the treatment was to start, a call came from Peterson, this one urgent. “I don’t know how to tell you this,” she began, “but we’ve made a terrible mistake.” Peterson said Stanford’s review of my biopsy slides had determined that I didn’t have an indolent lymphoma after all. Rather, she said, it was an intermediate form, similar to that which I was initially told that I had. Somebody at Stanford had written the wrong thing in a report, and that’s what led to the radiation-only decision. Since intermediate lymphomas spread faster than the indolent type, the bad news was that I would need more aggressive treatment--chemotherapy as well as radiation. The good news was that my chances of a lasting remission would improve from 50% to better than 80%.
To say that the whirlwind of changes left me bewildered, angry and shellshocked would be greatly understating the case. Experts at some of the top cancer centers in the country had told me one thing, then another, then another still. I had no idea who was right or whose judgment to trust. My mood didn’t improve when my fiancee called Horning for clarification about the mix-up. Through a receptionist, she was told that Horning saw no need to speak to her because everything that needed to be said had already been communicated to my doctors back in Chicago.
For the record, Horning denied any memory of that inquiry when asked about it months later. She also said she recalled no diagnostic mix-up nor found any record of it in my file. When I faxed her a copy of the erroneous letter to my doctors that Peterson had provided to me nearly a year before, Horning expressed “surprise,” noting that Peterson, not she, had signed it. No other explanation was forthcoming.
In the wake of Stanford’s revised report, Chicago’s experts reviewed my case and decided that perhaps Stanford was right after all. They mapped out a new course of action: I would start with three chemotherapy treatments spaced three weeks apart. Next, I would undergo what is known as a bone-marrow harvest, in which a couple of pints of precious marrow cells would be extracted from my hip and frozen, to preserve the option of performing a radical and dangerous procedure called a bone-marrow transplant should the more conventional treatments fail. Then, I was to get 15 days of radiation treatments to my right groin and to a spot in my abdominal cavity where a CAT scan showed a suspicious-looking lymph-node area.
By then, two months had passed from the time I was told I had cancer. I knew that the deadly stuff was growing inside me every minute. I was ready to do something, anything. I accepted Chicago’s recommendation.
Compared to the diagnostic roller-coaster I’d been on, the treatment itself seemed like a breeze until the final phase--radiation. By then, I’d become wiser to the pitfalls of hospital care. On the first day I asked the technicians positioning me on the table to verify the parts of my body they were about to bombard with radiation.
To my shock, the “field” covered the right groin but ignored the abdominal area that might also be cancerous. If even a single cancer cell remained alive after my treatment it would likely reproduce, and the disease would spring up all over again.
As it turned out, Ramez Farah, my radiation specialist, was on vacation. So one of the technicians telephoned a physician working with Farah and then returned to say that he’d been instructed to go ahead and zap me anyway. After the treatment, however, I phoned the second doctor myself. He told me his order to the technician had been to not give me any radiation until things were straightened out.
NOT LONG AFTER I STARTED treatments, the University of Chicago Medical Center launched an advertising blitz that continues to this day. The airwaves have been saturated with the visions and sounds of patients thankful that their care is entrusted to a hospital famed for breakthroughs in cancer treatment, liver transplants and other serious maladies. Newspaper ads tout “one of the most internationally distinguished and renowned teams of experts in the world.”
It’s a slick image campaign, reported to cost in the seven figures and designed to lure new patients--preferably those with private insurance--even though the university medical center is a financially healthy, not-for-profit facility. It is also, surely unintentionally, an advertisement for Doctor Hell, where what’s best for the patient sometimes takes a back seat to what’s best for the institution and its bureaucracy, which will live on regardless of whether those it cares for do. “First and foremost, medicine is a business, and it follows many of the instincts of a business,” says Lowell Levin, professor of public health at Yale University.
The Chicago ad campaign doesn’t sit well with much of the medical center staff, which considered itself deluged before the promotion began. “Physicians here are really appalled,” says Geller, my oncologist. “The hospital is already very crowded.” In fact, I rarely had a test or appointment that started even close to schedule. My first CAT scan began four hours late; the waiting room was stacked up like the skies over O’Hare International. Elsewhere, doctors spent five minutes on a kidney problem here, 10 minutes on a leukemia there, maybe 15 on a bowel cancer behind Door No. 3. It had an assembly-line feeling.
But oncologist Samuel Hellman, an executive on the staff of the 637-bed complex that also logged more than 350,000 outpatient visits last year, says that accommodating the growing patient load wouldn’t be a problem. “While our clinics are full,” he acknowledges, “we should like to meet our mission and see patients who need liver transplants, who need the most advanced cancer therapy.
“And so we’re trying to make people understand that this is the kind of place (to come to) if you have serious illness.”
The practical side of delivering such advanced therapies means that patients rarely see the doctors who attracted them to the facility in the first place, a common experience at large teaching hospitals. The scampering, overworked medic corps is composed by and large of “fellows”--physicians who have completed their residencies and are now apprentice specialists. Full-fledged faculty members, such as Geller, oversee each case, an arrangement that in theory enables the experts to participate in the care of more patients than they possibly could if they did all the work themselves. But in reality, the fellows have the lion’s share of contact with the patients. Many, including the fellow assigned to me, are quite good and conscientious but are not the world-class specialists ballyhooed on TV. At least not yet.
Specialization itself contributes to patient problems. The days of Marcus Welby cradle-to-grave treatment for the whole family are gone. Now you see an oncologist for cancer, a gastroenterologist for your ulcer, a urologist for bladder problems and so on. For the business of medicine, specialization is advantageous: A 1989 AMA survey showed that generalists such as family practitioners averaged an annual income of $95,900, while radiologists took in $210,500 and surgeons $220,500.
In theory, specialization should mean a higher degree of expertise applied to a particular problem. But in a big hospital, it can also frustrate overall care; so many doctors and egos get involved that treatments can conflict, and patients are left bewildered, or worse.
Sidney Wolfe, a physician and co-founder with Ralph Nader of the Public Citizen Health Research Group, tells of a patient with a variety of problems--including cancer and heart disease. He went downhill quickly when disagreeing specialists ordered treatments for his various problems but neglected to coordinate them. “He became a series of organs ranging from the prostate to the heart to his lungs to his kidneys,” Wolfe recalls. “There was no quarterback directing the team. . . . This is a very serious problem, particularly for older people who are taking multiple drugs and have multiple organ problems to start out with. It is not infrequently bedlam.”
Alfred Katz, professor emeritus at the UCLA School of Public Health, says glitches in patient care also arise because government and insurance reimbursement schemes reward doctors for the volume of people they treat rather than the quality and length of time they spend with patients. “The system encourages doctors to take too many patients,” Katz concludes.
Ed Rosenbaum knows as well as anyone how modern medical reality can affect patient care. A Portland, Ore., rheumatologist, Rosenbaum came down with cancer of the vocal cords and--like me--found himself misdiagnosed, kept in the dark, shuffled among experts and waiting endlessly for appointments to begin. Now retired, Rosenbaum wrote a book about his experiences that inspired last year’s film “The Doctor.”
When he began practicing more than 50 years ago, Rosenbaum said in an interview, the physicians’ ability to cure serious diseases was limited, so they spent more time trying to comfort their patients. But as medicine advanced--and as it became big business--he found it had regressed in personal terms. “We began to neglect the art of medicine, the laying on of hands.”
In the preface to his book, “A Taste of My Own Medicine,” Rosenbaum eloquently summarized the shortcomings of the modern doctor-patient relationship and indirectly prescribed a resolution: “When I became ill, like my patients, I wanted my doctors to be gods--and they couldn’t be,” he wrote. “But I also wanted them to understand my illness and my feelings and what I needed from my physicians. Those things they could have done--and some of them didn’t.”
IT ONLY TOOK A FEW DAYS TO figure out the radiation-field mix-up in my treatment. The specialists had to readjust their instruments to get the whole problem area into the sights of the X-ray machine, and the treatments proceeded without a hitch.
But once again, what was at the least a miscommunication shook my already faltering trust in the system. It also introduced me to the bills from Doctor Hell.
The bills to readjust the field came to $1,233. But the hospital had already charged me $2,455 to set things up the first time around. I was expected to pay both when they did it wrong and when they did it right. Farah, the radiation specialist on my case, insisted that no mistakes were made in designing the original field, according to an official hospital response to queries for this article. The enlargement, he insisted, was necessitated by the results of tests conducted sometime following my chemotherapy. Yet no such tests were ever done, at least not on my body.
When an auto mechanic puts in a faulty fan belt, or when that new stereo plays only one channel, consumers expect the problem to be rectified free of charge. But whether hospitals should be judged by the same standard is a “complicated question,” according to Hellman, the oncology chief at Chicago. “You’ve got to remember that a hospital is not General Motors,” he says, cautioning that he didn’t know enough about my case to render a judgment. “(This) hospital is a nonprofit organization. In the end someone is going to pay for a procedure. Whether it was wasted or not wasted . . . someone’s eventually going to get charged for it.” Caveat Emptor .
Even justified bills can prove maddening. A single procedure can generate two or three separate invoices: one for the use of hospital facilities and staff, another for the services of an expert you never see and still another from an outside laboratory. Several times, I received late-payment notices regarding bills I never received. The culprit: incompatible computer systems, in different departments, that failed to pass on my change of address after I moved part of the way through my care.
Another Chicago hospital, Humana-Michael Reese, which I used for a procedure related to my treatment, sicked a collection agency on me, even though it had never sent me a bill. I complained, and some checking uncovered 70 other patients whose first billing notice came from the debt collector, according to Maureen Braig, a Reese official, who apologized.
My experiences, it turns out, were not unusual. A few years ago, a major credit bureau audited thousands of hospital bills and determined that 98% contained inaccuracies. Not surprisingly, when a group of hospitals commissioned its own study, the results were virtually opposite. The truth may lie in between, but it still points to an error-prone system.
On top of all this, just reading the bills can be a daunting task. Richard Landen, associate director of the Health Insurance Assn. of America, an industry trade group, calls them “notoriously user-unfriendly. It takes a fairly deep understanding of medical terminology and procedures to decipher most hospital bills.”
The reason for this, Landen explains, gets back to the question of whose needs are being fulfilled. Bills, he says, are designed for the ease of insurance companies and programs like Medicare and Medicaid, which pay the lion’s share of the nation’s $600 billion in annual medical charges. The patient, on the other hand, only pays 21% of the total.
THE TRULY SAD THING ABOUT Doctor Hell is how wide a net it casts. Tales of medical nightmares are disturbingly easy to come by.
Esther Cohen suffered two strokes and finally slipped into a coma. Still, her family kept vigil at her bedside in a Chicago-area hospital. Her daughter Sharon, a writer friend of mine, remembers a moment that still cuts like a knife. The intensive-care doctors were making their rounds. “No need to go into her room; she’s terminal,” one of them loudly declared, just outside Cohen’s cubicle.
“It was the most painful situation, and they didn’t do anything to help,” Sharon says.
Carla knows the feeling. She visited a well-known neurologist to find out what was causing the tingling and numbness in her right leg. After tests, she showed up for her appointment on time, cooled her heels in the lobby for 90 minutes, then was curtly informed she had multiple sclerosis but offered no advice on how to deal with it.
She started to cry. Without skipping a beat or saying a thing, the expert whipped out his pad and wrote a prescription for antidepressants. “It was like he was saying, ‘It’s not my business to let you down gently,’ ” Carla says, “ ‘it’s my business to diagnose you and find a cure for this disease. Since you don’t fit into that scheme of things, take these and get out of my face.’ ”
And then there was Jane. Back in 1983, Jane was treated for breast cancer at Evanston Hospital, a suburban-Chicago teaching facility affiliated with Northwestern University Medical School. For several years she appeared to be disease-free, but by late 1989 the cancer had returned and settled into the bones of her back.
Clearly, the prognosis was not good. Breast cancers that recur usually are fatal. Still, her doctors started radiation, and later chemotherapy, in an attempt to slow the spread of the disease and ease her pain.
For a time she seemed to improve. Eventually, though, one of her hips began to throb, and a bone scan was performed shortly after New Year’s in 1991. The radiologists who read it found no evidence of cancer there. The pain persisted, and a month later X-rays were taken, and they looked suspicious. So, as Jane related, her doctors reviewed the earlier bone scan and determined that it had been misread. Indeed, one radiologist told her that the hip and thigh bones were so eroded by cancer they looked like Swiss cheese.
Alarmed, the radiologist wanted to resume radiation immediately. But there was a catch: Jane’s hip was already so brittle that it could shatter simply under the weight of her own body. Radiation might make it even more fragile. So Jane was sent to an orthopedist for an opinion on whether the hip should be radiated or replaced with an artificial implant. His name was Gregory Palutsis. According to Jane, Palutsis examined her and said he would have to consult with the radiologist and her oncologist before rendering a judgment. Palutsis promised to get back to her quickly, she said.
But then it was as if he’d dropped off the face of the Earth. He didn’t call; nor did he return her repeated calls. Her son asked someone in the hospital’s public relations office to prod Palutsis. Nothing happened. Then her internist was asked to lean on Palutsis. Finally, more than a week after Palutsis said he’d get back to her, he called and said more tests were needed. Ultimately it was decided to remove the hip, but three weeks elapsed from the time she was sent to Palutsis on an urgent basis and the time she entered the hospital. And nine weeks passed since the bone scan that she believed had been misread.
The reason I know so much about Jane’s case is that she was my mother. While I was fighting medical bureaucracies on one side of Chicago, she was struggling with them in another part of town.
The tragedy of my mother’s case was that the final outcome would have been no different even if Palutsis and the radiologists had been more responsive. But in her waning days she might have suffered less pain, and certainly less anxiety.
In preparing this article, I asked officials at Evanston for their side of the story. Traci J. Auble, a hospital representative, said the primary doctors involved in my mother’s care, including Palutsis, were convened to discuss the case and concluded that she received “comprehensive quality care.” In a one-page letter drafted on the advice of legal counsel, Auble said the hospital could not discuss my mother’s case with me because I approached them as a reporter and not her son. “As you can appreciate the need for maintaining patient confidentiality, it is our policy not to comment on the specifics of this, or any other patient’s care,” the letter said.
My mother lingered in Evanston Hospital for 55 days before and after her surgery. During that time, some of the same doctors who now claim confidentiality talked freely with me and even asked me to decide whether they should try to resuscitate her if she went into cardiac arrest. They never got the chance.
She left Evanston for the last time on May 9, 1991, two days before her 79th birthday. On Mother’s Day, May 12, she slipped into a semi-coma. She died four days later at home in her own bed.
IN MY CASE, THE PROGNOSIS IS much more hopeful. It has been a year since my last radiation treatment, and there’s no sign of cancer. I’m told that every disease-free day that passes reduces the chance of a recurrence.
Every few months, I go back to Chicago for a precautionary CAT scan. My wife and friends tell me I’m a nervous wreck while I wait for the results. I’m also told I’ve acquired the annoying habit of rubbing my neck and other parts of my body to feel for lymph nodes, as if they might have suddenly swelled since the last spot check 15 minutes before.
But cancer and the fear of death don’t seem the all-consuming bogymen they once did. Still, each return trip to the hospital, however perfunctory, is a reminder of the bad old days thrashing my way through Doctor Hell.
On one level, my complaints may sound like the whining of an ingrate. Cancer takes millions of lives, often horribly, every year. I survived, knock wood, and didn’t really suffer any of the physical tortures many cancer victims endure.
Indeed, the health-care system itself has problems far more pressing than those that faced me: runaway costs, the uninsured, the untreated--all the issues that are suddenly at the forefront of the nation’s agenda. I was insured, I did get treatment, I’m alive.
In a sense, I was lucky. Not lucky to get cancer, of course, but at least lucky enough to come down with it when I was young enough, clearheaded enough and simply ornery enough to second-guess some of the things people were proposing to do to me.
That may be the best prescription for surviving a health-delivery system so flawed that it can hurt instead of heal. As Lowell Levin, the Yale critic, put it: “It’s the cranky patient who asks a lot of questions, who isn’t satisfied, who is suspicious and concerned, who is assertive and on the muscle--these are the individuals who fare better than the population as a whole.”
