Eric Manheimer, MD (2013 [2022]) Twelve Patients. Live and Death at Bellevue Hospital.

Eric Manheimer is multicultural, multilingual and as he reminds readers in the title, MD. He’s a doctor. And also the director of the biggest public hospital in New York, Bellevue. What makes Bellevue different, apart from its apparent excellence, is the hospital will treat anyone who walks through its doors. Even undocumented immigrants. Manheimer and Bellevue’s ethos represents the best of America.

His book was published and republished 17 times. Before the worst of America and the moron’s moron, Trump was elected twice, decimating public health and enriching plutocrats. The best of humanity is in these pages. The worst of humanity runs with policies that are diametrically opposed to Manheimer’s vision of health for all regardless of race, creed or most importantly the ability to pay.

I have not seen episodes of New Amsterdam, which are ‘the inspiration’ for the drama.  

We’ve all got skin in the game. We need healthcare. It makes up around twenty-percent of the US economic activity. And increasingly even then middle-classes are being squeezed and find themselves without insurance cover and healthcare.

Manheimer’s Twelve Patients are drawn from his extensive notes on over 200 patients.

‘Our cases were like canaries in the coalmines, the living warning signs of the visible and often invisible lethal global transactions and tribulations. All patients came with their medical issues and particular history that was assembled, analysed, and treated. They were by themselves incomplete stories of much larger and deeper events, geopolitical cataclysms, social dislocations, fraying societal contracts, tribal genocide campaigns, overpopulation and climate permutations.’

Read on.

Notes

  Canaries in the coalmine. What’s happening in the world. Bellvue is like a filter for the city. What’s different about Bellvue from the other 75 hospital in New York. It takes patients regardless of their ability to pay.

We will take care of anybody that walks through our doors and comes into our emergency room.

The nature of being a doctor.

I’m just want to make one comparison. We have this huge, humongous and incredibly expensive, criminal justice system.

A huge overlap. And a huge parallel.

First question: Does healthcare = health?

Transfer that to the criminal justice system. Does the criminal justice system mean safety in the community?

Second question: Is more better?

Or have we reached the upper limit? But it’s poorly distributed.

Translate to criminal justice system. If we had more prisons, more cops, more judges…Instead of spending $75 billion, we spend half a trillion, will that make us safer?

Maybe there is side-effects from the system itself, which causes its own problems.

Herman Bates. Health Commissioner, New York, early nineteen-century: ‘A society can determine its own death rate’.

200 patients. Selected those twelve because they illustrated social, political and economic issues.

A heart (transplant) costs $500 000. You can’t get a heart if you’re undocumented.

(His) Secret: ‘I never asked for permission. I only asked for forgiveness’.

1960s. New York alone had over 66 000 psych beds. Now there are less than 6000. Where do the people go?

Care promised, but never delivered. Because of the Vietnam War, which completely bankrupted the United States.

They ended up on the streets. And they ended up in prison.

The biggest system of health care in the United State is the prison system. US prison system larger than all other prison systems in the world, combined.

Chapter 1 — The One Strike Law makes no sense.

Themes:

The history and role of Bellevue Hospital

Urban decay, homelessness, and the criminal justice system

How public hospitals absorb society’s failures

Bellevue’s proximity to Rikers Island and its role as a safety net hospital show how incarceration, poverty, and mental illness converge in the public health system. New York alone had 66 000 beds for ‘lunatics’. Now it has around 6000 beds. Most graduate to the streets or justice system.

Chapter 2 — (Patient: High value prisoner)

Themes:

Intersection of medicine and incarceration

Security vs. care

Dehumanisation of incarcerated patients

What it illustrates:

The hospital becomes a medical extension of the prison system, revealing how mental illness and chronic disease are criminalised (spoon swallowers).