Life, Death, and Dollars in a Small American Town


Published: March 9, 2021

Publisher: St. Martin’s Press


As someone who grew up dependent on a rural, small town Iowa hospital, I was excited for the opportunity to read this book. The hospital was less than 15 minutes from where we lived. It was the hospital I was born in, went to for doctor appointments, and my parents were cared for several times for various ailments. Somehow this hospital has survived over the years, mostly due to joining a much bigger health system, but I can absolutely attest that it still has that small town feel. Two years ago, I spent nearly a month there while my dad was very ill and the staff from the PAs to the nurses to the aides to the respiratory therapists to the housekeeping and food service staff, every single one was kind and generous and personable. They seemed to love their jobs and care deeply for their patients and each other. I couldn’t have asked for a better experience for my dad. But, I know this isn’t always the case and many communities have lost their hospitals and have had to travel an hour or more to the closet hospital to receive care.

In THE HOSPITAL, Alexander begins with the history of the community he is writing about, the small town of Bryan, Ohio, in the NW corner of the state. It is just a bit over an hour to Toledo when traveling east or to Fort Wayne, Indiana, to the southwest. When you google Bryan, Ohio, you see images similar to many small towns across America; brick buildings on the main street, many empty, residential areas of older homes as well as newer, churches, parks, and businesses, some still thriving and others closed. Bryan’s history of having a hospital goes back to the early 1900s and I found the details of the creation of the hospital quite interesting. Over the years, the economics of the small town, businesses and factories closing, farms in crisis, and little too few jobs all had an effect on the success of the hospital. When families were struggling, the ER became their doctor’s office and the bulk of the fees fell to the hospital knowing that the patients weren’t going to be able to afford the care. Because the patients got whoever was on call, there wasn’t a lot of “shopping for care” or “personal care for the patient” because you got who you got in the ER and the ER doctor was just there to do their job and not build relationships. It was a horrible cycle that created numerous unpaid medical bills that eventually taxed the hospital’s bottom line.

At only nine chapters plus an epilogue, the chapters are quite long. I’m a chapter reader, which made this hard for me to need to spend several days reading just one chapter. It was my Kindle bedtime read and typically I only read in 10-20 minute chunks which made the chapters seem even longer. The research was very detail-heavy in spots and often more than I needed or wanted to know regarding specific dollar amounts or conversations held in the board room.

I really empathized with the personal stories of various residents of the Bryan, Ohio area and their struggles with receiving adequate health care and then paying for that care once it was received, often too late for true healing. I have no doubt that our health care system is extremely flawed. For those who can afford health care, it’s a constant worry to have the right deductible vs monthly premium and pray that nothing drastic happens to have to use it. For those who can’t afford health care, but make too much for Medicaid, there is the constant battle of how long can I avoid going to the doctor for this particular ailment because I can’t afford to pay for it.

The end of the book concludes with the beginnings of the Pandemic hitting our country and the impact on hospitals. I was disappointed in the abrupt shift to a very liberal tone once the author began this section. I would have preferred more facts on how COVID-19 affected hospitals rather than an opinionated rant about how COVID-19 was handled in the beginning stages. I also was frustrated because frankly, I was hoping for some solutions that could be taken from this in-depth look at small-town hospitals. But, there really were no solutions except for overhauling the insurance system, which isn’t something most of us, as readers, can do. Can we talk to our Senators and Representatives? Yes. Can we support our local hospitals by going to them and receiving care? Yes. But, keeping qualified doctors, specialized care, and systems that support those that struggle to pay for the care is a much bigger issue and one that needs to be tackled at the governmental level. Overall, I found parts of this research interesting and inspiration for conversations, but the systemic problems are much bigger than you or I can tackle.

Brian Alexander, an award-winning journalist and author, has written about American culture for decades. He is a two-time finalist for the National Magazine Award. He has also been recognized by Medill School of Journalism’s John Bartlow Martin awards for public interest journalism, the Association of Healthcare Journalists, and other organizations. He has been a columnist for NBC News. He grew up in Lancaster, with a family history in the glass business.

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Thanks to the publisher for sending an eBook copy of this book for the purpose of this review. This review is my honest opinion. If you choose to make a purchase through the above links, I may receive a small commission without you having to pay a cent more for your purchase.
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