My book report: The malady lingers on

Timothy Snyder, Our Malady:  Lessons In Liberty From a Hospital Diary, 2020, Crown

"In short, a man comes in here in perfect health," says Dr. Bock (George C. Scott) in The Hospital,  "and in the course of a week we chop out one kidney, damage the other, reduce him to coma and damn near kill him."  In Paddy Chayefsky's film, the victim gets revenge in ways which illustrate the shortcomings of modern American medicine.  Most of us would sue.  Timothy Snyder wrote a book.

The author of Bloodlands, Black Earth and other important works on twentieth century Europe was not in perfect health when his ordeal began.  He presented, as they say, at a Munich hospital with abdominal pain but perhaps because he didn't complain enough (coming from a Midwestern farm family where men did not gripe), they failed to diagnose appendicitis.  He flew home with a perforated appendix and underwent surgery in New Haven.  The post-op antibiotics were insufficient or incorrect, and by the time he joined his family for a Florida vacation he was already septic.  

Unsatisfied with his treatment in a Florida hospital (he's not specific) he returned to Connecticut thanks to his wife's organizational skills with paperwork and wheelchairs.  In the emergency room, surrounded by cases eerily reminiscent of Chayefsky's film, he was eventually admitted, wheeled into an alcove and all but "neglected to death" with an as-yet-undiagnosed liver infection.  Snyder had an advocate in the form of a physician friend who stayed with him and tried to attract the attention of someone who could help, but even she was unsuccessful.  Tests were done but nobody recognized the implications of the results.  He endured two spinal taps because something went wrong with the first.  Eventually he had liver surgery and it only took three tries to get the drain properly positioned.  And in spite of all this, he observed and thought and kept the diary "stained by saline, alcohol and blood" which forms the basis of this book.                  

You might expect the holder of an endowed chair at Yale with excellent insurance to get better care than, say, a Medicare patient in Georgia.  You would be wrong, I note with ill-concealed satisfaction.  The system of medicine for profit does nobody any favors and will only change when more privileged patients are forced to experience it.  Living part of the time in Vienna, where his son was born, Snyder contrasts the Austrian system of pre- and post-natal care with America's, where newborns and their mothers are hustled out of the hospital and the obsession with the unborn does not translate into concern for the early lives of children.  We are falling behind in life expectancy, crippled by opioid addiction resulting from bad care as much as from despair, and told that ours is the best system on earth because of the freedom it affords.  But as the sacred Founders knew (this is where it helps to be a historian), freedom without health is meaningless.  

All this is starkly in evidence because of the covid pandemic, which arrived during Snyder's time in the hospital.  A month or two later he would not have even been admitted to the overflowing emergency room.  He mercilessly quotes Trump's own tweets full of magical thinking and astonishing propaganda:  "Great discipline is taking place in China, as President Xi strongly leads what will be a very successful operation."  (The White House banned the Washington Post and New York Times but apparently still gets the People's Daily.)   When this book went to press only 150,000 Americans had died of covid.  It seems like a very long time ago.  Competent, less corrupt leadership could have saved lives but the system, as it exists, would still need an overhaul.

Dr. Snyder's prescription is a familiar one:  single-payer for all.  Take power from the corporations and insurance companies and return it to doctors and nurses.  Forgive student debt for doctors who locate to underserved communities.  Plan for epidemics, because there will be more.  Revive the ancient and honorable practice of making house calls.  Remember that the first years of life are crucial, that no parents can or should have to go it alone, that a free and fair society starts with happy, healthy kids.  On the last page he writes, "We deserve freedom, and we need medicine that works...It would begin from the premise that we have a right to health care.  Does that sound like a dream?  Let it be the American one."

It's a short book, a pamphlet really, only 146 pages.  Joe Biden could read it in a weekend.  Someone needs to make sure he gets a copy.