Twelve Patients: Life and Death at Bellevue Hospital
US: Jul 2012
“People love to read about work. God knows why, but they do.”
—Stephen King, The Writing Life
People do love to read about work, particularly when said work is a complex profession not readily open to all. This fascination with the working lives of others, coupled with an avid interest in the human body, creates a thriving niche in medical books aimed at the lay reader. Doctor/writers like Oliver Sacks, Jerome Groopman, Pauline Chen, Perri Klass, and Atul Gawande share the ability to turn abstruse medical concepts into compelling narratives. When we read these authors, we are not reading about nameless cases, but about people whose plights draw us in.
Dr. Eric Manheimer, until recently medical director of New York City’s Bellevue Hospital, has added to the genre with Twelve Patients: Life And Death At Bellevue Hospital. Manheimer is the first to proudly explain Bellevue’s history.
While infamous for its mental hospital, Bellevue has long been more than a mental care facility. From its beginnings in 1763, Bellevue is the longest-running hospital in the United States. Its services are extensive, its facilities state-of-the-art. Manheimer is justifiably proud to work there.
Manheimer intends more than 12 sharp little medical biographies. He uses each case as a springboard from an ailing individual to greater social ills. While these digressions are intended to edify, Manheimer’s impassioned asides lose urgency with unnecessary repetition.
Further, Manheimer is preaching to a left-wing choir, assuming readers share his liberal political leanings on everything from the need for socialized medical care to a call for more lenient immigration policies. While many readers may wholeheartedly agree with Manheimer, others may be so distracted by his overt liberal agenda that they abandon the book.
Although I share Manheimer’s views, I found Twelve Patients uneven reading. Manheimer is an excellent physician who genuinely cares not only for his patients, but for his staff, as well. His respect for everyone, from nurses to hospital cleaning personnel, is evident and welcome. But the self-congratulatory ego sneaking into the proceedings is not.
Manheimer and his wife, Professor Diana Taylor, are fluent Spanish speakers with a deep knowledge and interest in South American politics and culture. The couple has traveled extensively through South America and own a Mexican vacation home.This gives Manheimer ample opportunity to interact with Mexican, South American, and Dominican patients moving through Bellevue’s system. Many are undocumented, impoverished, and forced to endure abysmal working conditions.
While Manheimer is sympathetic to their plights, often going far beyond the call of duty to get these people care and/or comfort, his generosity feeds his ego. The man never passes up a chance to use his perfect Spanish, going into detail about the rise of gangs, the drug wars ravaging South America, the gruesome revenge killings. Given the larger picture—help for those otherwise barred from care, comfort for agonized families—perhaps a bit of ego is excusable. The long digressions on South American drug wars provide useful background, sure, but they would benefit from judicious editing.
In fact, all of Twelve Patients would benefit from editing. Unlike Gawande, Sacks, or Groopman, Manheimer is not a natural writer. He is given to wordiness, a fondness for describing the same surroundings countless times (his office overlooks the UN building, which is endlessly detailed), and awkward constructions. Like many memoirists, he appears to have an uncanny memory for dialogue. This is in service to the book, but denies plausibility.
This is not to say Manheimer is trying to mislead readers. But much of the more awkward dialogue could be eliminated in favor of description. Remaining conversations don’t need “she rejoins,” “I ask,” “Carefully calibrated, Tanisha responded,” My point is not persnickety, unkind criticism. This wordiness pulls the reader from the action—the patients, their families, their doctors and caregivers.
The opening chapters of Twelve Patients are compelling enough to overcome the book’s flaws. We meet Juan Guerra, a 59-year-old career criminal dying of cancer. Manheimer’s description is of a basically decent person who had little chance in life. Despite multiple incarcerations, drug problems, and terminal illness, Guerra has managed to keep his family together, including his devoted wife of 35 years. The hospital staff secures his freedom so he can go home to die.
The next chapter is devoted to Tanisha, a young woman of tremendous inner strength. A lifelong foster child, she has been raped countless times, repeatedly running away from abusive families. Once, early in her life, she stayed briefly with a family who loved her. When the matriarch died, Tanisha was moved again. Manheimer sets off on a quest to find “Abuela’s” (Spanish for grandmother) extended family in the hopes that they not only recall Tanisha, but are willing to take her in. Incredibly, joyously, they remember her fondly, and despite their limited income, welcome her home.
Manheimer counts himself amongst the 12 patients. He developed a squamous cell carcinoma near his throat, necessitating grueling treatment—platinum chemotherapy and radiation. His weight dropped from a healthy 155 pounds to a skeletal 123. Unable to swallow, he dripped Ensure through a line into his belly. Radiation left him too exhausted to function. Ill and depressed, he withdrew, indifferent even to his grandson’s birth. He attributes much of his recovery to wife Diana. If his suffering helps him connect to his patients, he doesn’t say so.
Octavio Salcedo, an illegal immigrant working in the States, also develops a squamous cell carcinoma, but is less fortunate that his doctor. At age 32, his body is literally rotting from cancer; one leg, beyond rescue, has been amputated at the hip. There’s nothing for him but a morphine pump. He wishes to die at home, in Mexico, where he can be with his children. His young wife stands by staunchly, soon to be a penniless widow with small children. Again, we are shown the tremendous lengths Manheimer and his excellent staff will go to so the Salcedos may have their final wish. Their heroic efforts will leave only the most heartless reader dry-eyed.
A story about Arnie, a Wall Street high-flyer who loses everything to drug and alcohol addiction, is less cohesive yet still saddening. While it’s easy to hate a man who grew wealthy off the losses of others, Arnie pays dearly. Even when he manages to clean up, he’s left unemployed, with the fallout of angry ex-wives and deeply troubled adult children. et his story ends on a fragile note; we learn nothing about what happens to him. Closing this vignette, Manheimer writes: “I… pondered the nature of forgiveness.” Don’t we all.
“A Heart for Rabinal”, halfway through the book, is the final story where the characters are able to transcend the writing. Thirty-nine-year-old Soraya Molino, a single mother, is near death from heart failure. As her story unfolds, it’s impossible not to fall for her sweet nature, which carries the reader even as Manheimer once again delves into tremendous detail about drug traffickers, this time in Soraya’s native Guatemala. Even as Soraya wins over the hospital staff and her landlord, who marries her, the new heart arrives too late.
At this point the stories in Twelve Patients are no less urgent, but it appears the editors split for the Hamptons. In “Four Generations”, hospital housekeeper Marta Sahagún runs between her pregnant, dying daughter and her aged, diabetic mother. It takes careful reading to figure out who’s who in the Sahagún family, but the real theme is obesity. While Manheimer acknowledges that nobody is forced to consume unhealthy foods, he is firmly in the camp who feels corporate food conglomerates are at fault for the rise in diabetes and obesity.He takes the opportunity to ding Bellevue for its exclusive contract with PepsiCo, extending his rant to companies like Snapple, Carnation, and RJR Nabisco.
The hopelessly Schizophrenic Jeffrey represents mental illness and the many ways it goes untreated. Manheim is quick to cite the persistent lack of funding necessary to care for this intractable illness. rom Jeffrey we move to arguably the weakest entry, “Trauma Detroit”, so nicknamed, well, just because. Why not knock my hometown when it’s already down? “Trauma Detroit” is a woman shot in a mugging. The bullet entered her groin. She almost bleeds to death before the hospital, simultaneously dealing with a wealthy lawyer who is also bleeding, gives the wrong blood to each patient.
It’s as if this horrific mistake takes the writing down with it. While we’re given lots of irrelevant background on the lawyer, his family, and his rich girlfriend, we’re told the “Trauma Detroit” is a dancer but not whether her injury is career-ending. Atop this, her husband is a veteran of Iraq and Afghanistan, a PTSD sufferer on disability whose experience, by his own description, “Fucked me up pretty much.” Add to this a distant mother, the possibility of incest with the father, which may or may not be ongoing, and you have one hell of a mess. Such a mess that Manheimer didn’t seem to know what to do with it, abruptly concluding with “The trail gets cold.”
We get another career criminal, this one nobody’s definition of nice, along with an even longer disquisition on narcotics trafficking, police involvement, and gang activity in South America. A woman who is the child of disappeared parents. More mental illness.I understand many of Manheimer’s patients are victims or even perpetrators of the South American drug wars, but that’s another book.
I’m not trying to write unkindly of Dr. Manheimer’s effort. Certainly he is skilled, generous, and devoted. But we aren’t all writers. This isn’t to say Dr. Manheimer doesn’t have a great deal to import, but Twelve Patients: Life and Death at Bellevue Hospital would have benefited greatly from professional assistance—better editing, even a professional ghostwriter.
Doubtless, Manheimer has many more patient stories. Next time.