Chapter 1: Histories -- 1 -- Histories The rumor we heard was that patients arrived with hand-drawn maps, our hospital marked like treasure. The stately Nigerian lady who responded, "Yes, Doctor," to everything (metastatic breast cancer). The boy with the black curly hair wearing red Converse All Stars and a Judas Priest T-shirt that screamed Mexico City (acute lymphocytic leukemia). The grandmother with the sari snagged in the guardrails (chest pain, real chest pain, might need bypass). We stood at these patients'' bedsides; we wrote down their histories; we said we were sorry for examining them with cold hands. We ordered blood tests, interpreted EKGs, scrolled through their CAT scans; we input diagnoses. We weren''t just doctors. Among us were nurses, social workers, X-ray techs, the people who rode up and down the hallways in the middle of the night waxing the floors.

Some of us wore white coats with frayed sleeves and busted pockets, others tight-fitting scrubs embroidered with our names. In our bad moments, we became tribal: we weren''t "we," we were ortho, medicine, plastics, the 4A nurses; we only covered the unit. More often though, the needs of our patients were so damn immediate, we found a way to work as one. We ran blood transfusions, heparin drips, a morphine pump when Norco didn''t touch the pain. When COVID came, we gave oxygen together, one of us twisting the knob on the valve while the other inserted those tiny prongs into flared nostrils. We consulted one another when things looked dicey: surgery if we found boils, ID for antibiotics, and if anything looked remotely like a seizure--a twitch, a rolling of the eyes--we paged neurology overhead. If Transportation was swamped, we wheeled them ourselves, to MRI, to Special Procedures, to the cath lab, even the ICU (how downtrodden we looked when we did this, like beaten dogs). We figured out ways to make things work.

Not enough money for your meds? We googled the $4 list at Walmart. Muscles too weak? We dug up a refurbished walker from the basement. Dying and homeless and alone? We called in a favor from the hospice that used to be a Tudor-style home. And when our work was done, once we could envision someone not dying within twenty-four hours of our discharge order, once the first chemo had gone in, once we could be sure their chief complaint was addressed, the thought still lingered in our minds: What brought them here? What are their stories? Ben Taub Hospital. The largest safety-net hospital in one of America''s most diverse cities. We are Heathrow if you replaced the Emirates and the Virgin Atlantic planes with Greyhound buses. There are no atriums with pianists here playing "Here Comes the Sun" to welcome you, no soothing sounds of running water from hidden speakers or-- gasp --from an actual indoor waterfall. There is no Starbucks.

Our cafeteria serves some form of barbecue most days for lunch and packaged salads topped with egg or chicken strips. That''s unless you prefer the full-menu McDonald''s (located inside the hospital) that''s open twenty-three hours a day. We do have a gift shop, though it looks more like a convenience store, heavily stocked with greeting cards. Not the pun-filled ones; rather, the kind that get the point across--condolences--available in Spanish, too. If you type "Ben Taub" into Google Maps, you''ll find it crammed between the Houston Zoo and the thirty other institutions that make up the Texas Medical Center, the largest concentration of medical facilities in the world. Some of the field''s most important innovations took place in this medical metropolis: the first successful bypass, the first artificial-heart transplant, the first beatless artificial heart (imagine that, no lub-dub, just a constant whirring), the first silicone breast implant, one of the first civilian helicopter ambulances, the Bubble Boy--all here. Not that the patients at Ben Taub know this. Some may have heard that MD Anderson is rated top in the country in cancer care, or that at Houston Methodist, you might find yourself fortunate enough to have a robot operate on your prostate (the TV ads air in Spanish, too).

It''s possible that at night, our patients look out their windows and behold the sparkle of so many new glass buildings, some of them named after billionaire sheikhs who sell the oil that becomes their gas. More likely, they''re looking out in the direction of the zoo, toward the parking garage and bus stop, wondering how they''ll get home. Ben Taub is Houston''s largest hospital for the poor--many working, some not--who cannot afford medical care. That is, after all, the definition of a safety-net hospital: one that serves society''s most medically and financially vulnerable. The vast majority of hospitals in the US are either for-profit or nonprofit. Nonprofits receive a tax incentive to provide care to the uninsured, though that care is often limited to stabilizing emergencies due to the high cost of medical care. For-profits behave similarly. Safety-net hospitals have emerged in America''s coverage vacuum to give the uninsured a way of receiving healthcare.

Ben Taub is a public, locally funded hospital that focuses on the uninsured but that is also open to people with health insurance. In Texas, the state with the nation''s largest uninsured population, and perhaps the worst state in the union to live in if you''re poor and chronically ill, scores of people come here. When they do, the community picks up half the tab through property taxes. The rest comes from a variety of sources, including Medicaid, Medicare, and payments made directly by patients. Ben Taub is the flagship hospital for Harris Health, the healthcare system catering to Houston''s uninsured patients. Five hundred sixty people stay at Ben Taub or Lyndon B. Johnson Hospital, its sister hospital, every day , and thousands more receive primary and specialty care at the county''s network of clinics, accounting for more than $1 billion worth of healthcare every year for the indigent. But there are instances when the insured and even the rich prefer Ben Taub.

Whenever I mention to locals that I work as a doctor at Ben Taub, I receive a fairly typical response: "That''s where I''d go if I got shot." Maybe this sounds uniquely Texan, but I''ve heard the same about traffic accidents. Whenever there''s a pileup on the freeway, it''s not uncommon to hear the radio announcer report something like, "Crews on the scene, the victims have been taken to Ben Taub." Ben Taub''s reputation in Houston is nothing short of sterling when it comes to trauma care, which is why it''s not uncommon to find the crushed, the burned, the dismembered, the stabbed, the shot up, the opened, the clipped, and the repeatedly tased sharing a room with patients beleaguered by mental illness and poverty. People outside the medical field might wonder why anyone would want to work in a place like this. Why deal with so many social problems and a lack of insurance when you can practice in one of the many hospitals down the road? Aren''t you ambitious? You''d have to be some sort of a do-gooder--a bleeding heart--to work here, the thought goes. This sort of characterization, however, while flattering, isn''t entirely accurate. Take Dr.

Ken Mattox, a trauma surgeon at Ben Taub who served as its chief of staff for over thirty years. Mattox is what you might call a quintessential old-school surgeon--he''ll wear scrubs only in the OR and on call nights ( never at restaurants), he''s always cleanly shaven, and he moves methodically down the hallways, even on the way to his patients awaiting exploratory laparotomies for multiple gunshot wounds. Because there''s never a need to rush. Like many Texans, Mattox opposes the federal government''s issuing regulations that can encroach upon local practices. The mandate to purchase private health insurance in the Affordable Care Act irked him, for instance, because patients at Harris Health already received coverage without having to buy insurance. He can sound like an ideologue when speaking about welfare--"I don''t want to take care of somebody that is indigent who is capable of working and making their own way"--but Mattox has dedicated the bulk of his career to ensuring Houston''s indigent patients receive excellent care. This includes undocumented immigrants. In fact, in 2001, when then-attorney general and current US senator for Texas John Cornyn wrote a legal opinion about how Ben Taub and the county health system might have been breaking federal law by providing nonemergency treatment to the undocumented, Mattox addressed Harris Health''s board of managers, who were fearful that federal funding might be cut off.

"If I need to be reported for my clinical care, report me," he said, insisting that services to this population ought to continue. "But spell my name right." A whole array of competing ideologies collide at Ben Taub. But when it comes to caring for uninsured Houstonians, the healthcare workers at Ben Taub--doctors included--put their political philosophies aside, for good reasons. Ben Taub is an excellent classroom. It''s where the diseases and maladies you read about in textbooks come to life, and it''s intended as such--Ben Taub is a designated medical education site, and many of the stiff white coats you see scuttling down the hallways are those of students and young doctors in training. You might spend a lifetime with patients at private hospitals without seeing belly tuberculosis, or even cardiac sarcoidosis, where all the cells infiltrating the heart glimmer on the ultrasound. If you spend enough time at Ben Taub, you''ll see most everything.

It''s.