HJAR Sep/Oct 2021

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2021 65 Tucked in the northwest corner of the state, Bryan, Ohio, is a lot like other American small towns: people are friendly, folks know their neighbors, and they pitch in when someone’s sick. That’s es- pecially true in Bryan: the hospital there, affectionately known as CHWC (Community Hospitals andWellness Center), is the county’s largest employer, staffed bymany doctors and nurses who’ve known their patients all their lives. In other times, this might sound idyllic, like a perfect plot for a warm sitcom. Now, though, CHWC struggles. As an independent hospital lo- cated near corporate-backedmedical giants that’ve been “gobbling up small independents,” CHWC has tinier margins and less access to discounts offered by suppliers and equipment manufacturers, and its size often means that high-tech cases go to larger facilities, rather than to CHWC. It’s almost a David-and-Goliath situation but Goliath has the edge, a situation exacerbated by poverty, opioids, methamphetamines, and lack of resources. Bryan, says Alexander, is actually, literally, physically bisected by haves and have-nots. But, of course, the story of a hospital isn’t just the story of a hos- pital. Alexander writes of the town itself, and of CHWC’s CEO, who grew up in Bryan and who exhibits a sense of ownership for the hospital he loves. It’s the story of patients: a woman with cancer; a husband with major life-threatening health issues; mothers and kids; and former factory workers who have multiple jobs but no health insurance. It’s the tale of nurses, of doctors who came for a year and stayed for many, and of a hospital board that wants what’s best for the facility. And it’s a story of a budget, its balance, and the wolves at the door... It’s difficult this year, if not impossible, not to feel overloaded with medical updates and information. It’s everywhere, everybody’s talk- ing about it, and you may feel like you know enough but you may not – at least, not until you’ve read “The Hospital.” Even for readers living in ametropolitan area with strongmedical facilities, there’s a hint of foreboding inside author BrianAlexander’s words here, and in inferences that one might make about the future of community hospitals and their patients. You also get a sense that much of what happened in Bryan can happen anywhere, a realiza- tion that’s attached almost completely to money and insurance, issues which Alexander presents as two sides of a delicate scale that’s being tipped by poverty and job loss. “The Hospital” is like Hillbilly Elegy with a bad cough, just wait- ing for a room. It’s political, scary, and empathetic, with C-Suite- level details you can feel free to skip. Most importantly, this book will make you consider yourself, neighbors, and your own nearby facility, with righteous alarm and trepidation of a high degree. n “It’s almost a David-and-Goliath situation but Goliath has the edge, a situation exacerbated by poverty, opioids, methamphetamines, and lack of resources.”