The House of Hope and Fear

The House of Hope and Fear by Audrey Young


I had heard whispers of this book during medical school at the University of Washington; whispers of derision, whispers accompanied with a "knowing" look.  Not in on the secret myself, I surmised that this book must be an unflattering expose of Harborview hospital, my future (and now current) destination as a doctor, as it had been universially derided by everyone who brought it up.  I also know that Dr. Young did not remain long at her post as attending physician at Harborview, though I do not know if that was her choice or if other factors were involved.

Since I am now an intern working at Harborview Medical Center, it seemed an appropriate time to bite into a juicy book about my workplace.  My preconcieved ideas about the book were dashed, right off the bat, as Dr. Young displayed an affection and a sense of pride about her workplace.  She also wrote about the far reaching accomplishments of Dr. Copass, controversial hero that he is, and repeated his oft-quoted mantras throughout the text.

The meat of the book regards the triumphs and challenges of being a young attending physician in a hospital that largely cares for poor and substance abusing patients.  She brings to life the vivid characters I see every day in the ER, and tells their stories to not only to reveal their fascinating social situations, but to try to portray how the expensive, stop-gap medicine that we practice in the US does not go far in treating the patient as a whole, and that larger issues like social inequality need to be addressed in order to confer better health care outcomes. 

To my own discomfort, I realized that this book would have benefited from the tension and relief of a narrative regarding a young doctor making a mistake and then fixing it for the benefit of the patient and her own development.  Alas, no such plot device was to be found, and Dr. Young deftly maneuvers around any possible missteps on her behalf.  The main source of narrative discord in this book are her plaintive railings against the broken US healthcare system, a larger beast than can be tamed by one doctor's tale.  My verdict though is that this is a nice, quick read, and will especially appeal to anyone who has had any involvement with Harborview Medical Center.