July 1, 2021

Have Mercy

Mercy Hospital was one of the 9 sites in the city of Chicago that was rotated through my EM residency training program. My very first shift there, my resolve to be an emergency doc was tested. A patient came in through the front door in acute respiratory distress. He was decompensating quickly, and by the time he was pulled onto the ER cart in the back, he was in florid respiratory failure, already unconscious, incontinent of urine, and cyanotic. My senior resident confidently volunteered my services to intubate him.

There was no time to get a line, so intramuscular ketamine was given while a laryngoscope and ETT were shoved into my hands. My attending was hesitant at handing over such an important task to an intern he’d just met. I will never forget his gravelly voice as he leaned over and whispered in my ear, “Krol, we have one chance at this, and if you miss, this man will die.” I somehow responded with a Zen-like calm, rather than the expected fear. I intubated the patient, and he survived. This was my introduction to Mercy Hospital on the south side of Chicago. (As an aside, I don’t blame my attending for doubting me; as I would learn, it is much more unnerving to watch someone with less experience intubate a critically ill patient than to just do it yourself, but if we don’t allow the trainees the experience, they won’t become experienced.)

The patient population at Mercy, in general, seemed to delay care, which led to increased pathology and complications. This made it a great place to train, but also was an eye-opening window into the disparities in health care in urban America. Mercy is located due south of the magnificent mile, and southeast of the “medical district” of Chicago; however, it could be a world away as far as culture and economy from the wealthy tourist areas of downtown Chicago. The poverty, lack of insurance, lack of access to preventative health care, as well as a host of other socioeconomic factors, brought a plethora of patients to us.

During training, there is little time to consider all the political and economic forces that create such inequities, but we weren’t blind to the fact that inequities impacted our patient population. In addition to the urban poverty, there were cultural factors, too. Mercy is one of the closest hospitals to China town. We noticed that elderly Chinese patients would often rely on traditional Chinese medicine and were often reticent to seek care in an American hospital. So, when they did seek care, it was often considered a last resort, and they were commonly critically ill by that point.

I am so thankful for the training I received at Mercy hospital. I learned about sepsis, critical care, ventilation, central lines, pacemakers, and the like. I also felt the care we provided there had a real impact on our community, and the need was great. It is a safety-net institution. So, when I learned that there was talk of closing Mercy hospital, it came as a complete shock. I took a special interest in Mercy hospital, since it was an important part of my training. Talk of its closure was most certainly not a public-health decision. At the time of the announcement of the closure in 2020, Mercy’s emergency department was seeing about 44,000 visits annually, and the hospital was delivering about 1,800 babies per year. That hospital was bustling, and the need for healthcare was and is still great in that community. There is not another hospital for 3 to 4 miles which, in a city like Chicago, affects thousands of people. There were already recent closures of Metro South in Blue Island and Westlake in Melrose Park, as well, so the impact to black and brown communities certainly does seem disproportionate. The fact that the hospital closure was announced during the COVID-19 pandemic was particularly upsetting. Recent information from the BMJ on the impact of COVID-19 on life expectancy shows a disparity in life expectancy that I find alarming: “Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively. Progress since 2010 in reducing the gap in life expectancy in the US between Black and White people was erased in 2018-20; life expectancy in Black men reached its lowest level since 1998 (67.73 years), and the longstanding Hispanic life expectancy advantage almost disappeared.”1

The history of Mercy Hospital is interesting. It is one of the oldest hospitals in Chicago, having been established by the sisters of Mercy in 1852. It was also affiliated with Lind Medical school, which is one of the oldest medical schools. Victims of the Chicago fire were treated there in 1871, and President Theodore Roosevelt recovered there after being shot in the chest in Milwaukee in 1912. The famous mayor, Richard M. Daley, was born there in 1942. Nearby, Michael Reese was also one of the oldest teaching hospitals in Chicago, having been established in 1881. The closure of the trauma program at the University of Chicago in 1988 is thought to have had a significant financial impact on Michael Reese, which eventually closed its trauma program in 1991, and later closed the hospital in 2009. This left Christ hospital as the only Level 1 trauma center on the south side of Chicago for 27 years, until the University of Chicago reinstituted its trauma program in May of 2018.

I tell you this brief synopsis of the history of health care on the south side of Chicago to give an insight into the systemic problem of health care not only in that particular community, but many others like it in our country. These hospitals close, or close to trauma, due to economic factors, not because there is not a great public-health need. There is a lack of a cohesive strategy to address health-care inequities which leads to a piecemeal system of temporary fixes that can only be described as inadequate. There is political football between state and local authorities about whose responsibility it is to fix the issue. We don’t seem to be willing or able to face and address the inequities head on.

Many countries have a clearly outlined 2-tiered public and private health-care system. We have a tiered health care system that is not formal or carefully planned, but instead a patchwork of inequitable of care that impacts the communities we serve. We need to shine a light more boldly on the inequities so that we can root them out. There has always been charitable care, and there will always be a need for charitable care. The question is how we are going to pay for it, and how do we help the most people with the resources we have? Each one of these hospital closures has a domino effect on the remaining hospitals of the community who feel the strain of providing care to patients in a health-care desert. I was disappointed by the lack of outcry from the community about the closure of a large safety-net hospital. Where was the media attention, where were the protests? It most certainly did not receive the level attention of many other recent events in the news. Fortunately, there is a glimmer of hope for Mercy and the community it serves. An organization called Insight Chicago has recently stepped up to purchase the hospital and committed to keeping the hospital open to serve the community, at least with essential services.2 Let’s boldly hope they find a way to remain solvent and keep their word.

References

  1. Woolf SH, Masters RK, Aron LY. Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data. BMJ. May 2021;373:n1343.
  2. Esposito S. New owners want former Mercy Hospital to do more than simply survive. Chicago Sun Times website. Published June 4, 2021. Accessed July 19, 2021. https://chicago.suntimes.com/business/2021/6/4/22519331/newowners-mercy-hospital-more-than-survive-insight-chicago.

Pamela Krol, MD, FAAEM, FACEP
Advocate Aurora Healthcare, Grafton, WI

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