Friday, May 31, 2013

Dr. Davis, Brick City and Austerity -- A Book Review

Disclosure: This is a book review with an agenda. The book, Living and Dying in Brick City by Dr. Sampson Davis, is another exhibit in the ongoing saga of an American underclass, specifically in the African American community. And the agenda is that of an old guy in retirement who has watched the wealth gap between rich and poor in America yawn wider than ever in living memory. Sampson Davis is one of the rare flowers that sometimes flourish and bloom in a thicket of weeds.


Readers familiar with the challenges described in this book will nod in agreement as Dr. Davis unfolds a taxonomy of problems faced by life at the margins of society. From substance abuse and gang activity to medical problems -- chronic or acute, seen or unseen -- he brings each to light with insights only possible for someone who has been there and done that. This guy knows what he's talking about. He has a way of "telling it like it is" but treats his subjects and readers with respect.  This book does more than paint a big picture. Each chapter focuses on some specific subject in a way making it come alive for the reader, ending with a summary of how to respond, remediate or possibly avoid the problem altogether. 

Chapter titles offer a clue in each case to the underlying problem being addressed. "Love Hurts" is about domestic violence. "Baby Love" covers contraception from the rhythm method to surgical sterilization, ending with a list of adoption agencies specializing in African American Adoptions. "No Air" describes the horrors of asthma and underscores the medical complications of smoking. And so it goes, an unrelenting list of problems he knows from personal experience, both by observing his peers while growing up and as an emergency room physician facing the medical fallout, all too frequently when intervention comes too late. 

Readers not familiar with Dr Davis should buy this book, even if they already know what to expect, for no other reason to support the writer and advance what is for him more of a mission than a quest to make big bucks as a writer. Buying his book is a good way for any who care about improving life for the working poor to be supportive of his work and spreading the word. 

Having said that, I cannot now ignore a story from yesterday's New York Times that stands in sharp relief to stories in this book. When she passed away two years ago at the age of 104, Huguette Clark left a three hundred million dollar estate. But unlike most rich old people, she had spent the last twenty years of her life as a resident in Beth Israel Medical Center, the very same place where Dr. Davis worked as an ER physician, gathering material for this book. The contrast between the life and death of Mrs. Clark and that of the people described by Dr. Davis is surreal. 

She came to the hospital in 1991 in terrible condition. 
Mrs. Clark, then almost 85, arrived at Beth Israel’s north campus on the Upper East Side on March 26, 1991. She was emaciated and her face was disfigured by skin cancer. She was missing part of her lower lip, which made it hard to eat or drink, according to notes made by Dr. Henry Singman, the admitting doctor who later became her full-time personal physician. 
“The circumstances of her admission were particularly strange: She was swathed in sheets and did not want anyone to see her,” Cynthia L. Cromer, a member of the Beth Israel development, or fund-raising, staff, wrote in a memorandum to “file” on June 7, 1991.
But her condition was stabilized and she was on the road to recovery when, thanks to the influence of her station in life, she escaped the fate of thousands of other ER patients who, lacking funds or insurance, are sent on their way in accordance with EMTALA
She was well enough by then to go home to her spacious apartment at Fifth Avenue and 72nd Street, overlooking Central Park, Ms. Cromer said, but “she asked if she might stay in the hospital longer: she feels comfortable and safe, and her apartment is being renovated.” 
Dr. Singman had told the development office that Mrs. Clark was “quite wealthy and suggested that she might make a gift to the hospital,” Ms. Cromer wrote, adding that she was mulling over “an appropriate cultivation approach.”
She not only remained in the hospital, she made the hospital her new place of residence the last two decades of her life, with hospital staff and resources taking care of her every want in a manner that would make the British aristocracy of Downton Abbey green with envy (except that allowing themselves to admit an impulse as pedestrian as envy would be beneath their station). 
Over the years, the hospital showered her with gifts like classical music CDs, an orchid, birthday balloons and an Easter basket. 
Mrs. Clark sometimes replied in writing. 
In a card dated Nov. 30, 1992, she thanked Dr. Newman “for the most delicious home made Thanksgiving desserts, which I enjoyed very much.” Dr. Newman annotated the file copy, crediting his wife: “5 different homemade pies (chez Seiko)!” 
On Oct. 30, 2000, Mrs. Clark thanked Dr. Newman and his wife “for the delicious chocolates, and the very interesting playing cards from Paris.” 
Earlier that year, Dr. Newman announced that he planned to retire, upsetting Mrs. Clark, according to the documents. 
“She is crazy about him and is also afraid that her position at the hospital might be compromised with him gone,” a development officer wrote. (When Beth Israel’s north campus closed in 2004, Mrs. Clark was moved to the campus on East 16th Street.)
Readers are invited to check out selected passages of Dr. Davis' work at Google Books and follow up with purchasing more than one copy as a gesture of support for his work and mission. My guess is that everyone knows at least two or three people for whom this book would be a welcome gift to read and pass along.

And as you read, reflect on the contrasts between your life and the lives of most readers, the lives Davis describes in his book and the extraordinary lifestyle of the now famous One Percent, typified by the subject of yesterday's Times story. To be clear, this bias and message is not that of Sampson Davis. He's too much a gentleman and professional to let political or social commentary stain his stories. When discussing contraception or unwanted pregnancy, for example, I don't recall even a passing reference to the subject of abortion. And perhaps as a child of Beth Israel Medical Center he is too much a gentleman to say anything that might damage that revenue stream, no matter where it comes from. 

One of the watchwords of our day is austerity, a wonderfully vague term carrying messages of thrift and good stewardship. We have all heard that during the Great Depression nothing was ever wasted, and during the Colonial era scrap fabrics were recycled into quilts and braided rugs. Fables of the grasshopper and the ant as well as New Testament injunctions that "those who do not work cannot eat" underscore the message of justice, industry and the importance of work. Against this background are harsh criticisms of the Welfare State and government programs doling out food stamps and other benefits to undeserving beneficiaries, many of whom are too lazy to work. Along with this message is the inevitable reference to government debts, spending money we don't have or printing money which creates shrinking value. A false conclusion, that austerity is a proper response to debt, follows the same argument that starvation is the best remedy for obesity.

Discussions of minimum wage laws, forgotten in times of prosperity, get attention at times like this when unemployment rises. The same tired old arguments are trotted out about how higher wages are inflationary and eliminate jobs -- all of which have plenty of popular support but little or nothing in the way of economic good sense. Wages go down when unemployment increase because the law of supply and demand works exactly the same whether the supply is widgets or jobs. People without work, however, are different from widgets. When that supply increases those at the bottom of the scale are trapped in an ever-decreasing feedback loop driving wages lower at every turn. Minimum wage laws at times like this are the only social safety net for workers at the bottom of the scale.

These are my thoughts as I finished reading Living and Dying in Brick City. I did not read it rapidly. I took my time knowing that I would be writing a review, having received a complimentary copy. After the first two or three chapters I realized that to make the report relevant I would need more to make it stand out from others in a similar vein. Yesterday's account of the late Mrs. Clark occurred just as I was finished reading. I hope to have connected a couple of dots without being overly preachy.

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