The House of Hope and Fear is a doctor's memoir about caring for patients at an institution that opens its doors to all comers, from the wealthy and healthy to the indigent and the homeless. The book opens with the doctor, an idealistic young woman going to work in a place-the county hospital-that truly subscribes to a mission of universal health care. At first the story focuses on her becoming acquainted with refugees, drug addicts, and the homeless. She chronicles people who have fallen through society's cracks, her attempts to provide aid, and as she gains experience, her growing realism about the limits her patients face, the limits that she and her hospital face. In time, she comes to recognise that her hopeful and idealistic view of the practice of medicine must accommodate the finite resources that even her sprawling care facility can offer. She introduces the outspoken medical director and exposes the inner workings of the executive board where policy decisions determine the rationing of drugs, therapies, and beds. Woven through the book are other characters who deliver on the hospital's mission in their own ways: a crusty nephrologist who takes patients others have fired, a veteran social worker, a fellow physician who is the narrator's confidante and friend. As the medical, operational, and emotional workings of Harborview Medical Center are revealed, a mounting crisis of resources is filtering down from the administration through the doctors and on to the patients. Through gripping storytelling, we see how the healthcare crisis comes down to docs and patients and meds. The House of Hope and Fear comes to a climax when the hospital is forced to shut its doors to new patients-a radical move that impacts the entire city.
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