”This place is simply too big for efficient medical care,” said Dr. Charles DeShazer, describing Cook County Hospital, the Near West Side colossus that serves as family doctor to 1,000 patients a day, most poor, most black or Hispanic. In his fourth year as one of 835 attending physicians, DeShazer is all too familiar with the critical conditions there.
”We are overburdened with too many patients, too little space and too few doctors and support staff,” he said. ”Most of the patients we see come in very late, and only when the discomfort of their illness outweighs the discomfort of having to deal with the hassle of this system.”
Still, the public hospital usually delivers excellent medical care without charge. The patients, of course, pay with their time. A typical wait for an appointment at the medical clinic is four hours; at the walk-in ambulatory screening center, six hours; for X-rays, three hours; for the pharmacy, five hours. For the patient, going to County Hospital is an all-day adventure.
DeShazer, 32, grew up in the neighborhood, or ”Hood,” as they say, only five minutes from County Hospital, and he now finds his medical practice rich in both satisfaction and frustration.
”Growing up,” he says, ”my universe was bounded by the four-block-square area from California Street on the west, Western Avenue on the east, Roosevelt Road on the north, and Ogden Avenue on the south.” There were three good reasons for this circumscription: the Disciples, the Vice Lords and the Goon Squads, the teenage gangs that brutally protected their turf just outside DeShazer`s area.
The hero of DeShazer`s shrunken universe was his father, Charlie Willie DeShazer, the youngest of 19 children born to a Mississippi sharecropper and his wife. Charlie Willie DeShazer never got beyond grade school, but he and his wife, Alcenia, whom he met in a Chicago church, insisted that their three sons and daughter earn college degrees.
The couple shared household duties while Charlie worked days in an auto-parts store and Alcenia worked nights in a factory. Charles wanted to be a doctor from the time he was 5.
”My parents always gave me unconditional love and support,” DeShazer said, ”and when I was 5, I received an immunization from our family doctor, a kindly Jewish man named Emanuel Feinhandler. He was aptly named, and when I told him that someday I wanted to be on the other side of that needle, he supported me, saying, `Well, of course, but you gotta do this and you gotta do that along the way.` My father helped, too, telling me, `Well, of course, you`re gonna be a doctor, and you`re gonna be a good one.”`
DeShazer got his medical degree, and now he finds himself on the other side of the needle, treating some of his old friends.
”I was working the wards a few months ago,” he said, ”when I heard this cry: `Chuckie, Chuckie.` Well, that was my nickname back in the `Hood.`
It was an old friend named A.B. He had been a star basketball player with great hands. Now, his hands were in police cuffs and his mind was shot with alcohol and drugs. That was the worst thing to see, that this friend of mine, who had been pretty with it as a kid, was now gone. His mind was dead. He was proud of me, though. He said: `You`re lucky, Chuckie. You got out.` Of course, then he tried to bum a cigarette.”
DeShazer managed to escape the gangs and drugs, though he admits to being ”periodically drafted to join the gangs and occasionally fearing for my life. But my brother Arnold was a star basketball player in high school, and I was good enough at neighborhood sports to be largely left alone.” DeShazer ran with a group of 15 like-minded young blacks, and he figures that ”maybe three of us got out intact.”
Too smart
Because anyone who made good grades was considered a ”sissy,” the young DeShazer often ”tried to miss questions,” but his teachers and older brothers insisted that he bypass the public high school in favor of the private and prestigious St. Ignatius High School.
”I didn`t want to go at first,” DeShazer said, ”because there were no girls at the school, but my father took out a loan and I enrolled.”
Fourteen years later, after stints at Loyola University and the nearby University of Illinois College of Medicine, DeShazer had his medical degree and was a long way from his grandfather`s Mississippi. And yet not such a long way either.
On a recent morning his first patient, whom we`ll call Mr. Jones, said he missed Mississippi. Although 90 percent of County Hospital`s patients are black, only 10 percent of its physicians are black, and Jones, a black man, was happy to have DeShazer examine him.
Jones was 30 minutes late for his appointment, which is common, and his chart was ”unavailable,” which is also common.
”The clerical staff is under separate management,” DeShazer said, ”and the medical staff always has to fight to try to get our medical records in time for the patient`s visit.”
A few questions quickly established that the patient was bothered by shortness of breath. He explained: ”My youngest daughter, my baby, was givin` me such a fit last night that I got up to whup her, but after two steps of chasin` her across the room, she was laughin` and I was about to drop. I was doin` myself more damage than her, so I decided it was time to lie down.”
The physician suspected chronic obstructive pulmonary disease from the patient`s history of smoking, and he ordered a lung exam and breathing-capacity tests. He also renewed prescriptions to treat the patient`s high blood pressure and diabetes.
”You know,” patient Jones said, ”in Chicago, I never have two good days in a row, but when I go back to my folks` place in Mississippi, I just forget about all my aches and pains. Livin`s a lot easier there.”
DeShazer later added: ”Smoking and drinking complicate about 90 percent of everything we see here. Yet when you drive through the ghetto, what do you see: alcohol and cigarette ads on billboards that are pockmarked with bullet holes! Also, about nine of every 10 patients we see have high blood pressure, and about six or seven of every 10 have late-onset diabetes.”
Skirmish with the clinic
The next patient to be admitted that morning was an elderly black lady, Mrs. Smith (another pseudonym), who was experiencing excruciating lower-back pain. She came quickly to her point:
”You know me, and I`m not one to complain, but I can`t go home feeling like this. I`ve been taking Tylenol No. 3 and it doesn`t make a dent in the pain. I`m ready to be admitted.”
The woman had recently injured her back while trying to move a stove, and bed rest did not help. She also had lost about 20 pounds, and her unspoken fear was that she might have cancer.
DeShazer asked some questions, then palpated her back muscles, causing great moans of pain. He decided he needed an orthopedic consultation to determine if the pain was due to a muscle spasm or a disk problem, and he knew that would be a hassle.
Seeing that the woman was in great pain, he found a wheelchair to take her downstairs to the orthopedic clinic. But the orthopedist advised continued bed rest before authorizing a visit to the clinic.
Fuming, DeShazer decided to admit her to the general medical ward.
”She`s stayed in bed, and that didn`t work,” he explained. He stuck the admission chart in her hand, ”so nobody can possibly lose it.” Then, in a soothing voice, he told her: ”Don`t worry. This isn`t cancer.” Through the pain, she smiled. She would be admitted to a ward so crowded that DeShazer would, a few hours later, have trouble threading his way among the beds to her wheelchair, but she was happy.
Later, DeShazer reflected: ”The big difference between what I expected medicine to be like and the way it is here is that the medical staff is not in control of medical practice. The bureaucracy controls everything.
”We have to worry about getting charts on time, getting lab tests done, getting consultations and getting follow-up care. We`ve been trying to get a Xerox copier up here for 4 years.”
It`s not DeShazer`s way to get mad without eventually acting to make things better, so he has enrolled in De Paul University`s Law School, which he attends four nights a week.
”The real power is legal and legislative,” he said, ”and I`m preparing myself to make a difference.” To relax, he works with his desktop computer and publishes a newsletter on minority health issues.
He also copes with the here and now. ”To survive at County (Hospital),” he explained, ”you have to be smart and you have to be lucky. I`ve tried to make friends with all the key people in the specialty clinics, the labs, medical records and the pharmacy. That`s the only way to get things out. If you try to muscle them, watch out. They`ll tell you to bug off!”
Birth-control regrets
About 200 patients a day walk into the ambulatory screening center. That night DeShazer was one of two attending doctors on duty, supervising a staff of nurse practitioners and medical residents. ”Be prepared to see a few characters,” he said.
One patient, a black female teenager, had a pelvic infection, for which drugs had been prescribed. But her boyfriend looked unhappy. DeShazer took the young man aside and explained that the infection is not related to sexual activity and that the condition does not mean the woman has been ”messing around.”
Sexually transmitted diseases, including AIDS, account for many of the clinic`s patients. And teenage mothers, usually raising their children without the fathers, are commonly seen.
DeShazer himself fathered two children by the woman he lived with during medical school. It is a touchy subject, and he says ruefully: ”I loved the woman, but we grew apart. I had thought that we had agreed that she would practice birth control until I got through medical school. (In) medical school … you only have time to eat, sleep and study. I told her that I wanted to focus on school, and I thought that she understood. It didn`t turn out that way, though, and I felt angry and trapped.”
The mother and two children live in Florida, and DeShazer said a big chunk of his $68,000 annual salary goes for their support. He wishes he could spend more time with the children.
”Initially,” he said, ”I felt that I had been victimized by a scheming woman, but now I realize that I was irresponsible. I should have also resumed responsibility for birth control.”
`Unbearable` problems
The biggest medical problem at County Hospital is the lateness with which patients present their problems. In rapid order, DeShazer examined a young black man in his late 20s whose uncontrolled high blood pressure had led to renal failure, a woman with a tumor so large it engulfed her breast, and a woman with an infected foot callus that had grown so big she could no longer walk. All were referred to specialty clinics.
Shaking his head, DeShazer said, ”These patients never thought that their problems were worth dealing with until they became unbearable.”
The next patient offered some good news. Although his legs are weak from diabetes, he said to DeShazer: ”To me, County (Hospital) is the best. This young girl (the nurse practitioner) took all the time in the world to talk to me, and that`s more than my private doctor does, and he takes my money.”
DeShazer`s father was treated successfully at County Hospital last year after a heart attack. ”I had complete confidence in his care,” DeShazer said.
Seeking a breakthrough
DeShazer will soon be moving on. By serving at County Hospital, which is officially designated as being in a medical-care-shortage area, he is concluding his four-year scholarship commitment to the National Health Service Corps. He is engaged to marry a woman who is trying to get him to change his workaholic ways, but, he said: ”For now, I plan to push on in the direction I`m going until I can make a breakthrough. I want to have a greater impact on a smaller scale.”
He hopes to help run a neighborhood health center and eventually create a network of such centers to which County Hospital`s thousands of patients can be referred for follow-up care. He also plans to continue to spend at least a few days a week at County Hospital.
”This place gets in your blood,” he said. ”It`s not about fire and safety codes. It`s about patients and doctors and compassion.”
