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Last published at August 7, 2009 at 8:01 PM

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Book review

'The House of Hope and Fear': inside the beating heart of Harborview

Seattle author/physician Audrey Young tells the story of the heroic patient care delivered at Seattle's Harborview hospital in her new book, "The House of Hope and Fear: Life in a Big City Hospital." Young reads Friday at Seattle's Elliott Bay Book Co.

Special to The Seattle Times

Author appearance

Audrey Young

The author of "The House of Hope and Fear" will discuss her book at 7:30 p.m. Friday at Seattle's Elliott Bay Book Co. Free (206-624-6600;

"The House of Hope and Fear: Life in a Big City Hospital"

by Audrey Young, M.D.

Sasquatch, 256 pp., $23.95

Dr. Audrey Young takes the reader deep inside the beating heart of the region's busiest public hospital in "The House of Hope and Fear," her memoir about caring for patients at Harborview in Seattle.

They are all here: the street people and drunks no other hospital will bother with, toes rotting off from bone-deep infection; maggots wriggling in wounds; and sputum alive with TB. There's the patient who vacillates between threatening to kill Young and inviting her to hear him play the horn at a local club. The intravenous drug user whose own father recommends that Young and the team of doctors fighting for his life give up. The wishes of the man's son prevail, and he emerges from his coma to live, free of illegal drugs for the first time in his life.

But Young, who travels on her own time to see him after he moves from Seattle to escape the temptations of drugs, finds him walking with a cane, living alone, and deeply dependent on prescription drugs to control flashbacks from LSD and chronic pain. There is no easy answer, she decides, to whether saving his life was the right choice — and that is without even considering the cost of his care.

This incident is no isolated moral dilemma in a hospital that provides the bulk of the charity care in Seattle. Opened in 1931, the hospital still seeks to live up to the philosophy of the mentor of the emergency department, retired physician Michael Copass, who instructed that care be guided by three principles: Work hard, be polite, "and treat the patient graciously, even if he is not the president of the United States."

Copass, she writes, trained her and a generation of other young caregivers and EMTs to fear above all a case of The Jaws: in which their mentor would inflict a silence louder than any word of rebuke if he caught them leaving a patient waiting too long, or delivering less than diligent care.

"Do I need to have a fit?" was a question no one wanted to hear, as Copass kept his finger on the pulse of a small arsenal of pagers, a walkie-talkie and cellphone to track incoming cases to Harborview, a hospital which staked its reputation on virtually never closing its doors despite crushing trauma loads.

Especially in summer. Weekends signified for these professionals not barbecues and beaches, but the gun shot, car wreck, construction accident, knife fight, drowning and motorcycle-wreck season. The injured arrived from Western Washington, Spokane, Missoula and the outlying reaches of Alaska, by ambulance and helicopter. They were all taken in, no matter their ability to pay.

It's a heroic mission that Young often found on a collision course with "the women in skirt suits and eye shadow, unflappable as dog trainers," coding the bills, and administrators pushing to churn twice as many patients to pump the bottom line.

"People make these numbers without getting sued?" Young asks. She does not get an answer.

Copyright © The Seattle Times Company

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