“The Hospital: Life, Death, and Dollars in a Small American Town” by Brian Alexander c.2021, St. Martin’s Press, $28.99, 307 pages

102 degrees. That’s what the thermometer said and that’s an awfully high temperature, COVID or not. Your first thought was the hospital. That’s where you’re taken when you’re very sick but as in “The Hospital” by Brian Alexander, will the facility be there to take you?

Tucked in the northwest corner of the state, Bryan, Ohio, is a lot like other American small towns: people are friendly, folks know their neighbors and they pitch in when someone’s sick. That’s especially true in Bryan: the hospital there, affectionately known as CHWC (Community Hospitals and Wellness Center), is the county’s largest Bookwormemployer, staffed by many doctors and nurses who’ve known their patients all their lives.

In other times, this might sound idyllic, like a perfect plot for a warm sitcom.

Now, though, CHWC struggles. As an independent hospital located near corporate-backed medical giants that have been “gobbling up small independents,” CHWC has tinier margins and less access to discounts offered by suppliers and equipment manufacturers, and its size often means that high-tech cases go to larger facilities rather than to CHWC.

It’s almost a David-and-Goliath situation but Goliath has the edge, a situation exacerbated by poverty, opioids, methamphetamines and lack of resources. Bryan, Alexander said, is actually, literally, physically bisected by haves and have-nots.

But, of course, the story of a hospital isn’t just the story of a hospital. Alexander writes of the town itself, and of CHWC’s CEO, who grew up in Bryan and who exhibits a sense of ownership for the hospital he loves. It’s the story of patients: a woman with cancer; a husband with major life-threatening health issues; mothers and kids; and former factory workers who have multiple jobs but no health insurance. It’s the tale of nurses, of doctors who came for a year and stayed for many, and of a hospital board that wants what’s best for the facility.

And it’s a story of a budget, its balance and the wolves at the door...

It’s difficult this year, if not impossible, not to feel overloaded with medical updates and information. It’s everywhere, everybody’s talking about it, and you may feel like you know enough but you may not – at least, not until you’ve read “The Hospital.”

Even for readers living in a metropolitan area with strong medical facilities, there’s a hint of foreboding inside author Alexander’s words here, and in inferences that one might make about the future of community hospitals and their patients. You also get a sense that much of what happened in Bryan can happen anywhere, a realization that’s attached almost completely to money and insurance, issues which Alexander presents as two sides of a delicate scale that’s being tipped by poverty and job loss.

“The Hospital” is like Hillbilly Elegy with a bad cough, just waiting for a room. It’s political, scary and empathetic, with C-Suite-level details you can feel free to skip. Most importantly, this book will make you consider yourself, neighbors, and your own nearby facility, with righteous alarm and trepidation of a high degree.