Brian Alexander - The Hospital: Life, Death, and Dollars in a Small American Town

There was nothing special about that morning. It was just a winter Mondaycold, but of course it would be cold, being almost mid-February 2019. Nothing like twelve days before, when Jim Watkins, the chief of the Williams County Health Department, had taken a photo of his cars instrument panel to immortalize the reading of 15. A couple of sub-zero days in midwinter werent unusual for this far northwest corner of Ohio, but even the crusty old farmers agreed that fifteen below was a little extreme.

At the Seasons coffee shop, talk about the polar vortex had faded, and High Street and Main Street had been plowed. Some side streets were still coated, but passable, and piles of crunchy snow, turning grimy, took up a few parking spaces in the CVS lot. The lawn of the county courthouse in the Bryan town square was covered in white, offsetting its extravagant Baroque/Romanesque mishmash of red brick and sandstone. Long strands of Christmas lights still swooped down from its peak. The main county roads and the state routes were clear, too, so most people were getting to work okay. Everybody kept an eye out for deer leaping out of frozen cornfieldsthe roadsides were dotted with the carcasses of struck deer this winter. Drivers sometimes ended their commutes in the ER because of them, or because they slid on the black ice that lay camouflaged like land mines.

Phil Ennen slipped into his long, brown overcoat, wrapped a scarf around his neck, and placed a rakishly wide-brimmed fedora on his head to prepare for his own commutea walk of about 150 yards across Garver Park to the hospital, where he was chief executive officer. He could see the building out his front door. At night, watching TV or lying in bed, he could hear emergency medical helicopters arrive and take off from the hospitals landing pad. Only 8,500 people lived in Bryan, and Ennen knew all of them, or so it seemed, so hed wonder who was strapped onto the gurney and what had happened and how bad it must have been to require flying the patient to Toledo or Fort Wayne.

He was fifty-five years old. Hed worked at the hospital for thirty-two years. He called it my shop, as if he were a cobbler making shoes. Ennen was protective to the point of defensiveness about his shop.

The aesthetic critique was one example. The hospital stood out in a town of late nineteenth- and early twentieth-century architecture, especially since the 2009 rebuild. The rectangular orange and green exterior cladding panels and the intersections of the buildings wings created a modernist, alien dissonance. A few residents had taken to calling it the Lego blocks place, as in, You goin over to the Lego blocks place to get yerself checked out?

What really got to him, though, was the Band-Aid station crack. That place is just a Band-Aid station, people would say, and Ennen would smile to cover his seething.

He grew up in Bryan. Most knew him as one of the Ennen brothers, Mary Helen and Jacks kids. His father owned a small manufacturing company up in the village of Pioneer that made parts for Detroits cars. His mother worked at the hospital he now ran. He met Mary, his wife, in the first grade at St. Patrick Catholic School. She was the daughter of Jim Ebersole, the barber who owned Mel and Jims Barber Shop on the square.

So Ennen understood the small-town way of simultaneously demanding community respect from outsiders while internally scoffing at any homegrown institution as second-rate. He steamed just the same.

Sometimes it felt like the towneven the whole countydidnt give a damn about the work he did on its behalf. Running a small independent community hospital was never easy, but it was especially brutal now. Many hospitals in many towns like Bryan had winked out over the past decade. Theyd gone bankrupt, or been absorbed (and sometimes gutted) by bigger regional health systems, or the towns themselves had slowly become more memory than living reality until there was no point in having a hospital there at all. Hundreds more such hospitals, over six hundred by some estimates, were in danger of collapse.

Ennens shop, Community Hospitals and Wellness Centers, or CHWC, lost money every month of 2018. It was being dogged by big hospital chains in Toledo to the east and Fort Wayne to the west. Both had been gobbling up small independents like CHWC for over a decade in a crazed rush to consolidate before they could be targeted themselves by even bigger predators.

Twenty-first-century America had become a healthcare country. At almost 18 percent of the entire economy, health was the nations largest industry by fara $3.6 trillion enterprise. CHWC was a tiny mote in that universe, but as was true in many towns across the country, the hospital was now the largest employer in Bryan, still standing as an independent, nonprofit, homegrown community asset. Ennen and his board of directors wanted to keep it that way.

That was the business. But there was also supposed to be a mission. Ennen said he believed in the mission of the hospital, but the mission and the business were so intertwined theyd become inseparable: Most days an outsider couldnt tell the difference.

Dr. Stalter, we need you!

Marv Stalter may not have heard, or may not have registered, the urgency of the shout. He was across the ER in Exam Room 3 with a seventy-seven-year-old woman. She had bladder cancer. There were tubes sticking out of her back. The tubes diverted urine from her kidneys and drained it into a bag.

Shed been in Room 3 for a while now, since a Williams County Emergency Medical Service ambulance dropped her off. A ride in the ambulance was often the only practical way to get somebody from the Genesis HealthCare nursing facility, the one off Center Street past the YMCA, to the hospital. Genesis HealthCare was a huge outfit that traded on the New York Stock Exchange and had about four hundred nursing-care facilities in thirty states and $1.16 billion in revenue. But ambulances for emergencies werent part of its service, so the Bryan outpost called on Williams County employees to pick up the slack.

This wasnt the first ambulance ride for the woman in Room 3. Shed been in and out of the ER several times, then had been admitted to the hospital, stabilized, and released. This time Genesis called the ambulance when she began moaning in an altered state of consciousness. Thats why Stalter was looking her over: The cancer and the drugs and the malfunctioning kidneys and being seventy-seven and dying and not wanting to be dying had affected her mind.