The Untold Story of America's Health Care Crisis

The following is an excerpt from Jonathan Cohn's latest book Sick: The Untold Story of America's Health Care Crisis -- and the People Who Pay the Price.

April 10, 2007 -- It was 4:43 on a clear November afternoon when the paramedics found Cynthia Kline, pale and short of breath, slumped against a bedpost in her double-decker Cambridge home. Although Kline was in obvious pain, she seemed keenly aware of what was happening inside her 55-year-old body. One of her blood vessels had closed off, blocking the flow of blood to her heart. Minutes before, she had phoned 911, taken the nitroglycerin tablets prescribed for such an emergency, then waited for help to arrive -- an ordeal that stretched out an agonizing extra few seconds while the rescue workers, having found the front door locked, scampered in through an open second-story window. Now, while the paramedics worked busily over her, noting vital signs consistent with cardiac distress, Kline turned to one of them with an anxious plea: "Take me to Mount Auburn Hospital."

Kline, a teacher who worked with special-needs children, had no formal medical training. Yet her instinct about where to go was as sound as a seasoned cardiologist's. Nearby Mount Auburn Hospital, a private teaching facility affiliated with Harvard Medical School, had some of the city's finest doctors and nurses. More important, it had an intensive cardiac care unit that specialized in cases like hers. A few days earlier, staff at Mount Auburn had treated Kline's advanced coronary disease by inserting a balloon into her circulatory system and then expanding it, in order to open up a partially blocked blood vessel. A variant on the very same procedure, "cardiac catheterization," could be used in an emergency like this one, when the flow of blood through a vessel was almost completely cut off. Cardiac catheterization had saved literally thousands of lives across the country.

The procedure had the potential to save Kline's life, too, just as soon as she could get to the hospital and receive it. But getting there was precisely the problem. On the way to Kline's home, the ambulance driver had checked with a dispatcher about hospital availability. Mount Auburn was no-go: the emergency room there was overflowing, with no space to handle new patients. So as the paramedics wheeled Kline into the ambulance, one of them told her they would have to deny her request: "Ma'am, we're going to Cambridge Hospital instead." Kline accepted the news, and maybe for a moment she thought it would be for the best. Although Mount Auburn was less than two miles away, Cambridge Hospital was even closer -- just a short trip through the crooked, disjointed streets that surround Harvard Square. It was also a highly regarded medical facility in its own right, with a top-notch medical staff and a recently renovated emergency area fully capable of handling the majority of trauma cases that came its way. Had Kline's condition remained as it was, it probably could have handled her case, too. But just four blocks into the journey, Kline's condition suddenly deteriorated. The instruments tethered to her arm could no longer detect a blood pressure; her heart rate, seventy beats per minute just moments before, was down to thirty-eight. Kline, strapped into a stretcher, was conscious through all of this-and increasingly agitated. At her side one of the paramedics, a kind-looking thirty-year-old, tried to calm her, explaining that the hospital was just seconds away. But as the ambulance made a right turn around one final corner, bringing the tall redbrick facade of Cambridge Hospital into view, Kline began to cry out: "I'm going to die. I'm going to die."

It was 5:04 p.m., just twenty-nine minutes after Kline had first called 911 and about an hour into the heart attack, when the green-and-white ambulance pulled up to the emergency bay. Informed of the patient's newly worsened state, attendants hustled the gurney into the hospital as the medical team began administering intravenous medication to increase Kline's heart rate. For a while it looked like she might pull through. Her pulse went back up to forty-five beats per minute -- a far cry from normal but at least not "very low," as it had been in the back of the rig. Her breathing was more regular, too. Soon, however, a cardiology exam confirmed that Kline needed catheterization, something the staff at Cambridge Hospital could not do. A nurse began inquiring about available hospitals, but now it was two hours since the chest pains had first begun-and time, finally, was running out. At 6 p.m. Kline's heart stopped altogether. The doctors began performing the familiar ritual of cardiopulmonary resuscitation (CPR), pumping her chest and using electrified paddles to shock the heart back into a regular rhythm. It made no difference. At 7:03 p.m., the trauma team relented. Cynthia Kline was dead.