When in Hotel, First Do No Harm
Many years ago, before she helped bring in the union, when she had no health insurance, when she got her medical care from Fantus Clinic of Chicago’s Cook County Hospital, Drusilla Brown’s systolic blood pressure used to run around 220. She is black; her mother had suffered a hypertensive stroke at age 50; she knew she was in danger; and she was doing the best she could. Typically she arrived at 8:00 am for an afternoon appointment, and did not leave until 4:30 pm. Only in an emergency could she get new prescriptions filled the same day—otherwise she would wait in line to turn them in, then return another day and wait in line to pick them up. There was a narrow window of time in which to pick up refills—a day early and she was refused; a day late and she had run out of pills. Meanwhile she had to go to work every day. She cleaned hotel rooms for $5.25 per hour, back-breaking work lifting mattresses, washing bathroom floors on her hands and knees. And she had a teen-aged daughter who still needed her mother.
Through their union, Ms. Brown and the other housekeepers in her Chicago hotel organized to get a raise; and eventually she got health insurance for the first time in her life. She left the overcrowded Cook County health system and began to see a private physician. Today her blood pressure is controlled. At age 60, she has suffered no complications from her hypertension. She looks forward to retirement in a few years.
Just before the Thanksgiving holiday in 2011, one of Chicago’s major hotel companies threatened to discontinue their workers’ health insurance as of January 1 if the union did not agree to a contract that included no job security. Ms. Brown knew better than many what no health insurance would mean for the affected workers and their families; what it would mean if the same thing were to happen to her. What doctors could she see for free; how long would it take her to get an appointment at Fantus Clinic? How would she afford her medicine, some of which is expensive? If she missed the medicine, would she end up paralyzed on one side like her mother, or even dead? For each worker, each family who might lose insurance, the worries would be the same.
Everyone faced, within a few weeks, loss of access to the physicians with whom they had long-established relationships; having to scramble for emergency care and medicines in an already overwhelmed health care safety net; having to travel long distances in winter snow and cold and then wait for hours, perhaps with a sick child, to see a nurse or a doctor. Ms. Brown understood, too, the consequences to the health care safety net, and to the people who already had nowhere else to turn, of having another 4500 people dumped there in a single day. She was one of thousands of people from across the city—hotel workers affected or not, railway workers, practicing attorneys and recent law school graduates unable to find jobs, high school activists from the South Side, senior activists from the West, South, and North Sides, nurses and doctors and therapists unionized or retired or neither of the above, clergy of many faiths, university food workers, teachers, social workers, and health professions students—who were outraged that a wealthy corporation would bully workers with the threat of cutting off access to health care for themselves and their spouses and children. When the workers refused to back down, when they rallied to demand both access to health care and a contract that would protect their job security, they were visibly not alone. Drusilla Brown was there, marching in the cold; my husband and I were there; so were 700 other people.
Hotel workers’ injury rates are high, higher still for housekeepers, women, Hispanics; and they are much higher in certain hotel chains than in others. Those rooms we leave behind at the end of a conference may look as innocuous as they are indistinguishable one from another, but they are crowded with challenges to the human musculoskeletal system: the more furniture, the more time a room takes to clean, a fact not accounted for in room quotas; the closer together the furniture, the more difficult to bend, turn, lift safely. Those huge mattresses get still bigger and heavier with every renovation, and also closer to the floor, platform beds being the current fashion, and so the injury rates go up; and by ten years of work, at the latest, everyone has pain every day. Many rooms have two beds, two mattresses, ten large pillows stuffed into long pillowcases. The hotel may offer its guests kudos for going green—foregoing a daily linen and towel change. But think of the size and number of the sheets and pillowcases you start with—nothing green about that, and they still have to be tidied. Then too, the shower curtains need to be changed sometimes, which often means standing on the edge of the tub. In some hotels management still demands that bathroom floors be scrubbed on hands and knees--"housemaid's knee" we learned to call the results of that all the way back in the fourth year of medical school. In non-union hotels workers have no health insurance, may work two shifts per day seven days straight, some of it off the clock, and their children be damned.
All of these stories I have heard from the workers themselves.
I have cared for workers with chronic pain and chronic stress symptoms caused by the demand that they do work the human body cannot perform safely; caused by injuries from which they are not allowed the time and rest the body needs for full recovery; caused by the requirement that they work at speeds that are beyond the capacity of the human nervous system to transmit signals. I have felt impotence and anger at my inability to use my hard-earned knowledge of applied human physiology to prevent illness rather than simply seek, sometimes dangerously, often unsuccessfully, to alleviate symptoms.
As physicians, almost all of us belong to at least one society, many of us to several. We may get our continuing education at conferences in other cities—all of those nights spent in hotels, able to sleep, shower, shave, brush our teeth, apply make-up, without worrying about the clean-up involved, and with a tax write-off to boot. Perhaps we take the children
, who, being children, put their handprints on the mirrors, drop crumbs and wrappers, and leave sticky juice residue on the desks and dressers—somebody has to clean all of that, and gets the same amount of time to do it as if the room had been left spotless.
We physicians are pledged to do no harm. Our good night’s sleep, our break from the cares of housekeeping, should not be purchased at the expense of someone else’s nights sleepless from back or shoulder or wrist or hand or neck or leg pain (so easy to bump into one piece of furniture while cleaning another); and not at the expense of daily doses of analgesics with all of their side effects and drug interactions.
Along with medical students and other physicians, I have pledged to honor all worker-called hotel boycotts and picket lines. I have pledged not to eat, sleep, or meet at a hotel that has unresolved labor disputes. As a physician, pledged to promote individual and public health and well-being, I can do no less. As a retired physician, I can and will take the time again to join picket lines when they occur near my home. As a retired physician, I also, incidentally, volunteer full-time working to bring about a single-payer health care system under which no employer will be able to bully workers with threats to discontinue health insurance; and in which public health, including worker safety, will be an unquestioned fundamental. Physicians for a National Health Program, the single-payer organization for physicians, and its Illinois chapter, as well as the Illinois Single-Payer Coalition of which PNHP Illinois is a member, have also pledged to honor all worker actions. I am proud of that.
Drusilla Brown is not her real name. She read and approved this essay.