North Lawndale, a neighborhood that lies in the shadows of Chicago’s Loop, is surrounded by some of the city’s finest medical facilities, Yet, it is one of the sickest, most medically underserved communities in the country. Mama Might Be Better Off Dead immerses readers in the lives of four generations of a poor, African-American family in the neighborhood, who are beset with the devastating illnesses that are all too common in America’s inner-cities. Headed by Jackie Banes, who oversees the care of a diabetic grandmother, a husband on kidney dialysis, an ailing father, and three children, the Banes family contends with countless medical crises. From visits to emergency rooms and dialysis units, to trials with home care, to struggles for Medicaid eligibility, Laurie Kaye Abraham chronicles their access—or more often, lack thereof—to medical care. Told sympathetically but without sentimentality, their story reveals an inadequate health care system that is further undermined by the direct and indirect effects of poverty. Both disturbing and illuminating, Mama Might Be Better Off Dead is an unsettling, profound look at the human face of health care in America. Published to great acclaim in 1993, the book in this new edition includes an incisive foreword by David Ansell, a physician who worked at Mt. Sinai Hospital, where much of the Banes family’s narrative unfolds.   “A provocative examination of our health care delivery for the poor. . . . Such an honest and candid account is essential if we are to seriously explore a restructuring of the health care system.” -- Alex Kotlowitz, author of There Are No Children Here “Goes to the heart of today’s problem in just a few words: ‘Health care is treated as a commodity available to those who can afford it, rather than a public good.’ . . . Powerful . . . deeply searching.” -- Victor Cohn ― Washington Post “Abraham has done prodigious research, and her grasp of the [Banes] family’s dizzying ride is formidable. . . . A powerful indictment of the big business of medicine.” ― Los Angeles Times “Abraham doesn’t pretend to have the answers—but she illuminates the problems with passion and skill.” ― Kirkus Reviews “This personally observed, lucid chronicle and call for reform of our ailing health system covers all levels of responsibility in the medical establishment, and deserves scrutiny by our administration’s health service planners.” ― Publishers Weekly David A. Ansell , MD, is the senior vice president for community health equity at Rush University Medical Center in Chicago. His most recent book, The Death Gap: How Inequality Kills , is also published by the University of Chicago Press. Mama Might Be Better Off Dead The Failure of Health Care in Urban America By Laurie Kaye Abraham The University of Chicago Press Copyright © 1993 The University of Chicago All rights reserved. ISBN: 978-0-226-62370-2 Contents Foreword, Preface, Acknowledgments, Introduction, 1. "Where crowded humanity suffers and sickens": The Banes family and their neighborhood, 2. The rigors of kidney dialysis for Robert Banes, 3. Gaps in government insurance for Mrs. Jackson, 4. Fitful primary care fails Mrs. Jackson, 5. Mrs. Jackson's melancholy, 6. The inner-city emergency room, 7. One hospital's story: How treating the poor is "bad" for business, 8. Who's responsible for Tommy Markham's health?, 9. Jackie Banes's "patient", 10. Empty promises: Preventive care for the Banes children, 11. Robert Banes plays the transplant game, 12. The Banes family and white doctors, 13. Life-sustaining technology, 14. Amazing grace, Epilogue, Appendix, Notes, CHAPTER 1 "Where crowded humanity suffers and sickens": The Banes family and their neighborhood Robert Banes sat on the edge of his hospital bed, cradling his queasy stomach. A thin cotton gown hung on him like a sack. At five feet, eleven inches, Robert weighs only 137 pounds. Robert's kidneys stopped functioning when he was twenty-seven. He received a transplant a year later, but his body rejected the new kidney after six years. Since then he has required dialysis treatments three times a week. Dialysis clears his body of the poisonous impurities that healthy people eliminate by urinating, but the treatments cannot completely restore his health, and Robert periodically spends a couple of days in the hospital. This time, he had been admitted to the University of Illinois Hospital because he had been urinating blood for a week, a problem that did not appear terribly serious to doctors but nonetheless had to be checked. Feeling nauseated, Robert was not paying much attention to the game show that droned from his television. A nurse came in and stuck a thermometer in his mouth. Earlier in the day, Robert had undergone a cystoscopy, a procedure in which doctors put a miniaturized scope into his bladder to look for the source of his bleeding. He had not been told the results of the test, so