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say, “Enough!”
    *
    I draw on the best source of information available to me as a physician: patients.What role did the health-care system play in their disease?Have my colleagues made treatment decisions based on the patients’ interests or based on self-interest?Have I been able to mitigate harm, or have I caused it?How have we doctors caused harm?Through uninformed but billable trial and error?By denying care?By providing the wrong care, or too much care?
    Although the stories in this book are true, names and identifying characteristics of patients have been changed to protect their privacy, except in cases where individual patients went public with their struggles.The names and identifying characteristics of physicians have also been changed to protect their privacy, except where I discuss their scientific publications.In clinical anecdotes, I note when doctors are identified by their real names.The views expressed here are not those of the American Cancer Society or Emory University.
    And, of course, the views expressed by the authors of this book are not intended as a substitute for medical advice, diagnosis, or treatment provided by the reader’s personal physicians.

Chapter 3
    Cadillac Care
    WHY DO I WORK at Grady?
    To do some good, if I can.
    That’s part of my motivation, but not all of it.I go to Grady for reasons that wouldn’t surprise my grandfather Willie Brawley.Willie, Benjamin’s nephew, was a sharecropper.
    I can see that in 1930 a man whose name matches my grandfather’s was listed among inmates at the Wetumpka State Prison in Alabama.It could be him.According to a family story, he became a union organizer and was lynched in 1948.My family didn’t treat his death as something to be proud of.Even my grandmother—his wife, whom I knew well—didn’t talk about him much.
    As a black man and a union organizer in the South, he surely understood what he was up against.Apparently nothing beckons a Brawley more powerfully than a hopeless cause, and I hear its call on the PA system at Grady.I go to Grady to understand where we are betraying our patients, where we are betraying ourselves, and how we can learn to do better.If you want to stay grounded, Grady is the place.
    Respect for people I knew growing up in Detroit could be a part of it, too.As I grow older and more experienced, I become increasingly amazed by the wisdom of those folks.When you are black and poor, you are by definition a survivor, and survivors have reasons to be suspicious.My parents and their friends didn’t trust doctors, didn’t trust hospitals.A hospital was the place where they withheld treatment or where they tried things on you without telling you what they were doing and why.
    White doctors think that we—black folks—worry about becoming unwitting subjects of medical experiments.That’s not quite it.Folks I grew up with were worried that the doctors who treated them had no idea what they were doing, that they were experimenting, trying various drugs or treatments, hoping that something might finally work.My family members were afraid they would pay the price for exercises in trial and error.It was about trust.
    When I was starting my career in medicine, I was contemptuous of such thinking.Initially, I dismissed these folks as outsiders who were suspicious of the system that excluded them.Now, having seen the way medicine is commonly practiced, I see that they were right to be suspicious.
    Now I wonder, can all of us benefit from a dose of skepticism?Can the health-care system make itself trustworthy, become accessible and driven by science?
    *
    I begin my search for answers at Grady, where patients are vulnerable, contrasts stark, lessons harsh.Yet, these are not entirely stories of desperation.Since we take patients no one wants, and without expectation of payment, we are immune to market pressures and the plethora of perverse incentives that spread dysfunction through the health-care system.
    Thus shielded, we