Instead of immediately treating him, a nurse and a doctor coldly debate whether he’s worth the effort to save. He’s filthy, smells of whiskey and his pockets are empty. No money to pay the hospital’s $50 admission fee.
“I’m sure he’s just drunk, Doctor,” the nurse says. “And he hasn’t a dime. Why did the police bring him here? How can we run the hospital?”
A millionaire had donated money to fund half of General Hospital, but not all of it, and had recently reminded the doctors, nurses and staff that the hospital, after all, “is not run for charity.” With that directive on their minds, the doctor and nurse take another look at the injured man sprawled on a stretcher.
“Call the County,” the doctor says. “Have them move the patient.”
The homeless man is passed off to the public hospital, joining others who lack the money and sufficient insurance for care elsewhere. The story packs a surprise at the end.
More than a half-century after Chandler wrote the story, public hospitals remain a destination for the sick who have nowhere else to go. The hospitals refuse to turn people away, absorbing the cost of providing free care and recouping it by charging everyone else more.
Chandler, who spent about two decades in England, had become acutely familiar with how the health system in the United States compared with public care in Europe. Later in his life, he cared for his ailing wife in America; despondent after her death, he ended up in hospitals after a failed suicide attempt and a drunken fall down a staircase.
“His experiences influence the story,” Mr. Gulli said. “He was trying to be Raymond Chandler the activist, rather than Raymond Chandler the detective story writer.”
Sarah Trott, who wrote a 2016 book about the influence of war on Chandler’s writing, said the short story makes clear that he disapproved of the state of health care.
“By candidly confronting the reader about whether money and wealth ‘should’ make a difference in the quality of…