For the past three decades, the health of the residents of Nantucket has been the charge of Dr. Timothy Lepore, a larger than life figure who carves scalpels from stone and hunts with a pet hawk. But it's in this dedicated surgeon's practice that Pam Belluck finds a microcosm of the struggles faced by the health care system back on the American mainland.

Laguna Honda Hospital in San Francisco is the last American survivor of an institution that goes back to the Middle Ages -- an almshouse whose sole function is to care for the sick and the destitute. Victoria Sweet's journey there -- as a doctor, as a student of the hospital's astonishing history, and as a human being -- constitutes one of the most moving, and eye-opening memoirs of the year.