Susan Sheehan had her dander up. After sitting through a speech bristling with statistics on the rising cost of federal medical insurance, she took the podium and told the audience of home health care experts, ''If I had gotten hold of that speech earlier, I would have spent six months tearing it apart.''
It was the kind of remark that brought down the house with applause.
It was also the type of outburst that is rare for this writer, whose Pulitzer Prize-winning saga of a mentally disturbed young woman, ''Is There No Place on Earth for Me?'' was a clear-eyed look at the bureaucratic maze of state mental institutions. Reviewers praised her writing for its avoidance of both sentiment and advocacy.
Now Ms. Sheehan's latest work, ''Kate Quinton's Days,'' brings the same unclouded vision to the problem of health care for the elderly. Chronicling one older woman's year-long ordeal to qualify for publicly funded home care and avoid the nursing home she dreads, Ms. Sheehan has portrayed, in very personal terms, one of the country's more pressing social problems.
Skyrocketing medical costs, coupled with rapidly changing demographics - statistics put the number of aging Americans at nearly 60 million by the year 2030 - have pushed publicly funded health care to the top of the nation's social agenda. Ms. Sheehan addresses the dilemma, however, not by probing statistics and bureaucracy, but by focusing intently on the individual's struggle.
''I take subjects I care about, (such as) welfare, Vietnam, and work, from the specific to the general,'' she says in a Monitor interview. It is the same approach she used in her earlier works that traced the lives of other members of the underclass - including a welfare mother, a maximum security prisoner, and a mental patient. ''I'm not very interested in statistics,'' Ms. Sheehan says, ''but I am interested in stories. I like to write about individuals. I like to listen to people.''
Ms. Sheehan's opening description of her real but fictitiously named subject provides a glimpse of her dispassionate approach. In a Brooklyn hospital, Mrs. Quinton gazed ''across the room at her closet (it was marked 'A') and at her roommate's closet ('B'). She looked at A and then B, B and then A, as she had been doing for days. Then her eyes focused on the clock in the hall outside her room. It was four o'clock; three minutes past four; five minutes past four.''
Although she considers herself a writer and not an advocate for any of the social issues she has written about (''I have a temperament that is too much middle of the road (for partisanship)''), Ms. Sheehan willingly climbs the soapbox when it comes to health care for the elderly. Not only does she decry the fate of those low-income elderly who are ''rail-roaded into nursing homes,'' but she empathizes with the Mrs. Quintons of the world. ''When you write about someone who is 81,'' she says, ''you think about getting old.'' Beyond that, Ms. Sheehan insists that ''how we consider our old people and how we treat them is a critical factor in our society. Look at how the Japanese revere their elderly. People like Kate Quinton should be allowed to go home.''
As a staff writer for The New Yorker - she started out as humor writer and contributor to the ''Talk of the Town'' column - Ms. Sheehan finds the magazine's journalistic standards, including almost nonexistent time and space constraints, well suited to her own reportorial style. For her books, which also run as New Yorker articles, Ms. Sheehan will spend up to two years researching her subjects, taking thousands of pages of notes in speedwriting.
While she insists it is difficult to find subjects ''interesting enough to spend two years on'' and not already exhausted by other journalists, she freely admits her bias toward social issues. Despite having written lengthy profiles of both Ethel Kennedy and Jacqueline Onassis, and a forthcoming biography of publisher Alfred Knopf, Ms. Sheehan generally avoids both celebrity and suburban subjects in her work. Her unflagging interest in the underclass stems from her belief that ''an acquaintance with the facts does change your mind.'' She says she hopes her books will offer readers greater insights into social issues, ''so when we're voting to fund prisons and welfare programs and home health care, we will be better informed.''
It is an approach to which Ms. Sheehan herself subscribes. ''I begin not knowing anything. I want to learn,'' says this writer, who, despite an upper-middle-class background - she was raised on New York's Upper East Side, graduated from Wellesley College, and is now married to a Harvard alumnus and former New York Times reporter - has willingly traipsed through prisons, psychiatric wards, and New York slums all for the sake of her work. ''I like the unusual,'' she says with a laugh, tracking those people ''that most of us never get to see.''
Although wearing a deceptively prim attire - gray flannel suit and silk blouse - Ms. Sheehan seems vigorously embued with a veteran journalist's curiosity and taste for adventure. Her first book was written while spending two years in Vietnam with her reporter husband, and her current book has taken her to New Guinea. Even the less exotic articles for the ''Talk of the Town'' column find her scrambling to such places as the top of the Rockefeller Center Christmas tree.
Yet Ms. Sheehan is just as adamant about preserving her family life in suburban Washington, D.C. She spends only one week a month in New York City and has done the bulk of her out-of-town research when her children have been away during summers. At other times she has toted her family along with her. On this trip to Boston she and her eldest daughter, a student at Wellesley, speak fondly of their visits to prisons, slums, and hospitals. ''Members of the Mafia have served our family dinner,'' Ms. Sheehan says with a smile. ''It gets to be like a family event,'' adds her daughter.
It is an involvement that characterizes Ms. Sheehan's life but rarely permeates her writing. While she has remained friendly with most of her subjects , an emotional attachment is strikingly absent in her work. ''I tend to put my emotions into my life and not my work,'' she says, adding that the cool, matter-of-fact tone of her writing does not come particularly easy.
Ms. Sheehan is also frank about winning the Pulitzer Prize. Although she describes the award as ''one of the most exciting things that can happen to (a writer) professionally,'' she also complains it has not aided either the publication or promotion of her most recent book. Because ''Kate Quinton's Days'' is not considered ''cheerful,'' Ms. Sheehan says she fears its impact will be lessened and the critical nature of its subject overlooked.
''That's probably as indignant as I've ever been in my life,'' Ms. Sheehan says about her speech to the health care professionals. ''But someone ought to get those people in touch with reality. I had a chance to do that today.''