Bellevue No One Was Ever Turned Away

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If, when I first moved into Bellevue, they had told me that the hospital as it stood had originally been built in 1736 and had been minimally improved since that time, I would have believed them; it looked that decrepit partly because what was then the main hospital building had certain oddities of construction, added over the course of thirty years. The administration section, for example, which was more or less in the middle of the front of the main building, was about four steps lower than the adjacent wing. The house-staff quarters, which were on the upper floors of the administrative building, connected, of course, with the wings on either side. But, depending on what floor your room was on, you might have to walk up or down three or four steps to get to the next wing. Nothing terribly difficult; just a bit strange.

The surgical wards, which were to be my home base over the next seven years, were still very much like the wards one sees in photographs of Victorian hospitals. They were wide open, just rows of beds on either side and two rows of beds head to head in the center, with about forty beds to each ward. There was a little green metallic stand near each bed, where patients could keep soap, a toothbrush, and other personal items.

Privacy was nonexistent. The head nurse could sit at her desk at the front of the ward and see all the patients at a glance—a very useful arrangement, particularly on the evening and night shifts, when there might be only one nurse to a ward. The wards in the L and M buildings looked out on the East River, so at least the view was decent. If a patient needed privacy, say for a physical examination, screens were moved into place around the bed. This was also done when it was decided that a patient was about to die. Privacy was afforded to the dying not only because it seemed the proper thing to do, but also because over the years the house staff had discovered that if patients happened to view the final moments of someone who had recently undergone surgery, one—or even several—of our preoperative patients might decide they preferred to live with their problems and sign out AOR (Assuming Own Responsibility), absolving the medical staff of legal responsibility. We didn’t want these patients to leave until they had had their operations.

Every resident, in 1953, was expected to consider Bellevue home for the duration of his or her employment. We were each assigned a room that contained a bed, a chair, a desk and, most importantly, a telephone. The house-staff dining room was open for three free meals a day, plus an extra meal between 11:00 P.M. and 1:00 A.M. On some divisions a resident might be on call only every third night, but in my surgical division the call schedule was every other night and every other weekend, plus, of course, 7:00 A.M. until 6:00 P.M. on weekdays and 7:00 A.M. until noon on Saturdays. We were on duty Tuesday, Thursday, and Friday nights one week; Monday, Wednesday, Saturday, and Sunday the next. Weekends off duty ran from noon on Saturday until 7:00 A.M. on Monday. Actually, the Tuesday-Thursday-Friday weeks were generally the more wearing of the two shifts, because on Saturday and Sunday there was no elective surgery. If you’d had a busy night, you generally could catch some sleep during the day. In any case, along with three or four meals a day, your room, and your uniforms, you were also paid sixty-five dollars a month to do with what you chose. Even in 1953, sixty-five dollars a month was not a princely sum.

In that year, unlike the situation now, there were far more residencies available nationwide than there were medical-school graduates to fill them. Many hospitals offered more money, less demanding schedules, and good training and supervision as well. Why, then, did I and so many others choose Bellevue?

To put it succinctly, for the challenge. Bellevue then was, even by the usual big-city hospital standards, horrendous. Like most residents, I didn’t know much about city politics, but I knew from my preliminary visit for an interview that Bellevue had to be grossly underfunded. Nobody walked, not the nurses, not the aides, certainly not the doctors; everyone sort of half-trotted. You could tell at a glance that there was too much for everyone to do and too little time to do it.

Even the chief resident of the division—who, one would expect, might get more sleep than the underlings—looked like the wrath of God, with bags under his eyes and a white uniform going to gray as he sat drinking a cup of coffee in the little kitchen just off the patient ward. He treated me nicely, expressed the hope that I would elect to intern there, but made it clear that I should only make the commitment if I was prepared to work my ass off. My surgical division accepted only six residents a year, but there was enough work for twelve. They wanted no one unwilling to give his all for Bellevue. (At that time women were still rare in medicine, and extremely rare in surgery. All that has, of course, now changed.)