Bellevue No One Was Ever Turned Away

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The second obvious challenge was the patients. In these open wards the general policy was to put the sickest patients at the front of the ward, nearest the nurse’s desk, so they would get the closest supervision. I looked into the division’s three surgical wards, and it was immediately obvious that at Bellevue a sick patient was one who would be considered critical, if not hopeless, in most hospitals. All the patients near the nurse’s station, and extending for some distance back, had tubes running in or out of most orifices, and all had the appearance of the chronically ill and malnourished recently felled by an acute illness. Among Bellevue patients, malnutrition was endemic, and it was the rare patient who didn’t have two or three diseases to complicate whatever major catastrophe had precipitated his admission.

The clincher was the fact that in those days Bellevue was truly a house-staff hospital. The word of the chief resident, in his fifth or sixth year of training, was law. Officially we had a director—a professor of surgery from Cornell—who visited the hospital for about two hours on Thursday when we held our surgical conference. During my last three years at Bellevue, he also made rounds between 6:00 and 7:00 P.M. on most Monday nights. The absence of a full-time director (to say nothing of the full-time staff doctors that most teaching hospitals now have) guaranteed that residents could take as much personal responsibility for patient care as they were capable of handling. Woe unto the resident who overestimated his capability; the wrath of the chief resident, who was ultimately responsible to the director, could be devastating. But within those boundaries, opportunities to provide medical care were limitless. Few great hospitals offered as much opportunity and challenge to the eager, young, recently graduated medical student.

There can be no question that in 1953, in New York City, Bellevue was the hospital of last resort. Remember that Medicare and Medicaid didn’t exist until 1965. Bellevue, and other city hospitals, were the places where the poor and the elderly came to get their care.

At any other city hospital, if the beds were full and an ambulance showed up with a desperately ill patient, the resident could write “No beds” on the admission slip and send the patient on to Bellevue. At Bellevue you weren’t allowed to write “No beds.” When a patient arrived, if he needed hospital care, he stayed. You either stole a bed from another ward or you built one out of spare parts that were tucked away in closets. No one was ever turned away from Bellevue.

All through my stay, Bellevue was a bit behind the times, to put it kindly. In 1955 New York had a record-breaking heat wave. No part of Bellevue was airconditioned, so when the operating rooms (ORs) got above a certain temperature, we had to cancel all but emergency and cancer surgery. We residents hated that because it meant “our” operations—hemorrhoids, varicose veins, and hernias—were eliminated. (The ORs were air-conditioned in 1957.)

There was also a severe water shortage in New York in that summer. All over Bellevue there were pipes that leaked and faucets that constantly dripped. Did anyone fix these, to save water? Of course not. It was easier just to take the pitchers of water off the tables in the doctors’ dining room.

During my stint at the hospital, we had some elevators that had never been known to work properly. Instead of fixing the buzzers, for example, signs that said “Push down for up” hung on the call-board for seven years. We residents rarely waited for an elevator unless we were going up more than four flights. We never took a down elevator.

In a hospital with twenty-five hundred beds, most of them filled most of the time, there was no page system. Every resident made certain that the head nurse or the clerk on the ward to which he was assigned knew where he was at all times.

Meanwhile, X rays were constantly being lost; or, if they proved to be interesting, stolen by the X-ray residents for their future teaching files. At Bellevue, finding X rays, or the chart from a patient’s previous admission, was a feat to challenge the skills of the most astute private eye. The resident who had a knack for this was almost guaranteed to be reappointed the next year.

There was never enough equipment on the wards. As a surgical resident I learned to keep a pair of bandage scissors tied by a rope to my belt. This was a trick I had picked up when, as a medical student, I had spent two months on the surgical wards at Boston City Hospital, an institution, by the way, every bit as challenging as Bellevue.