The View from the Vue (28 page)

“I guess Stephenson figures why should he knock himself out on guys who won’t put out anyway?” answered the C.R. “He probably thinks if he puts the screws to us, there’s at least a chance hell get some bottles of blood out of it.” The chief paused a minute, but before I could say anything, he added, “And if he doesn’t get blood, he’s going to cancel all our elective surgery. And the surgeons’, too, by the way. So, if you and the other guys don’t get with it in a hurry, your chief won’t have anything to do all day but beat on you and make your life miserable. ’Bye, Lar, ol’ buddy.”

I couldn’t really get mad. I knew Dr. Stephenson must have been up tight against the wall, and as blood bank director, a man is more than entitled to periodic bouts of rational irrationality. I sat down for a few minutes and pondered the situation.

Now there existed a custom at The Vue whereby every woman who delivered a baby there was supposed to have two persons donate blood for her. This was a difficult rule to enforce: after all, one can’t hold a baby back until the mother has coughed up her two pints of blood. So a few of the women sent in a husband and a brother, a larger number got one donor, but most would provide none. A surprising number of these welfare patients’ husbands offered to pay for the blood. They’d just shrug when we told them that you can’t transfuse a dollar bill to a dying patient. One day, I asked one of the Puerto Rican nurses’ aides why the resistance. She told me that Latin men believed that donating blood drains off their virility and robs them of their potency. She giggled.

“What’s so funny?” I asked.

“I wuz jes’ t’inkin, Dr. Karp,” she said. “Maybe you could git
my
husbin’ to give some blood sometimes.”

I directed my thoughts back to the major problem at hand, and decided that the only thing to do was to enforce the law. So I got together with the rest of the residents and the medical students, and we agreed that no patient would be discharged until she had arranged for her blood donations.

As the maternity ward began to fill up, and as large numbers of men began to consider the thought of cooking and cleaning
ad infinitum
, they made their way to the blood bank, bringing back their donation receipts to exchange for their wives. Of course, there were the imaginative fellows like the two-hundred-pound mesomorph who sought me out to explain that as much as he’d have liked to help me out, he simply couldn’t, because he had anemia—“real bad anemia.” I told him to go down to the blood bank anyway, that not only would they not let him give blood if he were anemic, but they’d see he got proper treatment for his condition.

“And if I am anemic, Doc, then can I take my wife home?”

“Then,” I said, “you can get your brother in. Or your sister. Or your father. Or anyone in your family who isn’t anemic.” The guy trudged downstairs, was relieved of a pint of virility and potency, and took home his wife.

This went on for two weeks. Great hordes of friends and relatives of parturient women flocked to the blood bank. Then one day I looked at the report, and did a double take. I couldn’t believe it. Perhaps for the first time in history, the Bellevue Hospital blood bank was in the black. I picked up the phone and called the bank. One of the assistant directors answered, and he was euphoric. “I don’t know what the hell you’re doing over there,” he burbled, “but keep it up.”

I told the guy what we were doing over there. He whistled. “Gaaah-damn!” he yelled. “That is just great. Really great. Keep it up, now, you understand?”

We kept it up for another few days. At that juncture, I received a phone call from Mr. Wilson, who was one of the hospital administrators. Mr. Wilson wanted to know what was all this about holding patients prisoner on the maternity ward.

“Why, Mr. Wilson,” I said. “Whatever in the world can you be talking about?”

I heard Mr. Wilson choke a little on the other end, and I felt a brief twinge of conscience. Mr. W. was really a very nice fellow. But business is business. So I just sat there and waited.

“I got a call from the employer of one of your patients,” he finally said, in tight, clipped words. “He told me that the lady had told him she was being ‘held’ at the hospital for lack of blood donors.”

Such episodes help to clarify the basis for our acts of humanity. The efficiency of this guy’s factory had probably been lowered by a factor of one cog’s worth.

“Mr. Wilson,” I said. “You know that every obstetrical patient is supposed to donate two pints of blood, and she hasn’t.”

Mr. W. was beginning to get angry. “Well, you let her go anyway.”

“I can’t do that,” I said. “Dr. Stephenson’s crew feels that it’s necessary to get every blood donor we possibly can. So all our residents have agreed to enforce the two-donors-per-patient rule. If you call our chief resident and he says it’s okay, I’ll discharge the patient.”

Mr. Wilson’s teeth ground audibly, and he said he’d do that. I thanked him, and went back to work.

A short while later I got a call from the chief. Mr. Wilson had called him, as well as the blood bank A.D. who was on duty at that moment. The chief resident advised me that everyone else concerned had concluded that it would be best were we to yield on the matter. “We’ve made our point,” he said. “Now, if the administrator wants us to send the patient home, I think we should.” He chuckled. “You did good.” I smiled, hung up, and called Mr. Wilson back.

The administrator sounded a bit calmer now. He explained that the blood bank official had led him to understand the full state of affairs, as had the chief resident. “But,” he went on, “we really can’t hold patients prisoners, you know. They could sue us.”

“We haven’t held anyone prisoner,” I said. “We just haven’t discharged them. If they’ve wanted to leave the hospital, we haven’t interfered with them in any way. In fact, we didn’t even threaten to refuse them follow-up care.”

Mr. Wilson uh-hummed for a couple of seconds, and then asked, “How about this particular woman? Did she actually receive any blood?”

“Only four pints,” I answered. “She had a post-partum hemorrhage.”

“Well,” said Mr. Wilson. “Isn’t that interesting? I think I’ll call her boss and tell him that. In fact, I’ll tell him the whole situation.”

“That sounds good,” I said. I got ready to go back to work.

“But we’ll just have to stop enforcing that rule,” went on Mr. Wilson. “You’ve seen those newspaper guys who’re always going up and down the corridors, trying to smell out a good scandal or two. Just think what one of them could make out of this business, if he got onto it.”

And so, the Bellevue blood bank situation returned to normal. Dr. Stephenson and his gallant crew continued to beat their heads against the wall, trying to keep the stores in the blood bank one step above disaster level. When things got bad enough, another drive was organized, everyone congratulated himself, and then it was downhill again for another few months. The crises went round and round. Every so often, some poor guy bled to death while a frantic effort was being made to locate enough of the proper type of blood for him. Eventually this sort of tragedy happened several times too often, and blood banks began to centralize their facilities and their resources, to provide greater cushions against sudden large demands on their reserves. This expedient has helped to some degree, of course, but it’s not nearly a satisfactory solution. Nor can such really be expected to be found, as long as we continue to show great concern for the efficient functioning of our factories and for what the newspapers may say about us, while demonstrating much less anxiety about safeguarding the lives of our neighbors, our families, and even ourselves.

In a place like The Vue, you might expect that there would be a good deal of violence. Actually, there was relatively little of an obvious sort. Bellevue was years ahead in pioneering the “better latent than blatant” theory. Although there was constant friction among doctors, administrators, nurses, aides, ancillary help, and patients, rarely did it erupt into a good, healthy fracas. Like the rest of Bellevue, it just festered quietly. Periodically, it would burst out here or there; then the troops would clean up the mess and, for a while longer, business would go on as usual.

The persons responsible for keeping the peace in The Vue were the guards, an elite corps of ex-cops and would-be cops employed for the purpose by the City of New York. They were directed to trouble spots by the paging operators.

The paging system at Bellevue was truly gothic. Twenty-four hours a day the loudspeakers would blare forth with requests for doctors to call their wards. The speakers were never muted at night, and I never could see how any of the patients ever managed to get a night’s sleep. The operators themselves were a riot. Only those with the thickest New York accents and the most outlandish Bronx twangs were chosen. When my friend Dr. Dahl was needed, it was, “Dokta Dawl, Dokta Daviddawl, Dokta Dawl, Dokta Daviddawl.” Once was never enough. And when we heard, in singsong tones, “Pagin’ d’ gahds, d’ gahds, d’ gahds! Pagin’ d’ gahds, d’ gahds, d’ gahds!” we knew that, somewhere in the hospital, brains were being spilled on the concrete floors, or were about to be. Then we’d see d’gahds, nightsticks in hand, charging through the corridors. We’d head the other way.

When I was a medical student, one of my interns was Frank Melnor. At the time, Frank was working on the neurology ward. Many neurology patients were sad cases, who, as the result of brain injury or stroke, were totally unconscious and would remain so until the day they would die, a time which the physicians were morally bound to defer as long as possible.

One night, Frank Melnor decided that one of his unresponsive patients had pneumonia and needed a chest X-ray. He wanted to put the patient onto a stretcher and wheel him to the radiology department. The trouble was, this particular man weighed more than two hundred pounds. So Frank went into the ward office to look for help. An aide was sitting there reading a comic book, and Frank requested that he stop long enough to help lift the patient onto the stretcher.

Since the aide didn’t budge, Frank thought he might not have heard the request, so he repeated it in a louder voice. However, this also brought no response.

Now Frank decided that he was being ignored, so he hollered at the aide to quit fooling around and lend a hand immediately. When the aide remained immobile, Frank could stand no more, so he ran over, ripped the comic book out of the aide’s hands, and flung it across the room.

This was a foolish move, because the aide looked like the late Sonny Liston in his prime. Very slowly he rose to his feet, and very slowly he advanced on Frank. Grabbing the intern by his lapels, he raised Frank off the floor and, in a monotonic drawl, patiently informed him that another such performance would certainly be Frank’s last. Then he let go, picked up his comic book, and went back to his reading.

That was not the end, though. The next day the aide reported Frank to his union leader, who in turn saw to it that Frank was reprimanded by the hospital administrator for attempting to use physical force on the aide. The fact that the aide had considered it appropriate to sit and read a comic book for eight hours between punching in and out was of no import. It was like the time that one of the interns, while wheeling his patient to the X-ray department, was thrown off an elevator to make room for the elevator operator’s friend, the garbage man with his sacks of goodies. The next morning, when the intern complained to an administrator, he was told to shut up and get back to work. “I can always get another intern,” said the administrator. “But I can’t get another elevator operator.” That wasn’t really true, of course. But the interns weren’t unionized and the elevator operators were. In any event, Frank Melnor had to solve his personnel problem by getting a portable X-ray on his patient.

Sometimes one of the members of the Bellevue animal population would figure in an episode of violence. You have to remember that since it was located on the banks of the East River, The Vue was home to a very large number of very large beasts. Gigantic rats, mice, and roaches wandered fearlessly through the corridors. They were part of the Bellevue folklore. For example, rumor had it that an intern, while carrying a blood specimen through the basement passageway to the pathology building, was devoured by an alligator that had taken up residence in the huge water puddles on the floors. Then there was the story of the intern who had been run down and killed in the parking lot by a Volkswagen. When the witnesses chased down the vehicle and brought it to a halt, they found that it was really just a cockroach. I don’t believe the story, though. No one in New York would bother to chase down a hit-and-run cockroach.

Cockroach stories sometimes crossed the line into the real world. It was nothing short of nauseating, after having washed off a lady who was about to deliver a baby, to see a large roach crawl out from beneath the sterile sheets and onto her belly. The lady was never terribly happy about it either. Then there was the time that one of the residents bit into a meatball in the dining room and uncovered one of the little beasties. A number of us at the table turned pale, but the unlucky fellow didn’t bat an eye. He just picked up his plate and carried it into the kitchen where Miz Matthews, the dietitian, was standing. Showing her the evidence, he said, “Miz Matthews, you know, you really ought to serve the cockroaches on separate platters.”

The most ubiquitous vermin were the mice. As soon as the lights were turned out at eleven o’clock, the Grand Army of the Republic began its nightly march. You could hear them scampering across the floor until morning. They ate any food that happened to be left out by an unwary patient. In fact, sometimes they ate the patients. They really did. We had to be certain that the moribund and the helpless were kept near the front of the ward, where the occasional activity and the light from the nurses’ desk would keep the patients from being devoured by the gang of hungry little omnivores. The Bowery Bums knew all this very well, and when they were admitted, they’d plead for a bed near the front.