Memories of City Hospital

Memories of City Hospital

“Too many people have decided to do

without generosity in order to practice charity.”

-Albert Camus

I was a kid when I started medical school.  I was an excellent student in college, mostly because I had a knack for knowing which material the professors deemed important enough to place in the tests.  There was a long line of classmates who wanted to study with me.  It was easy for me.  I did not see the need to develop daily study habits, or to organize my notes.

The first year and a half of medical school was spent in classrooms.  Again, I picked and chose what interested me.  There were times that I left a whole page of a test blank because I had not bothered to read up on something that I considered mundane.  I managed to remain in the middle of the class in a highly competitive school.  I was satisfied with my not standing out.

On the second semester of our sophomore year we were finally introduced to live patients.  It was a physical diagnosis course.  We were taught how to examine people, and how to recognize abnormal findings.  Any patient admitted with an enlarged thyroid, a heart murmur, or an unusual rash was like gold for us.  Once a week our mentors would take us through several hospital rooms to show us what we called “interesting findings.”  The poor soul who happened to own one of these abnormalities was often asked to allow a few dozen eager “young doctors” to listen to their chest or poke around their neck.

Soon after we moved on to doing complete histories and exams on one individual.  Instead of flashing in for a minute or two to do a quick exam we had to spend a full hour with one person, after which we were asked to write their personal history in exquisite detail.  The current illness, plus all prior hospital stays (including surgeries), allergies, medication lists, how all of their relatives had died…  The end result was several pages of handwritten paper that sometimes was added to a patient record that already had numerous similar notes from the students that had come before we had.

I was energized.  These were people; real human beings.  My lifetime dream, to become a doctor, was finally coming into focus.  I began to regret that I had not been as devoted to learning some of the stuff that months earlier I had considered to be trivial.  I realized, with quite a bit of panic, that there were reams of material that I did not know.  Because we were based at Barnes, a private hospital that catered to many of the rich and powerful, I felt like a pest when I asked these patients for yet another minute of their time, another standing still to let a stranger invade their privacy.

For my first full exam I was assigned to City Hospital #1.  City had a long and mostly proud history.  Built in the latter half of the 19^th century, twice it was destroyed (once by fire; later by a tornado).  In 1910 the current structure was built.  My first visit there was in 1968; by then the wards showed their age and the puny funding that the city gave it was clearly evident.  Professors from Washington and St. Louis Universities led daily heroic struggles to provide these indigent people a level of medical care that their wealthier neighbors enjoyed.  A few miles west at Homer G. Phillips Hospital the same scenario unfolded, this time taking care of a predominantly African American population (the hospitals were segregated until 1955, when the mayor officially ended the discrimination, but neighborhood patterns and a history of people doing what they had always done perpetuated the racial division).  Someday we’ll talk about Homer G.

As soon as I walked past the columns at the main entrance I knew that I was home.  No fancy decorations.  Floors in need of sweeping.  Air conditioning that didn’t always work.  Most important of all: I was needed.  At Barnes we were clearly superfluous.  At City we had to help, because there was no one else.  Wheeling patients to the X-Ray suite (No money for adequate staffing of orderlies).  Waking up at 3AM to give a penicillin shot (Only one RN for the whole hospital for the night shift).  Sitting next to a heart attack victim for eight hours at night (No electronic monitors or ICU gear).

I was thrilled.  Slowly (The process took years) I realized that I was no longer going to school.  I was training to be a professional.  I began to devour textbooks and journals.  I asked questions.  Lots of them.  I bonded to my mentors and the more experienced students and house staff.  I became noticed.  I clearly remember my first interrogation by one of the professors.  He was the chief of service.  A giant in his field; an intimidating presence for all because of his relentless pursuit of quality and perfection for all of the people who walked in the door, no matter how sorry an example of humanity they were.

I gave my presentation.  He asked questions; I answered.  He asked more; then, when I thought that I was done, he “attacked” again.  My supervising resident tried to take on some of the flak, but he was clearly interested in me.

After an endless hour of instruction he came towards me, smiled, and patted me on the back.  “That was very good.  Considering that it was your first one, it was excellent.  Good work!”

It was the beginning of a long friendship.

After this I made an effort to schedule as many of my teaching rotations as possible at City.  I could write two books about what went on.  The lady who was addicted to narcotics.  In those days you could buy paregoric over the counter, without a prescription.  This woman and her boyfriend devised a still that could extract opium from the bitter liquid that people mostly used to treat diarrhea.  They sold half of their proceeds, and injected themselves with the rest.  Eventually she destroyed all of her veins.  She learned how to find a vein in her groin.  She came in with a huge abscess; the surgeons drained three liters of pus from her groin.  A month later she developed an infection of her heart valves.

We had to find a vein in order to give her antibiotics.  One of the residents started an IV under her clavicle.  We began her medicine and waited for her to go through narcotic withdrawal.  To our surprise she remained happy as a lark; sweet and friendly.  We became suspicious.  One of my classmates stayed up one night at the nurses’ station.  Her boyfriend walked in at 1AM.  He went straight to her and began to draw the curtain around her bed.  My friend sprung into action.

“I’m sorry, sir.  Visiting hours are over.”

The gentleman drew a gun and pointed it at him.

“But for you, sir, we will be happy to extend them.”

He walked out of the ward, as quickly as he could.  Our patient never had withdrawal symptoms.

There was the gentleman who was unable to afford any more alcohol.  He had hallucinations; the most disturbing one being that he thought that there were dogs chasing him.  Somehow he escaped leather restraints and began to race up and down the ward, screaming at the top of his lungs.  There was no way that we could chase him down, and there were no orderlies on duty at night.  Whenever he became too exhausted to run he got on his hands and knees and looked for dogs under all of the beds in the ward.  No one got any sleep that night.

There were many people who were down on their luck.  They had lost a job, or had just moved into town and had no doctor to rely on.  We treated them like royalty.  The most grateful patients I have ever seen.

We washed maggots off of abandoned old people.  We even gave enemas.  We were up thirty-six hours in a row, and a day later we were back, trying to somehow stem the endless tide of disease and misery that this venerable building was cursed with.

Or, from my point of view, blessed.

I found my soul.  I understood why I was placed in this world.  I was spent, and happier than I had ever been.

I live downtown, a few blocks from that building that shaped my career.  The city ran out of money a long time ago.  First Homer G., then City were closed.  Services were switched to the old St. Luke’s at Delmar, but the handwriting was on the wall.  By late last century the poor had to fend for themselves.  The existing hospitals bear their burden now, with varying degrees of minimal success.

Part of the old City #1 complex was torn down.  The main building now serves as an apartment building.  Homer G. was turned into a facility for the elderly.  The beautiful psychiatric hospital, Malcolm Bliss (Many stories there also), was torn down.

Last year, shortly after our move, my wife and I drove to the nearest Walgreens.  It sits right across from the City #1 building.  I could barely hold back a few tears.

I wish that the brick walls could hear me so that I could thank them for doing so much for me.  All of those people who accepted me as their doctor when all that I had going for me was the desire to help.  My residents and professors, who never, not once, failed to give less than their best when faced with self-destructive sociopaths who did not appreciate or thank them.

Medicine is different now.  If any of the current regulatory agencies had come to visit the old City we would have been skewered and shut down.  Yet we had a spirit that no longer exists.  Progress leaves no room for the soul to grow.

OK; I’ll shed my tears now.  God bless the old brick façade.  May its ghosts smile on it forever.