WE WOULD ALL LIKE to believe that once we've
been admitted to a hospital our medical care will be administered by a team of professionals whose sole concern is our well being and that of the other patients in the hospital. In fact, most of us do believe this--or at least behave as if we do. In my 29 years as a surgeon I can't remember more than two or three patients who questioned me (or the nurse, or the X-ray technician, or any of the other members of the hospital staff) about the appropriateness of the medication, the blood tests, the physiotherapy, or any of the multitude of other things which were prescribed, the patients correctly assumed, for their welfare.
It's nice, once you're in the hospital, to relax and, at least to a limited extent, forget your troubles. "So I'm sick," the patient says to himself. "At least now there's no longer any need for me to worry about it. Here I am in this first class, highly regarded hospital, staffed by dedicated, intelligent people, and while I'm here, they'll do all the worrying for me. I can just lie back and let them take over. If it can posssibly be done, they'll make me well."
Would that it were so. Any knowledgeable patient knows, in his or her heart of hearts, that the people who run hospitals are fallible; a few patients will ask appropriate questions and try to play a role in their medical care so the best result may be achieved, but if you are one of the many who have complete faith in hospitals and prefer to surrender all responsibility to the hospital staff, then it might be best if you didn't read Michael Medved's book. It is going to disillusion you. Once you've read it, you will probably never again feel completely at ease in a hospital.
What Medved has done is to interview a representative sample of the people who make a hospital work. He doesn't identify the hospital, which he calls "Memorial," but it is almost certainly a California hospital, associated with a medical school large enough to require the services of a wide variety of specialists and technicians. Most of the doctors on the staff apparently teach at the affiliated medical school, but they also carry on private practices. Medved has interviewed an intern, a radiologist, a maid, a plastic surgeon, a ward clerk, a nurse, an oncologist--some 28 members of the staff, including the man who runs the hospital morgue. He has asked them not only about how they view their jobs, but what they think of their co-workers. He has asked them about their personal lives, including their sex lives. He has asked all the questions that ought to be asked if the reader is to know exactly what sort of people are providing patient care in the hospital.
What amazes me is how frankly those interviewed responded. For example, here is Dr. Charlotte Kirkham, a fellow in hematology, talking about her work: "My reaction to death is different each time, depending on the kid. If the kid, or the family, is bright, upwardly mobile, if the parents seem to understand what I'm talking about, then I'm more likely to be upset if that kid dies than with people where they don't know what the hell I'm talking about. I've got this one kid now who's three years old. The parents are crazy. They're just bizarre and stupid. The kid is a retard, basically, and he has ALL, that's acute lymphoblastic leukemia. He's probably going to do fairly well, but there's no way in the world I would cry if this kid died." Charlotte Kirkham may pass her boards in hematology with straight A's, but God deliver my patients from her clutches.
If Dr. Kirkham doesn't make you a bit uneasy, perhaps you'd like to consider these quotes from the chapter, "Killers at Large." Steven Ebersoll, a radiologist, has this to say: "About ten percent of the guys around Memorial shouldn't be practicing, but it's a real bitch to do something about it. We had a gastroenterology guy, a black guy, who was killing people, and everybody knew it. But we had a hell of a time getting rid of him, and then he just moved to another hospital. It was more difficult because he was black, and now we've got the same problem with this guy Lockwood who's screwing up in the delivery room. With this other guy, he sued us through the NAACP and made a big stink. It was awful."
Here are neurosurgeon Carl Gorman's comments from the same chapter. "A couple of years ago we had a neurosurgeon, a very talented guy, who was alcoholic. As a resident I worked with him a couple of times when he did brain surgery, six, eight hours in the OR, when he was drunk as a lord. He still managed okay, and I don't think he hurt anybody. In fact, if he hadn't picked up a bunch of lawsuits, I think he'd still be here. Now he's at one of the big hospitals in New York City, and he's back in business." I'd certainly like the name of that hospital, so I can be sure to avoid it if I ever get hit in the head while in New York.
I don't want to imply that Medved's book is completely negative; it isn't. In fact, most of the doctors, nurses, technicians and clerks seem to be dedicated people who do their jobs well. What Medved has done is to let us get to know them not only as professionals, but as complete people. Like the rest of us, they are human. Nancy Proctor, for example, is a dedicated nurse, widely admired by her co-workers. But when Nancy is off duty, she likes to have fun. Here is Nancy describing her social life as it was shortly after she went to work at Memorial: "I went wild, actually. I decided I'm going to screw everybody I can and I'm going to have a wonderful time. I was working pediatrics, and the group of interns were all single males anddone female. They were just terrific. . . . We'd always do things together. It was sort of like having brothers, but better. You can't have sex with your brothers.
"One time we had a slumber party for the nurses and doctors. We showed stag films and we had crazy games like 'Pin the Cock on the Male Pin-Up' and 'Pin the Tits on the Female Pin-Up.' And we played music and we went out and wrapped toilet paper all over the front yard of one of the older doctors."
Now if this behavior sounds juvenile to you, as it does to me, let me remind you that these are Nancy's off duty hours and she is entitled to spend them as she wishes. She was 22 at the time, and I suppose for some 22-year-olds these games seem like a lot of fun. The point is, the fun and games may not be related to how well Nancy does her job; perhaps this is the release she needs after eight hours of dealing with the sick and dying. Still, it would make me uneasy to know that the nurse in charge of my well being is the sort who really got a kick out of spreading toilet paper around. I think, if I were one of Nancy's charges, I'd rest easlier not knowing about her social life.
Medved writes in his introductory chapter, "This book is intended as neither an expos,e nor a critique of the medical profession, but rather as a small contribution toward that balanced understanding that will benefit everyone on both ends of the stethoscope. The extreme and one-sided images of medical practitioners--as either healing saints or hopeless incompetents--have become obstacles to optimal health care. What is needed above all is a more realistic and humane approach from the public to its physicians, and that approach requires the fundamental recognition that it is not the patients alone who suffer within hospital walls."
Medved may not have intended that his book be regarded as an expos,e, but I can assure him that that is exactly what it is. Perhaps not in the pejorative sense, but certainly in the sense that it exposes the hospital more completely than it ever has been. And Medved may not consider his book a critique of the medical profession, but it is onete; certainly the doctors and nurses in this book will not be confused with the dedicated professionals who used to appear in the Dr. Kildare films.
I think the best way to describe Hospital is to call it a revelation. Never before, to my knowledge, has anyone persuaded members of a hospital staff to talk so openly and completely about their lives. Frankly, after the personnel at "Memorial" read this book, I can't imagine how they will ever again be able to look one another in the eye, let alone work together as a team.
The things these people have to say will sometimes amuse you, often startle you, and frequently frighten you. Whether Medved's "contribution toward that balanced understanding will benefit everyone on both ends of the stethoscope" remains to be seen. I found Hospital a fascinating book; I think it is an honest book (I can't imagine any author inventing these confessions); but I also found it depressing. Some readers are going to learn from Medved's book a lot more about hospitals than they really want to know.