Magazine | October 17, 2011, Issue

Take Care

You can write about hospitals all the time, since they will take us all in the end.

Hospitals are institutions, with their own history and demography. The ground floors of the great teaching hospitals of the city have dark and disused shrines — niches hung with the portraits of their WASP overseers of old, in whiskers and stiff collars. At the fin of the last siècle, the portraits and chiseled names of the benefactors were all Jews. Passing donor, stop and see / What I am now, so you shall be. Jewish is also the ethnicity of most of the doctors who are not Chinese. The nurses and the kitchen and custodial staffs represent the islands; on a recent visit I met three women named Althea: not as popular a first name as Britney or Tiffany here, but big in Jamaica.

Like any institution, a hospital must struggle with problems of scale. You want to help as many as possible, but the more you help you may help them all less. Patients confined to hospital beds for long stretches are at risk for bedsores and clots, so a bed with an air mattress that reflates under different body parts successively is a blessing to them. But since one size fits all, patients who are in for shorter stretches must endure a bed that moans and hisses and gives them a love tap every six seconds — like sleeping with a Nicholson Baker book: distracting at the best of times, vexing in the watches of the night. Speaking of night, hospitals have no night, strictly speaking. They space out the tasks that must be performed for each of their hundreds of patients over the whole circadian cycle, so in the dark of pre-dawn the patient must be roused to have his blood pressure taken (higher than it would be, outside the hospital and the reach of its wake-up calls).

Perhaps the worst problem of scale is the quality of the food. Bad food afflicts all institutions, from college to the Marines. Why does it have to be so bad in hospitals? Even airlines sometimes served decent food, when they still served food. The patient is given a show of choice, but the fruit plate always becomes meat loaf on delivery. That’s all right, they taste the same anyway. The hospital of my acquaintance has made an honorable compromise, by letting a chain of French bakeries have a 24/7 outpost just inside its front door. For meals more complicated than muffins or les sandwiches, patients turn to take-out. The Yemeni place — OK. The Persian place — not so OK. The retro Chinese place — too far for delivery, but it will deliver to our apartment, from whence the wontons can be carried on, as if by Pony Express.

#page#The most perverse feature of the hospital-as-institution is the iatrogenic paradox. Hospitals are abodes of recovery and cure. Yet they are also bastions of filth. I do not mean to criticize the men and women who empty the garbage bags and clean the floors with their dry mops. They make their appointed rounds, and some of them are saints. But the accumulation of tissues, wrappers, plastic, crumbs, and dust always overtakes them. Every corner is an amen corner of grit. At least doctors now regularly wash their hands as they make their rounds. That took only 2,400 years since Hippocrates.

I mentioned saints. You know them when you meet them. They can appear in any guise, from surgeons to sweepers. They are the people who take interest and pleasure in you as they take care of you, and who (you are certain) take everyone they meet in the same spirit. When you see them you think of sunlight and gold. There are also, let’s face it, a few bastards — the curt, the sullen, as if being there weren’t problem enough. Then there are the majority of those who do their jobs. Is there any way to arrange the ethos of a profession and the structure of an institution to pull the average toward sainthood and away from bastardy? It seems that there is. A good hospital is the living proof. Culture and rules can pull for the good-hearted, encourage goodness in the normal, and leave the gnomes and goblins wrong-footed. Wingers, especially in America, have a yen for the rugged individual, from Leatherstocking to Galt’s Gulch. But you should have a very good reason to scorn a prop for goodness.

Hospitals are exercises in bifocal vision. There is the eye of the next of kin, and the eye of the patient. They see almost the same things, but from slightly different angles. The next of kin become master travelers. Since many of the hospitals in the city are on the East River, that means becoming an expert of the FDR Drive. The 23rd Street exit can take you to 23rd Street, but it can be better to make a hard right on 25th, which goes all the way to Second Avenue — unless you take the quick left on Asser Levy Place, past the old public swimming pool, to try and beat the light. Take your time — if you mess it up, you’ll have 30 or 40 chances to re-do. The FDR Drive is always the same, except when it’s different. Hurricane Irene — looks like Robert Moses didn’t expect such big puddles. Obama visits the U.N. — suddenly the oily stream is filled with police boats, with rather dramatic machine guns in the bow. If the FDR Drive had been there for the Blizzard of 1888, you could have seen jokers riding across the ice on horseback.

The patient’s view is much much much much grimmer. A room with a window is beyond price. It is also a postcard designed by an idiot. Lovely Roosevelt Island, with its backdrop of power-plant smokestacks. Traffic on the 59th Street bridge — what a treat. Roofs of gravel.

But among the stones, even in autumn, there is grass. Tough little buggers. You too.

Richard Brookhiser — Historian Richard Brookhiser is a senior editor of National Review and a senior fellow at the National Review Institute.

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