Bellevue Diary: Lights Within the Shadows
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From its founding 1736, Bellevue Hospital has been a dumping ground into which a city poured its poor, elderly, and dying. What makes the oldest hospital in the United States unique is that Bellevue is a place from which no one in need is turned away.
Bellevue Diary is a collection of short stories borne out of Dr. Monif s year of internship that collectively pays tribute to this great hospital.
Bellevue Diary is mosaic of short snippets of stories. Mosaics have to be near perfect to work. Ironically, this one comes close. What is surprising that it works on multiple levels: a historical characterization of a place and time and the impact of the Bellevue Hospital on a young physicians professional and spiritual growth into which is woven a thesis of deaths ultimate meaning. The pieces all come together to make this mosaic good reading.
Peter Firchow, PhDFormer Professor of English University of Minnesota
Gilles Monif MD
Gilles Monif, M.D. goes from Bellevue Hospital to the National Institutes of Health as a research fellow, and then to the University of Florida College of Medicine, and finally to Creighton University School of Medicine, He will achieve international recognition as a clinician, researcher, and educator in the area of infectious diseases that afflict women and their unborn babies. Currently, he resides in the Midwest with his wife and four children where he is president of a medical research company. In his life, A-3 cast a long shadow
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Bellevue Diary - Gilles Monif MD
Copyright © 2011 by Gilles Monif, MD
All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.
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ISBN: 978-1-4620-0845-2 (sc)
ISBN: 978-1-4502-9025-8 (ebook)
Library of Congress Control Number: 2011904972
Printed in the United States of America
iUniverse rev. date: 07/19/2011
Contents
Preface
Fred
Part I
Bellevue Hospital
Bellevue Hospital
The Room
Doubts
Part II
The Chest Service
The Chest Service
FUO
Double Jeopardy
The Gift
Good Offense, Bad Defense
Tobacco’s Addictive Grip
The Social Order
Left Breast Coat Pocket
The Dining Room
A Journey Not Kept
Peking Duck
Part III
A3: First Medical Division
Doubts
A-3
Night Sounds
The Touch
Emergency Room Baptism
No Problem, Big Problem
Checks and Balances
Mine or Theirs
VIP Rounds
Schwarzewolke
Not My Job
Fecal Impaction
Goya versus El Greco
Everybody Knows
Biggest Show in Town
Coming Home
Oy, Oy, My Heart
Bells Unrung
A Circus Team
Hubris
Sugar-Coated Bagel
My Lady
Female Medical Clinic
A Grand Event
When Breath Permits
Night Becomes Morning
Part IV
B4: First Medical Division
Matthew Greene
Unanswered Question
The Front Porch
Wrong Direction
Here, Kitty, Kitty
Proximity’s Price
Mother by Necessity
Second Thoughts
Chutzpah
Crashing the Gate
Little Words
Sooner
New Year’s Eve
A Different Bed
Miss PanAm
The Cup
Snow
A Drop of Truth
Reflections of the Father
Not Bricks
Ashes to Ashes
A Matter of Pennies
Score: Country One
Barton & Sons
Mayhem
Bellevue Nurses
Moses
The Rock
That’s It
The Ugliest Man in the World
Preface
Fred
The first day of anatomy was a personal challenge that could not be avoided. The bodies had to be carried up from cold storage in the basement to the Anatomy Dissection Room. Death had yet to touch my life. Though family members involved in the French resistance had died in World War II, I had never before been physically exposed to death. When volunteers were asked for, I took the first step forward. After carrying thirteen bodies up three fights of stairs, their collective weight blunted my initial fear.
Having volunteered, I got to choose the cadaver that I and three other classmates would dissect. I chose a thin white male, probably in his sixties. Having established a truly physical relationship, I named him Fred. In the many hours we spent together, Fred shared glimpses into his life with me. The skin of his hands told of hand work. His lungs, two sacks filled with coal dust, spoke of where he had been. The near absence of fat and his body’s donation by the City of Boston to the medical school bore witness to the probable poverty of his last days.
In teaching me about the human body, Fred opened my consciousness to, not death, but the steps before it.
Bellevue Diary chronicles more than just a tribute to a great institution. The events related are nonfiction. They occurred primarily between 1961 and 1962, the year of my medical internship. The names of most individuals have been changed; for several individuals, not to recognize them would be wrong.
The lights within the shadows provided the insights that allowed me to write, You meet many persons who desperately cling to lives that have long lost their substance. Physical existence is the last possession they have. And then there are those who come to death with ‘their cups filled.’
Before I too enter into the shadows, I want to share experiences that enriched my life.
"The people that walk in darkness have seen a great light:
They that dwelt in the land of the shadow of death, upon
them hath the light shined."
Isaiah 9:2
Part I
Bellevue Hospital
Bellevue Hospital
In 1736, Bellevue Hospital, the oldest public hospital in the United States, was founded. At the time, George Washington may have been four or five years old.
Following a fire that occurred sometime around the turn of the century, between 1906 and 1939 Bellevue was rebuilt in bits and pieces. She now shows her age: a conglomerate of brick buildings stretching along First Avenue from Twenty-Fifth Street to Thirtieth Street. The one architectural element that gives her an illusion of grandeur is the Administrative Building, which faces First Avenue. Its strong, vertical, inlaid concrete columns take one’s gaze upward to a pseudo-Athenian temple facade that towers two stories above the adjacent roofs.
What makes Bellevue great is that she is the hospital from which no one is turned away.
She is an open-ended funnel into which New York dumps its poor, elderly, and dying. If an individual presents at another hospital for admission and it is apparent that he or she will demand a disproportionate amount of care, the admitting physician has only to write No beds
and the patient is Bellevue-bound.
Competition for internships at Bellevue Hospital is intense. Its 2,500 patient beds are the medical equivalent of what was once the great library at Alexandria. Within each bed, a potential lesson waits—a lesson in which knowledge is exchanged for a dose of healing. Educationally, big-city hospitals are the Harvards of the medical world, and, as at Harvard, learning can come at a steep price.
The Medical and Chest Services are divided between three medical schools: Columbia University (since 1888), Cornell University (since 1888) and New York University (since 1898). Each institution has imparted to its house staff a unique profile. The Cornell interns and residents are dubbed the All-American boys.
By and large, they tend to be clean-cut and have the distinction of having been elected by their respective school faculties to the national honorary society, Alpha Omega Alpha (AOA). The New York University interns and residents emphasize academic brilliance over decorum and appearance. The Columbia interns and residents are called the aristocrats of Bellevue.
The latter image is largely fashioned by the predominance of Columbia graduates among its house staff. They are New York’s response to the proper Bostonians.
My reasons for wanting to be part of the Columbia Medical Service had to do with something else. The Columbia Medical Service at Bellevue had produced more academicians than even the Thorndike Service at Boston City Hospital. In the 1950s, a Nobel Prize in Medicine had been awarded to its director and his collaborators for pioneering research in the area of pulmonary physiology. What I did not know when making my selections for the National Internship Matching Program was that his retirement was imminent.
The Chief of Service’s replacement seemed a strange choice: an uptown physician whose patients had, more likely than not, frequented Harkness Pavilion at Presbyterian Hospital. At Bellevue, the patients, more often than not, called the Bowery home.
Despite having graduated in the top ten of my class and having very strong letters of recommendation, the absence of my election to the national honorary medical society should have raised a red flag. My election to Alpha Omega Alpha had been blackballed by two professors.
The Room
The house staff rooms are located on the fifth and sixth floors of the Administration Building. Five cartons of medical books and two suitcases of clothes quickly teach me that, at Bellevue, the elevators are more symbolic than functional.
Tired from carrying the last load of books up five sets of stairs, I quickly turn the key, push the metal door open, and begin carrying