I. Bellevue Hospital 1930s: “A Hospital of Last Resort”
Dewitt Stetten, Jr.
On the east side of First Avenue, between Twenty-sixth and Thirty-first Streets in Manhattan, stood the ancient brick pile that was Bellevue Hospital. It was surrounded by a tall iron fence and fronted directly on the East River, which is Manhattan’s most interesting river frontage. The large boat wharf on the New York Yacht Club was at the foot of Twenty-sixth Street, whereas a few blocks away on another wharf stood the Municipal Lodging House, an overnight accommodation for the abundant destitute of New York City and a source of many of our patients. Bellevue was the largest and most distinguished of the hospitals of the City of New York. It had 2,400 beds, a vast outpatient department, a relatively new and handsome psychiatric pavilion that had been constructed by our old family friend, Dr. Menas Gregory, with the support of his sponsor, Mayor Jimmy Walker, New York’s famous playboy mayor. It also housed the city morgue and the office of the medical examiner, which was responsible for the autopsies on all persons who died under suspicious circumstances in the city. It had a most active emergency room, which was fed by a busy ambulance service covering a band across Manhattan between Forty-second and Houston Streets, river to river. In addition to the usual services of medicine, surgery, pediatrics, obstetrics, and gynecology, it housed an active alcoholic pavilion, a fascinating prison ward, and a gloomy erysipelas ward. It was, in a sense, a hospital of last resort. Other hospitals in the city had the privilege of rejecting new admissions when all of their beds were filled. Bellevue did not have this privilege. No one could be denied admission, and consequently there were often rows of cots set up between the rows of beds on its wards. It was, in the opinion of its interns and residents, the most exciting hospital in the world.
(Excerpted from Stetten Jr., D. How My Life is Spent as printed in Perspectives in Biology and Medicine 1985;28:543. Reprinted with permission from Johns Hopkins University Press.)
II. Bellevue Hospital 1950s: “Ring Up for Down”
My earliest recollections of Bellevue Hospital, the “old hospital” that was Bellevue before the present modern building was opened in 1975, dates to my first year in school when, on Saturday mornings, we came from the medical school building across the street to the Bellevue Clinic building for “clinical correlation.” A patient, whose disease related in some way to the subjects we were studying, was presented to us and discussed. I remember the elevator in the clinic building had two signs. One, directing patients to the medical clinics on the fourth, fifth and sixth floors, was printed in English, Italian, Chinese, and Yiddish. Below it, a battered, hand-lettered sign read “Ring Up for Down.”…
One of the first patients I ever examined, as a second-year student, was on a large open ward at Bellevue Hospital. The short, gray-haired cardiologist who was my physical diagnosis instructor was his doctor in the cardiac clinic. Dr. Bertha Rader had cared for him for many years and was responsible for his having been admitted to Bellevue at this time for heart surgery, the repair of a rheumatic valve. He was very patient and somewhat bemused as six medical students, in turn, struggled to hear and then identify his heart murmur. The unspoken, but evident, understanding between this burly retired policeman and our instructor made it clear that teaching, learning, and patient care were being combined seamlessly…
The wards were large rooms, accommodating from 20 to 30 beds, arranged along the side walls and down the center aisles. The nurse’s desk and medication cabinets stood just within the entrance. Medical students, usually six or eight in a group, arrived each morning carrying our black bags awaiting morning rounds. Nursing students, all young women in those days, seemed equally nervous and uncomfortable as their instructors gave them assignments. Nurses, doctors, medical and nursing students, and patients were all in plain view of each other; privacy consisted of a small screen that could be positioned around the bed of a patient being examined, undergoing a procedure, or dying.
(Excerpted from Lowenstein,J. The Midnight Meal and Other Essays About.Doctors, Patients, and Medicine Yale University Press, 1997:pp112-113. Reprinted with permission of author.)
III. Bellevue Hospital 1980s: “Grow Old Along With Me! The Best is Yet to Be.”
Walking into Bellevue on my first day as a medical student, I passed through the little garden in front of the nineteenth-century brick hospital building. There was a three-tiered fountain and a stone birdbath atop carved marble legs. A curved path lined with wooden benches meandered through the garden. If it weren’t for the roar of New York City traffic on First Avenue, this could have been an English garden in front of a landed gentry estate. The spaces between the spokes of cast iron fencing that enclosed the garden allowed for a distant awareness of the ambulance sirens and the M15 bus and the Bengali man who sold newspapers stacked right on the pavement. But there was a demarcation between the twentieth century world out there and the nineteenth century world in here.
In order to get to New Bellevue, the 1970s-era concrete block that now housed all patients, one had to enter via this brick behemoth that was now termed Old Bellevue. The actual entrance to the hospital was an incongruously narrow pathway that ran along one edge of the garden. A raw concrete overhang from the parking garage clipped off any openness that the sky might have offered. The path led to a single door to enter and one single door to exit. Swarms of residents, nurses, patients, and visitors bottlenecked from either direction. The glass doors were grimy from the thousands of palms that pressed against it each day. The foyer was jammed with white coats and saris, kafiyas and dashikis. Spanish and Tagalog, Bengali and English, elbowed for air space as did the smells of coffee, curry, and homelessness. Gum wrappers and cigarette butts littered the doorways. Windblown scraps of the New York Post and the New York Times were tangled in trampling feet that pressed forward every morning. But these portals led into Bellevue, and now I, as a medical student, was in Bellevue, happily part of that swarm pushing through the doors.
Just inside the foyer was the Bellevue coffee shop. In the mornings there were huge lines snaking out the door – ‘regular’ lanes and ‘express’ lanes. For the uninitiated it appeared to be utter chaos. Five workers, one with a notably sonorous bass-baritone, would holler back and forth: “Two eggs easy, whisky down, sesame with a smear, coffee light.” Foil-wrapped packages of over-easy eggs, rye toast, and sesame bagel with cream cheese would catapult out of the kitchen, crisscrossing in the air with cups of oatmeal, toasted blueberry muffins, and cinnamon danishes. No mix-ups, no errors, no casualties. If only the laboratory staff was as efficient as the coffee shop guys, the interns often moaned.
On the second floor of Old Bellevue was Chapel Hall. Three chapels stood side by side – Catholic, Protestant and Jewish. Each room was a spacious, peaceful sanctuary with stained glass, dark oak paneling, corniced molding, and glowing candles. The arched wooden doors were always open, inviting. I rarely saw anybody inside, but the stately pews and darkly-bound books looked well tended and freshly arranged. These were the hidden jewels of Bellevue and here was where it seemed the ghosts of Bellevue resided. Ghosts of interns past who sprinted up the stone stairs literally carrying their patients in their arms. Ghosts of patients whose lives began in so many corners of the world, but ground to a halt in this brick building.
Around a corner, Old Bellevue abruptly connected to the New Bellevue building. Curved plaster moldings gave way to steel, concrete, and glass. The quirky angles and unpredictable crannies dissolved into rigid parallel lines and twentieth-century utilitarian geometry. There was no fancy architecture in New Bellevue, but I did appreciate the modern elevators. Since the stairwells were locked, the elevators were a necessity and like the morning lines in the coffee shop, they came in ‘local’ and ‘express’ varieties.
The architects of New Bellevue, if not as prone to gothic detail as those of the old building, were certainly generous to the patients with regard to space and light. It was as though the traditional tuberculosis prescription of ‘taking in the air’ had been carried over into the building’s design. Patient rooms lined the perimeter of each floor, edged with full walls of windows. Sunlight flooded the crisp, airy rooms, while the medical staff was consigned to windowless interior offices. The intensive care units – medical, surgical, cardiac, neurosurgical – were located on the south side of their respective floors. The sickest patients were therefore granted million-dollar river views. I remember many a long night on call as an intern finished off by a spectacular sunrise over the East River.
Years later, when I returned to Bellevue as an attending physician with the plan to spend my professional life here, I found myself in the front garden examining the birdbath. To my surprise, it turned out that the birdbath was actually a sundial. The shadow stick for telling time was gone, so the numbers of the sundial lay quiet and unused. As I peered more closely, I noticed that there was an inscription: ‘Grow old along with me, the best is yet to be.’ I thought about this for a long time and realized that this might represent the formal invitation to cast my lot with Bellevue Hospital and slip into its intricate, often disquietingly cyclical, history.