Super Medicine
At the Texas Medical Center doctors can rebuild your heart, give you new limbs, treat your cancer, save your children from affliction, and maybe even bring you back from the dead.
(Page 6 of 12)
“I don’t know, doc,” said Ernie. “Does yours?” He grinned broadly and looked around at the other doctors, nurses, and policeman, hoping for a laugh. “Payday,” somebody mumbled.
“That’s a good girl there,” said Ernie, obviously overcome with remorse at having made a joke at Rokey’s expense. “You going to take care of me?” She said she and the other doctors would, and dispatched him to the suture room, where a third-year medial student cleaned his face and sewed him up. “A guy took me out,” Ernie explained to the student, who seemed less than fascinated with his story. “On the street. And I didn’t even have fifteen dollars. I’m no stool pigeon, doc, but I tell you what. I’m gonna get him. I’ll pay his hospital bills, too, and I ain’t no Howard Hughes.”
Roxann Rokey is a first-year medical resident at Baylor College of Medicine — in other words, she’s what used to be called officially, and still is called informally, an intern. A medical internship is one of the great rites of passage in American life, a grueling year spent learning to be a doctor, with time off only to sleep and sometimes not even for that. “It’s sort of like an extended fraternity hazing,” says one intern at Baylor. “The older doctors say, ‘If we went through it, you can too.’” A generation ago interns had to work as much as 36 hours straight, for as little as $50 a month; now it’s more like 12 or 18 hours at a stretch and $10,000 a year. For the month of December Rokey had been working from 7 p.m. to 7 a.m., seven days a week. Her husband, also a Baylor intern, was working from 7 a.m. to 7 p.m., and on that Friday night she hadn’t seen him in five days.
Baylor interns work at several hospitals — Methodist, St. Luke’s, Veterans’ Administration — but Ben Taub is the most important part of the internship. “Big city hospitals are places to see a lot and do a lot,” says one doctor who trained at Ben Taub. “You work hard, the pay is terrible, and you need a strong stomach. People who like to do go there. At Ben Taub, it’s up to you — you get out there and do it. At Methodist you do histories and physicals. You’re somebody’s boy.” The reason urban charity hospitals are the best places for a doctor to train is not a pleasant one. The reason is that it’s difficult to learn to be a doctor in a private hospital. The only way to learn to be a doctor is by doing, and paying patients don’t like to be the ones doctors learn on. So most American doctors learn on poor people and then move on to treating people who can pay for medical services.
“If you’re an indigent patient,” says Richard T. Eastwood, executive director of the Texas Medical Center, “there’s more willingness to have eight medical students, residents, and interns hovering around you as a doctor explains what you have. If you were paying the whole bill you wouldn’t want a bunch of students punching you around and taking a long time to diagnose you. If you were well-to-do you might not want a resident to deliver your child. But if you weren’t paying you’d be glad. Public patients are available as teaching material. They’re especially important in training surgeons. When you do your first operation, it’s not going to be on Mrs. Fondren.”
In July 1949, the Houston oilman Hugh Roy Cullen announced that he was willing to donate $1.5 million for a new general charity hospital in the Texas Medical Center to supplement the existing charity hospital, Jefferson Davis. Early in May 1963, almost fifteen years later, Ben Taub General Hospital finally opened its doors, the only purely charity facility in the Medical Center and the only one that the can-do city of Houston didn’t build efficiently and impressively. The building of Ben Taub (named for a close friend of DeBakey’s who was Houston’s staunchest supporter of charity hospitals) was held up all those years by an endless chain of controversies. No aspect of the hospital’s planning went smoothly, and by the time it was finally built Cullen had pulled out his funding and the project had been repeatedly scaled down. Today the elevators at Ben Taub have buttons for ten floors, but the hospital has only six.
Among the many roadblocks to the hospital’s construction, two stand out: the unwillingness of the citizens of Houston to pay to operate it, and the fervent opposition of the Harris County Medical Society to its being located in the Medical Center and controlled by Baylor, which desperately needed a nearby affiliated charity hospital in which to train its students and residents. The medical society complained that Baylor professors would use the hospital to conduct private practice, and as a result a part-pay clinic was dropped from the plans. The Medical Center site, the private doctors said, would be too far away from the parts of town where most of the poor lived and would create traffic and parking problems. As for the citizens of Houston, they four times voted down the establishment of a Harris County Hospital District that could levy taxes in order to finance the hospital’s operation.
With the help of its traditional allies, the Houston business and political establishments, Baylor won the battle over the site, but Ben Taub had to open with no hospital district, woefully underfinanced. Then came the publication, in 1964, of what is still known in Houston medical circles as The Book: The Hospital by Jan de Hartog, a Dutch writer who during a year in Houston as a visiting professor had worked as an orderly at Jefferson Davis. The Book led to a spate of publicity about the conditions at Jefferson Davis and Ben Taub, and in 1965 the hospital district finally passed. Today Baylor has its teaching hospital and Houston has a good but, for a city its size, unusually small charity hospital (470 beds; Dallas’ Parkland Hospital, for example, has 800).
Ben Taub is obviously different from the rest of the Medical Center. It stands forlornly off in a corner of the plot of land, the only institution in the Medical Center that faces out toward Hermann Park rather than in toward the other hospitals. It has a special entrance and is inaccessible from any of the streets inside the Medical Center — Freeman Street and M. D. Anderson Street and the rest. And it is sealed off from its neighbors by a somber, gray brick wall.
Ben Taub is not a pleasant place to learn to be a doctor. Besides the exhaustion, residents must face a hospital overcrowded with people who obviously lead terrible lives and are also terribly ill (60 per cent of the admissions are through the emergency room, and the patients upstairs on the wards, as one intern says, “would be in the intensive care unit in other hospitals”; by comparison, the quiet emergency rooms at Methodist and St. Luke’s are almost vestigial). Patients scream, moan, and gasp with pain; they are disfigured and ill-cared-for; by the time they arrive, their diseases have progressed far past the point when they should have sought medical help. They are victims of society in a general sense; in terms of specific cause and effect, which is what doctors are trained to look for, they are victims of themselves — alcoholics, people who have gotten in knife and gun fights, diabetics who won’t take their insulin, reckless drivers, and drug addicts. The only common ailment at Ben Taub that is not the patient’s fault is hypertension, perhaps the greatest chronic health problem among blacks.
As a result, compassion for the patients does not run high. “It’s really hard to get up for treating these people who keep coming back here again and again,” says Jerry Goldberg, another Baylor intern, more political than most. “It’s hard to get altruistic like I was in SDS. Some of the patients we call slugs. They’re disgusting people. They won’t take showers or anything.” The first response to that is to concentrate on the individual patient and to regard the broader question of the health of indigents as permanent and insoluble. Even the patient is easier to deal with as a medical problem than as a person. “The first time you walk down the ward and hear people screaming, it gets you right here,” says Goldberg, clutching his midsection. “But after a while you stop paying attention to it. You just use the pain as information.”
One night at Ben Taub a white hippie came in unconscious, having overdosed on drugs. Two residents took him into a treatment room and stripped off his shirt, commenting contemptuously as they did so on how dirty he was. They figured he had overdosed on heroin, so they injected him with naloxone, a heroin antidote that is supposed to bring on instant cold turkey. Nothing happened. They tried another dose. The hippie still lay there unconscious. A third resident ducked his head in, saw what was happening, and walked out to the waiting room to talk to the hippie’s girlfriend. A minute later he came back. “For chrissakes,” he said, “didn’t anybody think of asking what the guy took? I just asked his girl friend. It wasn’t heroin. It was barbiturates.”
On that Friday night in December, the only patient at Ben Taub by whom the doctors were visibly moved was a little boy named Anthony, who was bruised and crying when his mother brought him in. She said someone had broken into their house, hit Anthony with a broom, thrown him against a wall, and left. The residents obviously didn’t believe her, and treated her with frosty, tightly controlled politeness, while clucking and cooing over Anthony. He was the only obvious victim that night.
A little after midnight that night, the first Code Three (the most extreme of emergency cases) of the evening came in. The emergency room had been forewarned via radio of his arrival by the two men in the ambulance that picked him up, who were taking orders from the fire department paramedics who work in Ben Taub’s telemetry room. The men in the ambulance had hooked up electrodes to the patient’s chest, so that his heart’s rhythm was visible on the paramedics’ oscilloscope screen.
Curtis Watson was the paramedic monitoring the case. He stared at the oscilloscope, which showed a wildly intermittent heartbeat. “It’s a gunshot,” he said. “the EKG is going crazy. They can’t get an IV line in him. They put the wrong goddamn tube in him.”
My Library
