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.
One day in February of last year Harold Dunkleberg, a house builder in the little town of Osborne, Kansas, noticed a lump under his right arm. He showed it to his wife, Rosalie, and she told him he ought to see a doctor. But Mr. Dunkleberg was reluctant to do that. He said it was just from wearing T-shirts that were too tight and, besides, he was too busy to go to the doctor. Still, Rosalie Dunkleberg couldn’t get that lump off her mind. She kept pestering her husband about it, and finally, in March, he went to the family doctor.
The doctor said the lump really ought to be taken out. Mr. Dunkleberg grudgingly accepted this diagnosis, but he put off the operation until the summer. On July 5, 1978, the doctor removed from Mr. Dunkleberg’s armpit a growth roughly the size of two fists pressed together and sent it off to Topeka for tests. Ten days later, the results came back and the doctor told Mr. Dunkleberg he had cancer—specifically, lymphoma, a cancer of the lymph system that can appear in many parts of the body.
Mrs. Dunkleberg is from Downs, Kansas, a town just east of Osborne, and she knew a man there, Jim Hart, who had had lymphoma. When Jim Hart heard the bad news he came straight to see the Dunklebergs. “Harold,” he said, “you feel good now but you have a son of a bitch inside you, and in six months it’ll get you.” He turned to Mrs. Dunkleberg. “Rosalie, if you love your husband, the only place you can go right now is M. D. Anderson Hospital in Houston.”
So on July 25, 1978, Harold and Rosalie Dunkleberg arrived at the Texas Medical Center, a collection of 24 institutions packed onto a 200-acre plot of land on Fannin Street just south of Hermann Park. Harold Dunkleberg was one of 1.5 million patients who came to the Medical Center last year. Like a great many of them, he was in serious trouble—so serious that his own doctor and his local hospital couldn’t do much for him. He came to Houston to receive from some of the nation’s leading specialists a major, protracted course of treatment that was his last chance to survive.
The Texas Medical Center is possibly the largest and most advanced complex of medical facilities in the United States. It has 23,000 employees, 10,000 visitors a day, 4127 patient beds, a physical plant worth $632 million, and an annual operating budget of $552 million. It is home to the M. D. Anderson Hospital—where Mr. Dunkleberg went for his treatment—which is the oldest institution there and one of the country’s best cancer centers. Texas’ only private medical school, Baylor College of Medicine, run by the brilliant and domineering Dr. Michael E. DeBakey, is there. DeBakey also does his famous heart surgery in the Medical Center at Methodist Hospital, Houston’s largest private hospital. DeBakey’s former protégé and bitter rival, Dr. Denton Cooley, is at the Medical Center, too, conducting the world’s busiest heart surgery at St. Luke’s Hospital and the Texas Children’s Hospital. Another large private hospital, Hermann, older and less prominent than Methodist and St. Luke’s but now building aggressively, is there. There is a second, almost brand-new medical school, the University of Texas at Houston. And Houston’s general charity hospital, Ben Taub, is also at the Medical Center.
Besides all that, the Medical Center contains two nursing schools, a dental school, a public health school, a high school for aspiring health professionals, and a dozen smaller patient-care facilities. Construction crews are perpetually at work there, building new hospitals, offices, and research labs, even a food factory that will upon completion prepare 12,000 meals a day. Patients come to the Medical Center from all over the United States, Europe, the Middle East, and Latin America. When the vice premier and supervisor of science and technology for the People’s Republic of China, Fang Yi, came to America this winter with his boss Teng Hsiaoping, one of the places he made sure to visit was the Texas Medical Center. “When you get outside Houston,” says one professor there, “the city is known for two things. It’s known for the oil industry and the Medical Center.”
Only one other medical center in the United States, the Chicago West Side Medical Center, has a comparable number of acres and patient beds. And the Chicago center—like the great medical centers of New York, Boston, San Francisco, Baltimore, and St. Louis—dates back to the nineteenth century. In 1940, what is now the Texas Medical Center was a prairie.
The Medical Center has grown, and continues to grow so dramatically, because it has been in the right place at the right time. It is in a rich, booming city whose leaders like to build monuments. It has grown up during a period when the federal government has invested heavily in medical research and the states in medical education. And medicine, during the years of the Texas Medical Center, has become more technological, more specialized, more expensive, and more admired by the nation at large. All these trends have directly benefited the Texas Medical Center. Despite a lot of talk about the importance of primary care, particularly in rural areas, the Medical Center is the direction American medicine has been going for the last forty years.
The end result is impressive. The doctors there are intelligent and hard-working, the facilities top-quality, much of the work indisputably lifesaving. Visitors invariably come away wowed.
But the impressiveness of the place is in a way unfortunate, because it distracts attention from the important question of why the Medical Center exists. Yes, miracles are performed there, but so are unnecessary procedures. Yes, the doctors are dedicated, but they’re also prima donnas. Yes, the care is good, but it’s a lot better for those who can pay for it than for those who can’t. Yes, the hospitals have won the world’s admiration, but they have done so partly through ardent self-promotion and concentration on the most spectacular and expensive kinds of patient care. The Medical Center’s main goal is producing advanced medicine, and it does that very well. But advanced medicine and health are not always the same thing.
THE CANCER WARD
When the Dunklebergs came to Houston, they joined a strange little community of people who have come to town for a course of treatment at the Medical Center. Some of these people go so far as to buy houses nearby; quite a few rent apartments; and the Dunklebergs, like most, settled into a motel that offered free shuttle bus service to the Medical Center. For two weeks, they would go to Anderson Hospital every day and Mr. Dunkleberg would undergo diagnostic tests.
Did he have any chance to be cured? Cure isn’t a word cancer doctors (oncologists) like to use; they prefer the word remission, meaning a cessation in the growth of the cancer cells. Nor do oncologists like to tell people whether they’ll live or die; they’d rather give percentages. Mr. Dunkleberg’s disease, lymphoma, once 100 per cent untreatable, now has rates of remission that go as high as 90 per cent for certain types. Of all the patients of Anderson Hospital, 40 per cent go home in remission. The cancer kills the rest.
There are three ways to treat cancer. The oldest, simplest, and most common treatment is surgery—just removing the cancer. The second is radiation therapy, which can kill localized malignancies. The third, and the most useful in treating a systemic cancer like Mr. Dunkleberg’s, is chemotherapy—the injection into the bloodstream of various chemicals so toxic that they can kill cancer (and other) cells. All three cause tremendous visible harm to the body. In most hospitals the average patient lying in his bed doesn’t look very bad; not so at Anderson. The surgery patients are often missing a leg or an arm. The radiation patients have badly burned skin and black lines on their bodies that mark the treated areas. The chemotherapy patients look worst of all. Chemotherapy almost always makes the hair fall out, so a chemotherapy patient is easily recognizable by baldness and lack of eyebrows. It often causes sterility, hormone imbalances that make the body look strange and puffy, and severe attacks of vomiting (for which the best-known antidote is marijuana, which younger patients smoke before coming in for their therapy and older patients often ask their doctors to prescribe for them—without success, since it is against the law in Texas).
One day in December I went on rounds at Anderson Hospital with a team of hematologists, specialists in cancers of the blood and lymph systems. The first patient they saw was a high school football coach from West Texas, a big, handsome man with silver hair who had myeloma, cancer of the bone marrow. Myeloma causes the bones to become thin, so that any movement is extremely painful. The coach was obviously a proud, brave man, and this was the first physical problem in his life that was beyond his ability to handle. That, as much as the pain, was tearing him apart. “I raised up a little today, but I started to break out in a sweat,” he told the doctors. “I want to get up and walk. I still think I could get up and hold onto something if I knew what angle to use. But then, if it bites you . . . boy, when it grabs you like that, I do not know how a human being stands it.”
Leaving the coach’s room, the doctors saw a woman leaning against the counter of the nurses’ station, crying in the loud, barking sobs of someone who has lost control. Her husband, a lymphoma patient, had just arrested — his heart had stopped beating. Inside his room, doctors and nurses were pounding on his chest, trying to revive him. In a minute or two his heart started beating again. That night he arrested twice more and was twice revived; and the next week, his cancer at bay, he went home. But there was no way for his wife to know that just then. Even if she didn’t think he was dead, it must at that moment have seemed just too much — the lengthy illness, living in the hospital, doctors pounding on her poor husband’s chest. A cancer hospital is an emotionally overwhelming place.
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