Saturday, December 31, 2016

Bellevue by David Oshinsky

Hardcover, 384 pages Published Sept 20 2016 by Doubleday ISBN13: 9780385523363

Many Americans, even those who have never lived in New York City, have heard of Bellevue Hospital, certainly of some patients, and probably some of its doctors. Its storied history captures our imagination: it has fearlessly and insistently treated epidemics for centuries, as well as the widest range of disease in our nation’s largest city. For most of its history, Bellevue was a teaching hospital associated with two IV League medical schools, Columbia and Cornell, along with that of New York University. In 1966, Columbia and Cornell turned over their commitment to NYU, who produced distinguished physicians trained on some of the world's most difficult and unusual cases.

Land situated on the banks of the East River, about 3 miles from downtown Manhattan, called Bel-Vue, was leased in 1795 to serve as a hospital for those afflicted with yellow fever. It could be reached by boat, on horseback, or by carriage. It was meant to enjoy cooling breezes and yet be far enough away from the city to avoid spreading infection. Ever since that time, Bellevue has served as a public hospital open to handle the contagious cases for which there is no cure.
"I don’t think there is a disease in Osler’s Textbook of Medicine that I didn’t see," said Bellevue medical intern Dr. Connie Guion in 1916.
Bellevue was the center of the AIDS epidemic in New York beginning in the 1980 and in 1990 Bellevue’s Infectious Disease Specialist Dr. Fred Valentine was instrumental in finding a cocktail of drugs that would keep the infection from progressing. Most recently in 2014, Dr. Craig Spencer, a volunteer with Doctors without Borders, arrived in Bellevue to be treated for Ebola, New York’s only Ebola patient. Aggressive treatment and early diagnosis helped to assure his survival, and he was released three weeks later.

The story of Bellevue is in many ways the story of medicine in the United States, plagued by lack of understanding of the role of sanitation in perpetuating disease, and discovering how lack of family or opportunities might lead to poverty, madness, and despair. Almost from the start, Bellevue had patients unable to pay for their care or explain their malady, and yet they could not be turned away. It has always been a refuge for those who had no where else to go: the homeless, the indigent, the immigrant. Today Whites rank last in ‘patient race.’

Bellevue not only handles disease, but has always handled catastrophic injuries from the city and environs. Oshinsky describes the aftermath of the 1863 Conscription Act riots, riots which began because the poor were drafted to serve in the Union army: the city erupted in mob violence, poor on rich, white on black, native on immigrant, Catholic on Protestant. More than one hundred died, and injuries were grievous.
"This is war zone medicine," a Bellevue emergency room doctor observed in 1990. "You'll never go anywhere in the world and see something we haven't seen here."
In 2001 Bellevue ramped up to take victims of the World Trade Center attack, only to discover an unusual sense of helplessness when few treatable injuries resulted from the incident.

Oshinsky is careful not to whitewash Bellevue’s history. His descriptions can be shocking in what they tell us of conditions there throughout the years. Never particularly well-funded, this public hospital was at the mercy of state budgets and political jockeying, and yet it attracted outsized medical talent by dint of its size, location, and affiliation. The worst bits--doctors operating before antibiotics or anesthetics, or psychotic homeless camping in unused closets—cannot keep the reader from finishing this read in absolute awe of the place.

Bellevue has been rebuilt several times, the latest ribbon-cutting in 1973 after two decades of construction to the tune of $200 million. Twenty-five floors for patients, each an acre or more in size, with stunning views of the river or the Manhattan skyline. Twenty elevators service the space, and the 1200 patient beds. The I.M. Pei-designed (Pei Cobb & Fried) atrium completed in 2005 connects the old buildings with the new.

Bellevue has had famous patients (including exposé-writing journalist Nellie Bly), and famous doctors (Dr. Andre Frederic Cournand and Dr. Dickinson Richards won the 1956 Nobel Prize for their work on cardiac catheterization). The ambidextrous surgeon Dr. Valentine Mott "performed more of the great operations" at Bellevue "than any man living," in the words of Sir Ashley Cooper, England's leading surgeon at the end of the eighteenth century.

Any day at Bellevue is positively epic in scope, novelistic, operatic even. When Oshinsky talks about NYC's Office of Medical Examiner being headquartered at Bellevue in the early part of the twentieth century and managed by Bellevue's chief pathologist, the powerful combination of politics, criminality, medicine, and forensics feels explosive. This is Life writ large, in all its manifestations, and Death, likewise. It is a gigantic, voracious story.

For those interested in the history of medicine, this is a must-read. The heroic pieces of the story are difficult to resist. David Oshinsky won the 2006 Pulitzer Prize for History for Polio: An American Story and knows how to tell a big story. There can't be that many who could do what he has done with this magnificent effort.

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