The View from the Vue Read Free Page A

internists regarded the surgeons as mindless technicians, peculiar hybrids of butchers and tailors, who were happy only when they were up to their armpits in blood—someone else’s blood, to be specific. Obstetricians and gynecologists either hated their mothers, enjoyed seduction, or were simply incapable of understanding anything more complicated than crotch plumbing. Pediatricians were afraid of adults. Urologists were animals, barely able to speak intelligible English. Dermatologists hated the sight of blood as much as surgeons loved it. And psychiatrists, of course, were nuttier than their patients.
    Fortunately, behind all the name-calling was the obvious recognized fact that the services were interdependent in terms of their own survival, let alone that of the patients. That prevented the potential antagonisms from ever going beyond the banter stage.
    The Bellevue patient-care system was centered around the Admitting Office. This was something of a misnomer, since much more than the mere admitting of patients was carried out there. The A.O. was the general receiving area where those seeking medical attention presented themselves and were sorted out and disposed of according to their particular needs. Doctors assigned to the Admitting Office looked over each new patient and then decided how he or she might best be served by the Bellevue setup.
    Some patients came to the Admitting Office with problems that were neither acute nor serious: for example, a head cold. They did this in the hope of obtaining treatment more quickly than it could have been gotten in the Clinic, where a supplicant frequently sat on a wooden bench for four hours or longer before a doctor called his number. These patients generally were not pleased when they were given Clinic appointments for the next day and told they weren’t sick enough to warrant care at the A.O. Their protests were heated enough to melt the gelatin capsules in the medicine cabinets.
    On the other hand, problems requiring immediate attention were handled on the spot. Lacerations were sutured, boils were lanced, asthmatic attacks were terminated, and strep throats were combated with shots of penicillin to the nether zones. In most cases, follow-up was achieved via the infamous Clinic.
    Not all conditions could be handled in the Admitting Office, though. Patients requiring longer-term care were admitted to the inpatient service. When there was no need for continuous close attention or intensive care, the patients were sent to routine wards. However, a patient with a severe heart attack, major hemorrhaging, or an overdose of drugs would be wheeled to the Emergency Room. This was the equivalent of today’s intensive-care unit, offering the best chance of survival to such critically ill people.
    The performance of this human sorting function was often more then a little tough on the doctor’s nervous system. No one wanted to give a Clinic appointment to a patient who would carry the appointment slip only as far as the front steps of the hospital, and then proceed to drop dead. On the other hand, every admission had to be considered with the utmost care. When a patient was admitted, an intern or a resident had to work up the individual, and that usually meant many hours of labor, involving a history, a physical examination, and laboratory scut. That was fine if the patient were truly sick, but God help the Admitting Office doctor who caused one of his buddies to be up all night with a crock. (A crock is a non-sick patient, a hypochondriac, a malingerer, or an hysteric. Most doctors are very unfond of them.) The A.O. physician often felt that whatever course of action he took, someone was going to bitch at him. Unfortunately, this perception was usually accurate.
    Perhaps the best way to sum up Bellevue is to say that it was a crisis-oriented place. Most of the patients who came there for care were truly good and sick. Then, as now, poor people did not have much truck with