Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital by David Oshinsky, Doubleday, 387 pages
At Bellevue, New York City’s most well-known public hospital, no one is turned away — not the indigent, the inebriated, the psychotic, nor the disease-ravaged with slim hope of recovery. Approximately 116,000 patients a year are seen in the Bellevue emergency room; annual outpatient clinic visits number a whopping 670,000. Now known as NYC Health + Hospitals/Bellevue, the infamous facility is immortalized in countless episodes of Law & Order and such movies as The Lost Weekend (1945) and
Jacob’s Ladder (1990). As many other movies have shown us, if you are not tough enough, New York City will chew you up and spit you out. Bellevue, with its teeming hordes of people in need, can test anyone’s strength of character. Between 1983 and 1997, 14 executive directors came and went. According to Pulitzer Prize-winning author David Oshinsky’s new book, Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital, one director was fired for covering up embezzlement, another was let go for refusing to slash the budget, and a third, who hailed from Houston, left because he found the city fundamentally inhospitable.
“Having arrived with no place to live, he was housed ‘in an old, dreary, mice-infested section of the hospital that had been converted into an apartment’ and then left to eat Thanksgiving dinner in a nearby coffee shop. ‘I don’t need to subject myself to that kind of life,’ he announced upon heading back to Texas two weeks later,” Oshinsky writes.
It is easy to chuckle at the cultural disconnect between a Texan’s expectations of friendliness and the disinterest the average New Yorker has in the quarter of a million people who move to the city every year. But Bellevue’s reputation as a microcosm of the dog-eatdog reality of New York City life stems from a combination of factors, including slipping health and safety standards in the 1980s — while crime in the city was on the rise — and the hospital’s large population of psychiatric patients, who were housed in a ward that had already long been the subject of public fear and fascination. Patients died from critical lapses in care, and in 1989, a doctor was murdered by an unstable vagrant who had been illegally living in the hospital. Though these headline-grabbing stories are often brought up at the mere mention of Bellevue, Oshinsky shows us just how small a slice of the venerable institution’s history resides in the popular imagination. His thoroughly researched book begins not with the hospital’s officially accepted founding date of 1736 but with the establishment of an infirmary building in the 1660s, when Manhattan was under Dutch rule.
More than the story of a hospital, Bellevue is a social and medical history of New York City — its public health scares, its changing immigrant populations, its commitment to healthcare for the disadvantaged, and the strides made in medical knowledge, research, and education. Oshinsky conveys a wealth of dense information in a relatively readable way, and his efforts at a linear presentation are admirable, though the book’s various overlapping threads — including groundbreaking scientific advances, the evolution of medical and nursing schools, presidents famously treated at Bellevue, and the history of electroshock therapy — make for a rather fluid timeline.
Among the most surprising portions of Bellevue is the exploration of germ theory, which led to the practice of sanitizing surgical instruments and environments, which in turn helped prevent postoperative infections and significantly reduce patient mortality rates. Oshinsky reveals that sanitization was slow to catch on in some quarters, with many oldfashioned doctors preferring to go from one surgery to the next without so much as washing their hands.
But it is Bellevue’s role in treating victims of the AIDS epidemic that makes for the most riveting reading. In the mid-1980s, one-third of the country’s AIDS patients lived in New York City, where the disease had become the leading cause of death among men between the ages of twenty-five and forty. Bellevue led the way in medical treatment and bedside care for AIDS patients, with one oncologist, Linda Laubenstein, among the first medical professionals to advocate for condom use among gay men to prevent the spread of the disease.
Though Bellevue required extensive rebuilding after the devastation of Hurricane Sandy in 2012, today it remains a fixture for hundreds of thousands of New Yorkers because healthcare for the indigent and uninsured is inscribed into New York City law. If a single hospital could be said to represent not just New York City but America, it is Bellevue, where every day the doctors and staff live out the ideals set forth in “The New Colossus,” the Emma Lazarus poem inscribed on the base of the Statue of Liberty:
“Give me your tired, your poor,/Your huddled masses yearning to breathe free,/The wretched refuse of your teeming shore./Send these, the homeless, tempest-tost to me . ... ”