Belle­vue: Three Cen­turies of Medicine and May­hem at Amer­ica’s Most Sto­ried Hos­pi­tal by David Oshin­sky, Dou­ble­day, 387 pages

Pasatiempo - - IN OTHER WORDS - — Jen­nifer Levin

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 . ... ”

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