If the walls of Bellevue could talk ...
‘Medicine and Mayhem’ mines a rich history
When Ebola arrived in New York City in 2014, there was little doubt where infected patients should be quarantined. For those of us who practice medicine in Manhattan, Bellevue was the natural choice.
But how did America’s most famous public hospital become so closely associated with high-risk, downtrodden and marginalized patients? We find out in Pulitzer Prize winner David Oshinsky’s compelling new
book, Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital (Doubleday, 322 pp., out of four).
In this rich history, we bear witness to a remarkable transformation as Bellevue evolves from bare-bones almshouse appendage in the 1700s to world-class academic medical center today.
Now an elite training ground for health care workers, the former pesthouse once accepted only patients who were unable to pay for their care. Those with nowhere else to turn — “the poorest of the poor, the dregs of society, the semi-criminal, starving, unwelcome class, who suffer and die unrecognized” — found a home at Bellevue. That reputation would permeate popular culture; the phrase “they’re waiting for you at Bellevue” eventually became a euphemism for mental illness.
The infectious, the insane and the indigent are not the only ones indebted to this remarkable institution. Bellevue’s pathology lab is where forensic medicine was founded. Researchers toiling in the basement morgue found ingenious ways to detect poisons and potions, trace bullet trajectories and even developed the modern sobriety test. If the right network executive reads this book, we might end up with CSI: Bellevue.
Much of this engaging story unfolds as a response to crisis. We see how the hospital employees from earlier generations adapted to outbreaks of yellow fever and typhus, setting the stage for a modern plague: HIV. Bellevue once housed more AIDS patients than any other hospital in the country, which created a unique opportunity for burgeoning physicians. To train at Bellevue in the 1980s meant “seeing more cases of Kaposi’s sarcoma than breast cancer, more obscure parasitic infections than the common flu.”
We also encounter haunting descriptions of antebellum medical practices. Long after I finished the book, I was still thinking about the description of a terrified 15-year-old boy on a Bellevue operating table in 1841, held tightly by his father, as a surgeon approached with a saw. In that scene, I came to appreciate why Bellevue has been described as the life beat and death rattle of the city.
Bellevue is bursting with story lines, so many, in fact, that it can make the narrative feel disjointed. But this is a minor quibble; Oshinsky simply has a wealth of great material, and it’s a joy to traverse it with him.
Nearly every week, I’m forced to tell an uninsured patient that he or she is unable to seek care in one of my hospital’s outpatient clinics for financial reasons. It’s an agonizing conversation, but after the patient’s look of disappointment fades, I’m able to offer a glimmer of good news. There is one place in the city that will provide excellent medical care, regardless of a person’s ability to pay. It is that single word which has provided so much hope to so many for so long: Bellevue.