In honor of the 10th Anniversary of Clinical Correlations we are presenting a wonderful 4 part series of life as a house officer at Bellevue Hospital in the 60’s, 70’s, 80’s and 90’s. Former resident Olivia Begasse de Dhaem conducted extensive interviews with our faculty who worked at Bellevue in each of these decades. With guidance from David Oshinksy, Olivia has written a story of what binds our students, residents and faculty and patients together through Bellevue’s rich history. While much has changed in our daily workflow, so much has stayed the same. Most obviously, the esprit-de-corps that develops while working on the halls of Bellevue Hospital has not changed and is so apparent throughout these interviews…enjoy the 1970’s!
Part 2 Residency During the Transition from the Old to the New Hospital
Interview with Dr. Loren Greene Dr. Jeffrey Greene and Dr. Nate Link
By: Olivia Begasse de Dhaem, MD
The ‘70s marked a key transition at Bellevue Hospital from the old, dark and sprawling hospital to the new, bright and colorful hospital still with us today, with its modernized patient rooms and large windows.
This installment in the Tales of Bellevue series actually begins in the authentic ‘Kips Bay Brewing Co’ building at 37th and First, where I am greeted by Dr. Loren Greene in her beautiful office adorned with delicate aquarelles, the artwork of her daughter, and various exotic souvenirs gifted by her patients. After graduating from the NYU School of Medicine in 1975, Dr. Loren Greene attended both her residency and Endocrine fellowship at Bellevue Hospital. Dr. Jeffrey Greene graduated from the NYU School of Medicine in 1976 and stayed on at Bellevue Hospital for his residency, senior chief year, and Infectious Diseases fellowship from 1980 to 1982.
Memories of the Old Bellevue
Dr. Loren Greene and Dr. Jeffrey Greene began their training in old Bellevue as medical students, and transitioned to the new building as residents [1, 2]. They remember the old hospital as a dark venue that bordered on frightening at times, including a rather dank and dusty library that served as the house staff’s only resource for medical literature (still years away from computers with internet) [1]. The old hospital was situated upon a romantic collection of tunnels that connected the main hospital to the psychiatric hospital, medical school and cafeteria [1, 2]. A far cry from today’s Au Bon Pain or Moonstruck diner, the old Bellevue cafeteria doled out entrees of unclear etiology, including a nebulous dish that the house staff only half-jokingly referred to as “chicken rule-out tuna [2].”
The old hospital also housed wooden operating amphitheaters, where Dr. Frank Spencer gave Surgery lessons. Since Dr. Spencer knew the names of all 150 medical students, they had to brace for the fact that they could be called upon at any time [1]. Any hospital personnel or civilian could attend the procedures performed in these amphitheaters; there was no deterrent of security at the entrance of Bellevue or scrubbing in before entering the operating theater, and HIPAA would not be enacted until 1996 [2]. These amphitheaters are now gone, casualties of the new hospital construction [1], though their memory lives on in Cinemax’s The Knick.
From Old to New: Did you Get your “NV 1975” (New ‘Vue) Pin Yet?
In 1975, those who helped transport patients from the old hospital to the new H building via the underground tunnels did indeed receive a pin for their efforts [1, 2]. The new building proved quite modern for the time, with high ceilings, large aerating windows, and spacious rooms of two-to-four beds, a drastic and welcome change from the 36-bed wards of old Bellevue [1, 2]. Opening to generally positive reviews, house staff commended the new building for its efficiency and improvements in patient privacy and isolation, even if it lacked the old haunt’s romance [1].
In the new building, the Medicine units were located on the 16th and 17th floors – a staircase conveniently connecting the MICU on 16 with the CCU on 17 – while the on-call rooms were down on the 12th floor with the cafeteria. In addition to their patients on the Medicine units and in the ICUs, the house staff also cared for patients on the prison ward, which remained in its exact location in the old building, as did the emergency room and laboratories. Meanwhile, the admitting desk stood at the current location of the information center at the Bellevue entrance [2]. With their caseload now divided between floors and buildings, the house staff increased their amount of walking exponentially. Thankfully, “messengers” were hired to help with various tasks such as bringing blood work to the lab (pneumatic tubes, while at that time available at the University Hospital, had not yet been installed in new Bellevue). And, for better or worse, the house staff now possessed beepers, and could thus be reached from anywhere in the hospital [2].
Clinical Work and Culture
As of 1968, all house staff including interns took call every third night, a significant improvement from the interns’ previous every-other-night schedule.Staffers were usually able to sleep for a few hours at night, but finding a bed was a greater struggle than at the old hospital. Furthermore, the on-call rooms could not be locked and were therefore not safe. Sheets were available to make the beds; however, as they were often too tired to perform this task, some residents slept on bare mattresses, while others simply overtook another house staffers bed when they were called away to see a patient [2].
Not only had the call schedule lightened, but the amount of ‘scut work’ had been reduced. By the 1970s, blood gas analysis machines were routinely available for patient care. Moreover, house staff no longer ran their own CBCs. Nevertheless, they still performed the majority of procedures themselves, including urinalyses on EW patients and acetone dipsticks on patients who presented with ketoacidosis [2]. Staffers mostly learned from each other in accordance with the timeless “see one, do one, teach one” motto [1]. Interns would observe their residents perform a bone marrow aspiration or sigmoidoscopy and then try it by themselves the next time [1].
Interns and residents formed the strongest bond in the entire hospital. In the interns’ eyes, residents stood on a pedestal. That the house staff had to do just bout everything themselves and solely relied upon each other only strengthened this bond [1]. Dr. Jeffrey Greene recalls one occasion where his co-resident went home during lunch to bring back a pair of shoes for the homeless, shoeless patient Dr. Greene was about to discharge [1]. Dr. Saul J. Farber, Chair of Medicine at the time, used to say that the most important people in the institution were the house staff. They were uniquely responsible for getting everything done for their patients, hence they quickly developed a sense of self-sufficiency. Patients, in turn, were grateful for this care, and considered the house staff to be their primary doctors; indeed, patients would ask to speak to their intern or resident, not to their attending [1]. Over the following decades, many external forces – the hiring of hospitalists in the late ‘90s, the arrival of electronic medical records in the 2000s, accelerated patient turnover, ancillary services – weakened but never broke this incredible bond between house staff [1].
Diseases and Patient Population [1]
Bellevue in the ‘70s offered a fascinating place to learn about infectious diseases. A spike of Legionella cases headlined 1977, and these patients underwent treatment with intravenous erythromycin. Additionally, as brown heroin was gaining popularity as a street drug, many users were presenting to Bellevue with disseminated fungal infections, retinal lesions, sometimes even sepsis. Dr. Jeffrey Greene obtained some of the contaminated heroin to conduct his own investigation into its source of infection. However, he failed to inform Dr. Farber, who later found out about these studies from the NYC Health Department. Dr. Greene realized then that, even if the house staff felt independent, they still had a duty to inform their supervisor of their research endeavors.
The Emergency Room at the old hospital had a “delousing room”, home to many unique doctor-patient interactions. Dr. Jeffrey Greene remembers an encounter in this room one particularly cold winter night with a patient, blind drunk, seated on a stool, completely naked except for cowboy boots. Upon removing the boots, one of the patient’s toes fell out. His feet were scaly, black, and cold. When Dr. Greene inquired about the missing toe, the patient looked blankly back at him in a drunken stupor. It appeared as though his toe had auto-amputated from frostbite.
Clinic [1, 3]
Outpatient clinic in the ‘70s in many ways resembled the clinic of today. Residents had clinic one half-day per week, regardless of their inpatient call schedules. Three preceptors oversaw fifteen to twenty house staff, and each staffer interviewed their own patients before presenting them to an attending. The lack of computers significantly impeded continuity of care: test results, imaging, even patient charts often disappeared by the time the three-month follow-up appointment rolled around.
Discharging patients without insurance from the hospital was a stressful event, as house staff rightly worried that these patients would not get the outpatient care they needed. While sick patients would improve during their stay in house, they would start deteriorating the second they exited through the revolving doors. The Bellevue clinic itself often felt futile and chaotic: not only were charts misplaced, the patient no-show rate was high, and patients had difficulty obtaining free medications. Furthermore, no translators were available to help the large Chinese patient population.
Conclusion
The ‘70s ushered in a new era at the H building that we know today. The house staff of the ‘70s benefited from increased hands-on clinical learning experiences and autonomy, as well as stronger bonds with their patients [1]. On the other hand, residency today is better suited for academic learning and patient safety; our medical knowledge base has expanded tremendously and patients ultimately experience better outcomes [1]. The mission of Bellevue Hospital, its dedication to the destitute, and its crucial role in epidemics shine through in Dr. Greene’s heroin patients from the ‘70s and Dr. Lowenstein’s methanol patients from the ‘60s. The new hospital and its dedicated residents would soon have to honor this mission yet again in the face of perhaps their greatest challenges yet: the epidemics of the ‘80s and ‘90s…
Acknowledgements
I would like to thank Dr. Loren Greene and Dr. Jeffrey Greene for their precious time, insight, and teaching. I would also like to thank Dr. David Oshinsky for his invaluable support, feedback, and advice.
References
[1] Greene, Jeffrey. Personal interview. 14 Nov 2015.
[2] Greene, Loren. Personal interview. 14 Nov 2015.
[3] Link, Nate. Personal interview. 4 Nov 2015.