Hospital or Hotel?


The first hospital I worked in was a three-story limestone building from the 1920s. It had a central boiler and radiators throughout for winter, but no air-conditioning for summer. The patients had no television, no radio, no telephone, and their call-bell was, literally, a bell they could ring if they could reach it. The place reeked of antiseptic solutions, and it had no carpets or cloth furnishings anywhere. It was a bleak and forbidding place in appearance. It was also clean.

That hospital was run by a formidable team. The Administrator was a middle-aged RN. The Director of Nursing was a slightly younger RN. Under them came five charge nurses responsible for all shifts on four wards and surgery. Then came the clerks of accounts receivable, accounts payable, and purchasing — one each — the pharmacist, the chief radiology technician, and the chief lab technician.

In those days RNs wore white dresses and starched white caps, except in surgery. The white caps were a badge of accomplishment and pride. I don’t recall a single one of them who was a "nice" person in the sense of being lenient or bending. They enforced the rules. Period. While they still had the habit of rising when an MD walked in, and carried his charts on rounds, the doctors had to toe the line around them too. I saw tempers flare from time to time, but the RNs always won.

That changed after Medicare went into effect in 1965. The hospital was suddenly overwhelmed with patients — we had them head-to-foot in beds in the halls — and the staffing was wholly inadequate to cope. A united cry went up to Congress, naturally, and they responded in typically near-sighted fashion by throwing more money at the problem they had created: Build a new hospital, you bumpkins.

A new profession was also born during this free-flow of tax-money: the hospital administrator. These people came from business schools, not medical schools. My last experience with a hard-nosed RN administrator was in 1968. She was replaced by a young man with a degree and no experience. His first order of business was to make the hospital look more friendly, more like a hotel, by carpeting the whole place, except for the emergency room and surgery. This happened everywhere in the US.

Thirty-odd years later I watched a large medical center change its "image" in the community by remodeling the entrance foyer to resemble a five-star hotel in Las Vegas — minus the slot machines and bar, unfortunately. This same hospital had recently remodeled its orthopedic ward with the same theme and intention — however the architect neglected to factor in the heavy portable equipment that tore up the floor coverings. Far worse, nobody factored in the spreading of infection inside the building or gave a thought to the principal vectors for such a spread: shoes and carpets.

My brief mini-series on infection brought considerable email from every region of the US, and the message was the same. We have an epidemic raging in hospitals, and something even scarier is going on in the community. How can we stop this?

We have all heard the news reports about infection outbreaks on cruise ships. What do the cruise-liner companies do? Ignore it? Oh, no, they’re not the State, they are private enterprise; their reputation, their money, their existence are all in jeopardy. They dock, they compensate the passengers, then they disinfect the ship — at their own expense. Why can’t hospitals do the same?

What am I suggesting? Close the building, rip out all fabric and incinerate it, sterilize the building, put in only hard surfaces that can be disinfected, and then treat the building itself as a strict isolation unit. Make visitors change clothes. Forbid child visitors. Make the building a bleak and forbidding place once more — a building that’s clean — a hospital.

I urge you to read the article that I linked to above. That is a tragedy that should not have happened in America. Please note the CDC response as well. Deny-and-cover-up is as well established in DC as MRSA is in hospitals. Blame the doctors for prescribing antibiotics? Okay, which doctors for which patients? They don’t say. How about the doctors in medical centers forced to deal with consecutive and multiple infections in brain-dead patients? That’s where this disease, and the ones about to follow it, come from, but there is a kind of deathly silence about this subject. I wonder why?

A hospital is a necessary institution in every community. We should be able to trust it. Now we cannot. It’s time we changed that. It’s not a hotel.