Bellevue
Also by David Oshinsky
Senator Joseph McCarthy and the American Labor Movement
A Conspiracy So Immense: The World of Joe McCarthy
Worse Than Slavery: Parchman Farm and the Ordeal of Jim Crow Justice
Polio: An American Story
Capital Punishment on Trial: Furman v. Georgia and the Death Penalty in Modern America
Copyright © 2016 by David Oshinsky
All rights reserved. Published in the United States by Doubleday, a division of Penguin Random House LLC, New York, and distributed in Canada by Random House of Canada, a division of Penguin Random House Canada Limited, Toronto.
www.doubleday.com
DOUBLEDAY and the portrayal of an anchor with a dolphin are registered trademarks of Penguin Random House LLC.
this page constitute an extension of this copyright page.
Cover design by Michael J. Windsor
Cover photograph: The Front Gates of Bellevue Hospital
(photo by Al Fenn / The LIFE Picture Collection / Getty Images)
Library of Congress Cataloging-in-Publication Data
Names: Oshinsky, David M., 1944– author.
Title: Bellevue : three centuries of medicine and mayhem at America’s most storied hospital / David Oshinsky.
Description: First edition. | New York : Doubleday, [2016] | Includes bibliographical references and index.
Identifiers: LCCN 2016027568 (print) | LCCN 2016028334 (ebook) |
ISBN 9780385523363 (hardcover : alk. paper) | ISBN 9780385540858 (ebook)
Subjects: | MESH: Bellevue Hospital. | Hospitals, Urban—history | History,
Modern 1601– | New York City
Classification: LCC RA982.N5 (print) | LCC RA982.N5 (ebook) |
NLM WX 28 AN7 | DDC 362.1109747/1—dc23
LC record available at https://lccn.loc.gov/2016027568
Ebook ISBN 9780385540858
v4.1
a
For my son Efrem,
who makes me joyful and proud
CONTENTS
Cover
Also by David Oshinsky
Title Page
Copyright
Dedication
Introduction
1 Beginnings
2 Hosack’s Vision
3 The Great Epidemic
4 Teaching Medicine
5 A Hospital in War
6 “Hives of Sickness and Vice”
7 The Bellevue Ambulance
8 Bellevue Venus
9 Nightingales
10 Germ Theory
11 A Tale of Two Presidents
12 The Mad-House
13 The New Metropolis
14 Cause of Death
15 The Shocking Truth
16 Survival
17 AIDS
18 Rock Bottom
19 Sandy
20 Rebirth
Epilogue
Acknowledgments
A Note on Sources
Notes
Illustration Credits
About the Author
Illustrations
INTRODUCTION
TAKEN TO BELLEVUE—it’s a phrase nearly as old as New York City. First used in the eighteenth century to describe yellow fever victims packed off to a desolate pesthouse along the East River, it is so familiar today that newspapers don’t bother to add the word “Hospital” to their headlines: “EBOLA DOCTOR TAKEN TO BELLEVUE,” “WOMAN STRUCK BY BUZZSAW BLADE TAKEN TO BELLEVUE,” “FAMOUS GRAFFITI ARTIST BUSTED FOR HITTING MAN WITH BEER MUG—TAKEN TO BELLEVUE.”
It borders on ritual. “If a cop gets shot in Manhattan, his first choice is often Bellevue…If an investment banker goes into cardiac arrest, his limo driver knows where to take him,” writes Eric Manheimer, the hospital’s former medical director. The same holds true when a firefighter is injured, a prisoner takes sick, a worker falls from a scaffold, a homeless person lies dazed in the street—the destination, more likely than not, is Bellevue. Should a visiting pope or president require urgent medical attention, the hospital’s superb emergency department awaits.
Bellevue closely mirrors an ever-changing New York. More than a hundred languages are translated at Bellevue, the most common being Spanish, Mandarin, Cantonese, Polish, Bengali, French, and Haitian Creole. Doctors and patients communicate on dual telephones through an interpreter trained in the nuances of regional dialects. The directional signs that guide visitors through the hospital are multilingual—the destinations now include a Muslim prayer room and a clinic for the survivors of political torture. Doctors and nurses have reported cases of a foreigner arriving at Kennedy Airport, hailing a cab, and uttering a single word: “Bellevue.”
They come knowing they won’t be turned away. Every immigrant group has availed itself of Bellevue’s protective umbrella over the centuries; every disaster and epidemic has packed its spartan wards. “It was never the tidiest [place] in the world—how could it be, when its policy was always to accept those patients who with some justice could be called the dregs of humanity?” the gifted surgeon William A. Nolen observed. “At times it was so loaded with victims of typhus, cholera, and yellow fever that, within minutes of a patient’s death, the body was in a coffin and a new patient was in the bed.”
One could chart the severity of a New York winter by counting the pneumonia victims on the hospital’s Chest Service, or measure the dangers of Prohibition liquor by totaling up the poisoned bodies in the morgue. If tuberculosis was running rampant through the city, then tuberculosis was what Bellevue treated. When AIDS arrived, when violent crime spiked, when addicts turned to crack cocaine, when released state mental patients became homeless, Bellevue usually saw it first.
Few hospitals are more deeply embedded in our popular culture. Tales of Bellevue as a receptacle for mangled crime victims, vicious psychopaths, and hopeless derelicts were always common fare, though the late-nineteenth-century circulation wars between William Randolph Hearst and Joseph Pulitzer churned out especially lurid exposés. The splashiest one—Nellie Bly’s Ten Days in a Mad-House—had an indelible effect. From that point forward, the hospital became synonymous with bedlam, dwarfing its immense achievements in clinical care and medical research.
Hollywood found Bellevue irresistible. Much of Billy Wilder’s Lost Weekend, the 1945 Academy Award winner for best picture, takes place there—the New York Times called it “a staggeringly ugly experience in the Bellevue alcoholic ward”—and the hospital makes a cameo appearance in the beloved Miracle on 34th Street, when the stubbornly proud Kris Kringle, caged in a tiny cell with barred windows, is deemed delusional and recommended for commitment. In search of the most forbidding hospital to film parts of The Godfather, Francis Ford Coppola quite naturally settled on Bellevue, whose morgue served in later scenes as Bonasera’s Funeral Home.
It didn’t help that Bellevue is a short ambulance ride from Greenwich Village. As such, its six-hundred-bed psychiatric building became a revolving door for legions of writers, artists, and musicians in various states of distress. William Burroughs spent time in Bellevue after cutting off a finger to impress his lover. Delmore Schwartz arrived in handcuffs following an attempt to strangle a hostile book reviewer. Eugene O’Neill visited the alcoholic ward often enough to be on a first-name basis with the staff. Sylvia Plath came after suffering a nervous breakdown, and saxophonist Charlie “Bird” Parker committed himself following two suicide attempts in 1954. (He died the following year.) Bassist Charles Mingus also signed in voluntarily, it was said, to escape a business dispute with the Mafia. He would later compose the jarring “Lock ’Em Up (Hellview of Bellevue)” to reflect the mania he found inside.
Poets and novelists such as Saul Bellow, Allen Ginsb
erg, and Richard Yates have memorialized Bellevue in their work. But the most detailed firsthand account remains unpublished. In 1960, Norman Mailer was committed to Bellevue for stabbing his wife during a drunken rage triggered, apparently, by her taunt that he couldn’t shine Dostoyevsky’s shoes. Mailer kept a private diary of his seventeen days under observation; clogged with detail, it reads like a narrative in search of a plot. Patients come and go—“spades” and “junkies,” “Puerto Rican killers,” and “teenage hoodlum homosexuals.” Guards rule with fists and clubs. Straitjackets restrain the worst offenders. Two men return to Mailer’s ward, close to unconscious. “Both had had shock [treatment], pipe to bite on, pillow under ass, hand on head. Wham. Drool from mouth.” Mailer thought about weaving his Bellevue comrades into a piece of long-form journalism, but never did. “I said my goodbyes,” the diary concludes, “feeling quite moved at leaving them.”
Mailer was one of numerous celebrities observed by Bellevue psychiatrists following a violent criminal act. (Found competent to stand trial, he received a suspended sentence when his wife refused to press charges.) George Metesky, the “Mad Bomber” who set off explosives that terrorized the city in the 1950s, was committed there before spending the rest of his life in a state institution. When serial killer David Berkowitz, better known as “Son of Sam,” sent a bizarre letter to the newspapers shortly before his capture, a team at Bellevue diligently parsed it for clues. The resulting profile described the author as a paranoid schizophrenic and likely loner who hated women, unleashing what one observer called “a flood of worthless tips.”
John Lennon’s assassin, Mark David Chapman, faced something quite different: a staff so uniformly hostile, so adoring of Lennon, that some of them questioned their own capacity to render a fair diagnosis. “When I first knew I was going to see him, I worried my anger toward him would interfere with my ability to do my job,” Bellevue’s chief psychologist recalled. “But he was such a pathetic character, I said ‘hello’ and he smiled—then he said, ‘Oh, excuse me, I shouldn’t be smiling.’ ” Meanwhile, Lennon’s body lay wrapped in a sheet in the Bellevue morgue, a few buildings away.
Some illustrious patients arrived with no fanfare at all. The great songwriter Stephen Foster was taken to Bellevue in 1863 with a gaping hole in his skull; the prolific short-story writer O. Henry in 1910 with cirrhosis of the liver; the legendary bluesman known as Lead Belly in 1949 with a bone infection complicated by amyotrophic lateral sclerosis, Lou Gehrig’s Disease. No private rooms or personal physicians or special amenities awaited them. They had come because they were destitute and desperately ill, and all three would die there while receiving emergency care. Their experiences—more than Mailer’s or Chapman’s—reflect the essence of Bellevue. In 2014, a recording mysteriously surfaced of a previously unknown Lead Belly song: “Bellevue Hospital Blues,” written days before he died. It’s the simple tribute of a man thankful for the attention he was shown.
—
Bellevue’s hold on our popular imagination has come at a price. The relentless focus on its eccentricities has obscured its role as our quintessential public hospital—the flagship institution of America’s largest city, where free hospital care is provided to the “medically indigent” as a right, not a privilege. In that role, Bellevue has borne witness to every imaginable disease and public health scare, every economic swing and population surge, every medical breakthrough and controversy going back more than two centuries. Its history is fraught with conflict because it reflects the shifting political currents that have roiled the nation regarding its responsibilities to the poor. Calls for Bellevue’s extinction are as old as the hospital itself. Its survival has never been assured.
A visitor to Bellevue in any era might see much the same thing: a well-schooled physician treating a charity patient against a background of bleakness and disrepair. It’s a scene that dates back to the 1700s, when a prominent doctor, accompanied by a student apprentice or two, would wind his way through the decrepit, foul-smelling almshouse sick wards to offer diagnoses, prescribe medicines, and fix what could be fixed. The doctor volunteered his services for several reasons, including a Christian duty to the poor and the chance to hone his skills on bodies too powerless to resist.
Bellevue’s early physicians were leaders of their craft (not yet a profession). They believed in the Miasma Theory, which blamed toxic clouds for the spread of disease, and considered bleeding and purging among the better methods for dealing with it. Most were enthusiastic grave robbers, participating in midnight raids that inflamed public opinion but provided the corpses needed for anatomical study. Some had studied in Europe, where clinical observation and laboratory research were changing the ways illness was understood.
New York in these years had only one medical school of note: the College of Physicians and Surgeons (P&S). But the city’s explosive growth in the early nineteenth century led enterprising doctors to open two competing institutions: the Medical College of New York City (later NYU) in 1841, and Bellevue Hospital Medical College exactly two decades later. Their common denominator, aside from accepting every white male student able to pay the freight, was the lure of Bellevue as a clinical mecca for the study of sickness and disease. By the Civil War, it had become both the nation’s largest hospital and its most important medical training ground.
The reason could be summed up in a single word: immigration. Bellevue’s early history reflects the waves of Irish peasants fleeing starvation on “famine ships” bound for Canada, Boston, and New York. Some carried deadly diseases that would devastate the slums and sweep through Bellevue itself, leaving numerous dead physicians and medical students in their wake. These outbreaks served a purpose, however: they brought reforms that eventually separated the “indigent sick” from the lunatics, paupers, orphans, and criminals who had once lived alongside them in a massive, multipurpose almshouse establishment. The former group stayed at Bellevue; the rest were shipped to newly constructed facilities on Blackwell’s Island (now Roosevelt Island), a narrow spit of land in the East River. Though Bellevue would remain a bastion of the “low Irish” for generations, it had become a more manageable institution—a public hospital serving the acute health needs of New York’s poor and working classes.
In medical circles, its reputation soared. It won plaudits during the Civil War for treating thousands of wounded Union soldiers and—more controversially—the anti-draft rioters who plundered large parts of New York City in the summer of 1863. It became the first American hospital to have a maternity ward, an emergency pavilion, and a medical school on-site; the first to organize an ambulance corps, a medical photography department, and a nursing school for women. (Its ill-fated men’s nursing school, another first, would collapse amidst carefully buried charges of homosexuality.) In 1865, Bellevue doctors took the lead in writing the most important public health document of that era, Sanitary Conditions of the City, portraying New York as two distinct places—one prosperous, healthy, and native-born; the other desperate, diseased, and foreign-born. The response was dramatic. Within a year, New York City had its first official Board of Health in place.
Amazingly, Bellevue played a central role in the three great medical crises of the latter nineteenth century involving the American presidency. In 1865, twenty-three-year-old Charles Augustus Leale, a few months removed from Bellevue Hospital Medical College, was the first doctor to reach the gravely wounded Abraham Lincoln at Ford’s Theatre. His central, if accidental, role in assisting Lincoln is still a matter of dispute. In 1881, Leale’s Bellevue mentor, Dr. Frank Hamilton, was summoned to Washington to help save President James A. Garfield following the assassination attempt that eventually took Garfield’s life. Some blamed Hamilton for the monumental blunders that marked the president’s treatment, with serious consequences for the practice of surgery. Then, in 1893, a team of five medical men, three from Bellevue, successfully removed a malignant growth from the mouth of President Grover Cleveland in a top secret operation pe
rformed on a luxury yacht off the coast of Long Island. Cleveland would go on to complete his term in the White House, the details carefully hidden from the public until after his death two decades later.
The years between Garfield’s stunning demise and Cleveland’s smooth recovery marked a changing of the medical guard. A new generation of clinicians and researchers came of age, wedded to the ways of modern science and contemptuous of the fading certainties of the past. Two of the most influential figures—William Welch, the father of modern pathology in America, and William Halsted, the era’s most innovative surgeon—bonded as interns at Bellevue in the bitter struggle to bring antiseptic methods to the profession. Over time, Bellevue became a world leader in specialties ranging from forensics to psychiatry to infectious disease. Its faculty and graduates read like a “Who’s Who” of modern American medicine: Hermann Biggs, a pioneer in the prevention of tuberculosis; Walter Reed and William Gorgas, who tamed the ravages of yellow fever; William Hallock Park, who brought the lifesaving diphtheria antitoxin to the United States; Joseph Goldberger, who discovered the cause of pellagra, a deadly nutritional disease; Thomas Francis, whose influenza research revolutionized the study of virus strains; André Cournand and Dickinson Richards, who perfected cardiac catheterization; Albert Sabin and Jonas Salk, who developed the two successful polio vaccines still in use today.
By the early 1900s, Bellevue seemed less a city hospital than a hospital city, with two thousand beds, a nursing school, the city morgue, a massive psychiatric pavilion, a special prison ward, top-flight laboratories, a maintenance force of four thousand, and a medical staff provided by the three best medical colleges in New York. A major facelift designed by the iconic architectural firm of McKim, Mead & White would remake the complex with mixed results, while the mass immigration of Italians and Jews to America dramatically reordered the patient profile. Bellevue remained what it had always been—a medical haven for the poor—though its admission rolls now showed many more Rossis and Goldbergs, and many fewer Rileys and O’Rourkes. Meanwhile, hospital officials took the revolutionary step of accepting numerous women and Jewish interns—partly to meet the growing patient load and partly because NYU Medical School, Bellevue’s primary feeder, ignored the infamous “Jewish Quota” employed at Harvard, Yale, Columbia, Cornell, and most other medical colleges in the region.