Diya Banerjee
New York, New York, United States

It is tempting to think of the history of medicine as an orderly procession of notable firsts—the first transplants, medications, wards, cures—together making up a linear march towards progress and humankind’s continual betterment. Bellevue Hospital, in its very building and plot, subscribes to the same narrative of history. Walking through the hospital is in many ways a trip back in time. The very first structure visible from the street is the newest ambulatory wing, several lofty glass ribs arching over the hospital proper and forming a littoral boundary, a physical manifestation of the anti-hospitalization movement of the past two decades.

Within, majestic early twentieth century walls of the old hospital frame the entrance, complete with WPA-style bas relief heroic figures. Under this threshold, a short passageway connects to the actual hospital and is lined with a series of banners which recall the centuries of accomplishments of the institution, ranging from the first cadaver transplant, the first labor and delivery ward, an august psychiatric hospital, all the way back to the pictures of the first ambulance and the first morgue. In the very far back, past the diner and the eyeglass shop, is the H building, the hospital itself, which betrays a less manicured and more heartbreaking version of history.

Bellevue began as a “Publick Workhouse and House of Correction” in 1735 with an infirmary containing six beds to address the problem of “vagabonds and idle beggars” in New York City. It grew in fits and starts. Though records are sparse, periodic expenditures track with catastrophes. For example, outbuildings were added to the house. The hospital also expanded its role at this time from a poorhouse to a pesthouse, adding the properties of “Belle Vue Farms,” after severe epidemics of yellow fever ravaged the waterfront areas. The hospital had its own cemetery, and large numbers of staff were occupied in burying the dead. Waves of epidemic broke over the hospital, including small pox, asiatic cholera, puerperal fever, and the deadliest of all—typhus. In 1847, 60–89 victims of the Great Typhus Epidemic would arrive daily, and the death rate was one out of ten. Illness did not discriminate, and by 1884 twenty-seven house staff doctors died from diseases contracted during service.

The hospital adapted and grew over time—the physicians of Bellevue helped develop New York City’s sanitary code, the first city Morgue opened, and a hospital based ambulance system extended the reach of the institution into many corners of the island. Bellevue continued to physically grow as the needs of the city evolved. In 1897, an Insane Pavilion opened to house and treat the mentally ill who were previously condemned indiscriminately to two basement wards known as the “Alcoholic Cells.” An old ferryboat was anchored off the hospital ground for the tuberculous cases to spend time in the open air.

From this sepia tinged foundation, let us zoom closer towards the present, to 1981 specifically, when AIDS appeared in New York City on the heels of a hepatitis contagion. This new plague changed Bellevue to such an extent that by the mid 80s, AIDS became the most common inpatient medical diagnosis. In 1985 the hospital had over four hundred AIDS patients, more than any other hospital in the country, and Bellevue sprouted an AIDS ward and outpatient program.

This was all recent enough to be part of Bellevue’s living memory—as an intern now, my generations’ attending physicians were trainees back then. The horror of that time still creeps in during rounds, when the GI consulting doctor mentions medications tried (including morphine) on young men who were dying of diarrhea, for example. Or, in illustrating the point that pneumocystis can be a cystic disease, an attending describes how the wards echoed with the horrible screams of patients receiving pleurodesis for their collapsed lungs.

Not everyone at Bellevue reacted well to the AIDS epidemic. Some doctors refused to treat patients, others became callous and cruel from stress and hopelessness. Those doctors left, now aging into the “distinguished” phase of their career, teach us more than just the science of medicine. They developed their identity in the shadow of death—the senior practitioner that always triumphs in the end and outwits us all. My fellow interns and I are apprenticed in a form of medicine that is not about the heroics of conquering disease, but about the humbler twin goals of easing suffering and prolonging life.

I am writing this essay from within the belly of the beast itself, in the windowless heart of the hospital that is the resident’s room. Around me is the rambling structure of the wards, which make very little sense if thought of as the deliberate creation of an omnipotent architect. In truth, Bellevue is a strange living thing, growing out of the needs of the poor, the sick, and the dying. Despite the ever-present threat of slow extinction from budget cuts, there is something eternal about the Public Hospital. I know that when the next plague comes to New York City, Bellevue will open its arms, and we will all do as much as we can for as many as we can—nothing less.

Bibliography

1. “About NYC Health Hospitals/Bellevue – History.” Accessed March 01, 2016. http://www.nychealthandhospitals.org/bellevue/html/about/history.shtml.
2. Knight, Edwin M., Jr. “The Tumultuous Past of Bellevue Hospital.” History Magazine, January 2000.
3. Sullivan, Ronald. “Aids: Bellevue Tries To Cope With Disease It Cannot Cure.” New York Times, December 23, 1985. http://www.nytimes.com/1985/12/23/us/aids-bellevue-tries-to-cope-with-disease-it-cannot-cure.html?pagewanted=all.
4. Tanne, Janice Hopkins. “Fighting AIDS: On the Front Lines Against the Plague.” New York Magazine, January 12, 1987. http://nymag.com/health/features/49240/.