The Pavellas Perspective

Before retiring from employment, I worked in and around acute care hospitals for 40 years. Although not a clinician, I learned to love the professions represented in my workplace, and many of the professionals, as well.

Having had this experience, I am mindful of the role of first responders and care givers in these parlous times. I want to recognize, here, the love and admiration I feel for the many people responding, selflessly, to the current pandemic.

Papyrus text: fragment of Hippocratic oath. Credit: Wellcome Library, London. Hippocrates (BC 460-370) is considered the father of modern medicine.

I offer these remarks I made before the Unitarian-Universalist Fellowship of [City], 1984. I have anonymized most of the names and locations of the hospitals which are mentioned.

…

The first inkling of the hospital’s soul came to me during my childhood. I sensed it, at around age seven or eight, as a special, nameless feeling.

I had had, by this age, three hospital operations: appendectomy, tonsillectomy, and the last one, more serious. It was during the recuperative phase of the latter, at the University Hospital in San Francisco, when the special feeling first visited me.

While recovering I was allowed to roam the pediatric section in a wheelchair. I visited other young patients, including a teenager in an iron lung. This boy and I became friendly. He was cheerful, or so it seemed to me. Those attending him seemed also to be full of good cheer and with smiling faces.

The floors were old, gray tile, but they were clean and shiny. The halls were long and echoey. People in white bustled importantly through them. My home base was a two-bed room where I was the only occupant.

Strange smells were everywhere. Occasionally, I was asked not to run my wheelchair so fast. My family visited me. One of my aunts was a nurse and she was a special friend to me during this time. The doctor, a surgeon, was stern and commanding. Tension filled the air when he arrived. People and things gathered quickly around me when he visited.

Occasionally, I was strapped, immobile, to a table to have my infected ears lanced. It hurt terribly, but I knew it had to be done. It had all been explained to me, and I trusted everyone. I was, however, afraid of Dr. Morrison (I still see his seemingly angry face).

Despite the pain and the isolation from home, that special feeling was there. And, it was all so interesting!

Twenty years later in 1964, I was undergoing my one-year administrative residency in a community hospital south of San Francisco. For one month of my traineeship I was an orderly, under the direction of a male licensed vocational nurse who had been a medic in the military. The workstation was the Intensive Care Unit, First shift, 7 a.m. to 3 p.m.

Patients in the ICU were ill with many problems, in some cases, not all of them identified. They were victims of internal trauma: diseased circulatory systems, nervous systems, digestive systems. All were aged 45 or more, some as old as 70, which seemed quite old to me then. Some were comatose; one was occasionally delirious with infection. I learned to feed them, change their bed linen, shave them, clean up their body wastes, massage them, listen to them. I took their TPRs regularly (temperature, pulse, and respiration). I measured their I&Os (the volume of fluid intake and output). I watched two people die, one from a worn- out liver and one who just wanted to be left alone and not be helped. He was old and tired and said he had had enough, despite (or because of?) the incessant encouragement of his family.

As these people lived out their destinies in our ICU, the activity around them was quietly enormous. RNs were day-to-day, hour-hour managers of patient care. The physicians were sometimes more than one to a patient, in and out daily, consulting with each other, quickly formulating strategies, readjusting orders.

The tension was constant. Sharp words sometimes snapped between players.

Alarms sounded when a patient’s heart went into fibrillation. A nurse would leap onto the patient’s chest to pound the heart and pump the lungs, while others quickly gathered to inject fluids and provide oxygen and other support.

I came to love these patients, even to dream about them.

In private and among each other, the employed staff engaged in locker room jargon and crude analogies. They sometimes expressed anger at patients. But all this disappeared upon our return to the serious, sacred duty.

The feeling of the specialness of a hospital came flooding back to me during this brief time.

Another twenty years have passed since then. I recall several times when patient care continued despite feelings in the administrative suite that everything was about to unravel.

Ten years ago, In one community-based, non-profit hospital of 250 beds, where I was chief executive for the first time, the board of trustees was split into two contending factions, members of the organized medical staff were angry with the board as a whole, my boss had been fired three months after I arrived as the number two man, and my boss had fired the director of nursing before that.  Also, the finance director was angry because I was named acting CEO and not he. And, I was told to fire the human resources director, a friend.

In addition, the “California malpractice insurance crisis” of 1974 encouraged our surgeons to take a four-week holiday. Our business dropped significantly. As the new and interim CEO, I laid off employees, cut hours of everyone else, and reduced salaries of managers and executives by 20%. Strife and tension were rampant. We made it through, however, and the hospital is now a thriving, expanding entity. During the crisis and turmoil, the patients continued to receive the care they needed, even during a general evacuation during a false bomb threat.

1976: I was chief executive for a county hospital in California. The medical offices (“clinics”) were integral to the hospital. The sign is a memento of days long gone by.

Later, I managed a 150-bed, rural county hospital in central California for four years. It had large outpatient clinics, an active emergency department and eighteen family practice residents in a three-year post-graduate medical training program. Ours was the oldest of the four hospitals in town, located across the street from the public cemetery. We were the hospital of last resort. Nonetheless, twenty-percent of our patients were able to choose, and they chose us.

Our old physical plant had the same clean, gray tiles I remembered from 30 years earlier.

We were just one of many county departments struggling for a share of limited property tax dollars. As a public entity, we were fair game for politicians and newspapers to criticize. All our business was done in public, with newspaper reporters at every board meeting. Employee morale was often low.

Our patients usually came to us not because of a single problem, but because of many problems. The young medical residents were amazed at how their patients could retain the will to continue under their past and present burdens of poverty, disease, hopelessness, and anomie.

Some of our patients were unpleasant people. They stank. Their behavior was ugly and sometimes crazy. We sometimes disagreed with, even hated their personal values. But we gave them what they needed, and we cared for them. Perhaps we even loved them. Maybe we loved them because when they left us, they took some of our caring with them.

Addressing the annual meeting of the organized medical staff

When I came four years ago to (this city), I found a hospital with a beautiful physical plant, dedicated employees, a committed board of trustees, an active medical staff with few but steadfast members, no money, bad politics, and an uncertain future. It was then a non-profit, community hospital which, over its sixteen years, had had three names and governances.

We had periods of almost no patients in a 199-bed acute hospital with high overhead. We weren’t paying our mortgage. An agency of the U.S. government had commanded the mortgage holder to divest itself of the investment.

The press was full of imminent doom or portents of radical change. The physicians stayed away in droves. We laid off 35 people.  Not one bank in (this city) would lend us operating capital, and I don’t blame them.

The State of (xxx) provided financial aid to help us continue, and we sought out the state as a vehicle for refinancing the mortgage. We soon saw, however, that state control would ensue from this, and dollars for capital improvement would eventually be insufficient to maintain a current physical plant with up-to-date equipment.

The outcome is now history, as we brought business operations to the point where the hospital was salable to a national investor-owned company. We now have sufficient capital for us to confidently serve the community into the future.

During the years before this resolution to the uncertainty and fear among the employees and members of the medical staff, patient care continued: babies were born; people were diagnosed, treated and healed. Our employees stayed on the job and continued to care.

In these and other experiences, I have sensed something vital in a hospital, no matter what its circumstance, no matter who owns it or operates it. It has a purpose that will not be denied.

I believe a hospital has a soul. The soul resides, in part, in the people that work there, in the tenets of their professions and trades, and beyond them, in some place that attracts and dedicates them to such work.

It’s there. I’ve seen it. I’ve felt it. It humbles me.

I must serve it.

END