Five Patients: The Hospital Explained by Michael Crichton

Author:Michael Crichton
Language: eng
Format: mobi
Tags: Non-Fiction, Thriller, Science
ISBN: 9780613215466
Publisher: Rebound by Sagebrush
Published: 1970-06-01T05:00:00+00:00

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What is the hospital’s responsibility? Originally, the answer was quite clear—it was

built to care for any needy person in Boston who had the initiative to seek it out. With

the passage of time, its community became not the entire city, but a part of it, the so-

called North End. This is a community of working-class Italians and Irishmen, with

areas of considerable poverty.

But the hospital has never lost its passivity, a tradition that can be traced all the way

back to Greece. Patients are expected to come to the hospital, and not the reverse. And

while the hospital will never turn anyone away from its doors, neither will it actively

seek out illness in the community. Furthermore, the impact of technology over the last

twenty years has been to make the hospital even more passive, as it becomes more

preoccupied with acute established disease, to the almost total neglect of preventive

medicine.

But the role of the hospital is going to change, as public expectations for medical

care change. According to Alexander Leaf, Chief of Medicine, “For a long time—since

Hippocrates—we have not attached any broader social obligation to the physician’s

education. You went through your training program whether in school or as an

apprentice, and then you hung out your shingle and treated whoever could pay you. But

now that is unacceptable to society, which is making other demands from physicians.”

He says, further: “I think we have to restructure the functions of the hospital if it is to survive for the next twenty years.”

Implicit in this is the notion that what the hospital now does, it does well. But it is

not doing enough, and the times, indeed, are changing. To quote Galbraith, “One must

either anticipate change or be its victim.”

The hospital can no longer be a charitable refuge for the poor patients—the poor

patient (or, rather, the patient whose bills can’t be paid) is disappearing from the

landscape.

The hospital can no longer act as a stronghold of technological, scientific excellence

for a few patients, when the disparity between in-patient marvels and community

horrors is ever-increasing.

Dr. John Knowles, director of the hospital, observes that “When I was recently the

visit on the medical service, the first five patients presented to me all happened, by a

curious coincidence, to have the same problem. And it serves to point up the

incongruity of what we’re doing here. All five were elderly, chronic alcoholics with

massive GI bleeding and end-stage liver disease. All five were in coma and we were

treating them vigorously, with everything medicine has to offer. They had intravenous

lines, and central venous pressure catheters, and tracheostomies, and positive pressure

respirators, and suction and Seng stocking tubes, and all the rest. They had house staff

and students and nurses working on them around the clock. They had consultants of

every shape and sort. They were running up bills of five hundred dollars a day, week

after week… . Certainly I think they should be treated, just as I think that a large

hospital like this is the place where this brand of complex medicine ought to be carried

out. But you can’t help reflecting, as you look at

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