The Battle of Lenox Hill

Thursday, July 1. Will the efficiency of a highest-rated New York hospital be seriously affected by the general paralysis of the Bicentennial Independence Day? This afternoon I enter Lenox Hill for “hernia repair” with increasing qualms, not about a possibly unfavorable answer to this question but about the limits of newspaper assignments and whether this one is going too far. I am not an “action reporter,” after all, and the surgery is postponable.

Seventy-five other patients are sworn in at the same hour, a process no doubt slowed by actuarial complexities resulting from the malpractice crisis. In fact the patient leaves “Admissions” with the feeling that his identification bracelet manacles him to a “no-fault” system in which a fatal mistake, such as the transfusion of incompatible blood, becomes a “therapeutic accident.” One of the new non-liability contracts which must be signed states that “the charges incurred represent the fair and reasonable values of the services rendered.” But how, one might ask, can this be known in advance?

Certainly my cramped room is not worth the “charge incurred,” with its shower but no tub, towel rack but only paper towels: blotting the entire body is one of the more peculiar experiences of the assignment. Worse still, the centrally controlled air-conditioning, set at 55°, is not modifiable by the thermostat, and the frigid drafts from a vent along one rim of the ceiling are reminiscent of those next to the window seats in some airplanes. Also, the bed seems to be extremely narrow, especially when the railings are up, though no one can manage these without an amount of trial and error, just as no staff member can immediately find the right cranks for raising and lowering the head and feet, each move invariably beginning in the wrong direction; the secret of the “knee break” segment remains undiscovered, and that part of the bed uncomfortably elevated, throughout my stay.

I am requested to exchange my clothes for the open-back, knee-length, immodest hospital gown, and to “prepare for tests.” But first comes a detailed inventory of personal effects, which includes a question whether my teeth are part of me or detachable—rip-offs of dentures reportedly being on the increase. Then follows the taking of blood pressure, pulse, temperature, and of specimens for the laboratory. The electronic digital thermometer registers, to two decimals, until a “beep” signals that the correct degree has been determined. But whereas the machine is faster and more accurate than mercury in glass, it also produces more anxiety, the patient realizing that the longer the interval before the noise, the higher the fever.

Technology has not changed the method of ascertaining pulse, which is still done by human fingers on radial arteries. In my case, the nurse looks alarmed and asks if my beat is normally only forty-eight. No, I say, and suggest hopefully that this evidently failing rate may be due to “vagus inhibition.” Continuing to grasp at this straw, I mention the thermodynamics calculation by which the heart’s lifetime energy expenditure is equivalent to that required to build the pyramid of Gizeh, and I explain that while sympathicatonics usually complete their pyramids, and vagotonics rarely reach the pinnacles of theirs, the “vagos” generally live longer. Ignoring my optimistic fumblings, she simply enters the pulse on the chart, but thereafter my metronome readings are recorded every hour.

Another consequence of rising malpractice insurance rates is that all patients must be accompanied on each intramural excursion, lest they trip, fall, be kidnapped, or otherwise disappear. My escort, an elderly volunteer, watches me like a bailiff during the journey to Radiology, where I join a queue of women wearing bathrobes and worried expressions (no doubt from the mammogram scare). But my own consternation must also show, since I still fear the deleterious effects of shoestore fluoroscopy three decades ago. In Cardiology, afterward, the line and the wait are still longer, despite the three-woman team, one dabbing the jelly, another attaching the clamps and rubber bands, and a third running the ticker-tape. From here I try to slip back to my room unescorted but am apprehended and made to join a convoy of wheelchairs.

The next step to prepare me for the operation is the shaving of “Hesselbach’s triangle” and the perineal and inguinal areas. The indignity of this is exacerbated by the tonsorialist’s too evident relish in the symbolic emasculation, and by his pun about peotomies and his ribald remarks concerning future itching and the impossibility of scratching in public. Even the soreness from the dry razor on the genitalia is a lesser affront than the manner in which he manipulates their centerpiece—like a barber pushing a nose to the side while scraping an upper lip. But however ridiculous the newborn look, the episode serves to loosen proprieties and to reduce the embarrassment, moments later, of being penetrated with a clyster by a teenage girl—instead of by the more or less male nurses of my past experience. Referring to what feels like a substantial inundation, she orders me to “Hold it ten minutes.”

July 2. At 6 AM I am awakened by a remarkably cheerful anesthetist shaking my shoulder and asking about my allergies, reactions to sodium pentothal, carbon dioxide, or ethyl chloride, as well as about details of previous operations (a childhood tonsilectomy, a fractured elbow seventeen years ago!). He says that I will receive “tranquilizing medication” in my room about an hour before the operation, which, however, has had to be postponed until mid-afternoon because of an emergency. Intravenous feeding is begun—after three unsuccessful attempts to find a vein in the left wrist—and, at about 3:30 PM, I am given two gluteal injections. I try to resist the numbness and grogginess, the euphoria and the shimmering vision, the oblivescence and dissolving time sense, and the feeling of increasing isolation from friends who have come to see me “off.” Nor am I “out” when the masked figure in Shinto green, rubber cap, gloves, and galoshes, comes for me with his stretcher. The drugs have not “taken,” I protest, but perhaps inaudibly, for I hear my “bon voyageurs” whisper “he is fading”—words that hardly reassure.

The I.V. apparatus being part of our procession, an onlooker might deduce that my vehicle is propelled by the bottled fuel. Despite my semicomatose condition, I am aware that the elevator is bumpy and not smoothly aligned on either floor. On the higher one I begin to whistle, not out of bravado, or “in the dark,” but rather because of a desire to know if my “inner” and “outer” ears are hearing the same thing (they are), and thereby to confirm my consciousness. Since no one else notices this music, however, it may be that only the visual memory can be trusted as real and not imagined. Perhaps, too, the operating theater is not really as cold as it seems (for cryosurgery?), or the crossing of the threshold comparable, in the sense of temperature, to a ferrying over the Styx.

Wheeled to the center of the room and transferred to a table—no signs of previous carnage—I lie in lonely splendor before a large green lamp (my day in the limelight). Green cylinders of oxygen are visible, and other, human figures—sacerdotalists, to judge from the solemn, ritualistic-sacrificial way in which they approach me. All wear the same green uniforms and all are masked. As they close in on me one of them outstretches and straps down my I.V. arm, another strips me, a third announces that “after this injection you will go to sleep.” I do, and, mercifully, in a place without darkness or dreams.

Time to wake up,” strange female voices are saying, four and a half hours later, and I am aware of being again on the same conveyance, this time guided by four laughing Philippine nurses. (Or are they demonic pallbearers, and have I been reincarnated on a different plane?) Suddenly I find myself talking to one of my friends (in voluble but incoherent French, I am told later), and am aware of being hoisted to my bed (“upsydazy”), trembling from burning head to glacial feet. “Antiembolism stockings,” white like British naval officers’ summer hosiery, are pulled over my shanks; but a note on the wrapper,

Seamless stockings are contraindicated in cases of gangrene, heart failure, extreme deformity of leg,

tickles my sense of “sick humor,” and a giggle makes the fire in the left side of the abdomen burn more intensely, until doused by a hypodermic of morphine. When consciousness returns in the night—with some far-off detonations, premature fireworks, probably—I feel a wet-paint stickiness on my left hand. The I.V. needle has been dislodged, perhaps as long as an hour before, since the sang on my fingers is already froid. An intern tears off the tapes (and patches of hair), then carefully replaces the feeder.

July 3. The pain is sharp this morning, the anesthetics having worn off, and I make my way to the bathroom at a step a minute, clinging to an Amazonian nurse. Here the I.V. comes loose again, but I realize it only when I see a pool of blood around my feet. This time the artificial feeding is abandoned and a light diet prescribed, yet even before the blood is mopped up, a lab assistant has extracted his daily vial from the other arm. Now, too, the rantipoling headnurse threatens me with the catheter unless I “pass urine.” But the receptacle’s cold steel and bull-size neck are strong deterrents: I ask for a faucet to be turned on, close my eyes, and eventually think forth a satisfactory flow, the one instance during the week when mind triumphs over matter.

My physician, making his rounds, reports the discovery of a prehernial lipocele, larger than the rupture itself; he explains that this was the reason for the extraordinary length of the operation, more than double the surgeon’s expectations. Biopsy shows that the tumor is benign, but this is only partly comforting since I remember hearing that lipomas are famous for returning in the same place.

July 4. The surgeon enters the room this morning like a three-star general on a tour of inspection, asks how I am, departs in less than ten seconds. Concern is expressed over my preoperation pulse, nevertheless, and another cardiogram has been scheduled; owing to the holiday, however, several hours pass before someone is located to administer it. Finally, at 4 PM I am pushed along to Cardiology where a truculent technician allows me to remain in my chair only because, or so I suspect, the arm and leg straps remind her, as they do me, of an execution.

By late afternoon, too, my temperature has mounted, a reaction, in all likelihood, to the presidential (and other) platitudes pouring all day from the television. But a further cause may be the thought that a society in which medicine is practiced for the profit motive, and which permits its physicians to accept retainers from the rich to be assured of being given priorty, has no right to mouth the equality formulas of the Philadelphia manifesto.

At midnight, a new doctor wakes me to say that “a cardiogram has been arranged for tomorrow.” But I have had one only eight hours ago, I reply. Has no one read it? He has not, at any rate, and knows nothing about the matter, or why my bandage has not been changed in the more than fifty hours since surgery. On the premise that the higher temperature is being caused by a pulmonary infection, he sends for a “blow bottle,” a plastic vessel consisting of two containers, one filled with water, the other empty. In order to force the patient to breathe deeply, he is made to blow through a hookah-like stem and to displace the water from the one bottle into the other. Since the transfer becomes progressively more strenuous, however, it seems that the exercise might easily cause a new hernia. Yet every two hours I am aroused from sleep to play Aeolus with this Sisyphean toy.

July 5. Today my surgeon’s profile is even lower: no visit at all. My chief pains now are gastric, for which the cure is to drink ginger ale and to burp like a baby. Otherwise I feel almost back-to-normally bad and am able to shuffle through the corridors along with the other nonagenarians. Doing so in my blue hospital skirt, white support socks, and green slippers, and thus in some measure resembling an emperor of China, I am undoubtedly regarded as undergoing “psychiatric evaluation.”

July 6. At 7 AM a new nurse arrives with an electrocardiograph. “Have you ever had an EKG in this hospital?” she asks, before adding to the already considerable collection. A staff doctor then describes the mattress-suturing technique that was used on me, removes the bandage with one pull, and exclaims: “A perfect job of mending.” He has me look at the incision, and its red, yellow, and purple cross-quilting makes me queasy. He also says that I can be discharged, after he returns with the surgeon. But neither of them appears—this, I hope, for the benefit of cases more serious than mine.

Nor is there any shortage of these, of course, either here or elsewhere. At home, where charity is said to begin, I sometimes watch the dog-walkers, the well-dressed women, and the retired-executive types as they pass the derelicts asleep on the bench below and across the street from my window. The misery and dire need of these people is obvious, yet no one ever so much as glances in the offending direction. And myself? Do I go down and offer help? I do not, being exactly comme les autres.

July 7. At 8 AM the same staff doctor peeks at my scar and again promises to “see me later.” At $400 a day, however, deciding that it is already too late, I dress, pack my bag, walk to the elevator, descend and pay the bill, take a taxi home.

July 8. The hospital telephones. Someone has discovered that the patient in Room 8606 is AWOL.