Good-bye Acoustic Tuesdays

On many Tuesday mornings, for over 20 years, I walked from my apartment on West 10^th Street up Sixth Avenue, past Joe Jr.’s Greek Diner on the northeast corner of West 11^th, up to West 12^th Street, then over toward St. Vincent’s Hospital bringing with me my book bag and a second briefcase filled with surgical instruments I would be using that day; it was an “Acoustic Tuesday.” My former ENT Resident, now colleague and friend, Dr. Salvatore Caruana MD, himself a Head and Neck Surgeon specializing in cancer, would often be walking on the same side of West 12^th Street toward his office at the Martin Payne Building. As I approached the 12^th Street entrance of the Hospital, he would often greet me in song by paraphrasing the old Rolling Stones tune, “Hello, Acoustic (Ruby) Tuesday…” because he knew if it was early on a Tuesday morning, I was on my way to join my colleague and friend the Chief of Neurosurgery, Dr. Raj Murali MD, and his team to help remove a benign posterior cranial fossa skull base tumor called an acoustic neuroma, a meningioma or another type of intra-cranial tumor, something surgeons with my type of training often do.

I am an “ear doctor,” more precisely an Otologist, Neurotologist and Skull Base Surgeon. I have spent over 13 years of my youth from pre-medical to Fellowship studies carefully learning the art and science of my craft that would allow me to walk into an operating room at St. Vincent’s Hospital or any hospital and perform the sort of surgery I love to do. However, of much more importance was where the surgery would be performed. I loved caring for my patients at St. Vincent’s Hospital. Any Tuesday or any day spent there was a pleasure. For I and my colleagues knew that for each patient, no matter what the patient’s socio-economic standing, there was one level of care: excellent, kind, charitable, and caring. Each one of us knew our part in that equation and that it would not only yield a “job well done,” but would be fun in the doing.

Not that each case was a “Grand Slam Homer,” to use a baseball comparison, or easy or even always successful. Try our best as we always did, on some occasions we were defeated by the sheer complexity of the pathology and could only remove part of a tumor or occasionally little at all. In the over 20 years of our collegial relationship, we lost two of almost 500 patients to post-operative complications and this was extremely difficult for Dr. Murali and me to bear. However, as my colleague Dr. Murali so wisely pointed out on many occasions, the “judge and jury” reside in our conscience and he and I knew full well everything possible had been done to bring each patient through carefully and successfully.

There are no half measures in neurological surgery.

History of St. Vincent’s Hospital

What allowed us to provide this “first world” level of care was the whole ethic that made St. Vincent’s Hospital the center of excellence it was. Founded by the Sisters of Charity on November 1, 1849 in a small house on West 13^th Street to treat victims of a cholera epidemic then raging in New York, the Sisters recognized the need to provide medical and later surgical care for the indigent poor of New York City. The ethic and mission of St. Vincent’s Hospital remained the same even as decades passed and times changed. The same group of religious Sisters founded the New York Foundling Hospital on October 11, 1869 to care for babies abandoned after the U.S. Civil War. If one passes the present building at 590 6th Avenue between 15^th and 16th Streets, one can read a plaque that encapsulates their motto, “Abandon No one.” That was certainly true of St. Vincent’s Hospital. No patient felt adrift, left alone. All were welcomed to receive care.

As a young attending, I was amazed that we were even allowed to admit to St. Vincent’s Hospital patients with hopelessly large and complicated disease processes, knowing in advance they did not have the slightest ability to pay. No medical or surgical decision we made was questioned or second-guessed. The patient received the care he or she required. That was all.

Over the years of the HIV/AIDS epidemic, St. Vincent’s Hospital was filled with young men and women dying of various complications of their disease. These patients received the same St. Vincent’s type of expert, kind, and compassionate care as did every patient. It was irrelevant that each carried within him or her a deadly, communicable disease. Every patient I treated with charity. I was often called to provide Ear-Nose-Throat (ENT)-related consultations and care for these patients. It was heart-breaking to do so, for many were my same age and I knew full well that ‘there but for the Grace of God go I.”

Then came protease inhibitors around 1992 and the wards were emptied, yet not the Spirit of St. Vincent’s. As the years unfolded, it became apparent that, even for the occasional “Acoustic Tuesday” surgeon as was I, all was not well at St. Vincent’s. Fiscal mismanagement? Lack of modernization? (Definitely, as far as medical records were concerned!) Overly-powerful unions? The “sleeping quarter” of the O.R. lounge was certainly a scandal to me. Even the Washington, D.C. Veterans Administration Hospital, where I trained during part of a year of General Surgery, did not have “sleeping quarters” for those at work. It is easy to point fingers, but the answer to St. Vincent’s demise is most likely a combination of all of the market forces that have brought down many institutions founded long ago upon the call to perform charity.

I am an “ear doc” and not an economist. I was never privy to the inner sanctum of St. Vincent’s finances and doubt I would have understood the entire picture if I had been. However, even to my untrained eye, it was apparent that things were changing and for the bad. Perhaps as the Catholic Health Consortium evolved with its “last man standing” absorption of cumulative debt, it simply became a financial cross too difficult for any one institution to bear. Furthermore, perhaps the Archdiocese of New York was faced with many other needy apostolates and simply decided that “first world, cutting edge” hospital care would have to go. It is hard to know the exact reasons.

I am a baby-baptized, practicing Catholic. I was once a Professed Franciscan Cleric in simple vows, who loves and respects the Roman Catholic Church and for all it stands. St. Vincent’s Hospital epitomized all that is the best about the Catholic ethic and tradition: respect for each and every person at each and every stage of life. Any negative comments about St. Vincent’s Hospital must be read through my eyes of respect and love.

Comparing two hospitals

My “home hospital” for all other patient care not involving the brain was and is the New York Eye and Ear Infirmary, about a 12 minute walk east on 12^th Street. The “Infirmary,” founded in 1820 for diseases of the eye, is the oldest Specialty Hospital in North America. It has always been fiscally sound, usually breaking even and actually now making money (a rare thing for any Manhattan hospital). It provides world-class, cutting edge care in the fields of Ophthalmology, Otolaryngology-Head and Neck Surgery, Plastic Surgery and (since Hurricane Katrina devastated New Orleans) breast and breast reconstructive surgery. The Infirmary does not have OB/ Gyne, a busy General Surgery Service, Paediatrics, and all other general medical and surgical services that St. Vincent’s Hospital provided.

As expected, the differences in the minute-by-minute and day to day workings of each hospital was quite apparent, but as a level-I Trauma Center, St. Vincent’s Hospital provided a very different type of care, something a specialty hospital such as the New York Eye & Ear Infirmary could never do. So comparisons between the two hospitals are not fair.

What both hospitals had and The Infirmary still has was something that is ineffable and cannot be bought or sold: kindness, caring, and a real sense of compassion for the patient in need. This is especially true of the Nursing Staff of each of these hospitals and was especially true of St. Vincent’s. Perhaps it was the ethic remaining from the days of St. Vincent’s School of Nursing, closed by my time. Perhaps it was the “quiet presence” remaining from the days of the Nursing Sisters of Charity at St. Vincent’s. Whatever the reason, it was real and wonderful for the patient and all who cared for any patient.

The need for a replacement hospital

As I write this memoire, it is highly unlikely that what we knew and loved of St. Vincent’s Hospital will ever re-appear. Perhaps medicine and surgery have become commodities to be bought and sold, much as the automobile industry. Perhaps MDs will evolve into “body mechanics.” One would certainly hope and pray this day never comes to pass.

What is ever more obvious and painful is the huge hole left in the pierced side of the Lower West Side of Manhattan. Alighting from the Seventh Avenue IRT Subway at 12^th and 7^th Avenue South, anyone can now see the gaping hole that once was St. Vincent’s Hospital. Even if I had the money to buy an apartment there, I would not because of the loss of what once was.

It is not just the memory of “les temps perdus” that causes pain, but the knowledge that real needs of the neighborhoods of people who comprise the Lower West Side are not being met.

One case illustrates my point. Several years ago, the husband of one of our secretaries at the Infirmary had a heart attack while in the bathroom of a restaurant on Hudson Street, not far from the now closed St. Vincent’s Hospital. By the time his wife went in after him, called 911, waited for the ambulance that had to lumber its way across town to Beth Israel Hospital, enough damage was done to his heart that he eventually died. Perhaps his outcome would have been different had he received timely care a few blocks away from the place where his infarct occurred.

Shortly after the closing of St. Vincent’s Hospital on April 30, 2010, many of us in the West Village received a survey from the office of then State Senator Thomas Duane, asking how the Hospital closing had impacted our lives. Among some of the many and meaningless questions was, “Have you had to wait an excessively long time in your doctor’s office?” I thought to myself upon reading it, “Is the author of this survey crazy?” Being inconvenienced by “the wait” in any doctor’s office is not the point. What matters is the precious time that could be lost during an evolving stroke or heart attack in order to get the patient to a proper place for treatment. This is what is key and what matters.

Ambulances do not ride on the sidewalks. They have to use the same busy streets as do all cars, trucks, and buses in New York City. The precious time lost in the emergent crisis of the patient described above is an all-too-real a danger to each New Yorker living in the West Village and in Lower West Manhattan.

On Tuesday, November 29, 2011, while seeing patients in my office at the New York Eye & Ear Infirmary, I became acutely short of breath and was taken by ambulance no more than three minutes away to Beth Israel Hospital where I was promptly and expertly treated for pulmonary emboli in both lungs. I remained in hospital for eight days. I regard my entire cardio-pulmonary crisis as a blessing in disguise because I was but a few short minutes away from an emergency room where the proper diagnosis was made and care instituted. An underlying, unknown cardiac arrhythmia was the culprit.

New Yorkers in the West Village and in the Lower West Side of Manhattan are not so lucky. Should a life-threatening cardiac, pulmonary or intra-cranial crisis occur, they may not be so fortunate as have been tens of thousands of patients who came in extremis to St. Vincent’s Hospital in a critical state requiring care within minutes. The need is evident. The time has long arrived that a state-of-the art center of medical and surgical care be created in the West Village for its own neighbors and for the people of Lower Manhattan.

Such a center may one day in the future proudly bear the name of St. Vincent’s Hospital. Yet whether it does or does not, the legacy of the outstanding, charitable, kind and compassionate care that was rendered to the citizens of New York City by the Sisters of Charity and St. Vincent’s Hospital is the hallmark for any care to be given to any patient in the future.

This is the standard. It is a very high mark.

It will long remain the guiding light on the hill that was once St. Vincent’s Hospital.