Bellevue Hospital

The book that I’m currently reading is titled, Twelve Patients: Life and Death at Bellevue Hospital by Dr. Eric Manheimer. Dr. Manheimer was the medical director at the hospital for 14 years and is currently a professor at NYU School of Medicine. In this book he gives the reader a glimpse not only into this notable hospital but also into the health care system, both its successes and failures.

Bellevue Hospital is 275 years old, making it the oldest hospital in the country. Bellevue has been a leader since the beginning having many firsts: maternity ward, pediatric ward, and C-section to name a few. Over the next few posts I’ll look at few of the more profound comments that have stuck with me.

An area of medicine that is growing at an enormous rate is that of palliative care. The fundamental basis of palliative care is death and the rights that should be afforded to the patient in this process. Quoted from Dr. Manheimer:

How people die and how we participate in their deaths is as much about us as about them. Our own humanity is at stake. In a society that is increasingly mesmerized by efficiency, measurement by numbers and a bottom-line mentality that extols profit and wealth over any other human value, the risk is clear to everyone I work with. When health care is now measured by a “medical loss ratio,” and the percentage of spending on health care is considered a “loss,” then we are really lost.

This comment was prompted by a story he told about a young man with terminal cancer that had lost both his legs and was literally falling apart at every point. He wished to return to his native country, Mexico, to die. Obviously this is not something insurance would pay for nor was it something that anyone would recommend. We are constantly pushed to use every available treatment to keep someone alive despite his or her quality of life. Just because we have the technology to keep someone alive doesn’t mean it is always the right thing to do.

When discussing this very situation in a class I took this fall, a comment was made in our text that often the family needs to see the suffering in order to make it feel real. If they are unable to see their loved one suffering they are unable to process their death. This harkens back to the comment of making death about us. When or why should it ever be about us? Wouldn’t the most respectful thing be to help the dying fulfill their wishes even if that’s not what medicine would tell us to do?