The Efficiency of
Medical Wards
Daily Observer
No sooner had I stepped
into the foyer, water pouring from the brim of my hat, than Lapius called,
“Here Harry, help me with these.”
He was bent nearly
double on the little bench trying to fit galoshes over his size 14 E
shoes. “You should buy galoshes one size
larger than your shoes, Simon. It would
be easier. Or better yet, get some boots
that you can step into instead of your shoes.
Anyway, where are you going? It’s
pouring out.”
“We are going to the
hospital to see Frank Wrong.”
“What’s with him?”
“He’s been in a
week. Recuperating from pneumonia. I just learned about it today.”
“Why do you need
me. I don’t know him.”
“That’s just the
point. You’ll get a chance to meet
him. Frank Lloyd Wrong is one of the
important architects of the city. In
fact, he designed the hospital we are going to.
You know, Metropolitan.”
“Gad. That’s an architectural horror.”
“I know. I told him so when he designed it. Let’s go.
It will give me a chance to gloat,” Lapius said gallantly. I squeezed the water off my hat, replaced it
on my head, and opened the door. Lapius
was jumping up and down to wedge his heels into the galoshes and in a moment we
were off to the open road.
Metropolitan was an
endless maze of elongated wings. When we
finally found the entrance, Lapius inquired at the desk and found that Wrong
was in room 714. The elevator stopped on
every floor on the way down and after having picked us up, stopped at every
floor on the way up. After about 15
minutes we were disgorged on the seventh floor, then followed a series of
arrows and signs till we finally located the corridor that led to room 714.
Wrong was bedded down in
one of the two beds in the room. The
only problem was that his roommate had visitors and Wrong himself had some
other friends there, so that the scene resembled pushing crowds at a cocktail
party, except that no redeeming cocktails were served. Several of the visitors were smoking, and
others were coughing. Finally we got to
the bedside. Wrong was almost recovered,
lying in bed in his dressing gown. He
welcomed us with a bright smile, and would have bounced off the bed to greet us
but there wasn’t anymore standing room.
“Frank, it’s good to
see you,” Lapius said beaming. “You
appear to be fully recovered. Thank
goodness for that.” Then he introduced
me.
After the amenities
Lapius said, “Well now, how do you feel about being a patient, after having
designed so many hospitals.”
“They took very good
care of me, Simon. I’m fully recovered,
as you can see. The only thing,” he
lowered his voice to a whisper, “it gets crowded around visiting hours. But it was quite an experience. I’ve had three roommates already. The first one died the day after I arrived.
That was scary. Particularly since I
wasn’t too sure I’d make it myself.
Then, as I was starting to recover, they put a fellow in here who had
severe colitis. You know he couldn’t do
a thing for himself. Weak, dehydrated,
and solutions being fed into his veins all day.
He was sort of pinned to the bed.
Helpless. So, you know, I sort of
had to help out. The first night was
rough. I was up and down all night
getting him bedpans. But after a while I
worked out a routine and took pretty good care of him. He finally made it. But oh, the few times he had accidents in
bed. Sometimes he was incontinent. The stench was overpowering.”
“How’s your new
roommate?”
“Oh, he’s fine. I’m finally getting some rest. But I made it despite all the nursing I had
to do.”
“Tell me Frank,” Lapius
urged, “Why did you have to do all the work?
Where were the nurses?”
“You know how it is at
night, Simon, in a hospital. There is a
skeleton staff, and the skeletons were in other closets. You can’t get a nurse just anytime you want.”
“Can’t you ring for
them?”
“Sure. But suppose they are in other rooms taking
care of sick people. They might be a hundred yards from their desk, so by the
time they get back and see the flasher, a lot can happen.”
“I guess your right
Frank. Well, old boy. Good to see you recovered. We’ll get together as soon as you get out.” We said good bye.
Back at the apartment
Lapius had just as much trouble getting out of his galoshes as he did getting
into them. I helped him get them off
riding-boot style. “We must have some
brandy to get the chill off, Harry, eh?”
I fixed two, and we
relaxed. “Hospital design these days is
preposterous,” Lapius said, after warming to the first sip of the amber
Napoleon. “Semi-private rooms. That’s a humbug, Harry. How can anything be semi-private? It’s either private or not private. A semi-private room could more accurately be
called semi-public.”
“What would you
suggest. A hospital of private rooms,
only one patient to a room?”
“Ridiculous. No what I would suggest is a return to the
ward system. In today’s hospital most of
the space is devoted to halls with wards, most of the space would be utilized by
patients. But more important, the
patients would be congregated where nurses could see them. Even the skeleton staff would be adequate for
emergencies. Hospital cost per patient
bed would be cut about ten-fold.
Everything, including patient care would be infinitely more efficient
than it is in the semi-private system.”
“Ugh,” I said. “Wards were dirty and crowded.”
“Semi-private rooms are
dirty and crowded too. Here look at
this,” Lapius rummaged through a drawer and withdrew a print of an old monastic
hospital. The patients were distributed
in alcoves, each guarded by a curtain, along the four walls, and the nurses'
station was in the center of the great hall.
“Look at that,
Harry. A much better plan than the
current monstrosities with endless corridors, each patient hidden from the
nurse. And that picture represents a
hospital in the 16th century.”
“But people don’t like
to be crowded together in a ward. They
like privacy.”
“Did Wrong have
privacy? He spent half the night nursing
his roommate. In a ward camaraderie develops. There are always healthy ambulatory patients
about to be discharged who will help the sick.
There is always someone who can fetch a nurse or doctor in case of
emergency. But Wrong had to help his
roommate even when he was running a 102 fever, simply because he was the
healthier of the two. That condition
wouldn’t exist on a ward.
Today they could build
wards with numerous semi-private bathrooms.
Wards could be designed for dignity and comfort.”
“If ward-plan hospitals
are more efficient, less costly to build and service, and equally comfortable
for patients, why do they persist in building semi-private?”
“Because of Blue Cross,
which promised to pay for semi-private accommodations in hospitals. That was when wards were for the
indigent. But with hospital costs what
they are with semi-private accommodations 50-100 dollars a day, we’ll all be
indigent again in no time. We should
forestall that by going back to the ward system.”
The phone rang and
Lapius had a protracted conversation.
“That was Frank Lloyd
Wrong,” Lapius said. “He says that his
stay in the hospital has stimulated his thinking in the design of
hospitals. He says he has some great
ideas.”
“Don’t tell me he wants
to design ward hospitals?”
“No. All private rooms,” said Lapius morosely.