Perspective
A Simpler Time
A surgeon looks back at Minneapolis’ old General.
For 70 years, Minneapolis had a general hospital. Although smaller than Bellevue in New York City and Cook County in Chicago, it had many similarities in terms of its mission and the patients it served. The city’s fathers created “the General” as a place where all comers, regardless of their financial standing, race, gender, religious affiliation, or culture could obtain competent medical care. For many, it was the safety net, the hospital with a heart, the place where they could go for care whether they were contagious, mentally ill, or convicted felons.
As part of the deal, patients at the General and other city hospitals had to understand that the doctors who treated them were in training, albeit under direction. Consequently, they had to put up with the errors inherent in the learning process. In most cases, they did so with a remarkable degree of goodwill.
In the mid-1960s, when the General became a county hospital and Medicare and Medicaid began reimbursing hospitals for the care of those who heretofore had been unable to pay, the atmosphere began to change. Until then, the General had always served people without regard for their financial status (in the 1950s, the indigent rate was 70 percent). For the first time, the administration had to be concerned about financial accountability. We still cared about our patients, and they had respect for their doctors and nurses, but the place wasn’t the same.
In 1976, the hospital moved to the new Hennepin County Medical Center facility. That same year, the General was torn down.
The old structure may be gone, but its spirit lives on in the memories of the many doctors, nurses, and other health care workers who spent part of their lives roaming its grounds. In looking back, it seems as though all our efforts were directed at providing good patient care. Although many of the practices taught and treatments given at the old hospital are now considered passé, some practices and core values of the old General should not be set aside. For this reason, I think it’s worth looking back at the dear place.
The ER
When the county took over ownership of the hospital, many departments expanded in scope and capability. None perhaps more so than the ER. Under the leadership of Ernie Ruiz, M.D., and nurse Hillie Prose, the latest techniques of resuscitation and stabilization were instituted, the sorting and dispatching of patients was improved, and the education of interns and residents got better each year. The hospital was designated a Level 1 trauma center in 1989, and its top-notch ER was an important consideration in the evaluation process.
In 1957, when I began my surgery residency, the ER was, simply put, in a state of controlled chaos. At times, the tarmac in front of the entry resembled Times Square on New Year’s Eve. It seemed always to be crowded with ambulances, police cruisers, taxicabs, and private vehicles loading and unloading people and supplies. On the south end were two open garages with ambulances ready to roll. With a call from the nurse in charge, the driver would pull out, stop to pick up his intern in front of the ER door, then move onto Portland Avenue with siren blasting. Walk-in patients and staff coming and going added to the congestion.
Parking was a big problem. Employees either took their chances on getting a spot on the street (there were no meters then) or paid for parking in one of the nearby lots. Medical and surgical residents who drove “beaters” hopped the curb and nestled their vehicles in scarce nooks around the buildings. An unwritten rule stipulated that certain precious spots were reserved for chief residents who were frequently called in at odd hours for emergencies.
There was no foyer in the ER. Pass through the single door off the tarmac and you were in the emergency room itself. To the right was a chest-high wooden counter that separated the nurses and social workers from the patients and their escorts. From behind this barrier, a clerk or social worker filled out the all-important “green sheet,” which asked for basic information about the patient such as whether she or he had a job. Was anyone ever turned away? Hardly. Questions about insurance and ability to pay? Not at the old General!
Across from the check-in area—and completely open to the public—were two large treatment rooms. (An encircling curtain or wooden screen offered patients some privacy.) The first of these tiled rooms was used for everything from wrestling a rowdy drunk into submission to performing open-chest cardiac massage in a final effort to save a life. A light that looked menacing hovered over a steel treatment table. The ER pharmacy stood to one side of the room. Looking back, it was a bare-bones operation, but it served its purpose.
In the T-shaped hallway, the sick or injured sat or lay on a wooden bench or an ancient wood-backed wheelchair waiting their turn for care. If necessary, a patient could be placed in one of the chairs and secured with leather straps. Across the hall, smaller treatment rooms were used for applying casts, catheterizing patients, or counseling those suffering from abuse or depression. At the end of a shift, the floors might be spotted with plaster.
In a narrow space adjacent to the check-in station was a long counter where interns and residents filled out green sheets and answered calls from people with all sorts of medical problems. On the wall behind them hung the notorious “Gomer” list. A Gomer was an ER repeater who came in with inconsequential problems and simply wanted attention or, in cold weather, a warm bed and a few good meals.
Nine ominous-looking doors stood a short distance away. Behind them, corpses were stored on steel trays waiting to being taken to the morgue, post-mortem room, or funeral parlor.
In the ER, it was not unusual to see a police officer standing next to a handcuffed prisoner needing a laceration repaired. (A knife was the weapon of choice in those days; shootings were rare.)
Finally, a new intern might hurry past with black bag in hand to a waiting ambulance. Above the hum of the motor and activity, the nurse in charge might send him off with a parting admonition: “The child is not breathing,” or “The woman is bleeding heavily.” Such words could raise an intern’s pulse rate sky high.
The Wards
There were no private rooms in the hospital. The wards were large, rectangular rooms; patients were positioned head to the wall, 11 to 13 along each side and four at the end. During the night, one nurse (and possibly two aides) could be responsible for as many as 30 patients. When pressed for extra space, a need that wasn’t uncommon, beds could be placed end to end up the center of the room. An emergency such as a patient in cardiac arrest or having an epileptic seizure in such a packed setting could quickly lead to chaos.
The nurses’ station was at the front of the ward. It had a single telephone, order slips, patient charts, and, perhaps, a Merck Manual. There, nurses, interns, and residents wrote notes and orders in patients’ charts. Occasionally, a patient who was confused or experiencing DTs would be strapped into one of the ubiquitous wooden wheelchairs and placed at the nursing station. For some reason, being in the center of the action would often calm the patient.
Lessons that Live On
How could the old General, being understaffed as it was from top to bottom, function? Everyone simply gave 100 percent plus. The nurses took things in stride, doing the best they could with the materials on hand and the time allowed. They treated patients with respect yet developed a hard veneer that came from self-preservation. The doctors worked their tails off. As the chief surgery resident, I often operated through the night, had breakfast in the cafeteria, then returned to the OR for another full day’s schedule. We were there to take care of patients and learn, learn, learn. The workers at the bottom of the prestige ladder noted this attitude. How could they slack off when no one around them was doing less than his best? We thought of our work as a war effort.
There was also a spirit of altruism that could be felt throughout the facility. For the interns and residents who worked at the hospital, remuneration was on the back burner. My salary as a fifth-year resident in 1962 was $2,080. The few teaching staff were salaried and had no financial incentive to perform a surgical procedure. The many doctors from the community who gave their time and expertise did so gratis. They were caught up in the spirit of teaching and caring.
Will we ever again see this kind of atmosphere in a hospital? One wonders. My nephew, a surgeon, is training the surgeons of the future. With new techniques and new and better equipment, they seem destined to become finer surgeons than those of us who trained under “battlefield” conditions. Yet they are beset with educational debt and an evolving health care environment that we never encountered. They must have a decent salary and perks such as health insurance—no working for less than one-third of the average annual wage. They’re told they can’t work and learn properly unless they get a certain number of hours of sleep and relaxation—no operating all night, then putting in a full day’s work.
Unless those interns and residents are careful in sorting out their priorities, self-interest will rise too high. They will learn all right, but I doubt with the assurance and joy that we had during our time at the old General. MM
Harrison Farley is a retired surgeon who lives in St. Paul, and is a frequent contributor to Minnesota Medicine.