In the fictional novel Saigon, Illinois, the main character, Holder, describes his experience working at a Chicago hospital during the Vietnam War as a conscientious objector beginning in the Summer of 1968. Holder describes the hospital as “Metropolitan Hospital is located on Chicago’s Gold Coast, a few blocks from Lake Michigan. It has 900 beds, 18 floors, and seen from above, looks like the letter H. Associated with a major university, it’s a teaching institution for both nurses and doctors—just the sort of place where hospital melodramas are set. There would be legions of tough nurses with big hearts, eager but overworked interns, arrogant resident physicians, conniving administrators, and frightened, often victimized patients.”
Some of that would describe Wesley Memorial Hospital, part of Northwestern Memorial Hospital and part of Chicago’s Northwestern University campus where the medical, law and business schools are located.
Wesley I think was actually 19 floors and was a teaching hospital for Northwestern students and residents as was Passavant Memorial Hospital. Both hospitals have their origins going back to the late 1800’s and neither facility exists today, being replaced by larger inpatient facilities and cancer center pavilions. When I was a medical student, these hospitals, in addition to a psychiatric hospital, Lakeside VA, Prentice Women’s Hospital and Rehabilitation Institute of Chicago (RIC) along with the surgical pavilion and ER building that I believe also contained the dental school at one time made up the med school campus. More recently, Northwestern has additional hospitals in the Northern and Western suburbs as big hospital systems get bigger and fight for market share with other large healthcare systems. More hospitals, more doctors, more revenue.
As Northwestern medical students we spent many of our clinical rotations at Wesley and Passavant, connected by tubes, sheltered from the wind of the lake. We would also go to the Lakeside VA (now gone), Ob/Gyn hospital and the RIC. A few of us would wonder further off campus to hospitals in Lincoln Park or Cook County Hospital to get a different perspective. I did both. The Lincoln Park hospital had a full AIDS ward. Not HIV clinic. AIDS ward. Patients died daily of opportunistic infections and lymphomas too strong against the treatments available before we knew more and could reduce viral loads and people are now living with HIV rather than dying from AIDS.
Cook County Hospital I thought was analogous to what it must be like to practice in a third world country with some really excellent physicians by your side. Extremely sick patients where you saw the natural history of disease, always had limited resources where demand exceeded supply for nearly every resource and some truly motivated physicians who did everything they could to heal the wounded and cure the ill and teach in between.
The patient population at Northwestern of course was a little different. It was not unusual to see civic leaders, entertainers, athletes, notable figures and a who’s who of Chicago daily life.
A few patients stand out that I recall. One was Sid Luckman, credited with being the first modern T-formation quarterback and considered by some football historians as the greatest long range passer of his time. He played 12 seasons for the Chicago Bears and led them to 4 NFL championships, including a 73-0 rout of the Washington Redskins in 1940.
When our service admitted Mr. Luckman for chest pain (he had triple bypass many years prior) my attending asked me what number Mr. Luckman wore. I of course told him “42”, perhaps the most well known “42” after Jackie Robinson. Not being able to make me stumble on this he followed up the question by asking me what a thermometer measures when placed under the tongue (sub-lingual). I did not know it was the lingual artery which he was quick to point out to me. I may have known Chicago sports trivia but did not know the lingual artery but apparently I remember that now as well. Mr.Luckman passed away many years later in Miami.
Another patient we admitted to our service was Dave “King” Feldman. Mr. Feldman handicapped and wrote about horses for Chicago newspapers for more than 60 years among many other accomplishments. He had a thousand stories and claimed he never met a horse or a man he did not like. Some of those stories he shared with the students and residents during the time we were helping to care for him. He was credited with never missing a deadline, including, when necessary from a hospital bed. That I can tell you is true. With persistent fevers despite triple antibiotic therapy for a complicated pneumonia, Mr. Feldman picked the winners of the first 6 races at the local park where they were running that day. I had him sign his Sun-Times picks and racing form from that day. I never got up the nerve to ask Mr. Luckman for his autograph. After being convinced he was dying for many years, he finally did many years after I met him in 2001.
Then one day as a sub-intern I admit a 69 year-old gentlemen from the emergency room with a history of coronary artery disease, emphysema, congestive heart failure with a chief complaint of shortness of breath. A typical admit on a medicine service. Add in diabetes and hypertension and you had the typical past medical history (PMH) of: CAD, COPD, CHF, IDDM & HTN. Many chronic diseases in just 11 letters.
The chief complaint and PMH belonged to the leader of the Chicago gypsies or as I was use to thinking of him as, The Gypsy King. He was a short, potbellied man who looked much older than his stated age who was not shy about telling you he smoked, ate and drank what he wanted and looked like it. He and many of his relatives were well known to the medicine service, a term, probably not referred to in The House of God, as “frequent flyers”.
Ten years perhaps passed between I last saw him between high school college and a few years of med school. He recognized me immediately as “Marty’s kid”. So did his relatives. Many from the clan were there. This much is true – gypsies do travel in troves or groups. There is a strong sense of family and caring for one another perhaps not too different from other Eastern European cultures. Many in the ER and up on floor that day had me at their parent’s funerals or their own children’s weddings. As a non-gypsy sometimes he was hard to tell a wedding from a funeral, both celebrate life, have colorful cars, horses, with songs, music and occasionally even dancing at the funerals. The funerals were very public processionals with mourners walking behind horses pulling the casket, perhaps past places the deceased lived, worked or raised his/her family on the way to the cemetery. Some of the most ornate headstones in many of the several Chicago cemeteries are gypsy. They live life and remember their past.
So it was on the next day on rounds that I present The Gypsy King to my attending with his chief complaint, reason for admission, treatment plan, management issues, his urine output overnight and current vitals, standard med student presentation. It was here at this point I began to realize I probably should not have been the med student assigned to this case because my attending did not want to hear any of it. He wanted to hold court over the team and tell us all about Chicago gypsies. How they do not assimilate their culture with ours, how they lie, cheat, steal and commit fraudulent activities to support themselves. How they milk the healthcare system without any return for society. This went on for several minutes. He was the bow-tied professor of medicine and the whole team took every word he said as gospel truth whether it be on cardiac physiology or gypsies. He continued telling us that our patient and his family were not to be trusted and would feign symptoms and complaints to keep their loved ones in the hospital. We were warned how their closest relatives would threaten us to continuously do more for their relative and defense mechanisms to deal with those requests.
What our professor described was textbook about gypsies if it had come out of a textbook written by a non-gypsy on stereotypes and perceptions of gypsies in Chicago and the world over. Our attending did not resort to claiming that gypsies stole babies but I expected that too.
I knew more on this than he did even if I didn’t know about the lingual artery and sublingual thermometers. I knew these people and he didn’t. I ran around the halls of the Den of Thieves and The Loop with their kids and grandkids.
I had a decision to make – keep my mouth shut and let the words pass through the hallowed halls of the university teaching hospital or perhaps put a senior leader and respected professor of medicine in his place. I chose the latter.
When he was finished with his dissertation on Chicago gypsies and their crooked, corrupt, illegitimate ways, I spoke up. I recounted how my father had done with business with these people for many years. How our mortgage and my college tuition was likely paid in part by income earned from my father earning their trust in doing business with them and their trust in him. And how the professor’s brilliant oral thesis was mostly false. Not all gypsies are cradle-to-grave criminals. It would be like making a claim that all Italians are part of the Mafia. True, there were some borderline businesses but many were also accomplished, hard working teachers, accountants, lawyers, musicians and craftsman who did not make their living imitating gas meter readers to steal from homes. They have social security numbers, pay taxes, attend weekend tee ball games, attend school plays – yes their children attend school.
It is often very difficult for modern educated Western people to look at a particular culture and declare them to be corrupt or otherwise radically deficient. Why?
For most of us who would not normally be part of their culture, much like they choose not to buy into anything more than a small slice of non-Gypsy life are really at opposite ends of a mosaic so vast, so secretive (until now) that really only a handful of people can begin to perceive its full dimensions. Most cannot claim what they actually do. Who would buy stocks or take legal advice form a gypsy, right? Who would give money to a gypsy?
My medicine professor he had a very narrow, and admittedly, somewhat biased view on this without knowing what I learned over 2 decades of having the opportunity that many non-gypsies do not – knowing gypsies.
For his part, my attending left me on the case as the primary caregiver for The Gypsy King which perhaps was almost as wrong as getting an autograph from a very sick horse handicapper.
For their part, the gypsies used the same kind of bargaining techniques with me that I watched them do with my father. For my father it was trying to get him to sell them more jewelry for less money or selling my father less jewelry for more money for them. For me, it was attempts to get them a private room or non low-sodium food or more pain killers. Just as many patients would try to do.
Some of this they teach you in medical school, some of this they do not or get it wrong when they try.
And The Gypsy King did pay his hospital bill.