NEW HAVEN REGISTER                               March 27, 2003
Memories of Kings County
Steven Wolfson, M.D.

Most of us think of history as linear, and assume that things tend to improve as time marches ahead. But at least in one crucial area, this assumption may be dangerously inaccurate: our health. Medicare and Medicaid are in decline, we see a relentless rise in the number of uninsured people in this country. Women’s right to choose is in jeopardy. We are moving backward in history. 

I know what it used to be like. In 1963, when I graduated from Medical School, I interned in one of the largest hospitals in the world, serving some of the poorest patients, in Brooklyn, N.Y. 

As Kings County Hospital interns, we spent days and nights fighting disease among 4,000 patients, most of them indigent, nearly all of them uninsured. We witnessed the harshest harvest of poor education, nutrition, and housing. We saw the ravages of drug and alcohol and nicotine abuse. Beset by all these plagues, our patients showed remarkable grace and courage, but we had little to offer them in terms of care. We performed triage for a society indifferent to their needs.

The wards were massive, open spaces, with up to 50 beds pressed up against the walls and running down the center. We could provide a little privacy, if not dignity, for our patients by setting up thin, portable screens. Obviously, conversations could never be private.

There was one room that contained only eight beds. We called it the “Second Eight”, and it housed the totally disabled patients. Most were elderly, some comatose, some merely vegetative, all were dependent on others for food, cleanliness, and survival. We often noted that their meal trays were often removed untouched because the patients could not feed themselves. No staff was available to feed them by hand.  With no other solution readily apparent, we organized a group of ambulatory patients to come feed the disabled patients.

The window to the room holding the “Second Eight” was painted over so that no one could see in or out.  After we found unobserved patients literally lying on the floor for hours, we had to threaten to break the window to get the paint removed.

The inhabitants of the Second Eight spent long times there. We hoped that some might go home with assistance, others to nursing homes. But the social service workers were established as “Civil Service”. This meant that they, realistically, could not be fired. Most grew old and retired doing as little as possible, which meant that the work moving patients out of the hospital took much longer than it should. Meanwhile, nothing slowed the entry of new patients.

Eventually, all the interns contributed to a fund and we gave that money to the only unmarried male intern and sent him on a date with one of the social workers. Within a day, for the first time, empty beds appeared in the Second Eight. 

Another institution at Kings County Hospital was the “GYN Room,” a section of the Emergency Room. It looked like a battlefront aid station, with gurneys lining the walls. There was blood on the floor, and pain in the air. Women were rushed in bleeding, infected, and delirious. All were victims of amateurish efforts to end pregnancies. They had been so threatened by their pregnancies that any risk was preferable to the shame, burden, and loneliness of single motherhood. So they used coat hangers, Lysol, went to women in the neighborhood, or men of some medical background who offered these services. And then they came to the GYN Room, usually in shock, for treatment. They died there, or they lived on, infertile or crippled, scarred for life.

We were chronically short of blood. If the women had family around, we asked for donors. When one boyfriend refused, I said that his girlfriend might die. How could I ever forget his reply: “I can always get another woman.” 

I really thought the world changed after my internship. Roe v. Wade was decided ten years later. Medicare and Medicaid were legislated, creating funding for the care of these fragile populations. And the Hill-Burton act mandated that hospitals receiving federal funds house all patients equally, insured and uninsured, wealthy and indigent. The hospitals I’ve worked in ever since have been as different from Kings County as night and day.

But all this progress is threatened today. Few who now debate the issues recall how things were before we tried to create the Great Society. Let me stress: they were bad old days. We really don’t really want to go back there. But it seems that we may.