‘Nobody Comes Here Because They Want to Get Rich . . . ‘ : County-USC--What Attracts the Staff ?

Do you remember the scene from “Gone with the Wind,” with the doctor at the train station? It showed him bending over this patient who was bleeding and moaning. And then the camera pulled back and it showed another dozen patients. And they were all bleeding and moaning. And then it pulled back some more and there were a thousand patients, as far as you could see, and they were all bleeding and moaning. And there was only this one doctor to take care of them all. Well, that is how I thought it was going to be at this place. It hasn’t turned out to be quite that bad.

--Dr. Robert Hurd Settlage,medical center perinatal care coordinator

Like their patients, doctors and nurses come to the Los Angeles County-USC Medical Center for many reasons. An opportunity to conduct high-powered clinical research is one major draw. A chance to teach is another.

Others come for the clientele, to minister to the sick poor. And some doctors and nurses are attracted by the medical center’s promise of an unending series of diagnostic rarities.

“Doctors live on interesting cases,” said Dr. James Halls, head of the Radiology Department. “Quite frankly, I don’t think I have got the temperament to look at a lot of normal chest X-rays for a whole day. I get edgy and want to get out and do something else. Here the spectrum of pathology is absolutely incredible.”

Money is almost never a motive. “Nobody,” said Dr. Larry Platt, “comes here because they want to get rich in the county system.”

Dr. Willis Wingert is a 63-year-old pediatrician who left a successful private practice in a small town to come to the medical center. Like most staff doctors, he has many duties. Not only is he in charge of the pediatrics emergency room, he also, among other projects, runs a clinic for pregnant teen-agers and is the medical center expert on snakebites.

“Private practice,” Wingert said, “is 40% well-baby care. That can be a little dull.”

Now, when he goes home each weekend, Wingert said, “Generally I feel I have done something good--in contrast to private practice, where sometimes I would go home and say I didn’t accomplish anything. They all would have gotten well without me.”

Part of the medical center challenge, in Wingert’s view, is “to provide health care to people who are not interested in it.”

“Their idea of health care,” Wingert said of the medical center clientele, “is a bottle of red medicine. Middle-class patients like advice. If you give these people advice and no medicine they say, ‘That doctor didn’t do a thing for me.’

“But the fact that they aren’t hot on care for their children doesn’t mean I’m not hot on care for their children. I’m aiming at the next generation. I’m not aiming at this one. As a pediatrician, I would have to say the present generation of adults has had it. I’m worried about their children.”

Many nurses come with the idea of sticking it out for a year or two, and 15 years later they can be found picking up their service pins at a polite little coffee-and-cake affair in the main auditorium.

Richard Brock’s motive was different.

“I actually came out here to be a movie star,” he said.

Brock, a 45-year-old nursing administrator in General Hospital, has been at the medical center now for four years. He came to Los Angeles from New York, where he had worked as a nurse and a TV soap opera actor, playing Dr. Michael Ferguson in “The Guiding Light.”

Heads for Hollywood

After two years, he decided to head for Hollywood and make it in the movies. Dr. Michael Ferguson ceased to be. “I think they had him go away to a convention and never come back,” Brock said.

Hollywood, however, proved tougher to crack than Brock had anticipated. Out of work and short on money, he returned to nursing. He worked first at Cedars-Sinai, and then made the switch to County and was promptly hooked.

“When I came from Cedars-Sinai they thought I was crazy,” he said. “There, there was carpeting on the floor, Picassos and private rooms. Here we don’t have carpeting. We have six patients to a (room). And while we don’t have any Picassos on the walls, we do have graffiti.

“But I got the feeling here of really being needed. I knew I could be of use here and be appreciated. I didn’t always have that feeling at private hospitals.”

An incident that helped convince Brock that he had made the correct move involved a patient named Przybeulski. A 45-year-old with liver disease, Przybeulski was a patient in Room 6200, which at the time served as the medical center’s alcoholic detoxification ward. He was believed to be a street person.

Brock tells the rest:

“His nurse said, ‘I want to call you by your right name. Please tell me how to pronounce it.’

“He said, ‘Oh, don’t worry about it. I’m nobody.’

“Finally, she got him to say, ‘Well, it sounds like Shi-BELL-ski. . . . but don’t worry about it. Nobody but my mother and my first-grade teacher ever called me by my right name.’

“And, of course, from then on everybody called him Mr. Shi-BELL-ski.

“And it was incredible. This little man, from who knows where, showed all the signs of being a real human being, in the race with everybody else.”

Doctors and nurses tend to differ in demeanor depending on where you find them.

A nurse in pediatrics has the gentle manner of a kindergarten teacher, her love for children obvious. “Who cannot like kids?” she asked. Intensive care doctors seem, well, intense, selecting their words with thoughtful precision as they describe a case. The emergency room staff, by contrast, appears much looser; it’s better to crack jokes than crack up. To interview medical center psychiatrists is to come away with the unsettling conviction that they learned more about you than you them.

And at Women’s Hospital, the nurse midwives in the Normal Birthing Center come across as gentle, compassionate, the best friends a woman in the midst of delivery could hope to have.

Momentous Occasion

“It is very satisfying to have a woman come in here in labor and make the experience very satisfying for her,” said Betsy Greulich, a 32-year-old nurse midwife who came to the medical center from Wisconsin via midwifery school in Kentucky. In a little blue book, Greulich keeps a record of all the babies she has helped deliver. On the night she was interviewed, the count stood at 333.

“It is probably the most difficult thing a woman will do in life,” Greulich said. “A lot of what a woman will feel about herself and her life will come from her birthing experience. After a birth, I will talk to the woman and tell her she did a good job.”

The research interests of these doctors often reflect the patient population.

Dr. Margaret McCarron, who has been at the medical center for 30 years and serves as associate medical director, has developed an expertise in toxins and drug overdoses. She has cabinet drawers filled with 1,000 PCP case files. She writes scholarly papers on the medical problems of cocaine smugglers who ingest packets of the narcotic. A current clinical research interest involves the motivation of people who drink rubbing alcohol. A bottle of tablets to poison gophers adorns a bookcase shelf in her General Hospital office.

Among her many responsibilities is the 13th-floor Jail Ward. “How come we’ve been having so many dog bites?” she asked a resident after rounds one day. “Because the K-9 units are out,” he responded matter-of-factly.

McCarron can throw a complicated chemical formula on a chalkboard for her colleagues to consider, and then in the next moment inform them that the best way to determine if a patient has consumed Prestone Anti-Freeze is by the color of his vomit. “The books don’t tell you that,” she said.

“Medicine is a very interesting thing,” McCarron said. “We move people through faster than other professions, and we give them responsibility. And responsibility is making decisions. You have got to act quickly in medicine.

“You have to learn how to think in a different way. You don’t practice medicine like arithmetic. You can’t say in medicine that two and two always makes four, because it doesn’t.”

In addition to doctors and nurses, of course, there are administrators and lab technicians and social workers and maintenance men, a shadow staff of personnel that, while it might not generate the interest or gain the glory of the medical experts, nonetheless is considered crucial to the operation of the medical center.

During the Watts riots, an emergency radio broadcast ordered all “essential medical center personnel” to report to work. To the surprise of many, janitors and other members of the support staff began showing up along with the doctors and nurses. They did not consider themselves non-essential, although they are usually the first to go in a cutback.

While many bureaucrats and non-medical staff members might initially be attracted by the Civil Service perquisites that go along with working for County, many soon become hooked on the medical center.

Ted Holland, 47, heads the 650-member plant management staff that essentially keeps the medical center facilities operating, the nuts and bolts department. He came to the medical center 23 years ago as an apprentice steam fitter, and after 10 years of night college started scaling the management ladder. He reached his current rung four years ago. Holland calls himself “a product of the place.”

His medical center is one of clanking steam pipes that traverse dark basement tunnels, of electrical switch boxes that hum with 4,800 volts, of 10,000 motors and hundreds of pieces of rolling stock, of twisting metal ladders that lead to boilers and backup generators.

The medical center is his patient. “It lives and breathes,” Holland said. He and his workers are forever coaxing more life out of ancient plumbing, or painting over graffiti-splattered walls, or salvaging spare parts from decommissioned medical gadgets.

Holland’s hospital stories are tales of engineering feats, and what he calls “hero work.” For instance, every Tuesday morning his crew tests the medical center’s backup emergency power system, loss of power being one sure way to lose a lot of patients fast. After one test, the switch refused to flip over from the backup generator to the regular power source.

Four of his workers wanted to attempt to throw the switch over physically, wielding a 2-by-4 as a lever. There was considerable risk that the current could arc and electrocute them. But it also was risky to leave the medical center on backup power.

“They convinced me they were going to give it a shot,” Holland recalled. “And when I saw them actually give it muscle and get that switch in, well, I felt like I was going to break down and cry.”

The medical center can be a window to the world at its worst, and it can exact a toll on doctors and nurses who stay on the ledge too long. One 20-year veteran of the place told how he needs frequent vacations.

“I suffer physical fatigue,” he said. “I stop talking to my wife. I don’t say much. I stop telling her what is going on. I cry. I have a psychiatrist that I see. I have been seeing him for 20 years. The same guy. I understand from psychiatrists I know that is not unusual for them to treat those who are in public medicine.”

The range of human emotion can be seen as a circle, and it does not take much to go around the bend from compassion to cynicism. There was a young resident in Women’s Hospital who seemed to have been at the place too long. He talked glumly about how these woman “should get their tubes tied,” how there were “too many of them already.”

When he gave a late-night tour of the third-floor wards, where young women are treated for a terrible form of cancer, the bleakness of his outlook became more understandable.

Most of the women were sleeping. He pointed out which ones would make it and which ones would not. He also considered it important to note the age of each.

“This one is 29,” he would say, “she won’t make it.”

Or, “Here’s one who is 16; she probably will make it.”

He stopped and whispered a question to the 16-year-old, who was awake. “How old is this woman?” he asked, pointing to a more sickly looking patient in the next bed over. The 16-year-old waved her hand; she didn’t know.

“Well, anyway,” the young doctor said, “she is going to die.”

The tour continued: “This lady has a complicated cancer. Her husband told her to kill herself. He said, “Why don’t you kill yourself and save yourself the trouble.’ He gave her the gun.”

Alexandra M. Levine came to the medical center as a 16-year-old candy striper. That was 22 years ago, and she now ranks as one of the institution’s rising stars, a nationally renowned cancer doctor, her name stitched nicely across her white smock.

While by no means blinded to the medical center’s shortcomings--the shortages of nurses, pharmacists and social workers who are vital to a doctor’s success top her list of complaints--Levine nonetheless calls herself a “big fan” of the place.

The medical care, she declares, “is the best in the city.”

Levine likes the idea of providing quality care “to somebody who can’t buy it.” Because of her reputation, many of Levine’s patients wind up at the medical center by choice rather than economic necessity.

She tells of a movie star being rolled into the emergency room, mink coat draped over her gurney, and of a bank president who became roommates on the cancer ward with a ghetto child, and ended up taking him home for Thanksgiving dinner.

Levine has received the ultimate Los Angeles accolade. She was a role model for a feature film. Released in 1978, it was called “Promises in the Dark.” Marsha Mason played the Levine part. It dealt with the relationship between a cancer doctor and a 14-year-old patient who was terminal.

When a Patient Dies

It is a subject Levine knows well, painfully.

What happens to her when a patient dies?

“When the patient dies,” she said, “I certainly have lost. I have lost in a lot of ways. No. 1, I have lost in a human sense, because you can’t treat these people without coming to appreciate them--I will say love them--because it is rare that I won’t really love somebody or like somebody an awful lot.

“So you feel a friend has died and that is awful. There also is the sense beyond that of having failed as a physician. And even though the fact is, there is nothing in the world you could have done, you can’t help it. A doctor is supposed to cure someone. Theoretically, I am supposed to cure him and when I didn’t cure him I failed.”

Levine does not believe in bracing terminal patients for the worst. “I say, “Let’s just assume that you are going to do well. You had better count on living, and plan your life that you are going to live for some time. I don’t know how long.”

While Levine can appear very cool standing at the head of a conference, clicking off the percentages pertinent in making a decision about whether to return a patient to chemotherapy, it is quite apparent in other situations that her best tool is compassion.

Making the rounds through her outpatient clinic, she forages vital information from what appear to be little more than congenial chats, listening attentively to patients’ stories about growing up in Arkansas, or about a second-grade teacher who taught them a crucial lesson about life, and so on. They fawn over her. She fawns over them.

When test results show improvement, Levine gleefully jabs her fist into the air like a cheerleader and congratulates the patient for a job well done.

And when the news is bad, alone, she curses.

“Damn it,” she said, squinting through a microscope at cancerous cells that had appeared in a blood sample. “Damn it. I can’t believe it.”

The patient was a Korean woman. She had been diagnosed for lymphoma two years ago and it was not treated properly and she had grown quite sick. Under Levine’s care, she had gone through the rigors of chemotherapy, and for a while it appeared that the cancer had been driven away.

Now, on what was to have been a routine checkup, the tests showed differently. The cancer was back, and in a way that statistics would indicate that she did not have long to live. Even though Levine has seen the statistics proved wrong, she was pained by the discovery.

“She had been doing so good,” Levine said. “I love this lady. She’s a gentle, sweet lady. Her hair was growing back, and she was so proud of that. And she was singing again. She used to be a professional singer, and she couldn’t sing for awhile but now she was singing again in a choir.”

Levine huddled with the young doctor working the case with her, plotting strategy about how to break the bad news.

The patient was on the other side of a door. The door was shut.

“I don’t want to go in there,” the young doctor said.

The room was small, with a linoleum floor and a hard light. The Korean woman had coal-black hair, with an unusual wiry texture to it. She wore short white stockings. She sat erect in her chair, her son leaning against a wall beside her.

The woman did not speak English. Her son was there to interpret.

Levine sat on a stool and looked into the woman’s eyes. Without diverting her gaze, she told the son to tell his mother to come back for some more tests. There was “something funny” on one of the slides.

There was a little more talk, a question about appetite, but nothing that seemed of great significance. And then the Korean woman smiled a nervous and brave smile , thanked Levine and prepared to leave.

Levine walked quickly from the room. Her first words confirmed a sense that had made its presence felt, at first vaguely and then with great power, in the course of the conversation.

“She knows,” Levine said. “She knows.”