Bellevue: All the Trappings of War-Zone Medicine, in Middle of a City

Dr. Robert Hessler surveys the gridlock of gurneys cramming the emergency room hallways and makes a troubling diagnosis: Something is wrong beyond the chest pains, broken limbs and stomachaches confronting him.

Each patient has a crisis, and has hurried here only to wait. The emergency room is an overstretched strand in the health care safety net, backlogged to the bursting point by overcrowding and social wounds.

“The emergency room is overwhelmed with patients who need to be administered to,” says Hessler, assistant director of emergency services at city-owned Bellevue Hospital. “We do what we can minute to minute. We’re using every little nook and cranny we can find to take care of these people.”

Five patients are going to intensive care; four more to the heart attack unit. Twenty-one have been patched up and are awaiting admission to the hospital, including one man with an oxygen tube in his throat.

But the traffic doesn’t stop with this batch of casualties. A cluster of arriving emergencies queues up for triage. The worst get seen first.

Time passes with neither comfort nor silence in this makeshift ward. Patients on stretchers stare at the ceiling without so much as a curtain for privacy.

Hessler, 38, patrols the area with a stethoscope dangling from his neck and the pocket of his unbuttoned lab coat bulging with diagnoses on a note pad. Delays are more than just an inconvenience; they imperil the delivery of care.

“It’s not a pleasant way to be sick,” Hessler said. “I’m always afraid that somebody who’s seriously ill has to wait longer than they have to for a physician.”

An average of 300 people a day pass through the emergency room at Bellevue.

President Bush, Soviet President Mikhail S. Gorbachev and other dignitaries would be rushed here if something happened while they were in New York. Because of its quality care, city cops hurt in the line of duty prefer 264-year-old Bellevue, the nation’s oldest continuously operating public hospital.

It also sees the worst wounds of the city: crack addicts, bullet holes from drug-related assault guns, AIDS patients, the homeless who have no place else to go for care, teen-agers who need severed limbs reattached after being run over by subway cars, inmates from city prisons whose manacled ankles protrude from stretchers.

At Bellevue, battlefield images fit like bandages on a wound.

“We’re kind of a field hospital. This is war-zone medicine. We see all the casualties,” Hessler said. “We see everything here. We are the window to the world. You will never go anywhere else in the world and see something we haven’t already seen at Bellevue.”

Drugs are found in two out of three patients who are shot, stabbed or hit by a car, doctors say. One-fourth of the trauma cases involve people who have mixed two or more intoxicants, usually alcohol and cocaine.

The homeless seek treatment for such ills as frostbite and rotted feet similar to soldiers who suffered trench foot, a disease caused by prolonged exposure to wet, cold and inactivity.

“It’s like a Third World situation,” Hessler said. “And when it’s cold, we see body temperatures of 66 degrees. That’s almost the equivalent of hibernation. Their whole body is cold, not just their feet and hands.”

The river of patients creates stress and frustration.

“A patient doesn’t have things people come to expect in a hospital--a bed, a room, certainly not a TV. If you have to go to the bathroom, you get a bedpan,” Hessler said.

The clamor is a long way from the quiet calm of Hessler’s hometown of Billings, Mont. He spent seven years at the University of Miami Medical School before doing his residency at New York University, one of the country’s top medical schools.

Hessler specialized in internal medicine, but opted for emergency doctoring. It allows him to do a little bit of everything that interests him: internal medicine, pediatrics, obstetrics-gynecology and surgery.

“I like to work with critically ill patients. They make you think and work the hardest you possibly can. You’re keeping people alive,” Hessler said.

“You have to do the right thing in the first few hours for whatever they have. It puts such a stress on some people that one of the major problems is physician burnout. Some doctors aren’t able to function with that pressure.”

Or the daily dose of death. For every rush of adrenaline that comes with saving a life, there are terrible pendulum swings of seeing people die.

“We’re not God. Not everybody can be saved,” Hessler said. “But if you die in spite of everything I could possibly have done, at least I feel we delivered the best possible care and did everything we could have.”

He stays, even though there are better-paying jobs with less heartache.

“People asked me why anybody from the NYU training program would want to do emergency medicine,” Hessler said. “We’re a setting of last resort, delivering care to people who don’t have any insurance, don’t have any money and don’t have any place else to go. We’re here because we want to help people.”

On call 24 hours a day, Hessler escapes the bedlam of Bellevue at his suburban home in River Vale, N.J. He eases the tension by clipping his rhododendrons, junipers and yews.

“After a day of wild and chaotic work, I can go home,” Hessler said. “I can trim the bushes, look at my lawn, water the plants, watch the birds flying around. I’m used to a more calm lifestyle.”

In addition to sewing up accident victims or treating kids who swallow rat poison, doctors care for societal ills. A Polaroid camera is kept to document suspected child abuse. A standard evidence kit can store specimens from rape victims.

In one sweep through the room, Hessler bandages a smashed nose, takes vital signs on a heart patient, scalpels the bureaucratic red tape so a patient can get X-rays and tries to find out why a patient is waiting for attention.

“You’re doing three, four or five things at the same time,” Hessler said. “You’re working so hard you don’t have time to think about what you’d rather be doing. You’re too busy patching people’s lives back together.”

Splotches of dried blood, bandage wrappings, discarded surgical gloves, bedpans, surgical tape, syringe cases and other medical flotsam litter the floor.

Patients stack their shoes, coats and other possessions on the bottom of their gurneys as they wait to be released or admitted. Their medicine is not sugarcoated.

“If you come to the emergency room, I can’t give you peace and quiet and comfort,” Hessler said. “And for people who aren’t critically ill, I can guarantee you a very long wait.”