Curtain Falls on Chicago’s Cook Hospital

Perhaps the most famous hospital in the nation, Cook County Hospital opened the country’s first blood bank and the first trauma center, and pioneered the use of penicillin and trained thousands of doctors.

More than anything else, Cook became a microcosm of urban areas, as tens of thousands of mostly poor, mostly minority patients -- many of them victims of violence -- were treated in a hospital with no air-conditioning and pre-Depression equipment.

The longest continuously operating hospital in the country closed its old doors Thursday after 88 years. The 430 patients were wheeled out of their drab, dark, prison-like wards through tunnels and into a $551-million facility with such novelties as in-room bathrooms and phones.

After 27 years as a trauma surgeon at Cook, Dr. John Barrett was delighted, nostalgic and philosophical about the move.

“I came from Ireland in 1975 because I wanted to work on gunshot wounds, and this was the place to do it,” said Barrett, head of the trauma department. “The new hospital is wonderful, but it won’t stop the violence that brings many people here in the first place.”

The move to the John H. Stroger Jr. Hospital of Cook County, named for the head of the Cook County Board of Commissioners, follows more than a decade of work to close Cook, or “County,” as the facility on the West Side is known.

Cook, the setting for the hit television series “ER,” was built in 1914 and was at the time a state-of-the art facility, with its lighted nurse call-boards and relative privacy -- four to a room, generally, except in less life-threatening cases, when patients were bedded in rooms of 10 or more.

The producers of “ER” chose Cook as the location for the series because it offered a tough, dramatic, recognizable backdrop for scenes of life and death and the reality faced by young emergency room doctors. The truth of Cook, however, could not be broadcast on network television.

Cook got about 3,500 “intentional violence” cases a year: victims of beatings, stabbings and gunshot wounds. Many of those people were dropped at the emergency room entrance by friends who did not want to be associated with the crime that had prompted the trip to the hospital, just a few miles from downtown’s Loop business district.

Of those cases, from 600 to 1,000 each year involved gunshot wounds. When Barrett began his training, the vast majority of gunshot victims had a single wound delivered by a relatively low-velocity round, many from .38-caliber six-shot revolvers of the type police officers used through the 1970s and 1980s.

As the technology improved in the trauma ward, so it did on the streets. Many of the gunshot victims today have multiple wounds, from guns that hold not six but 10 or 15 rounds, bullets that travel at a much greater velocity and therefore carry more kinetic energy than with older guns. Kinetic energy is what kills most victims, as the trail of damage extends outward from the bullet to affect tissues and organs not directly hit.

All patients -- most of whom had no insurance, some with modest Medicare or Medicaid benefits -- found themselves in surroundings that today seem from another era entirely.

When it was humid outside, as it often is during Chicago summers, nurses covered the windows with blankets to keep out the sunlight and placed fans 4 feet in diameter throughout the hallways, because there was no air-conditioning.

The rooms had no phones. Patients, regardless of their conditions, had to trundle to the end of each ward to a bank of pay phones. Televisions had to be brought from home.

Patients needing assistance pressed a call button that set off a light at the nurses’ station. A nurse had to watch the board constantly. The watch nurse summoned help by announcing it through a loudspeaker that echoed throughout the ward, day and night. There was little buffer against the noise because rooms were metal cubicles with walls that did not meet the ceilings, providing very little privacy.

Each ward, which held more than 30 patients, had one restroom for men, one for women, and a single bath.

Steven Smith, 39, was the last trauma patient admitted before Cook stopped accepting patients Wednesday night, and the first to be transferred to the new facility.

“I was in an altercation,” Smith said groggily as he recovered from unconsciousness and a sutured eyebrow. “They got the best of me.”

Smith had been to Cook before, he said. The transition was something to behold.

“This,” he said, “is a hospital.”

Indeed, the new facility is air-conditioned, has views of the city rather than of cinderblock walls, and incorporates the latest technology.

If a patient required oxygen in the old hospital, nurses stuffed a big, green oxygen cylinder into the cramped quarters. Oxygen and other medical gases now flow through a system in the walls.

Doctors will write most of their notes not on paper but on COWs, computers on wheels. Instead of film, the hospital will record CT scans, X-rays and MRIs digitally, meaning they can be accessed through the hospital and sent to outside clinics at the touch of a button.

Such technology has become standard at many hospitals nationwide. Here, it feels like a leap into the future.

Hundreds of people lined up Thursday, waiting for hours to have their prescriptions filled. When the new pharmacy is up and going, two robots will help deliver the medication.

Asked if she’d miss the old hospital, Ruth Rothstein, the head of the Cook County Bureau of Health Services, which runs the new facility, said: “Not for half a second. When I came in 12 years ago, it was the most dysfunctional building I’d ever seen. You can’t treat people in the Dark Ages when there’s sunshine outside.”

Barrett, the trauma unit chief, is retiring this month. He’ll miss the kind of camaraderie built when he and his team saved the life of a gas-station robber hit by 37 police bullets.

He plans to hike the Appalachian Trail, maybe teach, and hope for the day when trauma workers spend more time on people hurt in accidents rather than during altercations in poor neighborhoods.

“The true answer to trauma in the inner city is not bigger and better trauma centers,” Barrett said.

“The solution is prevention. We’re pulling people out of the river when we ought to be fixing the broken bridge that sent them in.”