Ear on Chicago; Emergency Ward: Cook County Hospital

This is the story of the Cook County Hospital, one of the world's great medical institutions. Our report opens in the office of the superintendent of Cook County institutions, Dr. Carl Meyer. Dr. Meyer, we'd like to take a tour of Cook County Hospital and look at some of the facilities you have here. Briefly, I'd like for you to tell us what the purpose of Cook County Hospital is. The purpose of the Cook County Hospital is to take care of the patients who are on them and to afford care in private institutions. This is a free hospital, is it not? Yes, sir. And I also understand that patients here can receive some of the best medical attention that the city of Chicago can provide. That's true, practically all of the attending staff in the Cook County hospitals have professorial rank in one of the major medical schools in the city. I know that also that the United States and for that matter of the world, look to Cook County Hospital as a leader in this type of work, is that true? That's true. We have educated in our courses 25 ,000 physicians from over America and Canada during the last 15 years. Is this not the largest such hospital

in the United States? That's true. The Cook County Hospital is the largest acute hospital in the world. Well, Dr. Meyer, we'd like to take a brief tour of the plant and look at the facilities and then when we come back to your office later, we'll talk a little bit about the future of Cook County Hospital. I'd be delighted to have you go around and delighted to see you again. Thank you very much, Dr. Meyer. And now we'll start our story in the emergency ward of Cook County Hospital. We're standing now in the emergency ward of the Cook County Hospital. We're going to have a conversation with the Assistant Medical Superintendent, Dr. Samuel Hyman. Actually, where we are now is the receiving pavilion. Emergency would describe a good number of activities here. The receiving pavilion is more specific because it means that that's exactly the point where patients are received. Now, Dr. Hyman, they come up here as we have noticed in the last five minutes and just about every kind of vehicle and sometimes they walk up. That's right.

Well, most of the people come here through the police department vehicles. Some come through private ambulance. Many come by means of private car and transportation. However, still some will walk in. Well, now you receive patients of all description and of all kinds of ailments that is diseases or accident victims and things like that. Is that right? That's right. And they all come right here before they go anywhere else in the hospital. That's right. Dr. Hyman, if you don't mind, I'd like to walk just inside of this room here and tell a little bit about what's going on in here. They're, well, you're rather busy this morning. I don't know if this is extremely busy or not. Is it? No, it doesn't. Well, anyway, to the right of the receiving room is a sign which says, examining room women and then to the left, examining room men. Now, what is the examining room? Examining room is the area where patients are examined directly by the house staff. That means a doctor looks them over and the

diagnosis what is wrong with them. Then after the examining room, where do they go? If they require hospitalization, they are then referred to the routine of being questioned by the well -prepared department to see what their eligibility status is. Then, if they are not an emergency patient, they go through the bath, receive fresh, clean linen, and are sent up to the ward. This particular room we're standing in is called the waiting room. Yes, it's a sort of a waiting room or a lobby. And of course, you have the Chicago Police Department here to the left, keeping tabs on the squad cars, is that right? That's right. And the people over here are waiting, some in wheelchairs. And then, of course, over there in the where it says, examining room, that's actually the front part of it is probably also a waiting room. It's a waiting room, yes. All right, now I think, yes, doctor? To the right of the lobby, there is a miniature

x -ray outfit where relatives, friends, or patients may have a chestplate taken free of charge. What about the dispensary over there? The dispensary is what is known as the surgical dispensary. Cuts and bruises and minor injuries are taken care of in the surgical dispensary, so as to avoid hospitalization. A minute ago, you told me you weren't very busy this morning. I'd hate to see it when you were. I see, well, probably a hundred patients sitting in waiting. Yes, sometimes it gets to be a little more crowded than this. Well, I think our next stop probably would be to go to one of the x -ray rooms to take a look at what might happen to a patient if he needed an x -ray after he left the examining room, right? Yes, sir. We're standing now in one of the x -ray rooms, and Dr. Hyman is with a couple of patients. We're going to ask him to talk to them just briefly before we go into any description of how the

x -ray operation is carried out. So Dr. Hyman, I'll give you this microphone and you talk to these patients. Thank you. How old are you? 17. And what is your trouble? Hernia. You're going to have a hernia operation here? Yes, sir. Do you know when? No, I don't. Very shortly, I assume. You're coming down here to the x -ray department to take an x -ray of your chest. I believe that's right. Do you know why? No. Well, let me explain this to you and also to the people listening in. At the Cook County Hospital, we have a program of prevention whereby all patients who come into our medical wards have routine x -rays of their chest taken. In this way, we are able to pick up tuberculosis of the lungs, lung tumors, lung cancer, heart disease. In the early stages, or if we do not find it in the early

stages, we were able to pick up a far advanced disease, patients who are knowingly are spreading tuberculosis or who are knowingly have lung tumors, cancers, heart disease, which need immediate treatment. Here we have another gentleman who is waiting for a chest x -ray. This man came into the hospital as an emergency. What has been your trouble? Reptile appendix, sir. When did you come into the hospital? Two weeks, three weeks, just coming Monday. Were you very sick? Oh, awful sick. A lot of pain. Are you better now? I see you're smiling. I feel a lot better. That's great. Here's another service that we're going to provide for you, that the Cook County Board of Commissioners and the hospital are providing for the people of the city of Chicago and the County of Cook County. We will give you a free x -ray of your chest so that if we find anything wrong, such as tuberculosis, lung tumors, cancers, heart disease. Dr. Hyman, thank you very much for

talking to these patients. I want to ask just a couple of more questions about the x -ray department. Now, first of all, these gentlemen are getting x -rays to determine whether they have diseases other than what they came into the hospital with, but actually, naturally, you have x -rays to determine diagnosis. Isn't that right? That's true, sir. And that's done in all of these rooms around here. How many x -ray rooms do you have? Well, there's a question I bet you can't answer. But I know I took a tour of the building a little while ago and well, there's a large number. Let's put it that way. But now, the other thing that I want to ask you is this, besides diagnosis, you also have x -ray for therapy, do you not? That's right. We have a large x -ray therapy department. We have what is known as a cobalt unit, which is housed in a separate building, adjacent to the hospital, where all the latest and most modern methods of treatment for tumors are provided for the people. Doctor, I think the next step we better do is to go into one of the examining rooms and see how the doctors perform the duties in there.

We're standing now in the examining room. Actually, we can't call it a room. It's more of a corridor. Stretches all the way from the receiving pavilion, where we were just a moment ago, all the way down to almost to the x -ray department. And that is a distance of about 150 feet. Also to the left of us and to the right of us are rooms where patients are examined. We're standing in the corridor of the women's examining department. Dr. Hyman is still with us, so we're going to ask him just a few questions about the operation here. Dr. Hyman, what do you do with the patient once they're brought into the examining room, determine what's wrong with them or where they go or what? Once the patient is brought into the examining room, the examining physician examines the patient and quickly decides whether or not the patient is sick enough to be admitted into the hospital or whether he should be given some medicine and referred to a clinic for diagnostic

follow -up and treatment at a later date. And if he is admitted to the hospital, then that person determines which department he's going to go. Yes, the examining physician determines whether or not it's a purely medical case or a surgical case or a specialty case. And in that instance, he decides whether or not the patient should go to a medical ward, a surgical ward, an obstetrical ward, a fracture ward, an orthopedic ward, and so forth. Now, once the patient is told where to go, he's probably moved there. But what happens to the patient is he go immediately to that ward or do you have to go through some sort of paperwork first? Much depends on how sick the patient is. If he is an emergency patient and requires immediate care, he is sent up directly to the ward without change of clothing or without any type of admitting routine. However, if the patient is not critically ill and is able to be bathed and given a change of clean, fresh linen, such as done. And then he is interviewed by a

welfare worker for the county welfare department. Before going up to the wards, before going up to the medical wards, he then has, he or she then has a routine chest plate as we described previously. You mentioned bathing. That's done right down here, is it not? Yes, it's next down the line. These are the rooms next to the examining rooms. All right. Thank you very much, Dr. Hyman. We have come up now to the second floor to ward 23, where surgical patients are being housed. Dr. Hyman, first of all, let me describe briefly what we saw when we came up here, down along corridor to the left and to the right are some private rooms where patients are located. And then far down to the western side of the ward is a large room containing somewhere in the neighborhood of about 50 beds or so. What's the capacity of this ward? 76 patients. You have about that now, I imagine. All the beds look filled. Yes, we're filled up now.

Dr. Hyman, I don't think we could possibly do this show without talking to a nurse. And standing right next to us is the young lady who's taking over right now as the head nurse in this ward, Miss Patricia Connors. Miss Connors, I wonder if you could tell us briefly some of the things that the nurses are involved in up here. Now, a little while ago, for example, I saw you and several other nurses preparing some solutions. What's that for? Well, that was an IV solution for the intern to give to a patient who had just returned from surgery and wasn't able to eat. What's an IV solution? What is that? Well, it's fluids that are given through the vein. Those fluids, I understand, are prepared right here in the hospital, are they not? That's correct. They are. Now, what about care of the patients in here? Well, that is rather involved. Most of the actual bedside care, such as the baths and the beds, are taken care of by the attendants who are trained and very capable. Medications are done by the nurses and just a nurse generally oversees that everything is done. How many nurses do you have? In this ward? In this ward, there is one nurse for each shift, at least. And then occasionally there is another graduate and there is,

let me think, there's a nurse technician for the night shift as well as a graduate. And what's the technician? What's her job? Well, it's a he. They're grad, they're mid -students and they're junior or senior year and they're trained in the capacity of a practical nurse and assistant. They're very good as a rule. What about feeding? The nurses aren't involved in that, are they? It just depends. The attendants are responsible for it, but if you have patients and you aren't too busy, then most nurses do. Thank you very much, Miss Conner. Now, we'll get back here to Dr. Hyman. Dr. When a patient is ready for surgery, what happens to him? If the patient is an emergency problem, he is prepared very quickly in the surgical ward and is scheduled for surgery immediately and surgery is then done. However, if the patient can wait and surgery is not an emergency, he is prepared on the surgical ward. That is, he is given

fluids and blood if necessary. And a surgical date is obtained and the patient is then operated on. A surgical date, that means some day in the future when he'll be operated on. That's correct. Now, next comes the operation and then after the operation. Then the patient is taken to a specialized ward known as a recovery ward where they receive detailed and minute post -operative treatment. All right, fine. I'd like to go up to the surgery then and take a look at that and a brief look at the recovery room. We've come up to the surgical operation department now and I'm going to call it that for one of a better description. Perhaps Dr. Hyman can tell me exactly what they call his room and what goes on here, but I would like to ask first of all we've been talking about resident physicians and interns and then a little while ago you were talking about attendant physicians. You better describe the difference between those three. The interns and resident physicians

are members of their house staff. They are physicians who have graduated approved medical schools and who have passed examinations to enter county hospital for an internship or a specialty training. The actual responsibility for the care of the patient are the attending physicians on the various wards. These men are mature physicians and surgeons and specialists and diagnosticians who take examinations every six years competitive civil service examinations to become attending men in this hospital. They are usually heads of the departments and various medical schools usually associated with medical schools and are quite interested in teaching. You are one of those attending physicians. Yes sir. Now the attending physician is the man who takes over here in surgery. Yes. I said that I may have called it the different name but is it actually called surgery? Yes these are the operating rooms in the surgical department. All right now thank you very much Dr.

I want to get over here and talk to the administrative supervisor of surgery. Ms. Lucille Gachracher and for short they call her Ms. G and that's what I'm going to do. Ms. G we're standing in the room where anesthesia is administered. Right here in front of us is well what do you call it? Well we call it the anesthetic room. That's the room where the patient is prepared for the actual surgery which consists of starting intravenous fluids checking the chart to see that the permit is signed and scrubbing the area of surgery for 10 minutes with two eleven soap and when all things are in order and the patient is completely relaxed we transport the patient into the main surgical amphitheater. And that is just to our right in here. That's right. Why don't you and I take a walk into the amphitheater then? Actually there are a number of operating rooms but this one happens to be the biggest one. Now in this amphitheater it is actually an amphitheater they have seats high up above the

operating floor and I suppose that's where visitors well not visitors but physicians and interns can come in and watch is that right? Well we have accommodations for 125 guests and we have scheduled classes or teaching surgery here for four medical schools. Medical students come from Northwestern Loyal in Chicago and Illinois and then if there are any important conferences like state organizations or national medical groups that's where they come to observe surgery. Miss G, this is one department where we've come where obviously we can't be where the patient is. Now in this particular operating room there is no patient however I understand that you are setting up for an operation in here. That's right at 1230 we will start a bone surgery for Dr. Miller this afternoon. Well then suppose you tell us what some of these things are lined up against that wall over there. First of all well right here. Well that happens to be a sponge

rack for hanging up the dressings in order to keep an accurate count and that of course is a discard sponge pale. Right next to it and next to that over there. That is a receptacle for the dirty sponges as they are discarded by the surgeon. And next there's a tray. Those are two male stands and that's where we place the sterile instruments and that is directly over the patient and the nurse stands beside that and hands the instruments to the surgeon. Two trays for that purpose. Next is another small. That's a small gown rack and we have four doctors gowns and later we have a basin there that's filled with water for cleansing the hands or rubber gloves. And next of course is the operating table itself. That's a sterile back table which we keep sterile with all the extra instruments and we reset for each individual case. If we have four cases and there's a scrub nurse there or a clean scrub nurse who does nothing but set up for the next

operation. In some of the operating rooms that I have visited a little while ago there was a great deal of natural light that is daylight coming in the windows. However in this particular room there is not. There are large lights but no daylight. Now in each of the rooms also is a large what looks to me like a spotlight. What is that? Well that's the overhead operating light and it's a very bright light which shines directly into the incision or the area where they are working. The reason this amphitheater is darkened is that in modern medicine we are constantly taking movies or photography and therefore it's much simpler for us to have the room darkened and also to show movies of different types of procedures that have been demonstrated to the clinic. We're standing a good distance away from the instruments and from where the operation will be performed and I imagine that all of the equipment over there is sterile.

That's right it's sterile and ready for the surgeon so that when he calls or comes down the floor we may begin surgery. Miss Ji I want to thank you very much for a very fine description of the operation here in this big amphitheater and also in there where you perform anesthesia. Thank you very much. It's been my pleasure. Thank you. We're now in the Office of Dr. George Blaha. We told you a little while ago that we're going to talk to him about some of the general overall conditions and some of the general overall information about the hospital and first of all I'd like to ask him the purpose of Cook County Hospital. Well the purpose of Cook County Hospital is to take care of the people, the poor of the county who become ill. That is the prime purpose of all of us being here for this great institution to be here on the west side and if there were no poor that did become ill we wouldn't be here. Secondly to take care of a patient correctly and properly. Also there are some other benefits reaped from it and that is the teaching of young doctors and fine doctors to go out

into the community and serve the county and the people of Chicago. Well Dr. Blaha besides producing fine doctors here I must say that I think you have some of the finest doctors in the country here on your staff. The people that we have been describing as attending physicians isn't that right? Yes we're quite unique in our staff. I believe we're the only hospital that has a competitive written examination for the attending staff to be placed on the staff of this hospital. That occurs every six years. It's a written type of examination and the top places are sought after by all the fine doctors in the city and they work here without pay. That's right there is no remuneration and they work hard. I'm going to ask you just a few things about some of the operation of the hospital. Dr. Blaha number one the laundry. You have to have clean linens practically every day all the time. So how about

that? We have our own building that houses the laundry. It is one of the most modern laundries anywhere in this part of the country. We've just built a new building about a few years ago and remodeled it and it does go on almost 16 hours a day. We have a tremendous amount of linens and bedclothing and various other patient gowns and all that the amounts are just fantastic. And what about food? Do you have to prepare? I assume some very special diets on occasion. Our dietary department is maintained by a train staff of dietitians and they take their orders from the medical profession. That is a patient may have a therapeutic and measured away diet and each patient is served individually from a heated cart that is prepared in a central kitchen, a dietitian and a diet made. A company is a cart and the orders are followed that is the orders written by the physician. Well I just wish we had a chance to see and talk about all of the things here at the county hospital but

obviously we just don't have time. But we do want to thank you for allowing us to take a tour of the building and talking about at least part of it. It's a pleasure to have you here and I wish that more people would come here to see the fine hospital in the city of Chicago and the county of Cook has. Now we're going to talk to the president of the Cook County Board of Commissioners Mr. Dan Ryan. Mr. Ryan we've taken a tour of the Cook County Hospital and certainly have enjoyed it and we want to thank you and all the people here for cooperating with us and showing us around. You certainly have a fine institution. Well Mr. Hell we are glad you came out you know Cook County Hospital is the largest charity hospital in the world under one roof. It's operated under the supervision of the Board of Cook County commissioners Dr. Carl Meyer is the medical superintendent and we cooperate with the three medical schools we have a teaching program out here. We

have a nursing school which is also privately operated by a private board and we appropriate the money for the nursing school and they furnish the nursing service for our county hospital. They do a wonderful job. Commissioner I think the people of Cook County have something to be really proud of here in Cook County Hospital. If they only knew just what was going on down here I wish everybody in Cook County could take a tour of the building like we have just done. Well that's true Mr. Hell and we have very few complaints on the hospital and this is the only place that the poor of Chicago have to go to. We are now in the office of Dr. Carl Meyer superintendent of all Cook County institutions. Dr. Meyer we have just made a thorough tour of the Cook County Hospital and we want to thank your staff for all the cooperation they have shown us. Certainly this is an institution that the people of Cook County can be well proud. We're delighted to have had you over here and made this

inspection. We're always open to have anyone come over and see what the Cook County Hospital is doing for the sake of the Cook County and Chicago. Dr. Meyer you've been a physician for many many years and been connected with Cook County for many many years. What are some of the other assignments that you have besides being the head of this institution? I have the indirectorship of the medical personnel at Oak Forest in Firmary, the county jail and the juvenile courts of Chicago. I understand that you and your assistants give advice to the juvenile courts. Yes we have a medical council of about ten outstanding physicians of Chicago would buy as the president of the county board and the county board on all things pertaining to medicine and the care of the sick. Dr. Meyer what do you see for the future of Cook County Hospital? I see a great future because it is one of the greatest training centers for young physicians of any place in the world. In other words a man here and a year's time can get about 20 years experience

that he would have to have in the outside in practice of medicine. And I suppose that you also will have many plans for expansion for the institution. We have very definitely made plans. We've been studying these plans for the past ten years. In other words the county in the next year will undoubtedly go before the electorate for increased funds to rehabilitate the county hospital and build an outpatient department, build a medical pavilion and a great laboratory for the diagnosis of diseases that are now so common and some very rare that need investigation. In the people of Cook County look forward to some outpatient clinics somewhere out towards the suburbs. Yes we have definitely advised that in the future that a location be found on the south side preferably south of 95th street and located in the dense area where there are few hospitals and no clinics. Well I'm sure that under your direction sir that

things will expand and grow here in Cook County we want to thank you very much for talking to it. Well I'm delighted to have had you over here to interview us. Thank you so much. So ends the story of the Cook County hospital. This is Hugh Hill speaking.