THE NEVER ON SUNDAY GIRL COMES TO BROADWAY

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP88-01315R000300010009-2
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 8
• Document Creation Date: December 16, 2016
• Document Release Date: November 4, 2004
• Sequence Number: 9
• Content Type: MAGAZINE

Approved For Release 2005/01/11 : CIA-FFDP88 013152000300010009-2
Approved for Rel'eas 2005/01/11 : CIA-RDP88-01315R000300010009-2
 pproved For Release 4005/01/111 : CJA-RDP8,?-01315R000300010009-2
wi a i t ilb~ t i~ a~:al ar ayi s~ i
by WARREN R. YOUNG
Sprinting through the corri-
dors and up the stairs of the Wash-
ington, D.G. hospital, the surgeon,
internist, anesthetist and oxygen
technician knew they had, at the
outside, only four minutes in
which to restore a life. Not four
fat minutes that would begin when
they and their equipment reached
the patient. Not even four min-
utes from the time the loudspeaker
alarm call summoned them. But
four minutes from the very instant
the heart of the man in Room 714
unexpectedly had stood still. After
that, even if the heart beat anew,.
oxygen lack would have clone ir-
reparable brain damage.
Luckily, everything meshed. The
heart's sudden silence just hap-
pened to have been noticed quickly
enough, and the four-man emer-
gency team and the needed tools
just happened to be near enough
for instant aid. While the surgeon
pounded the patient's breastbone
to force blood through the heart
and the anesthetist applied mouth-
to-mouth' respiration to ventilate
the lungs, the electric defibrillator,
electrocardiograph and oxygen ar-
rived. Presently the heart began
to beat and an infusion of ],(,,art
stimulant plus force-fed oxygen
kept it going.
The marvels of 1966 medical
techniques together with unusual-
ly good team planning had ward-
cc] off a sure death. But the drop-
lets of sweat on the surgeon's face
reflected more than the sudden
burst of exercise.
"We may have half a dozen of
these in a clay and- sometimes 1
think it's a miracle that we save
rescue took place. "Oh yes, we
saved this nman, and we're better
organized for crisis action, than
most hospitals, but look at our in-
efficiency. It's ludicrous. His life
hangs in the balance while the
medical talent demonstrates its
.galloping ability, and expensive
equipment is dragged through the
'halls. And during the time this
problem was being met, our capa-
bility for handling any other simi-
lar emergencies was drained. It's a
prime example of the stupidities
built into the framework of today's
tradition-encrusted hospitals."
As medicine marches into the
future, the nation's hospital sys-
tem retreats more and more into
obsolescence. The accusations
against the hospitals, documented
by the public and physicians, are
sorrowfully familiar: Patients giv-
en the wrong medicine. Patients
shockingly neglected, survival of-
ten depending upon some stranger
chancing to walk past a door at
the right moment. Nurses far too
short in numbers, low in morale,
underpaid and overwhelmed by
drudgework. Red tape. Depress-
ing food. Not enough rooms and
not enough money. Germs that
ambush one of eight surgical pa-
tients to imperil recovery. Wards
aura, of them," said drpp Vb(Yfor Relea
(i llespie of the Georgetown Uni-
versity Medical Center, where this
/ i
e :29OA101 /1 I
that suit no current need and lab-
oratories a mile from the patient.
And, amid all this, rising prices for
even second-rate hospital care.
Furthermore, medical staffs and
hospital administrators see their
problems about to expand as the
population continues to swell and
Medicare brings in many new pa-
tients. Ironically, all these people
could be cared for if all the ad-
vances of modern medicine were
more fully utilized. `
"By new methods and devices
we can pull many people through
today who otherwise would quite
literally be without hope," says
Dr. Gillespie. "But the basic ve-
hicle, the hospital, is holding its
back; the old ways are so hard to
give up, even when they make no
sense. Trying to practice in even
the best hospitals is like driving on
an expressway in a Model T loaded
IA P8,8-01315O 0340010
 ala. .., it ('Approved For Release 2005101/11 : CIA-RDP88-01315R000300010009-2:,:
'
pressirua engine. It
s high tinge to , ingly fascinated by one discovery.
design an entirely new model."' The facts indicated that at any
Dr. Gillespie is one of three men given time about 80%c of the pa-
whoarcill tenllit lugto (lo justth;ll. ticnts in the hospital were merely
Along with his superior in cardiac undergoing diagnostic tests, finish-
surgeryand research at the George- ing convalescence or receiving
town UniversiIy medical Center, treatment for chronic ailments;
Dr. Charles Al I lufnagel, and the they were not candidates for emer-
center's renowned pathologist, gency lifesaving measures. The
Dr. Charles F. Gcschickter, lie has other 201%, meanwhile, were in
set out to remodel the Geclrgc- serious condition, if only for a
town hospltnl. They plan to trans- day or two after surgery. This dis-
form it into it radically stream- covery, l,hcy concluded, was the
line(] facility to test promising key to the whole dilemma.
though unproven design features. "Looking at it from this angle,
Physicians and planners from large everybody can see how hospitals
and small communities will be in- ought to. be built, even laymen,"
vited to copy for learn from the says Dr. Gillespie. "There should
results. The U.S. Congress has he one section equipped to give
authorized an unprecedented Pub- absolutely top-quality, concentrat-
lie Health Service grant of $7 mil- ed treatment to one fifth of the
lion for the project (to which the patients and a second, larger sec-
university must add another $8 tion for more casual care. But no-
million, to be raised from its alum- body gives any thought to the
ni and friends), and after four matter and hospitals keep on being
years of quiet planning, ground is built essentially as second-rate ho-
to be broken next spring. tels, with the only concession to
our needs being to pencil in Spaces
for surgical chambers in place of
urgeon Hufnagel was a chid` hotel (lining rooms. The hospitals
inventor of plastic heart valves, attempt to provide complete corer-'
artery implants, supercooled sur- gcncy care for 100% of the pa-
gery techniques, heart re-starting dents, as if` any one of them might
devices and heart pumps; with Dr. need it at any moment, and in the
Gillespie's help, lie is still bring- process not only waste money but
ing out new versions. Dr. Ge- fail to come close to the goal. They
schickter, a cancer expert, is co- also try to spread the comforts of
author of the three-volume clan- home around for everybody, in-
sic Color Atlas of Pathology and eluding the 20% who are in no
other tones. Why are three such shape to use or appreciate then],
prominent doctors diverting so and provide room service three or
much time to blueprinting the hos- four times it day for those who are
pitalofthefuture?"Well," says Dr. too healthy to require it."
Hufnagel, "when you live in hospi- The 400-bed, 19-year-old red-
tals for years and complain about brick hospital already at George-
their clumsiness, you should do town, like so many others across
something constructive about it." the U.S., is overcrowded and in
Dr. Gcschickter has practiced, need of enlargement even for con-
medicine for 40 years, but before tinned conventional-stylecare.The
that was an architect and cngi- three doctors devised the idea of
neer. "I did two things," he has turning it into a pleasant, relaxed
said about his approach to this facility for the 801%, who need only
project. "One. I made up lily mind minimum care. Meanwhile, they
I wasn't going to go around with . would build it modern nine-story,
lily hat in lily hand to sell an old 192-bed concentrated-care wing
idea and, second, I told the ad- for the acutely ill 201%,. Into it they
ministrators at Georgetown that I are pouring all the genius for mod-
would not touch the plan unless I ernization they can muster. Glce-
had theiraudits for the last 10years ironic computers will improve rcc-
and a chance to analyze them. I ord-keeping and bedside care. Use
wanted to see where they were los- of new materials and procedures
ing money and wasting space. will make the concentrated-care
Most important, I wanted to see wing a practically impregnable
9. rant business altogether.
where we were losingApt ed For Releas61D2r(5O /04ffl : i ]l [' 'OW-O15R000300010009-2
As the three doctors pored over crating rooms wit e.in tile new
be one floor Iligher at the true
basement level. Packed into six pa-
ticnt floors above will be more test
equipment and emergency tools,
virtually surrounding every bed
will) lifesaving egllipinent.
Ordinary hospitals have tradi-
tionally divided up the space and
staff into surgical, medical, psy-
chiatric, pediatric and obstetrical
"services" and then sorted the pa-
tients somewhat arbitrarily into
these categories. This method ca-
tG's mainly to the convenience or
the department heads and their
specialty staffs, while scattering
equipment throughout the build-
ing, pulling up the budget and
making efficient therapy virtually
impossible. A patient almost ready
to go home after the most minor
surgery, for example, may find
Ilinsclf in it room next to some-
body who has just had a lung re-
moved. Ili the new Georgetown
plan, the most important consid-
eration in sorting patients will he
the,i;rarrl.r of their conditions.
This is daring because, first,
like any true experiment, nobody
knows how well it will really work;
and second, it means shattering
the molds of the past, discarding a
multitude of seemingly small but
terribly familiar patterns. For ex-
ample, says Dr. Geschickter, "ev-
erybody in our concentrated-care
wing will be on a"liquid diet. I
don't mind if some are able to cat
chopped Meat or custard instead
of drinking or getting infusions of
true liquids, so long as all that's
involved is it paper cup and nap-
kin to throw away afterwards. This
facility will be devoted to the safe-
ty and recovery of patients-not
to bowls of flowers and salads that
will and big rattling food carts
with china dishes."
In the niinilllurll-care sectloll, on
the other hand, nearly all patients
w111 be freed of the tedious wait in
their rooms for food which often
arrives tepid turd tasteless acid yet
is such an expensive item on the
budget. Instead they will go on
their own to a self-service cafe-
teria contracted out to a restau-
rant organization. The patients
will have it wider choice of foods
and fresher cooking. The hospital
will deal itself out of the restau-
 -
r new concctn n's ,,,.....- -'.111.1 --- _... . - -I
pilais-devised by Dr. GiIlespic(left), live rooms and surgical suites in a
Dr. }iufnagel (center) and Dr. Ge- subbasement, and pharmacy, X-ray
and laboratory facilities at the true
f
i
ddi
on o
a
t
schickter--calls for the a
wing for exclusive care of patients in basement level. Atop that will be six
serious condition..It will have storage stories of concentrated-Care units.
 Approved For Release 2005/01/11 : CIA-RDP88-01315R000300010009-2
> 4 14 typical victim. of tt. i
disease, a elan known a., say,
G.B., will realize even before his
therapy begins how efficient tiie
new plan is. Assuming that no
emergency treatment is necessary,
G.B. and his physician will tend to
hospital-en(ralice reel tape by
meansol pie-admissioninterviews,
probably by telephone.Thus When
check-in time arrives, G.B. will
move along quickly, instead of
waiting in line while an admissions
clerk types tip a sheaf of question-
naires. (If G.B. is brought inns an
emergency case, he will immediate-
ly be wheeled in to be prepared for
surgery, and an admissions clerk
will trail along to get the vital data.)
Arriving the evening before his
operation is scheduled, G.B. will
check directly into the new sub-
basement, where 31 rooms adja-
cent to the surgical suites will
shelter pre-.operative patients. His
overnight room will be small, sub-
terranean and windowless, but
quite livable, with a private bath-
room and a TV set. Any final tests
that may be required can be per-
formed on the X-ray and lab floor
directly above.
Next morning G.B. will be
roused at a reasonable hour and
transferred just a few feet to one
of 32 cubicles to be prepared for
surgery. The proximity of the
whole "pre-op" unit, with its over-
night rooms and "prepping" cubi-
cles, to the actual operating rooms
not only saves much long-distance
pushing and hauling but also per-
mits a realistic relationship be-
tween the time G.B. must get
ready for his surgery and the actual
'operation. If one of the opera-
tions preceding his takes longer
than anticipated, for instance,
G,B.'s "prepping" will be cor-
respondingly postponed.
The most vital benefit expected
from the pre-op unit is the defense
it will raise against germs. Of(]-
style practice requires putting a
pre-surgical patient through in or-
deal of scrub baths, antiseptics and
changes of garment to remove all
possible germs while he lies in
his room far from the scene of
surgery. Once the hoped-for de-
gree of cleanliness is obtained, lie
is carted through the regular hos-
pital corridors and carried on the
outside t uptrhlinZ, riniii;
await his turn. Undo the flimsy
armor of a sheet, his shivering,
shaved and iodine-painted carcass
lies cringing as people by (lie dozen
brush past hint-including clean-
up men toting slush pails and
bloody, germ-stained bandages,
doctors arriving hurriedly in wet
coats and muddy overshoes, and
wandering visitor's. His brain, pur-
posely only half-sedated, is still
working well enough to overhear
nurses' talk about minor mishaps
and lost sponges and to sink into
the worst possible frame of mind
for the ordeal ahead. Finally, as a
Georgetown critique points out,
"This bundle of contamination is
then moved directly to the operat-
ing room itself, ignoring all zoning
barriers and avoiding all protective
procedures." The patient is flopped
onto the table, bugs and all. "And
yet some surgeons still wonder,"
says Dr. Gillespie, "why so many
surgical patients have complicat-
ing infccCons."
But when G.B. has his gall blad-
der removed in the new George-
town facility, he will be saved from
such trials. From the moment the
arrives, lie will be kept as sani-
tary as possible. And in the pre-
op area, everything and everybody
will be isolated from outside con-
tamination. Even G.B. himself,
once "clean" and inside the unit,
will have to go out to a special
lounge if he must see a visitor-
and then re-enter through the main
entrance, shower and change gar-
ments again. Doctors and nurses
will have to take similar precau-
tions. "Surely, it will be an extra
bother," says Dr. Gillespie, "but
far less painful and tune-consunm-
ing than an avoidable infection."
When the operating room is
ready for G.B., he must nmerely be
wheeled in from next door and
given the final anesthetic. Then-
the surgery.
.,,. ti,sc , IL", t:i
the tiles and pocks in
1. (-
the
stone are marvelous traps for the
`bugs.' And we are bound to have
some vicious ones in all operating
room. There they sit, undaunted
by our attempts at sterilizing the
room between operations, ready
to pounce.,,
His solution, which will greatly
protect G.B. during the most vul-
nerable hour: wrapping the entire
inside of the room--walls, floor,
ceiling and all--with wide sheets of
vinyl. The scants of the vinyl will
be heat-sealed; the corners 01 the
room will be rounded off and
the room will be windowless. This
is a room that can be made truly
sterile.
G.B. may notice the absence of
the traditional operating-room sur-
gical light, which today sheds an
occasional germ-ridden grain of
dust from its shining reflector, its
overhead gear-tracks or its mov-
able, articulated arm. Not long ago
Dr. Gillespie called in the leading
manufacturers of these lights and
pointed out that their products
might be dandy for illumination
but are not germ-free. "They ex-
plained to me very patiently," the
recalls, "that this was simply the
finest surgical lamp ever made.
I'm not sure that I was equally
patient, but I told them the best
simply isn't good enough. Our
goal must he perfection."
And so, on that morning when
G.B. gazes up from his operating
table, he is likely to see only some
smooth ,lass plates in the arched,
smooth-vinyl . ceiling. Recessed
above the plates will he a complete
circle of spotlights which G.B.'s
surgeon will adjust with foot ped-
als for the exact lighting needed.
if G.B.'s operation is to be
observed, visiting medical men or
students will be denied the free
access they generally have. In these
"old" days of 1966, observers often
troop right into the surgical cham-
ber. In the new facility they will
17 he Operating room itself will watch from a small classroom irll-
be completely redesigned with a mediately above the table, looking
t
view to reducing the danger of in- through a thick glass panel 11101,1111-
view in the ceiling. Medical movie
fection. Today," Dr. Gillespie
"you see shiny square tiles on cameras and closed circuit TV pick-
says,
operating-room wall and at- ups will be mounted there too.
tractive terrazzo stone on the floor When G.IL's operation is fin-
ancl you think that's pretty nice. It ishccl the will not be moved into a
r om, as would he the
2001 /Odilal iinG1Ae1RDP66>~1adSR0003006Td
! cars -n t re est current hospitals,
pidity based on the idea that 'tile is
regular clevatorAp113imvediFolriRelease
attendant and especially the wheels
of the cart pick up dirt and germs.
 Approved For Release 200
not evert have a recovery room., if
G.B. takes a turn for the worse
on the operating table, he will he
kept there for as many hours or
days of care as may be required.
I, To make this possible, the hospital
will have 21 op rating rooms. But
if there are no otnplications after
G.B. has come out of anesthesia,
he will be whisked up one of five
high-speed elevators directly to his
concentrated-care room. The spe-
cial cart he rides on will become
his bed, eliminating one delicate
transfer. The cart will be rolled up
to a separate, two-wheeled head-
hoard held upright by "bayonet"
prongs plugged into the wall. Can-
tilevered out to one side of G.B.'s
headboard will be a built-in wash-
basin. On the other side will be it
shelf for small medical apparatus.
The cart-bed will stand unattached
in front of the headboard.
G.B.'s room will be one of 16
arranged in a rectangle with a
nurses' station planted in the mid-
dle, making up a concentrated-care
unit. Two identically designed units
will he on each of the six patient
floors, with supply quarters, staff'
lockers and lounges, and major
emergency equiprrlent housed be-
tween the two units. Twelve roollis
in each unit will be designated as
sub-acute spaces; the other four,
nearest the nurses' station and the
support areas, will he for the
most acute cases. The rooms hous-
ing the latter-small, lacking win-
dows to the outside and bare of
furniture except fo the headboard,
the cart-bed and equipment carts
-will be models of efficiency.
Flowers and gifts, will be banned
from the entire unit, and visitors
will be allowed in only rarely, if
ever. G.B., because lie is lust out
.of surgery, will be in one of the
acute 1'oo11is under consta[lt close
:watch by three duty nurses. The
patients cannot see each other,
since the side walls of their rooms
arc opaque, 13ui the inner end walls
are glass, and the nurses can see
every patient at all times without
leaving their station. Doctors, too,
will be available on every floor at
all hours.
[A-RQ,P,8$-01,315FQOOOQ01000~92
t J :r ad a ~: r s'' le>Mr: dt..
as ft w
eye and sec it trained professional
standing there looking at him wilit
all the emergency apparatus that
might he needed and not rust a
bowl of posies," says Dr. Gillespie.
"Today, only a person who has
undergone the most radical kind
Of inller?-heart repair Oran llnpl"eee-
dented major procedure is likely
to receive such attention, except
for it brief hour or two in a recov-
cry room. Even the child who has
his tonsils out or the young man
with it patched hernia sometimes
dies, and the post-surgery rates
of death from infection, unrecog-
nized hemorrhage and choking oil
their own fluids, is greater than on
the table."
G.B.'s recovery will be watched
not only by nurses but by electric
eyes too. Sensing devices will con-
stantly monitor his heart rate, his
temperature, his respiration rate,
Itiselcctr?oeardiogramandtlieblood
pressure both in his veilis and in his
arteries. The nurses will not rouse
G.B. early in the morning to
poke a glass Ihernlomeler between
his gums and then spend much of
the day checking up on his and the
very patient recovering from other patients' conditions. They
surgery of any kindAppttoaYleO iFor Rele 4 ~01jG 11 Il AtR,QRt$QrQ131
nonsurgical patient with acute ill- console of their station to get as
ness, deserves to be able to open 811 llicarly readouts trs they want. G.1B.
in each concentrated-care unit,
centrally stationed nurses will
have full view ol'all patients. Al-
though rooms can hold two beds
for emergency use, normally
there will be only one occupant.
will not' have to hope that if lie
cntersacrisissonlchoclyrrrai,spot it.
If any single bodily. function or
combination of functions deviates
beyond the fixed limits G.B.'s phy-
sician has programmed into a com-
puter, lights will flash and a buzzer
will sound the alarm. Within sec-
onds, 11urses, technicians, doctors
and a complete array of equipment
will be in action at his bedside.
Computer" systems are already
working well in some U.S. hospi-
tals and "eventually," says Dr.
Gillespie, ''our goal will he to
monitor tiny changes lx.~lure Ca-
lastrollhe occurs, as the computer
and we ourselves fain experience.
IN heart standstill can be predicted
30 seconds before it is going to
occur, for example, we can attach
a. pacemaker and keep it from
happening at all. Many of the trag-
ed ics now considered unavoidable
fates are really not that at all."
Some of the sensing devices will
probably have to he taped to
G.B.'s~~,sskin and others inserted
5 L c t- I ~s fr `t1,s`Cd bloodstream. opcrtat-
ing'room, and at the end of G,B.'s
a
fit l.td is ire G 2s
 / dApproved For Release 2005/01/11 : CIA-RDP88-01315R000300010009-2
i 11. i) ~ 11
hi` %; F"l~'k4 r{ k; yglf ~ a) wA)lA. }' I +ll r
t ~GJ Uly~ f~~~W- Oelintr?el out + walk snot in the orc-
Why z a(A: 0se~ I' '
caulions against post-surttical in-
fection. ])r?. Carl Walter of Bos-
ton's Peter Bent llrighain I lospitai,
it past innovator in operating-room
design, told Dr. Gillespie, "You
of the nurses. Only a highly trarncct can put all the vinyl you want on
nurse will be able to cope with the the walls, John, but how are you
Ij 1 operation these sensors will be left Cleo rgetown-type SysteIII, and her going to control people? If you
in place, The gang plug leading role will ,shift di tnlcttically from don't, none of it is any good."
from them will be pulled. out and her present
reconnected to the circuitry in his i preoccupation as a Germs, after all, are not self-pro-
combination bookkeeper, supply- polled; they are always carried.
concentrated-care room so that sergeant, walkathon champion. A study was immediately begun
signals will begin to flow at once She will become once more a true to find out where people really
to. the nurses' station computer r
eonsole? and indispensable professional as- need to go in a hospital--and when.
sociatc of the physician. After it year the answer to the peo-
Barring complications, a gall pie problem was found: multiple
The same computer setup will bladder removal is only moderate- corridors with one-way traffic. Bar-
ly serious, so after about 24 hours ricr?s, locks and blocks to wrong-
also plug the memory gap which G.B. will be moved ago
brings about. the appalling fro- tin. This way travel will rule out temptation
time his cart will roll only it few to slight the rules or short-cut the
quency of mistakes in medication.
("You know,, says Dr. Gcschick- feet into one of the Sub-acute routes. A doctor who dresses for
ter, "that at ]cast one in every six rooms. There he will have a win- surgery and then is inclined to step
ter, ' doses is given at the wrong (low and the computer will moni- back into a dressing room for a
drug for Only his pulse, breathing and smoke will be unable to do so be-
time, in the wrong amount or to temperature, He will be a few steps cause doors will have locked be-
the wrong patient.") When G.B.'s farther from the nurses but still in hind him. Visitors will not be
doctor orders medication, it will be their direct view. For perhaps three allowed into the
keyed into the computer instead of gent-free areas
scribbled on it notepad. The order more clays lie will thus recuperate unless they go rough a decon-
will go instantly and automatically in the concentrated-care unit, thor- tamination process.
to the hospital's at Even the scrub sink will be
pharmacy, ougltly attended anal well protected
the same time producing a. epee changed. "Every intern is taught 11 - against outside infection,
tronic record. Then the medicine On the fifth day, if all goes well, that he must scrub his hands and
itself will be sent a to the con arms with germ-killing detergent
p the resident physicians will exam- five minutes before gowning
Ceti trated-cai?e unit through pneu- ine G.B. and his computerized rec- for
Gill
.
D
i
"
f
e
r-
esp
or surgery, says
matic tubes, and the Cott[ ratter will
i ord of progress and pronounce him "E is is sup posed to do it with his
not only' remind the nurse each fit enough for transfer to the rmin_ I i
time site is supposed to give G.Q. imam-care section of the hospital. elbows extended far enough in
it dose but will require electron- front of him so that the washing
The resident physician's authority solution drips from his elbows into
is verification through the key- to discharge G.B. fr?oni concert- I `
board that this has been done and [rated care, instead of' having to the sink. But except in the movies,
donecorrectly.Otherwise,another wait for G.B.'s personal doctor, just about every surgeon decides
alarm will sound. - will he a radical but essential de- ? after the first operation or two that
The drudgery of charting G.B.'s parture from current procedure. this. awkward extra strain on his
case history as his condition muscles isnotabsolutelynecessary.
changes will be handled by the He just. holds his elbows out from
his sides and the floor around the
computer, using the data from
hi
s
s nlllllrllllltl carC 100111
si
Tile
nk
sernSOrs: If G.B. takes Ili G.B.'s life will be quite diflereni, becomes it sloppy raisin." " with.
I lc will wear no sensors and he will C;ccirftcttiwn solution is a si
alarming but baffling turn, the a circular cut-Out at the front into
Coiilpuler? will scalp all its d;tta on . he far front nurses and doctors . which the surgeoil steps and with
his dianltr)515, medication and pre- most t)f th e time, but when they do
side-willLis extending out beneath
vious changes of condition and visit, he will not have to Compete where his elbows actually will be.
match them against the new signals for their. time and attention with "( don't know why they've: never
coming in as well as against a direly ill patients. He will find the ,
vast encyclopedic store of corre- challenge of getting to the cafe- been made right before," says Dr,
Gillespie. "As it is with the whole
]ated indexes. It will then suggest teria and selecting foods a strength-
to the doctors what Yg rig citing task. I pis visitors will not feel field of hospital design, everybody
may be wrong knows what should be done, but
and what might best be done. The they have to whisper and, in short, nobody has bothered to do it."
doctor, of course, will decide he will begin to feel halfway back Matiy details are still being
whether to follow the suggestion, into the outside world. Eight clays worked out. All doors, whether
just as lie would have if lie had, after his surgery, lie will go, home, swinging or sliding, may be re
'looked up sornethifi } in it ho sl4 an averse of at least two th air stream barriers.
Such sophisticate prig-Y airlgr Release ahllll q~r[4#eRPPvg? Q' ~a9R00030;Odit6Ob9v2
will not. only help G.B. but will spent in an old-style hospital with Two-way Ads-t so riloedd gh linens bin and
for clean and nd
also boost the long-sagging morale it similar gall bladder case,
 Approved For Release 2005/01/11 : CIA-RDP88-01315R000300010009-2
aromil walls to reduce the urlnllier
of times stall Illetnhers need ~:nter.
Conveyor hells may replace sup-
ply carts. And, if an extra $1 mil-
lion can he found, a pressurized-air
surgical chamber may be built; it
would literally saturate patients'
tissues with c}xygcn and permit op-
erations aid therapy which would
otherwise be, impossible.
The new wing will he equipped
to serve as a' civilian disaster cen-
ter, something few communities
.''have but sooner or later nearly
always. need.j On those rare times
Architect Theodore Mariani
and associates have designed the
wing with flexibility for future
additions, in case funds become
available for mare innovations.
when a community is afflicted by
air crashes, riots, tornadoes, floods
or collapsed buildings, the need
for mass medical aid is ovcr?whelnl-
lug. "It's shocking to think." says
Theodore Mariani, head of one of
the two architectural firms work-
ing with the doctors. "that even if
we had a major bus accident in
Washington today, no single hos-
pital could care for more than six
or seven critically injured patients
at a time. In case of a full-scale
civil disaster, say with 1,000 in-
I he wing will have a helicopter
port, entranceways for 20 anlbu-
lances to unload simultaneously,
and a vast emergency area in a See-
ond sub-basement-directly under-
neath the surgical suites and pre- -
op unit. Ilere, supplies will be
stored, 1,000 extra cots can be
set up quickly in open wards and
space will be available for at least
4,000 uninjured refugees and need-
ical personnel. At more tranquil
times the disaster spaces can be
used by the hospital as spacious
and efficient wards.
Also, since the wing is designed
to he partially underground and
requires fully filtered air to coni-
bat germs, it will be made heat-
and blast-resistant as well, in order
to serve as a central refuge in the
event of nuclear warfare. "The
need for a nuclear shelter may, of
course, never come," says Mari-
ani. "But the requirements dove-
tail beautifully into its other func-
tions with only a minimum added
cost for the added protection."
Because of rapid changes in
medical technology, an important
question has arisen: is the addi-
tion of just one new wing the best
answer to the efficiency gap?
"Operating any hospital for just
two years costs more than its con-
struction," says Architect Mari-
ani. "Perhaps all the old hospitals
should just be torn clown every few
years. Industry does it that way;
a technologically obsolete factory,
no matter how recently built, is just
knocked down and replaced. But
in the case of a hospital, the coin-
munity has put so much sweat and
pain and emotion in between the
bricks that there is a strong urge
n
ff ^ Gael r
to salvage the existing facility."
Yet if the Georgetown "con-'
centrated artillery wing" concept
really proves out--in restrained
costs, saved lives and short-circuit-
ed frustrations--hospitals all over .
the country may be able both to
save the old and incorporate the
new. Adding a new concentrated-
care wing of appropriate size--
compact and computerized,
streamlined and sterilized-may
be fir wiser than endlessly try-
ing to rip out enough of the old
innards to find room for mod-
ern techniques. As Dr. Gillespie
puts it, "What we ]earn here may
make it possible to design pack-
aged medical modules that can be
stacked up to any desired capacity
and plugged onto virtually every
hospital in the country."
"It's fairly clear," says far. fluf-
rage], "that, immediately, we will
be able to improve the level of
care by at least 100%. Others can
do the same. Flow much higher than that Ave can go is the only
question." The urgency for such
improvement in tomorrow's hos-
pitals is revealed by another sur-
geon's remark: "Tile physical
plant must be improved quickly.
There's no ? point in a patient's
going through the delicate ordeal
of having a lifesaving plastic part
inserted if he is going to die soon
afterward of infection. We might
just as well put in a piece of bub-
ble gun I."
.. .
jured, all the hospitals in the entire
.area could accommo4 did for Release 2005/01/11: CIA-RDP88-01315R000300010009-2
about 100. The other 900, would -
just have to pile up and wait."