Friday, 20 April 2007

8. Hunter Killer Ambulances

Strolling north of our neighbourhood the other day I came across a Hunter Ambulance (so it said on the side). It looked a bit smaller and nippier than the average ambulance that rushes by all sirens blazing. Its possible significance dawned on me a bit further on. I was by a hospital and noticed a sign saying Intake and Vacancy Control Entrance. I assume this indicates a difference from the UK's 'bed management', which seems to consist of pushing people through and trying to empty beds of patients before they are properly recovered in order to fill them with the next patients waiting in line (I mean 'in the queue') - or do the UK Hospital Trusts call them customers now? Noo Yoik must be over-provided with hospital beds. 'Vacancy control' presumably means reducing the numbers of empty beds and so going out proactively looking for customers, as long as they have their private medical insurance card about their person. Adverts on TV for medical insurance schemes and for different hospitals all remind me this is a commercially competitive domain.

The Hunter Ambulance must be a bit like hunter killer submarines. They don’t actually kill anyone of course - it does say on the side of the ambulance 'Basic Life Support' - but they must have some equivalent of a heat seeking device for injured and ill people. Or at least a GIS system to locate building sites. Every construction site seems to display its rigger licence for scaffolding, but also advertises that it is inherently unsafe. Notices outside invariably say “To anonymously report unsafe conditions at this work site call” and gives a number like 1-800-HARDHAT. Scaffolders must have a high death rate in Noo Yoik – hence the term rigger mortis – or perhaps they just used to have before the invention of the hunter ambulance to whisk them off to hospital on the on-board basic life support machine. Very reassuring.

I was further reassured to find we live not far from a huge hospital area, ‘bedpan alley’, which the New York Times, rightly, I’m sure, regards as being of world-class importance. Taking the air, the somewhat polluted air up the riverside walkway between the East River and the Franklin D Roosevelt Drive on Sunday – by the way I have never seen a pedestrian leisure walkway so close to a motorway anywhere before, at times you feel you are on the non-existent hard shoulder – I noticed a sign for the conveniently placed Hospital for Special Surgery – convenient for any road accident victims, that is. Then the next day, walking north from 62nd street along York Avenue, the avenue closest to East River, I passed the Rockefeller University, initially founded as the Rockefeller Institute for Medical Research in 1903, a plaque tells passers-by. It made its name as a biomedical research centre. Over the next ten blocks, since the thirties, other hospitals, medical schools or research centres have taken over the neighbourhood: the New York Presbyterian Hospital/Weill Cornell Medical Center, the Memorial Sloan-Kettering Cancer Center, and the Weill Medical College of Cornell University, and buildings that are part of them: the Arnold and Marie Schwartz Hall of Science for Cancer Research, the Helmsley Medical Tower, all seemingly named after donors – of money, that is. The northern frontier of the medical blocks is at 72nd, where Sotheby’s has built a tall, brand new sea-green all glass building with American, British, French and Italian flags above the huge entrance – two Italian flags but one each of the others. I wonder why.

Linking all these medical institutions from the river to 1st avenue there are apparently a lot of tunnels for transporting patients. The word ‘patient’ does actually appear on some of the hoardings surrounding building sites. Hoardings hiding building, because Bedpan Alley is still expanding. In 2001 the Sidney Kimmer Center for Prostate and Urological Cancer opened – now that does sound reassuring. One of the newest additions is a not yet complete research laboratory (Memorial Sloan-Kettering) that towers above the rest and has started to eat westward into the traditionally residential areas. The Times, as people in Noo Yoik call the NYT – to distinguish it from the ‘London Times’ – cites the new opportunities for cancer research offered by the recent analysis of the human genome. Further westward (second Avenue and 66th Street), there are plans to close a single-screen local cinema – the Beekman Theater – don’t ask why all cinemas are called theatres – to build a breast cancer treatment and imaging centre. Local residents associations find it hard to argue against privately financed medical research developments, especially if it is to do with prostate and beast cancer, two of the sexiest areas of medical research, if I may coin a phrase.

The New York Presbyterian has got permission to redevelop most of a block (i.e. to knock it down, if I interpret the notice put up by the Par Wrecking Corporation correctly). It is a typical residential block with lots of old cast iron fire escapes fronting onto First between 71st and 72nd. They are due to erect a 19-storey block for staff residences and offices. Well, nurses and other workers need to live somewhere and hopefully not too far away like the far end of the Bronx. The terrace is boarded up and seems completely empty. On the corner of First and 72nd is what’s left of a fine looking old diner, all thirties angular aluminium on the outside and no doubt aluminium and neon on the inside, rather like the celebrated Empire Diner in Chelsea. It was called the High Life, I was told. Further down is what looks like another former restaurant or maybe a food shop. The words Good Fayre can be picked out the brickwork, less faded where the name used to be. A barber’s shop has disappeared, and a dance studio, places where people used to ‘hang out’, as one local said – the ‘loss of social networks’, as someone else put it – social scientists, what do they know?

As I go round a corner nearer the river towards an as yet unfinished hospital building I am hit by an overwhelming smell of fried battered haddock, every bit as authentic as something on the North Shields Fish Quay. It’s a newish diner probably catering for the British medical brain drain. (Make a note to go back.) The hoardings beyond it announce to all and sundry that I have arrived at the future Weill Cornell Medical College Ambulatory Care and Medical Education Building “creating a New Patient Experience”. Does that mean it makes you feel like a new patient, or gives you, as a patient, a new experience – novelty is not necessarily what a patient is looking for - or is it telling doctors and nurses that they guarantee if you work here that you will experience a good supply of new patients? brought in in their own state-of-the-art fleet of hunter ambulances, no doubt. Walking up 68th Street I finally get to the 23-storey MSK New Research Facility, “Building the Best”. It straddles the whole block from 69th to 68th but could not get any closer to 1st Avenue because it come up against a relatively new church – well not relatively new in US terms, it looks as though it was built in the early seventies, yes, I do mean 1970s: Saint Catherine’s of Siena Parish run by Dominican Friars (Irish and Italian to judge by their names). Their parish magazine has an advert for a Restaurant and Bar called Murphy’s Law (“Rooms available for Christenings and Other Private Functions, 417 E. 70th”). As laws go, Murphy’s Law is perhaps not terribly Christian, although Jesus might not have agreed with me when he was on the cross. At least big medical business cannot ride roughshod over the spiritual domain, I thought. It has some fine modern stained glass, as well as air conditioning, "a gift of the parishioners in 1976". As I leave I notice, below a statue, that the niche the church occupies here is not just physically a good fit, Saint Catherine’s of Siena is, I should have guessed, the patron saint of those who care for the sick. Nice one, guys.

Monday, 2 April 2007

7. Youth and Age on an MTA bus

We got on the bus, the 103 down Third coming back from the doctors. Cathy has had a chest x-ray. Very quick, no waiting – if she hadn’t had the last appointment yesterday she could have had it done at the doctor’s there and then. No charge, just ten dollars for yesterday’s appointment. UN health insurance coverage is good.

Quite full, the bus, people standing. I couldn’t sit down, but Cathy got the last of the four sideways seats at the offside front of the bus. I hung on to a pole close by. Sitting next to her was a little girl of about 4 or 5, and next to her a middle aged woman I took to be her childminder, or perhaps collecting her from school or nursery. The girl was white; hair more fair than red but she made me think of orphan Annie. The childminder was a woman of colour, not very dark, but I guess Afro-American rather than Indian. The girl was holding a doll on her knee, a pink-skinned doll, with an elastoplast on its bald head.

“Your head hurt?" she asks her chaperone.
“Yes, it hurts.”
“Did I make it hurt?”
“No, you didn’t make it hurt.”
“Who made it hurt?”
“Nobody,” she says, philosophically.

The little girl goes back to her thoughts and I watch the shops slide slowly by, a nail bar, Starbucks, Ye Olde Vitamin Shoppe ‘serving you since 1975’, a deli, another nail bar.

After one or two more stops, a tall, well padded man, seventyish, hauls himself up the steps of the bus using both handrails. He manages to put his MTA card into the slot by the driver and turns his whole body round to face down the bus. He sees much of the corridor populated with standing passengers.

“Holy mackerel!” he exclaims, with theatrical projection and articulation. A phrase I have never heard before, only read, when I was a boy, in a Superman comic coming out of the mouth of Clarke Kent, or was it Batman and Robin?

Then, turning his head slightly to his left he notices the first sideways seat on the nearside of the bus is free. Someone had just got off.

“I’ve hit the jackpot!” he declaims, to no one in particular, and at the same time to the whole bus. He lowers himself slowly down and sighs a loud sigh of relief as his behind eventually comes to a stop on the plastic seat.

“How ya doin’, precious?” Everybody looks up, wondering who the words are aimed at.

The four-year old sitting almost across from him answers: “I’m good.”Her chaperone reproaches her gently: “Say: I’m good thank you.”“I’m good thank you,” murmurs orphan Annie.

Another few stops, a deli and another nail bar.

“Your head still hurt?" Annie asks her companion.
“Yes, it still hurts.”
“Did I make it hurt?”
“No, you didn’t make it hurt, sweetie.”
“Who made it hurt?”
“It just hurt by itself?”
“It just hurt by itself.”

A couple more stops, more passengers get off and more get on. Suddenly, Annie’s minder gets up from her seat, keeps the child in hers. She has noticed before I did a tall elegant woman struggling to mount the steps. She indicates to the woman to sit down. The woman moves slowly and painfully, is short of breath. She more or less falls into the seat and throws her head back, closes her eyes, sucks in some air. Her short hair is greying blonde, not silvery but dull, it has no sparkle. The fine profile of a Vanessa Redgrave, but her cheeks are hollow, her skin a sallow off-white, more like a death mask. She may not be as old as she looks. Or maybe she is and it’s just the cut of her coat that takes a few years off her. She sighs a deep sigh, or at least as deep as her lungs will let her. A sigh of frustration, not of resignation, but recognisably a sigh of rage, of longing to be finally free of it all.

I look down at the little girl who runs her finger over the elastoplast on her doll’s hairless head.

In the meantime, the man opposite, I notice, has quietly disappeared.