Confessions of a Medical Heretic by Dr Robert Mendelsohn (1981)

Chapter 4 The Temples of Doom

A hospital is like a war. You should try your best to stay out of it. And if you get into it you should take along as many allies as possible and get out as soon as you can.

For the amount of money the average hospital stay costs, you could spend an equal length of time at just about any resort in the world, transportation included. And unless your condition required emergency treatment, your health might be better off if you spent the time and money at the resort, too. For the hospital is the Temple of the Church of Modern Medicine, and thus one of the most dangerous places on earth.

When a culture develops to the point where its citizens live in houses, the gods of the people have to reside somewhere, too. A temple is built to house the spirit of the religion. Whatever vision informs the religion is present in the temple, and the building becomes the center of prophecy, the place where the gods speak to the people. When I hear someone — usually an older person who wasn’t born in this country — say that the hospital is “where you go to die,” I say to myself that he or she has been hearing what the gods are saying.

Children, again, provide us with a message from their unclouded perception: kids are unabashedly afraid of going to the hospital. Just as their fear of doctors is something we could all cultivate to our advantage, so is their fear of hospitals. Of course, a child would be hard pressed to articulate his or her fear, Even most adults would have a hard time isolating and describing exactly what specific things he or she is afraid of in the hospital. Besides, adults are afraid to admit fear. Priests of the Temple take advantage of ignorance and reticence by assuring us, “There is nothing to be afraid of.”

There’s plenty to be afraid of. The God that resides in the temple of Modern Medicine is Death.

There are germs in hospitals that you can’t get anywhere else in town, not only because hospitals are such dirty places, but because of Modern Medicine’s fetish for ritual purification. Now, that appears to be a contradictory statement, but it’s not. Hospitals aren’t kept anywhere near as clean as they should be. Housekeeping staffs are generally smaller than necessary. Whenever you have an overworked staff, the tendency is for only the obvious jobs to get done, and not that carefully, either. So what you’re liable to find if you look closely is dust and dirt in corners and other out of the way places. Hospital dust and dirt isn’t the kind of dust and dirt you find anywhere.

Where else can you find all in one building: animal and vegetable waste from food preparation, rubbish and trash, biological wastes from diagnostic, medical, surgical, autopsy, and wound dressing activities, bandages, discarded tissues from surgery and autopsy, sputum, placentas, organs, amputated limbs, sacrificed research animals, disposable diapers and underpads, catheters, soap, bodily secretions, cups, masks, swabs, sanitary napkins, plaster casts, syringes, and fecal material? All of this goes down the same chute, collected and thrown by the same people — people who have access to patients’ bedrooms and operating rooms as well as the kitchen, laboratories, and morgue.

In one hospital, it was discovered that stretchers used to transport patients also were used to carry cadavers. That’s bad enough, but these stretchers still bore the residue from their prior grim journeys. In this same hospital, which by way is a large public hospital in Washington, D.C., “organic residue and fecal material” were also found in emergency rooms, floors, and working areas in the morgue. In patients’ rooms, soiled dressings, dirty shower stalls, hypodermic needles, and heavy accumulations of dust were found.

Such discoveries don’t shock me anymore, since I’ve realized that these conditions are the rule rather than the exception. And what makes these situations even more dangerous are the hospital heating and air conditioning systems which blow the dust and germs all over the hospital. Not to mention the plumbing system. Hospitals have more plumbing than any ordinary building. Besides the usual hot and cold water, hospitals have chilled water, distilled water, vacuum systems, fluid suction systems, oxygen, sprinkling systems for fire (most of which are inadequate), refrigerant, recirculated cooling water, drainage systems, sewage systems, and irrigation systems – all going through their walls and floors. Not only are the chances for accidental cross connection enormous, but so are the chances that illegal connections will increase the dangers of cross – contamination.

Modern Medicine’s fanatical devotion to purification ironically multiplies the dangers of creating a class of germs which are resistant to antibiotics. In Chapter Two I talked about how the overuse of antibiotics gives rise to bacteria which are resistant to the drugs. What better breeding ground for these supergerms could there be than a modern hospital, where antibiotics flow like soup? Some bacteria even adapt to the point where they feed on the antibiotics.

Then what happens, of course, is that the hospital staff becomes a walking culture dish for these germs. Since they’re exposed to them every day, however, they aren’t harmed by them. But that doesn’t do you any good when the housekeeper or the nurse handles your bedding your food, your clothes, and you.

The priests of the Temple, the doctors, are even worse spreaders of disease. Doctors neglect to wash their hands, unless it’s before the sacrament of surgery, where it’s part of the ritual. Usually they casually go from sick patient to sick patient, handling tongue depressors, syringes, and various parts of the patients. Yet they seem to feel that there’s something uniquely clean about themselves, and they don’t wash their hands in between. Doctors also have great confidence in caps, masks, and rubber gloves — none of which deserves any confidence at all. Masks become so contaminated after just ten minutes that they serve as bacterial cultures rather than shields.

Rubber gloves often are contaminated, too.

When I walk into a newborn nursery wearing a clean suit that I just put on that morning the nurses always make a fuss and make me put on a robe. I make fun of it by asking them if they’re insulting my new suit. Their behavior shows that they have placed their trust in the sacred vestments rather than their own perception of reality. There’s no guarantee that the white robe they make me put on is any cleaner than my suit. In fact, there’s evidence to the contrary. That white robe may have been sitting on the shelf for months. How do they know it was properly laundered? Especially since it was no doubt thrown into the same tub as soiled sheets, pillow cases, and operating room linens. Just because it’s white doesn’t mean it’s clean. The same goes for the bedding. The linens may be washed, but the mattresses and pillows are not.

Overall your chances of getting an infection in the hospital are about one in twenty. That’s a conservative estimate. Half of the infections in hospitals are caused by contaminated medical devices such as catheters and intravenous equipment. Before the explosion in the use of these devices around 1965, device-related infections were virtually nonexistent. About 15,000 people die from hospital-acquired infections every year. As in the case of drug deaths, hospital staff will fudge statistics when a seriously ill patient succumbs to a hospital-acquired infection. Your chances also depend on what you’re in the hospital for. If you go for an operation, you’re not only going to be exposed to the operating room dangers, but your body will be seriously weakened by the surgery and won’t be able to fight off infections as well. If you’ve been burned or wounded, you’ll also be weakened and therefore more likely to get an infection.

In my experience, a one in twenty risk would have to be the base line risk representing the minimum danger of infection. I’ve seen epidemics spread through hospitals so fast that everybody had to be sent home. Pediatric wards and newborn nurseries are the most vulnerable to spreading infections. It’s a well-kept secret in hospitals that the most dangerous place in the hospital — as far as the patients are concerned — is the newborn nursery, where none of the patients have (particularly those who are denied the immunity-transference of breastfeeding) developed their immunity to germs.

As bacteriologically overrun as hospitals are, I’ve rarely seen an epidemic that was blamed on the hospital or the staff. They always pin it on the visitors! The inevitable aftermath of the epidemic is restriction of visiting hours. Actually, keeping visitors away is only half of what should done.

Patients would be better off if they were kept out of the hospitals, too.

Hospitals are contaminated with more than germs. Remember, since hospitals are the temples of Modern Medicine, all the dangerous chemicals that doctors love to use are in plentiful supply.

With all those drugs at their disposal doctors are bound to use them. And they do. Patients in the hospital receive an average of twelve different drugs. But even if you’re not drugged to death or disability, there are other chemicals floating around that can make your stay less than healthy. In the first place, your doctor may not be using drugs, but everyone else’s doctor is. Poisonous solvents used in laboratories and cleaning facilities, flammable chemicals, and radioactive wastes all threaten you with contamination.

If hospitals were the sharply efficient places they pretend to be, we could rest less uneasily about those dangers. Unfortunately, hospitals are virtual models of ineptitude. There are so many simple mistakes — mistakes in which someone has two or three choices and chooses wrong — that you must feel extremely apprehensive when you start to contemplate all the opportunities for complex errors!

Everything gets mixed up in hospitals — including patients. My brother went to the hospital for a hernia operation many years ago. He was scheduled for surgery at 11 a.m. I went up to his room at 9:30, but he wasn’t there. I knew right away what had happened. I ran down to the operating room, and sure enough, there he was. They’d taken him instead of another patient. The only reason he escaped was that the other patient was supposed to get a hysterectomy.

Mixups occur in hospitals all the time. Surgeons operate on the wrong leg. Medicines are given to the wrong patients. The wrong food is served to people on special diets. Even babies are mixed up. Hardly a year goes by without some story appearing in the newspapers about a colossal mixup of babies and mothers at a local hospital. No doctor who has had any experience in maternity wards has not seen the wrong baby brought to the mother by the nurse and the nurse corrected by the mother. There are twenty to thirty babies in the average nursery. Every doctor knows footprints are not reliable, and those arm bands are always falling off. So who knows one from the other?

Not only are people mixed up in hospitals, they’re lost, too. Newspaper stories have told of patients found dead in hospital elevators and little-used bathrooms. Two years ago a baby was stolen from the University of Chicago Hospital. Every time I go by the newborn nursery at Michael Reese Hospital, I stir up the nurses by asking if anyone there has heard from the Fronzack baby. More than a decade ago, the Fronzack baby simply disappeared from their nursery and was never found. About a year ago, there was a case in Israel in which two mothers were given the wrong babies. It wasn’t found until the babies were two months old. At first, neither mother would exchange “her” baby. What do you call someone who’s been your mother for two months?

As far as I’m concerned, one of the best arguments for having your baby at home is the distinct possibility that you’ll go home from the hospital with the wrong baby.

Another hazard that threatens you in the hospital is the likelihood of an accident. In a suburban hospital in Pennsylvania, it was discovered that oxygen and nitrous oxide labels were accidentally switched when a construction crew installed gas lines in the emergency room. Until the mixup was discovered, people who should have been getting nitrous oxide were getting oxygen and people who were supposed to get oxygen were getting nitrous oxide. It took six months for the hospital to discover the error. The hospital admitted to five deaths from the accident, but said that all thirty- five deaths in the emergency room during that period were not caused by the switch because some of those were dead on arrival and some were too far gone to benefit from oxygen even if they had received it. If that sounds like the kind of fudging doctors use to cover up a treatment-related death, you’re getting my message.

As doctors rely more and more on technology, hospitals become more and more littered with electronic gear and wiring, and the chances of being electrocuted rise right along with the electric bill. In the same Washington, D.C., hospital cited earlier for filth, three patients and several doctors and nurses were severely shocked and burned by faulty electrical equipment in the coronary care unit. This type of accident is not uncommon, and it will grow more common as hospital maintenance staffs shrink and become less able to cope with complex wiring.

So loosely organized and run are most hospitals that murder is even a clear and present danger. Witness the deliberate injection of paralyzing drugs to patients at a Michigan Veterans Administration hospital. Deadly drugs are so widely available and so loosely controlled that the hospital couldn’t even begin to look for the culprit. The FBI had to be called in. If you want to commit the perfect crime, do it in a hospital.

Of course, you could make a case that hospitals are already getting away with murder. If the drugs, the germs, the surgery, the chemicals, or the accidents don’t get you, you still stand, a good chance of starving to death. One of the first major studies of the scandalous state of hospital nutrition examined every surgery patient in a large Boston municipal hospital. They were tested for protein-calorie malnutrition, a minimal standard which tells only whether the person is getting enough protein and calories every day over a period of time. Whether the patients were getting enough vitamins and minerals was not tested. Nonetheless, half of the surgery patients were not getting enough protein and calories. Half of these were severely malnourished: they were malnourished enough to threaten their recovery and lengthen their stay in the hospital.

Since they weren’t given enough food by the hospital, you can be sure they weren’t getting enough vitamins and minerals.

The results of this study are by no means uncommon. Many studies since have discovered malnutrition in anywhere from twenty-five to fifty percent of patients in American and British hospitals. The doctor who carried out the Boston study, George L. Blackburn, has since stated that malnutrition is one of the most common causes of death among old people in hospitals. That’s not really such a startling statement, in light of facts Dr. Blackburn uncovered. Malnutrition obviously puts a person in the worse possible state to fight off whatever disease brought him to the hospital in the first place. Add to that the dangers and stresses of the hospital, and you have a recipe for disaster. Of course, we can only guess about the true magnitude of that disaster. As with drugs, accidents, and other treatment-related deaths, doctors fudge. We don’t know exactly how many people die directly or indirectly from malnutrition in hospitals. What we do know, however, is that a lot of people are malnourished in hospitals, that malnourishment is deadly, and that a lot of people die in hospitals.

Why are people malnourished in hospitals? As bad as most hospital food is, if it were eaten it most likely would prevent most of the protein-calorie malnutrition these studies turn up. The problem is that it’s not eaten. Nobody sees to it that the patient eats. At best, the tray is brought in and set beside the bed on a table. And there it sits. At worst, the hospital schedule and staff gang up on the patient to keep him or her from touching the food: time for lab tests, time for therapy, time for an enema, time for drugs, time for this and time for that.

Plenty goes on in the Temple of Modern Medicine simply to make you lose your appetite. The psychological dangers of the hospital are every bit as deadly as the physical dangers.

Your hospital stay from the moment you walk in the front door until the moment you walk — or are carried — out has a psychological effect on you similar to a hex or a voodoo curse. Whether you consciously acknowledge it or not hospital procedures and environment encourage despair and debilitation rather than hope and support. Nobody’s optimistic. You see the long faces of the people suffering and dying, and you see the faces of the people who must watch them suffer and die. You see the hospital staff denature their responses and become machines. And then you are denatured at the admissions desk as you are reduced to a collection of numbers and symptoms belonging not to you but to the doctor. You leave your former world and identity behind. You’re literally stripped of your former life as you take off your clothes and hide them and your personal belongings in a closet — artifacts of your real life. That past life is kept from reasserting its ties with you — your relatives are restricted from spending more than token amounts of time with vou.

The effect of all these psychological pins is that you relinquish any notion you may have had about having control over your health. Your captors isolate you, alienate you, scare you, depress you, and generally make you feel so anxious that you submit to their every wish. Your spirit broken, you are ready to be a Good Patient.

Children and older people seem to be especially susceptible to the damaging effects of hospital voodoo. Children react very rapidly with strong feelings of abandonment and separation anxiety. Add to this the fear the child has of the operation or whatever they’re going to do to him or her.

It’s no mystery why children who have had as little as one or two nights in the hospital without their parents regress in their behavior to where they lose their toilet training or their ability to speak. Every doctor should know that the ages between three and six are years of great confusion. Kids hardly know what’s going on at that age. To subject them to the hospital environment without the benefit of a parent close by is patent cruelty.

More than twenty years ago, I wrote a paper about children’s fantasies before a hernia operation. I interviewed kids and asked them what they thought was going to happen to them. Almost every child thought something was going to happen to his genitals. When I asked them where on their body the operation was going to take place, some of them actually grabbed their genitals defensively. That was an eye-opener for me. Our conclusion at the time was that children should be counseled before surgery and have the operation explained to them. Now, I know that doesn’t do any good. What they really need is to be assured that their parents will be with them throughout the hospitalization. That’s what we should have advised.

I still don’t like to make rounds through hospitals at night: too many crying babies. I always have a lot of trouble with crying babies — I can’t ignore them. When I used to make night rounds regularly I would pick up the crying babies or the little kids and carry them out to the nurses’ station. If they could sit on the nurses’ laps or on the edge of the desk they wouldn’t cry.

Adults and the elderly also suffer from a hospital stay. Dr. David Green has called hospitals “the worst place in the world for aged people.” I don’t disagree with him, except that I would say that hospitals are the worst place in the world for everybody. I don’t know how we can expect children not to be harmed by the super stresses of a hospital stay when those stresses are so hard on adults. Ironically, we expect the kids to act like super adults in the hospital and adjust to the separation and the fear — while we expect the adults to adjust to being treated like helpless children. Hospital procedures have absolutely no respect for a person’s dignity. You have to take off your own clothes and wear a hospital gown that leaves you immodestly vulnerable to inspection and attack by innumerable doctors, nurses, and technicians. You have to lie down most of the time. You can’t come and go as you please. And you have to eat what they serve you — if there’s time. Then, to top it off, you have to sleep in a room with strangers — sick strangers at that!

Hospitalization degrades you. In my twenty-five years of practicing and witnessing the practice of medicine, I’ve never seen a degrading experience that did anybody’s health any good. But remember, hospitals are the temples of Modern Medicine. When you enter the temple of another religion, you enter the presence of that religion’s deities. No gods will allow you to take rival gods into their house, so you leave behind your old gods and all that they taught you before you enter.

Since the Church views all aspects of life that contribute to health as rival gods, you must leave your identity, your family, your confidence, and your dignity at the temple door. Only when you’ve been purified of your real life can you be eligible for the sinister rewards of the Church of Death’s sacraments.

I’m always fascinated when one kind of epidemic or another spreads through a hospital so fast that everybody has to be sent home or transferred to another hospital. Usually, very few people have to be transferred to other hospitals. We always manage to send nine out of ten patients home with no problems.

About twenty-five years ago, I decided to conduct a little experiment to find out just how necessary hospitalization really is. I was in charge of a hospital ward that had about twenty-eight beds. I decided that none of the twenty-four patients already there would stay unless they absolutely required hospitalization. I also had control of admissions. So when someone came to be admitted, we decided whether or not they really had to be. We had special procedures available to allow people to be treated at home. We could, for example, pay their taxi fare for outpatient visits, and we had a truck we could use to go out to adjust patients’ devices if they were in traction.

I kept this up until we got down to three or four patients. I figured I had pretty well proved that hospitals weren’t necessary. I found out afterwards that I was the one who wasn’t necessary. The nursing office started to complain because the nurses in my ward had nothing to do and were in danger of being transferred. The interns and residents complained that they did not have enough teaching material. That was the end of my experiment on hospital utilization.

Hospitals exist in such aggressive abundance for the convenience of the medical profession, not for the good of the people they’re supposed to serve. Hospitals started out as “poor houses” where doctors could send patients who didn’t have the money to pay for their services. After a while, doctors realized that it was much easier for them to have all their patients in one place, with all the machinery right there. Naturally, as medicine becomes less personal and more mechanical, it becomes increasingly convenient for the doctor to manage patients in the hospital. It’s a well-known fact that a doctor has to be sharper and more skillful if he treats people on an outpatient basis. As talent and consideration have become rare commodities among doctors, hospitals have burgeoned. Insurance companies drive people into hospitals by refusing to pay for outpatient treatments. If we didn’t recognize that hospital and medical insurance payments were really indulgences to keep a corrupt Church solvent, we would bridle at the absurdity of an insurance company preferring to pay thousands of dollars for treatment in the hospital that could be performed out of hospital for hundreds.

Modern Medicine doesn’t have to account for absurdities or for the dangers of hospitals. Hospitals are, for practical purposes, self-accredited. The boards and committees that decide whether or not a hospital should be allowed to carry on are made up of the same “good ol’ boys” that run the hospital. Even when a federal agency enters the picture, the massive institutional inertia of the system keeps bad hospitals operating and discourages adequate reform of bad practices in all hospitals. A few years ago the Department of Health, Education, and Welfare (HEW) spot-checked 105 hospitals for dangers that were specifically mentioned in the Medicare law. They found sixty- nine hospitals failed to meet the specifications regarding fire safety, drug records, size of nursing staff, number of doctors, dietary supervision, medical records, and medical libraries. All of the hospitals had recently been passed by the Joint Commission on Accreditation of Hospitals, and after the HEW test results were made known, the JCAH refused to withdraw accreditation of the offending hospitals.

Public outcry over hospital conditions have spawned what I call a “haunted house full of ghost reforms.” Most of these reforms take place either on paper or in secret meetings of the people who run the hospital. The Church is not about to give up any power, especially where its own temple is concerned. Would Catholics allow Jews to tell them how to run their churches and schools? Reforms such as hospital ombudsmen and patient advocates to review and act on patients’ complaints are set up merely to run interference on malpractice suits. They lull the patients into thinking that their rights are being looked after. More than two years after the American Hospital Association “formally adopted” the “Patient’s Bill of Rights” and distributed it to all member hospitals, only a fraction of the hospitals had made the “rights” available to patients.

We can’t really expect the temples of Modern Medicine to enact these reforms. since the very idea that a patient has any rights is totally contrary to the operating concept of the institution. Furthermore, if the patients’ rights were really looked after, the hospitals would be closed! It’s been known for some time that we really have too many hospitals and that people do not need to spend anywhere near the amount of time in the hospital that is presently routine. Numerous studies have shown over the years that most lengthy hospital stays are unnecessary. Five days, three days, or even half a day in the hospital for childbirth is at best unnecessary. Usually, it’s downright harmful to both mother and baby. The length of time in the hospital that heart patients can profit from is rapidly diminishing, according to the scientific literature. Whereas doctors once could point to studies that showed that a month was the minimum, we’re finding out now that a three-week stay is no better than a two-week stay, that a one-week stay might be still better, and that patients treated at home, on their feet do even better! Even the American Hospital Association admits that we’ve got more hospital beds than we need, so you can just imagine how grossly obvious the superfluous hospitals really are to those who can see what’s going on.

Of course, the AHA and other Church agencies do their best to keep the public from finding out what is going on. The privately funded (with the money you pay the hospitals) Commission on Professional and Hospital Activities maintains a computer bank of information on what goes on in American hospitals, including comparative death rates for procedures, accidents, infections, errors — everything you’ve got to be afraid of in hospitals. Just try to take a peek at this information. The Commission guards it with a vengeance the government would envy. For good reason. When explaining why the information is “classified,” Commission and AHA spokespeople will tell you that the “information could be misinterpreted and could discourage the kind of analysis that leads to improvement.” What they mean is that the public would “misinterpret” hospital shortcomings as so dangerous that they wouldn’t be caught dead in them. And, of course, that would “discourage improvement” because there wouldn’t be anything to improve: the hospitals would close! I suggest that this computer bank contains the potential for a “Pentagon Papers” and “Watergate” combined.

It’s well-known that Modern Medicine doesn’t act on scientific knowledge until public awareness grows strong enough to demand it. Research is the prayer of the religion of Modern Medicine.

Research is OK as long as you don’t act on it. A doctor doing research can ruin his career in the eyes of Modern Medicine merely by overstepping that line and advocating that his research results be implemented!

Whether the Temple or any of what goes on inside does good or harm is irrelevant. What’s important is that the faithful are faithful and that they show their belief by showing up for the sacraments, which are sold not on the basis of what they do but what they’re supposed to do. All their intentions may be good, but everybody knows what the road to hell is paved with.

Besides, Modern Medicine’s intentions can be counted on to be corrupt, too. When hospitals started relaxing visiting hours, they didn’t do it because they realized that people should be allowed to be with their family. They did it because pediatrics was dying and the beds in the pediatric wards were empty. They would have done anything to get children in there — let mothers, fathers, siblings, cats, or dogs in for a visit! Obstetrics is dying, too. People want to have their babies at home, not in the hospital. So today they’ll let anybody in the delivery room, husband, sister, mother, boyfriend … anybody! As long as they get the revenue.

What they’re counting on is that people will be lulled into feeling that the hospital really is the place for them, that the Temple really can save them. Of course, it can’t. The Temple has nothing to do with health. There are no facilities in hospitals for health or for any of the things commonly recognized as contributing to health. The food is as bad as you’d find in the worst fast food drive-in. There are no facilities for exercise. All the personal factors that can make you well or keep you healthy are removed — family, friends, and sense of self. In no uncertain terms, when you walk into a hospital, you are surrendering — “Here I am, totally unable to help myself. You must save me. I am without power. All power is yours.”

Hospital costs are the biggest single element in the country’s total bill for medical “care.” That bill is rapidly overtaking defense, the Number One item on the country’s total bill for everything.

When medicine exceeds defense, the Inquisition will really be unstoppable. No one seriously challenges whatever institution is the first item on the budget. Whatever costs more than anything else gathers bureaucratic inertia of such immense proportions that it controls the destiny of the country. Then the dream of Modern Medicine will be fulfilled: the whole country will become a hospital. We’ll all be patients in the Temple of Doom.

The first thing you should do to protect yourself against the dangers of the modern hospital is to resolve to avoid unnecessary hospitalization. Since most people are in the hospital because their doctor put them there, you simply should not let your doctor put you there. That means not taking drugs unless absolutely necessary and not having surgery unless absolutely necessary. (See the previous two chapters.)

There are many common procedures that doctors won’t do on an outpatient basis — unless you insist. Here is where, once again, you have to do some homework that will put you one up on the doctor as far as knowing what can and can’t be done. More than ninety-five percent of births to healthy women, for example, can and should be done outside the hospital. Yet doctors still scare young mothers and fathers into the delivery-operating room with horror stories of “complications” which are, in truth, statistical fantasies or complications which result from obstetrical intervention. Now that the scare tactics haven’t diminished the home birth movement, we see more and more “birthing rooms” appearing in hospitals.

Don’t kid yourself into thinking that birthing rooms made up to look just like a real (motel) bedroom are going to make any difference. Once you allow yourself to be lured onto Modern Medicine’s turf, they’ve got you. I have the recurring dream of a nice young couple going into the birthing room, like the one at Illinois Masonic Hospital — complete with brass bed and color TV set. The doctor smiles and acts just like a friendly uncle. But once the mother is strapped into the brass bed, the doctor pushes a button on a secret panel and the papered walls slide away, the furniture disappears, and they’re suddenly in an operating room under the glare of the operating light with the surgeon standing there scalpel in hand ready to slice her belly from one end to the other.

That fantasy isn’t so unreal. Birthing rooms are not so isolated from the operating rooms that the brass bed can’t be rolled into action before the young mother and father know what’s going on. If you’re on the doctor’s turf, you play by the doctor’s rules. Whereas if you have your baby at home, the doctor has to do his homework. If you need the hospital facilities, you should use them. But if you can have your baby in a birthing room, you can have it in your own bedroom.

In protecting yourself from your doctor’s tendency to send you to the hospital unnecessarily, you should use the same tactics discussed in avoiding drugs and surgery. Educate yourself to the possibilities, alternatives, and consequences. If that means going to other doctors, do it. If it means going to healers that aren’t medical doctors, do it. Don’t be afraid to confront your doctor with the information you gather. Of course, what you’re really doing is searching for the right doctor. And that, actually, is exactly how you should go about finding the right hospital — if you decide that you need one. Conventional wisdom preaches that the best hospital is the one which is heavily involved in teaching, one that has lots of students, lots of house officers, lots of research. That wisdom may have been valid thirty or forty years ago when there were some pretty peculiar things going on in community hospitals. But it’s nonsense today — unless you want to feel like the frogs, crayfish, and fetal pigs in a biology class. If you want to find the hospitals that have the highest rates of nosocomial (doctors’ jargon for hospital-acquired) infection, that make the most mistakes regarding lab tests and dispensing drugs, that mix up more patients, and that do more psychological damage — then go to teaching or research hospitals. If you want to be used for someone else’s purpose — whether it’s to demonstrate the right (wrong?) way to perform a procedure or to find out if this or that drug really works — you couldn’t go to a better place than a teaching hospital.

There used to be another piece of conventional wisdom which stated that if you had a very rare or serious condition you were better off in a teaching hospital. That’s no longer true, either. The teaching hospitals are there, don’t forget, to teach the orthodox treatments. What you’re going to get is the orthodox treatment, whether it works or not. If you want to get the latest, unorthodox treatment, you have to go to a smaller hospital or even one outside the reach of the Church — out of the country.

Don’t choose a hospital at all, because hospitals don’t treat patients, doctors do. Choose a doctor. If you’ve chosen the right doctor, chances are he will have chosen the right workshop for his skills. Most of the doctors I know who fall into that category of good doctors spend very little of their time in big teaching or research hospitals. The mythical three-legged stool of medicine — research, teaching, and patient care — is not a stool at all because the legs aren’t equal. Patient care almost always gets the short leg when doctors and hospitals try to make a stool out of it. So if someone tells me they have chosen a teaching hospital, I tell them to be on their guard because they’re in serious danger.

No matter who your doctor is and what hospital he or she has put you in, you’re always in mortal danger, so you always should be on your guard. Not passively, either. Your job is to make trouble. Trouble for the nurses, trouble for the doctors, trouble for everyone. Subvert the system that will steal your dignity and maybe your life if you let it.

That’s not always easy to do. If you hold a high rank in society, you can do it fairly easily. When the wife of the chairman of the board goes in, he often gets a suite right next to hers. If you’re not very highly placed, you’ve got to use whatever muscle you have. You’ve got to be prepared, cunning and skillful.

I like mothers and fathers to stay with their children while they’re in the hospital. In one of the hospitals I worked in, parents could stay with the child only if he or she was on the critical list. So I would put all of the kids on the critical list! They left me alone on that for a long time — until the showdown.

The visiting hours were supposed to end at 7:30 every evening. One mother called me and said her child was crying but that he would stop crying and go to sleep by 8:30 if only she could stay with him until 8:30. I told her to go up to his room and stay. Then the nurse called me and said that this woman has to leave because the child wasn’t critical and visiting hours were over. I asked her what she would do if the mother decided to stay. She said she’d call the supervisor. I called the supervisor and asked her the same question. She said she’d call the hospital administrator.

The administrator called me and I asked him what he planned to do. He said he’d have a police guard come and escort the woman out of the hospital. I asked him to do me a favor and hold off for fifteen minutes so I could see what I could do. He figured I was a nice guy and would take care of it for him, so he agreed.

I called up a local TV newsman — an activist — and told him I had a mother who was about to be thrown out of the hospital because she wanted to stay with her crying child for an extra hour until he went to sleep! He asked me to hold them off for twenty minutes so he could rush cameras to the scene. I said I’d see what I could do and I’d get back to him. Then I called up the administrator and asked him to hold off for just twenty minutes more because the TV camera crew was on the way to film the policeman escorting the woman out of the hospital.

The administrator said, “all right, Bob, you win. You call off your dogs, and I’ll call off mine. But tomorrow I want to see you in my office.” Next morning I went to his office and he told me he could throw me off the staff for doing what I did. I told him I knew that, but that I also knew that he wasn’t going to do it. Because if he did I would go right to the newspaper and make the biggest fuss he’d ever seen. He said that was right. And he made a deal with me: “Your patients’ visitors can stay as long as they want, but nobody else’s. I don’t want you to bring this up with the rest of the staff.”

That’s the way it was. Some of the nurses used to be frightened of me, or just plain mad at me, because I always demanded that my patients receive whatever I thought they should have ahead of everybody else. The nurse would say “But Dr. Mendelsohn, there are twenty-seven other patients on the floor. Why should yours come first?” And I would tell her that my patients did come first, because if they didn’t I was going to raise the biggest holler in the world. My patients did get taken care of first most of the time. I used to violate the rules all the time.

Which is exactly what you have to do to protect yourself when you are in the hospital. You can’t do it alone. You need someone with you all the time who’s close to you. Not a private nurse.

Someone from your family or a good friend has to stay with you. I learned that poor families were usually strong and rich families frequently weak, because I could almost always get a family member to stay with a poor patient. When I had a well-to-do or upper middle class patient, I had to get a private nurse because everybody in the family was working and no one was available or willing. That taught me a great lesson about the relative strength of poor and rich families.

Of course, it most likely will not be easy to keep a friend or family member with you at all times. You have to use some muscle. When the person is told to leave, he or she must not leave. Drop the word lawyer quite a bit because doctors are afraid of lawyers. Say, “well, my brother-in- law is a lawyer and he said I could stay.” That sometimes works. Another technique is to bring in a bunch of tough-looking relatives. I used to take care of gypsies on the South Side of Chicago. One day the prince of the gypsies fell out of a window and hurt his head. He survived, of course, and did very well. But he was brought to the hospital by his father, the king of the gypsies, and about two hundred other gypsies. They came in a caravan of cars, all with the little flags on the aerials. It was quite a dramatic sight. All the cars pulled up, and the gypsies got out on the front lawn. About twenty of them went up with this kid to his room. Visiting hours were long over, but there wasn’t one nurse or doctor who was going to go in there and tell those gypsies to leave.

The first responsibility of the friend or relative is to make sure that you are well-fed. If you expect to survive your hospital stay without starving, you have to take responsibility for your own nutrition. If the hospital food is not up to your standards, you should have food brought in from home. (If the hospital food is up to your standards, either you’re in an exceptional hospital or you should seriously reexamine your dietary habits.) Your relative has to be prepared to run interference for you when the nurse or technician tries to interrupt or cancel your meal for a test or some other procedure. In the event that you’re too weak or uninterested to feed yourself, your friend is there to feed you. He or she also can monitor your meals and tell the doctor what you’ve been eating and not eating. If you are on a special diet, he or she can make sure the food is part of the recommended diet.

Your friend or relative has to know what pills you’re supposed to get, so that you don’t get pills that the patient in the next bed should have gotten. Your partner also can make sure you’re not mistaken for the next patient when they come to collect him for his surgery. Your partner can make sure you don’t disappear. He or she can go with you for laboratory tests and examinations. If you’re taken for x-rays, he or she can go with you to make sure you are brought to the right place, to see to it that you don’t sit in a drafty hallway most of the day, to make sure you get the right x- rays.

Your partner is there to ask questions and, in general, to make trouble. Your partner should ask the nurse how fast the intravenous drip should be dropping, so that you don’t get it too fast. He or she also should make sure they don’t put a patient with a contagious disease in the same room.

Your partner should ask the doctor to wash his hands before he touches you. One of the side effects of doctors not making house calls is that they don’t wash their hands anymore. I remember when I made house calls, people would politely say when I walked in the door, “Doctor, the bathroom is right this way.” They would show me to the washroom where there was a towel and a bar of soap. It was expected that I would wash my hands before I went in to see the patient. I didn’t really learn to wash my hands until I started making house calls. Now, if you watch a doctor going from room to room and patient to patient, sometimes he washes his hands and sometimes he doesn’t. Sometimes he passes his hands through the water ceremoniously but not in a way that does any good. Your partner should make sure the doctor washes his hands thoroughly before touching you. Who knows what he’s had his hands in before getting to you!

If for nothing else, it’s a good idea to have a partner in the hospital to protect you from the psychological dangers, the “voodoo curse” of the hospital stay. A friend or a relative provides an invaluable link to your real life, to your identity, and to your dignity that can keep you alive and strong when the hospital staff and procedures gang up on you. Even the best hospitals are frightening and dangerous. It’s really common sense to have a good friend or a relative there to defend you and support you when you most need it. If you are fortunate enough to have someone who will team up with you to cause the nurses and staff to complain that the two of you are uncooperative and trouble makers, then I know that you are well-protected — and loved.