Hospitals these days are amazing places where charity and technology do great good together. They are places where the sickest among us are cared for and sometimes cured of disease. Not counting my birth, I have only been a hospital patient twice: once as a young boy and once as a septuagenarian. Both times, it was on account of dire diagnoses. From the first affliction, I had a good deliverance; with the second, I still contend. Images of the two hospitals reflect changes in standards of medical provision, and cultural expectations, between then and now. In 1954, my parents checked me into a modest, small-town institution dating from before the First World War. My destination was the children’s ward, a long, spare room furnished with white iron bedsteads with patient charts hung at the foot, enameled metal night stands, noisy steam heat and no air conditioning, hard terrazzo floors, and that not unpleasant but unmistakable antiseptic scent in the air. At that time, doctors wore whites and nurses wore caps and pins of their schools. Every one of them that I knew was a stern, yet kindly, authority figure.

In 2021, I was ministered to in an immense academic health center famous for its expertise in my ailment. I was given hotel-like accommodation and the benefit of all the gadgetry to which twenty-first-century medicine is a happy heir. Gone are the hospital whites and lordly doctors. Today one is healed by a busy team of specialist care professionals (physicians, fellows, residents, nurse practitioners, nurses, trial coordinators) well-tutored in, as we used to say, bedside manner, which I mean as a compliment. Out front, family and friends who come to visit can avail themselves of valet parking (in my view, the best thing to happen to healthcare since penicillin).

The esteem in which our culture holds these estimable institutions became especially evident during the recent plague, which also revealed a perversion of their purpose. From the beginning of the pandemic, two years ago, until its slow sputtering-out today, the welfare of hospitals has been touted as our paramount concern. The message from medical professionals, the political classes, and the media that hospitals must not be “overwhelmed,” or in any way compromised, appeared unimpeachable. “Appeared” is the correct verb here, given that our apprehension of the supposedly critical nature of our situation came primarily, in those early days, from unforgettable visuals—of patients piled up in corridors of Italian hospitals and Navy hospital ships sailing to New York to ease the burden of care then thought certain to overwhelm Gotham’s hospitals. Triage tents went up in hospital parking lots and personal protective gear became gold, while orthopedic and plastic surgeons went without work. In Covid’s third season, the drumbeat continues. “Tent morgue trailer set up; Augusta Health warns of urgent situation,” recently headlined my local paper. As I write in December, Austria and parts of Germany have locked down lest their hospitals become overwhelmed. People disagree about whether we should continue to be frightened and hunker down, or whether things are getting better and we should just get on with life. But no one, it seems, cares to dispute the centrality of the hospital in our calculations. 

I wonder if this is fair to the hospitals. Throughout their long history, and indeed until the late nineteenth century, hospitals were to be avoided, the very last place the middle and upper classes wanted to end up if they were sick. It was to the poor and downtrodden (today’s “marginalized”) that hospitals chiefly ministered, and with a more charitable than therapeutic purpose. This changed in the twentieth century with the marriage of medicine and science. As medicine came to have more and more to offer, the hospital changed its stripes and became a dispenser of acute-care curative medicine. Far from being a place of repose and resignation, the hospital became a battleground where disease, at its worst, might be fought and sometimes vanquished. Demand for medicine soared, and as its perceived value increased, prices went up. Hospitals became the most extreme expression of this reality. Hospitals are among the most expensive institutions to build, staff, and maintain. To utilize them optimally and to justify the great resources devoted to them, it is necessary that they run at near-full capacity. Just ask a hospital administrator: better to be “overwhelmed” (occasionally) than to have too many empty beds for too long.

Going to extreme lengths to prevent “overwhelming the hospitals” courts institutional idolatry. To prevent that unthinkable outcome, no price, if the record of the past two years is anything to go on, has been too high to pay. This includes closed churches, schools, and countless business enterprises arbitrarily judged “nonessential.” Moreover, it is idolatry with irony. If a pandemic is, above all, a public health crisis, the battle against this one disingenuously deployed the specter of “overwhelmed hospitals” when public health is not in large part what our hospitals do anyway.

As things have turned out, the worst did not come to pass. As treatments improved and vaccines appeared on the scene, this particular plague transmuted from genuine public health emergency into political fodder in a country already riven deep with cultural divisions. At every turn, the hospital—or the hospital-as-excuse—has stood in the front line. It is a part the hospital was neither designed for nor rehearsed to play. That the wellbeing of the hospital should have become an obsession in a highly secularized, risk-averse society that values physical health above all things, should not, I suppose, surprise. To repeat: hospitals are wonderful places, but misconstruing their importance does them no favors. The best examples are sturdy places staffed by steadfast, resilient people who have shown themselves not so easily “overwhelmed” after all. I am in their court. Should I suffer a medical emergency tonight, as much as anyone I want the lights to be on and the emergency room team on its very best game. None of us is well served by expecting more than that. And that is hard enough.

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