Memories of Hahnemann Hospital and an Unforgettable Patient

Andrew N. Wilner, MD

Disclosures

July 24, 2019

After 170 years of operation, Hahnemann University Hospital in Philadelphia, Pennsylvania, will shut its doors in September. This abrupt closing of a 496-bed academic medical center will disrupt patient care, research, and cost 800 nurses as well as hundreds of other employees their jobs.

It will also fling the lives of 570 medical residents into chaos. Some may be taken in by neighboring hospitals' residency programs, but others must relocate to different cities and reorganize their lives on short notice at their own expense. Through no fault of their own, these young physicians will suffer a distracting disruption in their training.

To some people, this hospital closing is just another example of a dysfunctional healthcare system, but the news struck me more viscerally.

Summer of 1978

My first exposure to "real patients" occurred during a hot and humid Philadelphia summer at Hahnemann. I had just completed the first year of medical school at the Free Faculty of Medicine, part of the Catholic University in Lille, France. The school had a relationship with Hahnemann, which allowed me to spend the summer of 1978 on the medical service. I remember renting a bedroom without air conditioning and driving each day along the winding Schuylkill River to the hospital.

For an impressionable young medical student, the patients were fascinating. A young man had septic arthritis in his wrist. It was so tender that the slightest movement released a string of expletives. Aspirated fluid revealed infection with Neisseria gonorrhoeae. After a few days of intravenous antibiotics, the pain, redness, and swelling disappeared.

A middle-aged man was admitted with chest pain and a myocardial infarction. He coded later that afternoon. During the resuscitation attempt, I helplessly watched the flurry of activity around his bed, not knowing what to do. When he didn't respond to CPR, the team traipsed out of the room to see the next patient. Standard stuff for an inner-city hospital, I guess, but it left me wide-eyed.

One case in particular I'll never forget, because I've never seen anything like it since.

The Man Who Exploded

Mr Green (not his real name) had a long history of excessive alcohol intake. The attending physician pointed out the classic signs of alcohol-induced liver disease. Under the single fluorescent bulb in his room, his skin radiated a mustard color. His sclera glowed an even brighter yellow. Spider-like hemangiomas on his chest blanched to finger pressure.

Mr Green spent most of his time in bed. He had severe gingivitis and had lost most of his teeth. Only two top incisors jutted from his mouth. Several fingers curled with Dupuytren contractures, and his spindly arms and legs rarely moved.

But the most striking feature was his belly, which protruded into the air as if filled with helium. He also had an umbilical hernia, which obliged him to wear a colostomy bag sealed over his belly button. Whenever he sat up, foggy fluid drained into the clear plastic bag.

It was my job to round on Mr Green every day. I would ask how he felt, and he would grunt a little in response. On exam, he had a hyperdynamic precordium and a flow murmur from his chronic anemia. His lungs had rales and bilateral pleural effusions. Both ankles swelled with pitting edema. One of the residents taught me to percuss his abdomen and demonstrate "shifting dullness" due to his massive ascites.

One busy morning, as often happened, a code blue interrupted rounds. As the team scurried up the stairs, I recognized the room number.

The chief resident arrived first and opened the door. There was Mr Green, sprawled out on the floor, more pale than usual and gasping for breath like a fish out of water. He lay in a giant puddle—liters and liters of ascitic fluid. I later learned that he had stood up to pee and his umbilical hernia had burst.

His pulse was thready and tachy. I took his blood pressure, which was around 80 mm Hg. We transferred him to the ICU.

Several days later, Mr Green returned to our service, even more gaunt and yellow than before. I resumed the daily exams and dutifully charted detailed notes. I had no idea what we were doing for him or how to make him better.

After another week, Mr Green was discharged. My days filled with other sick patients. Before long, it was back to France to start my second year as a less naive medical student.

Since my introduction to clinical medicine that summer at Hahnemann, I've treated patients for more than 40 years. No one else ever exploded.

Learning From the Human Tragedy

It's sad that a great institution such as Hahnemann University Hospital could not find a way to stay afloat. Patients like Mr Green will suffer. Although many will obtain care at neighboring institutions, some will fall through the cracks, suffer unnecessarily from their illnesses, and die prematurely. It's a human tragedy.

My vivid experiences at Hahnemann helped propel me through internal medicine and neurology residencies, an epilepsy fellowship, and a long and continuing clinical career.

I feel sorry for the residents and faculty who must somehow find new positions. But wherever they go, I'm sure they'll carry some unique memories with them.

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