Promises Kept - 2

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Bellevue Hospital in New York City is the flagship of the city's Hospital network. Affiliated with the New York University Medical School it is a widely-recognized center of excellence. In addition to its outstanding reputation as a hospital, it provides Hospital services for the seriously mentally ill and for inmates of the municipal jail system. Both the mental wards and the prison worlds are entities unto themselves.

As a young physician in training, I rotated through both units. To access the prison ward, one had to be passed through several locked gates. Once inside the ward, it was a medical ward like any other save for the incredibly negative vibes emanating from the surly, mostly Latino and Black, population. My orientation to the unit by the police supervisor was short and to the point. "Do you see that large heavy-set black fellow with the yellow bandana around his brow? He runs the unit. He enforces discipline. If an inmate is not cooperative, speak to him. He runs the place. He administers justice among the inmates. His word is law."

"Next warning! Never go into the inmates' bath or shower rooms. If you need someone who is inside either of those facilities, ask one of the inmates to send him out. We don't control and don't want to know what goes on in those premises. They rule there."

As chance would have it, the prisoner who ran the place, who we will call Ruby, was assigned to me as a patient. He was in jail, having been accused of running one of the larger heroin distribution networks in Harlem. On admission to the City's Riker Island prison, he collapsed and was transferred to the Bellevue prison ward. He had not yet made a court appearance.

Ruby had severe disease of his heart valves resulting from Rheumatic Fever as a child. It was clear he was going to need major heart valve surgery and it was clear that the only opportunity for him to have what was then an innovative and challenging procedure was to have it during his forced admission to the Bellevue Hospital ward. There his surgery would be carried out by surgeons-in-training under the supervision of a world-class surgeon who was the Department Chairman at N.Y.U.

At this point, Ruby had been under my personal care for about ten days and a relationship had developed. He asked my advice, should he consent to the surgery. In the course of our discussions, I pointed out to him that his physical illness had been handicapping him for years. That successful surgery would not only assure a longer lifespan but he would also feel significantly stronger. I also suggested that if the surgery was successful, he might be interested in a change of lifestyle. I emphasized to him that he had excellent organizational and management skills. That those skills could be utilized both to bring personal success and enable him to contribute to his community. He agreed to the surgery and was transferred from the medical to the surgical ward.

Four months later, I encountered Ruby again. As a physician in training, I had clinics at Bellevue Hospital in which individuals with significant medical, and in this instance cardiac, problems, were followed over time as outpatients. These Thursday evening Bellevue Cardiac Clinics had been organized by the Founders of the American Heart Association and were a paradigm for community health care. It was a privilege to initially learn there, and then over the twenty-five years that I taught at NYU to be associated with that clinic. Ruby remained my patient over those twenty-five years. He became, over time, the owner of the largest Cadillac dealership in New York City and a community leader in Harlem. He had thrived after the surgery. He had kept his promise.