Call Us → 212-616-5810

St. Vincent’s: The Hospital as Mirror

St. Vincent’s: The Hospital as Mirror

The Observer 4/20/2010

by Emily Geminder

St. Vincent’s vanished in pieces—the ambulance service went first, and the maternity ward, oddly enough, was among the last, departing with a rousing 6-pound, 15-ounce yowl. “The Wall of Hope and Remembrance,” as it’s come to be called, disappeared years earlier, but the pasted words remain, slightly cryptic in all their weighty grandiosity, testifying to their mute slab of hospital brick.

For years, the wall on West 11th Street was a shrine of photographs, hasty fliers, scribbled pleas—all amassed in the days following September 11, when the city’s center of gravity shifted southward, and St. Vincent’s, the only emergency room below 59th Street, became a point of convergence. It wasn’t the city’s only impromptu memorial, but it was the one that stuck, glued to the hospital wall for years, a curiously paused still frame in the city’s onward rush.

In any city—but particularly a city as averse to dying as New York—a hospital is a kind of vanishing point, the closest thing to a reprieve from the implacable mantra onward. (Manhattan outlawed cemeteries, if not mortality itself, in 1852, and started shipping its dead to the outer boroughs.) Nineteenth-century hospitals like St. Vincent’s emerged as stopgap antidotes to a new industrial landscape, one that churned its largely immigrant labor force through brutal working conditions and left them, as labor leader Ira Seward put it, “within a few days of want, if through sickness, or other misfortune, employment suddenly stops.” St. Vincent’s offered sustenance and a bed, a respite of temporary stillness, a glorified poorhouse putting on medical airs.

If, in its haste to master the modern science of bed turnover, St. Vincent’s lost that sense of sanctuary, it at least served as a partial remedy to the city’s chronic amnesia. Among the memorials New York has never built is a memorial commemorating its more than 85,000 AIDS deaths. At a time when efforts to ban discrimination based on sexual orientation were being roundly condemned by the Roman Catholic Archdiocese of New York, the hospital rooms under its tutelage overflowed with gay men, as St. Vincent’s emerged as the unlikely ground zero in the AIDS epidemic. In the 1980s, roughly a third of its AIDS patients died each year, and for that, St. Vincent’s was a kind of mute testimony.

WHEN A STORM unhinged its plexiglass encasement several winters ago, the contents of the Wall of Hope and Remembrance were gathered into binders, four of them, and entombed alphabetically in the annals of hospital storage. The Sisters of Charity who served as its guardians intended to restore the wall eventually, but in 2005, St. Vincent’s underwent the costliest hospital bankruptcy in the history of New York. Historic preservation plummeted on the triage list.

In fact, the hospital’s final years were marked by a series of protracted battles with Greenwich Village residents, who argued that the institution’s development plans would mar the neighborhood’s historic texture. Following bankruptcy and several shifts in administration, St. Vincent’s hired a slew of pricey consultants–seasoned veterans of the hospital-industrial complex—and recruited celebrities to the cause (among them Eli Manning for roughly $600,000). The board of directors, in conjunction with real estate developer Rudin Management Company, laid out plans to reconfigure the hospital’s unwieldy layout, dispersed across several blocks, into a single, streamlined facility.

To clear the way for new construction, the proposal called for the hospital’s most famous structure, the bucktoothed former headquarters of the National Maritime Union, to be demolished. (That when St. Vincent’s purchased the porthole-bedecked fortress in 1973 the building was barely a decade old and already symbolized things long gone–a New York City with port jobs and a resilient organized labor movement, for instance—maybe should have been taken as a portent of things to come.)

And—because what in Manhattan would ever get built without it?—the cylindric new edifice would be accompanied by a luxury residential condo, the spoonful of high-rise incentive for Rudin. The opportunity to insert a shiny glass chunk of real estate into one of the city’s most lucrative housing markets (and a landmarked historic district, no less) could make even an unpalatable nonprofit hospital project go down.

Unfortunately for Rudin and for the hospital, Village preservationists had their own team of celebrity crusaders. Eli Manning proved no match for the likes of residents Susan Sarandon and Tim Robbins, who sung the praises of the neighborhood’s special properties as an artists’ colony (though real estate prices had long ago pushed out the artists) and the stunted Village skyline (no longer quite so stunted).

But when Ms. Sarandon announced she wouldn’t bring her children to St. Vincent’s, she was merely corroborating what was already spelled out in hospital statistics: In 2008, only 14 percent of the hospital’s inpatients were residents of surrounding ZIP codes. And though the inpatient admissions—the revenue that greased the wheels of the operation—dropped by 10 percent, the emergency-room volume surpassed the citywide rate, largely made up of patients from Brooklyn, Queens and Manhattan’s few remaining working-class enclaves, such as neighboring Chinatown.

The preservationists’ chants of “Save the Village!” were perhaps a little late. To a long-departed isle of bohemian misfits, St. Vincent’s had been a stalwart: It gave Edna St. Vincent Millay her name and Dylan Thomas his last breath. Innumerable artists, alcoholics, addicts and exiles passed through its unremarkable rooms. But that Village didn’t exist anymore, except maybe as a patchouli-redolent pantomime on Bleecker Street. Members of the modern-day Village set were equipped to pay their way into the city’s state-of-the-art medical havens. In the way that health care always seems to, it came down to a question of access, which is really a question about money.

THE REQUIEMS FOR St. Vincent’s, composed even before the last siren wound its way through lower Manhattan, recalled its historic junctions with the narrative of New York: The 1849 cholera epidemic! The sinking of the Titanic! In a compulsively reinventing metropolis, where the blocks barely hint at themselves before receding and the skyline never sticks to its own story, the 160-year lifespan of St. Vincent’s was practically biblical.

But, in truth, the hospital’s most lasting legacy has more to do with the complex financial and social algorithms we employ to care for our sick. Like all hospitals, St. Vincent’s was a place of odd and jarring extremes-magnetic resonance imaging cut through the sludge of flesh with molecular grace, the intimate geographies of bodies collided with the bluntness of impersonal enterprise. The hospital’s linoleum arteries, crowded with institutional smells and the intractable meter of bed-management, witnessed moments of quiet wonder. Patients who couldn’t afford health insurance spilled out of its emergency room, while down the hall medical machinery worth millions of dollars whirred to life.

The modern dialectic of cost-shifting perhaps belies the fact that hospitals, in one way or another, have long depended on the rich to subsidize the poor. The four Sisters of Charity who founded St. Vincent’s—a 30-bed operation in a brick townhouse—were among the legions of 19th-century Catholic nuns who viewed the vast American landscape, untempered with social institutions, as a great civilizing mission. By 1853, just four years after the hospital opened its doors, demand for St. Vincent’s beds outpaced the sisters’ reserves, according to Bernadette McCauley’s Who Shall Take Care of Our Sick? Roman Catholic Sisters and Development of Catholic Hospitals in New York City.

As one early steward of the hospital somewhat prophetically observed, “Building … in New York is expensive.”

With that dictum in mind, the sisters dreamed up an early version of modern-day cost-shifting: Essentially, they took one hospital and made it into two. In the original St. Vincent’s, things stayed much the same; down the block, patients entered a St. Vincent’s with plushly furnished rooms, ample privacy, and all but mini-chardonnay bottles. It may have been the first concerted effort to turn the rich into hospital patients. (Until then, they preferred to die in private.) At the turn of the century, even the generously endowed New York Hospital, considered the city’s locus of technologically advanced care, had only six private rooms.

FOR MUCH OF their existence, private nonprofit hospitals like St. Vincent’s shared the burden of caring for the uninsured with the public hospital system. But that changed in the late 1980s, as a number of forces—diminished faith in the public sector, deflating state and municipal budgets, an upsurge in the ranks of the uninsured—converged to form the beginnings of a national health care crisis.

With the capacity of public hospitals eroded and for-profit hospitals increasingly exclusive, nonprofit hospitals weren’t eager to fill the gap in coverage. Both government and private insurance measures to control health care spending—slashing Medicare and Medicaid reimbursement rates, for instance, and ending the practice of Medicare-financed capital improvements—put pressure on already strained hospital finances. Without Medicare to finance the inexhaustible stream of new medical devices, nonprofit hospitals, in order to remain competitive with the private sector, began issuing bonds, suddenly beholden more to Wall Street investment analysts than to God-given mandates.

St. Vincent’s, where the Sisters of Charity had once independently choreographed all finances, stocked its boardroom with experts in the arcana of managed care, fluent in the ever-shifting acronyms of insurance reimbursement. Now a veritable industry, health care was manufactured and consumed, hinged to the fluctuations and demands of the market.

Among the hospital’s competitors for market share was Continuum Health Partners. Former CEO of its St. Luke’s-Roosevelt Hospital Center is State Health Commissioner Richard Daines, regarded by some within St. Vincent’s as the angel of death that hovered over the hospital. Continuum, which also runs Beth Israel Medical Center, is expected to see increased inpatient volume due to St. Vincent’s closing. It is also in the running to manage a prospective urgent-care center in the area.

Meanwhile, as the state threatens to pull up to $370 million from the city’s public hospitals, citywide admissions rates for uninsured patients jumped 14 percent over the last four years. St. Vincent’s closing is expected to translate into an annual 20,000 more ambulance visits to Bellevue.

IF HOSPITALS ONCE provided brief sanctuary from a ravenous new breed of industrial capitalism, they’re ever more subsumed into the market ethos. What will become of St. Vincent’s? The National Maritime building was once called the “box the Guggenheim came in.” Maybe it could be a museum. More likely it will be luxury condos after all.

What’s surprising now about the pieces of paper that once covered St. Vincent’s isn’t so much, as newspapers were quick to point out at the time, the wide and divergent multiplicity of their humanity, but that there is a certain hieroglyphics of grief, and for a few days everyone shared it. They speak in codes—”Last seen WTC2 F86″—and litanies of personal details, in smiling, centrally located photos, and above them in bold font, the word “Missing.”

In the end, it wasn’t photographs or inventories of birthmarks city officials asked for. Licked envelopes and tufts of hair displaced images as the required modes of identification. But the wall on West 11th Street remained, filling other functions, becoming as the days went on a kind of continually annotated conduit: construction-paper hearts, stuffed bears, sonograms. In other words, the ways the living talk to the dead.

If there’s a fleeting antidote to the doctrine of commerce all but encoded in the city’s DNA, it’s the feeling quickened by places like hospital waiting rooms, graveyards, shrines of photographs, a sense of proximity to things unknown. Which is maybe why we so seldom memorialize the dead in New York, sending up sky-high glass mausoleums instead.