Portal de Periódicos da CAPES

Commentary

2013; Lippincott Williams & Wilkins; Volume: 88; Issue: 10 Linguagem: Inglês

10.1097/01.acm.0000434973.33096.68

1938-808X

Joseph J. Fins,

When completed in 1932, the New York Hospital–Cornell Medical Center towered over Manhattan’s Upper East Side. Built amidst tenement houses and steel gas tanks, the only structures of comparable stature were the Queensboro Bridge to its south and the Hell’s Gate railroad bridge to the north. Robert Moses had yet to build the Triborough Bridge, and construction of the FDR Drive would begin in a couple of years. The only other notable structures north of the 59th Street Bridge, made famous decades later by Simon and Garfunkel, were a few brick buildings to the hospital’s south: the Rockefeller Institute, a fabled place of discovery. In a period photograph taken from what was then called the Chrysler Tower, one sees a white shining monolith reflecting sunshine and the goodwill of a citizenry who placed this structure above the rest, making it a monument to healing and scientific medicine. The contrast is stark. Amidst the black and gray tones of an urban landscape, part industrial and part residential, the architectural beauty of the hospital is pronounced. With its neo-Gothic windows and elegant lines, it was a beacon of hope to those who sought relief there. Isolated and pristine in the immigrant Upper East Side neighborhood of Yorkville, the hospital represented all that modern medicine would come to offer. Its innovative and award-winning design was featured in the February 1933 issue of the Architectural Forum.1 But there was more to it than scientific innovation. Although a voluntary hospital, without a religious affiliation, the medical center was a cathedral of healing. Crafted of Indiana limestone and modeled after the pope’s palace in Avignon,2 the structure sanctified medicine and placed it in a priestly tradition. With its etched carvings of Aesculapius’s staff and an ecumenical chapel greeting those who entered the colored marble foyer, the hospital was not focused on the bottom line but directed to a higher plane. Indeed, the visitor traversing the main entrance would have his or her gaze lifted to an inscription framed by three stone arches: Acts 3:2, At the Gate of the Temple which is called Beautiful…. And the hospital was beautiful … and big. The medical center loomed large, but it was always consistent with the outsized place of academic medicine in the American mind. I recall once seeing the medical center as I drove across the 59th Street Bridge with my parents. It was an inspiring vista for a high school student who had just read Arrowsmith.3 When my Dad told me that Rockefeller University was the fictitious setting for the novel, academic medicine’s ability to inspire grew only greater. The connection between academic medicine and Rockefeller University was more than literary. Legendary Paul de Kruif, author of Microbe Hunters4 who collaborated with famed author Sinclair Lewis, had assisted Simon Flexner in his laboratory at Rockefeller. Simon was the brother of Abraham, who wrote the famed Flexner Report that helped catalyze the ascent of academic health centers. All of this came to mind as I was delivering a lecture to second-year Weill Cornell medical students. I was trying to capture the interplay of the history of medicine and the evolution of medical ethics in the 20th century, as seen from a local perspective. I featured notable events like the landmark Schloendorff informed consent decision written by New Yorker Benjamin Cardozo and the role that neurologist Fred Plum (a Cornell alumnus and faculty member) played in the Karen Ann Quinlan right-to-die case. I concluded by returning to the historic photograph of the medical center. Remarkably, it was as if I had never seen the image before. For the first time it struck me: What a towering presence the medical center had been when compared to its surroundings. In years past, I thought of how 20th-century medicine grew into places like the New York Hospital–Cornell Medical Center. When places like these were first built they were more a promissory note of what modern medicine might achieve than what was possible back then. I suddenly realized they were outsized in their hopes, certainly by an architectural metric contrasting their footprint with their environment. Now, 80 years after the opening of the New York Hospital–Cornell Medical Center, it seems fair to say that academic medicine has fulfilled much of the promise envisioned by its builders nearly a century ago. Yet today, academic health centers no longer loom as large in the public consciousness. Some might say that they are fighting for their very survival, with their tripartite mission of teaching, patient care, and discovery under threat from health care reform. But if one picture is worth a thousand more words, one need only look at the modern image of the medical center against the backdrop of a built-up Manhattan skyline. The medical center no longer stands alone but is nestled into a crowded cluster of other skyscrapers. Other buildings tower over it and boast more dramatic styles and colors. In its modern pose, the medical center is almost lost in the picture. But even now, for me, it will forever be a beacon on the hill.