have also been able to accomplish thernfollowing on a shoestring budget: learnrnto quilt and can fruits; raise broiler hens;rnreceive a master’s degree and write a doctoralrndissertation; help my husband in hisrnhome business (a school); run successfullyrnfor Amherst Town Meeting, twice;rnmanage Pat Buchanan’s Bay State campaign;rninvite an inner-city child to vacationrnin my home by being involved withrnthe Fresh Air Fund; do freelance writingrnand interview such people as Newt Gingrichrnand Martin Luther King III; advisernother mommies to homeschool or bust;rnand learn to lift weights.rnPerhaps to the local reporter I was arnquestionable award winner, but just likernthat other homemaker from hell—Morticia.rnIsabel Lyman writes from Amherst,rnMassachusetts.rnHEALTHrnHospitals andrnHotelsrnby Ernest van den HaagrnOnce in a while I have to go to a hospital.rnMost people do. Of course,rnI go for medical reasons and don’t expectrnit to be a pleasure trip. Fortunately, thernmedical care I have received in New Yorkrnhospitals is superb. But hospitals alsornfunction as hotels and restaurants. Patientsrnmust be lodged and fed in additionrnto being treated. The food and hotelrnservices provided by hospitals arernabysmal (though in rural hospitals theyrnare a little better). Why?rnHospitals only grudgingly recognizernthat they are not solely medical institutions.rn”This is a hospital, not a hotel” isrna familiar refrain—as though the twornfunctions were mutually exclusive. Historyrnshows why bad food and discomfortrnhave always accompanied good medicalrncare. Hospitals started as eleemosynaryrninstitutions for the poor. Physicians didrnnot want to go to the slums to see poorrnpatients, who could not pay anyway, andrnso hospitals were founded to take care ofrnthem. Because the poor were gratefulrnand undemanding—they certainly didrnnot complain about a lack of comfortsrnto which they were not accustomedrnanyway—hospitals grew used to offeringrnonly a minimum of comfort. They stillrndo, and this eleemosynary tradition hasrnremained very strong. Administratorsrnare only fitfully becoming aware thatrnthey run a business, which includes hotelrnand restaurant functions in addition tornmedical care.rnConsider some of the unnecessary discomfortsrnwhich hospitals impose on patients.rnIt takes only a few moments tornregister in a hotel. In a hospital, I, an ambulantrnpatient, am sent from person tornperson with intermittent v^’aiting for oftenrnan hour, just to register. Yet, my doctorrnhas already reserved a place for me,rnand I—for that matter, most patients—rncame insured and with credit cards.rnPrivate rooms are far smaller than anyrnhotel would dare offer. There is a bedrnand a chair or two. No vase for flowers,rnno table, scant closet space, and no lamprnover the bed which makes reading quiterndifficult, and no controls for patients tornregulate heat or air conditioning. Thernbeds are often uncomfortably narrow—rnsupposedly to facilitate the tasks of physiciansrnand nurses—^but 1 have seen no services,rnor examinations, facilitated by thernnarrowness of the bed. The mattress isrncovered with plastic, which makes thernpatient slide around wildly. This is tornprotect it from incontinent patientsrn(very few are). Nurses are not allowed tornremove the plastic cover.rnRooms are first attended to by a workerrnwho makes the bed, then by anotherrnwho mops the floor, and finally by a thirdrnwho empties wastebaskets and cleansrnbathrooms. They arrive at differentrntimes, disturbing patients at least threerntimes a day. Hotels manage to mergernthese three operations into a single visit.rnIt is almost impossible to persuade hospitalrnpersonnel to knock before enteringrnone’s room, or to close the door whenrnleaving. For nonambulant patients thisrnis quite a problem. But unnecessary deprivationrnof privacy seems de rigueur inrnhospitals.rnFood has to be ordered 12 hours in advancernand is available only three times arnday at fixed mealtimes. (One cannot orderrnbeer or wine with meals.) Nor canrnone order anything—not a cup of coffee,rna glass of juice, a sandwich, let alone arnhot dish—outside mealtimes. Unlikernhotel guests, patients cannot eat whenrnand what they would like, and howeverrnwilling one might be to pay, one cannotrnobtain items ordinarily on restaurantrnmenus. On the other hand, full board isrncharged whether or not one wants to eatrnthe meals provided. Patients who ask forrnthe food they prefer are regarded asrnfrivolous nuisances. They are remindedrnresentfully that “this is a hospital,” asrnthough this justifies unnecessary deprivationrnand discomfort.rnHospitals also are remarkably noisy.rnNurses’ aides and cleaners shout at eachrnother from one end of the corridor tornanother. When they do not conversernloudly, they whistle. (Hospitals inrnSwitzedand, Italy, and Germany are veryrnquiet places.) Doctors do not like thernnoise either, but feel powerless. Theyrntell patients that the hospital unionsrnmake it impossible to discipline the custodialrnstaff. However, hotels that havernsimilar problems succeed and are muchrnquieter than hospitals. But hotels are interestedrnin the comfort of their guests—rnhospitals only in their health, conceivedrnas though excluding comfort.rnAs mentioned before, privacy is routinelyrndenied patients. They cannotrneven refuse to see visitors. Some yearsrnago, a nurse from a local hospital calledrnto tell me that a patient, in the intensiverncare unit with a heart attack, urgentlyrnwanted to see me. I protested that I didrnnot know the patient and could not be ofrnassistance. But the nurse insisted thatrnthe patient was dangerously agitated andrnthat just visiting him would help. So Irnwent.rnThe patient, whom I’d never seen before,rnexplained that he had attended arnlecture I gave and thought I would bernable to help him. He was dying, and wasrnalso in the throes of a messy divorce. Hisrnex-wife feared that he would disinheritrnher. She had hired an attorney. This ladyrncame to the hospital every day to discussrnher client’s demands and to ask thernpatient to sign papers. He did not wantrnto see her; she upset him. He had so advisedrnthe nurses, but the undesired visitsrncontinued. I spoke with the nurse inrncharge, who told me that she had conveyedrnthe patient’s desires to the visitor,rnbut did not feel able to prevent the visits.rnI called the attorney, who respondedrnnoncommittally and called me back a littlernlater to inform me that she had foundrnme to be neither a physician nor a memberrnof the bar (I had not pretended to berneither) and that consequently she wouldrnignore my request to stop the visits. Irncalled the resident to inform him of thernsituation, and was told that he had norn46/CHRONICLESrnrnrn