Accent on Living

EVEN the doctors among my friends seemed a bit startled by the financial findings I brought home this fall from a stay of two weeks in a London hospital, so herewith a brief report of the episode. My troubles at the time, a consequence of chronic asthma, are of no interest here; suffice it to say that they led me to telephone an old friend, a surgeon, who suggested that I meet him the next day at St. Thomas’s Hospital, where he would be making his rounds as a staff member. The surgeon turned me over, when I met him the next morning, to a doctor on the hospital’s medical staff, with the result that within a half hour of entering the place I was wearing a rather bright pair of the hospital’s pajamas and was comfortably in bed in a double room.

St. Thomas’s is an imposing series of large buildings, connected by long corridors, extending along the bank of the Thames directly across the river from the Houses of Parliament. My own room was in the unit nearest the Westminster Bridge; it was called the “private patients’ wing,” which meant that the patients were paying their way instead of availing themselves of the free services provided by the National Health program. From my ground-floor window, I looked out at a) a gay and apparently imperishable flower bed in the pavement just outside; b) a glimpse of the bridge with its ceaselessly plodding red buses; and c) a fine view of Big Ben’s tower on the opposite bank.

What set St. Thomas’s apart from any other hospital, for me, was the quality of the nursing services — in short, the general daily care of the patient. The word “dedicated” is much abused, and it does suggest slightly a devotee who might be overdoing it; so I shall say merely that the nurses at St. Thomas’s were extraordinarily competent, diligent women who took a great satisfaction in their work. But they seemed also to hold the concept, which I took to be the result of much training and discipline, of the patient as an individual human being and not as production-line material to be pushed through the hospital’s process. The nurses displayed nothing like a bedside manner, to be put on and off; but one felt instead a consistent courtesy and interest on the part of an extremely well-informed professional. The nurses in this wing were all graduates who had completed their training, and their skill and effectiveness, especially in assisting each other in all sorts of situations, seemed to me remarkable. If a patient pushed his call button, the response was immediate. I realize that there must be enough nurses on duty to maintain standards of this sort, but numbers in themselves do not necessarily create a goodhumored, smoothly coordinated staff. I must remember, friends told me later in almost identical words in England and here at home, that nursing in Britain is a vocation, a highly regarded calling like the law or medicine, and attracts the best young women in the land. As for St. Thomas’s, they said, it still shows the influence of Florence Nightingale, who founded its nurses’ training school and laid down the principles governing the nurse’s duty, among other things, to the patient.

On my first afternoon at St. Thomas’s, I was presented with a booklet describing its history and facilities, and a printed slip setting forth the charge for double and single rooms in the private patients’ wing. The weekly rate, the notice went on to say, included all hospital services, such as X rays, laboratory work, medicines, and such. So it proved to be, and the only additional charge on my bill at the end of two weeks was a small item for personal telephone calls.

The patient was left all possible free choice in following his preferences. It was for him to decide whether to begin with early morning tea at 7 or to sleep until breakfast and the morning papers at 8. I accepted all teas — early, midmorning, afternoon, and late evening — not only because the tea was so good but because it was so genially and smartly served. The delicate little sandwiches and the pastry of the afternoon tea were as good as those in the best London hotels.

Friends who came to see me, British and Americans alike, were prepared to commiserate with me about the food. The British are needlessly apologetic about much of their cuisine anyhow, but the idea of hospital food seemed to strike them all unhappily. I doubt whether any of them believed my pronouncements on the meals, which they thought were a false cheeriness or the vagaries of a man not himself, but the cooking was excellent and entirely to my taste (save for one venture into a mysterious version of breakfast scrambled eggs, an oddity because all other eggs were most artfully prepared). The vegetables, in particular, were flavorsome, the soups powerful and obviously the result of much good kitchen work, and the variety of offerings was all that I could wish. I should have been perfectly happy to continue indefinitely with St. Thomas’s cooking.

The serving of the meals deserves mention. Each morning, the Sister — a title denoting supervisory rank and without religious significance — presented to me the luncheon and dinner menu of the day and made a delightful little ceremony of noting my choices. Breakfast changed daily and was ordered in late afternoon. Dinner and luncheon were served in courses instead of en bloc, and it took three trays to deliver each of these meals. The unfailingly cheery manner of the waitresses in what must have been fairly strenuous work gave a fine lift to every meal. All services were phenomenally punctual.

Shortly before I was discharged from the hospital, I asked my physician about his fee. It was through my friendship with the surgeon that I had been referred to him, I said, and I did not want friendship at any stage to deter him from charging me for his services; in fact, I felt that he ought to present me with a substantial bill.

The physician replied offhandedly that the amount of his fee was not up to him but was fixed by the triangular arrangement between the hospital, the patient, and himself. “The arrangement,” he said jocularly, “is designed to protect people like you from people like me.” The charge arrived at, which appeared in my final bill, seemed to me very low indeed, and I asked him later whether the general financial basis of his work under such arrangements was satisfactory. Yes, he said, it most certainly was: formerly the staff had carried on a great deal of free work, but fees for this were now paid by the government under the National Health Service, and this income, together with that from private practice, was not out of line with earnings before the national program was begun.

St. Thomas’s was certainly the finest hospital I have known. The all-inclusive rate for my double room was approximately $45 a week, the fee for the physician — a specialist of considerable reputation on both sides of the Atlantic — was a little over $70 for fifteen days of daily attendance, and the total charges for my sojourn in the hospital were about $165.