Monday, July 28, 2008

I know How to Win a War

“I know how to win a war.” I’ve heard John McCaine say that several times, but that is a wrongful boast. Strictly speaking, you don’t know how to win a war unless you have already done just that.

Like General Dwight Eisenhower, who led Allied forces to victory in World War II in Europe. He knew how to win a war -- but he never said that. When Eisenhower ran for President in 1952, his military record spoke for itself, and he had no need to boast.

And, based on his experience of military victory and its cost, Eisenhower negotiated a truce in Korea between the American led forces and the Chinese and North Korean communists. It was not a total victory. The fighting stopped in 1953. The two armies, after three years of fighting and 33,000 American deaths, fought to a standstill on a border, called the Demilitarized Zone, where soldiers from these two sides still glare at each other.

Eisenhower did know how to win a war, but in the case of Korea his decision, as President and as Commander in Chief, was that a complete victory was not possible.

Let that be a lesson for both candidates.

HARBORVIEW MEDICAL CENTER. I went down to Seattle last week. The water was sparkling on Union Bay. The Space Needle, built for the Worlds Fair in 1962, still looks beautiful. I visited a friend with a panoramic view of Lake Washington. We sat in cozy armchairs looking out the window at the sailboats far away on the lake, far down the hill. And we had coffee and talked about good fortune and hard times, and she was happy to have her view, but other things were taking her life away.

The next morning I took a busman’s holiday to tour Harborview Medical Center, right near downtown Seattle, in the midst of roaring traffic, situated on top of First Hill with dramatic views of Puget Sound and skyscrapers, ferries, and seagulls.

Harborview is the big time -- over 400 beds, a Level I Trauma Center, and a teaching hospital. I work at a small regional hospital with a helicopter pad on the roof, and we send our most difficult cases by chopper down to Harborview where they have fully staffed surgical units around the clock and a burn unit that takes cases from all over the Pacific Northwest.

Harborview is owned by King County, but staffed and managed by the University of Washington Medical School.

My goal was limited -- could I navigate through this nine-story building with several outlying buildings? Could I make contact with nursing staff who might have a moment to speak with me?

I succeeded. People were friendly, they gave me directions, I found the Kidney Research Institute and the hand clinic -- they have a clinic for everything from bunions to broken bones. And people were willing to answer my questions. But then I’m good at this -- I’m good at observing somebody who might have a spare minute. I’m also good at not caring if they brush me off.

My sense, which I trust, is that Harborview is not wasteful or chaotic. Good things happen

I had lunch in the cafeteria. They have the same steam table that we have out here in the country, with the same mashed potatoes and gravy -- an inviolate hospital custom. There must be a tanker truck coming every day out of Idaho, with a spigot that connects to the kitchen at every hospital in the country -- squirts out the mashed potatoes, drops off a vat of brown gravy, and goes on to the next hospital.

Otherwise -- and I’m coming from a smaller place and prepared to be impressed -- the Harborview salad bar wasn’t very good -- not as good as ours up here in the Skagit Valley.

My friend, the one I visited the day before, she used to live in the Skagit Valley and her opinion is that the medical facilities in the big city are superior in every way -- their doctors are the cream of the crop, with better focus and training, and with more experience doing unusual procedures.

I’ve heard that from other people as well. You even hear it on the radio, like “our hospital does bypass heart surgery 450 times a year, so we’re really good at it, and you don’t want to try some general access surgeon who has only done it three times and might be a little rusty.”

Maybe, but I’m not convinced. Harborview is an exciting and stimulating place -- it’s got major sex appeal, right out of a TV show. The atmosphere of research and education is enlightening, and that is something our smaller regional hospital could emulate. I’ve studied this possibility. Medical research is not just for the big prestigious institutions anymore. The online medical journals show an emerging pattern of doctors from every corner of the globe forming collaborative research efforts -- and simply bypassing the bigshots.

That sounds good to me, and I hope they might try this where I work.

No comments: