Philadelphia Reflections

No Well-Run Hospital will Tolerate Bullet Holes

When they repaired our bullet hole at the Delaware Hospital recently, it was much more than a renovation of the clinic pharmacy. It symbolized a new generation assuming power in the hospital.

There were originally three bullet holes in the clinic: mine, Mrs. DuPont's, and the pharmacy. Mrs. DuPont and mine were quietly patched soon after the incident, but the small hole in the ceiling above the pharmacy window went unrepaired for ten years. That was not an oversight.

Hospital people who were active spectators of the shootout repeatedly protested any attempt to repair the small unobtrusive hole in the false ceiling, bothering no one but symbolic to a cluster of insiders. Even when the wing was completely gutted and renovated, that small patch of the ceiling was left untouched. Because some of us wanted it left alone, our wishes were respected in "our" hospital. The Delaware Hospital, you see, once experienced a shooting incident. It happened very much like a certain episode in the movie called “The Godfather”, and indeed the recent criminals may well have got the idea from the movie. In any event, a very dangerous criminal was actually brought from prison to the hospital to have an x-ray. Ordinarily, prison authorities give inmates no advance notice they are going to the hospital. However, this prisoner was to have his gallbladder x-rayed. We don’t x-ray gallbladders this way very much at the present time (ultrasound examination has largely replaced x-ray) but in those days it was necessary to swallow several pills the night before, so the dye could have time by morning to concentrate in the gallbladder. Therefore, when the prisoner was given the pills to swallow, he knew he was going to the hospital in the morning. His buddies on the outside knew he was going too, and where he was going. How this grapevine works is, of course, a mystery, but it is natural to surmise some prison guard accepted a bribe.

So on a nice uneventful diabetic clinic morning at the hospital, the prison guards arrived with their manacled prisoner, marching him down the clinic corridor toward the x-ray department at the end of the hall. As this jaunty group passed the men’s room, the prisoner pleaded to be allowed to relieve himself. The guard went into the men’s room with him, unlocked his handcuffs, and waited. After washing his hands, the prisoner pushed a crumpled paper towel deep into the trash can, seized the gun which his buddies had previously hidden there, and wheeled around, shooting.

His getaway was well planned and smoothly executed. Everyone in the area dived for cover as he fired shots in random directions. By the time people began to peep, he had run down the hall, out the door, and into a waiting car. He was gone.

One of the volunteers in the clinic was a certain Mrs. DuPont, also a member of the board of trustees of the hospital. She was about thirty-five years old, surely one of the ten most beautiful women in the nation. How close the bullet really came to her I don’t know, but it was certainly closer than any bullet had ever come before, and she was scarce to be blamed for feeling she had a close call. My bullet was lodged in the wall a foot or so from the desk where I usually sat on Fridays, only this wasn’t Friday so I wasn’t there to have a close call. But if it had been Friday I might well have been sitting there, and I might well have had a close call. I mean, this event was really exciting.

So we all had a lot to talk about, with a lot of close calls we almost had. A group of old friends and old casual acquaintances were united in a shared experience which provided a welcome common topic of conversation. The doctors and the orderlies, the chambermaids and the heiress, the nurses and the administrative clerks, had a common event. Even if any of them manage to live another fifty years, I suspect they will rejoice in meeting anyone who can reopen the reminiscence.

The group had a strong sense of fraternity even before this notorious event, but it was formal. Titles were used, rules were pressed, formalities respected. The nurses wore the caps of their diploma schools, the volunteers wore pink aprons, the interns wore white suits. The attending physicians wore street clothes but they were a sort of uniform, too. In Wilmington, I wore a non-matching tweed jacket and grey flannel pants, like the other doctors. In Philadelphia, In some circumstances, it would have been a dark suit. The clinic ran by rules finely understood even if entirely unwritten. It was quite acceptable to ask Mrs. DuPont to dispose of a bottle of urine, but it would have been unthinkable to ask her to have lunch. We all nodded and smiled at each other in passing, but we didn’t chat except within our own groups. But the shooting episode was an enduring ice breaker. It was something you had in common with the clinic group, to which everyone else was an outsider. People retire, people, die, Times Change. New brooms sweep into administration and unknowingly sweep aside old icons. A new pharmacist regarded the bullet hole as a small curiosity which someone had told him about. A new head nurse had other things to worry about.

On the fourth or fifth time the contractors set about to patch the ceiling over the pharmacy window, no one of the original group was present to intervene. Since the area had been so totally renovated as to be almost unrecognizable as the old clinic with curtains between the beds, the little bullet hole was the last link with the past for the dwindling but still fairly numerous group of people who remembered another era. It is perhaps most forgivable for the heedless young professionals who bustle through the place, not to have known nor even to recognize the name of Dr. Lewis B. Flinn. Dr. Flinn died a few years ago, in his eighties, looking like a Roman Senator almost to the end.

Lew Flinn dominated the medical scene in the entire state of Delaware, but particularly in Wilmington, for sixty years. There were those who called him a dictator, but he was so universally revered it was difficult to find a single person who would criticize his decisions and actions. Some people, particularly the outs, the people who don’t count, resented his power and prestige. But in the thirty years, I knew him, I never heard of serious opposition to even one of his proposals. Lew Flinn can fairly be said to have transformed Delaware medicine from a second- rate hodgepodge into a professional environment of the first rank. Within the smallest state in the Union, he created the second largest private hospital in America. Late in his career, he investigated the idea of founding a medical school in Delaware and concluded without serious opposition that the quality of physicians in Delaware would be harmed by it. A new medical school takes time to amount to something and provides second-raters until it gets established. By contrast, Delaware was currently able to attract the cream of Ivy League schools to practice there, and it would be a step back to do anything but continue the process. There was nothing prideful in this conclusion, but there could have been. When Lew Flinn first came to Wilmington as a doctor he was diving into a pool of third rates, and misfits. Why in the world would an honor graduate of John Hopkins want to practice in Wilmington?

Lew Flinn was in fact such an honor graduate of John Hopkins that he eventually acquired certificate number one, of the American Board of Internal Medicine. With his training and natural ability, Flinn could have mattered anywhere he wanted to. He could have been successful in just about any medical career. Instead, he chose to come back to his home town. And make something of it.

Flinn had everything, absolutely everything. Wealth in the family, excellent connections, brains, and training. His manners were so instinctively gentlemanly that the simplest conversation would intimidate any awkward soul who was unable to match the occasion with the appropriate response. He could be brisk and disdainful, and commanding when the situation called for strength, but he seldom needed to call on anything but gentle persuasion.

However, of all the qualities which served him in his career of transforming Delaware medicine, surely the most important one was physical beauty. Eyebrows tend to rise at that kind of a statement. Nevertheless, a true understanding of the magnetic power of the man is best acquired by going to the Delaware Academy of Medicine building overlooking the pictures of former presidents. The first picture on the wall is of Lew Flinn, at perhaps age thirty. No movie star ever had a publicity picture taken which radiated a more electrifyingly handsome profile. When Lew Flinn approached a DuPont heiress with a request for money for the hospital, he got it. And his courtly manner turned the response of men from envy to admiration. If you want to get things done, look and act like that. While it was absolutely impossible to think of Flinn as a philanderer, it is easy to see why he was an irresistible medical evangelist.

Wilmington had four hospitals during the early decades of Flinn's career, and three of them were supported by different owners of the DuPont company. Flinn concentrated on the Delaware Hospital, but he also was active in promoting the Memorial and the Wilmington General Hospital. Eventually, he became chairman of the Department of Medicine of all Three. That may have seemed like a bit much to some of his colleagues, and at one point he was voted out, by the Medical staff of one of them. His power and prestige at the Delaware Hospital were never challenged, and he steadily built up its medical staff by recruiting specialists from out of town to came to Wilmington; I was one he recruited. He appeared out of the audience at a Chicago meeting where I gave a paper and invited me to have dinner with him. I can think of no other reason why he would have been at the meeting, and I heard similar stories from others who were recruited. I don’t believe he was ever paid a penny for his administrative work.

Flinn became a member of the board of trustees of the hospital, and from that position was able to advance the hospital in a number of ways. He knew what the town needed in the way of laboratories, equipment, and specialists. The trustees were guided into doing all the expensive things which make a hospital into one of the best in the country. He saw to it that the doctors were pampered. They had their own lounge and coat room, constantly supplied with hot coffee and daily newspapers. There was a separate doctors' dining room (the senior hospital administrators ate there too and were welcome members of the medical community), there were white table cloths. On Friday, fish day in that era, there was an oyster stew or lobster bisque. It was a great clubhouse to have around and it was so by design. It was lots of fun to come from Philadelphia, attend a doctor’s conference, work in the free clinic, and adjourn for lunch. Flinn built up a medical staff by courtesies when no other inducement would have done the job. We all liked each other.

It made Lew Flinn uneasy, to have to describe to other people what he was up to, what his plans were. If he proposed something, it was a proposal for immediate action and he meant to have it happen right now. On one occasion, though, he confided in me his philosophy of teaching programs for the internet and residents. He was not particularly interested in attracting resident physicians to the hospital, although they were welcome enough. The purpose of the teaching program for the interns was to serve as a framework for continuing education of the practicing physicians of the community. He fed them oysters to get them to come to the conferences and to have lunch with other practicing consultants in the dining room. You educated practicing doctors by asking them to help educate the interns.

After he retired, he embarked upon the project which was his greatest achievement, the unification of the three hospitals into the Delaware Medical Center. His reasoning was not so much that consolidation would reduce duplication of equipment, although that was an argument. The main need for a 1200 bed institution was to create pools of patients which were sufficiently large to make it possible for a specialist to make a living. When that was possible, Delaware could relax its constant recruitment efforts and expect the institution to generate a first class staff without subsidies or teaching salaries. It is my present information that this plan worked beautifully.

The new building, on ground donated by a DuPont widow, is a spectacular piece of hospital architecture. Money cannot buy a more sumptuous physical plant. One suspects Lew Flinn’s fundraising capabilities were a major factor in the lavishness, probably mostly through a spontaneous wish by his admirers to build a suitable memorial, to his memory.

Originally published: Monday, July 10, 2017; most-recently modified: Wednesday, May 29, 2019