Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Right Angle Club, 2018
New topic 2018-02-03 03:54:38 description

Bob Gill, M.D.

Because just about all medical internships still begin on July 1, I'm pretty sure I first met Bob Gill on July 1, 1948, which I remember was a very hot day in Philadelphia, especially in the old historical library of the Pennsylvania Hospital. That's the first hospital in America, and therefore the site of the first internship in America (Jacob Ehrenzeller). For alphabetic reasons we sat next to each other and were assigned as roommates on the third floor of the original old building. Since Bob's later life was distinguished by quite a bald head, this first meeting with Bob Gill was striking for remembering his original ("cute") widow's peak, which he soon lost forever. All eighteen of us two-year internet wore starchy white uniforms, probably the last time they were all so well ironed at the same time. The hospital laundry did wash them, but we bought our own, so uniforms were far from uniform. We shared the rigors of a two-year internship, without salary, rotating through all the services in preparation for general practice, but ultimately to measure up to the standard that you ought to become a doctor before you became a specialist. Today, an intern is paid about fifty-six thousand dollars a year. But there's a deceptive hook to that comparison.

The days of our 1948 internship followed the stock market crash of 1929 and the commodity crisis of 1930,s, -- years of depression, followed by wars and post wars, eventually finishing with two years of Korean War. We recognize now those were deflationary years, brought on by years of paying off the debts of World Wars I and II. In 1900 Philadelphia was thought to be the richest city in the world, eventually converting family-owned businesses into stockholder businesses, thus allowing industrial ownership to shift to Wall Street in New York. (There was also port-destruction by the maritime union, and wage-depressing migration from the South, suppressing wage levels, of course.) The consequence was protracted recovery from economic deflation, explained by conflicting theories of Maynard Keynes and Milton Friedman. Both were slow to perceive that medical revenues rose more slowly than economic circumstances justified for rapidly improving medical care; while the U.S. simultaneously struggled to pay off its war debts. Part of this was intended to hold down medical costs when corn flakes were substituted for beets and boiled potatoes for the resident medical staff.

Our grandchildren were to enjoy higher dollar income for doing easier work, yes. But grandchildren also accumulated a two hundred thousand dollar matching debt, mostly paid by the federal government, and often repaid later with federally-subsidized resident salaries. My grandson and I were to end up in substantially the same penniless condition, by different routes. Despite nine years after college without income, my generation never regarded itself as poor, because our future was bright. My grandson's generation, by contrast, enjoys a training period he seemingly hadn't earned. The big financial winners were the hospitals, insurance companies, and drug firms. The public may have added thirty years to its life expectancy, but could eventually foresee medical costs rising above what the public could afford. Although this complexity is considerably understated, essentially we had stretched ninety years of progress across forty years of revenue, It's almost too late to compensate the people who made the sacrifices, so we mostly compensate people who had other goals. Future sacrifices will be made by those who will almost surely outlive their retirement savings.

There's a trick to starting the internship on July 1. Without noticing it, the fourth of July quickly follows, and everyone else has arranged the schedule to have the newcomers suddenly in full charge of a hospital after three days of becoming a doctor. Let me tell you it is both a frightening experience and a totally unexpected one, with the fourth of July fireworks echoing three blocks away. Years later, I inventoried the records of the Pennsylvania Hospital for July 4, 1776. Not a great deal different from 1948.

Half a block away from the hospital was the mansion once occupied by Nicholas Biddle, comprising thirty or so rooms, reminding of the days when this was a rich neighborhood. One of Bob Gill's patients ran the Redevelopment Authority and offered the white elephant to Bob for the obvious bargain price of $25,000. It was no bargain because you could buy many similar neighborhood houses for $1500. The Biddle mansion had one condition; it had to be used as a single-family dwelling, so we had to split up our partnership since he had to run a medical office in it to afford it. Today, it posts a for sale sign for three million. Bob gradually filled the house with antiques and built up the Philadelphia equivalent of a Park Avenue practice in it, half a block from the increasingly posh hospital. Although Ben Franklin's own handwriting declares it is to be used for the sick poor, and if there is room, for those who can pay, the neighborhood circumstances gradually forced it into the mode of a fancy teaching hospital. It went from poor to land-poor, and eventually back to posh. In 1948 it was still a public charity, not finding it even worth-while to try to collect a 50-cent fee in the accident room.

Bob who died a few days ago at age 95, was one of three internets who were married, the rest of us stayed in the dormitory and played bridge on weekends. He was three years older than the rest of us because he started his educational career intending to become an engineer. Instead, he became a family doctor to the richest people in the city, as well as a member of the best clubs in town, and a famous historian of colonial Philadelphia. As a curiosity, he became increasingly British in his affections and interests, disappearing to London for long periods, and affiliated with many British organizations who for all I know regarded him as a British ex-patriot. He and I often enjoyed Thursday night roast beef at the Union League, single malt scotch at the St. Andrew Society, and his rehabilitated house gradually came to resemble a house on Wimpole Street. Nicholas Biddle once kept a baby elephant in the back yard, so it's not surprising to learn he had more outside yard space than I did in the suburbs, in retrospect a poor choice of real estate on my part.

Originally published: Monday, February 12, 2018; most-recently modified: Wednesday, May 15, 2019