A Week In The Life Of... ...A Hospital

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A hospital may be the most fascinating place we never want to visit. We know there are triumphs here: fingers reattached, lungs replaced and babies born, small enough to bathe in a big teacup, who would have had no chance 10 years ago but who now go home and grow up. Maybe they will become doctors too. But it is also a war zone, and if you are not fighting the enemy or loading the weapons or plotting the next campaign, you can hardly understand what a brave, brutal, mysterious place this really is.

That is one reason it has been possible for hospitals to reach a point of crisis without most of us knowing how it happened. When your child is lying on a stretcher, or your spouse is worrying about a lump, there is no time to learn about how these places work. You just want them to take care of you. One of the great democratic privileges of American society is the premise that all people have a right to the best possible care, regardless of whether they have the means to pay for it; the law requires hospitals to treat anyone who walks in the door. But today that promise is caught in a collision between money and medicine that is occurring in hospitals all over the country--nowhere more than in the elite academic medical centers that have always led the way in training the next generation of doctors, inventing the next generation of cures, and providing them to those who could least afford to pay.

When TIME set out to tell the story of what is happening, not just on the front lines but also in the backrooms of American medicine, we sought out the kind of institution best equipped to solve the insoluble problem: a world-class teaching hospital where the same urgency and intellect that is applied to saving lives is assigned nowadays to saving the institution itself. All across the country, teaching hospitals are trying to figure out how to marry progress with profits, how to come up with the money that will let them continue to lead the world in death-defying discoveries, without going bankrupt in the process.

Duke University Medical Center is one of the crown jewels of American medicine. In the labs, wards and classrooms spread out over the 210-acre medical campus in the North Carolina Piedmont, doctors are pushing hard against the limits of our imagination: tiptoeing electronically through the brain in search of hidden tumors, inventing vaccines that might turn lethal cancers into treatable ones, even breeding animals whose organs could one day be harvested for transplant to make up for the shortfall in human donors. These men and women muscled their way through college and medical school and internships and fellowships, just for the chance to work 100-hour weeks, live on hospital food, only rarely find time to see their families or to exercise, and drive cars that are not as fancy as the ones owned by their colleagues down the road at the fancy for-profit hospital. They chose Duke largely because of the scientists here and the work they do; yet they have come to realize that today their survival depends on decisions being made by the suits down the hall in the business office.