Going up, please

Every morning, our team faced the same difficult decision: going up the stairs or getting on the elevator. It was OK to do an hour on the stair stepper, but actual steps were a different ball game.

This time we were going up to the sixth floor to see Mr. Otis, a new patient who had just been admitted from the emergency department. The elevator was fairly full, but we squeezed on, not wanting to wait. After entering the elevator, I read the sign to the right of the door that said “Maximum capacity: 1400 kg.”

“Interesting,” I said. “Since every patient in medicine weighs 70 kg, this elevator could hold 20 patients. I wonder what would happen if we were to go above this weight?”

As a medical student, I should know that every time I ask a question, I will get a question for an answer. “What do you think would happen? Why don't you look it up? Look under the section on gravity,” Dr. Newman replied.

The doors of the elevator closed and we were on our journey to the sixth floor. Suddenly we heard a strange noise; the lights turned on and off as if we were blinking, and the elevator car jerked to a halt. Now we were stuck in the nether region between floors three and four. “I'm glad I brought my coffee with me,” Dr. Newman said, happily slurping.

Since we now had time to think and talk, Dr. Newman asked me—in his usual tangential style—if I knew the history of the first elevator at our hospital. This time I was ready for him, having spent the evening before prepping on the history of the Mayo Clinic.

“Dr. Charlie Mayo decided to copy a hydraulic elevator he had seen in Paris. He built the elevator resembling a syringe and as water was turned on, it pushed the elevator car upward. He, of course, didn't want to waste the water and as the elevator descended, it pumped the water into a tank, from where it was piped to flush the toilets. I guess that would be categorized as being ‘green’,” I quipped.

A voice from the ceiling interrupted our conversation. “We are working on fixing the elevator. We'll get you out in a few minutes. Do not panic.”

Dr. Newman took a sip of his coffee. “I guess we should panic,” he said. “Mr. Otis was the first to introduce the safety elevator, and his first passenger elevator was installed in New York City. Now the Otis Company has approximately 2.2 million elevators in operation worldwide.”*

I didn't know much about elevators, but I had recently read about the fastest elevator. Located in a 101-story building in Taipei, it can travel at a peak speed of 3,300 feet per minute, which is 2,000 feet per minute faster than a normal airplane. “Do you know anything else about hospital elevators?” Dr. Newman asked.

The first thing that came to mind was a sign next to an elevator door at a previous hospital where I'd rotated. The sign read “Information about our patients is strictly confidential and should not be discussed in public.” This meant that talking about Mr. Otis's medical problems in the elevator could be a HIPAA violation. I was glad we'd decided to talk about elevators instead of patients.

The PA on our service, who was standing too close to me, asked us if we had heard about the surgery resident who died in an elevator. “Not exactly what I would like to know at this moment,” I thought.

“Apparently,” she continued, “in 2003 in a hospital in Houston, a resident was trying to get into the elevator when the doors closed around his neck. The elevator ascended and decapitated him. The police report read that the person inside was going to the sixth floor and she could not stop the elevator.”

“What floor is Mr. Otis on again?” I asked. Of course it was the sixth.

“On another note,” an aged attending in the rear of the elevator added, “Dr. DeBakey, the great cardiothoracic surgeon who performed both the first successful carotid endarterectomy and aortocoronary artery bypass, had a key to an elevator that would take him nonstop from the third-floor operating room to his ninth-floor office. Instead of having his own private elevator, he had a key that would let him use the elevator by himself.”

At this point, the classical music inside the elevator started to play again, but the elevator didn't move. We were going to be in here for a little longer. The music playing was a Muzak version of “Up, Up and Away.” Weird.

“Interesting stories inside hospital elevators happen on a regular basis on T.V. shows,” a patient proffered. “The surgery residents in ‘Grey's Anatomy’ always find themselves inside the elevator with the person they are attracted to. Elevators are important in the life of these residents; without them there would be no private flirting.”

The elevator came back to life and we continued to move upward. The doors opened onto the fourth floor and we all got out. I reflected that it had started to get a little steamy in there.

We took the stairs up the last two flights to the sixth floor to meet Mr. Otis. We didn't know why he had been admitted to the hospital, but after reading the note from the emergency department we soon found out: His blood pressure was “elevated.”