Built in the shell of a mobile home, one of the most sophisticated intensive care units on wheels, the 26-foot-long "White Banana" streaks through the Wisconsin countryside near Madison. Inside, Dr. Marvin Birnbaum, 43, and three colleagues prepare for the desperately ill patient they will soon pick up. Over the wail of the siren, Beethoven's Choral Fantasia is playing on tape. ("We never put on a requiem when a patient is aboard," Birnbaum says. "That would be inappropriate.")
Birnbaum, a professor of medicine and physiology at the University of Wisconsin Medical School, developed the van in 1975 (colleagues nicknamed it). The White Banana is not designed for emergencies; instead it is used to transfer patients who are too ill to be moved any other way. In the past four years Birnbaum has personally made some 400 runs in the vehicle. Most commonly, it takes patients from small community hospitals to big regional institutions which specialize in "critical care medicine." "If a physician is in private practice," Birnbaum explains, "it is very difficult to have 40 patients in the office and stand by a bedside for 18 hours. He hasn't the time to deliver that kind of care."
The van is lavishly equipped, ranging from basic devices like heart monitors and oxygen to such sophisticated gear as a dialysis machine for kidney patients and a complete blood-chemistry lab. Only X-rays and major surgery are beyond the White Banana's capability. The vehicle, which cost $110,000, has already survived a blowout at 70 mph, a cracked frame (the van is 3,000 pounds overweight), a carbon monoxide leak that made everybody woozy and a breakdown that meant being towed with a patient inside. Problems like these add to an atmosphere already reminiscent of television's M*A*S*H, both in urgency and the poise with which they're treated.
"If the M*A*S*H attitude goes away," Birnbaum explains, "I get very concerned. The smiles stop, the joking ends, people look overworked, tempers go and they begin to pick on each other. That means the unit is bogging down under stress." He insists everyone be on a first-name basis, even the patients. "People get to know each other fairly well here. Nobody stands aloof. A lot of touching goes on." Birnbaum adds to the casualness by wearing street clothes, putting on his white medical coat only to pick up a patient or meet a family. "Families expect a doctor to look like one," he says.
The White Banana has a crew of five. A paramedic drives while Birnbaum, a nurse, a resident and a medical technician care for the patient. The vehicle is part of the university hospital's Trauma and Life Support Center (TLC), of which Birnbaum is director. (He likes to think TLC really stands for "Tender Loving Care.")
Besides riding the White Banana and his other duties at TLC, Birnbaum teaches several courses at the med school. His hours are ferocious. "He does not delegate authority easily," says a friend, "not out of arrogance, but out of fear that things won't get done properly." Dr. John Morrissey, vice-chairman of the hospital's department of medicine, says such dedication is unusual—"but you have to give up your personal life to do it. There aren't many human beings like that in the world."
Birnbaum was in fact divorced in 1976. The son of a Milwaukee appliance dealer, he can fix his own TV set but prefers stereo to the tube. He runs whenever possible with a girlfriend and owns a sailboat that he didn't get into the water even once last summer.
"My job," Birnbaum says, "is all-consuming. Then we get someone whose pupils are fixed and dilated when we pick him up at the community hospital. He is essentially dead when he arrives at TLC. Three months later that 17-year-old walks in to thank the whole staff. That makes a lot of the frustration acceptable."
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