A unique hospital cares for the whole child

The first impression of Scottish Rite Hospital is one of energy, movement, life. The sign outside reminds that this is a hospital for crippled children, but the message inside seems to say: Crippled? Maybe. But not for long. Not if we can help it.

And so, when you ask doctors and other staff members at Scottish Rite if they get depressed working with crippled children, they seem surprised by the question. Chief of Staff Dr. John A. Herring typifies the optimism of the hospital: “I ask that about doctors who work with children who have cancer,” he says. “Here, what we do is very uplifting. Most of the time we’re dealing with situations that we can make better. As the years go on, there are fewer and fewer problems with which we can’t do something positive. It’s not depressing to work here; in fact, it’s often very exciting.”

Blanche Carpenter, director of physical therapy, shares Herring’s upbeat attitude. “We can’t do anything about the way the child was born,” she says, “but now that he’s here, let’s ask what we can do to help. It’s not ’that poor child.’ These kids are lucky to be here. We can always do something, even if we only help the parents with their feelings of guilt.”

It’s tempting to attribute some of the staffs buoyant optimism to the striking Scottish Rite facility, the result of a $21 million gift from U.S. Sen. William A. Blakley. Blakley, a philanthropist whose generosity was exceeded only by his dislike of publicity, was emphatic about the way his money was to be used. “He told us to build a hospital that didn’t look, feel or smell like a hospital,” says hospital president James F. Chambers Jr.

The first thing children see when they go to Scottish Rite is a skylit atrium lobby, a wonder world of spaciousness and color with an obstacle course of slanted benches and large, padded cubes that invite climbing and exploring.

Above hangs one of the largest mobiles in the United States, an improbable 12 x 13-foot contraption reminiscent of one of Rube Goldberg’s cartoon machines, made up of a dirigible, bicycles, baseballs, fishing gear, soccer balls and other sports equipment. Amazingly, the whole thing moves, apparently powered by the two bicyclists.

But the Scottish Rite Hospital story is older than this beautiful building. In 1921, a group of Dallas Masons organized a Children’s Aid Committee to help physically handicapped children, appropriating $100,000 for an eight-bed hospital on Welborn Street, just opposite the current facility. The building was dedicated on December 21,1922, 60 years ago this month.

Today, Texas Scottish Rite Hospital is one of the leading pediatric orthopedics hospitals in the United States, treating childhood disabilities resulting from birth defects, accident, disease and chronic neurological problems. It is not the largest children’s hospital-in fact, its 125 beds are seldom full-but it is one of the busiest. In fiscal 1981, Scottish Rite admitted 1,320 patients and performed 2,295 surgical procedures. The hospital scheduled 22,798 outpatient visits.

And all of it was free. No family has ever been charged for the services of Scottish Rite Hospital. The hospital receives no federal or state money of any sort, is not an agency of the United Way and takes no portion of any dues paid by any Masonic order. Scottish Rite is entirely supported by voluntary contributions, mostly from private individuals.

But Scottish Rite is not a “poor people’s hospital”. Indigent families from South Texas bring their children for treatment, but so do affluent families from Highland Park. There is no discrimination on any grounds. The children of Masons do not receive preferential admission.

The main criteria for admission to the hospital are simple: First, the child’s condition must offer hope of improvement through the services provided by the hospital. The child must be under 15 years of age (except in special cases) and must be a legal resident of Texas. However, there is no length of residency requirement, and it’s an open secret that some families move to Dallas from out of state so their children can benefit from care at Scottish Rite. Also, the child must be referred by a physician and recommended by a Mason – an easy matter in a state having some 90,000 Masons. If there is no Masonic Lodge available, the hospital will have the recommendation completed by the Dallas Lodge of Perfection.

So money does not determine the quality of care a child gets at Scottish Rite. That may have something to do with the special feeling that seems to pervade the hospital, says Dr. Dennis Wenger, assistant chief of staff. “There’s a lot of criticism that there’s too much medical treatment in our society and that some doctors will schedule you up for something just because you’re there,” Wenger says. “Seeing our patients without charge removes some of that concern.”

“Here, the amount of care, physical therapy, bracing and recommendations will not be compromised because the patient doesn’t have enough money,” Wenger says. “I’ve worked in other handicapped children’s centers where you had to rely on an appropriate voucher being filled out and then hope that someone in state government would approve it so the child’s brace would be ready after surgery.”

But there’s no room for waste at Scottish Rite. Budgets are carefully watched, and each department must make a case for its expenditures. According to executive vice president J.C. Montgomery, the hospital is the steward of the money donated to it; magnificent new building or not, a dollar in contributions must be matched with a dollar’s worth of patient care.

“If a physician needs something, he’s got to justify it,” Montgomery says. “Then, if the need is there, we try to get someone to give the item to us. If we can’t get it that way, we put it out on bid. If the low bid is a good product, we take that. Then we still ask for a good-neighbor discount.”

Montgomery recalls that when the hospital wanted to change the clocks in the clinic to 24-hour military time in order to avoid confusion with timing for medication, the cost would have been almost $200. Nobody would donate the clocks or offer a significant discount. So, following a surgeon’s suggestion, staff members glued new red numbers over the old numbers on the clocks.

Ironically, some Scottish Rite board members worried about the impact the new hospital might have on contributions. Would potential contributors look at this architectural gem and decide to give their money to someone who really needed it?

“We pointed this out to Sen. Blakley,” Montgomery says, “but he told us he didn’t want to build something and then have to tear out walls in five or six years. He wanted something that would last for 50 years. Knowing that construction costs were going up, he wanted us to overbuild and grow into the new building.”

As it turned out, fears of a contributor backlash were groundless. “It’s been a humbling experience,” says Montgomery. “More people have supported us here than ever did in the old building.”

Pulses also beat louder at Scottish Rite when the 1981 tax reforms reduced the deductions allowable for charitable contributions. But, says Director of Development Walter Mays, the reforms have had no measurable effect on contributions so far. “People will support children even when times are rough,” Mays says. “We may lose a few small gifts, but those who have given in the past know the kind of work we do. They continue to give.”

Still, Scottish Rite Hospital is not a familiar place to most Dallasites. Its profile has long been low, partly because of the nature of the institution and partly because of the character of its longtime chief of staff, Dr. Brandon Carrell, who died this year. Carrell headed up the Scottish Rite medical staff from the Forties until 1977, when he became chief of staff emeritus. He disliked making speeches, writing scholarly papers and other activities that can help bring a wider reputation to a hospital.

The new hospitai, however, brought a steady flow of attention from the media and civic and professional groups. More than 300 tours of the hospital are now given each year, and foreign visitors to the facility are not uncommon.

The mission and capabilities of the hospital remain unknown to many people, however. Wenger says that many people who bring their children for an initial examination don’t realize that the hospital is a full-service operation. They’re often surprised to learn that their child’s surgery will be performed at Scottish Rite. “Some think we’re just a place you go for some physical therapy, some crutches and some general tidings of well-being,” Wenger says.

Wenger, who has made a study of charity hospitals in the United States, calls Scottish Rite “an anachronism” of sorts. He says that many similar private hospitals have closed their doors during the past two decades. Some, like the Scottish Rite Hospital in Atlanta, Georgia, have begun charging for their services on a graduated scale. A few have been reduced to advertising for patients.

Why? Because of two very welcome postwar developments, Wenger says. Many of the childhood diseases that charity hospitals once fought have now been eradicated. Between 1900 and 1930, almost every state opened at least one hospital for care of polio victims; these hospitals were pressed to the breaking point by the polio epidemics of the early Fifties. But thanks to the Salk and Sabine vaccines, polio has almost disappeared from America.

Another postwar boon, health insurance, has done its part to reduce the stature of charity hospitals. Scoliosis, spina bifida, cerebral palsy and other orthopedic disabilities can be painfully expensive to treat. In the early years of this century, it was not unusual for a polio victim to be hospitalized for five months. Even in those pre-inflationary days, a hospital stay of that length would have meant ruinous expenses for all but the wealthiest families. Hence the need for children’s hospitals supported by the state or by philanthropic groups.

Now, with health insurance plans to ease the burden of medical care, fewer families must rely on charity hospitals that may be located hundreds of miles from their homes. So, fewer debilitating childhood diseases and fewer families without insurance have meant a declining patient population for charity hospitals.

Not so at Scottish Rite. Wenger points to several factors that have meant continued health for the hospital. He cites the general growth of the Dallas/Fort Worth area and our proximity to Mexico as two reasons. “We probably see 15 to 20 new polio patients a year from Mexico,” he says. “In a way, we’re still on the frontier.”

Perhaps more important to the hospital’s ongoing vitality is the increasing subspecialization in orthopedics. As in all branches of medicine, the trend is toward physicians who know more about smaller, more specific areas of orthopedics. “This constant influx of new knowledge has made each area of orthopedics so complex,” Wenger says. “If you want to do hip surgery or spinal surgery well, you almost have to do it full time.”

Scottish Rite’s patient population has altered considerably over the years. Its focus was initially on traditional handicapping diseases such as polio and cerebral palsy. Advances in medicine have arrested many such crippling diseases, however, while making possible the treatment of others. Twenty years ago, children born with spina bifida (an open spine at (he base, resulting in paralysis below the hips) rarely survived. It was medically impossible to treat them. Today, Scottish Rite is working with 350 spina bifida children, including outpatients.

“If we follow the Western European model and go for national health insurance, there may be no need for charitable care in this country,” Wenger says. “Even if we don’t go that far, there will probably be nearly full coverage for all children. We’re gently making the transition to providing services according to our expertise. People are not coming here just because this is a charity hospital, though it is. They’re coming because their doctors know that we have the volume [of patients] and we’re more likely to give results. When a private physician in Highland Park sends his daughter to you for her hip problems, you know you’re doing a good job.”

Scottish Rite is broadening its reputation around the Southwest and the nation not only because of quality patient care, but also because the hospital is in the forefront of research into children’s orthopedic problems. Scottish Rite is a respected leader in spinal instrumentation designed to help victims of scoliosis (curvature of the spine). At one time, scoliosis surgery was followed by a year in a very confining cast; for six months of that time, the child was in bed, almost immobile. In addition to the atrophy of major muscles, the child’s emotional development was often affected.

Today, Scottish Rite scoliosis patients rarely spend more than three months in a relatively light cast, and they continue with most normal activities during that time. The hospital’s goal, Wenger says, is to eliminate the need for post-surgery casting altogether.

But it is not only the hospital’s medical achievements that make it unique. “Treating the whole child” has become a cliche in the helping professions, but Scottish Rite gives new life to that worn-out phrase. Its Child Life department works constantly to make each patient’s stay as enjoyable as possible, according to Dana Rosenstein, director of Child Life.

Child Life offers programs for the children seven days a week and one evening. In essence, it is the “playroom” of Scottish Rite. “We see ourselves as providing emotional support for the children while they are here,” Rosenstein says. “We want to help the child continue to grow and develop normally. Kids have to go to occupational therapy and physical therapy, but they can choose to come here. It’s a place to get away from the medical feeling of the hospital.”

Scottish Rite has two large and two small playrooms. On the fourth floor, a solarium is designated for the teen-age patients. Here, they can listen to music, read, or play air hockey and ping-pong. Another large playroom, this one for younger children, looks much like a preschool classroom complete with blocks, a sandbox, chalkboards, an aquarium and a hamster. Arts and crafts activities are planned for the children, but nothing is mandatory.

Rosenstein does not use the term “play therapy,” but some of the play in Child Life is obviously intended to acclimate children to their handicaps and allay their fears about what happens in a hospital. For instance, a child who will soon be placed in a cast is encouraged to pretend that he or she is a doctor and put a genuine cast on a doll’s arm or leg.

“We try to get them to talk about casting with us and show them what’s going to happen,” Rosenstein says. “This is a way for them to act out their anxieties.”

In short, there is always something to do and someone to do it with for children at Scottish Rite. When children are not being entertained by visiting celebrities like Glen Campbell, listening to a visiting church choir or laughing at strolling clowns, they can help to write their own newsletter, Child Life and Co.

Child Life workers also help their patients in ways that might never show up on a diagnostic chart. Scoliosis victims, who face the most serious surgery performed at the hospital, are forced to stay in bed, lying on their backs, for 10 days. Scoliosis is most often seen in teen-age girls, and many of them are quite anxious about the cast they will wear beneath their clothing for several months. During the period before and after casting, a Child Life person tries to befriend the patient and serve as a sounding board for the child’s fears about the future.

Concern for the child’s emotional well-being has also prompted what Gladys Neece, director of operating room personnel, calls “preoperative teaching.” The day before a child is scheduled for surgery, a member of the operating room staff visits the child and his parents to offer a dry run of the operation. The child is shown a surgical mask, an IV bottle and other medical equipment. He is told about the bright lights in the operating room and shown where the leads from the EKG machine will be attached to his body. If the family desires, they may visit the operating room and the recovery room before the operation.

Again and again, throughout Scottish Rite Hospital, you hear the institution’s success attributed to one factor above all: Patient care at Scottish Rite is a team effort. At many hospitals, the doctors are the remote superstars of the show, dispensing orders to a lowly supporting cast. Not at Scottish Rite.

Ed Barber’s Orthotics Department makes the various braces needed by Scottish Rite patients after surgery. Barber and his staff are not physicians, but they sense no “class” system at work in the hospital. “Our staff physicians are much more willing than many I’ve known to impart their knowledge to orthotists,” Barber says. “Some physicians take an approach of ’Well, you don’t need to know why this is done. Just do it because 1 tell you.’ That is not the approach here. Our physicians bring the patients right into our fitting rooms, and we discuss the problems on the spot.”

That sentiment is echoed by Evie Blair, Scottish Rite’s director of nursing units. Blair came to Scottish Rite in 1972 planning to stay a year. (“Those little syrupy kisses early in the morning keep you going,” she says). She also praises the hospital’s teamwork. “We don’t have the power struggles that you get at some other hospitals,” she says. “The egos don’t get in the way here. That goes all the way up to the administrators and board members, too.”

Blair, who oversees the work of 70 full and part-time nurses with an average of 10 years’ experience, believes that the hospital fosters a sense of shared respon-siblity between doctors, nurses and other staff members. That, she says, helps to account for the low employee turnover in her department.

“It’s not unusual for nurses to change jobs once a year,” Blair says. “It’s a rather transient field. We don’t have as much of that here because of the intangibles involved in working here. The kids are such a boost to the ego, and there’s respect between the different departments.”

Chief of Staff Dr. Herring agrees. “We really are equal partners,” he says. “It is a big team effort, not something you can do individually. Often, the problems are so complex that one particular physician cannot accomplish very much. Doctors need lots of advice and expert opinions.”

If anyone personifies the special spirit of Scottish Rite Hospital, it is the more than 300 volunteers who give their time to the hospital during the day, at night and on weekends. Volunteers -young and old, male and female -are everywhere. They help with clerical tasks, work in the dental clinic, pass out popcorn to waiting outpatients or simply talk to a frightened child. Volunteers may be high school students (Jesuit and Ursuline require community service hours from their pupils) or “foster grandparents,” senior citizens who spread warmth and cheer through the patient wards.

“Many people out there want to love and be of service,” says Myrna Watkins, acting director of Volunteer Services. “We have many young professionals, mostly single people, who help us at night and on the weekends. Perhaps they feel a need for more connection with children. It’s a real meshing of needs. They need us and we certainly need them.”

Volunteers are absolutely vital to the Scottish Rite operation, logging 39,000 hours of cost-free service to the hospital between January and September of this year. Figure those hours even at minimum wage, and you see just how important these helpers are.

The dean of all volunteers at Scottish Rite is Pauline Cohen, who has been helping at Scottish Rite every Monday and Thursday since November 1942. Now 80, Cohen laughs when asked to describe her work. “1 do nothing,” she says. Nothing? “Oh, I get them drinks, wheel them around to look at the flowers. Maybe do some errands for the nurses, take the kids to X-ray or to the brace shop.”

You sense that if pressed, Cohen might expand that “nothing” to fill several pages. But she looks anything but tired. She has a look in her eye seen frequently around the Hospital. “Dedication” is too tough a word for that look; maudlin as it may sound, “love” may be the right name.

Cohen calls the hospital “a blessing of God,” and perhaps it is. It’s also the living legacy of three generations of farsighted, generous, loving men and women. God’s hand slipped with these children. At Scottish Rite Hospital, they get a second chance.

THREE YEARS ago, my son had minor surgery at Texas Scottish Rite Hospital for Crippled Children. He was born with congenital Achilles’ tendon shortening, or tight heel cords, and he developed a worrisome habit of walking on his tiptoes when he was five. Several doctors -none of them specialists -assured us that the condition would correct itself as Jason got older, but it never did. Instead, the problem grew worse as he grew more active. Running down a soccer field, he would lose his balance and fall for no apparent reason; starting for a ground ball to his right, he would seem to be stuck for a moment and would often stumble before getting under way. Sometimes he would fall down just walking through the house.

When he was 7, his pediatrician, who happened to be a Mason, suggested that we have Jason examined at Scottish Rite. The doctors there didn’t think that his condition would correct itself; instead, we learned, it might well get worse as he got taller and heavier. They recommended surgery to lengthen his heel cords. After much agonizing, we agreed, and in early July 1979 Jason entered the hospital.

We soon realized that Jason’s problem was minor compared to those of many children who come to Scottish Rite, but no surgery is really minor when your child is under the knife. You put him there. It is easy to tell yourself and your child that this pain will make him better next month or six months from now, but tomorrow does not exist for a child in pain. The first night after Jason’s operation, the incisions in his heels hurt him badly. When we left his room at lights out, he was crying. We were close to it.

In order to avoid overcrowding, Scottish Rite allows only one parent to stay overnight with a child, a policy obviously intended for other children’s parents. That first night we sat on a couch outside the ward, both determined to stay. Several nurses noticed us there, but mercifully kept quiet. The next day, however, we were politely informed that rules were rules. My wife spent the night in a chair beside Jason’s bed.

The next night was my turn. Again, Jason had trouble sleeping. I bothered the nurses with foolish suggestions, but we were up against an implacable fact: Operations are followed by pain. So I paced the floor in the parent’s lounge, watched gas lines forming at the station across the street and heard Tom Snyder babbling with two horror film directors about the difficulty of scaring anyone these days. Around 2 a.m. I wrote a very bad poem before falling asleep holding a cup of coffee. Its last line, the only one 1 recall, read “We hope that love can pay for pain.”

Jason was released from the hospital four days earlier than expected. He was given crutches but never seemed to need them, preferring to shuffle along in the “space boots” designed and fitted by Scottish Rite’s orthotics department. Once he was playing in the rain and got his casts wet. They began to dissolve, so we rushed him back to the hospital with a flimsy story about an aquarium turning over. I think they had heard that one before.

By the time school started that fall, Jason was walking straighter and running faster than we had ever dared to hope. Today he’s an active, nimble 11-year-old. If he got around any quicker we might want to sue.

Returning as a visitor to Scottish Rite, I see what my anxiety and lack of sleep hid from me before: This hospital is a civic treasure, a beautiful and inspiring place where enough good is done for children to soften the hearts of a dozen cynics.


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