‘Hospital’ has become puzzle of ill-defined words

A 37-year-old man was admitted to a hospital with seizures. His MRI was frightening, showing a brain full of holes. Medication controlled the seizures, but the drugs were just Band-Aids on a big, undiagnosed problem.

The patient was not particularly alarmed. His brain was riddled with infection or tumor, but all he wanted to do was get out of the hospital and go back to his life.

The only way to diagnose his problem was a brain biopsy.

“Anything to get out of here,” the patient said, and signed a consent form.

The biopsy was performed uneventfully, and small specimens of the abnormal tissue were sent to the lab for a diagnosis. That was on a Friday.

On Wednesday, with the specimens still being processed and another weekend looming, the case had attracted the notice of the administrators known in hospital vernacular as the discharge police.

Within minutes, it seemed, the patient was on his way to the subway, clutching a thick sheaf of instructions, appointment slips and prescriptions, still without a diagnosis but free at last.

Your reaction to this story will depend on your understanding of the word “hospital.” The word has connotations of care and comfort, but its meaning is changing so quickly that even the people who work in one can’t agree on what it is.

Once hospitals were where you found a doctor when you needed one; now doctors are all over the place. Hospitals were where you were headed if you were very sick; now you choose a cheaper emergency center.

Once hospitals were where you were kept if you were a danger. They still serve this function — but, perhaps, the standards for predicting these dire outcomes have tightened up quite a bit.

These days, it may be easier to define hospitals by what they are not. Hospitals are definitely not places for unusual medical conditions to be figured out, not if the patient is well enough to leave.

Like the hospital, the patient with holes in his brain was also a puzzle of ill-defined words. He was very sick, yet not all that sick.

He was well enough to be an outpatient, but he had never managed to be a successful one. He was not suicidal, at least not in any immediate sense. The big holes in his brain made it even less likely that he would adhere to the complicated instructions.

But, a hospital is where hope reliably springs eternal.

The patient’s doctors certainly hoped for the best for him. They gave him a slew of prescriptions, and expressed their hopes that he would take the pills and keep his far-flung appointments.

Not so long ago, the multiple ambiguities of this patient’s case would have kept him in the hospital until at least some of the uncertainty had been resolved. Now, it is considered downright medieval to keep him in.

I’m sure you would like to know what happened to the patient. His doctors would, too, but he is missing. It’s anyone’s guess if he filled his prescriptions. He kept none of the appointments.

The results of his biopsy showed a perfectly treatable condition. Perhaps he got better, perhaps not.

The doctors will never know if they managed his case correctly In the word’s other senses (“succeed despite difficulty” among them), they now have a reasonably good sense of how they failed.