A Momentous Night

Pushed to the limit, an Osler resident made a call that would integrate hospital beds at Johns Hopkins — but do little to prompt changes in other racially discriminatory practices.

Illustration by Errata Carmona

Published in Hopkins Medicine - Winter 2022

It has been nearly 65 years since the racially segregated floors of the Osler Medical Service of Johns Hopkins Hospital were integrated. Though a remarkable event for the times, it remains a story untold. I write this essay nearly six decades after the described event to preserve the record of its happening and because there might be a lesson in it for today.

Integration Night

I was the assistant resident in charge of the emergency room that month and I reported to Wilbur E. Mattison, who in 1957–1958 was the Chief Medical Resident of the Osler Medical Service and today is almost 99. Wilbur was a gifted clinician and would become a clinical professor at Stanford University School of Medicine.

I was born in 1929 and grew up in Kingston, New York. In my hometown, the public schools and their sports teams and clubs were integrated. My view of the world changed when I moved to Baltimore in 1949 for medical school at Johns Hopkins. Within the medical institutions and the city of Baltimore, racial segregation was a way of life. One day a student nurse transporting a Black infant to the morgue was intercepted by a messenger who had been sent to tell her to be sure she took the infant to the Black morgue. I was stunned to learn that even the morgues were segregated.

I did my residency on the Osler Medical Service, which cared for the ward patients, most of whom were admitted from the emergency room or Hopkins-sponsored clinics. The Osler Medical Service was housed in a seven-story building. Osler 2 served Black males, Osler 3 Black females. White female patients were admitted to Osler 4 and white males to Osler 6. Osler 7 rooms were private and reserved for patients with communicable infectious diseases. Osler 5 beds were mostly for patients of the full-time faculty.

Two interns and an assistant resident were assigned to each floor for two months. We were expected to be available 24/7. There was no time off. Members of this residency staff were referred to as “iron men.” The work stress was compounded by the fact that only a few of the interns would be asked to return the following year. In my group of 14 interns, only four were asked to return. The culture of patient care on the Osler Medical Service was that it would be the best possible. It would be obtained by limitless hard work and perseverance.

As the assistant resident in the emergency room that month, I reviewed patients who might need admission and cared for them in the holding unit. These patients were very ill and hospitalization was needed to help diagnose and enhance chances for recovery. Examples were patients in diabetic comas, patients with chest pain or unexplained high fevers, and very sick patients whose cause of illness was obscure.

On this night, the holding beds were near full and new arrivals to the ER kept coming. Usually, you could work your way through until relief occurred. A patient in a holding bed would be transferred to the hospital. There would be some hospital discharges enabling admission of patients in holding beds or a slowdown in arrivals to the ER.

But tonight was different. I had sent white patients from holding beds to the hospital. But I knew from the morning briefing that there were no available beds in Black-only floors and no scheduled discharges. No matter how hard I tried, I could not meet even the minimal needs of the mostly Black patients in the holding unit. What was the matter with me? I could not get it done.

Working in haste on a variety of patients with serious illness was facilitating mishap. I needed help. The only way to ensure proper care and forestall a catastrophe was to move these patients into the hospital. The only way to do that was to put Black patients on white wards. I was on the edge of watching a tragedy. I could not stand to see the situation deteriorate before me.

I dialed Wilbur. We agreed that the only solution was to admit the Black patients in the holding unit to the available beds on floors reserved for white patients. Wilbur and I did not discuss the hospital’s segregation policy — I do not know what was on his mind — though we both knew the implication of my proposal. The conversation was all about how to get the best care for patients with critical conditions.

Wilbur has told me recently that after our talk, he called Dr. A. McGehee Harvey, chairman of the Department of Medicine, to tell him of the situation. Wilbur recalls that Dr. Harvey said to him that, “Whatever you decide, it has to be in the best interest of the patients.” According to Wilbur, issues of racial or social justice were not discussed.

In the wee morning hours, Wilbur sanctioned the admission of Black patients to beds meant to serve white patients only. He gave the order and assumed responsibility. Within hours, the patients were moved into the hospital where they would get the best care. What had happened? For the first time a small but significant number of Black patients were being cared for in beds previously dedicated for white patients.

What had not happened? Although the racial integration venture persisted — Hopkins never returned to segregated floors even when beds freed up on formerly Black wards — it did not stimulate changes in other racially discriminatory policies. It would be several decades before Black students, residents or faculty could be counted beyond single digits. It would be 1959 before the then-chief of surgery, Dr. Alfred Blalock, ordered surgical beds desegregated. The action precipitated by Wilbur and me brought neither praise nor chastisement. The integration of hospital beds was not the germ that would cause a reaction and spread quickly, setting loose an examination of internal policies.

The years 2020–2021 have seen an upsurge in racial strife. Because of social media, all of us are witness to disparities in the way police treat Black Americans and the disparate outcomes of Black and Hispanic victims of COVID-19, many of which are related to pre-existing conditions and access to health care. An encouraging sign is that now, Black and white people together attend public protests.

The stage is set for the next move. The time is right for major change.

Richard C. Reynolds ’53 has held academic appointments at the University of Florida and the former University of Medicine and Dentistry of New Jersey, and served as executive vice president of the Robert Wood Johnson Foundation.