In last week’s column I made a brief reference to my three-day trip to St. Paul, MN. I got to do some train riding, and draw on the special train fund that some of you contributed to for my 40^th jubilee. It was a beautiful ride along the banks of the Mississippi; the train was well patronized, which was nice to see; and the downtown St Paul depot has been beautifully restored, which was also nice to see. But I also had another reason for this trip. I wanted to see downtown St. Paul again. In the summer of 1981, when I was in the seminary, I spent a summer at St. Joseph Hospital in downtown St. Paul, doing a program common to many ministry students called Clinical Pastoral Education (CPE). It is partly about developing skills needed to do pastoral visits in a hospital but also a time to confront some of the issues within us that keep us from being a more effective minister. When I did the program, I was the only Catholic in the group and the only participant from out of town (which made my experience a little different from everybody else’s), While I am extremely grateful for what I learned about myself, at the time I did not handle some of the expectations of the program very well. When I finished, the program supervisor recommended that I take another unit of CPE (which is a real nice way of saying “You almost flunked”).

When I walked over to what was once St. Joseph Hospital, it looked forlorn. The sign out front said “Fairview Wellness Center.” The main door of the hospital where I lived and worked was locked, and a sign pointed customers to an adjacent (and newer) medical building, where some minimal services are provided. When I did a little research on the web, I found this statement from four years ago on the Fairview Medical System website: “For years St. Joseph Hospital operated as the smallest of four acute care hospitals in downtown St. Paul. More than half of the patients came from outside St. Paul and 72% of the hospital’s total emergency department visits were considered preventable with proper primary care . . . It became clear that our current care model was not meeting the needs of the surrounding community. Nor was that model financially sustainable for our health system.”

Yes, all that made sense. Our model of medical care has changed dramatically since the summer of 1981. When I stepped back and looked at the hospital building, it did look small and inadequate by today’s standards. There was a small circle drive in front of the main entrance and six medical floors. There was a cardiac floor (where I was interned), an oncology floor, several general medical floors, a psychiatric floor, and, on the top floor, a residential hospice.  On the main floor was a large cafeteria, which was popular with the senior citizens in the area. The hospital was also very Catholic. There were four Sisters of St. Joseph in pastoral care and two priest chaplains. At the time it seemed like a large modern facility; and I doubt there was any talk about whether it was “financially sustainable.” But all that is gone. Now the statue of St. Joseph  stands by the barricaded front entrance—like someone left behind by the rapture.

Once upon a time, these small and medium sized hospitals were at the heart of our medical system. One year in the seminary, I helped out at St. Clara Parish in Woodlawn. One of my responsibilities was bringing Communion to Catholic residents in a nursing home near the church and conducting a weekly Liturgy of the Word. When one of the residents had to go to the hospital, they usually went to Woodlawn Hospital, where I would visit them. Woodlawn was a dark, creepy old place with creaky wooden floors, two or three beds jammed into a room and a bathroom down the hall. As medical care has become more sophisticated, more specialized, and more expensive, the big systems have gobbled up the free-standing hospitals, and, the smaller players have been squeezed out. It is one thing for a small hospital in St. Paul or Chicago closes; it is another when the only hospital in rural section of Iowa closes because it cannot keep up with the big boys. Forty five years ago it was also clear what a Catholic hospital was. That was why many patients from “outside St. Paul” went to St. Joseph’s. Today, with the huge hospital systems, that Catholic identity is not so clear.

This is a fascinating time to think about all this. As of Monday morning, our federal government has been shut down for a month. The issue that caused the stand-off is affordable health insurance. But when it comes to medical care in our country, is the current stand-off just the tip of the iceberg?

                                                                                 Fr. Joe