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Luthor Harkon

Hospitals (aka medicae-facilities)

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Hi all.

I am actually wondering how most hospitals are made up on most (hive) planets in the Imperium. I know the standard answer in a 40K context is either ‘it depends’ or ‘everything is possible’. But I need it a little more concrete this time. My players are on the planet Zumthor at the moment. In my campaign Zumthor is an ice planet and a Frontier World on the verge of becoming a Mining World (due to some tinkering with the Administratum the leading planetary cartel was able to delay this process for decades in fear of resulting higher tithe rates), and its main (and only) city is a domed structure with only about 20 million citizens and is less than 2000 years old being build after the Angevin Crusade according to a fragmentary STC. The domed ‘hive’ city is similar to a hive in that way that there are different layers/levels (4) as well as some kind of upper hive spire sort of region above level 1 and a downhive like region beneath level 4.

To cut a long story short, while working undercover as Magistratum personnel our groups Guardsman suffered a serious critical to the head by an Autopistol bullet shot in a short gun-fight with gangers and was dragged to a hospital (called St. Erasmus) by the groups Tech-Priest. That is where the last session ended and I am somehow at a loss how to describe such a hospital.

In my description of the city (called Drustos) I wrote down that 'there are numerous public and private medicae-facilities scattered throughout the city. The largest public medicae-facility (ie. hospital) is the St, Erasmus on level 2 (a sort of urban mid-hive region). There are smaller more elite private medicae-facilities, up on level 1 and on upperside, the most famous being the Kensington Clinicum, on upperside. There are small numbers of charity medicae-facilities scattered in the poorer districts and the Consulam (Ecclesiarchical sect) sponsored The Prophets of Mercy facility down on level 4 (lower-hive) possibly the best of these. There can also be found many rogue medicae-facilities and unlicensed chirurgeons in Drustos, often catering to the criminal classes, but willing to treat anyone with the right amount of money.'

So how could such a mid-hive situated (or anywhere else for that matter) hospital look like and work like? What kind of physicians work there? How much technology would or could they have? Is there an Adeptus Mechanicus presence needed (in form of a Magos Biologis or something like that)?
Someone any ideas or inspiration in this regard? Thanks a lot in advance.

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Generally speaking, 40k medicine is always described as being very advanced. But most sources on this point deal with servants of the Emperor, such as Inquisitorial agents and guardsmen. A facility such as the one you describe sounds like a municipal one, run by local planetary officials. Such officials care principally about serving the planetary governor, who only cares about acheiving the tithe. As a result, such facilities - one would imagine - would be pretty rough and ready. 

If I were you, I'd imagine a hospital from the mid-late 20th century based in a really rough part of town during a particularly vicious economic downturn. For the visual look, imagine the movie se7en, or the videogame "the suffering" with yellowed tiles, stains on the walls, and people with horrific wounds sitting in sullen silence as they await harrassed and overworked staff to get around to them. The staff use rusty equipment, stained bandages, and wheel around trollies that squeak because they've never been maintained properly. Occasionally patients will be pushed past in giant iron lungs, experessions of misery on their faces as they wheeze painful breaths through ravaged lungs. Insane elderly patients in filthy robes wander the halls - until the players realise that these are in fact lobotomised servitors pushing around mops. 

The players are eventually seen by a hulking staff nurse, who expertly triages the injured before passing them off to a young and inexperienced doctor, who clumsily stitches the wounds, leaving ragged scars that will last forever. The hospital will charge them for their efforts, and tie them down in endless paperwork. If the players have gunshot wounds, the local Magistratum field agent will want to speak to them....      

Here are some evocotive images:-

http://colgurchemistry.com/Science9/Biology/iron%20lung%201.jpg

 

http://kevinturnquist.org/images/deinst1.jpg

http://static.guim.co.uk/sys-images/Society/Pix/pictures/2009/12/01/hospitalward_pic.jpg

 

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Here's some "flavour" moments to get your players into the mood of 40k medicine:-

-An ancient lobotomised servitor shuffles past, listlessly scrubbing the floors with a mop. Its bucket is half filled with stinking brown water. As it wanders past, it leaves a sheet of filth behind it.

-A medicae pushes a trolley past the players. On the trolley is the body of a young man, who appears to have been pushed up to his waist into an industrial grinder. He is very very dead. The Medicae is picking his nose with one hand as he steers the trolley with the other. 

-A young woman in a stained yellow surgical robe runs past, shrieking hysterically. She is restrained by two burly orderlies and gently led back to her ward. She appears to have tried to bite out her own wrists. 

-An old man asks the players how long they have been waiting to see the chirurgeon. When they reply he tells them he's been waiting ten days, and asks if they have a ticket yet. The players don't need a ticket: the old man is quite mad. 

-A drunken hab-worker gets tired of waiting, and decides to attack an orderly. He starts brutally beating the smallest orderly he can reach. The other patients watch, disinterested. They have seen it all before. 

 

EDIT: Man, that's some depressing stuff. I think I need help...happy.gif

 

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In addition to what has already been said, do not use our (modern/western) concept of rooms for 2 to 6 occupants. Use long rooms with beds only "seperated" by sheets (textile, plastique or both) seperating the beds from each other.  

"Rooms" are reserved for clientel paying really good. Make sure you have a lot of clerical people (monks, sisters) of low rank tending for the suffering... with cleaning them, taking away offal or speaking prayers/lighting candles. Of course, have a shrine with lots of candles at the end of the floor (for some saint fo healing).

Since you are "hive in an ice world", a lot of people can (and should!) have fingers, toes and properbly limbs frozen (and perhaps amputed), people who wandered out with bad eye protection could have become snowblind. 

Diaharoe, Skin disease, parasites etc. could be common as well.

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Aw ****. I came in here with such great ideas I thought, and they're incredibly blown away by Gregorius and Light Bringer as usual.

If 40k ever needed a help desk, I think I'd vote those two in first and foremost.

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Thanks a lot for the input. It's very helpful and highly appreciated. The last picture and the notion about the long floor-like rooms with plastic sheeting fits my vision rather well. Maybe I should check the internet for pictures of some soviet-style hospitals from the 80s (or from eastern europe). And while your ideas are great Lightbringer (what a misleading name gui%C3%B1o.gif), I fear some of them are a little too grimdark for my players. They already have constant nightmares from my games and I tend to lighten a few things a little more up, especially because I think not every corner of the Imperium is that 'derelict'. After all, most of the heretical actiivity they hunt after can't be much worse then.

Player 1: "What a mess! This asylum seem to have been taken over by the Logicians for their vile experiments!"

Player 2: "Well, actually it looks  little like the mid-hive medicae-facilty I have been recently to treat my headshot..."

Player1: "..."

 

http://static.panoramio.com/photos/original/24390295.jpg

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 Medicae, Doctors of Physik, and Serf Medicine

Respectable medicae of Sibellus are licensed by a Byzantine array of Guilds Medicus, their panoply of charters outlined in great detail within the bronze Hive Charter of Sibellus. They practice their profession within hospices and ward-arrays whose location, size, and fees for service are also specified by charter, and their operation, in theory at least, is paid for through disbursements from a central Dicasterium Censura Medicus of the Administratum in the spirebase.

In practice, corruption and disinterest has run rampant in the Dicasterium Censura Medicus for centuries, a thriving gray market exists for medical services, bribery for places in a mid-hive ward-array is commonplace, and many hospices are funded from Ministorum, Legio Scintilla, noble, or merchant house coffers. In effect the hospices become extensions of their patron organizations, though their Magisters fiercely maintain their own traditions and a facade of independence. Some ward-arrays have even developed close ties to the Machine Cult of Scintilla, and have become more concerned with bionic augmentation than with healing.

Each hospice is a prideful edifice of solemn tradition and antiquity, a complex hierarchy within which an aspiring medicus must toil for decades to advance to the next tier, and where the demands of bureaucracy are placed high above the needs of the sick. A licensed medicus of Hive Sibellus dresses in ornate robes and bears a staff of office, and a knowledgeable observer could identify rank, specialty, and hospice by his clothing. The upper echelon of Magisters-Medicus in the most gilded hospices are resplendent in their finery, and court the attentions and purses of wealthy guilders or lesser nobles.

The first allegiance of a medicus is usually to his hospice, rather than to his Guild. Unlike other guilds of Sibellus, the Guilds Medicus are of little consequence in comparison to the influence wielded by the Magisters-Medicus. Most Guild functionaries are also highly ranked medicae of the ward-arrays, and even the Guild libraria – that list a thousand years of names, deeds, plagues, and sicknesses – are maintained by the more prestigious hospices.

In 734.M41, a Magister-Medicus of the Resarius sub-distruct Hospice Primus so offended a lesser scion of House Klave at a grand banquet of patronage and largess that his entire hospice was declared errant from its charter and torn down to rubble – an almost unheard of event brought about by the influence of House Klave within the Sibellus Administratum. Even now nothing remains save a gaping void in the mid-hive where it once stood, as the extant charter blocks approval for any new construction. Almost all hospices and ward-arrays are vulnerable to those who can focus the eyes of Administratum or Magistratum upon them, and their Magisters-Medicus must toil to maintain the good favor of their patrons and the Sibellus nobility.

The efficacy of treatment varies widely from hospice to hospice, and the knowledge of most medicae is a regurgitation of generations of rote learning. Prayer and penitence is given alongside simple compounds for ague or squamous growths in many ward-arrays supported by arms of the Ministorum, and only the wealthy or influential can hope to gain the benefits of sophisticated devices-medicus that can extend life or forestall the most insidious diseases. The roots of madness are little understood, and few hospices do more than consign the terminally insane to asylums after harsh treatment with potent drugs or surgery upon the brain fails.

For all these impediments, the hospices of Sibellus are ever crowded to bursting, as there are too few wards and licensed medicae for the needs of such a vast hive populace. The majority of the hospices and ward-arrays are constructed in the upper hive crust or the mid-hive: there are few in the low-hive or spires.

The grand, pillared Qualdian Wards stand as an example of the one of the remaining independent ward-arrays. It lies in the Voltis spirebase, built through three hive levels as a massive templum of many entrances in the ancient fashion of pagan, pre-Imperial Scintilla. The Wards receives little from the Administratum, and depends upon a noble chantry made centuries ago. Those coffers are greatly dimished, and will be empty in a matter of decades, however. Successive conclaves of Magisters-Medicus have for a century postponed the necessary steps to continue the legacy of their ward-array, and time is growing short.

Within the Qualdian Wards, the massive central space of the old templum is filled by open framework decks, each sectioned into wards. Fine whitestone walls, engraved with prayers to patron saints of the medicus and the ill, enclose surgeries, tech-repositories, and private rooms for respected, influential patients. The mesh flooring of the common wards is crowded at every hour of the day by beds, waiting patients, scurrying apprentices, scribes, and tech-adepts and their devices-medicus. Robed medicae and their attendants stride through the throngs, trailed by servitors and skull-drones, dispensing instructions and examining the sick.

Beyond the common areas and the wards are the closed, secretive vaults of the Qualdian Wards. There, the medicae take counsel with one another, worthy apprentices are initiated, and librarium halls of ancient medical texts and overflowing patient records are maintained by disinterested scribes. In the base levels of the templum structure are furnaces, great pumps, and fundament waste channels that flow down through into the depths, tended by strange tech-adepts and uneducated serf families who rarely leave the Wards.

Each hospice of Sibellus jealously protects its own secrets of medicine, for all that most are known by doctors of physik, or militant medics of the Imperial Guard or Legio Scintilla elsewhere in the hive, or are described in renowned Imperial texts. Medicae of the ward-arrays are suspicious of those who question their knowledge, and despise the varied practitioners of medicine who exist beyond the hospice walls. Great legal battles have been fought between hospices and Sibellus universitatis that once taught – and in some cases still teach – the craft of a doctor of physik.

Beyond the hospices and ward-arrays, the needs of the upper hive and spire are met by roving doctors of physik, unlicensed by the Guilds Medicus, but subordinate to the Calixian Assembly of Physik. The scholarly leaders of that august body reside within the Lucid Palace, and enjoy the patronage of high Administratum officials, rendering them effectively immune to any legal or other assault undertaken by the hospice Magisters.

Doctors of physik in the hive proper are of many varied origins; some are from the hospices, seeking greater reward or cast out for some ill-defined sin, while others were educated on other worlds of the Golgenna Reach, or in the universitatis of Sibellus and Tarsus. Doctors of physik carry noted Imperial texts as a sign of their craft, and openly consult the scribed wisdom of past servants of the God-Emperor in the presence of their patients. Those doctors who practice their arts for nobles in the spire are wealthy and influential, with access to the most potent tech-devices and skilled adepts-biologis. Almost all diseases of the mind and body are within their power to at least alleviate.

Lesser but still distinguished doctors of the upper hive levels are supported by compacts made with guilders and lesser nobility, and stand head and shoulders above most hive professionals.

In the hive-mazes beneath these respected figures, an army of lesser practitioners and scholars of physik – and those who only pretend to such knowledge – rove the mid-hive to earn scints through lesser treatments and more dubious nostrums. They harvest coins from those who cannot gain access to the hospices, or who distrust the haughty medicae of those institutions. This can be a dangerous practice, especially close to the ward-arrays: apprentices-medicae who shy away from attacking a respected doctor of physik and his retinue think nothing of assaulting or even murdering lesser practitioners.

In the low-hive, where there are no licensed hospices, those who call themselves doctors of physik are a ragged mix of charlatans, faith-healers, and fallen medicae from upper hive regions. Small clinic-chambers and bloody surgeries are hidden away from the depredations of outlaws and gangers. Fiery prayer-healers of the Red Redemption stalk many districts, seeking out the diseased and injured and castigating them in the God-Emperor's name. Failure to become well is evidence of sin and a divine punishment, and many of those unfortunate enough to attract the attention of a Redemptionist prayer-healer are burned alive before their illness can take them.

In the deep poverty caverns, illiterate faith-healers draped in torn prayer-pennons mumble over those poisoned by hive effluvium leaked from alchemical plants and damaged fundament pipes far above. Others concoct philters from that same effluvium, and purge or bleed the sick. Such remedies have little to show in the way of success, but when ague or plague sweeps through the low hive, these lesser healers are much in demand.

The only effective medicine in the hive depths is that provided by charitable orders of the Sibellus Ministorum or Sisters Hospitaller, by dangerous crime barons and least-hereteks plying the augmetic trade, through the efforts of trained medicae who somehow fell from their station in the mid-hive, or in poorly maintained and ill-equipped workers' wards supported by manufactory brotherhood dues or the beneficence of a merchant lord. Manufactory guilds and Ministorum care for the benefits provided by these initiatives only in the abstract, and their efforts are paltry in the face of the suffering of the low-hive. Disease, violence, poison-weakness, mutation, and cancer are the low-hiver's lot, and prayer is their only sure answer to bodily decay – their lives are short as a consequence.

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Gregorius21778 said:

@Reason

Very impressive! Did you mad this one up all on your own or do you recite/work in some source of a novell or older publication? Whatever is true, I thank thee!

Sounds like Reasons own work to me, and quite inspirational at that. I've just pointed my group's Medicae (who worked on Sebillus for some time in an asylum, the Screaming Tower) at the above post. Now, if only I could only find a way remember half of those baroque phrases while actually running the game -the biggest challenge in running this setting properly i fear.

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This topic IS alread outdated, I know.

But after stumbling about this "gathered anekdotes" about Cuban hospitals, I thought about sharing them:

Please take note: the text was slightly edited by me, exchanging some refrence to a person with [PERSON] and some refrence to an organization with [GUILD]

Built in 1982, this newly renovated 600 bed, 24 story hospital The two top floors are the most modern and are reserved for medical tourists and foreign diplomats who pay in hard currency. The hospital has three intensive care units and all medical specialties except Pediatrics and Obstetrics/Gynecology and has no emergency room. The facility has a CT scanner (often said to be out-of-service), MRI and hyperbaric chamber capabilities.

 

Upon entering the building the (person) was struck by the grand and impressive lobby with a four-story ceiling, polished terrazzo floors and an elegant center reception booth. No one was in the reception booth, which displayed a digital streaming ticker-tape announcing an outdated hospital event; 30 or 40 people were sparsely scattered in the leather-like chairs throughout the lobby. There were no wheel chairs or other obvious signs this was a hospital.

She was told the majority of patients came from Venezuela and each received weekly one bar of Palmolive bath soap, Palmolive shampoo, and a tube of Colgate toothpaste. She was also told the Venezuelan patients frequently take these items outside to the front parking lot and sell them to local Cubans. Cuban in-patients receive one tube of Colgate toothpaste and no other toiletries.

Due to the high volume of foreigners receiving treatments and surgeries, most Cubans do not have access - the only chance might be a through a family member or connection working there and a gift or 20 CUCS (USD 21.60) to the Hospital Administrator. Cubans are reportedly very resentful

that the best hospital in Havana is “off-limits†to them.

 

[Other Hospital]
What is today the Obstetrics & Gynecology (OB-Gyn) hospital for Havana, used to be a private clinic prior to the revolution. The hospital has: 300 beds and reserves 12 beds for foreigners; an Intensive Care Unit for women as well as a Newborn Intensive Care Unit (using a very old infant ‘Bird’ respirator/ventilator - the model used in the U.S. in the 1970s); an Intermediate Newborn Care Unit; one room for babies less than five pounds needing weight gain; a Genetics Department with a specialized laboratory; and five surgical suites.

The [PERSON] visited this hospital with a pregnant [GUILD] Foreign patient. Normally [GUILD] staff is required to go to Cira Garcia Clinic, but because there were possible OB complications the [PERSON] was able to arrange, through a Cuban medical contact, for the patient to be seen by a highly-recommended obstetrician.

This hospital, located in the densely populated residential area of Vedado, had a dilapidated and crumbling exterior. The [PERSON] was stopped at the entrance by a guard, but upon mentioning the name of the doctor they were to see, were allowed to proceed to the second floor - supposedly the nicest part of the hospital, which is reserved for foreigners; it reminded the [PERSON] of some of the poorest hospitals she had seen in Africa - unkempt rooms, old wrought-iron beds, flat mattresses with only one sheet, no A/C, no TV, no amenities. At the nursing station there was no nurse, but a metal cabinet with glass doors that had one jar filled with cotton and one half-full 16 ounce bottle of isopropyl alcohol. There were no other supplies nor any indication this was a nurse’s station - no stethoscopes, no computers, no medical charts, no papers or pens on the desk - there was a lone dial-type black telephone.

After waiting 15 minutes a nurse in a white uniform appeared and told the [PERSON] and her patient to wait. She wasn’t friendly. There was no waiting room, so they found some chairs in the hall. It was very hot and the patient was very anxious and in pain. After 45 minutes and several attempts in a polite manner to move things along, a young female doctor came out smiling and asked for the patient - she asked that her husband remain in the chair, but did allow the [PERSON] to go with her upon insisting. At the end of a long hallway, the [PERSON] and the patient were guided into an “exam room.†There were no chairs, screens, posters, any medical supplies or equipment; only one old rusting sheet-metal table without any covering, extensions or stirrups. She asked the patient to undress and climb on the table with no intention to drape her. Having worked in third-world countries, the [PERSON] brought with her a bag of supplies that included paper drapes, which she placed on the table and over the patient. The doctor pulled out of a nearby drawer an old Pinard fetal heart stethoscope made of aluminum (funnel-shaped, like those used at the turn of the Century ) to listen for the baby’s heart beat. The [PERSON] could not believe her eyes this was one of the best OB/GYN hospitals in Cuba. When the [PERSON] offered the doctor a portable fetal Doppler she had brought from the [GUILD] Health Unit (HU), she gladly accepted.

Although the doctor appeared to be clinically competent, she was abrupt and rough with the patient. [PERSON] believes this to be typical of the hierarchical doctor-patient relationship in Cuba. She stated, “She has an infection and needs an antibiotic,†and gave the [PERSON] a written prescription for an antibiotic generally not recommended during pregnancy. Upon returning to the HU the [PERSON] did a culture that returned negative for a bacterial infection. Needless to say, the [PERSON] did not give the prescription to the patient. As a result of this experience, the [PERSON] concluded that the best care for her unstable female pregnant patients in Havana barring a MEDEVAC to the U.S.

would


be by the [PERSON] in their own home with telephone consults to an obstetrician in the U.S.

XXXXXXXXXXXX told the [PERSON] that XXXXXXXXXXXX foreign medical students are increasingly covering for the gross shortages of physicians in Cuban hospitals.


Built in the late 1800’s, this dilapidated 400-bed hospital was the first teaching hospital in Cuba and is only for Cubans. [PERSON] believes that if Michael Moore really wanted the “same care as local Cubans,†this is where he should have gone. The 22-bed emergency room receives all the major trauma and accident victims from Havana City, plus there are large Intensive and Intermediate Care Units. It also has a CT scanner and an MRI, which are reportedly often out of order. The hospital provides specialist care in all medical fields except OB-Gyn and Pediatrics.

During the hospital visit, [PERSON] was struck by the shabbiness of the facility no renovations were apparent and the lack of everything (medical supplies, privacy, professional care staff). To the [PERSON] it was reminiscent of a scene from some of the poorest countries in the world.

In an open-curtained exam room inside the emergency room, [PERSON] saw a middle-aged man lying on a gurney in his own soiled clothes with a large bloody bandage wrapped around his head - he was breathing, but was neither moving nor talking - there was no IV, oxygen (in fact no piped-in oxygen at all at this facility) or monitoring equipment. Neither did there seem to be any sense of urgency to his care.

The hospital is spread out over several city blocks consisting of many two-story buildings with various specialties: Internal Medicine, Cardiology, General Surgery, Orthopedics, Ophthalmology, and Neurology, etc. Each building is set up in dormitory style, with 44 metal beds in two large open rooms.

The laboratory equipment is very rudimentary - a simple CBC (complete blood count) blood test is calculated manually by a laboratory technician looking through a microscope and counting the individual leucocytes, lymphocytes, monocytes, etc.

As the [PERSON] exited a building, XXXXXXXXXXXX drove up in a badly dented 1981 Moskovich that belched exhaust fumes. The private car, which is a luxury in Cuba, was a gift from his deceased father. He was a thin man, appearing disheveled, unshaved, with a cigarette between his lips, wearing a tattered white lab coat without a shirt underneath. He said his salary was 565 pesos (approximately $22) per month.

This 400-bed hospital is located in Cerro - a poorer and more densely populated section than the others visited in Havana. It is an old, run-down facility similar in appearance to Calixto Garcia Hospital in that there are several two-story buildings each with a medical specialty.

The [PERSON] was dropped off a few blocks away so the guards wouldn’t see the diplomatic plates. When she walked in, the guards smelled of alcohol. In the emergency room there were about 40 mostly poor-looking Afro-Cuban patients waiting to

be seen. It appeared to be very orderly, clean, and organized.

The rest of the buildings were in shambles . The [PERSON] did not see any “real†medicine or nursing practiced during her almost one-hour walk through most of the buildings. As she saw patients, she could not help but think that their own home might provide more value-added than remaining in that hospital. Patients had to bring their own light bulbs if they wanted light in their rooms. The switch plates and knobs had been stolen from most of the rooms so one had to connect bare wires to get electricity. There was no A/C and few patients had floor fans. Patients had to bring their own sheets, towels, soap and supplemental foods. Hospital food service consisted of rice, fish, rice, eggs, and potatoes day after day. No fresh fruits, vegetables, or meat were available.
 

 

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Cuba has very high life expectancy and low infant mortality, so they must be doing something right.

Anyway, in this scenario, I would emphasize a lot of ritual prayer and so forth that don't have a medical purpose. "There is blood in your urine? Say the Prayer for St. Drusus' Intercession in Health 10 times daily, and repent of all your sins. Or perhaps a spell has been upon you by a witch?"

Also, medical treatment should be couched in pseudomedieval terminology. They are not "giving you an antibiotic," they are "balancing your humors."

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