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'Hiccoughs Happen'
Plans for Hospital Take Final Shape

By Rich McManus

On the Front Page...

Final plans for the Mark O. Hatfield Clinical Research Center -- a new 850,000-square-foot hospital and lab facility to be grafted onto the north face of the current (and outmoded) Clinical Center -- have been drafted and show a leaner, more elegant and more user-friendly structure than was announced a year ago. Despite a series of minor setbacks, dubbed "hiccoughs" by CRC Project Director Yong-Duk Chyun of the Office of Research Services, the $333 million addition is only a few months behind the original schedule -- time that planners have used to fine-tune everything from complex engineering features to such minutiae as placing commodes in patient rooms so as to achieve more commodious window size.


From grand plans for a dramatic Science Court atrium at the heart of the H-shaped building to determining the best color scheme for the finishes in 225 patient rooms, no detail has been too insignificant for consideration. Planners even built a standard patient room as well as an intensive care patient room in the CC's 14th floor assembly hall so that users could stroll through and critique such facets as lighting, TV placement, ceiling heights and the colors of furniture and drapes. Who, other than patients and caregivers, could give better advice?

An architect's model incorporates the final design changes recently approved by ORS. Note the two lanes of Center Drive that pass in front of the hospital, and the Science Court at the heart of the H-shaped structure.

"The response from users has been absolutely amazing," said Chyun. The NIH'ers consulted by the design team "have been very bright and cooperative," added Margaret DeBolt, the project architect with Zimmer Gunsul Frasca, the firm that designed the CRC. "They've gone out of their way to participate in meetings. They understand that we're not just bugging them." "There's a definite sense of ownership" on the part of the new users, said Chyun.

Holdups on the project have been sundry: difficult weather, controversy last fall over removal of old oak trees, the prolonged demolition of Apartment Bldg. 20 (owing to asbestos removal, retiring various water mains, and the sheer, stubborn stoutness of the structure itself) and the complications of finding and relocating long-buried utility lines ("It's not that uncommon to lose track of where they are," noted Chyun. "Out of sight, out of mind.") Too, the contract-awarding process for the realignment of Center Drive some 150 yards north of its current path in front of Bldg. 10 -- a key factor in CRC site preparation -- took longer than expected.

Planners built a standard patient room as well as an intensive care patient room in the CC's 14th floor assembly hall so that users could stroll through and critique decor and other features.

"Construction is very busy in the D.C. area right now," said Chyun, "so the time it takes for contractors to respond to bid packages has been slower. Instead of taking 2 weeks, it takes 4." Cheerily undeterred by the delays, Chyun says, "Hiccoughs like these happen."

Originally scheduled to open at the end of 2001, the CRC is now projected to debut in mid-2002. But the wait will be worth it, say designers. New features include a slimmed-down look -- instead of occupying 8 "blocks," the refined version will have 6: 4 nearest to Bldg. 10's ambulatory care addition, and 2 out front. "Our original design had more area than the defined program," said DeBolt. Parking entrances have been moved from the front to the sides, and Center Drive was realigned to include more buffer space and less proximity to Wilson House. "It's a tighter site now," she observed.

Imagine the letter "H" lying on its side. Initial drawings had all of the hospital portion of the CRC in the "south" bar of the H (nearest Bldg. 10) and all lab space in the north bar. "Now the hospital occupies the 4 central, inboard blocks," said Chyun. "That's because a hospital gets visitors. The labs can be outboard, at the far east and west ends of the south bar, because they get fewer visitors." Both lab and north bar patient blocks are being designed for interchangeability -- if the state of science demands conversion of a patient care unit to a lab, or vice versa, the adaptation will be relatively efficient, said Chyun.

What is generating the most excitement is the 7-story Science Court linking the north and south bars. "The treatment of this space is much more defined, and has much more character than before," Chyun enthused. Capped by a glass cone that will reflect light of varying colors -- in the manner of a stained-glass window -- the court will house a dramatic, helix-shaped staircase and see-through glass sides. Art consultant Larry Kirkland has been retained to further embellish the interior with elements lending "a higher level of meaning," said DeBolt. "He's a fascinating guy -- we're all very excited about it. He's been talking to (NIH deputy director Dr. Ruth ) Kirschstein and (NIH deputy director for intramural research Dr. Michael) Gottesman about his ideas, and also is interviewing some patients for their views. He wants to incorporate a number of different perspectives." The design team expects Kirkland to use certain germane scientific images and quotations in whatever he comes up with to improve the space.

While the Science Court will be an appealing venue for social interaction, even the less glamourous parts of the CRC will include warm touches. For instance, the new South Entry, set to open in early November on the south side of Bldg. 10, will feature wood ceilings and paneling, terrazzo floors, and stylish stone baseboards -- all of which will be echoed in the new north entry once the CRC is complete. The effect will be a sense of unity and complementarity, said DeBolt.

This view of the CRC model shows the courtyards separating the front two blocks from the rear four blocks of the new facility.

The decidedly unglamourous work of assigning space within the CRC -- the so-called "blocking and stacking" process -- has nevertheless not been artless. Unlike the Clinical Center, whose space was rigidly assigned by institute, the CRC will be organized based on the kind of research being done. For instance, the first floor will include an array of outpatient services, travel, pharmacy and the rehabilitation medicine department -- all of which require easy access and involve a majority of patients. It will also include a pediatric unit, with an adjoining outdoor playground. The third floor (see sidebar for all floor assignments) will house an intensive care unit, which makes sense because this is the floor that will connect with the surgery suites on the second floor of Bldg. 10. As in 10, a light-filled chapel will be on the top floor (floor 7) of the south bar. This floor will also include conference rooms, and sleep studies. "It's logical for these to be somewhat more remote," observed DeBolt.

A particularly knotty issue in finalizing the CRC design was deciding just how intimate the interface with the ACRF would be; initial plans had the two buildings in a virtual embrace on all floors. That has since been modified to connections only on floors 1 and 2 of the ACRF, and via "bridges" linking the 5th floors. "It was a lot more complicated than we had originally planned," Chyun said.

With so much of the vitality resected from old Bldg. 10, what will become of that facility? At present, authorities have completed a very general master plan approach for it. While notions are still being sketched, one idea is that a round-robin renovation of laboratories can be initiated (beginning with the E and F wings, followed by renovation of the distal wings in sequence) once space is freed in Bldg. 10 by occupancy of the CRC. "Whatever the final program plan, the renovation of old Bldg. 10 is a crucial part of the NIH campus master plan to meet the needs of the intramural program over the next 15 to 20 years," said Chyun.

For the near future, NIH'ers are advised of two coming disruptions: Chyun already sent an NIH-wide email warning -- followed by pamphlets available in some building lobbies -- that the corner of Memorial Drive and Center Drive between Bldgs. 10 and 31 will be chewed up by two phases of construction lasting from late July to mid-December. Then, late in the fall, workmen will demolish the porte-cochere in front of Bldg. 10, under which cars now come and go to drop off people and patients. "Once that happens, we'll proceed to the entire excavation. It will be huge," Chyun assured.

Space Assigned by Use, Not Institute

Not every square inch of space in the new Clinical Research Center has been assigned yet -- the lab space is still being parceled out -- but a general outline has emerged. Keep in mind three general principles: First is that, unlike its predecessor, the CRC is organized by type of research, not by which institute or center has dibs on a certain floor. Secondly, the lab blocks on the east and west ends of the "south bar" and the front 2 blocks on the north bar are but 6 stories tall. The only 7-story structures are 2 blocks on the south bar, nearest the ACRF, or clinic part of Bldg. 10, and the Science Court. The third thing to remember is that both bars feature "interstitial" space on the second, fourth and six floors. These are floors dedicated primarily to utility lines, ventilation systems and mechanical space. However, there will be some offices on mezzanines within these interstitial floors.

One more thing to remember is that so-called "day hospital" stations will be scattered throughout the clinical blocks; inpatient rooms will occupy all four clinical blocks.

Basement -- Nutrition department, NCI Radiation Oncology Branch, vivarium, corridors linked to loading dock for distributing materiel.

Floor 1 -- Pediatric units with adjacent outdoor playground, outpatient services, pharmacy, rehabilitation medicine department, travel office, alcohol studies.

Floor 3 -- Intensive care unit, oncology medical/surgical unit, bone marrow transplant and hematology/oncology.

Floor 5 -- General medical unit for NIDDK, NICHD and others doing endocrine studies, cardio-pulmonary care, infectious diseases, neuro and surgical subspecialties.

Floor 7 -- Alzheimer's unit, sleep lab, mental health unit, chapel, conference space.

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