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'No Other Place Like It'
New Hospital Gets Ready for Opening Day

By Rich McManus

Photos by Bill Branson, Rich McManus

On the Front Page...

Don't be fooled by the relative quiet that enfolds the exterior of the new Mark O. Hatfield Clinical Research Center as workers prepare for the building's Sept. 22 dedication ceremony; indoors, the air rings with hammer blows, the whine of circular saws, and the din generated by some 600 tradesmen as they hurry to complete the new 242-bed, 80-day station hospital addition.


"There's no facility like it in the rest of the world, or in the United States," said NIH director Dr. Elias Zerhouni at a special hard-hat tour for reporters held July 12. "The original Clinical Center [which opened in 1953] played an enormous role in the history of medicine. This building will represent a complete rethinking of 21st century medical research. We are extremely proud of this place...It will incubate original ideas about research."

Nine-story CRC atrium is a most impressive space, among many.

Touting the nearness of the bedside to the laboratory bench — long a hallmark of the CC — in the new hospital, Zerhouni added, "There's no place where you can even envision the kinds of research to be done here in the future." Especially with respect to infectious diseases, the CRC will be unique, he said: "This is very dangerous work that can't be done in a general medical center. This is the only facility in the world where you can do it — there's no other place like it."

Zerhouni emphasized that NIH "is not just a grant-making institution — we are also an intellectual leader. I see NIH as a real medical incubator for risky research areas." The riskiest work, he explained, will involve the creation of new biologicals, including immune therapy tailored to individual patients, which is already a feature of studies conducted by Dr. Steve Rosenberg, head of NCI's Surgery Branch, who also spoke during the tour. Zerhouni said the CRC will also host a busy bone marrow transplantation program — "Only a place like this can take that chance," he noted.

The CRC will bring the total Clinical Center complex to some 4 million square feet, making it one of the largest federal buildings in the country, said CC director Dr. John Gallin, who described the hospital as "a place where many fabulous things have happened (see sidebar)." He divulged that informed consent and patient safety — the forerunners of today's institutional review boards (IRBs) — were the topic of the first meeting of the CC medical board some 51 years ago.

Clinical Center director Dr. John Gallin is interviewed during the July 12 hard-hat tour for media by reporter Jennifer Ryan of WUSA-TV.

Gallin outlined the "long journey" that resulted in construction of a new research hospital at NIH. An assessment in 1989 concluded that the CC had 12-15 years of useful life left, he reported. In 1991, then-NIH director Dr. Bernadine Healy approved a proposal to build a replacement facility. Three years later, former NIH director Dr. Harold Varmus vigorously pursued the project, endorsed by HHS Secretary Donna Shalala. Twenty-nine firms competed to design the facility, and architectural firm Zimmer Gunsul Frasca (ZGF) won the job. A congressional appropriation in 1998 allowed construction to begin the following year, and by 2002, the exterior of the CRC was substantially complete. NIH officially takes possession of the CRC from prime contractor Centex at the end of the summer, said Project Director Yong-Duk Chyun. The two laboratory sections of the hospital will be the first occupied, beginning in mid-September, he said; Sept. 13 is when an NCI lab becomes the first new CRC tenant. In mid-October, the various CC departments will begin to move in, starting with the director's suite on the sixth floor, directly over the CRC's central portion. "All labs and departments should be moved in before Thanksgiving," said Chyun, "then the patients will move in on Saturday, Dec. 4." Gallin divulged that historical studies of CC census indicate that early December is when the fewest patients are on hand.

NIH director Dr. Elias Zerhouni addresses reporters July 12.

"This is the largest, most technologically advanced clinical research facility ever built," Gallin said, "but it is also a place of hope. There are many people alive today who came here [to the original Clinical Center] for their treatment."

He emphasized the human dimension of care, which substantially informed project design, from dispensing with speed bumps in the parking garage (which nauseated patients undergoing chemotherapy) to the installation of adjustable shower heads (upon the advice of an AIDS patient who was trying to keep a chest catheter dry), to an insistence on natural light not only in all patient rooms, but also elsewhere; Gallin is particularly proud that an atrium skylight illuminates even the entryway from the B1-level parking garage.

Gallin said it was essential that the building be flexible; lab modules can convert to patient care, and vice versa, and the lab benches themselves can convert to desk space. "We need a building that can change," he said. The CRC will feature a modest drug manufacturing facility, he noted, so that "we can synthesize small amounts of candidate drugs." There is also unique lab equipment, including three cyclotrons (actually a part of the old hospital since the mid-1980's) and three linear particle accelerators, as well as special imaging facilities.

The CRC will enhance the NIH intramural programs' legendary ability to respond rapidly to emerging health challenges, Gallin said, noting past successes with issues ranging from AIDS to anthrax, biodefense, obesity, smallpox and SARS. He touted a "strong behavioral health facility" that will be part of the CRC, explaining that the average stay for patients in this area is 123 days, compared with only 4.5 days of care on the outside.

NCI's Dr. Steve Rosenberg (r) addresses reporters in his lab space in the CRC. With him is Robert Frasca of the architectural firm Zimmer Gunsul Frasca, which designed the building.

Gallin said the CRC is "truly a national hospital," whose amenities include a plethora of medicinal plant displays donated by the U.S. Botanic Garden, bedside access to the World Wide Web and other educational tools, a K-12 school for young patients, meals on-demand from the hospital kitchen, and some retail operations at the foot of the 9-story atrium (tenants so far include Starbucks and Au Bon Pain, said Chyun).

Cost of the new CRC is around $650 million, according to Leonard Taylor, acting director of the Office of Research Facilities Development and Operations; $596 million appropriated by Congress for construction, and an additional $50 million on furnishings and fit-out.

Gallin shows reporters the adjustable shower head that was recommended by a Clinical Center AIDS patient.

Robert Frasca of architect ZGF acknowledged what Gallin called the building's "large footprint," but emphasized that it is "in many ways a very modest building." He said designers eschewed the high-rise concept, partly out of respect for NIH's neighbors, but also in an effort to humanize the scale of the facility. "We hope it will serve science for the next 50-100 years," he said.

Tour Facts

A Towering Column of Light, and Floors that Read the Impression of Your Foot

There is a poetry to the emptiness of the CRC, now hollow and virginal, but soon to be cluttered with life. No one has lived or died there yet. There hasn't been any gossip or flirting, or the echo of that disembodied public address voice — "One hundred, paging one hundred." No one has gotten lost in it yet, though they surely will, despite a new numerical room address system so extensive that it has caused the renumbering of all addresses within the CC complex.

Standing at the top of the 9-story atrium at 5 p.m. on a July Friday, it's easy to imagine the velvet rose of a coming November sunset, and the staggering peace known only to those who inhabit hospitals late or after hours, when the commonplace noises have exited, and a new building gains its identity as a breathing, living space.

CRC Project Director Yong-Duk Chyun shows pneumatic tube system.

There are no enclosed spaces as grand as this one at NIH now, and one can only imagine how the light will play there as seasons pass. It's beyond high-end shopping mall or airport grandeur (though it has those elements on its ground floor), ascending to the category of cathedral or rotunda.

Most people will experience the CRC in scattershot fashion; it will take years for a general impression to settle. Project Director Yong-Duk Chyun insists the building is easy to learn, but only time will tell. Here are some impressions from a recent series of tours.

Getting There

Center Drive is soon to revert to a circulation envisioned in the NIH Master Plan. The current two-way section that passes in front of the hospital will become one-way headed west, toward Old Georgetown Rd. And the driveway immediately in front of the CRC entrance will be one-way headed east, toward the Pike. Patient and visitor access to the CRC will be via West Drive, which enters NIH at Cedar Ln., passes the Children's Inn, and feeds Center Dr. near the "Sky Horizon" sculpture by Louise Nevelson (which, for the record, reminds CC director Dr. John Gallin of a large microscope).

The Basement

Down on the B2 level — the CRC basement — is where an overwhelming sense of million-ness begins. There's a brand-new kitchen the size of a football field, with stainless steel refrigerators and dishwashers, all awaiting the configuration of new nutrition department director Dave Folio. Across a concrete hallway soon to be trafficked by electronic carts (they actually timed how long it takes the carts to deliver food from the kitchen to the elevators leading to customers upstairs) is a locked-and-barred CIT telecommunications hub. Why can't we go in there? "It's been turned over to CIT. They have millions of dollars of electronic equipment and computers in there," says Chyun.

The HVAC area — another football field — is crammed with pipes and plumbing and conduits, and is adjacent to a massive electrical vault that seems to pulse with red-lit pent energy. More millions.

There is a small-animal holding facility (vivarium), and large-animal surgery, and the air-handling requirements for these are so important and so sensitive that tests are running all month long so the quality and pressure are just right.

A waterfall for Radiation Oncology Branch, NCI

Then there is NCI's Radiation Oncology Branch, a portion of which moved over rather late in the game (project planning-wise) from a subterranean headquarters on the backside of old Bldg. 10. Because patient tension here tends to be high and because the need to be underground precludes the possibility of windows, a calm-inducing water fountain has been built into one of the walls. And speaking of walls, some of them here are 3 to 6-feet thick, sometimes lined with lead bricks, to accommodate the energies developed by three linear accelerators. When the "Beam On" lights flash, one assumes it's best to be beyond the monolithic steel-and-lead slabs that pass for doors offering access to these three rooms.

The First Floor

Remember those nasty cobblestones that used to line the driveway up to the old ACRF, or clinic, part of Bldg. 10? They were jettisoned years ago for the same reason that the garage speedbumps were nixed — they irked patients. Visitors to the grand entrance of the CRC will find a smooth driveway lying under a free-standing overhang which, at night, features neon blue underlighting (perhaps a nod to the Bethesda skyline). Once through the revolving door (intended to preserve the building's air quality; air in the hospital is 100 percent fresh, with no recirculation), guests will find an unmistakable central admissions/information area featuring polished stone countertops and an airy, 2-story atmosphere. The renowned Clinical Center art program will find a home at the CRC, with a main exhibit space in this admission area. There will also be a prominent statement of the NIH mission, and an exhibit honoring the building's namesake, former Sen. Mark O. Hatfield (R-OR). A large aquarium is also to be located along one wall in the admissions area.

This addition to the CC pharmacy department was designed and built separately from the main CRC project; it includes the most strict air purity standards in the new building.

Centered on the floor of the 9-story atrium will be a sculpture embodying the theme of the biblical "Pool of Bethesda," created by the husband/wife team of Gene and Susan Flores, who designed the 9/11 Memorial Park near the Rockville Courthouse. A shade-loving species of palm will add to the sculpture's calming water-stream feature.

Two patient care areas with remarkable characteristics are located on the first floor. The pediatric unit features several playful lighting schemes. In some hallways, mobiles hang overhead with whimsical butterflies serving as light fixtures. And in lieu of room numbers on patient doors are mandalas of colored lights — kind of like colored marbles — whose patterns uniquely signify each room. Kids, Gallin assured, are sure to recall the patterns more readily than they would numerals.

An extensive rehabilitation medicine department has a special room whose floor was built entirely independent from the rest of the foundation, in order to be vibration-free. The floor supports a central area roughly 9 feet square that is embedded with sophisticated sensors that can record the tiniest amount of biomechanical pressure exerted by a bare foot, including that induced by the pinky toe. "I'm dying to see it once it's all done," enthused Chyun.

Chyun points out seam in the floor of biomechanical lab in the department of rehabilitation medicine. The lab's floor is separate from rest of the building.

On either side of the atrium are lushly planted courtyards with low concrete walls to encourage sitting as well as a variety of benches. The east courtyard will be dedicated in honor of Florence Mahoney, widely regarded as the founder of the National Institute on Aging, perhaps as early as October. The west courtyard is a mirror image of the east, but there are as yet no dedicatory plans for it.

NIAAA labs occupy the first floor's eastern laboratory block. Like all the lab floors, it features a shared cold room in one central corridor, as well as an equipment room, with lab space lit by large windows. Lighting is fully automatic in these facilities; motion detectors turn them on and off. Each lab block also includes a dark room for photo processing.

An expanded pharmacy department facility is also located on the first floor, although the main department will remain in Bldg. 10. The new section has air quality specifications that are the highest in the CRC, to accommodate a small drug-production facility known as GMP/GLP, or good manufacturing practices/good laboratory practices. A separate design/build contractor handled this portion of the hospital, Chyun noted.

Chyun shows vault within pharmacy department.

Some Sweet Suites

Located around the central atrium are the offices of the various clinical directors with programs in the building. Held strictly to the same space limitation, the suites nonetheless are prime real estate, with large, sometimes floor-to-ceiling windows and easy access to the atrium. The office suite of the CC director on the sixth floor is most impressive, located just above the 4th floor medical board room, which itself has an outdoor patio overlooking the front of the CRC.

Consistency from Floor to Floor

The four patient care blocks in the CRC have similar floor plans. Typically, there are 24 rooms per floor, half private (for those more acutely ill), half semi-private. There is a central nursing station in the center of each block, with satellite stations at each end, so that each station serves no more than four patient rooms.

In the "day hospital" areas, a nurse's station is in the middle of two patient rooms. "This is unique," said Gallin. "We think this will become a trend in clinical research. No overnight stay is required of the patients, and we even have a mini-business center where patients can hook up to the Internet."

What's Staying Put

The radiology department, surgical suites, department of clinical medicine, department of transfusion medicine and some diagnostic facilities will remain in the old building as will the two main cafeterias. The ACRF outpatient clinic will remain as is, hosting most routine clinic visits. While the new hospital will have five or six ORS-managed conference rooms large enough to convene groups of around 70-100, plus another three dozen or so small meeting areas, Masur Auditorium and Lipsett Amphitheater will continue to serve as the complex's main meeting rooms.

The CRC encompasses some 850,000 square feet (although total site construction totals 1.2 million square feet — 1.05 million on the CRC itself, with the rest accounted for by rebuilding a demolished underground garage and an old patio). The atrium ceiling above was hand-finished.

The CRC will have a multi-faith chapel on the 7th floor, with canted roof, skylight and stained glass column of light behind the altar area. The chapel is also getting the CRC's only hardwood floor. The pews and revolving altar from the old 14th floor chapel are simply migrating over to a new home in the CRC. "That's called value-added engineering," chortled Chyun of the cost-saving move.

Other Fine Details

Up on the seventh floor, be sure to take notice of the atrium ceiling. It is made of Italian plaster, and was hand-applied by artisans from Italy. If you look closely, there are subtle, non-repeating elements to the finish.

Chyun can't wait to see how the changing light of the seasons affects the character and mood of the atrium. Looking out toward the courtyards below, he observes, "I am truly impressed with the ZGF design. The proportions are just right."

Pointing out smokestacks on the hospital's roof, he divulges that the stack height was carefully calibrated in studies conducted at a special wind-tunnel modeling facility in Colorado. "They built a model of the entire north half of NIH to study how the prevailing winds would affect exhaust," he marveled. The stacks are just high enough so that their emissions clear the courtyards and don't affect inhabitants of the CC complex.

Chyun noted that a new K-12 school will be built where the lobby of the ACRF meets the CRC, near the current Voucher Office and Travel Office on Bldg. 10's first floor. The school will conveniently abut the new pediatric unit. Also in this area of the first floor will be a children's drop-off area so that parents/caregivers who have appointments in the building, but must bring children, have a place to leave them supervised and entertained.

Chyun stands beside a stack of tongue-in-groove flooring that will become the hardwood floor of the CRC's seventh floor chapel. It is the only hardwood flooring in the building.

In the event of a bioterror emergency, portions of the CRC can convert to "swing space" for relief of acute care capacity, said Gallin. There are about 30 isolation rooms throughout the hospital, Gallin added, with several other rooms convertible to that purpose should the need arise. There is also a vaccine-testing facility in the CRC, for biodefense purposes.

Like the old hospital, the CRC includes some holdover, "old" technology that is still useful, including a system of pneumatic tubes, and an electronic track conveyor for transmitting material.

Who Uses the Hospital?

Seventeen of NIH's 27 institutes and centers have space within the new CRC, but only 11 have labs. NEI has no lab space, but does reserve some capacity for patients. As NCI Surgery Branch chief Dr. Steve Rosenberg told reporters at the July 12 media briefing, the CRC is not a place for commonplace medicine: "If you can do it everywhere, you don't do it here," he declared.

"I can't wait to move in — we move the second week of September," Rosenberg continued. "We'll be able to do things we couldn't do in the old building." He cited a study showing that patients tend to recover faster when they can see the light outside and know when it is day and night.

The east courtyard at the CRC will be dedicated in memory of Florence Mahoney, a champion of the establishment of the National Institute on Aging at NIH. Both east and west courtyards are similarly appointed, featuring lush plantings and plenty of places to sit down.

Echoed Gallin, a 31-year NIH veteran, "I'm very excited about moving into this new facility." He predicted that the new CRC will focus more on prevention than on the acute care that became the hallmark of the original CC. "We hope to match the record of the Clinical Center's first 50 years," he said. He is fond of saying, "Although we can't do everything, we can do anything. It's just a matter of setting priorities." Not a bad new motto for Sen. Hatfield's new namesake.

A Resumé of Achievement

The new inhabitants of the CRC won't have long to sit on laurels and Rent-a-Crate boxes before public expectation prods them to perform. After all, the track record of the original Clinical Center includes the following successes, enumerated here partially by CC director Dr. John Gallin:

  • Lithium first used in treatment of bipolar disorders
  • Blood tests for AIDS and hepatitis developed
  • World's first gene therapy in human patient
  • First successful treatment of sickle cell disease with hydroxyurea
  • First artificial mitral heart valve developed
  • MRI first used to diagnose heart disease in emergency room setting
  • First cure of a solid tumor with chemotherapy

Who'll Be Where, Come Moving Time

Level 1
1B Pediatrics
1C Rehabilitation Medicine
1D N Pediatric Behavioral Health
1D S Admissions
1F Pediatric Oncology Research Lab for NCI
1F Urological Oncology Research Lab for NCI
1E N Alcohol PCU (patient care unit)
1E S Pharmacy
1G Alcohol Abuse Research Lab for NIAAA
1G Developmental Endocrinology Research Lab for NICHD

Level 3
3B Surgical Oncology PCU
3C Hematology-Oncology PCU
3D Critical Care/Intensive Care Unit
3F Surgical Oncology Research Lab for NCI
3E Hematology-Oncology Day Hospital
3G Medicine Research Lab and Metabolism Research Lab for NCI
3G Hematology Research Lab for NHLBI

Level 5
5B General Medicine PCU
5C Cardio/Pulmonary Procedures
5D Surgery PCU/Med-Surgical Day Hospital
5F Lab Host Defense Research Lab for NIAID
5F Diabetes Research Lab for NIDDK
5E Medicine/Telemetry
5G Cardiology Research Lab for NHLBI
5G Pulmonary Research Lab for NHLBI
5G Gene Therapy Research Lab for NHGRI/NIDCD/NIDCR/NEI

Level 7
7D Neuro/Neuro Testing /Sleep Lab
7E Adult Behavioral and Geriatrics

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