I don’t have a lot of experience with small hospitals. My medical school’s hospital was about two square blocks of buildings, all of them attached, ranging in age from 100 years to 10 years. The were connected by irregular bridges and linked (ex)-fire escapes, and by miles of dim tunnels.

During my residency, the campus covered several square blocks, with buildings linked by more airy bridges (a la Minneapolis) and “secret” tunnels that you could find if you just knew where to look—although getting lost underground was the rule.

My current hospital is—by number of admissions—one of the largest in the country. It’s fairly modern, with the buildings ranging from 50 year old to three years old. But it has that sine qua non of all hospitals—a basement city.

My hospital is actually quite beautiful. There are occasional hints of the complexity hidden above and below—signal boosters jut from drop ceilings, oxygen hook-ups slide out from behind panels—but really, it might be confused for any hotel or office building. Until you climb into the basement.

Hospital basements are not unlike what you see on TV shows about aircraft carriers—remarkably complicated and busy. Wide hallways—roads, really—on which electric trucks pull carts full of supplies and garbage; break rooms carved out of back hallways with tables and vending machines; and of course, a radiation oncology department, with impossibly nice furniture.

Looking up at the maze of pipes, I see, clearly labeled, medical oxygen, medical vacuum, hot water, cold water, waste water, and many more. And of course, running like a hamster highway above, the tube system.

Tube systems are a Victorian holdover that the older of my readers may remember from downtown department stores (and still from time to time at bank drive-throughs). A pneumatic tube several inches in diameter sits at the nursing station, attached to an electronic switchbox. One can draw blood, place it in a plastic tube, dial in the lab, and *poof* it is sucked into the tube and delivered to its destination.

In the basement, the tube system is revealed to be, at least in its midsection, a pastafied network of large tubes with whisting and sliding sounds surrounding them—like I said, very Victorian.

Then of course there is room HM—the morgue. This bland metal fire door looks like any other basement closet, except for the men in suits with small uncomfortable-looking gurneys who seem to sprout up from time to time.

I love the basement, that underground city feel. You never know what time it is—noon, midnight—but that city is moving. Trucks are delivering gloves, cooks are preparing meals, tubes are whistling overhead. It is (despite room HM) very much alive, and in a place with so much illness and suffering, alive is a nice break.