Dr. Jeffrey Norton tugged at a malignant tumor protruding from a patient's stomach on a recent afternoon while conferring with a group of medical assistants in blue scrubs.
Norton, a surgeon at Stanford Hospital, was performing a "Whipple procedure," which involves removing a section of the patient's stomach to treat a cancerous tumor. A flat-screen television near the entrance to the room showed organs shifting inside a dark, cavernous chamber as the procedure progressed.
Next to the flat screen, a small board illuminated an X-ray -- a throwback to the old days, before the movements of every organ could be monitored live and in full detail.
Norton performs this complex procedure nearly every day, and his experience showed through his calm, deliberate voice as he pulled a glistening, bulbous lump from the patient's stomach while explaining the next step of the procedure. A faculty member with the Stanford University School of Medicine, he was clearly comfortable operating and answering questions simultaneously.
Outside Norton's operating room, along smooth hallway floors, a legion of medical machines stood single-file along the wall. Behind them were metal shelves full of trays stacked with medical equipment.
Rooms and hallways throughout Stanford Hospital have little or no space to spare. The buildings that make up the sprawling Stanford Hospital complex were constructed in 1959, 1979 and 1989. These days, they meet neither California seismic standards nor the modern standards of medical care.
Dr. Jay Brodsky, medical director of perioperative services at Stanford Hospital & Clinics, said during a recent tour that the facility simply wasn't built with today's technology and volume of patients in mind. He motioned to a flat screen at the side of a hallway that tracks the status of every operation in every room. It showed a list of 10 patients who were waiting their turn.
"It's like a puzzle, but by the end of the day we will get it all done," Brodsky said.
The lack of facilities adequate to enable state-of-the-art, 21st-century health care is the fundamental pitch that Stanford officials have been making since 2006, when they first presented redevelopment plans for the Stanford University Medical Center to the Palo Alto City Council.
Since then, the details of Project Renewal have unfolded, with plans changing -- but never the essential purpose.
Most of the buildings at Stanford Hospital would be demolished some time in the next decade to make way for the massive reconstruction -- a project that would bring 1.3 million square feet of new development to Palo Alto. Construction would include a vast new Stanford Hospital comprised of five glassy pavilions rising 130 feet above the ground.
The redevelopment would also expand Lucile Packard Children's Hospital, renovate the Hoover Pavilion and replace Stanford School of Medicine buildings.
The city, which must approve of the redevelopment, is in the midst of reviewing a Draft Environmental Impact Report for the project and preparing to negotiate a development agreement (see sidebars).
The project has two major objectives: to meet California's seismic codes and to "right size" both Stanford Hospital and the Children's Hospital. That means larger rooms for patients, 248 new beds (144 at Stanford Hospital and 104 at the Children's Hospital), and enough space in the operating rooms for all the latest surgical equipment.
Both hospitals are overwhelmed by demand, according to the impact report. In 2005, for example, the Children's Hospital was forced to turn away 200 critically ill children because of the bed shortage, while Stanford Hospital turned away roughly 500 adult patients, the report states. The detailed analysis states that both hospitals "suffer from an outmoded ratio of semi-private patient rooms to single-bed patient room."
The massive expansion would add roughly 471,300 square feet of space to the Children's Hospital, which has already gone through a series of transformations since it opened in 1991. The hospital previously shared operating rooms with Stanford Hospital but in 2008 opened its own surgical facility tailored specifically to the youngest patients.
In one such operating room this week, a team of doctors was repairing the interior of an infant's heart. The heart stood still, but the baby's life was sustained by a heart-lung machine. Flat-screen monitors throughout the room kept track of all the vital signs.
Dr. Craig Albanese, director of pediatric surgical services at the Children's Hospital, said the new surgical center was urgently needed to meet a rising demand of child patients, many of whom come to the Children's Hospital as a last resort. Recent medical advances have made it possible for the hospital to save more lives than ever before. Many of the survivors, however, require multiple surgeries and thus, more space, he said.
"The partnership worked well when we had lower acuity and a lower volume of patients and when technology wasn't what it is today," Albanese said.
The Children's Hospital performed about 3,600 operations annually back when it shared the Emergency Department with Stanford Hospital, but the number jumped to 5,100 between January 2009 and January 2010, with the new operating rooms in place, Albanese said.
The Children's Hospital used to turn away about 40 children per month. Today, such instances are quite rare, he said.
But patient privacy and space remain a problem for both hospitals. In one Children's Hospital recovery room, two doorways lead to the same room, where on a recent morning four patients were recuperating. On one side of the room, two cribs stood side by side. On the other side, two occupied beds were separated by a curtain.
At Stanford Hospital, patients share small rooms, some of which lack basic amenities such as air conditioning or private bathrooms. Patients who need to shower have to walk across the hallway to do so. On several occasions the weather has gotten too hot and the hospital had to transfer patients to cooler rooms, said Lynette Hay, a registered nurse at the hospital.
With the expansion, both hospitals would replace the prevalent curtain system with private rooms for patients.
In the Children's Hospital, such a room would also provide foldout beds, private bathrooms, a television and other amenities to the young patients, said Sherri Sager, spokeswoman for Children's Hospital.
Sager said the private rooms would enable families to spend more time with the patient and become fully integrated in the recovery process. The private bathrooms, meanwhile, would reduce the cases of infection, she said.
Nowhere is the need for renovation more evident than at Stanford Hospital's Emergency Department, where beds are bunched close together and separated by curtains. At the trauma center, ground zero for medical care after a major disaster, beds are in short supply.
Dr. S. V. Mahadevan, medical director of Stanford Hospital's Emergency Department, pointed to the hospital's two-bay trauma room this week.
If a major emergency were to occur, such as a bus accident that left 20 people hurt, the department would be able to squeeze a few extra beds into the trauma-treatment area, he said. Accommodating the rest of the victims, however, could require the hospital to treat some patients in the hallways or find beds in more peripheral locations, he added.
Mahadevan, who lives in Palo Alto, said he is proud of the work that goes on in the hospital's emergency room, which is one of only three trauma centers in the South Bay. But like other physicians throughout the hospital, he acknowledges that the facility has plenty of room for expansion and improvement.
"We can do better. We just need the space to make it so," Mahadevan said.