Other environmental factors, such as Hurricane Katrina's strike on New Orleans, prompted inclusion of a 60-room advanced emergency response center at The Tower's base.

The plan, which designated ambulance bays as decontamination spaces, clustered patient rooms into three 20-room pods, each isolated by negative or positive pressure. Team members also programmed the 40,000-sq-ft center with a surge capacity of 30% in the event of a pandemic, natural disaster or act of bioterrorism.

As program elements accrued, so did costs, which exceeded budget by $100 million by the time schematics concluded. Team members say the overrun was more good news than bad. "It's not something I'd ordinarily advertise," says Moorhead, "but here we had great success because we had an opportunity to take a design Rush really liked and get to the heart of what it valued most about it. When someone suggested, 'Square off the building and make it rectilinear—that'll save a lot of money,' Rush said, 'No.' To me, that was a very telling moment."

Split Decision

Team members instead revisited plans to join the base of the The Tower to that of The Atrium, an existing inpatient facility slated for renovations.

Rather than proceed as planned, they elected to split the two structures apart, eliminating requirements for eight supercolumns to support the bed tower in addition to a 16-ft-high transfer truss system. Further revisions eliminated all moment connections.

The solution—at least for a time—was to locate a courtyard between new and existing structures.

Though the scheme shaved $40 million off construction costs, it wasn't the last time the team encountered financial challenges.

With the sudden meltdown of financial markets in 2008, Rush feared efforts to build The Tower could screech to a halt, even as crews proceeded with steel erection, then 30% complete.

"At the time, we were too far along to alter the program, so it became a matter of strategically aligning our contracts rather than cutting money out of the project," says Greenhalgh"