Table of Contents
Title Page
Copyright Page
Dedication
Epigraph
One - Occam Lied
Two - Pooh-Bah
Three - Insults and Injuries
Four - Safety Nets
Five - The Fixer
Six - Ability. Affability. Availability.
Seven - We Speak Your Language
Eight - No Margin, No Mission
Nine - The Code of Mutual Respect
Ten - A Good Death
Eleven - The Big Brass Ring
Twelve - Medical Advances and Retreats
Acknowledgements
Annotated Book List
Author’s Note
Index
About the Author
Also by Julie Salamon
Rambam’s Ladder
The Christmas Tree
Facing the Wind
The Net of Dreams
The Devil’s Candy
White Lies
THE PENGUIN PRESS
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First published in 2008 by The Penguin Press,
a member of Penguin Group (USA) Inc.
Copyright © Julie Salamon, 2008
All rights reserved
Library of Congress Cataloging-in-Publication Data
Salamon, Julie.
Hospital : man, woman, birth, death, infinity, plus red tape, bad behavior, money,
God, and diversity on steroids / by Julie Salamon.
p. ; cm.
Includes bibliographical references and index.
eISBN : 978-1-4406-3238-9
1. Maimonides Medical Center—History. 2. Hospitals—New York
(State)—New York—History.
[DNLM: 1. Maimonides Medical Center. 2. Hospitals, Urban—New York
City—Personal Narratives. 3. Cultural Diversity—New York City—Personal
Narratives. WX 28 AN7 M223S 2008] I. Title.
RA982. N5M357 2008
362.1109747’23—dc22
2007045629
Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.
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In memory of my father,
Dr. Alexander Salamon
May I never see in the patient anything but a fellow creature in pain. . . . Oh, God, Thou has appointed me to watch over the life and health of Thy creatures; here am I ready for my vocation, and now I turn unto my calling.
—from the Oath of Maimonides
“In short, a man comes into this hospital in perfect health,” says the doctor played by George C. Scott in disbelief, on hearing about a patient’s progress through the system. “In the space of one week, we chop out one kidney, damage another, reduce him to coma, and damn near kill him.”
—from The Hospital, a film by Paddy Chayevsky
Cast of Characters
EXECUTIVE SUITE
Stanley Brezenoff . . . . . . . . . . . former president and chief executive officer
Pamela Brier . . . . . . . . . . . . . . . . . . president and chief executive officer
Dr. David Cohen . . . . . . . . . . . . . . . . vice president, medicine/senior vice
president, clinical integration
Lillian Fraidkin . . . . . . . . . . . . . . . . . . . . . senior vice president, clinical
services/chief of staff
Dr. Samuel Kopel . . . . . . . . . . . . . . . . . . . . . . . . . . . . medical director
Mark McDougle . . . . . . . . . chief operating officer, executive vice president
Robert Naldi . . . . . . . . . . . . . . . . . . . . . . . . . . . . chief financial officer
Sheila Namm .................. . .vice president, professional affairs
Sondra Olendorf . . . . . . . . . . . . . . . . . . . . senior vice president, nursing
and hospital operations
Martin Payson . . . . . . . . . . . . . . . . . . . . . . . . . . chairman of the board
CANCER CENTER
Dr. Alan Astrow . . . . . . . . . . . . . . . . associate director, medical oncology
Bill Camilleri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vice president
Dr. Jay Cooper . . . . . . . . . . . . . . . . . . . . . director, cancer center/chair,
radiation oncology
Dr. Bernadine Donahue . . . . . . . . . . associate director, radiation oncology
Dr. Yiwu Huang . . . . . . . . . . . . . . . . . . . . . . . . . . . medical oncologist
Nella Khenkin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . social worker
Dr. Sushma Nakka . . . . . . . . . . . . . . . . . . . . . . . . . . . oncology fellow
Dr. Beth Popp . . . . . . . . . . . . . . . . . . . . . . . pain-management specialist
Dr. Petra Rietschel . . . . . . . . . . . . . . . . . . . . . . . . . . medical oncologist
Dr. Philip Rubin . . . . . . . . . . . . . . . . . . . . . . . . . . . medical oncologist
Dr. Kathir Suppiah . . . . . . . . . . . . . . . . . . . . . . . . . . . oncology fellow
Dr. Jason Tache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . oncology fellow
Dr. Mendel Warshawsky . . . . . . . . . . . . . . . . . . . . . . . . oncology fellow
DOCTORS , NURSES , STAFF
Jo Ann Baldwin . . . . . . . . . . . . . . . . . . . . . . . . . assistant vice president,
community outreach
Marcel Biberfeld . . . . . . . . . . . . vice president, psychiatry and community services
Ann Marie Ceriale . . . . . . . . . . . . . . . . . . . . . . . . nursing manager, ER
Lilia Colon . . . . . . . . . . . . . . . . . . . . . . . . labor-management developer
Dr. Joseph Cunningham . . . . . . . . . . . . . . . chair, department of surgery/
senior vice president, strategic initiatives
Dr. Steven Davidson . . . . . . . . . . . . . . . . . . . chair, emergency medicine
Clarence Davis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . director, safety
Dr. David Feldman . . . . . . . . . . . . . . vice president, perio
perative services
Maria Ferlita . . . . . . . . . . . . . . . . . . . . . . . . . . . vice president, finance
Dr. David Gregorius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ER resident
Douglas Jablon . . . . . . . . . . . . . . . vice president, patient relations/special
assistant to the president
Dr. Israel Jacobowitz . . . . . . . . . . . . . . . . . . . . . . . . . . cardiac surgeon
Chris Kam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . social worker
Kathryn Kaplan . . . . . . . . . . . . . . . . . . . . . . . . . . chief learning officer
Lisa Keen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . social worker
Eileen Keilitz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . nurse
Carol Kidney . . . . . . . . . . . . . . . . . . director of nursing, women’s services
Dr. David Kho . . . . . . . . . . . . . . . . . . . . . . . . . . . . radiology resident
Dr. Steven Konstadt . . . . . . . . . . . . . . . . . . . . . . . chair, anesthesiology
Dr. Stephen Lahey . . . . . . . . . . . . . . . . . . . . chief, cardiothoracic surgery
Dr. Richard Lazzaro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . surgeon
Dr. Bing Lu . . . . . . . . . . . medical director, Maimonides clinic, Chinatown
Pamela Mestel . . . . . . . . . . . . . . director of nursing, perioperative services
Dr. Howard Minkoff . . . . . . . . . . . . . . . chair, obstetrics and gynecology
Margie Morales . . . . . . . . . . . . . . . . . . . . . . . . . environmental worker
Dr. Carl Ramsay . . . . . . . . . . . . . . . medical director, emergency medicine
Madeline Rivera . . . . . . . . . . . . associate vice president, case management
Dr. Jacob Shani . . . . . . . . . . . . . . . . . . . . . . . . chief of Cardiac Institute
Dr. Allan Strongwater . . . . . . . . . . . . . . . . . . . former chair, orthopedics
Dr. Regina Tarkovsky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . hospitalist
Dr. Gregory Todd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . hospitalist
Janice Yang . . . . . . . . . . . . . . . . director of outreach to Asian community
COMMUNITY
Marie and Tina . . . . . . . . . . . . . . . . . . . . . . . . . . patient and her sister
Dr. Michael Bashevkin . . . . . . . oncologist, former partner of Samuel Kopel
Michael Bloomberg . . . . . . . . . . . . . . . . . . . . . mayor of New York City
Asghar Choudhri . . . . . . . . . . unofficial mayor of Little Pakistan, Brooklyn
Daniel Dube . . . . . . . . . . . . grandson of Newman Dube, hospital founder
Bernie Gips . . . . . . . . . . . . . . . . . . . Borough Park Hatzolah coordinator
Ms. Hernandez . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . patient
Dov Hikind . . . . . . . . . . . . . . . . . . . . . . . New York State assemblyman
Marty Markowitz . . . . . . . . . . . . . . . . . . . . Brooklyn borough president
Miriam Lubling . . . . . . . . . . . . . founder, Rivkah Laufer Guardians of the
Sick, major source of patient referrals
Elliot “Lazer” Rosman . . . . . . . . . . . . Borough Park Hatzolah coordinator
Hafiz Mohammad Sabir . . . . . . . . . . . . . . . . . . . . imam, Makki Mosque
Aaron Twerski . . . . . . . . . . . . . . . . . . . . board of trustees, Maimonides
Mr. Zen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . patient
Prologue
This story began with a telephone call. Jo Ann Baldwin, a fast-talking, funny, Italian-American woman with a strong Brooklyn accent, had reached me through my publisher. Between the rush of words and wisecracks, I discerned that she had read my book about charity and philanthropy based on the teachings of the medieval Jewish philosopher and physician Maimonides. The pitch was this: She was an administrator at a hospital called Maimonides, she was certain we had a karmic connection, and she wanted to meet.
While I’d visited hospitals often enough for the usual reasons, and had even been a candy striper in high school, I had no special interest in them, had never written about them, and didn’t even watch medical dramas on TV. I left medicine to the professionals in my family, of whom there have been many: my father, sister, stepbrother, and brother-in-law. On the phone, Baldwin wasn’t very clear about what she wanted, but she was amusing and unrelenting. We agreed to meet.
Over cappuccino in Greenwich Village, she told me about Maimonides Medical Center (originally Israel-Zion Hospital) in Borough Park, Brooklyn, which had been opened a century earlier to serve local residents. For decades the mandate had remained the same: to take care of the community, which meant the Orthodox (and, increasingly, Hasidic) Jews who dominated the neighborhood.
As in urban areas all over America, Brooklyn’s neighborhoods were constantly changing, as immigrants prospered and their children—the second generation—left, making room for new groups arriving from other countries. The area around Maimonides was no exception. While Jews still made up a substantial minority of the hospital’s local patient demographic, the rising majority derived from every kind of ethnicity and hailed from all over the world. New Chinese immigrants represented the fastest-growing population in the vicinity. Meanwhile, the hospital’s kosher kitchen was run by Patrick Lamont, born in Jamaica, and sixty-seven different languages, more or less, were spoken in the hospital.
Baldwin talked about the hospital’s determination to understand its patients’ languages and beliefs—an attitude, if not a practice, that had become more commonplace in many medical institutions. She ticked off a list of homey examples: For one thing, it had taken the hospital staff a while to figure out that the white blankets in the emergency rooms were keeping Chinese patients away. White, they eventually learned, is the mark of death in Chinese culture. Soon enough, new beige blankets were ordered for the entire hospital. They had learned the hard way (from the patients who had fled, never to return) that among many groups there was still a taboo against uttering the word “cancer,” never mind acknowledging the disease. They’d also had to learn how to deal with patients like the pregnant woman, shrouded head to toe by a chador, who, when she unwrapped herself for examination, shocked the doctor by showing him that she was covered with chicken pox.
Baldwin painted a vivid picture of a big, bustling institution that was representative in many ways of any major medical center. Thanks to advances in science and technology, many illnesses that once required hospitalization no longer did, meaning that the inpatient population tended to be sicker and older, more difficult to treat. The emergency room was crowded with uninsured patients who couldn’t afford anything else.
With 705 patient beds, Maimonides was a big hospital, among the largest 5 percent of the country’s 4, 936 hospitals. Its patients were primarily middle class but spanned the spectrum, with a sizable contingent of poor and elderly people who qualified for Medicare and Medicaid.
In 2003 the hospital admitted 38,667 patients, 127,319 people were treated in its outpatient clinics, and 81,190 passed through the ER. These patients generated $626 million in revenues; the hospital paid $618 million in expenses, including $17.7 million in malpractice insurance.
Four hundred and sixty new doctors trained there each year. Each week the kosher/Chinese/Italian/Caribbean kitchen used 2,000 pounds of chicken, 5,400 pints of milk, and 30 gallons of Jell-O. In 2003, 6,230 babies were born at Maimonides, more than in any other hospital in the state of New York. There were 1,075 deaths; 35 of those were stillborn babies.
What did it take to run a factory like this—and did it feel like a factory?
By the beginning of the twenty-first century, the practice of medicine had become industrialized and often seemed im
personal. What was the role of the hospital in a technocratic world where information and options were abundant while common sense and tenderness were scarce? What were the financial, ethical, scientific, sociological, personal, and cultural matters that determined what kind of care people received? What did it mean to care anyway?
As Baldwin talked about the social forces converging on the hospital in Brooklyn, I found myself mesmerized, though she never got around to telling me what, exactly, she wanted. When our meeting concluded, interesting as it was, I figured that was that. Still, every so often I would find myself mentally replaying that conversation, which felt unfinished.
A few months later, I received an intriguing invitation from a hematology oncologist at St. Vincent’s Hospital in Manhattan, Dr. Alan Astrow. He, too, had read the Maimonides book, and he was inviting me to a series of lectures he’d organized, looking at how doctors do and do not deal with the spiritual concerns of very sick patients. I gathered that he wasn’t advocating so-called alternative medicine or spiritual healing but was trying to understand how physicians, nurses, and other caregivers might help patients connect hope and reconciliation, deal with fear and despair—in other words, how to treat that part of the human entity not taught in anatomy class. I declined Astrow’s invitation because I had something else to do that evening. He persisted, and I succumbed, unable to resist his gentle, insistent sincerity.
The speakers—a Jew and a Catholic—had nothing startling to say, but I was impressed by the heartfelt reaction they stirred in the 150 or so doctors, nurses, and social workers in the audience, who had stayed after hours on a freezing winter night to participate.
Mainly I liked Dr. Astrow. He handled the proceedings smoothly and intelligently, but at fifty still seemed like a gawky adolescent who hadn’t quite adjusted to his growth. His shy smile and mournful blue eyes conveyed warmth and worry. A few days later, I received a thank-you letter, in which he wrote about his attempts to find a balance between his desire to be there for his patients, his need to set limits on emotional entanglement with them, and his professional ambition. I could see he was searching for something.