Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids
By Julie Salamon
Penguin Press. 363 pp. $25.95
Reviewed by Dan Cryer
Walk into any hospital, and you immediately join the cast of thousands of dramas. Behind every door lurk birth, death and all the crises in between. A hospital is a stage where acts of anger, frustration and tears play out daily alongside moments of relief and joy.
When the hospital is huge, when it sits in Brooklyn, when it is surrounded by waves of immigrants, when 67 languages are spoken there, when its emergency room is always packed, the potential for drama rises exponentially. Not to mention the likelihood of a first-rate book that manages to encompass this lively spectacle.
achieves just that, in spades. Given one year of total access, without a minder, to Maimonides Medical Center, she has written a book that reads like a novel, elicits equal parts dismay and awe, yet never wavers from truth-telling.
This is a book about collisions, where cultures, egos and priorities bump and bang like dodgem cars. Its vivid portraits of doctors, administrators, nurses, social workers and patients underscore four persistent themes: diversity, feuds, money and healing.
Maimonides was founded a century ago to serve the needs of Orthodox Jewish immigrants. Today, they still make up the largest bloc, 20 percent to 25 percent, of patients, supplemented by newer arrivals, including Chinese, Pakistanis and Hispanics.
To deal with such a diverse clientele, Maimonides relies on an equally diverse staff and numerous translators. But speaking another language doesn't always bridge the gap. Only from experience do administrators learn that Chinese were shunning the hospital because of its white blankets, which in their culture symbolize death. Hence the switch to beige.
Dave Gregorious, a young medical resident from Nebraska, is forced to make cultural leaps of his own. Not only does he have to adapt to New York's urban tumult, but he must learn to count to 10 and say "Push!" in multiple languages in order to aid women giving birth.
Leading the drive to reinvent Maimonides from community hospital to regional powerhouse is chief executive officer Pamela Brier. A petite dynamo brought in from Manhattan's Bellevue Hospital, she presides over an institution constantly in flux. Patients come and go; unions need to be pacified; big-name doctors and community groups have to be wooed; income has to keep pace with rising costs.
The emergency room, one of the busiest in the state, scoops up hordes of patients, but too many are poor people without insurance or too old and diseased to leave the hospital alive. Both linger in beds needed for others and thus hurt the hospital's bottom line.
Is the financial remedy, administrators wonder, a new high-tech cancer center? At book's end, it's not clear.
One of Salamon's virtues is that she declines to tie up such loose ends. The result is to underline institutional fluidity. Hospitals, like human bodies, are not static systems.
Feuds between star doctors keep the pot boiling, too. The naming of Samuel Kopel as medical director over his former partner, Michael Bashevkin, jeopardizes the hospital's financial base. With a huge practice among Borough Park's Orthodox, Bashevkin can steer lots of patients away from Maimonides. It's never clear what broke their bond - some "bad behavior . . . hot-linked to self-righteousness and pigheadedness."
Meanwhile, in the surgery department, aging star Joseph Cunningham prowls in cowboy boots, "exuding king-of-the-jungle bravado." He and his young challenger are a study in contrasts. If Cunningham is "Alabama molasses; his jabs . . . coated in sugar," Israel Jacobowitz is "Brooklyn pastrami, salty, spicy and apt to cause heartburn."
As one administrator notes, "To work with doctors who walk around believing that if one of them gets struck by lightning it's the other one's fault, it's shocking."
Salamon may admire these physicians' talents, but her heart belongs to Alan Astrow, second in command at the cancer center. Raised on Long Island and educated at Yale, Astrow is the book's moral hero. That rarity, an empathetic healer in the mold of the hospital's namesake medieval physician-philosopher, he goes out of his way to set up in-house seminars on the role of religion in patient treatment, on ethical issues from abortion to dying with dignity. His perennial dilemma: to be kind, yet still command respect among so many egomaniacs.
Brier strives not only to elevate the hospital into medicine's big leagues, but to dispel a longtime culture of "rudeness, incivility and bullying." She institutes a "Code of Mutual Respect" and sponsors workshops on "How to Speak Persuasively, Not Abusively."
David Kho represents the new paradigm. Born in Singapore, raised in San Francisco, and married to a Puerto Rican, he's a gentle humanist who cares about his patients. He comforts "Mr. Zen" in Mandarin and Miss Rodriguez in Spanish. Both are illegal immigrants, both are dying of cancer. The only medicine he can offer is compassion.
Salamon never sentimentalizes episodes like those. Nor does she sugarcoat the feuding over fiefdoms, the ceaseless quest for income, the ethnic pushing and shoving. What she gives us, then, is an all-too-human institution, flawed, restless, protean, bursting with life.