Hospital

by Julie Salamon

  Dube was what my mother would call a “real gentleman,” the type who stood when a woman entered the room. He was about five feet tall, had a thick, carefully trimmed white mustache, and was very natty in a sports jacket with tiny sky blue and white checks, plaid pants, and a striped tie. He spoke with the stentorian tones and elegant cadences of another era; he could have been a bit player in a Fred Astaire movie, part of the atmosphere. His precise diction was studied, not natural; he had found talking difficult as a child and eventually trained himself to speak, as he called it, “euphoniously.” Hearing his melodious use of the language would have pleased his mother; she was an immigrant from Brest-Litovsk, famous for the treaty that got Russia out of World War I, and never spoke Yiddish with her children because she wanted to improve her English.

  Dube gave me a tour of the business, pointing out an old sewing machine where, he said proudly, a gifted employee made prosthetic bras for women who’d had mastectomies. Then he told me his father’s story, and his own, compressing a century’s worth of social history into one family’s memory. He covered the 1929 stock-market crash, the 1918 flu epidemic, the development of health care in southern Brooklyn, World War II, and elocution lessons. He also offered medical advice, urging me to take cod liver oil every day, as he had done for forty years, a prescription he felt certain had kept him from having arthritis. He endorsed bran powder as well, noting that too many people strain when they go to the bathroom.

  As for the hospital, he told me he didn’t know much about Maimonides anymore, though he spoke warmly about it. His father stayed on the board until he died in 1966 and insisted on going to every meeting, even though he was blind for the last three years of his life and needed his son’s help to get there. Daniel Dube had been watching the construction of the new wing with interest but confessed that his company didn’t do as much business with the hospital as it used to. “Hospitals don’t pay their bills on time,” he said. “It can involve a great deal of money, and if you want to be viable in business, you have to pay your bills on time or you lose whatever benefit you have in discounting.”

  I asked him how the hospital was regarded in the community. “It is well regarded, but the great difficulty is that the first contact is through the emergency room, and the wait is interminable to be admitted to the hospital,” he said. “I can understand the difficulties, and I’m sure the hospital powers that be are doing the best they can. Before, the demands of the community were not as large.”

  I hadn’t mentioned Mr. Zen—indeed, I hadn’t yet met him—when Dube invoked his situation, if not his specific case. “Since the foreign element has come into the community, the undocumented element, where they have no private insurance and their only medical facility is the emergency room, that is the primary reason the hospital is burdened so strongly,” said Dube.

  Newman Dube’s legacy extended beyond the medical-supply shop; Daniel Dube had inherited his father’s sense of responsibility and his good heart. “But what would these people do without it?” he asked. “Many of them are illegal, but you don’t neglect them, you don’t just disregard them. They’re human. I don’t think anyone would ever think of not doing what is right.”

  We chatted a while longer, and then Daniel Dube escorted me to the door, ever courtly, his hand lightly touching my elbow. As I was leaving, he asked me where I was going.

  “I’m meeting Pam Brier,” I said.

  “Do me a favor,” he said. “I once gave Pam a silver tray that was given to my father, thinking they’d have an area to show it. I don’t think they ever did. Tell her I’d like to have it back.”

  I did ask Brier about the tray that morning, but neither she nor her secretaries could remember where they had put it. “I’m accused sometimes of getting mired too much in the details, but that elegant little detail eluded me,” she said.

  Brier told me she would pass along Mr. Dube’s request to Derek Goins, senior vice president for operations. When I reminded her about the tray some months later, she replied, “The sad answer to your question is that we have not been able to track it down. I put Derek on the case, and his staff has searched about, with no tray in sight. Most of the other people who would know about it are dead or far away.”

  Five

  The Fixer

  Douglas Jablon’s office, located a block from Eisenstadt, on the second floor of one of the little brick buildings, was headquarters for the Maimonides favor bank. His walls were covered with commendations and awards from yeshivas and monasteries, firefighters, police officers, and politicians. He was the fixer, the expediter, the goodwill ambassador, the Orthodox Jew frequently introduced by Nidal Abuasi, the Palestinian-born principal of the Muslim Al-Noor School, as “a colleague, a friend, and a brother.” The imam Hafiz Mohammad Sabir of the Makki Mosque on Coney Island Avenue and the Pakistani American Federation of New York, when praising Maimonides for reaching out to his community, qualified, “The whole credit goes to Mr. Douglas Jablon.”

  Mark McDougle, the number two administrator and chief operating officer, learned soon after arriving at Maimonides that, when it came to community matters, the answer would be: Ask Douglas.

  When McDougle first met with the leaders from the Flatbush Hatzolah in one of their homes, he asked them what they thought the hospital needed to do to satisfy their constituency. “They told me specifically how amazing Douglas is,” he said.

  One day I bumped into him in the hall before the Jewish High Holidays. He looked jazzed as he held up a typed list of names and telephone numbers. “I’m supposed to call these people to wish them a good Yom Kippur,” he said.

  The list was supplied by Jablon.

  Every day McDougle learned something new about the neighborhoods that surrounded the hospital. Driving to work in mid-October, he noticed that the streets of Borough Park were empty and wondered why.

  So he asked Douglas and learned about Sukkot, a harvest ritual known as the Festival of Booths. The holiday was rooted in Leviticus (23:42-43), where Jews are instructed to remember the huts God provided while they wandered in the desert for forty years, after the exodus from slavery in Egypt. That’s why so many Orthodox men had suddenly been walking around the neighborhood carrying two-by-fours. These once-a-year carpenters, he learned, were preparing to build structures called sukkahs, where for seven days, they could take meals and even sleep, as commanded by their Torah.

  McDougle was a rationalist, a midwestern WASP from Cincinnati, a spare, owlish man with a trim athlete’s build and short gray hair. Crisp. He preferred to conduct business via succinct e-mails rather than long conversations. His large office was uncluttered and largely undecorated, except for family photos and a few architectural posters.

  He was alternately perplexed and touched by the seemingly endless rules and rituals that surrounded Orthodox life in Borough Park. A siren followed by stillness heralded the Sabbath. Cell phones were turned off and automobile motors silenced every Friday evening at sunset, an exact but always shifting moment set not by the clock but by nature. The commandment to rest was at odds with the metabolism of a restless city, where meditation was something to be either avoided or accomplished efficiently—at lunch, in power-yoga classes, or, as McDougle did, by bicycling long distances on weekends.

  The hospital worked on a 24/7 schedule; little was predictable, and the workload always outstripped time and resources. The early shutdown on Fridays and the unavailability of Orthodox physicians became another problem to solve. But for those who understood its meaning, the calm that fell on the hospital was different from the weekend slowdown at other medical institutions, marking a presence rather than an absence.

  Almost two years into the job, McDougle was less surprised but still amused by administrative tasks that were particular to Maimonides and for which none of his earlier hospital jobs had prepared him.

  Ask Douglas.

  Just after Sukkoth I was in McDougle’s office when Pam Brier popped in to ask him if he knew whether she had
to cover her head when she entered a mosque.

  “I’m still stewing over my outfit,” she said. The imam of the Makki Mosque had invited her to speak after morning prayers, as Ramadan was drawing to a close. “Something long and something buttoned up,” she said distractedly. “I have to be polite. I have to ask Douglas, but he doesn’t even know the first names of the Hatzolah wives.”

  McDougle laughed.

  “I have to call the right person, but I don’t know who that is,” Brier said.

  McDougle replied, “Isn’t there someone here who is Muslim?”

  Brier said, “Someone I’m thinking about is Muslim, but she’s not Pakistani.”

  “It is good to be polite,” said McDougle noncommittally.

  Brier raised her index finger up in the air. “I know who to call,” she said “I’ll call Douglas for the name of who to call.”

  With that she left. McDougle shook his head and lifted his eyebrows, ever so slightly. Sometimes the chief operating officer seemed like chief straight man to Brier’s dizzy grande dame, and he accepted the part with good humor. “You have to deal with things here you don’t have to deal with in Manhattan,” he said dryly.

  Two days later Brier headed for the mosque. After much consideration she had settled on a long-sleeved black blouse and an ankle-length black skirt decorated with hints of color. She carried a scarf she had pulled out of her large collection; long, silk, black with shiny piping, it had seemed just the right thing, stylish and respectful. (Though it was Lili Fraidkin, not Jablon, who had put her in touch with a Pakistani surgeon for a fashion consult.) I was along for the ride, this arranged by Douglas Jablon, Mitzvah Man, who joined us in the town car the hospital provided Brier, along with Leon, her Russian driver.

  Jablon managed to be almost everywhere, but never out front. One hot summer night, a crowd of Hasidic Jews set fire to a couple of police cars and lit two dozen bonfires in Borough Park after two policemen arrested an elderly Orthodox man. He had been talking on his cell phone while driving and didn’t pull over when the roof light on the patrol car behind him began to flash. One thing led to another: The seventy-five-year-old man was hand-cuffed and taken into custody, the Hasids protested, and Joseph J. Esposito, the local police chief, was accused of saying something like, “Get those fucking Jews out of here.” (The New York Times reported that the police department acknowledged Esposito’s use of an expletive but specified that “quotes of his comments in the statement did not make any reference to Jews.”) Jablon was one of a handful of people from the community called in to talk to Raymond Kelly, the commissioner of police for New York City. Jablon told the commissioner that everyone was overheated, it was a hot night, it was a misunderstanding, and Esposito was a great guy.

  Jablon’s conciliatory nature was linked to fears of authority and anti-Semitism and to demons he was reluctant to discuss, though he once mentioned he was estranged from his brother over a matter of money. But if Jablon had a shtetl mentality, he was the first to acknowledge that the shtetl had gone multicultural. When Stanley Brezenoff declared the hospital’s new policy of community engagement, Jablon turned his staff’s attention there. “We never got any Chinese people, and we decided to dive into it,” he told me. “Why should these people, God forbid, they get really sick, they have a terrible disease—cancer, heart problems—God forbid they get a heart attack and go to another hospital in New York that’s more oriented to their languages, that’s a sin. God forbid a stroke, and here we are a minute away. Or chemotherapy? Why should they schlep?”

  Born in 1950, Jablon grew up in Borough Park but didn’t become observant until he was sixteen years old when, as he put it, “the world had gone crazy.” In reaction to the radicalism of the sixties, he became a student of Moshe M. Heschel (one of the many “biggest rabbis” in the neighborhood), stopping for religious classes on his way to public school. After college he sold “major appliances” at a department store and then quit to work for Dov Hikind, who became a New York State assemblyman in 1982, a position he still held twenty-four years later.

  During his three years on Hikind’s staff, Jablon was willing to overlook the assemblyman’s impulsive behavior and radical politics. He studied—with admiration—how Hikind kept his constituency satisfied by making shrewd use of personal contacts and street smarts to deliver social services.

  Jablon had been at the hospital for eighteen years before he was able to put what he’d learned from Hikind to use there. Opportunity arrived with Stanley Brezenoff in 1995. The new president found a community hospital with larger aspirations, a combative board of trustees, and a beleaguered chief administrator who understood hospital management but not local politics. He saw a hospital that had lost its connection to the surrounding community; the once-crowded ER had been suffering a decline in admissions as other Brooklyn hospitals recognized Hatzolah’s power and catered to it. New York Methodist Hospital in particular recognized opportunity; the administration put in a kosher kitchen for the volunteer ambulance service and made them feel welcome, not like pests.

  For Brezenoff local politics was the fun part of what he called “the swirl.” He and Marty Payson agreed that the first job was to win back the loyalty of the Orthodox and engage the new communities that had grown up around the hospital. It didn’t take them too long to identify their main man on that front. The answer was obvious.

  Ask Douglas.

  I asked Payson who specifically was responsible for unleashing Jablon. “Douglas will give me a hug and say, ‘It’s you Mr. Payson,’ and he’ll say the same thing to Pam and the same thing to Stanley,” said Payson. “He’ll say before we came, he used to hide his head from the community, because they had so many complaints and they took them all out on Douglas. As we began to build, he became a source of pride. So Douglas discovered Douglas. As we began to solve the problems and he saw what was happening, it gave him the nourishment to be Douglas. I can’t say any of us created Douglas. We gave him the freedom to be Douglas.”

  In his best Brooklynese, Brezenoff explained that he made it clear there was one party line: “It’s not okay to crack wise about Hatzolah, about the Pakistani community, or to regard yourself as superior [for] doing the community a favor. Douglas understood it, but before, he had to cajole and coax. I believe people quickly realized they couldn’t cross me on this issue. Then, as it translated into success, people embraced it, because they liked being part of something successful.”

  Jablon’s department grew from ten patient representatives to thirty. Their job was to interpret, mediate, and expedite matters between patients and doctors, nurses and everyone else. They came from many places, including Haiti, Ukraine, Greece, Germany, Pakistan, Nigeria, Borough Park; they spoke seventeen languages and were in beeper contact with ninety volunteers trained in simultaneous interpretation. Some were Ph.D.’s; others had only high-school diplomas. They were notary publics, so they could act as official witnesses to Do Not Resuscitate orders and do favors for doctors who needed something notarized.

  Jablon described his training method. “There’s no monkey business,” he said. “First of all, you gotta take care of patients. Number two, all this advertising is very important, but I believe the patient is the best advertising, especially over here. They sit outside in their chairs, outside the apartment houses, and if you treat them very well, they’ll talk good about us. You do one wrong thing, they’ll talk bad about us. I will not stand it from my department. My department has to have a hundred percent. I can’t be responsible for everybody in the hospital, but we try to make a difference. Sometimes the doctors get stressed out, sometimes the nurses get stressed out, but we’re not allowed to get stressed out. I say if you get stressed, you can come up and smack me in the face, hit the walls.”

  Brezenoff soon learned there were some things he could not ask Jablon to do—or not to do. The favor bank didn’t extend to certain situations. If, for example, a child came into the emergency room who was hurt in a way that raised the
suspicions of a social worker or clinician, the case had to be reported. “You have to make it clear to community leaders there’s a line we won’t cross,” said Brezenoff. “Douglas couldn’t do that.”

  Jablon’s defining trait was his inability to say no. This insistent desire to help was both weakness and strength, and it often elicited groans inside the hospital.

  Carl Ramsay found himself groaning a lot. The medical director of the ER—the beanpole, Dr. Ponytail—was part of the bed-tracking team. He saw the goodwill exerted by the patient-relations department as a giant stopper, backing up bed flow.

  “Only sixty percent of those beds are controlled by medicine,” he said. “The rest are controlled by all these fiefdoms: anything from patient relations to a cardiothoracic surgery nurse. I try to be polite. But when someone comes down and says, ‘We have this person who just came in and needs this kind of bed,’ and it’s the middle of chaos, I let them know we’ve had five patients waiting for twelve hours each, some twenty-four hours, waiting for that exact type of bed. It’s totally unfair. Then they say, ‘What’s wrong? Why are you getting so angry?’”

  Still, Ramsay saw how useful the patient reps could be. They helped calm angry families, arranged for interpreters, discussed DNR and health-proxy orders. He asked Jablon to give them more hands-on responsibilities—to wheel patients to rooms if transportation was jammed up, to help track down lab reports and X-rays, to take away empty trays and deliver urinals.

  John Marshall, the residency program director, went even further. “This is the first emergency department I’ve worked in that has actually had patient representatives in the emergency room like that,” he said. “They’re absolutely essential in terms of helping us—from the translation, dealing with families, everything else. If I ever went someplace else that didn’t have patient representatives, I would push strongly to start a patient-representative program.”