Hospital

by Julie Salamon

  His father, he told me, had worked at Maimonides as a masgiach, making sure the rules surrounding kosher food were observed, and had died there. Dov Hikind’s children, however, were born in Manhattan, at Mount Sinai, not at Maimonides, the neighborhood hospital that sponsored Hikind’s weekly radio program. Hikind felt he and the Maimonides administration understood one another. “If they have me on board, Maimonides feels they’re in good shape, because I can make the most trouble if I want to,” he said cheerfully. “And they know I will do what I think is best, so if I tell them something, they take it very seriously.”

  He wished me good luck even as he shook his head. “To write a book how great Maimonides is,” he said, “it would be a short book.”

  One night I ran into Dov Hikind again, unexpectedly. I had stopped by the emergency room one evening to see David Gregorius. He still looked like a kid in his green scrubs and bright orange Crocs, plastic clogs good for running around an ER. Yet he also seemed older, more self-assured than when I first met him just a few months earlier. Now he seemed almost oblivious to the scene around him. Without looking up from the computer monitor, where he was checking to see what patients were his, he said to a fellow resident, “I love working on Shabbos in the winter. The Orthodox leave early.”

  He was typing the words “penile edema” onto the computer. A twenty-year-old man had come in to the ER with a swollen penis. “Turned out he had masturbated too much,” Gregorius said with a grin.

  Next patient: a Russian woman with pain in her belly. As he examined her, the resident relied on her daughter, whose English was halting, to translate his questions.

  Gregorius asked about what she had eaten, what her vomit looked like, had she had a bowel movement.

  The daughter translated but then stopped at bowel movement.

  “What?” she asked.

  “Make cocky,” said Gregorius, using an Eastern European expression he had picked up in the ER.

  She blushed. “Everything as usual,” she reported after asking her mother.

  Gregorius learned that the mother had had an appendectomy and a gallbladder operation. He asked many more questions as he pressed on her belly, explaining gently what he was doing. During the examination he was jostled by Dr. Marshall, on the other side of the curtain, examining a patient in the next cubicle.

  The daughter asked if he could give her mother something for pain.

  Gregorius said, “I will gladly give her medicine for the pain.”

  A few minutes later, he entered the information into a computer and ordered morphine. “They dish out morphine here like it’s candy,” he said.

  Earlier I heard Marshall explaining to a resident, “I’d rather err on the side of alleviating the pain of people suffering, even if we run the risk of some people abusing it.” Marshall had come by and asked him to try to admit an elderly African-American man with cancer and pneumonia into the intensive-care unit. He had a bloody wound on his head from a fall on the floor at his nursing home. “They don’t want him because he has cancer,” Marshall said. The ICU people had a reputation for preferring to admit patients they thought they could save—or VIPs.

  I asked him about his philosophy on administering drugs for pain. “The hospital does quarterly reports on how we’ve been doing with pain medication,” he said. “That doesn’t drive my practice. Some physicians here are more antiquated and think narcotics should be withheld.” Before he could continue, someone called him away, too.

  Stranded by both physicians, I felt that I was in the way no matter where I stood—until I realized there was no such thing as being in the way. People sidled, pushed, nudged, and otherwise adjusted to the stream of patients, equipment, doctors, nurses, visitors. A drunk insisted he wanted to be seen by the cute woman doctor with the ponytail. An elderly Chinese “environmental worker” gamely kept sweeping and disinfecting, but there were still pockets of stench, smelling vaguely of blood, bottoms, dirty feet, and God knows what else. Intimate exams took place out in the open. A young woman casually pulled off her hospital gown and sat in her underwear as she examined the flimsy piece of cloth, trying to figure out which way it should go. An old Orthodox man on the neighboring gurney watched and offered advice.

  I needed an expediter and took refuge with Fabio Palermo, a young man with a shaved head, one of Jablon’s patient representatives. The male patient reps were easy to spot. They stood out like FBI agents: tie, slacks, pressed dress shirt. Palermo was another one who came to Maimonides by default. He had a B.A. in communications and wanted to work in TV production but couldn’t get a job. A friend said they were looking for a patient rep on the midnight shift. That had been five years earlier. “It’s very stressful, but you get a rush from helping people,” he said.

  A man with a heavy Israeli accent came up to Palermo and complained. “I have chest pain,” he said. “I’ve been here for an hour, and nobody cares. In a few minutes, I’m taking a taxi to another emergency room.”

  Palermo told the man he would see what was up. At a nearby computer terminal, he found the patient’s record. “He’s been here forty-one minutes,” he said. “They already checked him out in triage.”

  Looking across the room at the man, who was pacing next to his gurney, he said, “A lot of them know the golden words: ‘chest pain’.”

  At 7:00 P.M. Palermo’s job was to ask friends and relatives to go to the waiting room for an hour, to lessen the pandemonium during the shift change. Dodging patients and clinicians, he moved around the room, politely asking visitors to leave. He squeezed by a bed holding a grizzled man with clear, beautiful blue eyes, who stopped the patient rep. “Could you take this tray?” he asked. “Does it take a resolution of Congress? It’s been here for an hour.” Palermo took the tray.

  Palermo paused to reply to an urgent call on his beeper. “Dov Hikind’s mother is in the hospital,” he said. He told me he had to leave the emergency room and go up to see her in a few minutes and would take me with him.

  While I waited, I stopped to chat with a group of PCTs, patient-care technicians, doing the job that once commonly was called nurse’s aide. The elevated title didn’t make the work any easier. Unpleasant jobs—like bedpan duty—fell to them. The educational requirement was a high-school diploma or equivalency plus completion of a course in a nursing-assistant program or EMS training. Marie C. Pierre, in her forties, originally from Haiti, was taking a break, sitting on the edge of a desk eating sunflower seeds. “They have more sophisticated things here,” she said, comparing medical care between her old and new countries. “Some of the sickness in my country, we do healing with leaves. Here they have the same leaves, but as a pill. I’ve seen people come to the hospital with a hundred or hundred and one fever. In my country we do home remedies.”

  A tall, regal woman working on a nearby computer, Ethel Christopher from Trinidad, overheard the conversation. “We call pneumonia a bad cold back home,” she said scornfully. “I think people here overuse the hospital. A woman came in the other day, she has a lot of pain for her period and she comes to the hospital! They have a headache and they come to the hospital.”

  Pierre spit shells into her hand. “I have a headache, I just lie down.” Then she looked worried. “But sometimes you have a headache and it’s a bleed in the brain.”

  Christopher nodded vigorously. “That’s it,” she said. “People are just scared. If you look at the amount of people they send home before the day is done. They want to make sure some vessel didn’t bust. They do a CT scan, find nothing, go home. Then the headache comes back the next day and they come back. Because it’s free.”

  They dispersed. I found Fabio Palermo and followed him past a line of stretchers parked in the hallway, through a maze of more hallways and onto an elevator, which took us onto a patient floor. The evening quiet was jarring, too much like death after the lively turbulence in the ER. Our destination was a bright-eyed, elderly Eastern European woman wearing a little cap around her pink face, lying alo
ne in a bed in a large room meant for two. VIP. Her aide, a friendly woman with a Caribbean accent, lay back comfortablyin a chair, her leg hanging over an armrest. Dov Hikind stood at the foot of his mother’s bed.

  “How’s the hospital?” he asked me, and introduced me to his mother and the aide.

  The two women joked with each other, both speaking with strong, if different, accents, and the aide said, “She’s happy here.”

  Real or imagined, the easy affection that seemed to bond the women was so disarming I said aloud what I was thinking.

  “How did you come to have such a nice mother?” I asked Hikind.

  Hikind shrugged and smiled weakly at me. “A lot of people ask me that,” he said. He looked weary and vulnerable. But then, hospital rooms have that effect.

  His mother lifted her head. “A writer!” she said, smiling at me. “There’s nothing to write bad about this hospital. You come in. They take care of you. Vat else do you vant ven you come in sick? I came in, they took care of me, and now I’m a new person!”

  The Orthodox community had a love-hate relationship with Maimonides. The hospital could never do enough to please the 20 percent of its patients who considered it theirs. Because of the hospital’s historic ties to the neighborhood, the locals had far different expectations for Maimonides than for any other hospital. It was assumed that the food would be kosher, that the gift shop would be closed on Saturday, that the hospital would indicate with a light at the front door that someone had just died so the kohanim, Jews descended from the priestly line of Aaron, brother of Moses, would know not to enter the building, because they aren’t allowed to be in a room with a corpse. During the Passover holiday, all soda dispensers were shrouded and blowtorches blasted every last visible crumb of bread in the kitchen. In the gift shop, candy and chips disappeared from the shelves, replaced by Fruit Roll-Ups and kosher-for-Passover potato chips. In the cafeteria, food was served on cardboard trays and bread was replaced by little squares of matzo wrapped in plastic. Thousands of dollars were added to the budget to pay for the exorbitant markup on kosher-for-Passover foods. Yet even this was not enough for the most devout. The Bikur Cholim room, run by volunteers, posted a sign: WE HAVE A NON-GEBROKTS MENU (roughly translated as “really kosher for Passover”) for those not satisfied with the hospital’s purification process.

  Borough Park was said to have the largest cluster of Holocaust survivors outside Israel; Dov Hikind’s sweet mother was one of them. That history of persecution was often invoked to explain the community’s behavior, but it clouded as much as it clarified, like trying to explain how one mother could produce twins who were opposites, one sweet-natured and responsible, the other squalling and self-absorbed. The Orthodox tended their own through an admirable, elaborate network of charitable and volunteer organizations like the Bikur Cholim (Guardians of the Sick) and Hatzolah, which led to charges of exclusivity and tribalism. But—when nudged—the community was willing to help others. Nishei Cares, an Orthodox charity, supplied the hospital with 130 volunteer doulas, women who offered help to any pregnant Maimonides patient—no matter what her background—during and after delivery.

  Jablon accepted his role as punching bag, but he was unable to muster pure altruism. He wanted the acknowledgment from his own people that he felt he received from others. “The Gentiles come in, they love us,” he said. “There’s nothing we can do bad in their eyes.”

  He sighed. “The Jews complain,” he said. “That’s how they survive. But they also give. If somebody is in trouble, they will give. A person is in trouble and needs money, even if they don’t have it they will borrow it to give to that family. If somebody needs a baby-sitter, they’ll come in the middle of the night to help you. Someone gets stuck on the highway, they’ll stop the car. But to get a pat on the back! Never!”

  The mournful look on Jablon’s face had become a semipermanent fixture. “You go into places, people curse the hell out of you about the hospital,” he said. “They just have that feeling to bash Maimonides for no reason at all.” He invoked the case of the ninety-two-year-old man who was in the hospital for three months with lung cancer. “We kept him going that way for weeks on respirators; no other hospital would do that. For weeks! Passed away. Ninety-two!

  Jablon paid a shivah call (Judaism requires a seven-day period of mourning immediately after a funeral). He arrived a half hour before the afternoon prayers were recited and sat down to visit while he waited. One of the sons snapped at him, “Where did the administration learn how to run that hospital? From Auschwitz?”

  Jablon didn’t respond but stayed just long enough to participate in the short mincha service, one of the three sets of prayers observant Jews were required to repeat every day, to stay in touch with God while removing themselves from earthly concerns. Jablon couldn’t concentrate, though the service took only ten minutes. He repeated the words by rote and then walked out. Another of the dead man’s sons ran out after him. “My brother’s crazy,” he apologized.

  Jablon tried not to sort and catalog the hurts, but he couldn’t help it. He recalled a family who transferred a patient to NYU from Maimonides, about the same time Peter Aschkenasy, Brier’s husband, was in the intensive-care unit there after the accident. Jablon was in the waiting room, about to go in to visit Aschkenasy, and saw the deserters. When the nurse came out and told the family members they could visit the patient, but just for five minutes, they meekly obeyed. “They came out like good little children,” said Jablon. “Over here there would have been a war. They would have said, ‘You’re a dictator! Gestapo! The problem is, the administration made this open-door policy. The community has the ownership of the hospital.”

  Jablon was one of the first people I met at Maimonides, back in the early spring. I saw him again at the cancer center’s opening, standing at the back of the tent, scanning the room like a hulking Secret Service man at a gathering of government officials. Occasionally he would seek someone out, lean down—no one was taller than he was—and whisper something, eliciting a nod or grin, and then resume his watchful post.

  A few weeks later, before I’d really begun my yearlong stay at Maimonides, Jablon invited me to his son’s wedding to Chaya Gitty Green. (Yitzy Jablonsky had reverted to the family’s name as it was before his grandfather, Douglas’s father, changed it.)

  As I had never been to a Borough Park Orthodox wedding, I didn’t know what to expect, so I asked Jo Ann Baldwin, the woman who had initiated my hospital adventure.

  FROM: JO ANN BALDWIN

  SENT: 7/11/05, 1:41

  SUBJECT: HEADS UP!!!!

  My husband Dan just called to remind me to let you know. Our first Boro Park event that we attended, the invitation said 6:00, so Dan and I got there at 6:00. The caterer was setting up . . . Douglas said that Chupa is at 7:30 and everyone started laughing that it would never happen that early . . . the earliest you should come is 7:30, and you should probably eat something. The last wedding we left at 11:00 and dinner was not served yet.

  FROM: JULIE SALAMON

  SENT: 07/11/05, 2:25

  SUBJECT: HEADS UP!!!!

  So am I to gather this isn’t a sit down dinner???

  FROM: JO ANN BALDWIN

  SENT: 7/11/05, 2:37

  NO NO NO. . . . it is a sit down dinner, there is a cocktail party that is supposed to start at 6, but that never starts until later . . . then the chupah (sp?) we go into a huge room, men on one side, women on another, and then the wedding ceremony. which is really interesting, and kind of tribal, then we go back to the hall and have a sit down dinner, but the bride and groom don’t come right away, people have told me that they are supposed to be consummating the marriage in a room in the hall, but I refuse to believe this. . . . Welcome to Boro Park. See ya later.

  FROM: JULIE SALAMON

  SENT: 07/11/05, 2:53

  THANK YOU!!

  Also, what about a gift? Are they registered? How does it work in Boro Park? Also, what are you wearing?

  FR
OM: JO ANN BALDWIN

  SENT: 7/11/05, 3:39

  You just gave me a huge laugh . . . registered . . . Douglas had to pay the caterer extra to keep out the Schnoorers (sp?), the only reason I know what a schnoorer is, I had to get security to remove one from Beth Israel as he was trying to follow one of my surgeons into the bathroom to get money. A schnoorer is a religious person who begs for money, sometimes for an organization, but many times for himself. They are con artists, but that is not acceptable to say. I told Douglas that if they were outside the hall, I was going to call a local convent and get the little nun who sits in the subway.

  So they are not registered anywhere. I just give money in a card, and I’m not sure that I do that right either, Connie (works for Douglas), told me I was a fool because many people put 18.00 in an envelope because that number signifies good luck. I said, so does 180, or 1800 and she laughed in my face. I’m giving what I would give to any friend who was marrying their child off, that’s not you. You just met these people. I’m giving my gift for Douglas and our relationship, I love him. You don’t have to do anything like that. If you have time to run out and get a gift you can do that. Who doesn’t need a vase? . . . Do not feel obligated to give a big gift that will embarrass Douglas, You can pick something nice up. Yitzy (son) is pretty modern, he works for the police department, and the girl is a teacher.

  CLOTHING: Okay this is important, forget the fact that we have reached temperatures of over 90 degrees and remember you have to have your arms covered and no pants. I’ll either wear a suit or a dress, I also have my obligatory “old fart” dress that I have purchased just for these occasions, however, it may be too hot to wear that. Just no bare arms and no pants and you will be fine.