Hospital

by Julie Salamon

  How to describe the scene at Ateres Chynka? That was the huge banquet hall on Elmwood Avenue where Yitzy and Chaya were wed on a hot night in July, in an intimate ceremony with fourteen hundred of their families’ closest acquaintances. The guest list covered those who loved Jablon or owed him or who were owed by him. There were representatives from all his communities: Jews of course, but also Chinese, Haitians, Catholics, Muslims, physicians, nurses, firefighters, politicians, and policemen.

  If I’m vague, it’s because I don’t remember much. That was my first introduction to a Borough Park scene, and I was overwhelmed. I was married under a chuppah, a wedding canopy, as required by tradition, and had attended many Jewish weddings, but nothing like this. Yitzy and Chaya’s wedding—outsize, noisy, tribal, unabashed—felt authentic, the difference between white-water rafting on the Zambezi River and a ride at Disneyland (though the wedding also felt a little like both). Jablon, trying to please everyone, had followed Orthodox practice of separating men and women but wanted to accommodate the non-Jews and non-Orthodox guests— about half the people there, including much of the Maimonides administration. As people arrived, they picked up seating cards on a table in the entryway. My husband and I were seated at Table 2. Turned out, so was everyone else who wasn’t Orthodox—a few hundred people. Table 2 was an entire subdivision, separated from the rest of the party by a partition. At Table 2, genders could mix.

  It was a wild party, music supplied by Yossi Piamenta and his excellent hard-rock Hasid band. They played in the all-male section but were loud enough to be heard in the women’s area and in Table 2. Jablon had paid the caterers extra to keep out the shnorrers, scruffy-looking religious Jewish beggars, but they sneaked in anyway and were hitting up everyone for money on the way to the restrooms. Sometime around midnight, just after the main meal had been served, Chief Joseph Fox, police commander of Brooklyn South (and Yitzy’s boss), began dancing with two of his detectives.

  About then my husband and I decided to leave. But first I wanted to pay my respects to Jablon’s wife, Edy, whom I had just seen from a distance. I made my way to the women’s section and then was immobilized by the mob of women talking, eating, and dancing, and mesmerized by the sight of hundreds of perfectly coiffed heads, all wearing wigs. Suddenly Jo Ann Baldwin appeared by my side and introduced me to a tiny woman. I told them I wanted to get through to Edy Jablon, but I was stuck. A small hand that felt like a steel clamp took hold of my wrist, and I found myself being dragged away from Baldwin, through the crowd, and deposited in front of the mother of the groom. She smiled politely when I thanked her for inviting me and said good night.

  I didn’t catch the name of my cavalier, the tiny, elderly warrior, armored and helmeted in her evening gown and wig, determined to reach her destination no matter whom she had to mow down. It was very noisy, and she had introduced herself in a mumble evocative of Marlon Brando in The Godfather.

  Later, I saw her now and again at various meetings in the hospital. I could see she commanded respect, but I didn’t learn exactly who she was until Alan Astrow took me to a gathering of physicians and rabbis discussing the religious protocols surrounding end-of-life matters. She pursed her lips and shook her head as someone talked about dealing with advanced directives, health-care proxies, and DNRs. “I am very against this idea,” Miriam Lubling muttered in her thick Polish accent. “A doctor should say, ‘May you live a hundred and twenty years.’ The minute you sign, the nurse gives you up. As long as you live, you should get help. Even if you are not Jewish. You have a mother; you shouldn’t sign, to give up. I don’t like it. I don’t like it. Even for goyim [non-Jews].”

  In Borough Park there were many nonmedical people, most of them rabbis, who took it upon themselves to refer patients to specific physicians and hospitals. Some of them had become so powerful they could make a doctor’s career and even positively or negatively affect a hospital’s bottom line. Miriam Lubling was in a class by herself. She not only referred patients, she paid cash. If a person in Borough Park needed hospital care and didn’t have insurance, Lubling would shake down local organizations and businesses. Jablon said, “At my synagogue where I pray, they have no respect for anybody. The rabbi walks in, everybody keeps talking. All of a sudden, she walks in and everybody stands up.”

  When I found out how important Lubling was, I asked Jablon to formally introduce us.

  He sighed.

  He said he would make the introduction because he just wanted everybody to be happy. He tried to love everyone, he said, so he would be the first to tell you Miriam Lubling was an angel of God. But he also tried to be honest, so he would also tell you how he’d almost killed her right in the hospital lobby—she made him that angry.

  At the time Lubling was in her eighties (she never revealed her exact age), certainly more than old enough to be Jablon’s mother—and half his size. Though she was feared and respected in Borough Park, Jablon said he couldn’t help himself that day. Lubling drove him crazy. She was a fixer like him, but her loyalties lay elsewhere, even though Lubling believed otherwise. She insisted that she regarded Maimonides as Gan Eden, the Garden of Eden, paradise, and pointed out that her daughter worked there (for Jablon), and that the daughter had given birth to nine children at Maimonides, and one of those children had recently had a child. Lubling herself had been a patient in the hospital after she’d collapsed in her apartment (which was in the neighborhood) and had to go to the emergency room.

  Yet she was an associate trustee of New York University Medical Center, though she was an immigrant nursery-school teacher of modest means. She had achieved a position usually reserved for wealthy philanthropists because she sent the hospital—NYU, not Maimonides—so many patients. Moreover, she made sure their bills were paid. What rankled Jablon was the source of these patients, which was Borough Park.

  A doctor at NYU had saved Lubling’s late husband’s life, inspiring the unwavering devotion that instigated the screaming match with Jablon. The fight had to do with a patient’s rather surprising odyssey through the hospital system.

  “I had brought in this case from Mount Sinai, and she was hunting for this same patient to bring into NYU!” Jablon explained indignantly. “I stole a patient from Mount Sinai, and the administrator was about to call Brezenoff or Pam to complain about me, how I grabbed that patient. I told the family, ‘That doctor operating is going to kill you.’ The patient came here, and the next morning I go to visit and I find the patient is at NYU! Mrs. Lubling! She says, ‘Mameleh, mameleh, I send you patients.’ What patients? I had such a fight with her. She’s about three foot two and I’m nine foot seven, and I’m fighting with her. You can imagine, my size fighting with this little old lady in the lobby, and nobody said a word.”

  Jablon told me to meet Lubling in his office at noon one day and disappeared as soon as she showed up with her daughter, Peshi Drillick. Drillick was an attractive Orthodox woman, remarkably slender and unwrinkled for a mother of nine, recently a grandmother, outfitted in black down to her well-applied eyeliner. She had come along to interpret in case I couldn’t understand her mother’s Brandoesque inflections and Polish accent.

  When I asked Lubling to explain what she does, she pulled fourteen pieces of yellow paper from her pocketbook, representing her morning’s work. “This one couldn’t get an appointment for two weeks,” she said, studying one slip of paper after another. “I got it for today. Here’s Mr. R., his kidneys aren’t working, I made it for today.”

  Drillick smiled. “There’s no waiting for an appointment when it comes to my mom. They know they have to please her. She brings them business. When she needs an appointment, she needs it done immediately. If they’re not going to work with her, she’ll go somewhere else.”

  Lubling handed me a printed roster of names, many with stars next to them, indicating Jewish patients. “NYU sends me the list every day,” she said. “The stars telling me what I might have to do with.”

  Drillick said, “She goes room
to room to see what the patient’s needs are.” Then added, “Nobody would make a list like that here. It’s not allowed.”

  I was reminded of all the complaints I’d heard from doctors and nurses about the large Orthodox families that took up residence at Maimonides when family members became ill. Their devotion was admirable but problematic. They crowded into patient rooms and brought bags of food, making it difficult to keep rooms clean, then complained bitterly about how dirty the place was. Orthodox volunteers poked their heads into rooms and asked, “Jewish?” Kosher snacks were produced for those who nodded.

  Drillick responded to my unspoken thoughts. “My mother’s strength is that she’s not embarrassed,” she said. “She doesn’t care what the doctor thinks about her so long as she gets what she wants done. Most people get intimidated. You don’t want to sound pushy, you don’t want to sound nudgy. Her attitude is, ‘You don’t like me, who cares?’”

  Lubling came by her resilience by a means that was sadly common in Borough Park. On the eve of World War II, her family encouraged her and a sister to leave Poland for Israel, then the British protectorate of Palestine, while her father, mother, and other siblings stayed behind. They were killed in the war. In Israel she met and married her husband, built a business, and, at the age of thirty-six, he fell in the shower, hit his head on a faucet, spent two years in a hospital, and was given up for dead.

  That was not an acceptable option for Lubling. She sold the family factory and took her husband and children to the United States, where a physician at NYU removed the clot in his brain. In appreciation she began a branch of Bikur Cholim, one of the Jewish charity organizations that offer help to the ill. That’s when she began referring patients.

  She assured me she wasn’t exclusive to NYU. “Sometimes the child has hole in heart, Columbia has best doctor,” she said. “And here, Maimonides, to Dr. Shani the cardiologist, and Dr. Rudolph and Dr. Jacobowitz. Lenox Hill when Rudolph was there.”

  What about the new cancer center?

  “I was at the groundbreaking, a very beautiful, nice thing,” she said. “Those doctors are very, very good.”

  Which doctor does she recommend?

  “Dr. Bashevkin,” she said—Kopel’s former partner, the same Bashevkin whose refusal to participate in the new venture was making its growing pains much more severe than anticipated.

  Jablon joined us after an hour had passed.

  “So how’s NYU?” he asked Lubling as he walked in.

  She said something I couldn’t understand and then smiled. “He has a wife, an angel,” she said sweetly, nodding her head at Jablon, and then she was gone.

  Six

  Ability. Affability. Availability.

  November 2005

  Daily Log—J.S.

  Saw this quote attributed to Abraham Heschel, who wrote the definitive biography of Maimonides the physician/philosopher, not the hospital:

  “When I was young, I admired clever people. Now that I am old, I admire kind people.”

  I imagine that Heschel—especially when he was old—would have liked Alan Astrow.

  This diagnosis would never appear on his medical chart. But you could argue that being considerate landed Alan Astrow in the emergency room at Maimonides.

  It took nine stitches to stop the blood flowing from the gash on the doctor’s forehead. He had to leave his apartment on the Upper West Side of Manhattan before dawn so he could make it to the hospital by 7:00 A.M. for the Tumor Board, a weekly discussion of complicated cases, involving surgeons, hence the early hour. He had tried to slip out of bed quietly and without putting on a light, so he wouldn’t wake his wife. Fumbling in the dark, he smacked his head against the wall.

  Being a nice guy always seemed to get Astrow into trouble. In high school, as coach of the intramural basketball team, he insisted on keeping one of the lesser players in the game for two quarters. He knew that his job was to make the team win, but that unruly compassionate streak refused to submit to common sense. Sometimes he wished the unpopular kids who glommed onto him would vanish, but why would they? He was trapped by his own sense of fair play.

  When I met him at the cancer center three days after he hurt himself, he dismissed the large white bandage covering a wide swath of his forehead. “It looks worse than it is,” he said sheepishly.

  We were going to lunch at a Turkish restaurant across the street, at the edge of Chinatown: Russian music blared, and a Polish waitress took our order. On the way out of the cancer center, we walked by the large conference room on the main floor, which was still unfinished, six months after the hoopla of the opening and six weeks after the oncology group had finally moved in. The gleaming wooden flooring had been laid that week, but the wall separating the room from the lobby didn’t yet exist. The other walls were in need of a final coat of paint. Astrow was not reassured when the painter explained he couldn’t finish the job because there was no light. Wires hung from the ceiling, marking the place for light fixtures. The chairs hadn’t yet been delivered.

  The Joint Commission had just finished its inspection, a nonevent for the cancer center. “The whole place here was in a tizzy for months about this JCAHO visit,” said Astrow. “Then they came over for forty-five minutes, took a tour, saw it was still under construction, and said, ‘Nice facility.’”

  He appeared to be remarkably calm, considering his worried nature and the fact that it was already Friday morning. In three days, for the first time, he and Daniel Sulmasy planned to hold one of their colloquiums, “Spirituality, Religious Wisdom, and the Care of the Patient,” at Maimonides—in the conference room that was at the moment unwalled, unlit, unpainted. He had no choice but to trust Bill Camilleri, the man who had gotten the building built, who promised him that the job would be done by Monday.

  Astrow was too exhausted by then to get upset by the construction snafu, and he was trying to convince himself that his other problems, like his injury, appeared worse than they actually were.

  He hadn’t been able to convince himself, with good reason. So far his attempt to organize a thoughtful public conversation about religion and medicine had generated nothing but anxiety and hard feelings. He had believed that the conference could be a good thing for a hospital with so many Jewish and Chinese patients. The speakers—Chun-fang Yu, a professor of religion at Columbia University, and Rabbi Shai Held, scholar-in-residence at the Jewish Theological Seminary—had impressive credentials.

  Instead he had made people angry.

  He ordered a mezza platter and brought me up to date: A week earlier he had merely been worried he didn’t have time to publicize the event adequately. It would be embarrassing to have colleagues from Manhattan come to Brooklyn and find an empty room. He never knew how many people would show up, but this time the size of the crowd took on greater symbolic importance, as either ratification or rejection of his decision to come to Maimonides. Astrow was finding himself infected by the hospital’s sensitivity to being on the wrong side of the bridge.

  The earnest pondering of big questions wasn’t his primary consideration now. For the first time in his career, he had to consider the bottom line. His job was to run a division. The young woman administrator he’d hired during the summer was very bright but had been alienating almost everyone— especially Sam Kopel. She regarded her ideas and attitudes as necessary antidotes to hidebound thinking; they saw cocky youthful certitude and condescension. While the radiation-oncology business was still slow, adding to the financial pressures, the hematology group was getting busier all the time. Astrow was finding it hard to return calls to patients as quickly as he would have liked. He needed to recruit new doctors before the group could handle too many more patients. He needed a nurse-practitioner but had received almost no response to the ads he placed in nursing journals. The receptionists complained that the indirect lighting meant to make the place more attractive made it impossible for them to see. The previous week he had been summoned to a charity function honoring Pam Brier and
Edward Lichstein, chief of medicine. That same week he met with several rabbis and other doctors and social workers to discuss how they could work better together. It was at this gathering he met Mrs. Lubling, who mumbled her objection to Do Not Resuscitate orders before excusing herself to answer her cell phone.

  With so many practical and political tasks already competing for the energy he had left for patients, Astrow didn’t need extra work. But for years now, the spirituality conferences had helped him to combine his inner and outer worlds, the technical, tangible functions of being a doctor with the more ephemeral concerns that made him feel alive. Bringing this conference to Maimonides was risky, a public revelation of something personal and precious that could easily be dismissed or rejected. Now that he had set it in motion, he wanted it to succeed.

  He invited all the private hematologic oncologists affiliated with the hospital. He took a stack of flyers to the hospital’s bioethics committee, which met the first Tuesday of every month, to discuss exactly the kind of morally fraught issues the spirituality conferences addressed. How should they deal with an Orthodox family, grieving over the death of a child hit by a car, ready to break the Orthodox taboo against donating organs but wanting to restrict the gift to Jewish families? Should they discourage the pregnant mother, diagnosed with metastatic breast cancer, who wanted full-blown treatment, knowing that fetal defects could result from scatter effects of radiation but also knowing that without the treatment the mother would likely die before the baby’s birth? Should parents be permitted to select the gender of their unborn children? How long should life be sustained by machines?

  Two days later he got an urgent call from Marcel Biberfeld, a regular participant in the bioethics committee. Astrow could feel Biberfeld’s anger trembling through the phone, though Biberfeld’s voice was controlled. “He was very angry,” said Astrow. “Not yelling, but very angry.” Biberfeld asked why Astrow had invited Shai Held, someone who didn’t represent the Orthodox community. A powerful board member had expressed his displeasure. What was Astrow going to do about it?