Hospital

by Julie Salamon

  Bing Lu’s wife, Xiaoxi Hu, also a doctor, had just opened her office, a lovely converted storefront space where everything was new, including acupuncture tables with curtains for privacy. Hu, a brisk, friendly woman, stopped by to say hello, told us to make ourselves comfortable in her office— still largely unfurnished—and then vanished.

  Bing Lu had gotten permission from his department chairman and Pam Brier to begin doing acupuncture in his wife’s office. The hospital clinic didn’t offer it for the usual reason—money. Most Maimonides patients were covered by Medicare or Medicaid or by HMOs that based reimbursement on the government insurance rates, which did not cover acupuncture. Private patients either had insurance that covered the cost or were willing to pay for it on their own. The hospital could offer the same deal, but acupuncture treatment required different beds from the ones used in medical examination rooms. For the hospital the economics (revenue versus cost) didn’t make it worthwhile.

  Lu found himself reconnecting with his old teachers as he began combining old and new, using herbs and acupuncture in the context of conventional— Western—medicine.

  “Western medicine is good at treating organic problems like pneumonia, heart failure—structural failures,” he said. “Chinese medicine is better in milder functional disturbances rather than organic disturbances. You have to weigh the evidence. Let’s say a middle-aged woman, married, with children, taking care of family, taking care of career, stressed out, very busy, always has tightness. Tylenol or Motrin does help, but she doesn’t sleep so great, sometimes feels nervous, et cetera. As an alternative to Paxil or Prozac, you have acupuncture. Another alternative: healthy lifestyle. These are real alternatives.”

  The conversation wound back to the subject of compromise.

  “After finishing high school, I had the option of going into a family business, to learn how to manufacture watches, or to medicine. When I decided to study medicine instead of being a watch man, it’s because I felt with medicine you could go to the end of the world, discover the cure for cancer.”

  He smiled wistfully. “I told you my childhood wish, the Nobel Prize.”

  He remembered that his father, who had been a farmer, kept a map of the world in their house. “When I am punished, I am sent to the wall looking at the map. He, for a farmer, had a very broad worldview, was very open-minded, and encouraged me to do these things. When I was six, I read a series of books called One Hundred Thousand Questions.”

  Bing Lu had reached the opposite end of the world. Many questions were still left open, and his laboratory days were most likely done.

  “I tried to do some small research initially,” he said. “But now I’m kind of not just New Yorkerized, I’m Brooklynized. I’m more of a practitioner, not making innovative findings. In that way I feel I wasted all that time. I compromised too much. I feel I made a balanced choice. From that point of view, I’m making a compromise. I have a private practice on Staten Island. I have the luxury of taking my younger son to school every morning. Balancing everything. This goes into my series of compromises.”

  He showed me a photograph of his children. “Besides being a scientist, I am a Chinese immigrant,” he said. “I have to do what I’m doing now in many ways to help my children have a better launching pad, and I think I’m doing that fine.”

  November 23, 2005

  Daily Log—J.S.

  It’s cold today, ice on the street, day before Thanksgiving. Clutching the railing, trying not to slide down the slippery steps from the elevated train platform to the street. I was supposed to talk to Sam Kopel today. He was all caught up with the JCAHO inspection. Then I got a voice message from him: “Hi, Julie, Sam Kopel. Sharon just called. She’s not feeling well. I’m rushing home, so I don’t know if you and I are going to be able to meet later on this afternoon.” I called him back, and he said she’s disoriented and has a fever. Not much of a Thanksgiving. We made a date for after the holiday. After I hung up, I couldn’t stop shivering. What is it like to be the oncologist always identified as “you know his wife is dying of cancer.” As though it is somehow his fault, something he dragged home from the office.

  This morning I met Sushma Nakka, first-year fellow in Gellman. She’s small and pretty and generally accessorizes her white doctor coat with nice earrings and necklaces. Nakka told me she always celebrated Thanksgiving. “It’s an American holiday, no religion.” When her seven-year-old son turned four, she also began doing Christmas, because he likes presents. Shopping, the American religion.

  She trained after medical school at Mahatma Gandhi Memorial Hospital in Hyderabad, India, and then moved to New York to meet her fiancé, who became her husband ten days after they first laid eyes on one another. It was an arranged marriage. Nakka worked as a resident at North General Hospital in Harlem and then completed a two-year fellowship in pain and palliative care at Memorial Sloan-Kettering, where she stayed an additional year as house staff. She said she thought the people in Harlem were “more appreciative.” At Memorial, she said, the patients were more educated and much more demanding.

  She told me her father is a family physician. Her mother is a physician in India. Her brother is a physician; he’s coming to America, in the middle of visa-application process. She speaks Hindi and Urdu. Lots of Muslims where she comes from, and she speaks Telugu. Muslims ruled her region for four hundred years.

  For a minute I couldn’t remember. Which building is Gellman? The hospital is a maze, cobbled together from era to era as the place expanded. I go into the main lobby in Gellman, which is pretty nondescript, quiet today, pre-Thanksgiving. Even though it is Wednesday, I take the Sabbath elevator, which stops on every floor so religious Jews don’t have to “work” by pressing buttons. The walls are grimy, despite Pam Brier’s cleanup campaign. Yesterday she canceled our interview to go to the hairdresser. I saw her later in the day with Leon the driver trailing her, weighed down by the giant cardboard boxes he was lugging..

  I told Pam her hair looked good. She opened one of the boxes and handed me a chocolate turkey wrapped in colored tinfoil. Happy Thanksgiving.

  Nakka had agreed to take me on rounds, where she would check in on the hospital cancer group’s patients and consult on patients for other doctors who saw indications of cancer or weird blood counts. I found her in the lab, where she was piecing together a diagnosis for a seventy-six-year-old Chinese man who had been admitted two weeks earlier for repair of his aorta. He was in the ICU. She had been asked to do a consult for anemia and was looking at his blood under a microscope.

  “Let’s go,” she said. We walked down several hallways and took an elevator.On the way I asked her what she thought was the biggest difference between being a doctor in the United States and in India.

  She smiled.

  “Back home my sister works for a veterans’ hospital. When she goes shopping or to the movies, they look at her as the doctor and they bring her free sodas,” she said. “She is treated like a celebrity.”

  And in the United States? I asked.

  She laughed. “Here, no.”

  We arrived at the ICU. A pale, bony resident with beard stubble and a Russian accent told her that someone from renal had seen the patient, but he wanted a hematology consult because the old man was anemic and had spiking fevers.

  We went to see the patient. His throat was swaddled in bandages; he’d had a tracheotomy, a hole cut through the skin at the neck into the trachea (breathing tube) when someone is unable to breathe without help. His eyes were wide open but revealed nothing.

  Nakka introduced herself and began to ask questions.

  A young Orthodox Jewish nurse, wearing gloves as she examined the settings on machines, said, “He doesn’t speak English.” Nakka walked out to the nurses’ desk and called out, “Anyone speak Chinese?” A tall young Asian man said, “Give me a minute.”

  David Kho entered the room a short time later. The patient fixed his eyes on the tall young doctor with the Asian face as the doctor interpr
eted Nakka’s questions: “Have you had anemia before? Have you been treated with iron tablets?”

  The old man couldn’t speak because of the tubes in his throat, but he nodded and blinked.

  “Did you have a transfusion before? Did you ever smoke? Any family member with anemia or cancer?”

  The word “cancer” popped out from a stream of Chinese. The old man looked frightened, though interpreting emotion is even trickier than language, especially with someone breathing through a hole in his neck. Nakka made notes in the patient’s thick chart, observing that his skin was oozing, his extremities were swollen. Was he suffering? I asked. She said he was taking morphine, and then ordered several tests.

  David Kho, the resident interpreting for Nakka, told me he would be glad to talk to me later. When we met, he told me he had been born in Singapore and moved to the Bay Area of San Francisco when he was nine. He had been willfully oblivious to his Chinese heritage. “You just wanted to fit in,” he said, “just to be a regular Joe.” His father was a biochemist and his mother an accountant—not quite regular Joes. “I tried very hard to fit in,” he said. “You lose a lot of your culture and your heritage as a result of that, to be assimilated. It’s not something you see as a strength, to be able to speak other languages.”

  Being at Maimonides was, for him, part of an awakening that had begun when he was a medical student at the Columbia University College of Physicians and Surgeons, working in the clinics in poor neighborhoods. Most of his classmates were like him, well-to-do, confronting poverty for the first time. The school made a big effort to integrate the students. They ate meals with host families, worked in the clinics. They were taught statistics and theories about why blacks and Hispanics were excluded from good health care. They understood the reasons: No insurance. Poor access. Language. Yet few of the medical students spoke passable Spanish.

  “To see it happen at a world-class institution where people come from all over the world to get treatment and people who live two blocks away can’t get care, that’s something else,” he said. “To see it right in front of you is pretty powerful.”

  His experience there made him think about being Asian. “Being Asian and what have I done for the Asian community?” he said. “Which was absolutely nothing.” He came to Maimonides hoping to reconnect with his roots, which he had done with mixed results. “When I was a kid, it was a curse to be different. I wanted to be the same,” he said. “Now, all of a sudden, this is, ‘Wow, you’re so special; you speak so many different languages.’ For me it’s odd to integrate all these experiences together.”

  Though many young doctors were perplexed or offended by the demands of the Orthodox, Kho appreciated the powerful urge to protect one’s own. “To me a place like Maimonides arose because the Orthodox or Hasidic people said, ‘They’—other people—‘don’t understand anything about Shabbos. We’re going to build our own hospital.’ It’s odd, crazy that a minority group, albeit a very influential and powerful one, were able to organize themselvesto build a hospital to cater to those needs. It seems that’s how it’s going to have to be until everyone’s on equal footing to get medical care.”

  Kho was a sophisticated and sensitive man who had been trained in the gospel of Arthur Kleinman, the Harvard medical anthropologist. In medical school at Columbia, Kho had heard lectures on cultural competence, ethics, and philosophy. He had studied the biases that could distort communication between patient and physician.

  For David Kho these questions weren’t academic. His wife was half Jewish, half Catholic, had grown up in Puerto Rico. He met her when he was doing research in Boston, before medical school. They both were accepted to the College of Physicians and Surgeons and married while in medical school. He learned Spanish, he said, “in recognition of her heritage.” The perfect Maimonides couple.

  He was gratified by the efforts Maimonides was making to hire Chinese-speaking doctors, nurses, patient reps, and social workers. Yet despite all these efforts, he wondered how much improvement there could be in health care for new immigrants without their assimilation. “Just to hear about the cultural mind-set of patients when they come into the hospital is crazy,” he said. “A lot of cultures don’t have the concept of preventive care. They don’t go to the doctor unless they’re deathly ill. That’s the way the Chinese community is. We throw all this money at it—and that’s a good thing, to have people who speak the language and understand the culture. But it’s only half the equation. If the patient has the mind-set ‘I’m only going to come to the doctor when I’m on my deathbed,’ then they are going to die. I can’t see that patient reps or having doctors that speak Chinese or making inroads in the community will change the mind-set of these people,” he said. “The only thing that will change the mind-set is themselves. More education. Whether the something that is preventing them from coming is our point of view or their point of view, it is reality.”

  He seemed like someone who could cross the gap. But when I asked him his long-term plans, he looked sheepish. He wanted to be a radiologist, he confessed and explained why. X-ray scans could be beamed anywhere on earth via computer. He spoke with envy about a world-renowned radiologist who lived as a recluse. Kho’s dream was to move to Hawaii and read X-rays on the beach, far from patients.

  “Patients break your heart,” he said.

  NEW SUCK REPORT, VOLUME 7, ISSUE 2

  Dudes,

  Sorry it has been awhile. Not much new to report from The Brooklyn. The battle with the roaches is escalating, as you might guess . . .

  I am not currently working in the ER for the month. I am doing my EMS month, which basically is playing paramedic and riding around in the ambulance. The medics call us the “special truck”, as during my shift, we are the only ambulance in Brooklyn with a doctor aboard. I have decided that paramedics have a way cooler job than ER doctors, as they still get to save lives, but they also get to take lots of naps during their shift, not to mention eat. It has been so wonderful to eat lunch everyday the last 2 weeks, i think I might quit the whole doctor thing and become a paramedic, as I think sleeping and eating while at work are the two qualities that I seek most in a job. The one drawback of the EMS job is when you have to pick up dead people from their apartments, especially when the person has been dead and rotting for like a week. I swear, you haven’t smelt nasty until you’ve met a week-old rotten dead guy. Uggh.

  In other interesting news about my new home, I was running today and my iPod stopped working . . . just plain stopped. I couldn’t figure it out, so thinking I’d find a store that sells them, I Googled “iPod Brooklyn” and to my surprise i did not find any stores. But the top 10 results from the search were DIFFERENT stories like “Brooklyn teen shot by police after stealing iPod”, “Brooklyn Man slain over iPod”, and “Another Brooklyn iPod murder” or something like that. Awesome. This is my new home. Maybe I should listen to my mother and carry ID while running at night. Naaaaw . . . . . . “No Guts No Glory” I always say.

  Ok. I close with the picture of the Verrazano Bridge taken from my balcony. Pretty huh? It’s no Colorado Rockies, or Grand Canyon, or Harvest sunset in Nebraska, but it’s all i got for now. love, davey

  For some time I had been trying to talk to Davey—feeling guilty for pestering him. I could see from his e-mails he was exhausted. But we all had our jobs to do.

  Julie

  unfortunately, i am working night shifts from Saturday thru tuesday, from 7pm to 7am each night. by 10:45am on Monday i’ll be sound asleep, as it is during “my nighttime” for the next week. i think i am back on day shifts on Thursday (7a-7pm) and off the next day but on all weekend, and back to nights the next week think? you can actually access our schedule on the internet. . . .

  When I finally found him, I tried having the multiculturalism conversation with Davey in the ER. Big mistake. Hard to deconstruct the Tower of Babel when you’re standing in the middle of it.

  “The whole term ‘multiculturalism’ has always been kind of weir
d,” said Gregorius as he scanned the computer screen looking for his next patient. “You don’t have to define people all living together. It happens anyway. It’s probably been going on forever, and in the last twenty years or ten years they’re saying, ‘Oh, we’re multicultural now.’ We always were multicultural. So I don’t know. People are just bringing attention to the fact. ‘Oh, look at us, we’re doing great stuff.’ I’d have to think about that one.”

  He raised his eyes for a second and gave me a pleading look.

  “My girlfriend, Jenn, is here, visiting for a month,” he said. “She’s ten times smarter than I am. Want to talk to her?”

  Sure, I said.

  He pulled out his cell phone and called.

  “She’ll meet you in the lobby, where the ATM machine is,” he said. “She is five ten, blond, pretty, she’ll be wearing a black puffy coat, jeans.”

  “That’s enough,” I said. “I’m sure I’ll find her.”

  Jenn Pfeifer sounded like just another attractive young woman in Los Angeles—or Manhattan, for that matter. In Borough Park she would be as hard to spot as a pink flamingo trying to go incognito in a flock of geese.

  We walked over to a nearby bagel shop where young Orthodox neighborhood matrons—no older than Pfeifer—hung out wearing long, shapeless skirts, their hair tucked into wigs, chatting while their babies lounged in strollers. Like many of the kosher food places in the area, the shop had décor that was functional, like the basement social hall in a church or synagogue without an endowment. You came, you ordered, you sat, you ate. The women were diverted for a minute by Pfeifer and then went back to their conversations.

  She noticed their reaction. “I come out to visit about every month,” she said. “In the summer when I first came out, I went running around Borough Park in my little running shorts, and it was a very weird experience. I was just doing what I’m used to doing. Walk out the front door in Santa Monica and you go for a run and you pass a dozen people doing the same thing. You’re not used to being the person who sticks out like a sore thumb.”