Hospital

by Julie Salamon

  In February the hospital held a press conference, and Brier was asked to go on early-morning television to talk about the program. She bought a new scarf. The phones started ringing. Within a month several hundred people had signed up for the rectal screenings. “It was amazing,” Cohen told me. “We’ve had a lot of younger people calling and saying they want the test, and we say, ‘No, unless you’re in a high-risk group.’ As soon as people hear there’s something you can get for free, they want it. Even if it is a colonoscopy.”

  I asked Brier how she felt about the largesse now, in a tough budget season. She said she chose not to worry about the financial ramifications. “Most people, I suspect, will have insurance, or we will make them eligible,” she said. “It’s the undocumented who will have a tough time. But I can’t believe you couldn’t call discovering colon cancer an emergency, and you could certainly get the surgery covered. But we’ll treat those people. You know what? It’s going to be fine. I’m sanguine about it. I don’t think Bob Naldi loves it. But it’s already generated so much positive goodwill, and it’s a good thing to do. I think it’s good for us to be known as the hospital that walks the extra mile and really cares about patients in the community. I love to be able to say that and not have it be words. You know me. I’m into that. I love this! I love this!”

  David Gregorius had made his peace with Brooklyn, he told himself that spring, and with the cockroaches, with living three thousand miles away from Jenn, with shifts that were routinely so busy he might go fourteen hours without eating or drinking anything. He had come to appreciate the local community doctors who insisted on being called when one of their patients was admitted, even if they complained about it at 4:00 A.M., a phenomenon he had not experienced at other hospitals. He told me, “After I’ve dealt with Maimonides for a year, if you cut me loose in a little ER in western Nebraska by myself, I’d be competent, actually. A year ago I was a med student, and the first day of internship it’s eyes wide open, especially in this ER. Now I feel comfortable.”

  Then John Marshall, his program director, forwarded all the residents an e-mail he’d received from the medical center at Loma Linda University in Southern California. There was an opening for a second-year resident.

  Davey clicked onto the Loma Linda Web site and saw a picture of a curved white building set against a blue sky, palm trees, flowers, in a place romantically called “the Inland Empire.”

  Loma Linda University and Medical Center are located in a vast metropolitan area east of Los Angeles known as the Inland Empire. It is considered to be the crossroads of Southern California. The beaches of Newport, Laguna, and Malibu are only 60 to 90 minutes to the west, with superb swimming, sun-bathing, surfing, and sailing. Also 60 minutes to the west is downtown Los Angeles, with its top-quality restaurants, world-renowned museums, opera, theater, and other cultural opportunities. . . .

  Gregorius was the only resident from Maimonides who applied for the spot. Still, he didn’t know if he would be accepted; he had heard that more than thirty people from around the country were competing. He told me he didn’t have his hopes up, but he felt he had to try. He said he could never feel truly happy in New York. He and Jenn were game, but it was hard to have a bicoastal relationship. And sometimes he thought Maimo might just kill him.

  That spring came, another e-mail brought another promise of change—this one from a headhunter hired by Maimonides, looking for oncology surgeons. One reply looked like it could be the answer to management’s prayers for the cancer center. Patrick Borgen, a forty-eight-year-old surgeon, chief of the breast service at Memorial Sloan-Kettering, said he—he himself, not one of his underlings—was interested in coming to Maimonides. Borgen was said to have star quality plus: the résumé, the charm, the experience, the patina of Sloan-Kettering, and a large Brooklyn clientele who now traveled to Manhattan to see him.

  Jay Cooper was so excited he forgot science and fell back on ancient superstitions, refusing to mention Borgen’s name. “I don’t say the person until I see a signed contract,” he told me. “Someone said, ‘You mean that person is not coming?’ That person told Pam he’s coming. That person told Marty Payson he’s coming. That person told me he’s coming. However, I haven’t seen a signed contract, so I don’t believe it yet. When I have a signed contract, until he shows up the first morning, I won’t believe it. And if you show up the first morning, I still won’t believe it, but if you show up after lunch, I’ll begin to accept you are really here.”

  I admit it. I was elated at the prospect of Dr. Borgen swooping in to save the day, just as I was approaching the end of my year at Maimonides, even though I knew that happy endings were as fleeting as everything else. As Orson Welles put it, in a parenthetical note at the very end of the screenplay for The Big Brass Ring, a labyrinthine thriller that was never made into a movie: “If you want a happy ending, that depends, of course, on where you stop your story.”

  In Jewish tradition, endings were never really endings. Stories in religious texts never stopped but became fodder for endless commentary and analysis, which were often relayed in the form of additional stories. At Maimonides, as in any community, the past, present, and future were linked by these individual narratives that connected in obvious and mysterious ways, one ending beginning yet another story.

  Later, after I’d stopped going to the hospital almost every day, Lili Fraidkin offered a commentary on the events that were unfolding at the cancer center. It was her cancer story.

  In the summer of 2001, on the eve of September 11, in retrospect a time of innocence, Fraidkin was diagnosed with adenocarcinoma, a form of cancer that can be found in many organs. Fraidkin’s was in her uterus. The cancer was slow-growing but had advanced to the lining of the uterus, raising the fear of metastasis to a serious pitch, because Fraidkin had been too busy to take time out for her annual visit to the gynecologist.

  Fraidkin knew she wanted the surgery done laparoscopically, a capability Maimonides didn’t have at the time. She didn’t plan to tell anyone at the hospital, but before she could make arrangements, Pam Brier walked into her office and gave her the name of a doctor to call at Mount Sinai. “She eavesdropped,” Fraidkin told me. “Then she personally paid for my daughter to fly in from Vegas, first class, the first time my daughter ever flew first class.”

  The day Fraidkin returned from the hospital Brier appeared with her driver and four big trays of food. During the week people from the hospital started dropping in. One morning Fraidkin got a call from Joyce Leahy, the hospital’s lawyer, saying she couldn’t come to see her that day—could she come tomorrow? “Joyce Leahy?” Fraidkin remembered thinking. “We say good morning every day, that’s it, and now, ‘I was going to come to see you—is it okay if I come tomorrow?’”

  Then it hit her. Brier had assigned everyone on the executive floor to visit Fraidkin.

  Fraidkin told me the arrangement wasn’t Brier’s only response to Fraidkin’s illness. “That week she announced at the staff meeting, ‘I want every one of you females to see your gynecologist this month. No delays,’ and on and on with the smears and the breasts,” Fraidkin told me. “ ‘This happened to Lili, it can happen to you,’ were the words she used. And then she tells the men, ‘You men might as well have your prostates checked.’ She even had a town-hall meeting about two or three months after that. I was sitting there, mortified. She just went on this preventative-medicine campaign that boggles the mind.”

  Fraidkin would never stop missing Stanley Brezenoff, and sometimes she felt shut out by McDougle and Brier. But for a slender woman, Brier exerted a mighty grip. “That’s my cancer story,” Fraidkin told me. “And my Pam story.”

  It was also a warning story.

  Fraidkin had had an incredible experience with the surgeon from Mount Sinai recommended by Brier. Fraidkin was so impressed that when he came in to check on her the morning after the procedure, she asked him, “Would you consider going to Maimonides?”

  Her daughter protested.
“Mom!” she wailed.

  Fraidkin smiled sweetly at the doctor. “This is what I do, honey,” she snapped at her daughter. “Back off.”

  She learned that half the surgeon’s patients were from Brooklyn and that he was interested in splitting his practice between Maimonides and Mount Sinai. He and his partner met with Brier and Howard Minkoff, chair of obstetrics, and with Cunningham, she said. They made a deal, did a blitz in the Jewish papers.

  And then? “We waited and waited, and waited and the patients never materialized,” said Fraidkin. “This was a major cancer surgeon, and they didn’t want people to know they had cancer. Those same patients who lived in Brooklyn, they all chose to see him in Manhattan.”

  He stayed a year, and then he left.

  “They don’t want the world to know,” said Fraidkin, referring to the Borough Park patients, the Orthodox specifically. “When you come to Maimonides, the world knows. Their world knows.”

  What if Patrick Borgen, chief of the breast service, Memorial Sloan-Kettering, signed the contract and came to Brooklyn? Would he prove to be the keystone for Sam Kopel’s ambition, the big brass ring, the happy ending, or a disappointing indication that all their assumptions about the cancer center had been wrong?

  “If you want a happy ending, that depends, of course, on where you stop your story.”

  Twelve

  Medical Advances and Retreats

  . . . it struck Oleg that Shulubin was not delirious, that he’d recognized him and was reminding him of their last conversation before the operation. He had said, “Sometimes I feel quite distinctly that what is inside me is not all of me. There’s something else, sublime, quite indestructible, some tiny fragment of the universal spirit. Don’t you feel that?”

  — FROM CANCER WARD BY ALEKSANDR SOLZHENITSYN

  Evening approached. From the boardroom’s fifth-story view, Brooklyn appeared to be a sea of green, shimmering in the heat of a summery Monday; the temperature had climbed to near ninety degrees that afternoon. The hospital brass and directors were arriving for the June board meeting, which Marty Payson and Pam Brier had agreed would be an upbeat gathering.

  As Payson headed toward the podium set up at the front of the room, I overheard Brier tell someone that Marty Markowitz, the Brooklyn borough president, was in the hospital. Heart trouble; he needed a stent.

  Mark McDougle was standing outside the door, talking urgently on his cell phone. When he walked in, Brier glanced at him and raised her eyebrows. He gave a brief shake of his head, indicating no.

  The meeting began after the board members had a chance to seat themselves at the large conference table that almost filled the room, set for dinner with flower arrangements. Payson said the construction was going well, that the sleek, glassy building was a symbol of the new Maimonides. He discussed the cancer center in glowing terms, glossing over the $8 million operating loss. “We’ve been seeing red ink for a year and a half, and one of our challenges will be to see red go to black,” he said. “But I believe that five, ten years from now the cancer center will parallel the main institution.”

  Next a cheerful physician gave a frightening report about dangerous infectious diseases. Then Brier spoke. “News bulletin,” she said. “The borough president is a patient here. It’s all over the Internet. He chose to come here Saturday afternoon and is doing extraordinarily well, treated by Dr. Shani. Who knows, that may be another advertisement.”

  She pointed out that Maimonides had just been featured prominently in the New York Times; the previous week the Metro section had displayed a front-page article under the headline SPOONFULS OF CULTURE HELP MEDICINE GO DOWN, about Bing Lu’s Chinatown clinic. Then board members watched an NBC Nightly News report about overcrowding in emergency rooms, with the Maimonides ER front and center. Carl Ramsay, the ER medical director, offered the national television audience a perfect doomsday quote.

  Marty Payson leaned over and whispered to Brier, mischief on his round face, “Couldn’t they have done the birthing center?”

  After the video clip, Brier reported that New York magazine had just published its annual list of “Best Doctors,” and Maimonides had the biggest representation of any hospital in Brooklyn. Then, irrepressibly, she deflated the moment. “Ask me what goes into the Best Doctors list, and I haven’t the vaguest idea,” she said to the board, as though talking to herself. “Many great doctors aren’t on it, and I know at least one who is on the list who is deceased.”

  She announced that Joe LoCicero was just about to sign his contract and dropped a big hint about Patrick Borgen (“a top breast surgeon from a leading cancer hospital in New York” may be arriving).

  “Why would he want to come to Maimonides?” a board member asked.

  Without pause Payson answered, “He’s in his forties, he can build his program; it’s a career change to get out of a corporate culture to a culture where he can treat patients the way he wants.”

  Brier gave a brief report on Victory, acknowledging that Maimonides’ investment had not produced the hoped-for results. The turnaround plan hadn’t worked; the failing hospital’s discharges were lower in May than in the previous year.

  Payson chimed in, “We went there as a defensive move, and that has worked,” he said. “Some goodwill came out of it, but not a heck of a lot. Our future is in modernization and recruitment of world-class doctors. Regarding Victory, I have zero regret. We were right to do it, but there is a limit to what we want to do, and we have reached that limit.”

  A board member complained about the lack of coordination that kept patients languishing in the emergency room. Sondra Olendorf knew that the man’s elderly mother-in-law was a patient in the intensive-care unit, languishing even as her son-in-law spoke. The patient’s doctor had ordered a CAT scan at nine that morning and now it was 7:00 P.M. and the CAT scan still hadn’t been done. Olendorf said that she wanted the problem fixed before the meeting was over.

  Her beeper alerted her as excuses poured in. The ER was exceptionally busy that night, and once again they were short of beds, so everything was backed up, they said. Olendorf wasn’t interested. Out of earshot, the hospital’s top nurse got someone on the phone and said quietly but with unmistakable intent, “I want to be able to take this board member to see his mother-in-law after this meeting is over and she will have had her CAT scan and be back in bed!”

  As the discussion of the emergency-room situation wound down, Sam Kopel announced that the intensity modulated radiation therapy function was up and running at the cancer center.

  Mark McDougle spoke after that. “The bad news is that Bill Camilleri has decided to resign,” he said. “Now that the cancer center is built, it’s time for him to take care of his own health issues.”

  Brier stared across the large conference table at McDougle, a strange expression on her face. “Bill almost always comes to board meetings,” she added in an odd, wandering voice. “He’s very quiet. He was the brains behind the brick and mortar. He was hired because he was an expert in building cancer centers, and he didn’t disappoint us—in that respect.”

  “In that respect.”

  Brier was annoyed with Camilleri. She had planned a proper, official farewell, and he chose not to show up—even after she sent Mark McDougle out of the room to call Camilleri and tell him to get over there.

  Camilleri had no intention of accepting public praise from Brier, not after she had pushed him out. Earlier that month McDougle had given him the news, though Camilleri wasn’t fooled. He had every intention of wrapping things up at the cancer center before he left, but he would not be part of a show for the board of directors—not even to help McDougle, whom he felt had tried to be fair to him.

  “Mark called and tried to talk me into going, and I said, ‘Pam doesn’t want me there,’” Camilleri told me later. “Mark said, ‘Everyone wants you there to say good-bye,’ and I said no. No! That was a political decision on my part. Pam, for the first time in a year, would have put her arm around me
and said, ‘We’ll really miss you,’ and I didn’t want to give her that photo op.”

  The board meeting was only the first stop in the busy evening Brier had planned for herself. She invited me to come along. As we left the boardroom around 8:00 P.M., the hot, bright sky softened into pink dusk. We headed over to Gellman, to the windowless intensive-care unit, where day and night were indistinguishable, so Brier could say hello to Marty Markowitz. We were joined there by Marty Payson.

  Markowitz was wan and scared-looking, his usual bounce flattened. But he mustered strength to make a joke about needing a glass of wine. His wife tried to smile. She was pretty, despite tired lines, her graying hair pulled back into a ponytail. Payson told the politician that he, the hospital chairman, had been in this same ICU twice after having heart stents put in, and now he was fine. Brier said she would try to do something about the heat; the air-conditioning was on the fritz.

  After a few minutes, Brier and I left. As we walked out of the ICU, past the elevators, Brier glanced at the door of the room reserved for the Orthodox volunteers, the Bikur Cholim, Guardians of the Sick. The door was covered as usual by scuff marks. She pulled out her cell phone and called Derek Goins, the senior vice president for facilities and building operations.

  “I am standing by the Bikur Cholim room, and I am indignant,” she said. “This door is filthy. I want it painted, and in high gloss, because it cleans better.” She closed the phone and forced a pleasant look. “Not to micromanage,” she said lightly.

  Our next destination was a high-school gymnasium for a meet-the-doctor evening sponsored by Maimonides and Kingsbrook Jewish Medical Center and the Crown Heights Hatzolah. Steve Lahey would be speaking about heart disease and its prevention. Sitting in the back of her black town car, Brier said to me, “Rarely does Douglas not do things perfectly, but we should have advertised this as a partnership with Kingsbrook,” she said. “When I mentioned this to Douglas, he was scrambling to get a banner with both our names on it. Hah!”