She leaned forward to give instructions in halting Spanish to Freddy, the driver substituting for Leon, the Russian who was usually at the wheel. As we drove through quiet residential streets lined with two- and three-story brick houses, Brier mentioned that Rebbetzen F. had given her a cheesecake to celebrate Shavuot, the Jewish holiday commemorating the giving of the Ten Commandments to Moses at Mount Sinai. It was the custom among observant Jews to eat a dairy meal.
How was the cheesecake? I asked.
“Delicious,” Brier replied.
Not a moment later, unprompted, she confessed.
“I gave away Rebbetzen F.’s cheesecake,” she said. “The last thing Peter and I need is another cheesecake in the house.” Then she told me she had mentioned the rebbetzen not because of the cheesecake but because when Brier had seen her on the street the other day, the lady asked, matter-of-factly, “How is the recruitment of Dr. Borgen going?”
There were no secrets in Borough Park, Brier said.
How is the recruitment going? I asked.
Brier said she thought it was going well. After her last meeting with the breast surgeon from Sloan-Kettering, he sent her a bouquet of flowers. But they were still negotiating.
The car pulled up next to the curb at our destination. As we got out, a man with a beard and yarmulke snapped photographs of Brier. Her maroon silk jacket became incandescent in the flashes of light.
A crowd was waiting in the school’s gym, which had been divided by an accordion gate into a men’s section and a women’s section. There was a banner, containing the names of both Maimonides and Kingsbrook.
Folding chairs faced a large picture of the late Rabbi Menachem Mendel Schneerson, beloved descendant of the Chabad-Lubavitch dynasty. A heretical thought: This crinkly-eyed, white-bearded man, in another setting and another season, wearing red and white instead of all black, would have made a convincing Santa Claus. Here, though, Schneerson’s legacy was serious business: He was believed by many of his followers to be the Messiah; the Lubavitchers had yet to choose a successor.
Jablon, who was pacing in the back of the room waiting for Brier, whispered to me. “Did Pam see the banner?” he asked. He glanced at his watch. “Oy, I have four weddings tonight after this,” he said.
Brier stared at the thicket of black hats between her and the podium. At 9:05 she shuffled through the crowd of Orthodox Jews and one black man, Mathieu Eugene, a Haitian-born physician who was running for city councilman. As she stood at the podium, in front of Rabbi Schneerson’s portrait, the angle between them made it appear as though the rabbi’s uplifted hand was just above the hospital president’s head, giving her a benediction as she gave one of her convincing stump speeches. “I have this goal of stamping out colon cancer in Brooklyn. . . .”
The applause continued as she concluded and walked halfway down the men’s side of the gym, taking a seat next to an Orthodox man in a black hat. No one revealed displeasure, if any was felt.
Jablon, watching with me from the back, saw the faux pas and whispered. “She’s the only woman in the world who can do whatever she wants here,” he said.
As Lahey began his presentation on early detection and prevention of cardiac disease, Brier looked around and abruptly rose and made her way to the other side of the partition, where she took a seat and whispered with some of the women. After a few minutes, she glanced back at the always-waiting Jablon, who immediately came to her side to pull her away, as she apologized for having to leave.
Next stop: Flatbush. The son of a Hatzolah boss was engaged to marry, and there was a party at Hatzolah headquarters, a building with five large doors to accommodate ambulances and a sign: DEDICATED BY MAIMONIDES HOSPITAL. Another sign said ME’HITZAH, meaning “the women’s entrance.” Brier and I entered there.
Upstairs we found a large room packed with tables laden with dried and fresh fruit, pastries, and large bouquets of flowers. On one side of a partition, men danced in a circle to klezmer music played on a keyboard, while on the other side, women in festive shirts and jackets and long dark skirts, verging on fashionable, ate and talked. The groom’s mother, a small woman wearing a honey-colored wig, greeted Brier, who asked her hostess how many children she had. “Nine,” she said with a laugh. “I iron fifty-five shirts a week—six boys.”
Brier bit into a piece of dried fruit and ate half a cookie, wrapping the remains in a napkin, which she deposited on a table. After a bit more chat, she said it was time to leave. On the way to the car, we saw Elliot “Lazer” Rosman, of the Borough Park Hatzolah, standing in the mist. A light, warm rain had begun to fall.
Brier told him that Marty Markowitz had been admitted to the hospital for a couple of stents.
“He could lose a couple of pounds,” Rosman said.
On the way back to the hospital, in the intimacy of the dark, I asked Brier why she never talked about her father. I had heard about her eccentric mother and her crazy aunts, about her past and present husbands and their other wives, about her daughter and her daughter’s girlfriend. I knew that Brier was an only child. She’d told me her parents were first cousins, who had met during World War II.
“My father?”
She sounded surprised but answered.
“I was thirteen when he left, and before that I didn’t see him much, because he lived in other places,” she said without inflection. “He was an entrepreneur, and we didn’t know what he was doing. I’d get little postcards from him from Russia saying he was selling Sony transistor televisions. He lived in Uganda for a long time and convinced the government he should set up a television station that would broadcast in four different dialects. Ultimately they kicked him out of the country for being Jewish. He lost everything, but that’s the way life is. He was a very interesting man, very driven, but I didn’t see that much of him.”
Her face faded and reappeared as we drove past lights on dark, quiet streets. “He moved to western Australia, lost a lot of money on the Australian stock market, and ultimately moved to Maui,” she said. “He had just set up another TV station, sort of was getting back on his feet, when he died. He must have been in his seventies.”
She fell silent, and I asked her what it was like after her parents split up. Did she see him then?
“Not much,” she said, her voice revealing nothing. “He married right away, a younger woman, a physical therapist from Iceland. The only person I ever knew from Iceland. There isn’t that much to tell about him. I remember one night when he was in town, we had dinner at the Beverly Hilton with the education minister from Uganda, who was assassinated about six months later. There were always weird things circulating around my father. There was an air of excitement with him I would sometimes catch when I spent time with him. But if I saw him twice a year, it was a lot.”
The approaching bright lights of the hospital put an end to her dutiful recollection. The woman who seemed unable to keep secrets had the politician’s gift: She could at once be transparent and elusive.
It was ten-fifteen. She had more than an hour to kill before the eleven-thirty meeting she’d scheduled with the night-shift environmental workers and their bosses to discuss cleaning procedures and why they weren’t working.
“Let’s go visit Marty Markowitz again,” she said. On the way back to the ICU, she leaned over and picked up a soiled towel that was on the floor next to a leaky pipe. She handed it to a nurse, who told the hospital president to go wash her hands. Another nurse complained that she was sweating; could Brier do anything about the air-conditioning?
We found Markowitz alone, slack-jawed in his hospital bed. Brier apologized again about the heat and then assured him that he would go home the next day.
His laugh was hollow. “I’ll go home and face my future.”
Brier understood. “To tell you not to have stress is like telling you to fly to the moon,” she said. “I love my stress.”
He sighed. “When I think of what you and Peter went through . . .” The recognition of mort
ality lay in the unfinished sentence.
Brier changed the subject and asked him to tell us how he’d met his wife. He obliged. Neither of them had been married before, he said, when they met seven years earlier. He was fifty-four, and she was forty-two. “Three dates later we were engaged,” he said, smiling.
He looked at me apologetically. “I’m sorry,” he said. “I didn’t catch what you do at the hospital.”
Brier introduced me again, this time more formally.
For Markowitz the presence of a writer taking notes had an adrenaline effect. He immediately sat up in his bed and began a politician’s spiel.
“The hospital is a microcosm of Brooklyn,” he said enthusiastically. “All the languages, the religious and ethnic backgrounds! Before the new cancer center opened—state-of-the-art, by the way—this borough, a city of two point four million—no, two point six million—people didn’t have a cancer center.”
Even his color seemed to improve.
“This hospital is an independent entity,” he said. “The last of the Mohicans! Not a Manhattan-channeled health institution, an outpost of the mother ship! This is the mother ship and the satellite all wrapped up in one!”
Laughing, Brier patted Markowitz on the arm. “You can stop, Marty,” she said, and told me we should go.
As we left, she offered him a final reassurance. “Once you get past this, you’ll feel better.”
On the way to the conference room on the executive floor, she stopped to scold a technician for not wearing her identification badge. She approached three nurses, talking in the hallway, wearing the standard baggy slacks and shapeless patterned blouses. They looked startled at the unexpected apparition, a blond woman in an elegant silk jacket, who planted herself in front of them and said, “Hi there. I’m Pam Brier, president of the hospital.”
When we arrived at the conference room, fourteen workers were waiting for her, along with the men they reported to, including Derek Goins, senior vice president of operations; he told Brier someone would paint the Bikur Cholim door first thing in the morning.
The night cleaning staff was mostly black and Hispanic, but there were a couple of older white men and one woman. They sat quietly at the table, eyes on the president.
“I know how hard it is to keep this place clean,” Brier began. “First, I wanted to say thank you and to tell you we are going to invest five hundred thousand dollars on environmental staff, to make sure every shift gets help. The hospital isn’t clean enough, and one of the reasons is that we’ve greatly increased the number of patients and not the number of you.”
Almost everyone nodded.
“If any of you have ideas on how to improve things, share them with a supervisor,” Brier said.
One or two people spoke up, mainly to confirm the need for more staff. None of the workers seemed to know what they were expected to do in this circumstance, but a few of them approached Brier afterward with suggestions.
The next morning Brier called me to let me know a painter had begun to clean the Bikur Cholim door. She said he told her he had painted the door three weeks earlier. “It had gotten dirty again so fast,” she mused. Then, as she was about to hang up, she said, “I must apologize to Derek.”
Five days earlier I had spent the morning on Gellman East with Margie Morales, a member of the environmental “study-action” team, a subgroup of a DLMC (departmental labor management committee), the labor-management experiment of consultant Peter Lazes. The team was charged with finding better ways to keep the place clean.
Morales, a substantial woman with a shy, eager manner who wore her hair pulled back, had offered to let me follow her around as she cleaned rooms. She was using the Seven-Step Cleaning Procedure the team had developed after interviewing fellow workers and visiting other hospitals.
She told me the hospital’s unchecked stream of visitors was the biggest impediment to cleanliness. The other major problem was staff resistance. “Before, the men mopped and the women picked up the garbage,” she said. “Now we’re all doing the same jobs, forming a concept of teamwork so it’s not a man’s job and not a women’s job. A lot of people don’t want to make the change.”
We entered an empty room, and she began to go down the Seven Steps checklist. “First thing you do is ask, ‘What’s here that doesn’t belong here?’” she explained. “Remove it if there’s a newspaper on the floor or old flowers on the sill, remove it before you do the shine. That’s our first S. Sorting the unwanted from the wanted.”
Morales, who told me she had three children between the ages of seventeen and eleven, had worked as a secretary and a bookkeeper before she took the cleaning job at Maimonides two years earlier.
Her reasons were personal. “My husband passed away six years ago, and he was here three months,” she said. “He had cancer. So it means a lot to me to have the rooms clean. I like doing this type of work, making sure the patients have rooms that are clean. What if it’s my family member? I treat every patient like it’s my family. I want to make sure the IV poles are where they are supposed to be and the garbage pails aren’t in the middle of the room where people can slip on them.”
Every day at Maimonides, I was reminded that the “health-care system” wasn’t anonymous or abstract; it was the sum of individual human successes and failures, each of which could build or destroy. Most people didn’t set out to screw things up; they just didn’t take time to remember (or to learn) the legacy of the man whose name the hospital carried. Maimonides the philosopher /physician valued daily self-scrutiny. In his commentaries he wrote that “the perfect man needs to inspect his moral habits continually, weigh his actions, and reflect upon the state of his soul every single day.”
The hospital, however, was populated by humans, imperfect men and women, existing in an imperfect world. Politicians started out believing in the social contract and then forgot their duty to fight for the people they represented. Drug and insurance executives said that their desire was to improve and protect health care, but their jobs and fortunes depended on profitability, not making medicine available to everyone. Technocrats worshipped faster and more efficient machines that helped prolong health and life, but they neglected empathy, understanding, and the probing that requires genuine conversation and time. Doctors planned to devote their lives to healing and then spent too much time analyzing their bank accounts or nursing bruised egos instead of making sure the system provided for their patients. Patients agreed with all of the above but failed to accept responsibility for the abuses they inflicted on themselves by working too hard, exercising too little, and smoking, drinking, and eating too much.
Depending on the day or night, life in the hospital could seem full of exquisite promise or pointless despair. The system was tainted by callous disregard for decent and equitable care, by money lust, by corporate influence, and by lack of political will. But a great many people who were part of the system wanted something better. Yes, individual doctors and nurses behaved badly, sometimes inexcusably so. Clerks were rude to patients and to each other. People made mistakes. Yet I was constantly struck by the sense of urgency that accompanied desires for fairness, for compassionate medicine, for efficiency, for meaning—and yes, for cleaner rooms. Both Pam Brier and Margie Morales struggled to sort the unwanted from the wanted, to make the hospital what it should be. They needed their lives to matter.
Toward the end of my year at the hospital, Alan Astrow asked me, “Did you know what you were getting into?”
His question had been prompted by a visit with one of his patients, Marie, a forty-five-year-old woman with metastatic gastric cancer. The first time I met her, she was sitting up in bed hunched over a plastic bin, retching, while her sister, Tina, watched, her face contorted in sympathetic pain. Tina had more or less moved into her sister’s hospital room. She had done all she could to maintain the illusion that they remained the same people in the picture frame on the room’s windowsill—the young girls, now middle-aged, mothers but still s
exy, buff, glowing size-two blond women with large dark eyes. Marie and Tina were only thirteen months apart, so similar (when Marie was healthy) that people mistook them for twins.
Tina often had circles under her eyes, but her own weariness didn’t prevent her from making sure her sister’s hair was combed and her makeup was right. The patient’s bed was covered by a faux-leopardskin blanket from home; she had a matching headband. She wore pretty shorty pajamas. She intended to defy this sickness and go home.
This remained Marie’s professed intention, even during the weeks she lay dying in a comfortable room on Kronish 5, the refurbished wing, which had broad hallways, shiny wood floors, sage green walls.
I told Astrow that I admired how sensitively he talked to Marie and her family, the way he laid hands on his patients during physical exams. For a sometimes-awkward man, he had a remarkably natural touch.
He dismissed the compliment. “I’ve been doing this a long time,” he said.
Yet there was nothing rote or complacent about his manner or his concern. He had been preoccupied with this patient since the first time they met, and she looked at him and said, “You’re going to cure me.”
She was divorced, the mother of two young children, daughter of Italian immigrants, sister of a policeman, a friend of Douglas Jablon’s. Astrow was a doctor who believed in telling the truth, yet he was leery of those who believed there was a moral imperative to give people information they didn’t want to hear. He turned to Jewish theology for help on the question of truth versus chesed, Hebrew for “kindness.” He concluded that neither is privileged, that there was a tension between truth and kindness that could not be resolved.
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