Hospital

by Julie Salamon

“I believe eventually we’ll have a single-payer system, because this system is insane,” he said. “And it will be driven not by liberals or people like myself but by people like General Motors. The country can’t afford this system. But I don’t get involved in any way, shape, or form, because I can’t affect it. Life is short. I do what I can affect. Seriously. I’m not an academic, and it’s too big. No individual hospital can change it. There are associations and groups that do that, so I hope for the best and focus on what I can do. At Maimonides an opportunity came where I can make a difference at a particular institution that affects people’s lives.”

  Payson took a spoonful of soup from a cardboard cup.

  Because of his association with Tulane, he had visited New Orleans often since Hurricane Katrina. He’d seen the disastrous effect on that city’s health-care system, not just for the obvious reason of taking care of sick people but because medical jobs were a big part of the local economy. A pillar of the community, to put it in old-fashioned terms.

  “The most important thing I’ve learned and believe is that many of the issues relating to success or failure of hospitals are national in common,” he said. “In other words, declining revenues, increasing expenses. But the solutions are not national. You can’t wait and hope that model will change. The solutions are local. You have to look at your own hospital. What is its mission, what is its community, who does it serve—and scale it for that mission. Get it well managed and you can survive.”

  Throughout the year I took time at my computer, transcribing interviews and notes, making to-do schedules that seemed to get longer instead of shorter. At the beginning of June, I checked one of several “people to talk to” lists, which included the following:

  —Sirisha Perumandla, oncology fellow

  —Chinese healers on Eighth Avenue

  —Robin Guenther, architect

  —Rebbes who recommend docs

  —Clarence Davis about evacuation plan

  I learned that Clarence Davis, the director of safety and security, was scheduled to go on vacation June 7. I moved his name to the July list.

  On June 4, Davis went to Macy’s to buy a suitcase for the trip he was taking to the Dominican Republic, where he’d met his wife four years earlier. She was Polish, living in Germany, a classic blond beauty. He was African-American, chiseled, movie-star handsome. Rollerblading and racquetball kept him young; he was fifty when they met. She was thirty-four, but she thought they were about the same age. They danced the salsa. They watched basketball games. Coup de foudre. Love at first sight. She moved to Brooklyn from Berlin. They married.

  On the way to Macy’s, he collapsed and went into a coma. On June 15 he died, at age fifty-five. From cancer, diagnosed three months earlier at Mount Sinai; he didn’t want anyone at Maimonides to know. His family wanted to bury him in New Jersey with his mother and siblings, but his wife, Magdalena Davis, decided no, he belonged to Brooklyn. She wanted him in Green-Wood Cemetery, close to where they lived, close to the hospital. Beyond that, she couldn’t think.

  Clarence’s boss, Derek Goins, called Douglas Jablon. Magdalena was relieved to have someone take charge. “First of all, I never did this before, and I wouldn’t even know where to start,” she said. “I just lost my husband, the love of my life. I couldn’t even speak.” She was thirty-eight years old, a new arrival, alone.

  “They gave us a price, seven thousand dollars, and I said, ‘That’s too much,’” Jablon told me later, conjuring the vision of him, the giant Orthodox Jew, accompanying two attractive women, the blond Pole and her African-American stepdaughter, to the funeral home. “The undertaker went down to about thirty-eight hundred dollars, A to Z. Do you know how cheap that is? Jewish funerals [with their plain wooden caskets] cost more than that, and this was a beautiful casket. He said to me, ‘Thank God I don’t deal with Jews all day.’ To make a long story short, I said, ‘They don’t have the money even to pay the thirty-eight hundred,’ and he said, ‘Don’t worry, we’ll wait for the insurance.’”

  Next stop, picturesque Green-Wood Cemetery, the 478-acre parkland burial place designed as a rural retreat, filled with rolling hills and mansion-worthy crypts; burial place of Henry Ward Beecher, Leonard Bernstein, and the gangster Joey Gallo; a tourist attraction that would be designated a national landmark later that year.

  “Soon as I walked in, I didn’t even know this guy, the manager, and he said, ‘Mr. Jablon, I know who you are. It’s ninety-five hundred dollars, not a penny off,’” Jablon told me. “I was greeted like that! We started going around looking for a grave. Twelve thousand dollars for this one, more for that one. Did you ever go in there? Ahhhh. They should sell condos. It’s gorgeous.”

  On the morning of June 21, Jablon went to early-morning services at his shul, satisfied that everything was arranged for Clarence Davis. The Baptist minister was booked for services at the funeral home. A hearse would take Davis and his family to the cemetery. Pam Brier would speak the next day at Schreiber Auditorium; the event was being publicized by flyers all over the hospital.

  Instead of settling back to enjoy morning prayers, Jablon was stabbed with a familiar feeling of incompletion. What about all the people who loved Clarence at the hospital who might want to say good-bye to him today and couldn’t get to the service?

  From this miasma of nervous energy came a vision. Jablon was a kid again, and an Italian person on his block had died. The hearse containing the body drove slowly up the street, like at a state funeral, so everyone in the neighborhood could say good-bye. At least that was Jablon’s interpretation of his memory. He decided that Maimonides should do the same for Clarence.

  He called Derek Goins and told him he wanted the hearse to pass by the hospital, to pause beneath the underpass between Eisenstadt and Gellman so people could pay their respects. When Goins asked Jablon how people would be notified—they couldn’t put it over the loudspeaker that a hearse would be driving by; it would freak out the patients—Jablon said, “Don’t worry, I’ll call six, seven people inside of the hospital who are real yentas [gossips] and tell them this is happening.”

  After the funeral the hearse drove to Forty-eighth Street and turned onto Tenth Avenue toward the hospital entrance. The yentas had done their job. Several hundred people were lined up on the sidewalks. Jablon climbed out of the hearse and had to steady himself; his knees were shaking. As he walked around to the back and opened the door, Davis’s men, the hospital security guards, lifted their arms in salute.

  “If someone needed root-canal work or some kind of surgery, they could have done it right there without any anesthetic,” Jablon said. “The morale in the hospital went straight up to the sky. I said, ‘This is what Clarence wants. Everybody should be together.’ He touched everybody. He touched everybody. He touched everybody. It was a very rough situation.”

  As Jablon told the story, his voice shook with holy fervor, like he said his knees did that day, and I wondered how much of his excellent story was true.

  All of it was true, Sondra Olendorf assured me. Calm, steady, perceptive Olendorf seemed incapable of exaggeration. She had gone to the service at the funeral home that morning and walked back to the hospital not knowing Jablon’s last-minute plan. She wondered why the street was blocked and then noticed crowds of people standing in front of the hospital. She watched as Jablon got out and opened the door, and as the security guards saluted. She found herself clapping and crying and saluting along with everyone else.

  When Olendorf told me this story, it was dusk and she was sitting in her office, as usual without the lights on. “Hospital morale goes in peaks and valleys,” she said. “Everyone has been concerned about the budget, about what the state’s doing to reimbursements, about all our plans. Things have been at a lower ebb; all you see is the dysfunctional element. And then there are things like this, people are going, ‘Yeah, what a place to work, to recognize that guy who worked here, that we can be true to ourselves, that family thing, in honoring each other, t
hat you can rely on one another no matter what, and this is one of those times.’”

  The morning of the funeral, Magdalena Davis, the widow, had been staring out the window of the hearse in a shell of numbness. She had been talking silently to her dead husband, in her newly acquired English, saying, “I wish Clarence Davis would have been a little bit asshole so I wouldn’t miss you so much right now.”

  She didn’t know a lot about his work. He would come home and tell her about the big fight he’d had with his boss, and when she visited him the first time, she was shocked to see how frumpy his office was. But she also saw how attached he was to the place, and that the attachment was mutual. When he emerged from the coma at Mount Sinai, his room was packed every day with visitors from Maimonides. She was talking to one of these visitors, a nurse, who was just leaving the room, giving Magdalena her telephone number, telling her to call if she needed anything, at the moment Clarence died.

  In the hearse Magdalena realized she wouldn’t see Clarence again, but she couldn’t cry. She was a quiet person, not the type to scream or wail. She felt she had become a ghost, the fairy-tale romance turned to ashes in three months. But when she saw the people standing at the curb at Maimonides, she began to cry after all, because she saw she wasn’t alone.

  Acknowledgments

  On my first “official” day at Maimonides, Jo Ann Baldwin took me to the security office for a badge. I didn’t fit into any of the usual job categories at the hospital so I was simply designated writer. At first people were wary, then curious, then more helpful than I could have dared hope. I can’t acknowledge everyone who became involved, because some people preferred to talk to me privately and because I would inevitably omit someone who wouldn’t mind public thanks. My gratitude, however, extends to everyone I encountered at Maimonides (and in the worlds touched by the hospital) whether they appear in the book or not.

  Still, I must single out a few people who were crucial to this enterprise, beginning with Pam Brier and Marty Payson, who opened the door and then let me roam free, and were unstinting with their time and trust. For their amazing candor and generosity, I give deepest thanks to Alan Astrow, Jo Ann Baldwin, Steven Davidson, David Feldman, Lillian Fraidkin, David Gregorius, Douglas Jablon, Lisa Keen, Nella Khenkin, Samuel Kopel, Mark McDougle, Pamela Mestel, and Sondra Olendorf.

  Many other people at Maimonides gave me guidance, but the following group provided especially important assistance in a variety of ways: Connie Barone, George Blaine, Annette Cruz, Terri Gagliardi, Derek Goins, Holly Hartstone, Joyce Leahy, Jill Markowitz, Ellie Silver, Kathy Thompson, Dawn Volpe, Velta Willis, and Andrew Yacht.

  While writing the book in 2006 and 2007, I had the privilege of being a Kaiser Media Fellow. The programs arranged by Penny Duckham and her staff at the Kaiser Family Foundation provided an enlightening series of field trips and meetings on health policy and medical issues. I greatly appreciate the insights of my colleagues in the fellowship program as well.

  Writing the first draft of a book can be lonely and scary. I was lucky to have a cherished band of advisers who were willing to read early versions. Many times I would have been lost without the encouragement and advice—and occasional douses of unfiltered franknesss and tough love—of Megan Barnett, Brian De Palma, Patti Lynn Gregory, Noelle Hannon, Roxie Salamon-Abrams, and Lilly Salcman. I also was sustained by the constant reassurances, patience, and wisdom of my very favorite men: Bill Abrams, Eli Salamon-Abrams, and Arthur Salcman.

  For their invaluable legal and medical expertise, I thank Alan Einhorn, Bobby Cohen, and Suzanne Salamon.

  A longer list of friends and family deserves gratitude for all kinds of reasons—Rick and Carol Abrams, John and Debbie Abrams, Raquel Cano-Schneiderman, Madeline DeLone, Danny Gregory, Trish Hall, Bill Klein, Barry Kramer, Sara Krulwich, Lila Deis Lauby, Wendy Miller, Lynn Paltrow, Muzzy Rosenblatt, the Saddleback Lake “August Outlaws,” Michael and Ilene Salcman, Rob Schneiderman, Pam Schwartz, Andrew Tatarsky, Jane Tylus, the WAT yoga and kick-boxing group, and Veronica Windholz. Endless appreciation to Suzie Bolotin and Peter Workman, who changed much in my life a few years ago, when they asked me to think about Rambam.

  Everyone at Penguin Press and the Robbins Office has been gracious and helpful, especially Liza Darnton and Lindsay Whalen at Penguin, and David Halpern, Coralie Hunter, and lan King at the Robbins Office. Special thanks to Maureen Sugden and her magic red pencil, and to Liz Calamari.

  Finally, two incomparable women have had immeasurable influence on me—Ann God-off, my editor, and Kathy Robbins, my agent. With their clarity, wit, intelligence, and vision they have deepened my outlook on everything that matters.

  Annotated Book List

  The hospital is only eight miles from my apartment in SoHo. But the trip to Brooklyn could take as long as an hour, depending on time of day and how the subways were running. I always carried a book. Their first lines alone convey the range of subject and style. Here is what I came to think of as my Maimonides reading list, with special thanks to New York City Transit for getting me there on time most days, and for the delays on the D and N lines that gave me extra time to read.

  Bartlett, Donald L., and Steele, James B., Critical Condition: How Health Care in America Became Big Business—and Bad Medicine (New York: Broadway Books, 2006). One terrible thing after another.

  First sentence: “You are standing in line at a supermarket to buy a box of Cheerios.”

  Belkin, Lisa, First, Do No Harm (New York: Random House, 1993). Heartbreaking case studies about the hard ethical questions, beautifully described.

  First sentence: “It was standing room only in Room 3485 the day the committee voted to let Patrick die.”

  Bruck, Connie, Master of the Game (New York: Simon & Schuster, 1994). I picked up this biography of Steve Ross, the man who built Time Warner, to learn more about Marty Payson. After checking out the thirteen pages given to Payson in the index, I couldn’t resist the rest of this fine saga about Ross’s life, accurately described by the Wall Street Journal as “a remarkable rag-trade to riches story.”

  First sentence: “Steve Ross would have loved his funeral, his friends and family later agreed.”

  Cohen, Rich, Sweet and Low (New York: Farrar, Straus and Giroux, 2006). Families, like hospitals, are complex. One of the main buildings at Maimonides is named after Rich Cohen’s grandfather, Benjamin Eisenstadt, who invented individual sugar packets and then Sweet’N Low, the artificial sweetener. He made a fortune and became a major benefactor of the hospital. This wonderful, funny, sad, unresolved book combines the history of sugar manufacture with Cohen’s family story, both unexpected tales of desire and corruption.

  First sentence: “Everyone in my family tells this story, but everyone starts it in a different way.”

  Cohn, Jonathan, Sick (New York: HarperCollins, 2007). Not to be confused with Sicko, the Michael Moore documentary—much calmer, but just as scary.

  First sentence: “It was 4:43 on a clear November afternoon when the paramedics found Cynthia Kline, pale and short of breath, slumped against a bedpost in her double-decker Cambridge home.”

  Committee on Quality of Health Care in America, Crossing the Quality Chasm (Washington, D.C.: National Academy Press, 2001). For my purposes, fascinating.

  First sentence: “The American health care delivery system is in need of fundamental change.”

  Didion, Joan, The Year of Magical Thinking (New York: Alfred A. Knopf, 2005). When a hospital doctor hesitates before telling Didion that her husband is dead, the social worker says, “It’s okay. She’s a pretty cool cucumber.” The coolness of her deliberate, distilled prose becomes a weapon against devastation. I couldn’t stop reading.

  First sentence: “Life changes fast.”

  Estrin, Joseph, with Barry P. Moskowitz, An Uncommon Commitment (Brooklyn: Maimonides Research and Development Foundation, 2003). A helpful and enthusiastic history of the hospital, written by one of its physicians and published on his ninetieth b
irthday, with a foreword by Dr. Joseph Cunningham.

  First sentence: “From the busy sidewalks of Borough Park, Maimonides Medical Center rises like a jumble of geometric shapes amid the tidy shops and row houses.”

  Fadiman, Anne, The Spirit Catches You and You Fall Down (New York: Farrar, Straus and Giroux, 1997). This book has become a medical anthropological classic since I first read it almost a decade ago. When I reopened it during my hospital year, I found the story of clashing cultures and the limits of modern medicine hadn’t lost its power to haunt and amaze.

  First sentence: “If Lia Lee had been born in the highlands of northwest Laos, where her parents and twelve of her brothers and sisters were born, her mother would have squatted on the floor of the house that her father had built from ax-hewn planks thatched with bamboo and grass.”

  Frazier, Ian, Gone to New York (New York: Farrar, Straus and Giroux, 2005). Like Frazier, I’m from Ohio, so I read his marvelous adventures in the big city with a particular appreciation, especially his take on Brooklyn.

  First sentence: “If you drilled a hole straight through the earth, starting at the corner of Seventh Avenue and Forty-second Street, you would pass through ten inches of pavement, four feet of pipes, thirty-five feet of Seventh Avenue subway, about twenty-two hundred miles of rock, about thirty-six hundred miles of nickel-iron core, and then another twenty-two hundred miles of rock.”

  Gawande, Atul, Complications (New York: Henry Holt, 2002). The surgeon gives the inside scoop without cant. He lays out the big picture with crisp authority and handles the intimate details with tender care. Enjoyable and educational.

  First sentence: “I was once on trauma duty when a young man about twenty years old was rolled in, shot in the buttock.”

  Ginsberg, Allen, Kaddish and Other Poems (San Francisco: City Lights Books, 1961). After Sharon Kopel died, I revisited this brilliant, anguished poem, which I hadn’t read since college. Ginsberg’s immersion in loss is almost unbearably beautiful in this ode to his mother, who died in an asylum after a life plagued by mental illness (“over and over—refrain—of the Hospitals”).