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Hospital ….. by Julie Salamon

One thing is clear from Hospital, an account of a year in the life of Maimonides Medical Center in Brooklyn: Running a hospital isn’t much fun.

It’s a million chores made worse by financial worries, ethnic rivalry, bureaucratic infighting, personal avarice, unreasonable expectations and near constant complaint. True, it also means saving lives, relieving pain, restoring health, serving the truly needy and, once in a while, celebrating the human community in a transcendent way. It’s a necessary job, and therefore an important one.

Former New York Times and Wall Street Journal reporter Julie Salamon spent a year taking the D train from her home in Lower Manhattan to the almost century-old, 700-bed hospital in Brooklyn’s Borough Park. (It’s a symbolic journey, as Maimonides both resents Manhattan’s higher-status medical community and is constantly trying to lure stars from it to cross the East River.) The hospital’s historical mission has been to serve the Orthodox Jews who make up about one-quarter of the patients. They function (as one person in the book describes them) as “unionized patients.” They have their own ambulance service, Hatzolah, that carries as many patients to Maimonides as the city’s emergency medical services. The difference is that Hatzolah’s male-only attendants stick around to cajole doctors and nurses and try to get their clients seen quickly.

The head of the Emergency Department, Steve Davidson, at one point got into trouble inside and outside the hospital for hiring someone that a Hatzolah coordinator didn’t like. This required elaborate fence-mending.

“Later he told me,” writes Salamon, “he finally grasped the farcical nature of his situation. . . . Hatzolah didn’t work for him, he worked for Hatzolah. How had he missed this salient point until now?”

But serving the rest of the patients is no easier. Brooklyn teems with immigrants, many of them illegal, newly arrived, non-English-speaking, uninsured, medically unsophisticated and ill. An estimated 67 languages are spoken there. Immigrants are now most of Maimonides’s patients, both in the hospital and in a network of clinics throughout the borough.

“Urdu was the main language on Newkirk Avenue, Spanish in Sunset Park, Russian at the Fifty-seventh Street site, and Chinese (in several dialects) on Eighth Avenue, a few blocks from the new cancer center,” Salamon writes. “About eighty-five thousand patients a year — more than double the number who were admitted to the hospital — were treated at the clinics. The hospital made an effort to install doctors and staff who spoke the same language and, when possible, were from the same background as the patients.”

This would seem a rich (if difficult) vein to mine, and Salamon chips away at it on occasion. But mostly she spends time with people in the executive suites and department chair offices. They include (among others) the hospital president, a woman who suffered a life-threatening car accident soon after taking the job and had to fight to regain her strength as she fought to establish her power; the thoughtful new head of hematology and oncology, who is determined to have his colleagues and trainees think of the spiritual needs of their patients; the West Virginia-reared head of nursing and hospital operations who carries a Curious George lunchbox as a totem that makes her endless inquiries more palatable; and the vice president for patient relations, a politically savvy former assistant to a New York State assemblyman known in the hospital as “Mitzvah Man.”

These people have interesting stories, and they tell them to Salamon, who carries a tape recorder. But focusing the book on them distances us from the more engaging crises taking place every day in the clinics and hospital rooms. It becomes too much an account of administrative events and conflicts described, not observed. And, frankly, there’s just too much kvetching.

One wonders how much a part (if any) HIPAA — the excessively restrictive Health Insurance Portability and Accountability Act of 1996, which governs patient privacy, among other things — played in steering her away from real-time encounters with doctors, nurses and patients. That’s where Maimonides’s — and every hospital’s — real story lies.

There are exceptions. Salamon recorded snippets of clinical encounters in a daily journal, and she reprints some of them in the book. She tells a few long stories as well. One of the more memorable is about “Mr. Zen,” a solitary, Chinese-speaking, undocumented restaurant worker with a cancerous tumor that weighed at least five pounds. For various reasons he managed to stay in the hospital for eight months, a symbol of resistance to life’s misfortunes, one of which was the hospital’s desire to move him out. As he was dying, with more than $1 million in bills racked up, a physician read to him from the Heart Sutra. Although Mr. Zen was an atheist, the doctor, a Buddhist, figured “that was the least I could do for him.”

Medicine has lots of honest, hard-earned pathos and no small amount of drama. Not enough of it is in this Hospital.


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