Meds, math and beyond
Reporter Julie Salamon profiles a chaotic Brooklyn hospital.
Thu May 22 2008
Photograph: Michael Kirby
When author Julie Salamon rushes to the front door of her Soho apartment, the former New York Times and Wall Street Journal reporter is wearing a faded sweatshirt and black leggings, and her hair is wet. She was at the hairdresser and, realizing she was late for her meeting with TONY, told the stylist to skip the blow-dry. “I had an outfit all laid out, but I guess you’ll have to settle for me like this,” she says with a cheerful shrug.
With her broad smile and sunny demeanor, Salamon “as is” works just fine, especially since the topic is her warts-and-all account of the Brooklyn hospital Maimonides. Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God, and Diversity on Steroids is precisely what its title suggests—an exhaustive and revealing account of one of the country’s busiest medical facilities. Starting in September 2005, Salamon had unsupervised access to the Borough Park medical center for a year. She sat in meetings where staff members bickered over compensation and credit, followed doctors as they gave patients life-altering news, and interviewed whomever she pleased, from the ambulance drivers to the cleaning staff. She accumulated 5,000 pages of single-spaced notes, and didn’t let the Maimonides administration read a word. “It was an incredible act of faith or insanity on their part,” she says.
It helped that the hospital’s president, Pamela Brier, was familiar with the author’s work. Salamon has written six other books, including the 1991 Hollywood classic The Devil’s Candy, her penetrating report on the filming of The Bonfire of the Vanities. And the hospital brass was no doubt disarmed by Salamon’s warm, self-deprecating personality. “Sheila Namm, the head of risk management, got a copy of the book, and—this is sort of embarrassing, because I didn’t think of it as a strategy—she said, ‘You come in and you’re so shy and quiet and people start talking to you, basically to fill the gap. And they end up telling you everything.’”
Indeed they did.
The chief of surgery admits to her: “It’s all about turnover. The more you can get in and out, the more times that cash register clicks.”
An oncology fellow: “I have lived around the world and thought I was the least-prejudiced person you’d ever meet. Since coming to Brooklyn, I’ve become, believe it or not—I shouldn’t even say this—I’ve become a lot more prejudiced.”The ER nursing director: “I’ve been here for six weeks, and three days out of five I’ve gone home crying.”
This is an unfair sampling—an equal number of examples of staff heroism and goodwill could be also be compiled, often from the very same people. But the professionals speak with amazing candor throughout, and this is part of why Hospital—with its mix of cultural reportage and adrenalized drama—is such a gripping read. The medical director, for example, nurses a bitter grudge against a former colleague and is brazenly competitive with his current ones. When Salamon informs him that another doctor had visited 12 patients that day, he says, “You should follow me around. I see about 30 in a day. I’m like a ballerina.” But despite the entertaining sketches of intense and sometimes diva-like staffers, Salamon’s overall portrait is of talented professionals dedicated to their work. This, she says, is the advantage of writing a book—no one is reduced to a sound bite.
Maimonides definitely could not be reduced to a sound bite. The 705-bed hospital is one of the country’s largest and most diverse. With 67 different languages spoken in the neighborhood, the hospital is a veritable U.N., its hallways jammed with Hasidic, Chinese, Pakistani, Haitian, Russian and Bulgarian patients and staff, all taking their meals together at the kosher/Chinese/Italian/Caribbean cafeteria.
Financial pressures create even more complexity. One patient, known to the staff as Mr. Zen, is an undocumented worker whose seven-month stay sets the hospital back more than $1 million. The administration readily acknowledges the clash between the desire to give care and the reality of having to make a profit. When Salamon asks Brier what should be done about the U.S. health-care crisis, she tartly replies, “Well, if I knew that, I guess I’d be a candidate for the Nobel Prize, wouldn’t I?”
Instead, the Maimonides staff do what they can in a very chaotic corner of Brooklyn. The doctors and administrators come off, at times, as grandiose, cynical and brash, but Hospital very effectively conveys their heroism. “These are intelligent people working hard, and they actually are not cynical—even their anger and frustration comes out of a kind of idealism and desire to make the hospital better,” Salamon says. “I found that exhilarating.”
Hospital (Penguin Press, $25.95) is out now.