Hospital (20 page)

With a note of surprise in his voice, Hikind said, “This is not Maimonides propaganda.”

Jablon pressed the “off” button. “Forget about it,” he muttered, clearly responding to something besides Hikind’s words. “I don’t know, people just aren’t happy. Not at the hospital only, but in general. They like to complain.”

He pulled up near the Makki Mosque, where the imam was waiting. We walked to an empty restaurant, but it was difficult for us to hear each other over the television set playing an Urdu soap opera. Choudhri, who had joined us, took us to his small, crowded office in a nearby tenement building, the smallness accentuated by the noise from creaky pipes. Like Jablon’s office, Choudhri’s was adorned with plaques and photos confirming that he was a personage of note.

The imam discussed his history with the hospital. Like many Pakistanis in the area, he was from the Kashmir region. He had arrived in New York twenty-two years earlier. In Brooklyn at the time, there were few Pakistani shops, so the imam’s family, like most others, bought meat in kosher shops, because the rules of kashruth closely parallel those of halal. Until Brezenoff and Brier arrived at Maimonides, however, the hospital was regarded as off-limits. Contact was made; a clinic providing an Urdu-speaking staff opened on Newkirk Avenue.

But he confirmed that the event that cemented relations with the hospital was, paradoxically, September 11, the moment that had blown apart the Western and Muslim worlds.

“They were the only people who helped us through this time,” he said. “Every day the FBI came to this area, taking six, seven families every night. No politician came to help us. None of them [were] returning our calls. The shops were closed, the shopkeepers were crying. The hospital called the whole staff and requested them to shop here.”

Choudhri joined the conversation. “The politicians didn’t know us, no one!” he said. He spoke about feeling betrayed by politicians he had worked to cultivate. “In 2000 there was a big fund-raising for Hillary Clinton [in her first campaign for New York senator]. I went with my wife, to the thousand-dollar room, I had a picture with her, with Gore’s wife. Since the election Hillary doesn’t know us.”

Choudhri was on the community board of advisers at Coney Island Hospital, the public hospital that treated many Pakistani patients. “I said to them, ‘There is no Urdu-speaking person in patient relations. Why don’t you hire a Pakistani?’ One day they say, ‘Yes, we have someone.’ I meet her, and I said, ‘You are Pakistani?’ She said, ‘No, I am from Fiji.’ I go to the director and say, ‘You go to Fiji to find someone who speaks Urdu? That I do not like.’”

Another hospital hired a Pakistani department chairman, but then an Indian director came in and wanted to push him out. “We came here, this is our country,” Choudhri said with a sigh. “We should not carry on the old stuff. The thing is, you cannot change everybody.” For an instant I thought Jablon was speaking, but it was the Pakistani, echoing the same frustration and desire, just in a different key.

A
few days after Brier spoke at the mosque, Jablon took me to Dov Hikind’s office, a few blocks away from the hospital. Jablon dropped me off and, as usual, kept his opinions to himself.

“You’ll hear what Dov has to say,” he said with a short laugh before he left. “He’ll have plenty to say.”

As New York State assemblyman, Hikind was a go-to man for the community. He was called on to get park benches fixed; to yell at the MTA for having instructions on subway-card vending machines in English, Creole, Russian, Polish, Italian, Greek, Korean, French, Chinese, Japanese, and Spanish but not Yiddish or Hebrew; to lead blood drives by donating his; to help low-income people get heat.

He worked hard for his community. Yet when I met him in his office, Hikind struck me as a bully who thrived on insinuation and provocation, or maybe I just felt that way because I knew his reputation and I don’t like zealots. He certainly didn’t look fiery, with his trimmed graying beard, glasses, and cardigan sweater.

Hikind seemed to be Jablon’s exact opposite. Jablon was conciliatory, Hikind was inflammatory. Jablon said things like “We’re so stupid we only look at two percent of ourselves. Two percent of our body is skin. The rest is ninety-eight percent, and we don’t look at that. We look at two percent, which is stupid. People look at color, which is stupid. They look at how you dress, who you pray to. God wants me to take care of everybody.” Hikind was a Democrat who endorsed George W. Bush and who had been a follower of Meir Kahane, founder of the Jewish Defense League, a right-wing terror group. (Kahane, an émigré to Israel from Brooklyn, lived and died by fanaticism and hatred. He was assassinated in 1990, by El Sayyid Nosair, later convicted as a conspirator in the 1993 bombing of the World Trade Center.) Hikind’s methods were more mainstream than Kahane’s, but his politics were no less divisive. He had been repositioning himself for years as a more tolerant fellow than he’d been in his youth, when he was arrested several times as a Kahane disciple. But recently Hikind had urged the New York City police department to implement what he called “terrorist profiling.”

Hikind invited me to sit at a table in his office and offered me his view on the cultural aspects of Maimonides. “I think what you should look for is a lot of negative feelings between nurses and patients, especially Orthodox Jews, a lot of resentment, latent anti-Semitism,” he said, staring at me intently. “Many of the nurses at the hospital are minority. Catering to this community can be difficult. I think it would be very, very interesting to watch that. How does it play out in a hospital where, unless you’re giving birth, people are very sick? How someone looks at you. Whether they smile or not. All these things can make a difference. That’s where I think there are a lot of problems. Some of those things are difficult to address.”

His father, he told me, had worked at Maimonides as a
masgiach,
making sure the rules surrounding kosher food were observed, and had died there. Dov Hikind’s children, however, were born in Manhattan, at Mount Sinai, not at Maimonides, the neighborhood hospital that sponsored Hikind’s weekly radio program. Hikind felt he and the Maimonides administration understood one another. “If they have me on board, Maimonides feels they’re in good shape, because I can make the most trouble if I want to,” he said cheerfully. “And they know I will do what I think is best, so if I tell them something, they take it very seriously.”

He wished me good luck even as he shook his head. “To write a book how great Maimonides is,” he said, “it would be a short book.”

O
ne night I ran into Dov Hikind again, unexpectedly. I had stopped by the emergency room one evening to see David Gregorius. He still looked like a kid in his green scrubs and bright orange Crocs, plastic clogs good for running around an ER. Yet he also seemed older, more self-assured than when I first met him just a few months earlier. Now he seemed almost oblivious to the scene around him. Without looking up from the computer monitor, where he was checking to see what patients were his, he said to a fellow resident, “I love working on Shabbos in the winter. The Orthodox leave early.”

He was typing the words “penile edema” onto the computer. A twenty-year-old man had come in to the ER with a swollen penis. “Turned out he had masturbated too much,” Gregorius said with a grin.

Next patient: a Russian woman with pain in her belly. As he examined her, the resident relied on her daughter, whose English was halting, to translate his questions.

Gregorius asked about what she had eaten, what her vomit looked like, had she had a bowel movement.

The daughter translated but then stopped at bowel movement.

“What?” she asked.

“Make cocky,” said Gregorius, using an Eastern European expression he had picked up in the ER.

She blushed. “Everything as usual,” she reported after asking her mother.

Gregorius learned that the mother had had an appendectomy and a gallbladder operation. He asked many more questions as he pressed on her belly, explaining gently what he was doing. During the examination he was jostled by Dr. Marshall, on the other side of the curtain, examining a patient in the next cubicle.

The daughter asked if he could give her mother something for pain.

Gregorius said, “I will gladly give her medicine for the pain.”

A few minutes later, he entered the information into a computer and ordered morphine. “They dish out morphine here like it’s candy,” he said.

Earlier I heard Marshall explaining to a resident, “I’d rather err on the side of alleviating the pain of people suffering, even if we run the risk of some people abusing it.” Marshall had come by and asked him to try to admit an elderly African-American man with cancer and pneumonia into the intensive-care unit. He had a bloody wound on his head from a fall on the floor at his nursing home. “They don’t want him because he has cancer,” Marshall said. The ICU people had a reputation for preferring to admit patients they thought they could save—or VIPs.

I asked him about his philosophy on administering drugs for pain. “The hospital does quarterly reports on how we’ve been doing with pain medication,” he said. “That doesn’t drive my practice. Some physicians here are more antiquated and think narcotics should be withheld.” Before he could continue, someone called him away, too.

Stranded by both physicians, I felt that I was in the way no matter where I stood—until I realized there was no such thing as being in the way. People sidled, pushed, nudged, and otherwise adjusted to the stream of patients, equipment, doctors, nurses, visitors. A drunk insisted he wanted to be seen by the cute woman doctor with the ponytail. An elderly Chinese “environmental worker” gamely kept sweeping and disinfecting, but there were still pockets of stench, smelling vaguely of blood, bottoms, dirty feet, and God knows what else. Intimate exams took place out in the open. A young woman casually pulled off her hospital gown and sat in her underwear as she examined the flimsy piece of cloth, trying to figure out which way it should go. An old Orthodox man on the neighboring gurney watched and offered advice.

I needed an expediter and took refuge with Fabio Palermo, a young man with a shaved head, one of Jablon’s patient representatives. The male patient reps were easy to spot. They stood out like FBI agents: tie, slacks, pressed dress shirt. Palermo was another one who came to Maimonides by default. He had a B.A. in communications and wanted to work in TV production but couldn’t get a job. A friend said they were looking for a patient rep on the midnight shift. That had been five years earlier. “It’s very stressful, but you get a rush from helping people,” he said.

A man with a heavy Israeli accent came up to Palermo and complained. “I have chest pain,” he said. “I’ve been here for an hour, and nobody cares. In a few minutes, I’m taking a taxi to another emergency room.”

Palermo told the man he would see what was up. At a nearby computer terminal, he found the patient’s record. “He’s been here forty-one minutes,” he said. “They already checked him out in triage.”

Looking across the room at the man, who was pacing next to his gurney, he said, “A lot of them know the golden words: ‘chest pain’.”

At 7:00 P.M. Palermo’s job was to ask friends and relatives to go to the waiting room for an hour, to lessen the pandemonium during the shift change. Dodging patients and clinicians, he moved around the room, politely asking visitors to leave. He squeezed by a bed holding a grizzled man with clear, beautiful blue eyes, who stopped the patient rep. “Could you take this tray?” he asked. “Does it take a resolution of Congress? It’s been here for an hour.” Palermo took the tray.

Palermo paused to reply to an urgent call on his beeper. “Dov Hikind’s mother is in the hospital,” he said. He told me he had to leave the emergency room and go up to see her in a few minutes and would take me with him.

While I waited, I stopped to chat with a group of PCTs, patient-care technicians, doing the job that once commonly was called nurse’s aide. The elevated title didn’t make the work any easier. Unpleasant jobs—like bedpan duty—fell to them. The educational requirement was a high-school diploma or equivalency plus completion of a course in a nursing-assistant program or EMS training. Marie C. Pierre, in her forties, originally from Haiti, was taking a break, sitting on the edge of a desk eating sunflower seeds. “They have more sophisticated things here,” she said, comparing medical care between her old and new countries. “Some of the sickness in my country, we do healing with leaves. Here they have the same leaves, but as a pill. I’ve seen people come to the hospital with a hundred or hundred and one fever. In my country we do home remedies.”

A tall, regal woman working on a nearby computer, Ethel Christopher from Trinidad, overheard the conversation. “We call pneumonia a bad cold back home,” she said scornfully. “I think people here overuse the hospital. A woman came in the other day, she has a lot of pain for her period and she comes to the hospital! They have a headache and they come to the hospital.”

Pierre spit shells into her hand. “I have a headache, I just lie down.” Then she looked worried. “But sometimes you have a headache and it’s a bleed in the brain.”

Christopher nodded vigorously. “That’s it,” she said. “People are just scared. If you look at the amount of people they send home before the day is done. They want to make sure some vessel didn’t bust. They do a CT scan, find nothing, go home. Then the headache comes back the next day and they come back. Because it’s free.”

They dispersed. I found Fabio Palermo and followed him past a line of stretchers parked in the hallway, through a maze of more hallways and onto an elevator, which took us onto a patient floor. The evening quiet was jarring, too much like death after the lively turbulence in the ER. Our destination was a bright-eyed, elderly Eastern European woman wearing a little cap around her pink face, lying alone in a bed in a large room meant for two. VIP. Her aide, a friendly woman with a Caribbean accent, lay back comfortablyin a chair, her leg hanging over an armrest. Dov Hikind stood at the foot of his mother’s bed.