Hospital (3 page)

Later, Brier confided that she had always wanted to write a book about life in a hospital but never got beyond sixty or seventy pages of a journal she’d once kept. Payson never divulged exactly why he opened the door. Brooklyn born and bred, son of a father who bought and sold string and a public-service-minded mother who was an air warden during World War II, Payson rose to the vice chairmanship of Time Warner and then was squeezed out of the company after a bitter corporate battle. Upon leaving the corporate world, still in his fifties, he directed his energy to hiking the Himalayas, cross-country biking, and good works. Still, he had spent more than twenty-two years in the entertainment world, and his take on the hospital world reflected his time there. He told me, “When I first got here ten years ago, I realized hospitals have a lot in common with the movie business. You’ve got your talent, entrepreneurs, ambition, ego stroking, the business versus the creative part. The big difference is that in the hospital you don’t get second takes. Movies are make-believe. This is real life.”

Maybe it was his showbiz inclination to want publicity or the adventurer’s spirit in him, but eventually Marty Payson—and Brier—convinced the other hospital administrators to sort out issues of patient privacy and to let me see Maimonides “warts and all” (Payson’s words).

What Payson meant when he spoke of “real life” at Maimonides, I would learn, was action no less vivid than that in movies and TV shows, but more diffuse and often less obvious. There were, as would be expected, poignant, terrible, disturbing, and uplifting medical stories, and there were also bitter internal feuds, warm personal connections, comedy, egotism, greed, love, and loss. There were rabbinic edicts to contend with, as well as imams and herbalists and local politicians. Profound ethical issues gave juice to the proceedings, though most of the drama was humdrum but urgent, revolving around mundane work matters, like systems foul-ups that kept blood-test results from being delivered on time, anal-compulsive bosses, careless record keepers, shortages of everything except forms to fill out, an ever-changing regulatory requirement, recalcitrant and greedy insurance-reimbursement systems, and the surprising difficulty of figuring out how to keep rooms clean and get doctors to wash their hands.

Politicians have long made unkept promises about reforming a health-care system that has devolved into an unfathomably complex maze of overlapping bureaucratic fiefdoms. I began to see the hospital as a place of repairing and damaging, birthing and dying—and red tape and budgets and stress—but also a community struggling with the thorny social forces changing the world around it. As I filled reams of paper with my hand-scrawled daily logs, and boxfuls of taped interviews, I discovered the very human quality that remains the keystone of what can seem like a giant, impersonal enterprise.

Over the course of a year, I would become privy to many conversations and miscommunications, as well as the thoughts, interactions, successes, and failings of a remarkable confluence of compassionate and contentious people. They were ambitious, shortsighted, altruistic, selfish, foolhardy, and wise. They tried to respect themselves and their patients, a task that often appeared far more difficult than diagnosing illness or performing complex medical procedures or speaking one another’s languages. They tried to remember— against the odds posed by a greedy and corrupted health-care system and by institutional and human frailty—that healing was the heart of the matter.

One

Occam Lied

Dudes

Greetings from the Big Apple, or as I shall henceforth refer to it as . . . . New Suck! . . . I actually am winning the War on Cockroach Terror, but it is a non-stop battle, so keep me in your prayers. So things here in The Brooklyn are not what I thought they would be. I only thought it would blow slightly, but alas, it blows severely. Anyone who said that New Suck is the greatest city on the planet obviously never lived in San Diego. or Boulder. or Denver. or the North Pole. Or even Grand Island, Nebraska. Yes, i would rather live in G.I. Nebraska than here. Sure there is lots to do. if you like doing them in a giant hot smelly city at the same time as a gillion other people, and paying up the wazoo to do them. . . .

I’ll give you the goods now: I live in a place in The Brooklyn called Boro Park, which is the highest concentration of Orthodox Jewish people in the world, bordered by Sunset Park and the most diverse zip code in the United States. Our hospital has translators for 67 different languages, if that tells you anything about the population here. And the people here are also very sick. Not like “Dude that run was sick!”, but more like “dude that old man is sick as hell, I’m pretty sure he’s gonna die in 5 minutes!”

So it will be good to train here I guess. If you can get the translator down to the ER fast enough to figure out what the heck is going on, you can actually save lots of lives here. sweet.

And my favorite part about New York is . . . i forgot. was there one? I’m delirious now. I am working all night shifts with one day shift this week, so my schedule is all jacked up. . . .

In summary, New Suck is fairly sucky, hence the name. . . .

ok i gotta study or sleep or something now.

Love, davey

“Fishing kills me exactly as it keeps me alive.” The Old Man and the Sea

Alright, so I got a day off and the most logical thing to do here in New Suck would
be . . . go surfing, duh.
First problem—I live nowhere near the beach
Second problem—I do not have a car

But once I got to the subway stop, all i had to do was

Love, Davey

“Fishing kills me exactly as it keeps me alive.” The Old Man and the Sea

Kids,

After working the night shift (7pm till 7:30am) I went home and slept for about 3 hours then got up to go to the beach again. . . . I know, this seems crazy, but apparently there was a hurricane named Irene not long ago, and her aftermath was sending larger-than-usual swells to parts along the East Coast. So, armed with my new friend Chris from San Diego (and his Jeep . . . . YES! no more surf-board on the subway) we headed off to the same beach where a child was sucked out to sea and drowned the day before . . . . and also near the same beach that one of my kid patients had been swimming at with his infectious diarrhea from South America the day before . . . wonderful. Ah, New York. Anyhow, I won’t bore you with the details, other than Irene was AWESOME. Much better than the previous week’s adventure. It was not like surfing a hurricane like in the movies, but it was big enough to scare me on occasion, and big enough to have some very excitingly gnarley and fast rides! . . .

What else. hmm. I have been doing great in the Peds ER, so that is good. I even got the Saved-the-Day Hero award (mythical) two nights IN A ROW, One for eyeballing a kid in the waiting room and deciding she looked a little sick to be waiting for another hour, so checked her out in the wait room and decided she was bleeding in her head, so got the CT scan and the Neurosurgeon involved quickly enough to save the little girl’s brain . . . so that was cool. And the other one was just being in the right place at the right time, noticing a drunk psychiatric patient on a gurney in a hallway who was sawing through his leather restraints with a knife. I learned that I get yelled at if i try to wrestle a knife away from a crazy drunk guy. i guess “that is what security is for” i am told. the same security that let the guy INTO the ER with a knife. outstanding. New York. so that was kind of exciting. a bunch of people that night were like “you saved the day man, i totally respect you now”. what the hell does that mean? did i garner no respect previously? I guess i am skinny with long hair and look like i’m 21, so nobody is quite sure that i am a doctor or something.

ok. i gotta go to bed.

Love, davey

p.s. Danielle, I don’t hate New York completely, for the record. It just sucks completely. for the record. But I think this opinion has a lot to do with the suckiness of my occupation, and my long long hours. davey tired.

“Fishing kills me exactly as it keeps me alive.” The Old Man and the Sea

D
avid (aka Davey) Gregorius, first-year resident in emergency medicine, had bumbled into an agreement to spend three years of his life at Maimonides Medical Center because of his infatuation with a beautiful, long-legged blonde, who also happened to be brilliant, kind, and humble. He met Jennifer Pfeifer when he was a medical student at the Midwestern University-Arizona College of Osteopathic Medicine, near Phoenix, on his way to a rotation at a hospital in Sacramento. Pfeifer was at UCLA working on a Ph.D. in developmental psychology; one of her classmates, a boyhood friend of Gregorius’s, introduced them. They fell in love. Gregorius was back at school in Arizona when Pfeifer told him she had been thinking about doing postdoctoral work at Columbia or New York University. So after Gregorius had already sent out twenty-five applications to hospital residency programs, she said to him, “Why don’t you send a couple to New York?”

Later he remembered picking Mount Sinai because one of his teachers in medical school had gone there. As he recalled, “The other one was obviously Maimonides, but I really don’t remember picking it,” he said. “I thought I put Methodist. I thought I put some kind of M. But the whole application process is clicking on computers, you know? Click, click. When I got the e-mail back inviting me for an interview to Maimonides Medical Center in Brooklyn, whatever, I went WHAT? But I still went. I thought, I’ve never been to New York, I’ll check it out.”

He traveled on the overnight flight from Phoenix, landing bleary-eyed in New York on a cold Sunday morning in December. He spent the day in Manhattan, staying with a friend on the Upper West Side. She showed him Times Square, Central Park, the usual tourist stuff. On Monday morning he took the subway to Borough Park, crossing the East River, away from the Manhattan skyline toward Brooklyn, once described by another transplanted midwesterner, Ian Frazier, as having “the undefined, hard-to-remember shape of a stain”—in other words, a place you wanted to be from, not head toward. In recent years, however, the real-estate craze in Manhattan had given the borough new definition, no longer stain but hot spot for the disenfranchised young people who couldn’t afford the East Village or Lower East Side and for cramped, growing families looking for bigger spaces, more sky, yards.

Gregorius, born in Missouri but raised in Nebraska—fifth generation at least—had a vague TV- and movie-inspired notion of Brooklyn “as a knife and guns place.” When he disembarked from the D train, he was relieved to find himself in a safe-looking (only slightly shabby) neighborhood, with rows of two- and three-story houses and little stores—newsstands, flower shops, delis, bakeries, and shoe-repair places—some of them displaying signs with Hebrew lettering.

On the short walk from the elevated subway tracks to the hospital, he passed worried-looking bearded men dressed in long black coats and large black hats and young women wearing matronly clothes and herding large groups of children. There were black people whose words floated by with a Caribbean lilt and Pakistanis with bright scarves sticking out from under winter coats. He didn’t pay much attention; he was mentally preparing for his interview with John Marshall, the residency program director.

They hit it off. Marshall was balding but youthful, a calm man with dark, penetrating eyes, who seemed intellectual yet also knew how to have fun. He was thirty-seven, from Detroit, had been in the air force, and was a passionate downhill skier. What a coincidence! Gregorius had fantasized about becoming a fighter pilot but quit the Naval Academy at Annapolis when he was told his less-than-perfect eyesight nixed that ambition. He transferred to the University of Colorado at Boulder and reverted to his back-burner dream, being a doctor (like his dad). And yes, he would figure out how to combine work with pleasure. Maybe a job in an emergency room in the Colorado mountains, maybe two or three shifts a week. Make that an emergency room in Vail, add ski patrol a couple of days, leaving time for fishing twice a week.

The hospital in Borough Park did not fit Davey’s blithe vision of work hard, play hard. His memories of his first foray into the Maimonides emergency room were vague: It was crowded. Really crowded. Stretchers with patients were lined up two and three deep, with the lucky ones semisecluded behind curtains that barely closed. He noticed but didn’t fully comprehend that the melting-pot mayhem—Hasids, Chinese, Pakistanis, Haitians, Russians, Bulgarians—did not seem to include anybody like him, a tall, skinny, curly-haired, dark-eyed, non-Jewish, non-Muslim, non-Asian, non-African, non-Italian white surfer-ski boy from the Midwest. The visual overload was matched by the audio: Tower of Babel at top volume, accompanied by the constant beeping of monitors, pagers, telephones. The usual ER smells of antiseptic and bodily stink, but also strange spicy odors he couldn’t place.