Hospital (52 page)

On National Cancer Survivors Day, Jay Cooper and Nella Khenkin found common ground in a conference room decorated with a large rainbow. Khenkin chose the entertainment, which included a Russian woman playing the keyboard, Chinese fan dancers, and a junior-high student with a thick Brooklyn accent who belted out a Mariah Carey song. The fan dancers were late, so the program was rearranged; next came the long lecture on nutrition and the role of herbs in a healthy diet, to please Cooper. Still waiting for the fan dancers, the patients and former patients joined in a spontaneous sing-along, gaining momentum with “You Are My Sunshine.”

Cooper acknowledged the rainbow. “For those of you who like symbols, this year’s symbol is a rainbow of hope,” he said. “To some degree you can pick how you want to interpret that rainbow. One interpretation is that the rainbow has many colors. There are many kinds of tumors, many kinds of treatment, many ways we make progress day by day. . . .”

Alan Astrow thanked the patients and their families and friends for coming to the celebration and singled out Khenkin for making it happen. Then he introduced Bill Camilleri, who a few days earlier had been told by McDougle that the hospital wanted someone else to take the cancer center to the next stage. “He built this place from the ground up,” said Astrow. “It is a beautiful facility, and a lot of that is really thanks to you.”

Camilleri was gracious. “I’m happy to see everybody here,” he said before reading a canned message from President Bush and introducing Steven Cymbrowitz.

Out in the hallway, a slight elderly man who said he was Marty Payson’s cousin complained. “My wife, she has colon cancer, now the lungs, and I’ll tell you, she knows more than the oncologist knows,” he said. Nodding toward the sounds coming from the celebration, he grumbled, “My approach would be different. No speeches! No songs! You’ve got to make them laugh, laugh is the thing.”

Over at the hospital, a banner had gone up:

I sat on a bench outside Gellman on a warm, windy afternoon with David Gregorius, about to celebrate his one-year anniversary. I hadn’t recognized him when he first walked up; he’d grown a mustache and beard.

“Are you going Hasidic?” I asked.

He laughed and shook his head. “No, I’m not! I’m not!”

“No
payot
?” I teased, twisting my finger next to my ear, referring to the side curls common among the Hasids in Borough Park.

“Is that what they’re called?” Gregorius replied. “My attendings are doing that, too. ‘Hey, dude, what’s up with the beard?’”

He explained he was preparing for his tenth high-school reunion in Nebraska. “Some of my friends are having a mustache-growing contest.”

“How are you?” I asked.

“I’m enjoying the warm weather,” he said. “Oh. You mean, how do I feel about New York? Maimonides?”

“Yeah.”

“New York is growing on me a little bit, but still not somewhere I want to be forever,” he said.

That’s when he told me about Loma Linda.

“Actually, I attempted to transfer to a program in Los Angeles, where my girlfriend is, but I didn’t get in. The whole process made me appreciate here, because I had to tell all my program directors and everybody, and they were so upset. They understood completely. They had met Jenn. They said, ‘We don’t want to lose you, and we hope it all works out for you, but we also hope it doesn’t.’ I had to ask five or six attendings for letters, and they were reluctantly happy to help. I never felt so appreciated.”

I said, “Like going to your own funeral.”

“Exactly!” said Gregorius. “Like the living funeral. So that California thing didn’t work out. Which is fine. I took a shot. If it was meant to be, it was meant to be.”

As we sat there, some young African-American women in scrubs stood on the curb smoking cigarettes and talking. A group of black hats, Orthodox men in long black coats with beards and
payot,
walked by. Gregorius grinned and tugged at his beard.

Across the street a group of about thirty significantly pregnant Chinese women waddled through the doors of Eisenstadt, following a woman holding a clipboard talking to them in Chinese. Every month the hospital had a special Chinese-language orientation for pregnant women. They met for a couple of hours in the boardroom and then were taken across the street to visit the Stella & Joseph Payson Birthing Center, named for Marty Payson’s parents.

Gregorius looked at them. “I did a month in labor and delivery,” he said. “It was funny, ’cause a young girl, normal—I shouldn’t say ‘normal’—a young girl would come in and say, ‘I’m having a baby, I’m having a baby.’ You say, ‘Yeah, yeah, sit down. I’ll take a look.’ Then you examine them. They’re having a baby? They’re not having a baby. They’ll have a baby in about twelve hours. But when an Orthodox Jewish woman comes in and says, ‘I’m having a baby,’ the red flag goes up. You say, ‘What number is this?’ They say, ‘Eleven.’ You say, ‘Let’s go!’ I’m not kidding. We have so many on more than number ten. Most women are freaking out because they think they’re having a baby, but they have plenty of time. When the Orthodox women say they’re having a baby, the baby is right there ready to drop out.”

John Marshall, Gregorius’s program director, had told me that the young doctor from Nebraska had been chosen as Intern of the Year. “He’s a good clinician, very much a team player, hard worker, people really like him, people hated the thought of him going.” He told me that Gregorius was a leader—“despite his humor and sort of lackadaisical personality”—pretty much a shoo-in for the position of chief resident the following year.

I asked Gregorius, “If you look back on this year—this is a huge question, but how do you think you’ve changed, if you have?”

Gregorius gave me what I deserved. “Have I changed?” he said slyly. “I have more facial hair.”

I persisted. “What do you think the imprint of this experience will be?”

He turned serious. “It’s definitely made me a stronger and better doctor, but that’s gong to happen anywhere,” he said. “Kind of like you, I’ve learned a lot of stuff about different cultures, that’s for sure. I can say a lot of things in Russian and stuff like that now. I don’t think it’s changed my view of other cultures, but sometimes I am very flabbergasted at the way immigrants who were kids when they moved here now have kids who were born in Brooklyn, and they can be ten or eleven years old and they don’t speak English. Usually the child speaks English and the parent doesn’t, and sometimes it’s even the other way around, where the parent spoke English and the child didn’t. I tell that parent every time, ‘This kid should learn English. This is America, and eventually they’re going to want to leave Brooklyn, I hope. There’s so much beautiful stuff to see. Check out Montana. It’s great!’”

I asked him if he regretted the mistake he made, pushing the
M
for Maimonides?

“I’m more into living by the mountains, by streams,” he began.

By then, weirdly, the wind had kicked up; on my tape recorder, Gregorius sounded like he could be standing on top of a mountain.

“But I don’t think of this as a hell nightmare or anything,” he said in his laid-back voice. “I’ve been really lucky my whole life. Things seem to fall into place. I’ve gotten my second choice in about everything. After high school I wanted to go to the Air Force Academy and didn’t get in but got accepted to the Naval Academy, and that was one of the best experiences of my life.”

He continued. “I saw
Top Gun
and wanted to be a fighter pilot and then found out I couldn’t because my vision wasn’t twenty-twenty. I wanted to transfer to Notre Dame, and I had like a three point four average, but that wasn’t high enough. So I went to Colorado at Boulder, which was one of the best things that ever happened to me. Then for medical school I wanted to go to Colorado or Nebraska and didn’t get in, so I went to Arizona, and that was one of the best things that ever happened to me.”

And Maimonides?

He stretched out his legs and crossed his arms, thinking.

“New York is a big city that is not my final destination and a really busy hospital that I appreciate working in, though it’s really grueling,” he said. “I’m learning from really brilliant guys, like Dr. Marshall. I think, ‘Man, that guy could go anywhere he wants, and he stays in Brooklyn! In the long run, I think it’s going to be good for me.”

A few months later, I received this:

One day I asked Marty Payson what lessons he thought Maimonides could teach people in the hospital business, or was it just doomed to a state of perpetual crisis? Health-care reform was a major platform of Bill Clinton’s 1992 presidential campaign. Fifteen years later health-care reform would be a major platform of every presidential candidate, including Hillary Clinton, the former first lady.

The Maimonides chairman had just gone onto the board of the Nassau Health Corporation, responsible for the public health-care system in Nassau County, Long Island. He had been chairman of Tulane University’s health-sciences committee, with oversight of the university medical center, and he was chair of Howard University’s medical-affairs committee.

Payson’s small office in a law firm on Manhattan’s East Side was decorated with breathtaking photographs of vistas he had climbed to on his mountaineering and long-distance-biking expeditions. He was a roly-poly dare-devil, who insisted that he was careful. He had done plenty of time at black-tie dinners, but he liked to order in lunch from the deli downstairs, using the paper bag as a place mat.

Payson had just turned seventy years old. He had been on numerous boards and a top executive at a huge entertainment company. “The company I helped build, today it’s just another big company with all its problems,” he said. “The fun has gone out of it. With the hospital, you hope you leave something. You never know, but that’s the goal.”

What about the big-picture, national health-care policy?

“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:

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.