Hospital (8 page)

When Brier first confronted her dowdy new workplace, she recalled an earlier first, her first day as a hospital administrator, at Jacobi Medical Center, a public hospital in the Bronx. She had had knots in her stomach when she walked through the door and realized she knew nothing about running a hospital. She knew about health-care policy, finance, and government oversight from the decade she’d spent at HHC. But she’d never been a field commander, never directly in the line of fire.

She decided to treat her willingness to admit ignorance as strength. “The first thing I did when I got to Jacobi was walk around and shake hands with every person who was there, and the second thing was take almost every single doctor out to lunch or dinner with a paper and pencil and take notes,” she said. “When I got to Jacobi, I felt like I was playing dress-up, very scary, very sobering. I made them put a sign up that showed the way to the director’soffice. The secretary didn’t want to. She said, ‘They’ll come and bother us.’ I said, ‘That’s all right.’”

Some found her methods disarming; others were dismissive. Steve Davidson, the ER chairman at Maimonides, had been hired shortly before Brier was. In advance of meeting his new boss, he called a physician friend who had worked with her at Jacobi for an assessment. “He said send her pretty flowers every month and send her a nice silk scarf twice a year,” said Davidson. “Neither of which I’ve done since I got here.”

Allan Strongwater, former chief of orthopedics for a decade, left Maimonides for the NYU Hospital for Joint Diseases in Manhattan a few months after the cancer center opened, after many disagreements with Brier over how his department should be run and over fees. “She would like her hospital to be the model for public health,” he said. “Look at her history. That’s where she grew up.” The dispute, he said, was personal. “Most of the people in hospital administration, including Pam, want to deliver good-quality care and be in the black. The difference is, Stanley [Brezenoff ] once told me he didn’t want to be in the front of the crowd or in the back of the crowd—he wanted to be in the middle. He didn’t want to be visible. Whereas Pam, it’s all about Pam.”

After Jacobi, Brier was put in charge of Bellevue—unwieldy, impossible Bellevue—the city’s own Bedlam, best known for its infamous psychiatric ward. “They’d had ten directors in ten years, and I can assure you they were not glad to see me,” Brier said. “Just the scale of it and the pitch of it make you feel like an ant.” Jacobi felt bucolic next to Bellevue. “There were these huge plants in the back of the lobby, and they were dead, listing to one side. I thought, Oh, my God, what have I done. What are people going to think? You can’t keep the plants alive, what are they going to do to the patients?” She bought new plants, listened to complaints, and ten months into her tenure was featured in an approving article in the
New York Times
that declared, “She has proved to be a rarity in New York City’s municipal hospital system: an administrator who earns praise from such historical antagonists as the unions, medical schools and the city administration.”

She stayed three years—record-making for a Bellevue administrator— but was ready to leave when Brezenoff asked her to come with him to Maimonides Medical Center as his number two.

“My friends said, ‘You’re going where to do what?’” she recalled. “‘ You’re going to be the number-two person where?’” Tired of city politics and assured that she would be Brezenoff’s likely successor, she went. The doubling of her salary eased the transition. Within a decade at Maimonides, her annual income had reached $850,000, including bonuses, a heady amount for a former public servant, whose conscience was salved by telling herself it wasn’t
that
much compared to the $2.5 million Memorial Sloan-Kettering paid its chief executive or the $1.5 million that Montefiore in the Bronx paid her counterpart there.

What she found in Brooklyn was not the exhilarating chaos of Bellevue, the rush reminiscent of the sixties, the feeling she was helping society’s outcasts, doing God-or-whoever’s work. Instead she walked into a grim, unfriendly atmosphere where things were done the way they had always been done, where insularity ruled, and where a whole new set of politics had to be mastered, including that of a strong Hasidic community with its own idea of what God’s work meant. The head nurse had an M.B.A. and dressed the part. She didn’t know what to make of Brier, who wore designer clothes but sometimes used a shopping bag as a briefcase and liked to drop into the emergency room for surprise visits at midnight. The hospital board’s members were fighting among themselves, and there was hostility between the core Orthodox Jewish constituency and the nurses, many of whom were Caribbean and African-American. Shortly after Brezenoff and Brier arrived, the nurses went on strike.

“It made Bellevue seem friendly, which, believe me, Bellevue wasn’t,” she said. “In your brighter moments, you could say there are so many things to work on, and in your dark moments . . . oh, dear.” Brier fired the head nurse and another senior nurse because she felt they weren’t doing their jobs. Brezenoff protested, not on the merits but because he believed that loyalty counted for something, and then let Brier have her way.

“I think appearance is very tricky with my mother,” Jenny Brier once said. “Some people look at her and think she’s a twig. But she’s a big trunk in a twig’s body.”

At the cancer center opening, many politicians offered speeches and boiler-plate congratulations. The affair took a distinctly human turn when Steven H. Cymbrowitz, a New York State assemblyman, approached the microphone.

A boxy man with thin hair that was greased and combed back, he was well cast as a local pol. His voice sounded uncertain, but his message was strong as he brought home why it was important to have a multidisciplinary, one-stop-shopping approach to patient management. He spoke of his wife, Lena, a Democratic state assemblywoman, who had been diagnosed with stage-four colon cancer a few years before by a doctor at Maimonides but then was treated at New York University Hospital. He described the arduous experience of Brooklyn cancer patients who are treated in Manhattan and who keep their records in their cars as they move from office to office, doctor to doctor. Cymbrowitz told of the night when there wasn’t room at NYU for a CAT scan and of his agony as he watched his wife being wheeled across Thirty-fourth Street in a gurney, while he stopped traffic. After she died, at the age of forty-three, Cymbrowitz was elected to her seat in the assembly and helped obtain the city’s $5 million contribution to the cancer center. “To make sure there was something to come out of Lena’s passing,” as he put it.

He had another personal tie to the hospital, which he didn’t discuss. Two months earlier he had gone to the front door to pick up the newspaper and found he couldn’t reach the knob. When the ambulance brought him to Maimonides, he was paralyzed and couldn’t speak. The hospital’s neurologists dissolved the clot in his brain in time, leaving only a slight weakness in his left hand as a souvenir of the frightening episode.

As he stood before the crowd at the cancer center’s opening, Cymbrowitz was struck simultaneously by three emotions—the sadness he always felt when he spoke of his wife’s death, his loyalty to the doctors who had saved his life, and anger at Pam Brier. She had called him earlier and had the nerve to tell him not to mention Lena. “We’ll have a naming ceremony,” she told him. “This isn’t the place.”

It made Cymbrowitz furious just to think about it. After all the work he had done to put together the government money, Brier was trying to change the rules as he perceived them. He didn’t think he was unreasonable. Taking Lena’s name off the building—that he could understand; the hospital wanted it to be the Maimonides Cancer Center. He agreed to settle on a bust of Lena in the lobby, which would be called the Lena Cymbrowitz Pavilion. Now he was worried that even that might go. He had heard that Brier had been trying to raise private money for the cancer center; the hospital had no endowment like the big academic hospitals. Was the honor just going to go to the highest bidder? “With Stanley this wouldn’t have happened,” he remembered thinking. “Stanley didn’t let anything fall through the cracks.”

Whatever else people may have thought about Pam Brier, she possessed remarkable physical courage that commanded special respect in a hospital. Her most recent surgery—a knee replacement—had taken place a month before the opening. The trunk in the twig’s body seemed to be made of iron.

But the last twenty months had caused her to doubt her abilities. An essential insecurity underlay the bravado, the royal gestures, the wackiness. Could she carry on what she and Brezenoff had started? So much to do, to fix, to build, to prove.

The cancer center’s opening felt like a turning point. For the first time since the accident, she thought maybe she could keep pace with her ambitions. “Following Stanley was one of the worst things I ever did,” she said once. “Truly revolting. He’s the most brilliant public servant I’ve ever watched.”

Then she gave a sharp crazy laugh, as if she realized the absurdity of . . . maybe everything. “That was my biggest worry,” she said, and then laughed again. “Hah! Could I live up to Stanley!”

Three

Insults and Injuries

Douglas Jablon, vice president, patient relations—the Mitzvah Man—said that gossip was the hospital’s most vicious enemy. “That’s why God gave you teeth,” he said, “the cage to hold in the serpent tongue.”

Political intrigue and turf wars were not unique to Maimonides; struggles for space, equipment, staff, and money are part of hospital life. “It’s big business,” said Allan Strongwater, former chair of orthopedics. “Big business with HMOs, big business with insurance companies, big business with the government—big big business. So even though you and I are colleagues as physicians, you are cutting into my market share. Naturally I think I’m doing a better job and should be paid more. If I send a patient to a doctor for a second opinion and he says, ‘It’s not that difficult, anyone could do that,’ you as a patient don’t know. There is this underlying competition for patients and that’s why you get these battles.”

Steven Konstadt, the chair of anesthesiology, who had been recruited from Mount Sinai a year earlier, paraphrased Oscar Wilde: “The joke at Sinai was, you can always tell your friends because they stab you in the front.”

At Maimonides, however, feuds had become part of the personality, the hospital’s yin and yang, nurtured in a familial atmosphere that promoted the idea of unconditional love and tolerance and acceptance, then erupted in fury when conditions, standards, and limits were imposed. Birthdays were celebrated and hurts were sustained with equal tenderness. When a surgeon was diagnosed with leukemia and left abruptly for home without telling anyone, everyone knew anyway by the end of the day. Within twenty-four hours, the physician’s assistants in his department had offered to give him their sick time for the year. But when they called Lili Fraidkin to make the offer, she told them the offer was unnecessary; the senior staff had already donated enough sick-leave time to cover a year’s pay, enough time for the doctor to finish his treatment.

Just as kindness was dispensed without hesitation, so were complaints and disappointments aired—with the expectation that someone would listen. Injuries weren’t required to instigate insult.

“We are like a family,” said Carol Kidney, nursing director of obstetrics, in her robust Irish brogue. “Johnny broke the window and everyone knows it and ten years later they remember that Johnny broke
two
windows. Everything that happens here becomes the talk of the community. We’re integral to the community. It’s like a small town in Ireland. It’s like living in a frontier town a hundred years ago.”

Mark McDougle, who came to the hospital to be Brier’s number two, the chief operating officer, less than two years earlier, had been taken aback by this aspect of the Maimonides gestalt. “My issue with all this, I don’t know if it’s right or not, too much is taken as personal,” he told me. “I guess being a midwesterner, it’s easy for me to say that. Too much is taken as personal.”

“It’s like the Cymbrowitz thing,” he said. “I can give you his side and I can give you Pam’s side. Steve—his wife died of cancer. That’s a personal thing. I think he had a notion of what we were going to name and how we were going to do it, a thought that was different from Pam’s. So you had this misunderstanding. There was a misunderstanding, he should let it go.”

Feuds were literally built into the foundation: The hospital’s two main buildings—the Abraham Gellman Wing and the Benjamin and Betty Eisenstadt Memorial Pavilion, connected by an overpass over Tenth Avenue—were reminders of a bitter family quarrel. The benefactor, Benjamin Eisenstadt, made a fortune through his invention of sugar packets and of the artificial sweetener Sweet’N Low; Gellman was named for Betty Eisenstadt’s beloved brother Abraham, a trauma surgeon who enlisted in the army during World War II and died in combat at the age of twenty-eight. His picture, showing a full-faced young man in uniform, smiling with his mouth closed, was displayed along with his Purple Heart in a display case in the lobby, with an inscription that began: “He gave his life so others might live.” The memorial represented Benjamin Eisenstadt’s legacy of philanthropy and family feeling—but not all his feelings about family. The business that made the hospital pavilions possible was also the subject of a blood feud that lasted forty years; Eisenstadt disinherited one of his daughters. (His grandson Rich Cohen recounted the tale in sad, often hilarious detail in
Sweet and Low,
published in the spring of 2006.)

Even Maimonides himself (Rabbi Moses ben Maimon, aka Rambam), the revered philosopher and physician for whom the hospital was named, had been attacked as an instigator and fomenter, for having the nerve to inject Aristotelian reason and logic into religious discussion. Abraham Heschel, in his classic biography, describes the hostile reaction provoked by the Rambam’s teachings: “Just as quickly as reports of Maimonides’ renown spread through the world, seeds of suspicion and misunderstanding also sprouted,” wrote Heschel. “His opponents used their imaginations to spawn all kinds of reasons for rejecting and condemning” Maimonides’ interpretation of Jewish law.