Hospital (19 page)

Carl Ramsay found himself groaning a lot. The medical director of the ER—the beanpole, Dr. Ponytail—was part of the bed-tracking team. He saw the goodwill exerted by the patient-relations department as a giant stopper, backing up bed flow.

“Only sixty percent of those beds are controlled by medicine,” he said. “The rest are controlled by all these fiefdoms: anything from patient relations to a cardiothoracic surgery nurse. I try to be polite. But when someone comes down and says, ‘We have this person who just came in and needs this kind of bed,’ and it’s the middle of chaos, I let them know we’ve had five patients waiting for twelve hours each, some twenty-four hours, waiting for that exact type of bed. It’s totally unfair. Then they say, ‘What’s wrong? Why are you getting so angry?’”

Still, Ramsay saw how useful the patient reps could be. They helped calm angry families, arranged for interpreters, discussed DNR and health-proxy orders. He asked Jablon to give them more hands-on responsibilities—to wheel patients to rooms if transportation was jammed up, to help track down lab reports and X-rays, to take away empty trays and deliver urinals.

John Marshall, the residency program director, went even further. “This is the first emergency department I’ve worked in that has actually had patient representatives in the emergency room like that,” he said. “They’re absolutely essential in terms of helping us—from the translation, dealing with families, everything else. If I ever went someplace else that didn’t have patient representatives, I would push strongly to start a patient-representative program.”

He continued, “Do they sometimes ask me to see patients who are more . . . let me say, who have more access to the administration than other patients? Sure, they do that. But they’ll do it not just for those patients. It’s not just that community, it’s other communities as well. If they feel somebody is falling through the cracks, somebody has a lot of pain, they help, regardless of whose godson or nephew they are.”

Jason Tache, a third-year oncology fellow, was not so enthusiastic about Jablon’s apparently bottomless goodwill. “With Orthodox families you’re dealing with seven, eight, nine children, which means when you have a patient, you have somebody who knows the vice president for patient relations,” he said. “So many of them become VIPs automatically. The Pakistanis are VIP. The whole hospital is a VIP. Everybody is a VIP. And when everybody is a VIP, nobody is a VIP.”

Driving with Brier and me, through residential neighborhoods en route to the Makki Mosque, Jablon pointed out the mosque that had been headquarters for “the blind sheik,” referring to the Egyptian Muslim cleric Omar Abdel-Rahman. The blind sheik was serving a life sentence in federal prison for his role in the 1993 bombing of the World Trade Center. After that the FBI spent a lot of time in the neighborhood.

The atmosphere in the car became sober as Jablon, Brier, and I returned to a constant point of reference for New Yorkers in those years, the September 11, 2001, attacks. Not just the twin towers of the World Trade Center had been destroyed. The surprise invasion had shaken the sense of American invincibility that was the underpinning of its arrogance as well as its tolerance. Suddenly the large and growing Muslim population was no longer the latest colorful addition to New York’s protean populace, but rather a potential menace. Whites, Asians, and black people eyed every Pakistani taxi driver with suspicion. Was he just trying to make a living, or was he a holy warrior eager to die for his faith? “Where are you from?” became code for “Do you want to kill me?”

We talked about what it had been like in the days, weeks, and months after. The city had felt under siege. Fear crowded out political correctness, unleashing incivility, suspicion, and violence. Reports were coming in of Muslim kids being stoned, fights breaking out. Someone threw pork chops in the backyard at the Al-Noor School; a Muslim teacher was chased up to the school’s front doors; an African-American girl wearing a head scarf was pushed on the subway stairs.

Immediately after the attacks, hospitals all over the city were on alert for a massive influx of wounded people, which never materialized. Those who didn’t escape the towers jumped to their deaths or were vaporized. Brier spoke of what it was like at Maimonides. The staff set up hotlines and help desks, following standard instructions for emergency preparedness, but it soon became clear that the wounded who needed tending were coming not from outside the hospital walls but from within. It seemed no one had been left personally untouched. Brooklyn provided a significant proportion of the Manhattan workforce, the secretaries, police officers, firefighters as well as the young executives, proud progeny of lab techs and nurses, and many of them worked at the World Trade Center, just across the river, an easy commute. The non-Muslim hospital workers, the vast majority, erupted in sorrow and bitterness, arousing feelings of persecution and anger among the Muslim employees. Brier saw that the institution was facing not the expected medical emergency but an emotional crisis that touched its core. How were halal and kosher, samosas and Irish stew, won ton soup and churros and goat curry going to mix now?

Brezenoff was in Italy on vacation, and he did what he could from a distance. As soon as the international telephone lines were up again, he called Nidal Abuasi at the Al-Noor School, just to make sure Abuasi and his wife were all right, a gesture that Abuasi later recalled with warmth and gratitude. (“That showed perception,” Abuasi told me. “That shows care and sensitivity that we cherish.”) It was up to Brier, however, to deal with the crisis, and she was scared. Walking around the hospital Tuesday night, September 11, she saw that the emergency-preparedness operation was missing something vital. She told her husband, who was there with her, “We’re not really helping recharge people’s souls.” Brier decided to organize a series of prayer and reflection services in Schreiber Auditorium, the hospital’s main gathering place, several times a day for the first week, then twice a day the second. With trepidation, she approached Avrohom Friedlander, the hospital’s chief chaplain, a small, watchful Orthodox man outfitted with beard and broad-brimmed hat. “There can be no religious proselytizing or undue focus on Orthodox Judaism. You have to be restrained about this,” she told him. She was relieved when Friedlander said he understood and agreed to lead some of the discussions, while priests took charge of others, and then Imam Hafiz Mohammad Sabir agreed to come.

The sessions were intense. Some people complained about supervisors who were not sensitive to the turmoil they felt, Muslim employees talked about being Muslim in a non-Muslim world, families of firefighters and policeman spoke of their concern for their loved ones. “We let everyone know that whatever goes on in the outside world, when you’re in this hospital or one of our clinics, you are safe,” Brier recalled, looking out the window at the heavy Friday-morning traffic. “I know this sounds touchy-feely, but I think it resonated with the staff—the Muslim staff, who are a minority, and the non-Muslim staff, who were really very distressed and angry about what was going on.”

We all sat silent for a while until Brier dispelled the mournful feeling evoked by these memories and briskly asked Jablon if Brezenoff had spoken at the mosque. No, he said, Marty Payson had, but not Brezenoff.

Brier nodded without comment. She always spoke of Brezenoff neutrally or with praise; her former boss remained the measuring mark.

As the car turned onto Coney Island Avenue and reached the stretch known as Little Pakistan, kosher shops were replaced by halal. After passing several blocks of small storefronts, we came upon a police car sitting at the head of a long row of town cars parked in front of what appeared to be more storefronts, until the sign out front came into focus: There is no God but Allah, Mohammed is messenger of Allah, Help from Allah in approaching triumph in the name of Allah most gracious most merciful. This humble edifice was the Makki Mosque, where three to four thousand people regularly worshipped, as many as twenty-two thousand on a major holidays.

Only one of the town cars out front had been hired for a passenger, the representative from the United Nations delegation who was visiting that day. The rest of the cars were parked while their drivers prayed inside.

A smiling man with black hair and a lazy eye greeted us. Jablon whispered that this was Oscar, an important person (his real name is Asghar Choudhri, designated the “unofficial mayor of Little Pakistan” by the
New York Times
). As Brier stood on the sidewalk straightening her skirt, Choudhri said, “Of course you will be talking about the earthquake.” Brier nodded, even though it hadn’t until that moment occurred to her to mention the earthquake that two weeks earlier had devastated Pakistan; early United Nations estimates had put the dead at 73,000 and those left without homes at 2.3 million. Her intention had been simply to inform the Pakistanis about the free colon-cancer screenings and to speak generally to them about improving their health.

“They are waiting,” Choudhri said as he opened the door, and she walked inside to find a surprisingly large hall; apparently the interior walls separating the small buildings had been removed. The imam, an elegant man wearing the traditional Pakistani
salwar kameez,
a long shirt over loose cotton trousers, stood at the front. Brier couldn’t see the floor between him and her; it was carpeted with Pakistani men, kneeling or sitting, some dressed Western style, others in traditional clothing.

Brier slipped out of her delicate black velvet loafers and left them on a pile of men’s shoes, then wrapped her scarf high on her shoulders until it swaddled her head. Only a bit of blond hair was visible as she followed Choudhri through a narrow path that opened in the sea of men, who moved to let her pass even as their eyes remained cast downward. Jablon and I followed behind. What were these silent men thinking as this elegant twig passed by with her head covered, followed by a giant Jew in a yarmulke and me, carrying my tape recorder, tiptoeing in stocking feet through throw rugs covered by Pakistanis?

The imam made the introduction in Urdu, which Choudhri translated for us. Referring to Brier as “The Pam,” the imam said, “She is really concerned about the earthquake, and she wanted to come down and tell you that you are not alone.”

Brier looked small in front of the microphone and began to speak in a quavering voice. Her words were strong, though, clear and focused in a way they often were not in meetings with her staff. Her impromptu speech began with a note of thanks, and then she said, “It has been a very sad and tragic time for the people of Pakistan and all of you. We at the hospital provide medical care to people, which we think is important. But we are not so blinded to the realities of the world that we think medicine alone helps make people healthy. Housing. Shelter. Enough food to eat. Freedom from the basic kinds of diseases that poverty and tragedy bring.”

She spoke of how groups of hospital employees had been collecting blankets and supplies to send to Pakistan, then went on to say, “We became closer friends with the imam and with many people connected to him after 9/11/2001. It was a horrible time. We knew how much suffering there was going on and how much hatred there is that is surprisingly redounding in New York City in a way that we’re ashamed of ourselves, really. And we decided, the staff at Maimonides—all of us, doctors, nurses, other staff— that when a patient comes to the hospital, if the patient speaks Yiddish, Hebrew, Arabic, Urdu, Chinese inside that hospital, inside those clinics, everybody is to be treated respectfully and everybody is to be safe. We think that is very important, and we welcome the people from this community. It’s complicated for us to figure out how to offer people some financial assistance to pay for their care. In some cases we are able to make people eligible for Medicaid and other what we call special-service programs that carry with them financial assistance. In other areas we’re not able to do so. But I do want to promise you we are committed to looking for ways of doing that.”

The kneeling men now looked at her intently. Hard to interpret the gaze, which felt collective.

She encouraged people to come to the cancer center for information on the colon-cancer test. “I tell you about it not to drum up business while we’re all here, but to tell you there are some services you can get if you have no money or some money, if you have no insurance or some insurance. I will not be so secular as to talk about it in the midst of a house of prayer, but I do want to tell you we will give you information on how you can be tested for colon cancer whether or not you have insurance, no questions asked. Right?”

She spoke for a total of nine minutes and then stepped aside. Some men began to applaud but were silenced by the imam, who said, “The Pam, we always welcome you here in the Pakistani community. Douglas Jablon, I love you a lot because you were the one who has taken us to the other leaders so we could have good relations with the priest, the rabbi. You are the best neighbor. Maimonides is the best medical center in Brooklyn. Not in Brooklyn, in New York.”

Choudhri said, “In the United States.”

With that he led Brier outside and told a young man to bring us next door to a Pakistani restaurant, where Brier ordered an abundance of take-out food. When the man behind the counter refused to accept money, she pressed it on Choudhri’s helper and told him to give it to a relief fund for the earthquake.

A few weeks later, on a freezing day in December, Jablon took me to visit the imam and Choudhri. As he drove, he played a tape of the most recent broadcast of Dov Hikind’s weekly program on WMCA talk radio. “I just want to mention one thing, and we’re going to be very brief,” the politician said to his sidekick. “This is amazing. We were both . . . ummmm, not shocked, but this was nice to read in the newspaper: ‘Maimonides top hospital in survival rate,’ one of the headlines in one of the major newspapers here in New York.” He was referring to the annual New York State hospital report card, released by the Alliance for Quality Health Care and Niagara Health Quality Coalition, a nonprofit group, which gave the hospital “three-star” ratings in more categories than earned by any other hospital in New York.