Hospital (25 page)

One of those men was Alan Astrow, wearing corduroys and Hush Puppies. He introduced himself after class, and when they discovered they both lived downtown, they rode together on the subway. His shoes kept coming untied. He said maybe they could have coffee sometime, but then he never called.

Nathanson stayed in the class. She and Astrow didn’t speak further after that initial subway ride, though she always noticed when he walked into the room, head bowed, dragging his coat on the floor. As the weeks passed, she found herself paying special attention when he talked in class. At first she thought his thinking was simplistic, because his manner of speaking was so straightforward, almost childish sometimes in its directness. Then she listened. “Weird,” she said. “Smart. Weirdly brilliant, the things he would say. He would just be able to pull things from past reading but say them in such a simple way they would sound strange.”

She believed that this dorky man with the carefully combed brown hair, sweet smile, and sleepy blue eyes was truly an original thinker. Wednesday after Wednesday she listened as unique observations poured from his mouth, foot-noted with references to obscure texts, reaching conclusions that transcended the usual divisions between conservative and liberal, platitudinous and radical.

Six months after he said they might have coffee sometime, he called and asked her to go to the theater. “I’m going to say it was
Twelfth Night,
but if I’m wrong and he finds out, I’ll be chopped liver,” she said. “He remembers everything. Every play we’ve ever seen. With me, I don’t like it, gone.”

She laughed. “Even if I do like it.”

They joked that they had nothing in common. She was slight and fast, unafraid to climb forty feet in the air to work on scaffolding, splattered with paint, arguing with construction workers. He was cautious, wore white doctor’s coats, and pondered metaphysical matters. She was happy with take-out Chinese food; he liked fancy French restaurants. She knew nothing about religion; he seemed to know everything.

But she felt comfortable with him. They were the same age. They had lunch together and liked each other. “He was so careless, so absentminded about himself, so unprecious,” she said. “I was comfortable with him because I’m not that orderly.”

He also seemed innocent, strangely pure—until she found out he was dating someone else, a woman even more countercultural than Nathanson considered herself to be. She was conventional enough to decide, at thirty-five, that she wanted marriage and children, so she did the conventional thing for a woman who chose to succumb to the biological imperative. “I gave him an ultimatum,” she said. “I told him we couldn’t continue to go out if he was dating her.”

They married. They had children, a boy and a girl. They moved to the Upper West Side, to an apartment big enough to encompass this new life—a life that outwardly may have had the predictable trappings of the New York Jewish intelligentsia but which for them was a surprise, daring and experimental.

Without Marshall Meyer she doubted they would have found each other. “Reading this text together brought out something original in both of us,” she said, and then corrected herself. “‘Original’ is the wrong word. Something deep and unconventional. We spoke our souls in some ways in this setting that we would not have if we had met without the class.” Meyer touched what they had in common: a fundamental inability to pass through life lightly, a willingness to stand apart, a desire to search for the sacred in beautiful and terrible things.

Everything about being a doctor changed for Astrow during a hematology elective when he was a resident at Boston City Hospital. It was late fall of 1982, or maybe early winter 1983. He drew blood from a patient with a rare diagnosis, and after that nothing was the same.

Later the memory was embarrassing, in the light of the disaster that followed, but Astrow’s first response to the diagnosis was excitement: toxoplasmosis of the brain, a disease a doctor-in-training might read about but would never expect to witness. Pregnant women would come to know about toxoplasmosis, the disease spread by cat feces that could result in severe damage to babies in the womb. Caused by a single-cell parasite called
Toxoplasma gondii,
its presence goes unnoticed by most people infected with it. “Severe cases are more likely in individuals who have weak immune systems,” explains the Web site of the Centers for Disease Control and Prevention (CDC), the U.S. government agency assigned to promote and protect public health. Back then, however, there was no CDC Web site. There was no Internet. The CDC had only recently classified a mysterious outbreak of symptoms and infections related to a collapse in immune systems as AIDS, acquired immune deficiency syndrome. That summer, July 1982, the CDC reported 413 cases of the new disease in the United States with 155 deaths; a year earlier the CDC had reported seeing 108 cases.

Astrow was only dimly aware of these cases when the man with the toxoplasmosis of the brain died, followed by a Haitian patient with tuberculosis, and then a pronounced number of young men showed up who were deathly ill with aggressive lymphoma or Kaposi’s sarcoma (KS)—another disease so rare a resident might expect to see one or two over an entire three years of training. By the time Astrow began his fellowship at New York University, in 1983, KS had become an epidemic; all three hospitals serviced by NYU residents and fellows were overrun with young men suffering from fevers of unknown origin or from atypical or fungal infections.

When he entered medical school, AIDS didn’t exist, at least not as a known disease. When he entered the field of hematologic oncology a decade later, it became his life’s work. In 1986 he joined the staff at St. Vincent’s in Greenwich Village, the heart of the gay community in New York. The hospital turned two entire floors over to HIV units, trying to cope with the onslaught of KS and AIDS-related lymphomas. The hospital’s residency program suffered. No one wanted to come to New York to train because of AIDS.

Astrow was surrounded by death—grisly deaths submerged in pain, stigma, disfigurement—early death, imposed on his peers, men in their twenties and thirties. The dead included his best friend, a surgeon at St. Vincent’s. They included a sweet young hairdresser, a patient, who gave Astrow a blue sweater someone had given him from Bloomingdale’s. Twenty years later, after more than 550,000 people had died of the disease in the United States, after protease inhibitors had tamed the plague and transformed it into a chronic illness, Astrow still wore that sweater. He thought of that young man every time he put it on, like a ritual blessing for the dead. A kind of kaddish.

By comparison with those grim days, Astrow’s dilemmas at Maimonides were minor, which didn’t stop him from worrying about them. He realized he had to repair his unwitting breach of etiquette, caused by inviting a non-Orthodox speaker to his spirituality conference at the cancer center. He sent Dean Twerski a polite e-mail to say he understood there was a problem.

Twerski could be fearsome, with his haunted eyes and deep, resonant voice that harmonized with his intellect. Biberfeld had convinced him to join the board because he was Hasidic and lived in the neighborhood. Twerski had seen great improvement in the medical care at Maimonides over the past decade, but the community was always ready to pounce. “What happens in the hospital in fifteen minutes will be known in every synagogue,” he once told me. “That’s a very hard way to run a hospital, where everyone knows everything. There’s been a slipup, I’ll get calls, eleven, twelve o’clock at night: Someone is in the emergency room, and things aren’t moving. I will go over, and things will start moving.”

But he called Astrow in response to his e-mail and was sympathetic to the doctor, if not to his predicament. Twerski didn’t buy Astrow’s proposition— that the yeshiva-educated minions in Borough Park would be eager to hear alternate views from another branch of Judaism. He told Astrow it was a bit of an insult, to bring an outsider to a community where there were so many scholars. What Astrow saw as a chance for discussion, Twerski saw as a slap in the face.

Twerski also seemed skeptical about the whole idea of a debate between religions, and he questioned the validity of the distinction between ethics and spirituality and religion. Astrow explained he wanted to demonstrate that you could disagree with another person and yet listen respectfully to him or her.

Listening to the silence on the other end, Astrow realized he hadn’t convinced Twerski and probably wasn’t going to. So he took Mark McDougle’s advice. He explained that the conference wasn’t about ethics or religion but about spirituality, which was different. He said it wasn’t really for the communitybut a continuing-education program for the doctors and nurses, for which they would receive credits. In other words, the conference could be explained to the touchy rabbis as hospital business, not a competition for the souls of Borough Park.

During the conversation Twerski remembered that Astrow had taken care of one of his relatives. He told the doctor he and his family were grateful and suggested that in the future Astrow should consider checking with the religious-affairs committee of the board before inviting lecturers to speak on such sensitive subjects.

Later Astrow would say that the whole episode was a blip, maybe because happiness evaporates while disappointment lingers—the way months or weeks or even days of illness inhabit memory more powerfully than do years of health.

But Jill Nathanson was a witness to her husband’s happiness that night. She looked at him and saw the self-assurance with which he wore his nice dark suit. The bandage had been removed from his forehead, which showed no trace of the stitches. Someday he might shrug it off, but that night there was no mistaking the expression on his face. He couldn’t deny it. He was happy.

There was a fruit platter and wine and cheese. The chairs had been delivered—seventy-five of them—and they were filled. The light fixtures were in place, and the walls were painted.

Jay Cooper even cracked a joke. “This room didn’t exist just a few days ago,” he said by way of opening the first conference at the cancer center.

Astrow stood up to introduce the speakers. First, though, he explained why they were there.

“As physicians, nurses, and other health-care professionals, we may recognize that caring for patients involves several dimensions,” he said. “The most obvious is the technical, the scientific, the biomedical—to diagnose and treat illness with thoroughness, attention, and skill. A second dimension might be termed the emotional, or the psychosocial, in which we try to engage with our patients as whole human beings. Who are our patients? What do they care about? What worries them? How do we show our concern for them as unique individuals? Here in the heme-onc division at Maimonides, we attempt to address these interlocking realms with our fellows in our weekly biopsychosocial rounds, organized by Dr. Allan Novetsky with the assistance of Dr. Sheldon Berman.”

He may not have been smooth, but he could be eloquent. “There is a third dimension, which for want of a better term I’m going to call the spiritual, which may underlie the other two. By spirituality I refer to the unseen, often unspoken, values that motivate us. In the contemporary world, when we speak of an invisible hand that drives us, it is often assumed that we are referring to the marketplace and the invisible hand of economic self-interest. But most physicians and nurses, I think, want to see themselves as more than simply one party in a financial transaction. Why do we do what we do? What keeps us going? Not just that we ought to care, but why? Faced with a suffering or demanding patient whom we might prefer to avoid, where do we find the strength to enter the patient’s room? What is the conception of the human person and the role of the physician and nurse that medical practice relies on?”

That night Alan Astrow was in his element.

Seven

We Speak Your Language

On the home page of the Maimonides Medical Center Web site:

At Maimonides Medical Center, providing culturally sensitive care for patients who aren’t fluent in English is important. One of our priorities is facilitating better health care access for non-English speaking patients and their families. To achieve this goal and to serve our culturally diversified community, the Medical Center has been recruiting multilingual physicians, nurses and staff, especially for patient care areas. A prime example of this effort can be seen in the emergency department. As a result of an increasing Chinese, Russian, Spanish, and Arabic patient population in the emergency department, we now have coverage twenty-four hours, seven days a week by multilingual patient representatives who are available to assist patients and their families who speak languages such as: Arabic, Chinese, Czech, German, Greek, Hebrew, Hindi, Italian, Polish, Russian, Spanish, Ukrainian, and Yiddish. Informational brochures and relevant hospital forms have also been created in many of these same languages to assist patients.