Hospital (28 page)

Warshawsky was a man of many interests and many opinions. He’d given me a few chapters of a book he was writing about his experiences in the medical world of South Africa. The manuscript revealed a good eye for detail and—his yeshiva years notwithstanding—a lusty sensibility.

Warshawsky’s ferocity was genuine, but his aura of physical robustness was misleading. A decade earlier, at age twenty-three, he had stared down death from leukemia. His dry-eyed gaze was a physical condition, the residue of a bone-marrow transplant undergone while he was a medical student in South Africa.

For him the graft-host analogy wasn’t theoretical. He had endured many variations of the disease. His lungs had been so weakened that it was an effort for him to climb a flight of stairs. Infertility problems had almost kept him and his wife—another cancer survivor—from having a child; it took eight years of fertility treatment to produce their baby. Perhaps worst of all, for someone whose livelihood depended on keeping up with research, he suffered from Sjögren’s (SHOW-grins) syndrome, a chronic disease rooted in many causes, including transplants, in which white blood cells attack the moisture-producing glands. The inability to make tears had damaged his corneas, the sensitive membrane covering the iris, the colored part of the eye. His corneas had become scarred; light caused exquisite pain.

He hadn’t been able to read an entire book for two years, serious deprivation for a Torah scholar and cancer-specialist-in-training. He had heard of patients who suffered so much from the condition they had their eyelids sewn shut. He felt he had almost reached that point when Douglas Jablon— the Mitzvah Man, the fixer—told Warshawsky that Edy, Jablon’s wife, also had been debilitated by dry-eye syndrome; after years of misery she had found relief. Dr. Perry Rosenthal, a cornea specialist who taught at Harvard Medical School, had developed a special lens—called the Boston scleral lens—filled with a fluid that merged with the eye’s own tears and provided a protective coating for damaged corneas.

Thanks to Jablon’s intervention, Warshawsky had recently returned from Boston. For the first time in years, he could endure light without pain. He no longer needed glasses.

“I had given up hope, and then I went to see Dr. Rosenthal, this elderly guy, and he put in this lens, and I could see clearly,” he said. His sense of excitement was palpable. “It was a miracle. He’s been on
Oprah,
on ABC, but the medical establishment has not promoted him the way he should be promoted. The first reason is that doctors, myself included, they can’t believe that such a simple, elegant thing would actually work. The second thing is egos. You’ve got people who have invested their lives in corneal transplants— big high-tech things—they don’t want to give that up so quickly. It makes no sense to modern doctors that something so simple could overtake something so high-tech.”

I’d cornered Warshawsky in the cafeteria to talk about another low-tech aspect of medicine—the competition between him and Razaq to fill one of the new positions opening up at the cancer center. Each had played his own race/ethnic card with Astrow. Razaq was a soft-spoken Pakistani Muslim who pointed out to the new chief that the Muslim community in the area was growing. Razaq spoke Urdu and Hindi and felt he could draw a different set of patients from an emerging population to the cancer center. Warshawsky, backed by Kopel, knew that his strength was as possible conduit to the Orthodox patients who were not using the cancer center. “I have to see if I can get the Orthodox vote,” said Warshawsky. “I have to compete with Bashevkin.”

“I think Astrow has this idealistic vision that Bashevkin will come here,” said Warshawsky. “He doesn’t understand old rifts and old feuds. Everyone looks after their own, that’s how it works. You scratch my back, I’ll scratch yours.”

What did he think about his rival, Razaq?

“As a physician I respect him,” said Warshawsky slowly. “But at the end of the day, we are separated by our cultures. Not our cultures. By our race. Our nationality. You can’t deny it.”

When he was in medical school, he told me, he shared a cadaver with an Indian Muslim. They got along fine until Al Quds Day, the last Friday of Ramadan—designated by the Ayatollah Khomeini after the 1979 Iranian revolution as a day for Muslims worldwide to unite in their support of Palestinians and denunciation of Israel. (Al Quds is the Arabic name for Jerusalem.)

“Come Al Quds Day—where they moan how they lost Jerusalem and are going to reconquer it—I would punch the guy in the face and he would punch me back,” recalled Warshawsky with satisfaction. “And then the next day we’d be sitting in class working together again. Muslim-Jewish fights on campus were the big thing. We would call in the big boys from the JDL [the Jewish Defense League], and they would come in with their gangs, and the other side would come out and say, ‘Death to Israel.’ You’d smack a guy, and the next day this is the same guy you’d have a conversation with about the biology of cancer cells.”

He grinned a little wildly. “It’s crazy,” he said. “It is. It is the same thing here.” He lowered his head and glanced around. The tables were occupied by mixed groups of various ethnicities eating and chatting.

As noted, Warshawsky had a good sense of drama.

He modified.

“It’s simmering,” he said. “It’s undercurrents. I tell you straight out, there’s a lot of complications in physician-patient relationships precisely because of this. Because physicians don’t understand other cultures, and a lot of these cultures do a lot of things that are very distasteful to a lot of physicians. I can only say for myself, as a Jewish physician, I’ve struggled, and there have been times I’ve asked someone else to take care of a patient.

“Like when an Arab guy came from Ramallah, got off the plane, got an angiogram that showed he needed an operation, and came to this hospital thinking he could just walk in and get it, and I found that very very disturbing.

“Picture me in Lebanon, say—if I was allowed to go into the country, which I would not be—or Saudi Arabia, breaking my leg and needing medical attention in the hospital. What are my chances of coming out of that hospital alive? I’d say zero. And yet with impunity those same people walk into this hospital dressed up in traditional gear expecting charity in a Jewish hospital.

“But this is America,” he said. “You’re not allowed to turn someone away from the emergency room.”

He nodded his head toward a group of Orthodox doctors who sat at a nearby table. “A lot of things upset me here as well,” he said conspiratorially. “But I can’t really talk about it, because you can’t talk badly about your own people, even though they are guilty of many things that are despicable. It doesn’t look good on you to talk badly about your own nation.”

Only a few months were left until the fellows were to be graduated. Warshawsky was frustrated with Astrow’s delay in making a decision. The young doctor wondered aloud if Astrow was too soft to be chief. “He isn’t narrow-minded like most of them,” Warshawsky said. “He’s incorporated the humanistic side of medicine, which is very unusual. I see that with patients. But administration is a different animal. You can either do it or you can’t. You need single-mindedness, the ability to detach yourself from feelings.”

Warshawsky continued. “Dr. Astrow is a universalist. He sees things in terms of multicultural, including Christianity, Buddhism . . . we can all just get on. He’s missing the point. Because we can’t. Astrow, I don’t think he understands it that well.”

He shook his head. “I don’t know if Kopel understands it completely,” he said. “I don’t know if I understand it completely.”

Lisa Keen, social worker, the former sixties radical who often took me on rounds with her, always seasoned her observations about hospital life with peppery commentary about the doctors and nurses. The Prince, she told me, was a good one, compassionate.

What about that not-so-compassionate stuff he said?

Watch him, she said.

A few weeks later, I caught up with him sitting at a nurses’ station on Kronish 7, looking at the chart of a fifty-nine-year-old woman from Bangladesh.

“She’s gone,” he was saying brusquely to Keen, who was the social worker on the case. Suppiah showed her Mrs. Devi’s CAT scan on a computer screen. Cancer of the colon had spread to her liver, abscesses measuring seven centimeters.

“That’s what you are going to tell her?” Keen asked. “She’s gone?”

Suppiah shook his head, but still, there was no avoiding it. “This is a death sentence,” he said.

Keen wanted Suppiah to talk to the family about the prognosis. She was concerned that the doctors parading through Mrs. Devi’s room had been so preoccupied with the immediate issues of lab tests and treatment plans, with the patient’s progression through the system, they had forgotten to tell the family the true meaning of all this activity. Through the patient-rep office, she found someone who spoke Bengali, a technician in the blood bank, who agreed to meet Suppiah in front of the patient’s room.

Keen felt a duty to patients and their families, to provide hope (when there was none), to make them believe that someone cared about what happened to them (which someone did, at least in an abstract way). She knew that the impersonality of the hospital lent a certain futility to her mission, but she persisted, even though she was scheduled to retire in June and could have taken it easy.

Suppiah arrived shortly before the interpreter and peered into Mrs. Devi’s room. She was curled up in her bed like a child. She was tiny, even tinier than her husband, a slight man with a weathered face, wearing a red-and-white checked scarf around his neck. He was a contractor who worked with his son. The son, in his thirties, had acquired American heft; he had a sweet, chubby face. His English was minimal, though he had lived in the United States for fourteen years. His father followed him ten years later. The mother had stayed in Bangladesh, caring for the rest of the children, arriving in New York two years before she showed up at Maimonides.

Suppiah agreed to talk to Mrs. Devi’s husband and son. Keen and I joined them outside the patient’s room, where we smiled and nodded awkwardly at one another, waiting for the interpreter to arrive. His name was Asm Rahman, a slender man in a shirt and tie, with brown skin and black hair worn slicked back, who had studied medicine and wanted to become a physician. For five years he’d been working in the Maimonides blood bank. There was no private room for family conferences on that floor. Suppiah— and Rahman—had to deliver Mrs. Devi’s death sentence under a fluorescent light in a busy hallway.

Suppiah fixed his gaze on the family as he explained in great detail what he saw. Certain phrases popped out. “Large mass sitting on the colon . . . multiple areas of infection . . . probably why she has fevers and belly pain.” He paused every so often, and the son and father turned their attention to Rahman, as he interpreted word for word, as Suppiah instructed him to do.

“Do they understand what I just told them?” Suppiah asked Rahman.

“I understand,” the son said sadly, in English.

Suppiah looked at him gently. “Could you tell me what I said?”

The son nodded, turned to Rahman, and spoke at length in Bengali.

Rahman nodded. “He says he knows there is a large mass in the colon and liver and an infection. He wants to know what they can do about it.”

“First is to get a biopsy,” said Suppiah, “To take a piece of tissue and analyze it, but this is complicated by the infection. I haven’t seen her yet, but from what I see on the CAT scan, she is very, very sick. I cannot stress that enough. She is very sick.”

As Rahman interpreted, apparently taking Suppiah at his word, skipping nothing, it was clear that the message had been received. Both son and husband looked stricken. Their eyes reddened. They seemed oblivious to the movement in the hallway: an old man walking by slowly, trailing his IV drip; orderlies wheeling someone on a gurney.

Suppiah said the disease looks like cancer, very advanced. The son and the father began to weep.

Suppiah said he understood (from Keen) that the family didn’t want Mrs. Devi to know the details of her illness. Could he ask why? The son replied, “That’s what she wants.”

Suppiah said, “I’m not going to tell her anything, but I need to examine her. Does she speak any English?”

No, said the son.

Suppiah smiled. “That works out very good,” he said. “I don’t speak Bengali, so I won’t be able to tell her.”

The son and father looked blank, not comprehending the weak joke.

Suppiah explained that Mrs. Devi should sign a health proxy form, giving her husband and son the right to make decisions about her treatment. He touched the son’s hand and offered more details about controlling infection, antibiotics, chemotherapy.

The son asked, “What is the prognosis? What is the best and the worst?”

Suppiah hesitated. “The problem with this question is her infection,” he said. “If I give her therapy now, she will die from the therapy. If this is cancer, people who have this type of cancer and no infection, the average life survival is a year, a year and a half. Because of her infection, this can be much shorter than that. I’ll know more when I get the results of the biopsy.”

Suppiah and Rahman went inside to examine Mrs. Devi.

Keen held the son’s hand and urged him to tell his mother everything.

He shook his head. “I tell her she has an infection.”

Keen said, “My guess is, your mother knows.”

The son shook his head. “She don’t tell me nothing,” he said in English, his face twisted with grief. “If she told me something, I’d bring her right away. Only now she said she had a pain over here.” He pointed toward his lower torso.

Keen asked him if he would like an imam to pray with. He said he would ask his father, who had followed the doctors into the room.

When Suppiah emerged, rubbing Purell on his hands, the son pressed him for answers. Suppiah again was gentle. “I know you are looking for an answer,” he said. “I wish I could give it. We will do what we can.”