Hospital (29 page)

Rahman, a Muslim like the Devis, told the husband and son that the hospital would do everything that could be done, and they responded, “What happened is God-given,” and he said the doctors would use the latest technology.Later he told me, “I feel sad because this is a great loss for them, but I don’t know how to console them.”

The hurt and love in the eyes of the son, the tender helplessness of the young physician and the blood-bank worker required no translation. Transcendence one minute, frustration the next. The convergence at Maimonides distilled the sweet and sour verities of humanity into a heady, combustible brew that could expand consciousness or cause it to implode.

As a child I was inculcated with unwavering belief in the miraculous nobility of America-the-refuge, country of immigrants. In our small rural town in Ohio, my Hungarian-speaking Czech-Jewish father was welcomed as a hero for his willingness to set up a medical practice in a poor, remote place that was not attractive to most American-born doctors.

No one seemed to consider him a threat. But nostalgic appreciation of immigrants—an appreciation easy to come by when there weren’t many of them—had diminished to the vanishing point in recent decades by the large influx of newcomers, many of them illegal. Their willingness to take tough jobs for low wages had made them objects not of gratitude but of hostility. Their untaxed wages didn’t contribute to the cost of running schools or hospitals—though they did fatten the bank accounts of those who employed these desperate, hardworking people.

Immigrants were dispersed throughout the country, but New York remained a major gateway. The public hospitals were the mainstay for people who had no coverage (and no documentation). Many of them ended up at Maimonides.

Location, location, location.

Under the Brezenoff-Brier regime, Maimonides moved its primary-care clinics out of the hospital into smaller offices located in the surrounding neighborhoods. This was both a marketing and a social-services decision: Go where the patients are. Urdu was the main language on Newkirk Avenue, Spanish in Sunset Park, Russian at the Fifty-seventh Street site, and Chinese (in several dialects) on Eighth Avenue, a few blocks from the new cancer center. About eighty-five thousand patients a year—more than double the number who were admitted to the hospital—were treated at the clinics. The hospital made an effort to install doctors and staff who spoke the same language and, when possible, were from the same background as the patients.

Bing Lu, a native of Wushi (now Wuxi), a coastal city near Shanghai, was the medical director of the Maimonides Primary Health Service in Brooklyn’s Chinatown. He estimated that as many as 80 percent of his patients there were Chinese. We met in his small office at the end of a hallway that led to several examination rooms; residents periodically interrupted to ask questions about the treatment for respiratory ailments. The weather had turned cold.

Lu, who was forty-seven years old, wearing a dark suit, a white shirt, and a tie, looked like a prosperous Chinese businessman, a common sight in these heady days of commercial globalism. He apologized for his garrulous-ness. When I heard his story, I was glad he didn’t skimp.

He told me that he had studied traditional Chinese medicine, including acupuncture and herbal remedies, as an apprentice to a famous physician. He learned the four main diagnostic methods:
wang
(inspection),
wen
(listening and smelling),
wen
(asking),
qie
(touching). “Touching the pulse is very important,” he said, “and so is looking at the tongue. Today, for most patients I still look at their tongues.”

He continued, “Once you gather this information, the processing is based on a very elaborate or complex hierarchy of theorems we call
bian zheng lun zhi,
almost like a therapy based on dialectical analysis of syndrome, juggling within the mind of the physician.”

Yet his teacher encouraged him to study Western medicine, telling him he could always return to Chinese-style practice later. Bing Lu entered medical school in the spring of 1978, at the end of the Cultural Revolution. For almost ten years much had been stalled in China, including university studies. Bing Lu became merged with a driven generation, the so-called class of ’77, the first group to take entrance exams in a decade, a class whose slogan was “We have to catch the time back.”

He had big ambitions—the biggest, and most secret, to win the Nobel Prize. He had it all planned out. First step was coming to the United States to study. In China he was doing research in medical biology on the hepatitis B virus, probably the direst illness for Chinese, with a chronic infection rate of between 5 and 15 percent. He arrived in New York in the spring of 1986, to begin his career as a Nobel-aspiring researcher—studying the hepatitis virus—at Albert Einstein College of Medicine.

When he told me about his youthful dream, Lu laughed with embarrassment. Eight years into his quest, his wife was on his back to be more practical. They already had one child. Being a clinician was secure; research was quixotic and paid poorly. So he took the qualifying exams to become an FMG, “foreign medical graduate”—now known as the more politically correct IMG, “international medical graduate.”

Even after being away from the trenches in the lab for so many years, he was surprised at how much he remembered from medical school. “I’m accustomed to working very hard, not a problem,” he said. “Some residents would turf patients, and I would say, ‘Fine, turf to me, I’ll learn something.’” (Definition of “turf,” from
House of God,
Samuel Shem’s frisky bestselling novel about life as a medical intern: “to get rid of, get off your service and onto another, or out of the House altogether. Key concept. It’s the main form of treatment in medicine.”)

Bing Lu trained at the Miriam Hospital, affiliated with Brown University’s medical school in Providence, Rhode Island, another Jewish hospital. I asked him about his religion, a question that didn’t seem impertinent at Maimonides.

“Nothing official,” he said. “I kind of believe in a somewhat abstract higher being,” he said. “I don’t think it’s Jesus, not Buddhist per se, not exactly God. In Chinese we call it
tien,
which is actually ‘sky’ in Chinese. If you are puzzled, don’t know why life is unfair, you look to the sky and go, ‘Oh, sky, why does this happen to me? Why is this injustice?’”

At Miriam he often questioned his decision to leave research. One day a doctor who had become his mentor asked him, “Don’t you see life as a series of compromises?”

Lu paused in his story. The room was quiet except for the buzz outside of patients and staff moving around. The practice was constantly growing; in a couple of months, it would move to the old Kopel-Bashevkin faculty practice offices a few blocks away, near the new cancer center.

“I like to talk, my wife says,” said Lu, who wore his discontent cheerfully. “If you like, we can visit her. Her office is nearby.”

We went outside and walked past a bubble-tea place. We stopped for a minute to say hello to Cheng Neng Fang, a doctor of traditional Chinese medicine, a skinny man with a wispy beard, whose shop was packed with all kinds of teapots and drawers filled with herbs and roots. Lu said something to him in Chinese. He nodded and handed me his business card.

Bing Lu’s wife, Xiaoxi Hu, also a doctor, had just opened her office, a lovely converted storefront space where everything was new, including acupuncture tables with curtains for privacy. Hu, a brisk, friendly woman, stopped by to say hello, told us to make ourselves comfortable in her office— still largely unfurnished—and then vanished.

Bing Lu had gotten permission from his department chairman and Pam Brier to begin doing acupuncture in his wife’s office. The hospital clinic didn’t offer it for the usual reason—money. Most Maimonides patients were covered by Medicare or Medicaid or by HMOs that based reimbursement on the government insurance rates, which did not cover acupuncture. Private patients either had insurance that covered the cost or were willing to pay for it on their own. The hospital could offer the same deal, but acupuncture treatment required different beds from the ones used in medical examination rooms. For the hospital the economics (revenue versus cost) didn’t make it worthwhile.

Lu found himself reconnecting with his old teachers as he began combining old and new, using herbs and acupuncture in the context of conventional— Western—medicine.

“Western medicine is good at treating organic problems like pneumonia, heart failure—structural failures,” he said. “Chinese medicine is better in milder functional disturbances rather than organic disturbances. You have to weigh the evidence. Let’s say a middle-aged woman, married, with children, taking care of family, taking care of career, stressed out, very busy, always has tightness. Tylenol or Motrin does help, but she doesn’t sleep so great, sometimes feels nervous, et cetera. As an alternative to Paxil or Prozac, you have acupuncture. Another alternative: healthy lifestyle. These are real alternatives.”

The conversation wound back to the subject of compromise.

“After finishing high school, I had the option of going into a family business, to learn how to manufacture watches, or to medicine. When I decided to study medicine instead of being a watch man, it’s because I felt with medicine you could go to the end of the world, discover the cure for cancer.”

He smiled wistfully. “I told you my childhood wish, the Nobel Prize.”

He remembered that his father, who had been a farmer, kept a map of the world in their house. “When I am punished, I am sent to the wall looking at the map. He, for a farmer, had a very broad worldview, was very open-minded, and encouraged me to do these things. When I was six, I read a series of books called
One Hundred Thousand Questions.
”

Bing Lu had reached the opposite end of the world. Many questions were still left open, and his laboratory days were most likely done.

“I tried to do some small research initially,” he said. “But now I’m kind of not just New Yorkerized, I’m Brooklynized. I’m more of a practitioner, not making innovative findings. In that way I feel I wasted all that time. I compromised too much. I feel I made a balanced choice. From that point of view, I’m making a compromise. I have a private practice on Staten Island. I have the luxury of taking my younger son to school every morning. Balancing everything. This goes into my series of compromises.”

He showed me a photograph of his children. “Besides being a scientist, I am a Chinese immigrant,” he said. “I have to do what I’m doing now in many ways to help my children have a better launching pad, and I think I’m doing that fine.”

Nakka had agreed to take me on rounds, where she would check in on the hospital cancer group’s patients and consult on patients for other doctors who saw indications of cancer or weird blood counts. I found her in the lab, where she was piecing together a diagnosis for a seventy-six-year-old Chinese man who had been admitted two weeks earlier for repair of his aorta. He was in the ICU. She had been asked to do a consult for anemia and was looking at his blood under a microscope.