Hospital (47 page)

Yet almost everyone seemed to agree with Stanley Brezenoff’s assessment: The cancer center needed another type of prominent surgeon, the medical equivalent of a movie star, someone who generated the kind of buzz that sold tickets. LoCicero was an academic heavyweight with a national reputation, but what did that mean to patients in Brooklyn? Another problem, in the ephemeral matter of star quality: LoCicero specialized in the depressing area of lung and esophageal cancer, where cure rates remained abysmal, not the happy-ending treatment medical centers liked to feature in their ads. And while LoCicero was indisputably distinguished, it was felt that Maimonides also needed a charmer, preferably in a discipline like breast cancer, with a relatively high rate of success—a surgeon with a golden tongue as well as golden hands, who could capitalize on the gratitude of his or her patients.

While waiting for this surgical pied piper to appear, Cooper had time to dream. One day he told me his hope for the center. “Suppose someone pulls their car into the parking lot and is going to get chemotherapy the next four, five days,” he said. “I want a system where we say to them, ‘We know you’re not feeling well, you’re slightly nauseated, and you have two kids who don’t understand why mom isn’t home making dinner. Tell us what you want tomorrow for dinner, and we’ll arrange to have some restaurant to deliver it in take-out containers, and we’ll put it in your trunk. Bring in your laundry, and we’ll arrange for it to be dry-cleaned, and it will be back in your car when you go home. Need your car inspected by the Department of Motor Vehicles? Leave it with us, and we’ll have the local service station inspect it and bring the car back for you.’”

As this inspiring fantasy poured forth, I concentrated on keeping my mouth from dropping open in astonishment. Cooper’s relentless pursuit of perfection was admirable, but he sounded like a crackpot.
Have the laundry dry-cleaned? Have the car inspected?

A mental split screen popped into my head: Cooper’s utopian vision appeared on one half like a tidy television commercial; on the other half was Nella Khenkin’s real-world existence, a dark, absurdist comedy. I’d spent hours with Khenkin, the cancer center’s sole social worker, watching her try to obtain basic services for patients from the surreal tangle of bureaucracies that dictated medical care as it existed that spring—not in the ivory tower of Jay Cooper’s imagination, but in the U.S. health-care system as it played out on Eighth Avenue at the tail end of Brooklyn’s scrappy Chinatown, in the Maimonides Cancer Center, a converted check-processing plant across the street from an auto-body shop.

Many times I walked into Khenkin’s small office to find her with her pale, fleshy hand pressing against her forehead, ear glued to the phone, able to talk to me for a half hour while she waited for an answer almost guaranteed to be unsatisfactory. Here is one example, among dozens, maybe hundreds, Khenkin could describe in her luxurious Russian alto:

“Patient came, and we are talking about bras and prosthesis she needs,” said Khenkin. “I was calling HIP, and after forty-five minutes they finally picked up and transferred me to five different people and told me all the DME—‘durable medical equipment’—should go through a special partnership organization not with them, with somebody else.”

The story unfolded with the excruciating detail familiar to anyone who has suffered on the waiting end of a “Let me put you on hold, please.”

“After spending so much time, I was supposed to call this other organization! I call this other organization, which is affiliated with HIP, kind of a management program. They told me they can’t tell me anything, they need to get information and get back to me. They called me much later when the patient wasn’t here, and told me the patient doesn’t belong to the organization and I need to go back to HIP, who sent me there.”

Khenkin didn’t give up. “I can’t even begin to start telling you about the frustrations that go with each patient when you need to get something for them,” she said. “So far I didn’t get what I’m looking for—simply, the name of the vendor agencies that are dealing with patients from HIP for this particular supply. Finally I got the name and the phone number late in the evening yesterday. I contacted them and”—she took a deep breath, as if girding herself for the finish—“the phone is disconnected and there is no such agency! So. This is the story.”

Khenkin’s office was a repository of such stories, miserable epics of organizational confusion so rampant it seemed deliberate. The insurance companies had become as insidious and detrimental to the national health as any illness was. The contractual obligation to cover illness and catastrophe had become submerged in a growing mountain of Catch-22’s that seemed freshly minted to justify nonpayment.

“These insurances get worse and worse,” said Khenkin. “Forget about it! Patient is falling apart, they would not send even a nurse, and forget about the aide. If we present patient is very weak and in pain and end stage of disease, they question to you why the patient is not on hospice. If he is so sick, he needs to be on hospice. If patient is not so sick, why do we need to send him a nurse? He should come to the doctor’s office. No matter how hard you try, you can be as a fish on a frying pan. You can’t justify unless there is an injection that should be done or he is diabetic, and even with this they want the patient to come to the doctor to save money, they don’t want to send the nurse. Very frustrating, dealing with these insurances.”

Khenkin found her work dispiriting at times, yet rewarding when she was able to awaken dormant compassion in a bureaucrat, or wheedle drugs from a pharmaceutical company’s representative, or provide help in ways she hadn’t anticipated.

She told me about a young Chinese mother who needed to come to the center for chemotherapy but was too tired to make the necessary arrangements. She asked Khenkin for help. “She has a job off the books in the nail salon, which she can’t keep because she is so frail and weak,” said Khenkin. “She can’t take care of the child, and the child acts out. The child is constantly not in school. The mother couldn’t explain the reasons and now needs to go to court. I believe after I put everything together and talk to the teacher, I will have to involve the lawyer.

“Someone tells me, ‘I don’t have food,’ I arrange food,” she said. “Or someone tells me, ‘Nella, I forget stuff.’ ‘Did you have your MRI?’ I ask. ‘Do you know it’s not cancer? If not cancer, let me send you to geriatric doctor to check for Alzheimer’s or make a referral to adult health center.’ Or sometimes it’s just grab somebody I see crying and bring in here, and we cry together.”

Khenkin was the heart of the place. She met regularly with a variety of support groups at the center: One for prostate-cancer survivors. Another for people undergoing treatment, or who have recovered. One simply called “the feelings group.”

The feelings in all these groups ran the full gamut, pathos and humor, reassurance and resignation, guilt and accusation, fury and acceptance, advice and understanding. Here’s an excerpt from one session I sat in on, names changed:

Khenkin sensed that Jay Cooper found her methods too homespun. When she asked to take one of her groups to the family room, designed for private conversations, she was told no, because they were not allowed to eat there. “We are not animals,” she said. “I tell myself I should not be upset by little things, but it hurts.”

Another cultural divide loomed before her. Could she cross it, and did she want to?

Khenkin, who had been in charge of office celebrations, had planned an elaborate presentation for the staff holiday party, built around the idea of the birth of the cancer center. She bought a large stuffed cow, representing the milk supply for the new baby, and a Spider-Man doll to present to Jay Cooper, as protector of the baby, and other gifts for the “uncles”—Astrow and Huang. She bought a chess set for Kopel, the mastermind. When she presented her ideas for the center’s staff holiday party to the planning committee, the group told Nella they worried that Cooper would think the gifts were too corny. Khenkin understood. She left the gifts under her desk and canceled the entertainment she had planned, a man who dressed as a big Gypsy doll and made people dance.

Several months later she still felt unsure about the direction the center was taking. They were preparing for National Cancer Survivors Day in June. The year before, Khenkin had planned the party, with an Elvis impersonator and music. Cooper had met with the center’s directors and told them the program should be educational, that Elvis didn’t set the right tone. Khenkin worried: Had they become so intent on luring more affluent patients, or those with better insurance, that they would forget their mission to serve the community? Their patients had enjoyed the Elvis party.

“Maybe we will need to wear a tie now,” Khenkin told me. “I felt in the past my role was to get to every patient, but especially to those who are more in need, who are indigent, who do not have anything and I need to help them. Now I also learned that now we need to concentrate on people who have good insurances, to serve them better, and by serving them we will get money we can redistribute for other people. I’m learning new attitudes, but some things I can’t understand. We need to find the happy middle. Sometimes I would agree we need to wear a tie, and sometimes I would be willing to take off the tie, to be closer to the patients.”

Khenkin understood the need for change. She agreed with the decision to restrict the pharmaceutical-company representatives from freely wandering around the center peddling their goods, the way they used to (even though she risked losing a backchannel source for medicine some patients couldn’t get any other way). She saw the value of adding a more professional veneer, just as she appreciated the design and comfort of the décor approved by the feng shui consultant.