HOSPITAL: MAN, WOMAN, BIRTH, DEATH, INFINITY, PLUS RED TAPE, BAD BEHAVIOR, MONEY, GOD, AND DIVERSITY ON STEROIDS by Julie Salamon (Penguin, June, 2008)
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The title of HOSPITAL, replete with a 15-world subtitle, tells it all. Julie Salomon tries to pull her story of one year at Maimonides Medical Center in Brooklyn into one piece. Much as she tries, it doesn’t work. There’s just too much here. The multi-titled plethora shows Salomon’s difficulty in focusing on the problems besetting this big, tension-filled hospital.
Maimonides Hospital has a tall order. Even more than most hospitals. It must translate 67 different languages (if possible) for its patients. It must try to collect money from patients (if possible) who don’t have insurance. It must mend (if possible) the fights between physicians. Salomon asks, “What were the financial, ethical, scientific, sociological, personal, and cultural matters that determined what kind of care people received.” Bewildered, she adds, “What did it mean to care anyway?”
This is her essential question as she tries to figure out, “What did it really mean for a hospital to measure up. What was the bottom line?”
The numbers are overwhelming. With 705 beds, Maimonides is one of the largest five percent of the nearly 5,000 American hospitals. In 2003, the 6230 babies born at Maimonides constituted more births than at any other hospital in New York State. In 2003, nearly 39,000 patients were admitted. 127In 2003, nearly 39,000 patients were admitted and 81,190 crowded into its packed emergency room.
Pulling these statistics together, meshing them into the sort of whole that describes a year in the life of such a hospital is probably an impossible task. Salomon does her best but she digresses too much. There’s too much about the personal lives of doctors and their families. Knowing about Pam Brier’s clothes, even though she is the head of the hospital, is irrelevant.
Further, the history of the hospital counts—but she omits mention of some of Maimonides’s eminent faculty: David Segal, Arthur Perlmutter, Dressler who first identified the Dressler syndrome after bypass surgery, Adrian Kantrowitz, the brilliant cardiac surgeon who pioneered bypass surgery. These all deserve attention—more than the marital romance of oncologist Alan Astrow and his wife.
The beginnings of Maimonides hospital are worth knowing—but Salomon omits them. How did it get to be what it is today? It used to be an amalgam of Israel Zion (the current Maimonides) and Beth Moses Hospital, which is now forgotten in the bad neighborhood where it tried to make do.
In 1950, my husband was chief resident in medicine at Maimonides. The life then would have been more important for a book like this than details the romance between Alan Astrow and his wife. While Salomon believes in what Astrow is trying to do to bring humanity to patient care, devoting a chapter to him is yet another distraction.
Even the death of Clarence Davis, with which she closes the book, seems another lack of focus to the story of this big, complicated institution.
Like Maimonides itself, Salomon tries hard but the task just seems too tough. When Pam Brier sums up what patients go through, she shows the superhuman nature of Salomon’s task: “You have to have someone with you to take notes, to ark questions, to hear. Even if you take notes, it’s hard to focus…For all the care organized around you, when you’re in the hospital bed, I won’t say you’re dead meat, but you’re really in a vulnerable position.”
Like the patients in the bed, Salomon tries but her story is as vulnerable as the patients are. It leaves you wondering if there are any answers to describing a hospital, especially one as complex as Maimonides.