Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids (Hardcover)

by Julie Salamon (Author)
Key Phrases: crucial conversations, hematologic oncology, new cancer center, New York, Borough Park, Alan Astrow (more...)

Editorial Reviews

From Publishers Weekly
Starred Review. In this remarkable portrait of the doctors and administrators at Brooklyn's Maimonides Medical Center, bestselling author Salamon (The Devil's Candy; The Christmas Tree) illustrates the complex machine that is the modern hospital, vying to provide cutting-edge facilities and compassionate care, while making money doing it. Salamon compares Maimonides to a factory, where medicine is industrialized, streamlined for efficiency and as dependent on skilled administrators as on talented physicians. Located in a Brooklyn neighborhood known for its simmering mix of ethnicities and cultures, particularly its influential ultra-Orthodox Jewish community, Maimonides is insanely busy, with perhaps the most densely packed emergency room of its size. A new resident in obstetrics learns to count to ten and say 'push' in Cantonese, Mandarin, Russian, and at least two other languages that I'm not sure what they were. Administrators juggle budgets, politics and feuding staff while insurance paperwork increases mistakes and steals treatment time. Although it's hard to deconstruct the Tower of Babel when you're standing in the middle of it, Salamon succeeds in providing a completely unique, three-dimensional and compellingly human perspective of the demanding work—both frustrating and rewarding—that is not always apparent to hospital patients and their families. (May 19)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From The Washington Post

Reviewed by David Brown

One thing is clear from Hospital, an account of a year in the life of Maimonides Medical Center in Brooklyn: Running a hospital isn't much fun.

It's a million chores made worse by financial worries, ethnic rivalry, bureaucratic infighting, personal avarice, unreasonable expectations and near constant complaint. True, it also means saving lives, relieving pain, restoring health, serving the truly needy and, once in a while, celebrating the human community in a transcendent way. It's a necessary job, and therefore an important one.

Former New York Times and Wall Street Journal reporter Julie Salamon spent a year taking the D train from her home in Lower Manhattan to the almost century-old, 700-bed hospital in Brooklyn's Borough Park. (It's a symbolic journey, as Maimonides both resents Manhattan's higher-status medical community and is constantly trying to lure stars from it to cross the East River.) The hospital's historical mission has been to serve the Orthodox Jews who make up about one-quarter of the patients. They function (as one person in the book describes them) as "unionized patients." They have their own ambulance service, Hatzolah, that carries as many patients to Maimonides as the city's emergency medical services. The difference is that Hatzolah's male-only attendants stick around to cajole doctors and nurses and try to get their clients seen quickly.

The head of the Emergency Department, Steve Davidson, at one point got into trouble inside and outside the hospital for hiring someone that a Hatzolah coordinator didn't like. This required elaborate fence-mending.

"Later he told me," writes Salamon, "he finally grasped the farcical nature of his situation. . . . Hatzolah didn't work for him, he worked for Hatzolah. How had he missed this salient point until now?"

But serving the rest of the patients is no easier. Brooklyn teems with immigrants, many of them illegal, newly arrived, non-English-speaking, uninsured, medically unsophisticated and ill. An estimated 67 languages are spoken there. Immigrants are now most of Maimonides's patients, both in the hospital and in a network of clinics throughout the borough.

"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," Salamon writes. "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."

This would seem a rich (if difficult) vein to mine, and Salamon chips away at it on occasion. But mostly she spends time with people in the executive suites and department chair offices. They include (among others) the hospital president, a woman who suffered a life-threatening car accident soon after taking the job and had to fight to regain her strength as she fought to establish her power; the thoughtful new head of hematology and oncology, who is determined to have his colleagues and trainees think of the spiritual needs of their patients; the West Virginia-reared head of nursing and hospital operations who carries a Curious George lunchbox as a totem that makes her endless inquiries more palatable; and the vice president for patient relations, a politically savvy former assistant to a New York State assemblyman known in the hospital as "Mitzvah Man."

These people have interesting stories, and they tell them to Salamon, who carries a tape recorder. But focusing the book on them distances us from the more engaging crises taking place every day in the clinics and hospital rooms. It becomes too much an account of administrative events and conflicts described, not observed. And, frankly, there's just too much kvetching.

One wonders how much a part (if any) HIPAA -- the excessively restrictive Health Insurance Portability and Accountability Act of 1996, which governs patient privacy, among other things -- played in steering her away from real-time encounters with doctors, nurses and patients. That's where Maimonides's -- and every hospital's -- real story lies.

There are exceptions. Salamon recorded snippets of clinical encounters in a daily journal, and she reprints some of them in the book. She tells a few long stories as well. One of the more memorable is about "Mr. Zen," a solitary, Chinese-speaking, undocumented restaurant worker with a cancerous tumor that weighed at least five pounds. For various reasons he managed to stay in the hospital for eight months, a symbol of resistance to life's misfortunes, one of which was the hospital's desire to move him out. As he was dying, with more than $1 million in bills racked up, a physician read to him from the Heart Sutra. Although Mr. Zen was an atheist, the doctor, a Buddhist, figured "that was the least I could do for him."

Medicine has lots of honest, hard-earned pathos and no small amount of drama. Not enough of it is in this Hospital.

Copyright 2008, The Washington Post. All Rights Reserved.

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Product Details

• Hardcover: 384 pages
• Publisher: Penguin Press HC, The; 1 edition (May 15, 2008)
• Language: English
• ISBN-10: 1594201714
• ISBN-13: 978-1594201714
• Product Dimensions: 9.3 x 6.3 x 1.4 inches
• Shipping Weight: 1.4 pounds (View shipping rates and policies)
• Average Customer Review: 4.1 out of 5 stars See all reviews (26 customer reviews)
• Amazon.com Sales Rank: #226,132 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

28 of 29 people found the following review helpful:

5.0 out of 5 stars Awesome Book, Read it One Sitting, May 19, 2008

By	M. Warshawsky (Woodmere, NY) - See all my reviews (REAL NAME)

Ok so maybe I am a little biased because I actually work at the hospital where this book was conceived and written.
Seriously though, Ms. Salamon has has manged somehow to give an overview of Maimonides Hospital in Brooklyn that is both accurate and wonderfully descriptive. She has succesfully captured the flavour of Brooklyn and Maimonides in an entertaining yet authentic way.
This is not one of those PR stunts to try make Maimonides famous and rich, rather it is a soul searching account of the most horrendous and uplifting experiences that go hand in hand when an urban hospital meets multiple cultures.

At the end of the day it is a book about human emotions and human deficiencies.
Ego and humility, arrogance and compassion mixed with a healthy dose of back stabbing and genuine love for humanity.

Highly recomended.

21 of 21 people found the following review helpful:

5.0 out of 5 stars A powerful case study of our baffling health care system, May 24, 2008

By	A. Harmon (Los Angeles) - See all my reviews (REAL NAME)

That Maimonides Medical Center granted this writer such unfettered access to the institution is indeed astonishing, and Salamon does not squander the opportunity. What she finds is a health care pressure cooker: Ludicrous insurance protocols, cultural divides among patients and an exhausted staff prone to ego and petty feuds, and sometimes profound compassion.

But General Hospital melodrama the book is not. What I found instead was an illuminating portrayal of our broken health care system, without the gross oversimplification that presidential political campaigns are apt to use in endless sound bytes.

Salamon's prose is at its best when she documents the experience of Maimonides cancer patients--real people in pain, often lacking insurance and citizenship, praying for miracles and avoiding the awful truth as best they can. Salamon thankfully avoids turning these tragic stories into overwrought narrative thread. Her voice is simple and frank, and therefore irresistible. A powerful work.

15 of 15 people found the following review helpful:

5.0 out of 5 stars Send Me the Sequel, May 27, 2008

By	C. B. Terrigno (Wilmington, Ohio USA) - See all my reviews (REAL NAME)

I purchased this book for my children to give to their father on Father's Day. He trained at Maimonides when we were newlyweds and I thought he would enjoy receiving it from his sons who were born there in Brooklyn.
I began to glance through it and I was compelled to cancel my appointments and read it completely. Wow, the memories came flooding back to me.
In the early and mid eighties, we spent a great deal of time interacting with a group of people who were foreign to me in both physical and spiritual identity. The Orthodox Jewish community provides an integral part of her story and it is fascinating.
Like the author, I am from Ohio. But, unlike Ms Salamon, I had no idea who Maimonides was and why would he have a hospital in Brooklyn named for him? It was a life-altering experience for me to learn the differences between various New York cultures and and this is the insight Ms Salamon provides throughout this book.
The reader becomes enthralled with the personalities of the physicians, administrators and staff and Ms Salamon is concise and accurate in recalling events that establish their identities. However, it is the wrenching descriptions of actual procedures as well as the reactions of young and terminally ill patients that keeps this book from becoming another hospital tell-all.
I am very impressed with this book and I greatly anticipate reading her earlier books and essays.