First do no harm

THERE ARE no cuddly characters in "Hospital," Julie Salamon's year-in-the-life account of a big-city medical institution. Which is how it should be: The doctors, nurses, social workers and administrators of Maimonides Medical Center in Brooklyn's Borough Park neighborhood are focused on keeping patients, and the hospital itself, alive, not on conforming to medical-drama stereotypes of gruff healers with hearts of gold. So one can only feel for the Maimonides staff when Salamon shows up, a writer shadowing busy health practitioners not so much to understand what they're doing as to expose their failings.

Salamon, a journalist of undeniable gifts and author of "The Devil's Candy," the inside story of the disastrous filming of Tom Wolfe's "The Bonfire of the Vanities," has a keen eye and an acute ear, both on display here. Describing the hospital president, Pamela Brier, guiding a tense budget meeting, for instance, she writes: "When Brier spoke, her voice was steely, but underneath the table one slender leg was bobbing with nervous energy." It was Brier who invited Salamon to Maimonides, granted her access and encouraged the staff to cooperate with her. But Brier, a talented executive who clearly gives herself body and soul to her duties, seems dangerously unfamiliar with what Graham Greene said was the writer's true calling. "The job of a writer," he warned, "is to betray."

Despite the fact that Brier is the successful leader of a competitive New York City hospital, where she contends with easily bruised egos, community tensions, runaway expenses and local politics (and with the aftereffects of injuries she sustained in an auto accident shortly before taking the job), Salamon wants us to see her as a bit of a nut case. In meetings, Brier "would get up while someone was talking, walk to a cabinet, pull out a bag of popcorn, and pour it into bowls." Is that such a heinous offense? How about this one: "During a telephone call with a fellow hospital president, she might make a truly odd pronouncement, like, 'I want you to know I'm considered one of the great constipation experts in the borough of Brooklyn.' " Never mind that 200 pages later Salamon provides the context that makes this statement less an "odd pronouncement" than a caring, if tongue-in-cheek, admonition to a hospitalized colleague.