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First do no harm

Hospital Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids Julie Salamon Penguin Press: 382 pp., $25.95

May 18, 2008|Jesse Cohen | Jesse Cohen is the series editor of "The Best American Science Writing."

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.

No doubt Brier reasoned that a book on Maimonides could showcase the hospital's achievements, such as that it rates a top ranking by the Joint Commission on the Accreditation of Healthcare Organizations or that it delivers more babies than any other hospital in New York state or that it boasts a first-class cardiology department. For Brier, all this is about more than bragging rights -- it's about convincing Brooklynites that they don't need to travel to Manhattan to get the best care. Of course, not wanting to see those healthcare dollars leaving Brooklyn is a part of the calculus too. But in Salamon's eyes, that isn't enough motivation: "Like the Brooklyn clerk played by John Travolta in 'Saturday Night Fever,' the hospital administrators understood that they were perceived as something less because they sat on the wrong side of the East River."

This complicated set of considerations led to Maimonides' decision to build the borough's only comprehensive cancer center. It was a way to relieve Brooklyn cancer patients from making an arduous trek to Manhattan as well as to reap the financial benefits that would come from the higher reimbursements paid by insurers for advanced treatments. And, by Salamon's account, to play in Manhattan's league. To do so, Maimonides persuaded a Manhattan oncologist, Alan Astrow, to cross the river and head the center's hematological oncology department.

The first year of the cancer center gives "Hospital" what little narrative arc it has, and Astrow is enlisted to play the lead. But one can well understand why he seems to shrink from Salamon's embrace. Astrow has a full plate: Not only is he making the transition to a new workplace, in a new division, whose political links to its parent institution are still being forged, but he is also leading a department for the first time in his career. Salamon's dogged presence can only have upped the degree of difficulty, and he pushes back when Salamon greets him with a glib remark ("You must feel like a stranger in a strange land"); he resents the comparison to Moses. Somewhat cluelessly, she reports feeling "startled by his vehement, almost angry, response." Later, she undercuts him by quoting one of his residents, who characterizes him as a "very nice guy. . . . He's just weak."

All of this made me want to shake the hand of Joseph Cunningham, the hotshot surgeon who once ran the hospital's thriving cardiothoracic surgery department. Like many surgeons, he exudes swagger, even arrogance, but also the confidence and singleness of purpose that would inspire any sane person who needed heart surgery to turn to him. He refuses to play Salamon's game.

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