Saturday, September 6, 2008

A hospital's characters and its stagecraft

It is commonplace to see the drama of the medical profession portrayed in the popular media. But Hospital, a new book by Julie Salamon, is remarkable for the way it captures the life of a hospital in all its confusing, infuriating and inspiring complexity.

For one year Ms. Salamon had virtually unlimited access to Maimonides Medical Center in Brooklyn, NY – its people and its facilities, day and night. Pam Brier, the President and CEO of Maimonides, knew Ms. Salamon was an experienced writer, the author of other books, whose journalism credits include the New York Times and Wall Street Journal. Nonetheless, it took courage for Pam to give a reporter carte blanche at her hospital.

Pam Brier ends up as one of the characters in Hospital. We see Pam on stage, and we sense her presence even off stage. She addresses the men in a mosque to discuss Maimonides’ cancer center. We see Pam in day and night staff meetings as she demands spending cuts. One night she rounds in the emergency department. We overhear her fretting about patient volume. One manager sulks, thinking he’s been ignored by Pam. A doctor thinks she plays favorites.

I serve with Pam Brier on the Board of the New York eHealth Collaborative, but I do not know her well. I was fascinated to see her, through Julie Salamon’s eyes: someone with personal courage, a bit eccentric, plenty of worries, fully engaged in the life of her hospital and its difficult relationships.

But Hospital is not just Pam Brier's story. There are 69 other characters in the book – doctors, nurses, residents, patients, social and community workers, environmental aides, executives. We see them as the author does, as complicated, interesting, flawed, and worthy individuals.

Hospitals are political environments, as are all places where human beings work together and compete for resources, satisfaction, and respect. “Political intrigue and turf wars,” writes Julie Salamon, “were not unique to Maimonides; struggles for space, equipment, staff, and money were part of the hospital life.”

Beyond the politics and the professional jealousies, the book tells something about a hospital's stagecraft. We see the importance of medical record coding, length of stay management, case mix, and health insurance contracts. There are neighborhood politics. There are donor politics. These are unseen forces that shape a hospital world, and they help give this book its fascinating reality.

Despite financial pressures, despite individuals who give or take offense, despite various ethnic tensions, an undercurrent of hope buoys Hospital. At one point Dr. Alan Astrow, Associate Director, Medical Oncology, reflects:
In the contemporary world, when we speak of an invisible hand that drives us, it is often assumed that we are referring to the marketplace and the invisible hand of economic self-interest. But most physicians and nurses, I think, want to see themselves as more than simply one party in a financial transaction. Why do we do what we do? What keeps us going? Not just that we ought to care but why? Faced with a suffering or demanding patient whom we might prefer to avoid, where do we find the strength to enter the patient’s room?
Here is the author herself, summing up:
Depending on the day or night, life in the hospital could seem full of exquisite promise or pointless despair…Yes, individual doctors and nurses behaved badly, sometimes inexcusably so. Clerks were rude to patients and to each other. People made mistakes. Yet I was constantly struck by the sense of urgency that accompanied desires for fairness, for compassionate medicine, for efficiency, for meaning – and yes, for cleaner rooms. Both Pam Brier and Margie Morales (a member of the environmental staff) struggled to sort the unwanted from the wanted, to make the hospital what it should be. They needed their lives to matter.
Thank you, Pam Brier, for giving Julie Salamon the ability to research and write Hospital. I'm not sure I would have been as brave.


marian said...

With all that is swirling around you, I cannot imagine how you find time to review a book. Do you ever sleep?
I will recommend the book to my book club. Please take some time ti rest. I dson't know what CGH would do without you.

Tom Quinn said...

I was at a meeting in NYC this week with two people from Maimonides, one of whom appears in the book. They were not altogether certain they appreciated some of the characterizations in "Hospital." I might feel as they do, were I in their positions. Looking back, five or ten years from now, I wonder if they will feel as critical of Julie Salamon's work.

As to my reading, I do it a page or two or three at a time, each day. I read every day...but just not very much or very quickly.

Thanks for your kind thoughts, Marian.

-Tom Quinn