Hospital

by Julie Salamon

  Brezenoff told me Altman would be the best person to help me sort out the Bashevkin-Kopel feud. When I asked her about it, she looked pained. “I would hate to say it was about money,” she said. “It’s really not about money, though you could say it was all about money. But it wasn’t.”

  She spoke of the two doctors as men who were passionate about their profession and purpose but who were different types. “Dr. Bashevkin is emotional about every one of his patients. Dr. Kopel is very scientific about what needs to be done. What does the data support, what does research support and that’s what the patient will have. Dr. Bashevkin combines emotion, heart, soul—his entire being. Dr. Kopel is very brilliant but very rational, scientifically makes the decisions about what needs to be done. Never underserve. Never. Standard of care is always made, state of the art. But you have to know Dr. Bashevkin to understand the difference. I run a home infusion company. If ever I take care of a Dr. Bashevkin patient, he [Bashevkin] will show up at the door to do the delivery, he will come here to pick up the supplies, because he is planning on putting in the intravenous line and being the nurse.”

  Altman had a slight Israeli accent, which gave the suffering in her voice a special authenticity. How could these men not be convinced by her? I thought. They must be really, deeply angry.

  “He doesn’t stand on protocol,” she continued, about Bashevkin. “He doesn’t care what other patients receive or what the system normally does. He wants to do what he thinks is right. He will pick up the solutions, run to the patient’s home, he’ll be there, he’ll call. Dr. Kopel knows there is a system out there. We have twenty-four-hour on-call service, nurses, respiratory therapists; he realizes existing systems are there to provide the care to his patients. He’s not wrong. State-of-the-art standard of care is met this way in this country.”

  Yet when Altman described how Kopel tended to both her parents, both of whom died of cancer, she focused on his attentiveness. “He was very supportive,” she said. “He did everything; from house calls to everything he would never admit to doing, he did. I am indebted to him. He is really one of a kind. When he believes in something, he does not care for personal gain. Finances to him are not important. But in the real world finances are important to a lot of people.”

  Her dark eyes glistened; maybe it was my imagination, but I thought I saw a tear.

  “Sam views the world as right and wrong,” she said, shaking her head. “He’s definitely a right-and-wrong kind of person. He had strong convictions and he’s very selfless when he believes in something. If you told him this cancer institute will only be successful if he does not draw a dollar from it and use all his savings, he would say, ‘No problem!’ He is selfless and very much a moral crusader. He will do what’s right. People like that, there aren’t too many of, and that’s the issue here. It doesn’t make the other people bad. They have a lot of financial burdens, they have more children, Orthodox people do; they have large families. They were unbelievable doctors, they still are. Dr. Bashevkin is selfless but is in no position to work for little. He has quite a few children. His partner Dr. Liebowitz has been married twice, with children, responsibilities. These are real-life situations. You can’t just do one thing without doing the other. Everybody could be happy. But the criteria would have to be established before you embark on a new program. That’s where it came apart.”

  She sighed. “Sam believed what they were doing was something very important, very great, very necessary, and he had ethics on his side. Justice was on his side, and in his mind that’s what counts, that’s the way he operates. What’s right! But I live in the business world and what’s right can only go that far. You’ve got to work with people. And compromise and negotiations—or all of us would be out of business if we only dealt with what we believe is right.”

  Why had they come to medicine? Bashevkin grew up in a small town in Massachusetts, via a typically convoluted sort of Jewish-immigrant story: A grandfather who came to the United States for pleasure, started a junk business in Sioux City, Iowa, stopped in the Berkshires to say hello to family, and met a cousin who became Bashevkin’s grandmother. They stayed in the small New England town of North Adams, where the grandfather sold coal and grain for chickens. Then people stopped using coal and raising chickens so the business became the wholesale grocery that financed a medical education: feed man to physician in two generations.

  Bashevkin’s interest in medicine may have begun with his asthmatic mother; he remembered being impressed with how immediately she improved when the doctor gave her a shot of adrenaline. In high school he worked as a nurse’s aide at the local hospital. “You have no idea how good that was in terms of understanding the idea of how that job should be done,” he told me. “Back then they had the real New England battle-ax nurses. I used to have to wash patients and make their beds, and I still remember Mrs. So-and-So would come to my patient, stick her nose in the patient’s armpit, and say, ‘You call that clean?’”

  “She’d come, you had to get the patient out of bed, and if he wasn’t, she’d ask, ‘Why isn’t the patient out of bed?’ Now if I want to get the patient out of bed in the hospital, I put in an order, it doesn’t happen, I ask, it may or may not happen, finally I yell and scream, it happens.”

  He had been raised with an allegiance to his religion—his mother kept a kosher home—and he felt compelled to study further and attended yeshiva, then New York University’s medical school. He always had an impulse to do good, but he was not inclined to practice medicine as social policy. He simply wanted to be a good doctor for his community, which he chose to define largely as Orthodox Jews like him.

  Kopel represented a different set of ambitions. He was a justice seeker and a mischief maker, a competitive man of many parts. When he and I talked the day after the interdisciplinary meeting, and I told him I’d spent the rest of that day watching Astrow with patients, Kopel wanted to know how many patients Astrow had seen. When I said about a dozen, Kopel brightened. “You should follow me around,” he said. “I see about thirty in a day. I’m like a ballerina.”

  We had many conversations in his two offices, both small, one in the cancer center and the other at the main hospital, a mile away, on the second floor of the Eisenstadt building, where the top administrators were clustered, and where Kopel often held wine tastings on Friday afternoons. Both offices contained a large collection of CDs, mostly opera; family photographs; and memorabilia that reminded Kopel of Great Barrington, where he and his wife had a summer house—close to Tanglewood and music.

  Like Bashevkin, he had also studied in a yeshiva; Sharon—his wife, his college sweetheart, his first real girlfriend—taught science in a Jewish school for girls. But he declared himself a happy pork eater. He had almost flunked out of Brooklyn College, he said, because he spent so much time demonstrating against the Vietnam War and listening to Dylan and the Beatles and smoking dope. But he parted company with his fellow radicals in 1967 after the Six-Day War, when the left denounced Israel. He married Sharon, and their only daughter was born in Bologna, during Kopel’s medical-school years in Italy, a happy period that left him and his wife with a fondness for all things Italian.

  Unlike Bashevkin, who could comfortably talk about family roots, who could locate his place on a page in American history, Kopel had an autobiographyfull of missing chapters. Though his passport said he was born in Mława, Poland, when he asked, his father told him, “You were born in bed, now shut up.” Relatives said he was born in Russia. His mother said only that she carried him on foot from somewhere in the east to Germany, where they stayed with relatives while his father recuperated from amputations (one foot and part of another) and tuberculosis. The family reunited in a DP (displaced persons) camp, an hour south of Munich, with a picturesque name, Föhrenwald, “fir tree forest,” and a clear view of the Alps, which lay to the south. Föhrenwald was the last of the DP camps to be shut down after World War II, in February 1957. The Kopel family was there until the end. Their U
nited States visa had been delayed, Kopel believed, because his father was an amputee.

  Toward patients he was brisk and straightforward, and could seem unemotional (though he kept his home telephone number listed so they could reach him). He saved tears and sighs for opera, safe entry into his well-protected heart. Just as vividly as he remembered his first infatuation with Sharon, he could place his initiation into Verdi.

  Kopel lit up when I asked him about opera. “As a kid I would watch the Ed Sullivan Show and someone like Mario Lanza would come on and I’d go, ‘My God!’” he told me. “Something about full-throat opera singing struck me. But at college I was about Dylan and the Beatles and the Band. That’s what I would listen to while smoking dope. Opera started, I can actually place it: I was a resident at Brooklyn Jewish. I was driving down Flatbush Avenue, the radio tuned to WQXR, and Beverly Sills comes on singing ‘Sempre libera’ from La Traviata and it was so great I had to pull over.”

  As he talked, I stared at a photograph on his wall, of a younger him, not that much different, a little more hair, smoother skin, leaning conspiratorially toward an attractive brunette—Sharon, his wife, smiling, confident—on his fortieth birthday. Was he telling her a secret? I asked him. That’s what it looked like. “No,” he said, “I was about to kiss her.” That Sharon was full-faced, rosy, a little fleshy; not like the thin, gray, sick woman who showed up at the hospital periodically for chemo treatments. The eyes were the same, though. Sly, provocative.

  “You know she’s a striver, that she’s good, that she is doomed by illness,” Kopel was saying. He was talking about Violetta, the main character in Traviata. “In the first minutes of the overture. Those high violins, those dissonant notes, go home and listen to it. That is a musical depiction of tuberculosis, of disease. It’s perfect.”

  His initial interest in starting a cancer center, in the early 1990s, was purely professional, a desire to implement at Maimonides the idea of multidisciplinary cancer care that had emerged in the 1980s. An ambitious surgeon named Rene Khafif recognized the financial potential, and he and Kopel drew up a business plan just as Brezenoff came in. The potential may have been there, but the new president said no, unable to justify making an investment that would take years to recoup at a time the hospital was in financial trouble. By then, Kopel was medical director, part of the administration, and he took Brezenoff’s side. Khafif left Maimonides and sent Kopel a letter, accusing Kopel of not fighting for something that would provide better patient care.

  That goad alone would have been enough to trigger Kopel’s competitive instincts. But additional, painful incentive came later that year. In August 1996, Sharon felt a lump in her breast. A biopsy was pronounced negative— the wrong diagnosis, it turned out, a too-common oversight with youngish women with dense breasts. But a second biopsy was deemed suspicious; she had an extensive lumpectomy and then radiation.

  Even with Kopel, the medical director, pulling strings it took six weeks of utter frustration to get Sharon’s treatment organized. He didn’t need La Traviata to touch his emotions then, from this new vantage point on the other side of cancer treatment. Watching the psychological toll on his wife, he said, he now saw the radiation therapy room as a “disgusting little hellhole.” He became determined to resurrect the cancer center dream. Finally, when the hospital reached financial stability, Brezenoff agreed, though he would leave Maimonides and Brier would become president before construction began.

  On the very day the groundbreaking took place, on September 26, 2003, Sharon Kopel received a new—more ominous—diagnosis. Kopel knew she might not live through the time the construction would take. But she was very much alive, though she had been too sick the day of the official opening in May to leave the house. Sharon was tough, and told Sam she planned to be there for the next dedication, of the Lena Cymbrowitz Pavilion, scheduled for the end of September 2005—and she was.

  After I had been hanging around Maimonides for several weeks, I bumped into Astrow near the front entrance of the hospital. By then I recognized the expression on his face, just as I had become accustomed to noticing the difficulty he had keeping his shoelaces tied. He looked worried. As the usual Maimonides mix of rebbes, women wrapped in hijab, and various others walked by, I said, as a joke: “You must feel like a stranger in a strange land.”

  Astrow snapped. “Don’t call me Moses.”

  I was startled by his vehement, almost angry, response, because he rarely showed anger. When I first met him, he told me, “I’m almost pathologically concerned about saying things that will be hurtful to other people.” It hadn’t taken me long to discover why his patients loved him: That compulsive worrying was an admirable trait in the person in charge of your destiny. He had empathy to spare. By then I had watched him reveal the most hurtful facts to terminally ill patients, but in a manner that mitigated the harm as much as humanly possible. He practiced what he preached: “Medicine should not be caveat emptor. You should be watching out for the patient.”

  When I invoked “stranger in a strange land,” I had been referring to the science fiction novel with that title by Robert Heinlein. Astrow went straight to the source, Exodus 2:22. This biblical passage takes place after Zipporah, the wife of Moses, gives birth to their son, whom Moses names Gershom, derived from the Hebrew verb garash, “to drive out,” referring to the Israelites’ exile in Egypt. Moses explains, “I have been a stranger in a foreign land.”

  Later, during another, calmer conversation, I asked Astrow why he’d reacted so strongly.

  “Moses in the Torah, he had a direct relationship to God,” he said. “He’s seen as the person who’s supposed to solve every problem and ends up being lonely and isolated. I’m not God, I don’t have a direct relationship to God, and I don’t want to end up lonely and isolated. That’s one reason.”

  The other reason was my fault. I had told him that Pam Brier had heard him speak at a cancer center gathering and said she thought he was “luminous.”

  What I thought would be reassuring turned out to be fuel for more worry.

  “I got in a lot of trouble, I think, at St. Vincent’s for being seen as this spiritual ethical person,” he explained. “If you’re seen as a little too interested in religion and spirituality and ethics, you’re seen as a nice boy and not a particularly effective person, and if you have a real problem, you go to someone who is a tough person interested in power. This nice one is seen as just interested in ethical issues, who nicely just puts a window dressing on everything, but that’s not the person you go to if you really have a problem. I think I got into problems in that way at St. Vincent’s and was underestimated as a result. I think I really have to watch that.”

  I said, “I don’t think she meant it that way.”

  He replied, “It’s like being seen as a nice Jewish boy.”

  “God forbid,” I said.

  “It’s problematic,” he explained. “If you’re seen as being too nice, you cannot accomplish very much. You can’t be too nice. You can be honest and principled and respectful of other people, but that doesn’t mean you can’t make a decision and tell people when they aren’t doing their jobs and be effective. That’s your job.”

  World-class worrier that he was, he couldn’t finish the conversation without completing his thought. “Seeing yourself in terms of Moses is also being totally grandiose, isn’t it?” he said. “I was talking to my wife about this. If you really want to do anything, if you want to accomplish anything, you have to be slightly grandiose. If you’re writing this book, you must have some grandiosity behind it, large ambitions—you probably have large ambitions for every book. However you fantasize, it never turns out quite the way you fantasize. You haven’t really transformed the universe. But that’s what keeps you going. When people point out your grandiosity, you can feel a little bit foolish about it.”

  He laughed. “That’s the Jewish religion! Our hero is Moses, who has a direct relationship to God, and we’re supposed to look up to Moses a
nd aspire to that somehow, but then Moses is praised for being very humble. He speaks directly to God, but he’s the everyday Joe; he’s very humble. Well, I’m not Moses.”

  Then he smiled and said slyly, “Of course my father’s name was Martin, and his name in Hebrew was Moses—Moshe.”

  It was the kind of discussion people had at Maimonides—at least those who thought about such things—the hospital named for the man who was, for Jews, the other Moses. “From Moses to Moses,” the rabbis said, tracing the line from the receiver of the law to the codifier. But the biblical Moses— the dashing man of action who defied Pharoah—was the primo Jewish leading man, not the bookworm Moses—Moses ben Maimon, Maimonides, the medieval philosopher and physician. Moses the Egyptian slayer may not have been Hollywoodized as many times as Jesus, but he was indisputably an icon, both religious and pop. The Ten Commandments had remained a perennial favorite for half a century, televised each year around Passover and Easter. The story had legs. Who doesn’t know some version of it? Moses led his people out of bondage and became spokesman for God. What a hero! All the more compelling because he was flawed—human—subject to miscalculations in carrying out divine will, his honorable intentions frustrated by ego and impatience. In the end he was ordered by God to pass the torch, before his journey was completed, to his successor, Joshua.

  Speculating about Moses in the context of the hospital and the cancer center, it wasn’t Alan Astrow who brought to mind the uprooted child who became a dogged, uncompromising warrior, the man who led the people to the Promised Land but then was forbidden to enter. Maybe the more fitting surrogate was the behind-the-scenes man, Sam Kopel—the medical director who had willed the cancer center into being but whose feud with Bashevkin was damaging the new enterprise. “I feel I have a life sentence here at Maimonides,” Kopel once told me. “I love it and hate it.” No matter how much he achieved, he remained the displaced person, the immigrant boy who spent most of his life feeling rootless, stateless, not belonging anywhere.