Hospital (11 page)

“Sometimes it makes me crazy,” said Sam Kopel, a major Cooper supporter. “It’s hard for Jay, with all his accolades, to get himself to go to some Brooklyn doctor’s office and say, ‘Hi, I’m Jay Cooper. I’d like to help you.’ Alan Astrow wants to. It doesn’t come naturally to him because he’s shy, but he’ll grit his teeth and do it, and I’m proud of him for that. Jay is an intellectual elitist and it’s got to be exactly right, exactly coherent, and he will be glad to explain it to you ad nauseam. I do think he recognizes that’s exactly the wrong approach when you want to go to people to get them to refer to you. You’ve got to be humble; you’ve got to be friendly. Jay can do that but he can’t overlook anything.”

Kopel had been instrumental in bringing Cooper in as a consultant when the hospital was still hoping to recruit a surgical star—as Brezenoff had wanted—to be director. But when the surgeon that Cunningham had been pursuing decided not to come, Cooper was the obvious choice. His medical and academic credentials—significant publication, membership on national committees—were impeccable, and his punctiliousness was invaluable in a branch of medicine that required the use of toxic drugs and dangerous machines. And he was available. Still, Brier told me she had been uncertain about making Cooper the head of the center and almost let him go before he stepped into the position. Leadership required more than mere brilliance, and she was concerned that Cooper would become “too mired in the details.” Her feelings were a carryover perhaps from their old association, when Cooper ran radiation at NYU and Brier was president of Bellevue. The two hospitals—one private, one public—shared residents and supervisory medical staff, but Bellevue, refuge of the have-nots, was the poor relation, like the sister who didn’t marry money.

Cooper almost dropped out because of Brier’s reluctance to give him what he wanted. He was insisting that radiation oncology should be a separate department, as it was in most medical centers. Brier wasn’t keen to establish another department, afraid of offending other physicians in the hospital. On the Friday before July Fourth weekend, a year after Brier’s accident, they had a testy meeting. “I very clearly told her that was her decision, but unless it was a department and I was assured it was going to be a department, I wasn’t coming, and she understood I was serious,” said Cooper. He was even more upset when she told him that Brezenoff couldn’t remember making such a promise and that nothing was in writing.

Kopel bumped into Cooper as he left the president’s office. “He had a very dark look on his face,” Kopel told me. “I asked him what happened. He said that he was on the verge of kissing this entire project good-bye.”

Kopel stayed on the executive floor that afternoon, waiting to catch Brier before she left for the weekend. “I was quite beside myself,” he said. “I told her that she might have just extinguished the only legitimate star in our firmament. She didn’t quite see it that way but promised to think it over. Luckilyfor us, by the beginning of the next week, to her credit, she called Jay to apologize.”

After that, Brier made a point of being respectful to Cooper, and he reciprocated. He did not like being reminded of that heated moment. “That story gets repeated and repeated and repeated,” he told me tensely. “It wasn’t as if Pam and I were yelling at each other or disagreed with each other. It was Pam telling me her understanding of what had happened. My making very clear to her my understanding of what had happened.”

Back in the nineties, when the cancer center was a notion not a plan, both Brezenoff and Kopel had thought the perfect person to be director of the cancer center would be Estee Altman. Altman, a pharmacist by training, ran Infusion Options, a for-profit subsidiary of the same holding company that owned the hospital. Infusion Options provided intravenous therapies— antibiotics, nutrition, chemotherapy, pain management, fluid, and catheter care—for patients at home, as well as nursing care and equipment. Infusion Options also mixed the chemotherapy drugs at the cancer center.

Altman, who was a friend of both Bashevkin and Kopel, had both business acumen and diplomatic skills. She also happened to be a beautiful woman—the hospital’s Jewish Grace Kelly, someone called her—not because she was a blond movie star-turned-princess but because she was slender, beautiful, regal, and touched by tragedy. Altman’s parents were Holocaust survivors. On the day I talked to her in her small crowded office near the cancer center, a delivery of flowers came for her, an anonymous gift welcoming her back from a trip. She accepted them with gracious delight but also gave the impression that flowers came her way often.

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 United 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.