Hospital (30 page)

“Let’s go,” she said. We walked down several hallways and took an elevator.On the way I asked her what she thought was the biggest difference between being a doctor in the United States and in India.

She smiled.

“Back home my sister works for a veterans’ hospital. When she goes shopping or to the movies, they look at her as the doctor and they bring her free sodas,” she said. “She is treated like a celebrity.”

And in the United States? I asked.

She laughed. “Here, no.”

We arrived at the ICU. A pale, bony resident with beard stubble and a Russian accent told her that someone from renal had seen the patient, but he wanted a hematology consult because the old man was anemic and had spiking fevers.

We went to see the patient. His throat was swaddled in bandages; he’d had a tracheotomy, a hole cut through the skin at the neck into the trachea (breathing tube) when someone is unable to breathe without help. His eyes were wide open but revealed nothing.

Nakka introduced herself and began to ask questions.

A young Orthodox Jewish nurse, wearing gloves as she examined the settings on machines, said, “He doesn’t speak English.” Nakka walked out to the nurses’ desk and called out, “Anyone speak Chinese?” A tall young Asian man said, “Give me a minute.”

David Kho entered the room a short time later. The patient fixed his eyes on the tall young doctor with the Asian face as the doctor interpreted Nakka’s questions: “Have you had anemia before? Have you been treated with iron tablets?”

The old man couldn’t speak because of the tubes in his throat, but he nodded and blinked.

“Did you have a transfusion before? Did you ever smoke? Any family member with anemia or cancer?”

The word “cancer” popped out from a stream of Chinese. The old man looked frightened, though interpreting emotion is even trickier than language, especially with someone breathing through a hole in his neck. Nakka made notes in the patient’s thick chart, observing that his skin was oozing, his extremities were swollen. Was he suffering? I asked. She said he was taking morphine, and then ordered several tests.

David Kho, the resident interpreting for Nakka, told me he would be glad to talk to me later. When we met, he told me he had been born in Singapore and moved to the Bay Area of San Francisco when he was nine. He had been willfully oblivious to his Chinese heritage. “You just wanted to fit in,” he said, “just to be a regular Joe.” His father was a biochemist and his mother an accountant—not quite regular Joes. “I tried very hard to fit in,” he said. “You lose a lot of your culture and your heritage as a result of that, to be assimilated. It’s not something you see as a strength, to be able to speak other languages.”

Being at Maimonides was, for him, part of an awakening that had begun when he was a medical student at the Columbia University College of Physicians and Surgeons, working in the clinics in poor neighborhoods. Most of his classmates were like him, well-to-do, confronting poverty for the first time. The school made a big effort to integrate the students. They ate meals with host families, worked in the clinics. They were taught statistics and theories about why blacks and Hispanics were excluded from good health care. They understood the reasons: No insurance. Poor access. Language. Yet few of the medical students spoke passable Spanish.

“To see it happen at a world-class institution where people come from all over the world to get treatment and people who live two blocks away can’t get care, that’s something else,” he said. “To see it right in front of you is pretty powerful.”

His experience there made him think about being Asian. “Being Asian and what have I done for the Asian community?” he said. “Which was absolutely nothing.” He came to Maimonides hoping to reconnect with his roots, which he had done with mixed results. “When I was a kid, it was a curse to be different. I wanted to be the same,” he said. “Now, all of a sudden, this is, ‘Wow, you’re so special; you speak so many different languages.’ For me it’s odd to integrate all these experiences together.”

Though many young doctors were perplexed or offended by the demands of the Orthodox, Kho appreciated the powerful urge to protect one’s own. “To me a place like Maimonides arose because the Orthodox or Hasidic people said, ‘They’—other people—‘don’t understand anything about Shabbos. We’re going to build our own hospital.’ It’s odd, crazy that a minority group, albeit a very influential and powerful one, were able to organize themselvesto build a hospital to cater to those needs. It seems that’s how it’s going to have to be until everyone’s on equal footing to get medical care.”

Kho was a sophisticated and sensitive man who had been trained in the gospel of Arthur Kleinman, the Harvard medical anthropologist. In medical school at Columbia, Kho had heard lectures on cultural competence, ethics, and philosophy. He had studied the biases that could distort communication between patient and physician.

For David Kho these questions weren’t academic. His wife was half Jewish, half Catholic, had grown up in Puerto Rico. He met her when he was doing research in Boston, before medical school. They both were accepted to the College of Physicians and Surgeons and married while in medical school. He learned Spanish, he said, “in recognition of her heritage.” The perfect Maimonides couple.

He was gratified by the efforts Maimonides was making to hire Chinese-speaking doctors, nurses, patient reps, and social workers. Yet despite all these efforts, he wondered how much improvement there could be in health care for new immigrants without their assimilation. “Just to hear about the cultural mind-set of patients when they come into the hospital is crazy,” he said. “A lot of cultures don’t have the concept of preventive care. They don’t go to the doctor unless they’re deathly ill. That’s the way the Chinese community is. We throw all this money at it—and that’s a good thing, to have people who speak the language and understand the culture. But it’s only half the equation. If the patient has the mind-set ‘I’m only going to come to the doctor when I’m on my deathbed,’ then they are going to die. I can’t see that patient reps or having doctors that speak Chinese or making inroads in the community will change the mind-set of these people,” he said. “The only thing that will change the mind-set is themselves. More education. Whether the something that is preventing them from coming is our point of view or their point of view, it is reality.”

He seemed like someone who could cross the gap. But when I asked him his long-term plans, he looked sheepish. He wanted to be a radiologist, he confessed and explained why. X-ray scans could be beamed anywhere on earth via computer. He spoke with envy about a world-renowned radiologist who lived as a recluse. Kho’s dream was to move to Hawaii and read X-rays on the beach, far from patients.

“Patients break your heart,” he said.

For some time I had been trying to talk to Davey—feeling guilty for pestering him. I could see from his e-mails he was exhausted. But we all had our jobs to do.

When I finally found him, I tried having the multiculturalism conversation with Davey in the ER. Big mistake. Hard to deconstruct the Tower of Babel when you’re standing in the middle of it.

“The whole term ‘multiculturalism’ has always been kind of weird,” said Gregorius as he scanned the computer screen looking for his next patient. “You don’t have to define people all living together. It happens anyway. It’s probably been going on forever, and in the last twenty years or ten years they’re saying, ‘Oh, we’re multicultural now.’ We always were multicultural. So I don’t know. People are just bringing attention to the fact. ‘Oh, look at us, we’re doing great stuff.’ I’d have to think about that one.”

He raised his eyes for a second and gave me a pleading look.

“My girlfriend, Jenn, is here, visiting for a month,” he said. “She’s ten times smarter than I am. Want to talk to her?”

Sure, I said.

He pulled out his cell phone and called.

“She’ll meet you in the lobby, where the ATM machine is,” he said. “She is five ten, blond, pretty, she’ll be wearing a black puffy coat, jeans.”

“That’s enough,” I said. “I’m sure I’ll find her.”

Jenn Pfeifer sounded like just another attractive young woman in Los Angeles—or Manhattan, for that matter. In Borough Park she would be as hard to spot as a pink flamingo trying to go incognito in a flock of geese.

We walked over to a nearby bagel shop where young Orthodox neighborhood matrons—no older than Pfeifer—hung out wearing long, shapeless skirts, their hair tucked into wigs, chatting while their babies lounged in strollers. Like many of the kosher food places in the area, the shop had décor that was functional, like the basement social hall in a church or synagogue without an endowment. You came, you ordered, you sat, you ate. The women were diverted for a minute by Pfeifer and then went back to their conversations.

She noticed their reaction. “I come out to visit about every month,” she said. “In the summer when I first came out, I went running around Borough Park in my little running shorts, and it was a very weird experience. I was just doing what I’m used to doing. Walk out the front door in Santa Monica and you go for a run and you pass a dozen people doing the same thing. You’re not used to being the person who sticks out like a sore thumb.”

Maybe it was the way she ended her sentences with question marks, but she seemed oblivious to her own slightly crooked beauty. When she told me that her last name was Pfeifer, I said, “Like Michelle?” (The movie star.)

“Yes,” she said, “only with two
f
’s, not three.”

“You must get that a lot.”

“Yes,” she said. “Isn’t it ridiculous? She’s probably the most unique-looking person on the planet. I don’t look anything like her.”

Her modesty wasn’t false, but she was not an accurate judge of her own appearance. The comparison to the beautiful blond actress wasn’t as ludicrous as Pfeifer insisted.

I told her about my visit to the ER that morning. “I was following Dave, and first he checked out this skinny little Jewish man wrapped in his phylacteries, and next to him was an eighty-year-old man from Trinidad. Has he talked much to you about what it’s like for him?”

She swallowed a bite of bagel sandwich.

Jenn’s diagnosis:

“It’s pretty difficult,” she said. “Did you get his e-mail about learning to count to ten when he was doing ob-gyn rounds? He learned to count to ten in Mandarin, some words in Russian, probably can’t remember any of them now, but at the time he could do that. It’s a frustrating experience to feel you’re competent at doing something but then all of a sudden the language barrier is in the way and you can’t do what you know you can do. Sort of disempowering.”

As she talked I could see she was preoccupied by the logistics of their relationship. He had two and a half years to go in his residency, and he was always tired. She was considering trying to transfer to Columbia or NYU, so they could live in the same city—something they hadn’t really done.

“He calls me every day and makes all this effort, but he’s missing the energy that he had a year ago,” she said sadly. “The exhaustion is breeding some sort of apathy. You’re so tired you don’t want to make yourself feel better about anything. Then he gives these temporary glimpses into something being really good, really elating. He tells me about cases he has that sound so exciting, pretty awesome, miraculous. But then it immediately gets squelched by the day-to-day reality of, ‘Oh, I have to go back in there again, and I’m really tired, and I’m losing weight.’”

He was disappointed by his first performance review. Marshall had told him, “You’re doing fine, but people are worried you’re a little too laid back.”