Hospital (43 page)

He prepared a detailed history for the NYU doctor:

Sharon had described her progress under treatment. “The first few treatments were pretty good, because I weighed 182 pounds, so I looked healthy for a while,” she told me. “Then the heavy-duty vomiting started. I swear to you, one morning I looked in the mirror and I was green and had no hair and the clothes were hanging off me and I was scared. I looked like a concentration-camp victim. Not a survivor, but a victim.

“We tried four or five treatments,” she said. “Should I count the ways they’ve been trying to kill me? The first one I had my head in the toilet. Then I had a pulmonary embolism. They got me to the hospital, and I felt, ‘This really is the end.’ Little did I know bigger and better were in store for me.

“They took me once to the hospital in an ambulance, because Sam couldn’t wake me up,” she said. “I had gone into diabetic shock. That was a horror. I didn’t know what was happening. Vomiting, rashes, dizzy, then nonstop diarrhea. Why do people do this?”

I asked Sam whether he thought Sharon was prepared for death.

“She was always asking me if there was something else to be done,” he said. “But she was prepared.”

I asked him about the concept of “the good death.”

He replied without hesitation. “The dignified death is a myth,” he said flatly. “Unless you just keel over and drop dead, and there’s not much dignity there either. People dying of chronic illnesses like cancer or Alzheimer’s, it’s an awful process. Evolutionarily, the body wants to keep going. The struggle can be mitigated by judicious use of medications and not overdoing the medical procedures. But it’s always a struggle.”

On the day of Sharon Kopel’s funeral, after finishing my milky tea at the Chinese bakery, I went back into the rain and continued up Eighth Avenue to the cancer center. I found Nella Khenkin, the cancer center’s social worker, in her small office filled with books and paraphernalia—wigs, makeup, pamphlets—meant to help cancer patients deal with the indignities of treatment. A full-bodied woman of fifty, Khenkin had immigrated to the United States fifteen years earlier from the former Soviet Union, where she taught Russian language and literature. Steeped in her ancestral home’s appreciation of suffering and melancholy humor, she was a wise and comforting presence.

“Friday was his birthday,” she said by way of greeting. Kopel had turned sixty two days before his wife’s death.

Unlike Sam Kopel, who spoke with both the sorrow of a man who has lost his wife and the sense of failure doctors often express when patients die, Khenkin saw aspects of a “good death” in Sharon Kopel’s final days.

“I understand that she suffered a lot, so for her it is the end of her suffering,” she said. “It is amazing she let him have his birthday on Friday. Didn’t spoil it. Didn’t make it sad. Can you imagine if it had happened on Friday? At least he will be able to celebrate his birthdays many, many years—and then a couple days later, of course, it will be a memorial day.”

Khenkin told me that her own husband had died almost exactly three years earlier. “I remember when we came to the funeral home, Kopel was the person who met me there. Dr. Kopel,” she said. “It was very important to me he was there with support, though he didn’t know me very well. And then later, when I was sitting shivah, he took time, the medical director! I just came to the practice at that time. I was amazed to receive such respect. I expected the little people would not be interesting to someone in that position, but he took the time.”

She told me car pools were being organized for the Kopel funeral. “A lot of people want to go,” she said. “He brought her here to the New Year’s party in a wheelchair. She was very frail, but I’m glad she was here, able to see the center. It was his baby; he was building this center and thinking about it all the time.”

She sighed. “So how are you?”

I rode to the funeral home on Coney Island Avenue in a car with Alan Astrow and Jay Cooper. I met Astrow in his office, and he told me that his mother had given away her jewelry and informed her children that she’d prepared a will. She told him she was going into the hospital for a cataract operation. Astrow called her oncologist to see if she was well enough for surgery. “The disease is progressing slowly,” he was told.

In the car the two doctors avoided mention of where we were going and why. Instead Cooper complained about American Airlines changing his flight on the way to a conference in Florida and losing his luggage on the way back. They discussed a story on the front page of the
New York Times
about a breakthrough in ovarian cancer and how misleading drug trials are. They avoided the obvious connection between the news and our destination. Cooper gave directions to the cabdriver and said he grew up three blocks from the funeral home. We passed a cemetery; he told us Mae West was buried there. When he leaned forward to instruct the driver further, the driver raised his hand and said, “Stay calm, sir, I’m born and raised in Brooklyn.”

“So am I,” said Cooper tersely.

The funeral home had capacity for 315 and was overflowing. The Maimonides crew was there in full force, from Marty Payson on down. Lisa Kopel-Hubal, Sam and Sharon’s only child, spoke. Then Sam Kopel stood at the podium, poised and elegant in his black suit.

I didn’t take notes, but I remember the speech as a kind of aria, composed by a man who appreciated operatic emotion but rarely showed it.

At Sharon’s funeral he made a joke about how his computer had a virus, not cancer, so his speech was handwritten.

He said he and Sharon loved opera and ranked individual ones according to hankies needed.
Falstaff
zero,
Madame Butterfly
off the charts.

He noted that his grandsons were the first in his family to be born in the United States; Lisa, their daughter, was born in Italy, when he was in medical school.

He said Lisa was Sharon’s masterpiece, her
capolavoro,
and he used both the Italian and the English. Sharon’s product, not his. He had missed every parent-teacher meeting—not proud of it, just reporting.

(Lisa later told me that this wasn’t true, that she remembered him home for dinner every night, that he taught her how to ride a bike, he took her to see
The Magic Flute
at the movies, he took her ice skating.)

He said Sharon had taught science for years at a Jewish day school and that she was beloved. That when the principal once asked the children who the most famous Jewish scientist of the twentieth century was, the children did not, as you would expect, offer up the man who declared that
e
equals
mc
squared. No, the children said, the most famous Jewish scientist of the twentieth century was Mrs. Kopel. The audience laughed through tears.

Sam described their meeting, at summer school. He was there because he’d flunked a course; she was merely industrious. He copied her papers. For thirty-six years she took care of him, he said: investments, shopping, everything. He went to an ATM for the first time three months earlier, he said. He was still afraid of supermarkets, he said, but he guessed he would have to get over that.

Then he paused and said dramatically that he wanted to say it publicly, that Sharon never resented her late diagnosis. She never discussed recrimination.

(Later Sam told me he saw one of Sharon’s doctors walk into the funeral home just then, and he wanted to reassure him. I remembered Lili Fraidkin once whispering when she was irritated with Kopel that Sam felt guilty for not diagnosing his wife’s cancer earlier. When I asked him whether he felt guilty, he said, “When I said Sharon never resented the late diagnosis, was I subconsciously giving myself absolution? Probably. My analyst would probably say yes. I don’t reject that. Why didn’t I see something the others didn’t see. Like everyone else, I rationalize.

“Ovarian cancer can be cured, even in late stages,” he said. “When it’s the sort of typical ovarian cancer, presents with fluid and swollen belly, those patients respond to chemotherapy beautifully. I have lots and lots of patients like that. Every oncologist does. Sharon’s cancer was different. This was a variant, and it behaved in a more malignant fashion.

“If you’re asking, do I have sleepless nights about it? I would say no. Was it the subject of analytic sessions? Absolutely.”)

He said taking care of her the last three years was a privilege.

Sharon always came through for him, he said. After being in a coma for a week, she woke up for a few hours on Saturday, the day after Sam’s birthday. “I don’t know how or why,” said Sam. He corrected himself. “I do know why, but not how.” She wished him happy birthday. That was the why.

He concluded by repeating something he said often: that the four years they spent in Italy in their youth were the best years of his life.

Three weeks passed. After a balmy interlude, winter asserted itself, with the biggest snowfall ever recorded in New York, 26.9 inches in Central Park. By the next day, the sun came out, melting the snow, leaving the streets a mess. The hospital felt dank, dispirited. Brier’s husband had had yet another operation, another attempt to restore mobility to his knee, at New York-Presbyterian Hospital/Weill Cornell Medical Center. On her daily visits to Aschkenasy, Brier tried, unsuccessfully, not to be overcome with envy of the clean hallways, the beautiful rooms, the unscuffed elevators, the hospital’s $1 billion capital campaign. Plus, HealthGrades had just issued its 2006 report; after receiving the Distinguished Hospital Award for Clinical Excellence for three years in a row, achieved by only 5 percent of the country’s hospitals, Maimonides was dropped from the list because of an uptick in mortalities. And January surgery numbers, in Brier’s words, were “in the toilet.”

At the biopsychosocial meeting, Ms. Hernandez was back on the agenda.

Astrow walked into the room carrying a banana for breakfast. As usual, he was last to arrive. The fellows looked at him expectantly.

“We have a twenty-four-year-old with metastasized lung cancer,” he began. “Even if she smoked like a fiend, that wouldn’t explain this. She’s from Mexico.”

“Dominican Republic,” said Keen.

Mohammad Razaq spoke. “We gave her one dose of chemotherapy.”

Razaq was the quiet Pakistani who had told Astrow, along with Warshawsky, that he would be interested in staying at Maimonides for a full-time position after his fellowship was completed that spring. Like Warshawsky, Razaq was growing impatient with Astrow’s slowness in making a decision.

“Why is she still in the hospital?” Astrow asked.

Sramila Aithal, a fellow, answered. “She doesn’t have insurance.”

“She’s very sick,” added Inna Sominsky, whose blond hair was streaked slightly differently that morning. She looked tired. Her two young children seemed to wake up earlier and earlier.

“Failing,” said Razaq.

“At four we’re having a family meeting,” said Lisa Keen. “Her mother she hasn’t told, because the mother has high blood pressure. The father of the children, who has legal rights, is coming, supposedly.”

Astrow nodded. “What is the patient’s understanding?”

Keen replied, “That she has a limited time to live, but that God and a miracle will save her.”

“Does she have English?” Astrow asked.

One of the fellows nodded. “She does,” she said.

Keen shook her head. “No, she doesn’t.”

“She doesn’t have an understanding. . . .” Astrow seemed to be talking to himself. Then he looked at Keen. “What do you plan to say to the family this afternoon?”

Keen didn’t directly answer. “Dr. Rubin said if she doesn’t respond to the chemotherapy, she’ll die in the hospital. If she does respond, she has maybe six months.”

“What’s happening to the children?” Astrow asked. “Is the father involved?”

Again Keen shook her head. “No, but the boyfriend and the grandmother are.”

“The mother needs to understand she has to think of the welfare of her children,” Astrow said. “That has to be brought up.”

“We’ve started,” said Keen.

Warshawsky raised another question. “What happens if you’re illegal and suddenly the children come to the attention of the authorities?”

“They are citizens by birth,” Aithal said.

“Even if the parents are illegal?” asked Sominsky.

“Born in the U.S.A. Yes,” said Astrow.