Maimonides Rocks

By Steve Brozinsky

Hormones start surging at the Maimonides Medical Center when the nice Jewish boy from Flatbush, Dr. Julius Berger, meets Dionne Clark, one of the new interns. She is bright, beautiful and Black. Intertwined with several perplexing medical mysteries are the adventures of Allison Kincaid, the drop-dead-gorgeous pharmaceutical sales rep.

• Language: English
• Publisher: Steve Brozinsky
• Release date: Jul 1, 2010
• ISBN: 9781452387888

Book preview

CHAPTER ONE

Noah Strong must have taken that exit ramp onto Fort Hamilton Parkway eight thousand times, but the afternoon’s unexpected rain mixed with some oil on the roadway and just a wee bit too much speed caused him to lose control of the Volvo and careen down the embankment, flipping over three times for good measure.

Noah later swore that just like in the movies all of this seemed to happen in slow motion and when the car finally stopped he found himself upside down, fully conscious, and with his fastened seatbelt saving him from further harm. His left side hurt a little bit but he sensed he was not seriously injured.

CHAPTER TWO

Dr. Julius Berger had just finished orienting the new interns at Maimonides Medical Center in Boro Park. Once known as Israel Zion Hospital, Maimonides had witnessed exponential growth in the 1990s, fueled by generous benefactors, grateful patients and an incredibly bullish investment portfolio. Its physical plant and graduate programs in medicine and surgery were the envy of many New York City hospitals and Maimonides was increasingly more successful in recruiting top faculty and house staff from metropolitan area medical schools.

Dionne Clark was one of these stellar medical school graduates. She grew up in Bedford-Stuyvesant and earned a scholarship to Simmons College in Boston. She then attended Howard Medical School, graduating first in her class.

She was the only African American in Maimonides’ new intern group, and Dr. Berger noticed her sitting by herself in the cafeteria, her starched white intern smock framing her sleek neck rather prettily. Her brand new miniature ophthalmoscope and otoscope where properly positioned in the breast pocket of her white jacket, just below her name tag and caduceus; a stethoscope was peeking out of her jacket’s left hip pocket and the medical intern’s Bible, The Washington Manual, was bulging in her right hip pocket. This was the umpteenth edition of the book that Washington University in St. Louis had been publishing for decades, updating house staff on what they needed to know from asthma to zoster and everything in between. Dr. Clark certainly looked ready to begin her internship.

So Dionne, asked Dr. Berger as he sat down across the table from her. Was there anything in particular in medical school that made you choose medicine as opposed to pediatrics or OB/GYN or surgery?

Dionne rescued him from his thinking what a lame line, Do you remember who William Osler was, Dr. Berger?

He was the famous Hopkins doc early last century. I think he is known for his many aphorisms. I think he came from Canada and, by the way, from now on it’s Julie, unless we are in front of a patient.

Right Julie. And one of his famous sayings was ‘Doctor, listen to the patient. He is telling you the diagnosis.’

And, what are we getting at?

Well, I was doing a cardiology clerkship at George Washington Hospital in D.C. early in my fourth year. I was one of three students who accompanied two interns, their resident and the chief of cardiology into the room of an elderly African- American man who had been admitted the night before with some congestive heart failure. This swarm of white coats and white faces scared the hell out of him. It was only my presence that calmed him down a little bit. Anyway, one of the interns tries to impress the Chief by describing what he thought was an S3 gallop and this guy puts the stethoscope on the patient’s chest, closes his eyes to show he is really concentrating and spurts out ‘Tennessee, Tennessee, Tennessee.’

Dr. Berger knew what Dionne was alluding to. Pathologic heart sounds were different from the lubb-dupp that the lay public knew and these abnormal sounds, designated as S3 and S4, were frequently difficult to differentiate from one another. So, as he recalled from his medical student days, clinicians were taught that a cadence emphasizing the first syllable, such as the state Tennessee, might help differentiate the third heart sound while a cadence emphasizing the second syllable (Kentucky) would signify the fourth sound or S4. Berger nodded as he recalled this teaching gem from four years ago.

Dionne continued, Now the resident begs to differ–that it was an S4 gallop–and he puts his stethoscope on the poor guy’s chest, closes his eyes and taps out ‘Kentucky, Kentucky, Kentucky.’ Before the Chief could cast the deciding vote, the patient looked straight at me and in the ultimate William Osler moment, ‘Honey, they’re both wrong. It’s Nor Carlina!’

Is that really a true story?

Absolutely. Cross my heart, I’ve got plenty more.

I’d love to hear them, Dr. Berger said as he rose from the cafeteria table and shook her hand. For days afterward, he wondered whether it was his or Dionne’s grasp which lingered just a split second longer than necessary.

CHAPTER THREE

The EMT paramedics had to be contortionists to safely extricate Noah Strong from the inverted automobile. Backboard, neck collar and head tape all had to be expertly applied so as to minimize any potential damage to the spinal cord. Noah was whisked by ambulance to Maimonides which had a state-of-the-art trauma unit. More victims of motor vehicle accidents than gun shots were cared for at Maimonides; the opposite was true at Brooklyn’s other major trauma center at Kings County Hospital.

Noah was evaluated by the trauma surgeon and sent for a CT of the chest, abdomen and pelvis. Good news: one broken rib on the left but the spleen, heart, lungs, kidneys and liver were all fine.

After an overnight stay, Noah was allowed to go home. His father and mother, Leonard and Joan Strong, insisted that he stay with them at their apartment in Bensonhurst for a week rather than return alone to his duplex in Bay Ridge. Noah didn’t need much convincing as his sore left side told him that he’d be out of commission for at least a few days anyway.

CHAPTER FOUR

Dionne’s fellow interns were certainly an eclectic bunch. Most were from New York State medical schools but a few were from India, Pakistan and the Orient. Three or four had studied at Guadalajara or Bologna and had already worked a full year in a stateside hospital in a so-called fifth pathway program, which finally enabled them to secure a spot in an accredited internal medicine training program. Some of the United States graduates had spent their entire fourth year globe trotting, with electives in Hong Kong, London, Tel Aviv, Rome and Cape Town. Others had by their own choice slaved away as fourth-year interns at Kings County or Bellevue in Manhattan, hoping to get credit for that year and thereby shorten the time needed to qualify for the certifying examination in internal medicine.

Several of the interns were observant Jews attracted to Maimonides because of its offer of Sabbath scheduling whereby they were guaranteed to be off duty from Friday afternoon to Saturday evening. These doctors were not so affectionately called yommies, after the yarmulkes or skull caps that they wore.

Dionne and Julius’ immediate supervisor was Chief Resident Joseph Bianchi. He was a redheaded, follicly-challenged Italian from New Jersey. He had trained at Saint Vincent’s Hospital in Greenwich Village and reminded everybody of Sonny Corleone, the James Caan character in The Godfather, both in appearance and temperament. Berger had survived his internship primarily by staying out of Bianchi’s way.

Hospital folklore predicts that every intern class will have a loser. Usually this is a guy (rarely a woman). By August of Dionne’s internship it was apparent that Teddy Benjamin would claim this dubious title.

It all started Benjamin’s first night on call with a page from the emergency room resident, Dr. Kirsch, in early July. Hi, Dr. Benjamin. I know we haven’t met yet but you’re lucky. I’ve got an incredibly interesting admission for you. Those were words to be dreaded by any intern. They generally connoted a very ill patient who would monopolize the doctor’s time and energy. This admission was no exception. He had pneumonia, pancreatitis, and diabetic ketoacidosis--all three. Any one of these diagnoses was serious. The triple whammy all-too-often resulted in a critically ill horrendenoma.

Fortunately for Dr. Benjamin (and the patient), Teddy’s supervising resident was Angelina Vitale-Schwartz. Angie had married a young dentist the same week she received her M.D. from Rutgers fourteen months previously. Her incredibly unflappable demeanor and steely-eyed work ethic were probably the reason Bianchi had paired her with Benjamin, who had just spent the previous year taking such non-taxing electives as radiology and dermatology. He was in over his head from the get-go.

Dr. Schwartz, I need some help here. My new admission from the ER looks really bad! His temperature is 102.4 and he is tacking at 120. He is all scrunched up in a fetal position and won’t let me examine him. I can’t get a second IV line into him which the head nurse recommended and I--

Dr. Benjamin, did you read ‘House of God’?

What?

I asked if you ever read ‘House of God’.

No, I haven’t. But what’s that got to do with this sick patient?

Everything! You don’t need to write a book report but I expect you to read it by the end of your two months with me. Secondly, calm down! Your peeing in your pants won’t help matters. Third, you are to call me Angie or Angelina or Dr. Vitale. Those are the names on my medical school diploma which my parents paid plenty for and for which I worked my ass off. Now, let’s meet at the patient’s bedside and figure out how you’re going to save him.

He dutifully followed Dr. Vitale Schwartz’ orders for the next sixty days and by September calculated that if he included his upcoming vacation he would have already completed, make that survived, twenty percent of his internship year. During the winter he served two months with Dr. Berger on the Private service, cementing his reputation as the worst intern and actually forcing two of the community internists to exact a promise from the Chief of Medicine, Dr. Greene, that Dr. Benjamin was to neither interview, examine nor prescribe anything for their hospitalized patients.

House of God had been published in 1978. It was a wickedly satirical account of an intern’s twelve months at one of Boston’s elite hospitals. Stress and sleep deprivation were recurring themes and its portrayal of the unseemly side of the medical profession did not garner too many fans at the American Medical Association. No wonder Angie Vitale urged Teddy Benjamin to read it that first day on the wards. Its author, Stephen Bergman, switched his career to psychiatry. Benjamin was so rattled by similar experiences at Maimonides that he, too, sought out a residency in psychiatry.

One of the enduring mysteries of House of God is what happened to the movie version. It starred Tim Matheson and Ossie Davis and a pre-Seinfeld Michael Richards and was completed in 1984. It was never released in theaters and few prints were ever made into other formats.

CHAPTER FIVE

Around the corner from the main complex of buildings that comprise Maimonides Medical Center was a three-story edifice which resembled a dormitory. In fact it was a dormitory of sorts. It housed the on-call rooms for generations of interns and residents. For more than seventy years it was a given that an intern’s work day did not end at 5 p.m. No whistle blew; no time card was punched. Whether considered a rite of passage or an integral part of an intern’s training, it was understood that the admitting team of intern and supervising resident would follow that day’s emergency admissions through the night. These first few hours of a hospital stay were when the most critical decisions were made as to diagnosis and treatment. Thus, the on-call rooms were where the house officers would retire in an attempt to catch an hour or two of sleep in between admissions. It was rare to sleep through the night undisturbed. If there weren’t an admission, there was a telephone call from the ward nurse. If there weren’t a call from the nurse, there was a page for a code 3 which meant a sudden summons to a cardiac arrest somewhere in the hospital.

Interns’ conversations frequently mentioned that they had pulled an all-nighter, meaning that they never even made it to the on-call room. If an intern dozed off during morning rounds, you knew he most likely had been on call the night before. The presence of a five o’clock shadow at 8 a.m. told you the same thing. Somehow the female house officers always looked better than the men after a night on call. Maybe they were more efficient and managed to grab a few hours of sleep. Maybe they cared a bit more about their appearance and wouldn’t dare show up for morning rounds without having showered.

This insanity of one hundred twenty-hour work weeks including the expectation of making critical patient management decisions when deathly tired came to an end following a widely publicized case in 1984.

Libby Zion was an eighteen-year-old college freshman when she presented to the New York Hospital emergency room on March 4, 1984 with some jerking movements and fever. She was admitted by an overworked intern who was covering forty patients in the hospital. Although the intern had a supervising resident, a series of miscommunications and poor management decisions resulted in Libby Zion dying. Her father, journalist, writer and attorney, Sidney Zion, sued. The malpractice trial took place in 1994. It captivated New York City for weeks. Its legacy was that interns and residents were forbidden from working more than eighty hours a week or from being on call more than twenty-four consecutive hours (New York State Department of Health Code, Section 405, a.k.a. The Libby Zion law). These recommendations were formally adopted by the Accreditation Council for Graduate Medical education in 2003 and made mandatory for all residency programs.

Those on-call rooms at Maimonides continued to be used however. Medical students from other schools taking electives at Maimonides stayed there for a month or two. A newly-married but overworked house officer might have a spouse pay a conjugal visit. A not-so-newly-married resident or fellow who was trysting with a nurse or pharmaceutical rep might take advantage of the building’s Las Vegas-like mantra, what happens here stays here. Security personnel asked few questions so long as a photo ID badge, successfully swiped, gained the user access to the floors above.

CHAPTER SIX

Five weeks after the accident and three weeks after he returned to his Bay Ridge home, Noah Strong felt well enough to resume the pickup basketball games he loved. He had been a bench warmer on the Lafayette High School team ten years previously. He did not play at all while attending Brooklyn College but the weekend games at the park in Bay Ridge gave him a good aerobic workout that also helped him unwind from the stresses of the position of IT head for a startup telecommunications company headquartered next to the Ferry Terminal near Battery Park in lower Manhattan.

While fighting for a rebound in a particularly physical contest, he took a violent elbow to the solar plexus that left him on the ground, gasping for air. He recovered after five minutes and was able to resume playing, thankful that he had apparently completely recovered from the injuries sustained in the rollover accident the previous winter.

CHAPTER SEVEN

After a few months in the emergency room, Dr. Ken Kirsch, the resident who steered that first admission to the inept Dr. Benjamin, rotated to the Private service in the Aaron Pavilion. Although the Private service contained mostly elective admissions of the attending staff of community internists, its lack of critically ill patients was more than made up for by the sheer number of patients the resident was required to see. One intern and one resident were responsible for some sixty patients in the Aaron Pavilion and adjacent Solomon Wing. Mind you, the Private internist wrote admitting orders and directed the workup of these patients, but the house staff needed to check labs, review scans and x-rays, and in general keep the docs in private practice up to speed on the progress of their patients.

Dr. Kirsch, known as KK, was the male counterpart of Dr. Vitale-Schwartz, at least in terms of coolness, efficiency and unflappability. He was always clean shaven and immaculately dressed. Unlike Vitale-Schwartz, he was kind to his interns, nice to the nurses and cordial to the attending staff. He volunteered to take call Yom Kippur so the yommies would have less difficulty obtaining coverage. Many of the octogenarian patients he cared for just couldn’t wait to fix Dr. Kirsch up with their granddaughters. Not wanting to disappoint them, he feigned interest but claimed that his hospital training years and concomitant long hours prevented him from pursuing any romantic endeavors. Although the other interns and residents knew it, Dr. Kirsch thought it served no purpose to tell these patients that he was gay.

KK was very popular with the attending staff and hospital administrators as well. Laudatory letters congratulated them for having the good sense and excellent judgement to hire such a fine young man and an example of what a caring physician should be.

Maimonides almost always ran at one hundred percent occupancy. It was not at all unusual for a patient to be discharged in the morning, and have that bed filled with another admission by noon (generally from the emergency room) only to have that bed vacated once again when the new admission went to the operating room or, if his condition worsened, to the intensive care unit.

Beds