Memories of Brookdale

^{By Michael Gordon, MD, MSc, FRCPC}

It was on CNN non-stop, pictures of Brookdale hospital in Brooklyn New York—a veritable war zone. It brought back memories of when as a medical student in Dundee Scotland I took a summer off and returned to Brooklyn to visit my family and do a studentship at the then called Beth-El Hospital which some time later took on the name Brookdale.

With very little in the way of orientation, I was assigned to a medical resident and started off by shadowing him until after a few days he began to let me spread my wings and gave me tasks to do—the first which was being to take blood every morning from the 30 patients on the unit. It was before the introduction of vacutainers—the needle topped gizmo that drew the blood into small vacuum filled test tubes—no more syringes and needles and open test tubes. I became very adept at phlebotomy, a skill that helped me throughout my medical career. That experience, along with a month stint at a Danish research laboratory where I had to take blood from experimental rats through their tail veins, made me adept also at inserting needles into scalp veins often necessary in young children. At the time, I was a bit surprised that all the interns, but one, was male. My medical class in Dundee Scotland was a third female, and now half of the medical students across Canada (and in most places) are female.

Beth-El—an inner city hospital—was an exciting place to work. Its chief of medicine was the renowned Holocaust surviving professor, Isidore Snapper. At the time I did not realize what a great man and physician he was, but I did recognize his brilliance and humor as a teacher. He adopted me and whenever possible included me in his activities.  While waiting for him to take me to another hospital for rounds, I overhead a phone conversation during which he was negotiating the acceptance of an offer from the Brookdale Dairy company to change the hospital’s name to theirs and in exchange for a huge sum of money. And just like that, Brookdale hospital, which is now a major teaching center, got its name in 1964.

Doing rounds with professor Snapper was a great experience. The whole house staff and students attended with me as the most junior of the lot standing at the back of what looked like the Pied Piper snaking through the ward.

At the bedside of one elderly woman who spoke primarily Yiddish, which I could understand, to the professor, she asked, “Professor, what is better for a headache, a warm or cold compress?” There was a sound of tittering down the line—Snapper replied with a smile on his face as he held the patient’s hand, “it depends on who your grandmother was.”

At another bed there was a woman in her 20s who was admitted with an overdose of Secobarbital. She had her stomach lavaged and after a long period of semi-coma, woke up. At the bedside, she claimed it was an accident. I asked the resident naively how someone could “accidentally” overdose on what appeared to be 30 capsules. He looked at me incredulously and said in a whisper, “we know it was not an accident but one never want to label someone as a suicide attempt—that becomes a blight on that person’s name.” Of course, at the time I did not know enough to question that philosophy and how it might preclude social work at least from taking on an important therapeutic role.

Another experience taught me a profound lesson in social medicine and the sheer indecency of the anti-abortion movement. One afternoon there was a call for an emergency in the emergency room. I rushed down to see the “action” of the emergency room staff working, which was very exciting for a young medical student. The curtains were drawn around an African-American teenager who was covered in blood. She had two IVs running with blood and a gynecologist was examining her and arranging for urgent transfer to an operating room. I asked the nurse standing next to me what had happened. She looked at me in surprise and then whispered, “A back street abortion.” She is bleeding like stink and probably has had her uterus ruptured.  She was wheeled out of the ER to the operating rooms and learned later that her life was saved, but she required a hysterectomy—that meant her reproductive days were over. It wasn’t until I was more senior and after I had worked in parts of the world where abortion was legal, did I realize the stark ramifications of anti-abortion laws and practices.

When I look at the pictures of Brookdale, in the throes of battling Coronavirus, I am moved to tears. The physician who became one of the spokespeople for the beleaguered health care staff eloquently described the challenges and fear of the patients and the treating staff. The emergency room, overflowing with patients does not look like the small ER in the old Beth-El. But the spirit of devotion and commitment to the wellbeing of patients has not changed. Brookdale is one of many hospitals under attack by the onslaught of very ill patients. There are doctors and nurses everywhere who can associate with those hospitals that helped train them in their most wonderful professions.

The current situation reminds me of SARS where the hospitals in the most of Ontario but for sure in Toronto were in epidemic mode—one needed to be screened before entering the facility, there were no visitors and as geriatric and long-term care facility methods had to be developed to make sure personal care workers were infection free. Families stood outside some of our large main floor windows to see their loved ones brought down by staff member to say hello and speak via cell phone.  The staff wore personal protective outfits. One psychiatrist told the story of how he entered a patient’s room fully garbed in his yellow gown and N95 face mask, and asked the patient if she was OK with the way he was dressed to which she answered, “if it works for you it is fine with me”.

I am also reminded of the polio epidemic of 1952 when I was 11 years old, where 3145 people died and 21,000 were left with some degree of paralysis. I recall being told to not go swimming, drink from a water fountain or mingle—hard for an 11-year-old who lived near the ocean. All the kids wore a large slab of camphor dangling on a string from their necks to “ward off the virus.” It was the summer and I recall that at the movies during the newsreel there were pictures of gymnasiums filled with irons in action with hundreds of patients being treated. In 1954 the first trial of a vaccine was launched, the Salk Vaccine which proved to be effective. It was administered by injection. A year later the Sabin vaccine was introduced which is oral and is now the standard worldwide. All the world now is testing drugs to mitigate the effects of COVID-9 and multinational efforts are underway to develop a vaccine which would of course be but takes a long time to develop and test.

This is not the first time that Brookdale came to the aid of the community when faced with a monumental calamity. In late October 2012, a few days before the expected arrival of Hurricane Sandy in New York, Brookdale Hospital was enlisted by the New York State Department of Health in the State’s emergency response efforts to the anticipated storm. Brookdale housed 105 acute-care nursing home residents and hospital patients. Ninety-five residents were from three nursing homes in the zone of flood risk  Preparing to accommodate these nursing home residents and hospital patients involved an emergency staff effort to retrofit two hospital floors that were being used for hospital storage. It is a tribute to what was once the small community hospital is now in the forefront of academic medicine and teaching in all areas of health care but a facility that truly serves the surrounding mostly underprivileged community.

I will continue to watch the news and hope Brookdale is no longer in the limelight because they have finally received the resources they need to responds to the need, or better still the need has dwindled—in a multi-cultural, multi-ethnic and multi-religious community in which Brookdale sits—no matter what one’s belief we can all say Amen.

Dr Gordon is a geriatrician and ethicist; formally medical director and head of geriatric medicine at the Baycrest Health Science Centre in Toronto. He trained in medicine at the University of St. Andrews in Scotland and in medical ethics at the University of Toronto. He has traveled and lectured widely and is a medical writer having published a number of books the most recent ones being Parenting your Parents: Straight talk about Aging in the Family—co-authored with Bart Mindzenthy.