Health Care from the Inside Out: Two Sisters, Two Perspectives

The first time I met Suzanne Salamon, she told my fuming mother that at 74, she was virtually a youngster in Suzanne’s geriatric practice in Boston. She also complimented my mother on her pretty green eyes, which forever put her in my mother’s corner.

Even my porcupine mother appreciated that Suzanne is a dream of a doctor – empathetic, smart and humble.

What I didn’t realize at the time of my mother’s first visit to Suzanne is that I knew her personal story through her sister Julie Salamon’s books. I had read Julie’s autobiographical novel “White Lies” about the child of Holocaust survivors whose father found meaningful work as a country doctor in a small Ohio town. Julie’s memoir, “Net of Dreams,” opens with Julie, her mother Lily (Szimi) and step-father visiting Auschwitz where her mother had been interned. Later in the trip, the trio crosses paths with Steven Spielberg who was filming “Schindler’s List” on location in Poland.

Julie, Lily and Suzanne Salamon

The sisters recently teamed up in Boston for the Hadassah-sponsored program, “Health Care from the Inside Out: Two Sisters, Two Perspectives.” Both women have collective wisdom and extended experience on the subject – Suzanne, as associate chief for clinical geriatrics at Beth Israel Deaconess Medical Center and Julie, as the author of another book, “Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, G-d, and Diversity on Steroids.” The “hospital” of the title is Maimonides Medical Center in Brooklyn, where 67 languages are spoken and up to 705 beds are occupied at any time.

It’s clear that the sisters have early and influential memories of the power and the magic of medicine. Their presentation on the current health-care conundrum was as informative as it was compassionate. But it was also their interaction with each other – and their sweet acknowledgement of their mother, who was in the audience – that made their appearance particularly poignant.

The Salamon sisters’ physician father, Alexander (Sanyi) Salamon, had settled the family in Adams County, Ohio, after a difficult and ultimately false start in New York. The only doctor for miles, Sanyi Salamon’s patients revered him. Like many solo practitioners in rural areas, his office was attached to the house.

The sisters told a story that began late one night with a knock on the door of their family’s house. A couple had just received word that their son had died in Vietnam, and the mother was inconsolable. “I always wondered what my father did aside from tranquilizing the woman,” Suzanne said. Their stoic father never talked about his first wife and young daughter who perished in Dachau, but Suzanne wondered if he mentioned them that night to the woman. “As a mother, I looked at that story differently. As a doctor, that story taught me a lot about empathy.”

The year that Julie was at Maimonides, she observed the tension between the bottom line and patient care. “The business of a hospital comes down to people,” she said. “It’s a continuum of experiences from which emerged a lot of discussion of respect, communication or lack thereof. There are competing pressures to secure reimbursement and spend the right amount of time in a system hurrying them.” She added that the moment a patient is admitted to the hospital, the insurance company is forcing the staff to plan the discharge.

With Medicare reimbursements falling far short of actual costs, many geriatric practices are in debt. The 85 and over population is growing, and short visits for patients in their 80s and 90s are ineffective. There are complicated medical histories to sift through and difficult discussions to make about end-of-life issues, such as designating a health-care proxy, when to start palliative care and whether to insert a feeding tube.

“My job is to bring up tough subjects,” Suzanne said. To that end, she never uses euphemisms with her patients, with the exception of characterizing Alzheimer’s as memory loss. “There’s a lot less secrecy today. It’s been years since I’ve been asked to keep a devastating diagnosis from a patient,” she noted.

I looked around at the mostly senior audience and wondered how many of them had healthcare proxies? How many of them have been willing to hand over power of attorney to an adult child? I thought about the 15-year battle my sister and I recently won with our mother to help her legally with her financial issues and health challenges. Did my tablemates more easily accept help from their adult children?

At Maimonides, Julie observed a patient’s room transformed into a sacred space when the subject was end-of-life issues. Stereotypes about doctors and patients fell away as real people emerged. “Finding moments of grace can be difficult,” Julie said. “But part of what you give to your patients is your humanity,” Suzanne added.

The elder Salamons’ grace and humanity remained intact after Dachau and Auschwitz. And those tributes are in full bloom in their daughters: Suzanne Salamon, the doctor and Julie Salamon, the writer.

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