Sister Act Takes on End-of-Life Care

Julie and Suzanne Salamon Image by Judy Bolton-Fasman

By Judy Bolton-Fasman April 30, 2012

The first time I met Suzanne Salamon, she told my fuming mother that at 74, she was practically 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.

My mother was so comfortable with Suzanne that she told her I was conspiring to “once and for all” put her in a nursing home. “We never got along,” she said. But then Mom added, “Judy’s the only one who takes care of me.” Which was it? Suzanne had seen contradictory impulses in other patients. “No one wants to send you to a nursing home,” she said, ever so gently. Even my porcupine mother appreciated that Suzanne Salamon is a dream of a doctor — empathetic, smart, 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 southern Ohio town. Julie’s memoir, “Net of Dreams,” opens with Julie, her mother Lily (Szimi) and stepfather visiting Auschwitz where her mother had been interned. Later in the trip the trio cross paths with Steven Spielberg who was filming “Schindler’s List” on location in Poland.

The sisters recently teamed up in Boston for a Hadassah-sponsored program called “Health Care from the Inside Out: Two Sisters, Two Perspectives.” Both women speak from experience: Suzanne is associate chief of geriatrics at Beth Israel Hospital and Julie as the author of the nonfiction book “Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God, and Diversity on Steroids,” about Maimonides Medical Center in Brooklyn.

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. Like many solo practitioners in rural areas, his office was attached to the house. The sisters told a story that late one night there was 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. 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.

The 85-and-over population is growing and short visits for patients in their 80s and 90s is impractical. There are complicated medical histories to sift through, difficult discussions about end-of-life issues such as designating a healthcare proxy, when to start palliative care, or 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.”

I looked around at the mostly senior audience and wondered how many of them had healthcare proxies? It took 15 years for my sister and I to convince our mother that she needed help with her finances and health care 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 dealing with end of life issues. Stereotypes between doctors and patients fell away as real people emerged. “Finding moments of grace can be difficult,” she said.

“But part of what you give to your patients is your humanity,” Suzanne added.

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