A Hospital Within a Hospital

A middle aged man collapses. A passerby notices and immediately summons hatzolah. When the paramedics arrive they determine that the patient is in cardiac arrest and begin resuscitation immediately. After several failed attempts they are finally successful and quickly proceed to transport the patient to the hospital.

Upon arrival they are whisked through the ER and head straight to the catheterization lab. Doctors begin their valiant attempt to unclog the blockage in the coronary artery as the family stands outside davening fervently. After completing this procedure a doctor emerges to greet the family members anxiously waiting for report of their loved one’s status. The doctor begins by defining what has occurred as a myocardial infarction. As he begins to detail the ensuing damage to the heart muscle, the family is suddenly thrust into a world of medicine with terminologies and verbiage that is confusing at best and frightening at worst; so begins their leap into this world previously unknown.

After spending some time in the recovery room, the patient is transferred to the cardiac intensive care unit. Thus begins the long and arduous road to recovery. After several days in the CICU, the recovery has stagnated and the patient’s condition has reached a plateau, but the patient has yet to regain full consciousness. A suitable place for a longer than anticipated recovery must be found.

An elderly parent develops pneumonia and is admitted to the hospital. After several days of receiving antibiotic treatment, before her infection subsides, the patient’s lungs cease to function properly and she is placed on a ventilator. Each specialist offers a slightly different prognosis and different courses of action that can be taken. The absence of a coordinated approach to her care leaves her family members confused and uncertain. In addition, there is worry that the medical staff does not place the same value on her life as they do. The thought that all is not being done to properly care for their mother is disconcerting.

Howard Lebowitz, M.D. Enter Dr. Howard Lebowitz, a well-regarded member of the Lakewood kehila. He is a man of chesed who is involved in kiruv but most notably renowned as a highly acclaimed physician. He earned his medical degree from Harvard Medical School in Boston MA where he graduated cum laude. Dr. Lebowitz continued to complete his residency and internship in internal medicine at Boston’s Brigham and Women’s Hospital. He then served as an attending physician at that Harvard affiliate for five years. In 2001 he relocated with his family to the torah oriented community of Lakewood. Once living in Lakewood, Dr. Lebowitz began to practice medicine at Monmouth Medical Center in Long Branch, NJ and Kimball Medical Center in Lakewood.

While working at these hospitals, Dr. Lebowitz took notice of the plight of the families he encountered. He pondered the situations, and recognized several faults in our hospital systems. He noted that a typical hospital is designed for short term acute care with an average stay of no longer than 4 to 5 days. When progress continues, medical care remains pointed and appropriate. However, in the absence of improvement in a patient’s status, care begins to lose its clear objectives. The plan of care becomes vague, medical staff may lose interest and family members are left to navigate this path that becomes more overwhelming with each passing day.

Dr. Lebowitz also recognized that typically in cases that require long term hospitalization, illnesses are usually comprised of several different components, each necessitating its own specialist. As they are consulted, each of these specialists offers their own unique perspective as to which tests should be taken, what medicine should be administered and in what dosages. It is a sad truth that many times a keen observation by one of these doctors gets brushed aside due to an uncoordinated effort. Additionally, as the families attempt to understand the overall picture and stay in contact with the numerous experts involved, they are commonly rerouted as they begin to
hear: “that’s an issue from another discipline”. Inundated with a barrage of information on topics they know nothing about, they feel completely at a loss. As Dr. Lebowitz says “it’s imperative to have a leader of this team effort but many times that’s exactly what’s missing.”

When dealing with an end of life scenario, these issues ascend to yet another level. Unfortunately for the frum community many of the secular medical professionals do not value life the same way we do. Often, a serious feeling of skepticism and mistrust begins to permeate the air and families feel uncomfortable leaving patients alone. The fear is that should any change in the conditions evolve, the medical staff may not respond in accordance to halacha and the family’s directive. As these challenges arise, families are often hesitant to approve new suggested treatments as they are uncertain of the sincerity of the doctors’ motives. Many times this causes a delay in obtaining seriously needed treatment. As Dr. Lebowitz says, “many times a tracheostomy is medically beneficial but because of mistrust in the doctors, it’s commonly postponed.”

Careful consideration by the Dr. led him to realize that the only viable option was to establish a completely private hospital designed specifically for long term acute care. In 2002 a Long Term Acute Care Hospital (LTACH) named the Specialty Hospital of Central Jersey (SHCJ) opened its doors. A new idea in medicine had found its way into our midst.

When I heard about this unique phenomenon, I scheduled a conference with Dr. Lebowitz and some of his colleagues to get a firsthand look at his facility located in Monmouth Medical Center’s Southern Campus (formerly Kimball Medical Center).

I toured the impressive unit with the hospital’s vice president Ms. Kathryn Collins. We began with the administrative offices where Ms. Collins pointed to Dr. Lebowitz’s vacant desk. “That’s usually how it looks because he’s constantly at the nurse’s station or at the bedside. He doesn’t have much time to spend at his desk.” Newly remodeled in 2013. The modern decor and colors impart a professional atmosphere and are both warm and inviting to patients, their families and the staff at the hospital.

As we walked the fourth floor hallway, Ms. Collins provided a history of the hospital. I learned that Specialty Hospital of Central Jersey is owned by Acute Care Health Systems (ACHS) and is considered New Jersey’s leader in the development of long term acute care hospitals (LTACHs). In 2002, ACHS established a 50-bed privately owned “hospital-within-a-hospital” with 25 beds at Monmouth Medical Center in Long Brach, NJ and 25 beds in Kimball Medical Center in Lakewood. Housed in a traditional hospital setting and partnered with a group of well known respected physicians and practitioners, Specialty Hospital is designed to provide an intensive level of care to patients with acute medical issues that necessitate an extended hospital stay in an acute care setting. Often Specialty Hospital is a place where patients with poor prognoses are brought to a state of healing and rehabilitation.

The patient population at Specialty Hospital is comprised of patients who require one or more of the following: three weeks or more of intravenous antibiotics for severe infections (such as those of bones or joints or endocarditis), ventilator/pulmonary care, dialysis, post stroke care, post surgical, cardiac and complex wound care.

Specialty Hospital offers a comprehensive respiratory program that provides significant respiratory care for non ventilated patients as well as a high success rate of ventilator weaning for ventilator dependent patients. Medical management of post surgical or diabetic complex wounds is also a focus at Specialty Hospital. Cases of complex medical conditions such as respiratory and or renal failure, post cardiothoracic surgery and gastrointestinal disorders requiring Total Parenteral Nutrition (TPN) are commonly treated at Specialty Hospital. With Intensive Care Unit (ICU) level Advanced Cardiac Life Support (ACLS) trained nurses at the bedside and 24 hour physician availability, patients are monitored 24/7 and are seen daily by staff physicians and specialists as needed.

Care at the hospital is provided by a team of three staff physicians, two nurse practitioners and one physician assistant. Nurses and respiratory therapists are assisted by certified nursing assistants, physical, occupational and speech therapists to provide the highest level of care to promote a safe and timely healing process. Pulmonology, nephrology, cardiology as well as infectious disease, gastrointestinal, nutrition and psychiatry consults are common components of the broad level of care afforded to each patient.

In 2013, the two separate hospital sites merged and the Specialty Hospital became one 50 bed unit in one centralized location. The beds are on two floors – the fourth floor and the fifth floor.” Ms. Collins continued, “We try as hard as we can to give patients the privacy of their own room.” As we walked past a room, I noticed and questioned the two bed set up. Ms. Collins was quick to explain, “We put an extra bed in the room so that the family can have the opportunity to sleep over if they’d prefer to, although we don’t feel it necessary for the family to burden themselves by being here ‘round the clock’.” Their graciousness and thoughtfulness was more than impressive.

We paused at the nurse’s station where Ms. Collins pointed to the assignment board. “We have a tremendous staff to patient ratio,” she began, “ there is one nurse for every 3 to 4 patients in addition to a charge nurse who is not assigned to any specific patients but is there to assist in any situation.” This ratio is closer to that of an ICU than regular hospital floors. Is this the secret of their success? I wondered. Perhaps it is the nurses’ warmth, I thought as each one greeted me with a genuine smile.

Ms. Collins showed me the fully stocked visitor’s lounge where family members can relax and take a break from the intense circumstances they find themselves in. In the lounge I met a patient’s family member. When they realized that I was trying to gain an understanding of the unit, they were quick to offer their opinion, “There is nothing like this place and there is no one like Dr. Lebowitz. He makes us feel so comfortable and confident and he is there for us  in every situation.” This unsolicited testimony spoke volumes. The tour concluded and we headed to the conference room where we met with Dr. Lebowitz and some of his colleagues.

I began my interview by asking Dr. Lebowitz for an overview of his services. “We saw the void left by traditional hospitals so we set out to establish Specialty  Hospital of Central Jersey. It is structured in a way most conducive to treating  patients for extended periods of time. When the patients arrive, the families feel as though they’ve reached an oasis after traveling through the desert. Although it is located within Monmouth Medical Center Southern Campus, we are a completely independent operation. Our floors are leased from the host hospital and we do not share any medical personnel with them. Many specialists who have rights there do not have rights on our unit. We have our own carefully selected group of expert physicians who see our patients. We just benefit from having
easy access to advanced imaging, laboratories, diagnostic tools and the emergency room  should the need arise. We are a hospital within a hospital.”

PA Yaakov Schechter, a full time member of the medical team and well known community and hatzola member adds, “Even a transfer from another wing within the building necessitates discharge and new admission paperwork.”

As we talked, PA Schechter received a call on his cell phone about a transport taking place. The patient was on her way home from the LTACH and there was a question regarding her care. It was obvious that the care that begins upon admission continues well past the patient’s discharge.

Dr. Lebowitz continued, “The team leader often missing in other hospital settings is present here on our unit. This prevents patients from floundering as their care is carefully followed by our dedicated team who coordinate between all the consulted specialists. It is always someone who knows the patient well communicating with the family.  It’s a fantastic framework in long term care. “

PA Schechter added that of course families can question and discuss issues with the specialist themselves if they prefer, but it is most often unnecessary.

Mrs. Bayla Parnes RN is the clinical educator at the hospital. She pointed out, “Families from out of town who may or may not have relatives in Lakewood may remain close by availing themselves of the services provided by the Lev Rochel Bikur Cholim hospitality house. The accommodations are comparable to that of a hotel and are located a mere stone throw away.”

Another important detail Dr. Lebowitz added, “This facility is the only one in its class that is owned by frum people and built on a foundation of strict adherence to halacha, giving patients a certain comfort zone which they do not experience elsewhere. When it comes to end of life care and do not resuscitate (DNR) orders, we are in touch with their Rabbonim per their requests, are aware of the halachos and put great value on the patient’s wishes and requests.”

I continued by asking if they are involved with Chaim Aruchim, an organization that helps guide families in helping them make halachic decisions in end-of-life situations. PA Schechter chuckled at this and stated that Dr. Lebowitz is the one giving the shiurim for the rabbonim there.

Mrs. Parnes continued, “We work hard to train the staff about the importance of respecting the halachos related to end of life care. They are familiar with a goses and many similar circumstances. They have the utmost of respect for the body of a niftar and they follow strict instructions outlined for them that help to ensure proper kavod hameis.”

Dr. Lebowitz adds, “I consider our facility as just one jewel in the crown that is the myriad institutions of Chesed that Lakewood is so fortunate to possess.”

Next, I posed a question that had piqued my curiosity. “Why is it”, I asked “that people who have trusted doctors all their life, suddenly become questioning and uncertain when it comes to dealing with end of life situations? Why is that the case and how can that be changed?”

Dr. Lebowitz, in complete agreement with my query explained the reasoning. “The atmosphere is emotionally charged when you’re dealing with a critically ill patient. It’s a life and death situation and the family members want to be sure that the doctor is choosing what is the correct direction for the patient.”

He went on to explain the situation with an appropriate comparison. “I was sitting on a plane recently, ready for take-off.  As I secured my seatbelt, my heart began to flutter with that familiar nervous feeling that you experience when you’re about to go up in the air. As I sat there, I pondered the situation and wondered, ‘Why is it that when it comes to doctors there are so many referral agencies and so much research done? There is often not a stone left unturned while obtaining the information that you need about which doctor to see. However, when it comes to
booking a flight, we choose our travels based on convenience and schedule, not ever considering who the pilot is. I propose that perhaps there should be a referral agency for pilots! It is a life and death circumstance after all, so wouldn’t you want to make sure the pilot is trustworthy?”

He continued, “The difference is that a pilot is on the plane with you, so you are confident that he will do his utmost to get you to your shared destination safely. In most circumstances, the doctor is not on board with you. However, at our hospital it’s different. We are flying this plane together. The patient’s best interest is our best interest as well. We are copilots working in unison.”

Mrs. Parnes added, “We have family members of patients here who have told me that after admission to our unit, for the first time in weeks they feel comfortable leaving the patient’s bedside for some much-needed respite. They know that their loved one is in good hands.”

As our meeting comes to an end, I begin to realize that the well-known story that I’ve heard about Dr. Lebowitz is in fact just a small anecdote to what he truly stands for.

When Dr. Lebowitz was making rounds at a hospital, he passed a room where a team of emergency room doctors, nurses and support staff were furiously working to revive a woman who had suffered cardiac arrest.

At the moment that Dr. Lebowitz passed by, the ER team had just about given up. They had spent fifteen minutes without success trying to get the patient’s heart to beat regularly. With grim faces, they left the room. Without knowing why, Dr. Lebowitz, whose specialty was not ER treatment, went up to the gurney and tried on his own to restart the woman’s heart.

Nothing seemed to be working. After about a dozen attempts, Dr. Lebowitz decided to try just one more time. Suddenly, the patient’s heart began beating properly. Sweating profusely, Dr. Lebowitz exited the room as some other medical staff took over the treatment of the woman.

Sometime later, Dr. Lebowitz decided to drop in and see how the patient – who was not Jewish – was doing, thinking that it might be a Kiddush Hashem for her to know that it was a frum doctor who had saved her life.

When the woman saw Dr. Lebowitz and read his name tag, she declared: “Dr. Lebowitz, how can I thank you for what you did in saving my life? Just saying ‘thank you’ isn’t enough. Thank you is what you say to someone who holds the door for you. Thank you is what you say to someone in the supermarket who lets you go ahead of them in line, but not to somebody who has given you the continued gift of life.”

With tears in her eyes, she turned to the doctor and said, “My gratitude to you is that every time I will now sit down with my family for a meal or family occasion, I will say, ‘Thank you, Dr. Lebowitz’. Every time I sit in my favorite chair to read a nice book, I will say, ‘Thank you, Dr. Lebowitz’. Every time I celebrate a birthday or some other major milestone in my life, I will take to say, ‘Thank you, Dr. Lebowitz’.

Where everyone else’s commitment ends, the dedication of Dr. Lebowitz begins.

 

As I left the unit I stopped to read the sign I had passed when I entered, “The Secret to Patient Care…is Caring for the Patient”. This dictum is one that can truly be felt as one walks through the unit. It is a hospital where it’s okay for families to ask questions; and the staff is always there to answer to the best of their ability. It is well understood that the nature of the illnesses the patients are plagued with are in need of delicate emotional handling for both the patient as well as their families. After my tour and interview with the staff of the Specialty Hospital I realized that it is no wonder that the institution receives rave reviews from its patients and their families. The atmosphere at the hospital certainly reflects the values and mission of Specialty Hospital where “The Secret to Patient Care…is Caring for the Patient”.