Portfolio at NYU

Posted 03.31.03
A good doctor

By David McKenzie

On September 11 at 9.00am, Dr. David Goldschmitt was leaving for Newark airport to travel to a medical conference in Florida. His mother turned on the TV to check the weather channel for him. It is a routine they go through every time he travels, which is not particularly often. She saw the towers burning and called her son-He had to get to Manhattan immediately.

Goldschmitt is the director of emergency medicine at NYU Downtown Hospital. The small hospital hunches at 170 William Street between Pace University and the Southbridge towers.

He jumped in his 1989 Chevy Blazer and drove to the Holland tunnel from his home in Newark, NJ. The tunnel was closed. He tried the Lincoln tunnel, the George Washington Bridge and the Staten Island ferry. All were closed.

"I was going to get into the city by hook or by crook," says Goldschmitt. He packed some provisions and drove back to the Holland tunnel, where massive blocks of concrete had been moved to block the entrances. He drove up and showed his ID. "I am not just a doctor," he exclaimed at the police, "I am the director of the emergency room 6 blocks away from the World Trade Center!" They pushed the concrete aside and he drove through a deserted tunnel into the cloud of dust and misery of Lower Manhattan.

Even by his own admission, Goldschmitt does not look, dress, or act like an emergency room doctor, much less an ER director. He has a quiet, unassuming and soothing voice. His wan face has strong bone structure and a bushy gray-brown moustache; he pulls his hair back into a short gray ponytail. Thinly striped shirts, drab ties and dark slacks make up his wardrobe. He wears brown cowboy boots each day. At one of his first doctor's jobs, the security guard pointed him to the nearby construction site, rather than to the door of the emergency room.
On the day of the attacks, Goldschmitt finally got to the hospital at 5.30 pm. "My first impression was, am I necessary?" Most of the first wave of patients had arrived.

NYU Downtown hospital dealt with the brunt of the first and most seriously injured patients from the World Trade Center attacks. They lost their power when the second tower collapsed. Engineers had to dig through several feet of ash to get to the generators. They had to bring a mobile generator powered cat scan; which they put in the parking lot. David Goldschmitt worked constantly to keep things moving.

ER medicine is Goldschmitt's passion. In a notoriously stressful profession, his dedication to trauma medicine has lasted 15 years. "I remember the first day I met David," says Dr. Tony Azar, the attending physician at NYU Downtown ER, he has know Goldschmitt for 15 years, "I was a 4th year and I was accepted to residency at Metropolitan Hospital." Goldschmitt, then at Metropolitan, met him on his first day; he took Azar on a round and described each patient by name and condition. The young student couldn't keep up. "I stood in the doorway of a new patient with him," says Azar, "'Oh my, look at this', he said and rattled of all the signs and symptoms and gave a diagnosis." For the next 30 minutes the future specialist closely examined the patient. Goldschmitt was spot on. "I have never been the same since that day," says Azar, "I was overwhelmed."

Goldschmitt's route to emergency medicine was indirect. He was born on June 1956 in Irvington, NJ, to what he describes as an impoverished family. His father, who died last February, was a structural steel engineer and his mother, a secretary. When he was one year old, the family moved to Parsippany, NJ to a small acreage where deer roamed in a nearby forest.

"When he was very young someone gave him a football," says his mother, Florence Goldschmitt, "Instead of running outside to play with it, he spun it on the ground to see how long it would spin-he was always intellectual." But he was not antisocial, "He was in cub-scouts, and we always friends coming over." Goldschmitt was never the type to have lots of friends. "He would rather have deep friendships with a few, not mild friends with lots," explains Florence.

After school, he attended Bowdoin College in Brunswick, ME, where he graduated Magna Cum Laude with degrees in Biology and Art history. To help pay for his expenses, he worked as a licensed practice nurse. He was active in drama and fostered a great love for the theater. "My pre-med advisor said I didn't have the personality to be a doctor," says Goldschmitt, " I was not focused and passionate about the science of medicine."

So, instead of medical school, he went Chicago University to do a Master's in medical sociology. It was during the big storm of 1979 and he couldn't bear the weather and focusing on the administrative side of hospitals. "I decided I would shoot myself in the foot if I had to be an administrator," says Goldschmitt, fully aware of the irony as he sits in his director's office.

He finished his year in Chicago, but never bothered to write the final thesis. Instead, he left for New York to apply for med-schools and to work as an actor. A play that he had worked on in Chicago was set to come to Broadway, but the New York production never got off the ground. Goldschmitt wanted to work as a character actor, but he did not have much success. His instructor at the American academy off Arts summarized what he thought was the problem, "You are too ugly to be a leading man, but you are too good looking to be a character actor."

"Part of being an ER physician is acting," says Goldschmitt, "you have to have patients that believe in you." The entrance of the ER is at the back of NYU Downtown. Bold red writing in English and Chinese alert to the serious role it performs. "The ER is the crucible of Crisis," says Azar, "the dark side of humanity comes through here."

Inside the ER ward, a doctor and a nurse walk quickly into room pc-5. A man lies on his side, he screams repeatedly in pain. It echoes through the bustle of the room. In a corner, a nurse places sutures on a gash on a dark haired man's hand as he looks curiously around the room. In the far corner a young Asian man sits in a wheelchair, he is attached to a drip and stares blankly at a white wall. Goldschmitt walks through all of this confidently towards the exit to be interviewed.

"There are times you have to prioritize, who is going to die, who is not going to die," he says, in a quiet tone, motioning with his bony hands, "That is part of the art, pointing it out-you are the sickest, you are the next sickest." Goldschmitt is passionate about the clinical side of ER medicine. He feels that he makes a difference in people's lives. "If I was at a private practice I would be seeing Mr. Jones every week and every month for the same thing. Most people who come to ER leave different from when they come in."

He did not share this love for medical school. Goldschmitt describes the first two years at med-school as the most miserable in his life. He got in on his eleventh interview. The promised grants at University of Medicine and Dentistry of New Jersey in Newark fell through at the last minute. He had to work 30 hours a week as a truck driver and a singing waiter. He was $40, 000 in debt before his first class started. Because he hated medical school, he quit serious theater altogether, he thought he would be tempted to quit and try acting professionally. "He always had good friends in theater," says his mother. He has lost touch with all of them.

ER medicine was not an initial goal of Goldschmitt, in medical school he wanted to be a surgeon, but that was changed in 1982.

He tells the story with measured and practiced delivery. On a hot August afternoon, an accident changed his life. An old woman had a seizure in her Chevy at a stoplight and fell unconscious. The car careened across the street, straight at Goldschmitt and his motorbike.

"I dropped the bike and ran off the street", says Goldschmitt. The car struck the bike and the 2000-pound machine flew into the air. The engine landed on his abdomen, the directional light plunged through his right arm, and the spokes of the wheel smashed into his legs and destroyed his knees. Two major compound fractures jutted out of his legs. "I left a little piece of me in Newark," he says, smiling about part of the bone in his arm that was never recovered.

It was 4pm. He never lost consciousness. Goldschmitt motioned to the residents who came out onto the street. He asked them to pick him up. A small group took off his dented helmet and raised his bloodied and broken body. He told them to carry him to the Chevy. He checked the woman's pulse. "Call an ambulance for us," he said as they lay him back onto the grass by the side of the road.
After the accident, he was told that he could never be a surgeon and that he would only be able to extend his arm halfway. "You should never tell me I can't do something," says Goldschmitt, showing a rare moment of bravado, "because then I will just do it." He wears the cowboy boots because the raised soles and tight supports help him to stand and walk with his still destroyed knees. He can just about extend his arm fully, but he would never be a surgeon.

Emergency rooms have a high turnover rate of patients. They come in, the doctors fix them as best they can and they are transferred. Goldschmitt cares deeply for his patients. For a doctor he has an enormous capacity for empathy. "You can not treat a patient in ER unless you communicate with them," he says, "The minute you define someone as a gall-bladder, you miss something." He thinks that the day that doctors thought of their job as a profession, they lost something. As a medical professional, he does not deal with the emotional strains in a cool, scientific way.

Recently, Goldschmitt and a group of doctors failed to save the life of a critically ill baby. They each went to the family to give support. He insisted that each of the doctors leave the hospital for a few moments to deal with their emotions. "It is easy to become cold and disengaged," says Azar, "David taught me that it is ok to go home and cry, to let your emotions come out." More than once, according to the nurses at the hospital, he has helped patients with their bedpans, a task that most ER directors would never think of doing . Dr. Azar says that Goldschmitt sometimes gets too caught up in his patients social situation, "he sometimes tries to be a social worker."

Underneath his enormous capacity for caring, David Goldschmitt is saddled with self-doubt. The ER ward is his place of comfort and confidence. "I don't think he has high self-esteem," says Mary Lyke, nurse manager of NYU downtown, who has worked with him for 8 years, "He has no reason to, I don't think he sees how good he is." David Goldschmitt mentions his shyness often, but he seems resigned to it. "His father would tell everyone how wonderful his son was," says Florence Goldschmitt, her voice wavering over the phone, "but he would never tell his son."

David freely acknowledges his low self-image. When he was involved in musicals, he wanted to work as a character actor, not as the leading role, he especially enjoyed singing as a character different from himself, "I don't like me, I don't have to be timid, I don't have to be insecure."

In an average week he works 80 hours. Twenty-five are taken up by a clinical rotation. The rest he is an administrator. "I had the foolish notion that I could make a difference," says Goldschmitt with a tired smile. When he joined NYU downtown as an attendant, he saw tons of problems that he thought he could fix.

The vast majority of the ER staff adores David Goldschmitt. "He is an absolute godsend," says Stacy Hughes, a physician's attendant working at the hospital for 7 years, "he is one of the few who is not callous."

He is well liked, but this might be a hindrance in his administrative role-which is essentially a political position, "Most ER directors I have worked with have been bastards," says Azar, "sometimes David takes all the abuse." In his first few months as a director, he would not say a word in department meetings. "When you get into a meeting," says Lincoln Cleveland, a former physician at NYU Downtown, "you either win or you don't." He feels that Goldschmitt's personality hindered his ability to fight for issues, "He just didn't want to make enemies."

Goldschmitt feels more stress from his administrative job than his clinical role. Some of his workers think that he takes too much of the blame from the powers that be. "You don't have anyone to refer the nasty stuff to," says Goldschmitt, " even if a medical cart is sitting in the wrong place, I get the blame."

Being a brilliant doctor can take its toll. "In this job he hasn't had time to go to places and do things," says his mother. "I think he is a lonely man," says Azar, who Goldschmitt counts as one of his few friends. In his spare time he restores a 17-room mansion in Newark, where he lives alone. Last year were five people living there: his girlfriend of 8 years, his foster son and a cousin. In a terrible twist of fate, his girlfriend professed her love for his foster son and they moved to England together. His cousin moved to California. "He was devastated," says Azar, "but he would never be one to complain." Goldschmitt doesn't seem too perturbed about his solitary existence, "I am fine with lonely right now; the thought of another relationship makes me cringe."

NYU Downtown hospital is struggling to gain recognition for its work after September 11. For a time, the ER staff wrote 'the forgotten hospital' on the letterhead of internal memos. At the helm of its emergency room is a doctor who has made his life caring for strangers. In the weeks after the attacks, people pasted flyers of their missing and dead on the glass walls of the emergency room. The wall represented all the people that Goldschmitt, with all his immense clinical talents, could never save. "There was a feeling that it was too overwhelming," says Dr. David Goldschmitt, "and the wall only accounted for a hundred lost lives, much less the 4000."