"The hospital in Borough Park did not fit Gregorius’s blithe vision of work hard, play hard. His memories of his first foray into the Maimonides emergency room were vague: Crowded. Really crowded. Stretchers with patients were lined up two-and three-deep, with the lucky ones semi-secluded behind curtains that barely closed. He noticed that the melting-pot-mayhem--Hasids, Chinese, Pakistanis, Haitians, Russians, Bulgarians...did not seem to include anybody like him, a tall, skinny, white surfer-ski-boy from the Midwest. The visual overload was matched by the audio: Tower of Babel at top volume, accompanied by the constant beeping of monitors, pagers, telephones. The usual E.R. smells of antiseptic and bodily stink, but also strange spicy odors he couldn’t place.

Had he landed in the Third World, or a developing nation, whatever the correct terminology of the moment was? Before he could panic, he came across evidence that he was, indeed, firmly situated in the First World, 21st century: Maimonides had HealthmaticsED, a very cool, very tomorrow, computer system that, among other things, allowed doctors and nurses to track on a patient in real time. The computer monitors were stationed like beacons of sanity throughout the room. For Gregorius, they made the chaos seem almost comprehensible.Overcrowding had become commonplace in American emergency rooms which had, for people without medical insurance, become the doctor’s office. In June, 2006, almost a year after Gregorius began his residency, the Institute of Medicine of the National Academies would publish a report that warned: “A national crisis in emergency care has been brewing and is now beginning to come into full view.” The emergency department at Maimonides, which would process more than 84,000 patients in Gregorius’s first year, was not the busiest E.R. in the country or in New York City. But it was arguably the most intense.

Maimonides...make that Brooklyn, early 21st century...was an epicenter of the cultural forces that had been rocking and roiling the American experiment for a generation. The hospital, by necessity and tradition, remained a DMZ zone, where patients dragged in not just their wounds, fevers and malfunctions, but their accents and customs, their immigration and insurance problems, their feelings about being outsiders. Hope and heart-ache in 67 languages. Sick and scared, they yearned for kindness and prayed for competence from the doctors, nurses, floor cleaners, lab technicians, paper pushers and social workers, who had their own troubles, and were often newcomers themselves. At Maimonides, cross-cultural forces made for one big surf tide."