It was the early 1980s. AIDS was tearing through New York. Our high-risk obstetric clinic in Harlem was full of women who were hungry, sick, frightened, and showing up — which was itself a small miracle. My team decided to do something about the hunger part, which seemed like the piece most immediately within our reach. We called a local bagel shop. We negotiated a deal. Every clinic morning, seven dozen fresh bagels arrived with two pounds of butter and cream cheese and a box of disposable knives. The women ate. They stayed. They talked to the midwives. Not a single bagel survived to noon. We did this for four months and considered it, without exaggeration, one of the more effective public health interventions we had managed.
Then the health department arrived.
I was summoned to the hospital director’s office. She was not unkind. She explained, with the careful tone one uses when delivering a terminal diagnosis, that the health department had visited and found our bagel operation to be unsanitary.
Each bagel would need to be individually wrapped.
The cream cheese would need to come in individual sealed packages.
The knives — disposable, used once, thrown away — presumably needed to be individually wrapped as well, though I confess I lost track of the regulations at some point.
There were more regulations, though no requirements I remember if the bagels had to be plain or sesame, or everything.
The free bagel clinic, which had been keeping hungry pregnant women in their prenatal appointments during one of the worst public health crises in American history, stopped that day. Cold turkey. No bagels, no butter, no cream cheese, no patients lingering long enough to see their midwife.
Marcus Aurelius wrote that the impediment to action advances action. What stands in the way becomes the way. He was a wise man and a good emperor and he had clearly never met a municipal health inspector.
Mark Twain, who understood bureaucracy the way a river understands a levee, observed that the very ink with which history is written is merely fluid prejudice. I would add: the very forms with which public health is administered are merely the preference of people who have never been hungry in a waiting room.
I think about those bagels now when I read about the CMS mandate requiring hospitals to screen every inpatient adult for food insecurity. The federal government has decided, with great administrative seriousness, that the appropriate response to hunger is a checklist. You ask the patient if she has enough food. She says no. You document the no. You report the no to Washington. Washington counts the nos. In October 2025, Washington will publish the nos in a report that will be cited in papers and grant applications and policy discussions among people who will not be hungry while they read it.
Nobody brings bagels.
The Stoics believed we should focus only on what is within our control and release what is not. The health department, in its wisdom, took the bagels outside our control. CMS, in its wisdom, has taken the response to hunger outside the hospital’s obligation. The result, in both cases, is the same: an institution that identified a hungry person and then stopped. The difference is that in 1982 we at least had the good sense to feel bad about it.
There is a word for the belief that naming a problem constitutes solving it.
In medicine we sometimes call it documentation. In government they call it a quality measure.
In Harlem in the 1980s, the women in my clinic had another word for it, though I will spare the health department the details.
In my mother's kitchen we called it mishegoss.
In Cologne, where I grew up, we call it Quatsch or Unsinn.
In Harlem the women called it jive.
In Harlem in the 1980s, the women in our clinic called it pendejadas.
I will let the health department choose which translation they prefer.
The bagel shop, by the way, never charged us full price. They understood what we were doing. Nobody asked them to fill out a form.