She arrived at Mount Sinai West’s emergency room with slurred speech and no identification. Paramedics had found the woman on the floor in a luxury apartment building on Central Park South, disoriented, apparently experiencing a stroke.
She was one of thousands of people who are brought to New York hospitals each year, identified only as “unknown.”
By all appearances, she was just another Jane Doe the hospital was required to take in — needing care that would probably take about a week. But in the next day or two, a family lawyer, following a tip from the manager of the woman’s building, identified the “unknown.” She was the Baroness Birgit Thyssen-Bornemisza, 80 years old, from one of Europe’s wealthiest families, with businesses in banking, steel and other industries, and one of the world’s premier private art collections.
But beyond that, the patient in Room 23 was a mystery. She had no Social Security number, no insurance, no identifiable source of income, no immediate relatives. If she had any friends or a bank account, the lawyer did not know of them. Google her name: no information.
How could a woman from such an illustrious family, living in the heart of New York City, leave so few traces of her existence?
Since April 4, she has remained in her hospital bed, tethered to a feeding tube, with an unpaid bill that has long since passed $600,000. She spends her days largely unheeded, visited by a longtime home attendant who brings her flowers. For hospital administrators, she is a problem, occupying an acute care bed she does not need, with no money coming in and no way to discharge her safely. In June, the hospital petitioned to have her placed into guardianship, in part so someone else could take responsibility for her care.
She had spent decades working to be invisible, to avoid ties to institutions, public or private. Now it was catching up to her.
Her monthslong hospital stay, with no rehabilitative treatment, was a confounding case, said Elisabeth Benjamin, vice president for health initiatives at the Community Service Society of New York.
“Health care bureaucracy hits legal bureaucracy,” she said. “And the victim of that is this woman.”
A baroness is born
A few facts from her early life are known.
Birgit Muller was born in 1942 in Hanover, Germany. Her mother, Ingeborg Muller, and her father divorced when Birgit was young. In 1946, Ingeborg married Baron Henrik Gábor István Ágost Freiherr Thyssen-Bornemisza de Kászon et Impérfalva, a geophysicist and eldest son of one of the Continent’s richest men. By then, the young baron, who went by the name Stephan, had embroiled the family in two international scandals — first by eloping with a teenage bride in Texas and then by killing another paramour in a shooting accident in Hungary. A rare photo of Ingeborg and Stephan as newlyweds shows them resting their heads on each other. They both look besotted.
But it was a tumultuous time. During World War II, the Nazis nationalized the Thyssen steelworks, and many family members fled Germany or tried to. Stephan, who was born in Hungary and held a Hungarian passport, nonetheless remained and aided the Nazi war effort.
According to “The Thyssen Art Macabre,” by David R.L. Litchfield, which delves into the family’s Nazi ties, which it often denied, Stephan oversaw a company that used concentration camp laborers to build armaments. Stephan insisted his hands were clean. “I have absolutely nothing to hide, was never a German and am only interested in science,” he maintained in a letter quoted by Mr. Litchfield. Still, a family-commissioned book, “The Thyssens: Family and Fortune,” by Simone Derix, identifies Stephan as a financial contributor to the SS.
After the war, the Allies initially refused to let Stephan leave Germany, but in 1948, he and his new family moved to the Hotel Metropole in Monte Carlo. An Austrian governess and white-gloved butlers looked after 6-year-old Birgit.
Three years later, the trio migrated to Havana’s grand Hotel Nacional, bringing with them enough European masterpieces to decorate two suites. Birgit led a sheltered life in Monte Carlo and Cuba, without school or much of a social life. But some hints may be gleaned from two books she wrote in French with her tutor about globe-trotting girls like herself. Her parents paid to have the books printed.
(Because Ms. Thyssen-Bornemisza has been deemed incapacitated, The Times did not interview her for this article. Her guardian did not respond to interview requests. Some details related to guardianship are from a court hearing, which the judge permitted The Times to attend. Some historical details are drawn from Mr. Litchfield’s and Ms. Derix’s books.)
Five increasingly cloistered years into their stay at the Nacional, the family refused to let the hotel refurbish their quarters. When the manager cut off their room service and electricity, they subsisted on biscuits and bottled drinks. Accounts of the stubborn baron’s “hunger strike” — featuring photos of his 14-year-old daughter — went around the world.
The communist revolution in Cuba propelled them to New York in 1961. Living at the Plaza, they began to pop up in society columns. Cholly Knickerbocker noted that the “erudite baron,” his baroness and “their lovely daughter Brigit” — a common misspelling that persisted in the press — “entertained a distinguished group of ambassadors, ministers and socialites-without-portfolio.”
They disappeared from the columns after 1964. Stephan may have tired of cocktail chatter. He also may have wanted to be less visible. His uncle Fritz had been jailed and fined for backing Hitler’s rise to power, and his sister Margit had moved to Uruguay after investigators looked into a 1945 party she hosted at the family castle in Austria, during which some of her Nazi guests gunned down at least 180 Hungarian Jews.
Though Stephan sought to distance himself from his family, he relied financially on his estranged younger brother, Hans Heinrich (known as Heini), who controlled the family businesses and fortune. According to Mr. Litchfield’s book, Stephan had “settled” in 1952 for a payout of $20 million (about $224 million in current dollars). But the family ran through much of the money, and he gradually came to depend on an additional stipend of several thousand dollars per month, paid through a family foundation.
Stephan and Ingeborg became increasingly furtive. Eschewing credit cards, they paid for everything in cash. Though they were permanent legal residents, they refused to get Social Security numbers. Their lawyer, Stanley A. Cohen, doubts they ever paid U.S. taxes.
“They didn’t want anything to do with government,” Mr. Cohen said. “They were happy being completely anonymous,” he added. “They didn’t trust anybody.”
Stephan died in January 1981, after a period in which he ate only vitamin tablets, Heini told Mr. Litchfield. “He looked like a skeleton,” his brother reported.
New York court files contain no record of a will. There was no obituary or death notice, and none of his three siblings attended the funeral. Heini wrote Ingeborg and Birgit a terse letter advising that he would voluntarily increase their monthly stipend to $4,000 from $2,000.
A team of two
So began decades of intense, hermetic closeness between mother and daughter, with minimal contact with the outside world. Ingeborg and Birgit went everywhere together, taking hourslong walks in matching outfits from Bergdorf’s and Saks.
They downsized from the Plaza to a rent-controlled, terraced three-bedroom apartment on Central Park South, where the staff addressed them both as “baroness.” They piled old photos and furs carelessly about the apartment and decorated it with paintings by Birgit. If Birgit had friends or romantic attachments during this period, they are no longer in her life. Her one known interest was painting, which she pursued studiously.
When Birgit, then 52, enrolled in the venerable Art Students League in 1994, a three-minute walk from their apartment, her mother would accompany her to class, then wait in the lobby to walk her home.
“Her work was good,” said Anne Costello Coyle, whose late husband, Terence, was one of Birgit’s teachers. “She had a knack for putting down the composition very fast.” The school archives contain no photos of her or her paintings.
Ingeborg approached Ms. Coyle about opening a gallery together on Park Avenue. The only paintings she intended to exhibit would be by Birgit and Terence Coyle.
“Birgit was so excited about the gallery idea,” Ms. Coyle said. “It seemed to keep them going.”
The plans ultimately fizzled, but Ms. Coyle became close to Birgit, encouraging her to socialize with classmates, to no avail. “Somehow she just did not make friends,” she said. “And she didn’t try.”
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Ms. Coyle got to know Birgit’s and her mother’s quirks.
They only rode elevators with operators, she said. And they were profound germaphobes. “They would never go to a public bathroom,” she said. “They would never get in a taxi. They had to have a stretch limousine. Because, you see, if you took a smaller limousine, there’d be more germs.”
Also, they were afraid of having their purses snatched, so they carried little paper bags with their money and cosmetics.
Neither worked or got involved in charities. Mostly they walked the city, from Central Park to the Bowery and back. They were on one of their marathon hikes around 2002 when Ingeborg suffered a stroke.
She had no health insurance, having refused the family’s earlier offer to pay for coverage, Mr. Cohen recalled. The hospitalization depleted what savings she had.
Ingeborg died soon after, with no obituary and no memorial service. Birgit, then roughly 60, could barely afford the cremation, Mr. Cohen said. (Birgit kept her mother’s ashes next to those of her father.)
Heini’s fifth wife, Baroness Carmen Thyssen-Bornemisza, a former Miss Spain, took an interest in Birgit. “She was sweet, a very adorable person,” Carmen said, speaking by phone from Madrid, where a palatial art museum bears the Thyssen-Bornemisza name and collections. “She was really lost when her mother died. I asked her to come to Switzerland. But she was not even able to make decisions without her mother. I said, ‘Whenever you want, I’m here.’”
Carmen also sent a modest monthly check. She declined to name the sum. If Birgit needed more money, Carmen said, she never asked for it. “They were not greedy at all,” she said.
At some point Birgit fell and injured her hand. Ms. Coyle introduced her to Bhagwatie Faerber, a housekeeper and caregiver from Guyana, who had moved to the United States to flee a stormy marriage. When Ms. Faerber first visited Birgit’s apartment, she was shocked.
“Oh, my God!” she said recently, remembering her introduction to Birgit’s world. “Everything was a mess. Dirty. Thick, thick dust. You can’t breathe.
“Only one of the three toilets worked. And you had to be careful how you used that one. The shower didn’t work.”
In an echo of her father’s “hunger strike” at the Hotel Nacional, Birgit refused to let in repairmen.
“She wouldn’t allow people to do anything,” Ms. Faerber said. “She’d rather live in the dirt.”
At the same time, Ms. Faerber said, “she’d wash her hands 100 times.”
Ms. Faerber accompanied Birgit to the diner nearby on Seventh Avenue, where Birgit ate most of her meals, or to feed the birds in Central Park. Every month, a family foundation in Switzerland wired Birgit’s payment to a Montreal bank, which would send Birgit a check. Ms. Faerber would escort her to a Citibank branch to deposit the check. “She had an A.T.M. card,” Ms. Faerber said. “She didn’t have credit cards. Always cash.”
Ms. Faerber, who is now 61, recalled that often Birgit would cry about her mother. Yet she also resented her mother’s all-encompassing control. “Things that she wanted and didn’t get, she would blame her mother,” she said. “She was very angry at her.”
Ms. Faerber never heard her speak of any romance.
Following Ingeborg’s death, the family foundation announced it was cutting Birgit’s stipend in half. Though Carmen kept sending Birgit checks, Birgit feared that her monthly income wouldn’t cover her rent. Mr. Cohen arranged for her to move to a downstairs studio apartment, also rent-controlled. Even so, Mr. Cohen said, she initially refused to put her name on a lease. “She didn’t want to sign anything,” Mr. Cohen said. “I said, ‘You have to!’ Finally, she signed.”
The Covid pandemic further isolated Birgit. The diner she frequented closed. Her failing eyesight made it risky for her to walk the streets. To deposit her check, she would sometimes take a taxi to the Citibank a few blocks away.
On days when Ms. Faerber worked for other clients, she still called Birgit several times a day. “If I didn’t call her, it was a problem,” she said. “She’s very strict, very spicy. But I have a lot of patience.”
On April 2, Ms. Faerber said, they had a normal conversation at around 8 p.m. But the following morning, Birgit did not answer. After several tries, Ms. Faerber became concerned. “I call the doorman,” she recalled. “‘Can you please send someone upstairs to check on her, please?’”
A building employee heard moaning inside the apartment and broke the security chain. Inside, he found Birgit splayed on the floor. Paramedics brought her to the same hospital where Ingeborg, who’d also suffered a stroke, had died two decades earlier.
When Mr. Cohen saw her, he recalled, “Birgit said to me, ‘This is what happened to my mother.’ I said, ‘I know, Birgit. I know.’”
Privacy becomes isolation
For more than six months, she has remained in her hospital bed, becoming what hospitals call a longtime boarder — someone who cannot pay, doesn’t need acute care, but cannot be transferred to a nursing home or rehab facility because there is no money or insurance to pay for care there. Far from her young life in the aristocracy, she was now living an existence no one would choose.
At a guardianship hearing in August, a social worker for the hospital, Whitney Sewell, testified that Birgit had not received therapy to help her walk or swallow. “In the hospital we don’t have the ability to provide rehabilitative services that a rehab does,” Ms. Sewell explained.
The hospital will not discharge her without a nursing home or a rehab center to take her, and none will do so without a Medicaid application in process or other hope of payment. And so Birgit remains in a shared room on Mount Sinai West’s ninth floor, her bill still running.
Ms. Faerber visits regularly, she said, to make sure Birgit is dry and does not have bedsores. On good days, Ms. Faerber said, Birgit is alert, but she cannot see or hear well. “If she’s fully awake, you will get sensible things coming out of her mouth,” she said. But she added that Birgit’s mental state had declined during her time in the hospital.
And there have been two financial blows. For years, the family foundation in Switzerland had urged Birgit to get a Social Security number because of tightened regulations in the U.S. to cut down on money laundering. But Birgit refused. Finally, a few months ago, the foundation cut off her checks. Around the same time, Carmen Thyssen-Bornemisza’s assistant died, and Carmen did not know how to contact Birgit, so her regular checks stopped coming.
At the guardianship hearing, conducted virtually, Birgit appeared briefly but was not able to answer a simple question from the judge. Joyce Campbell-Priveterre, a court evaluator assigned to the case, testified that she had found Birgit to be “somewhat animated” but “frail.”
“She definitely did not appear to be oriented to time and place,” she told the court. “She was just not able to participate in any conversation.”
Guardianship, which provides essential protection to many frail or incapacitated people, has also been criticized as overly intrusive, and its legal processes as secretive. Claude Pepper, the former chairman of the House Select Committee on Aging, once called it “the most punitive civil penalty that can be levied against an American citizen, with the exception, of course, of the death penalty.”
Judge Lisa Ann Sokoloff granted the petition, appointing a woman named Diane Lansing as a guardian with temporary authority over the baroness’s person and finances. Among the guardian’s duties were to apply for a Social Security number and Medicaid — a level of involvement with the government that Birgit actively resisted — and get her discharged from the hospital.
“We really are in the dark about her finances,” Judge Sokoloff said at the hearing. “She may have money squirreled away, she may not.”
John W. Rowe, a professor of health policy and management at the Columbia University Mailman School of Public Health and former chief executive of Mt. Sinai Medical Center, said he sympathized with hospital administrators if a patient doesn’t need acute care and is taking a bed away from someone who does.
But he called the $600,000-plus bill the hospital quoted to Mr. Cohen an artificial number. For most patients — those with insurance, Medicare or Medicaid — a hospital would bill a fraction of that number, he said. And if patients do not pay, New York has what is called a Bad Debt Pool that partially reimburses hospitals.
In New York City, about a third of residents over 65 live alone, at risk of becoming socially isolated — a condition that carries a health risk comparable to smoking 15 cigarettes a day. Birgit, who sought a level of isolation, illustrated the fragility of such a life, as all her supports gradually slipped away. From a health perspective, guardianship may indeed benefit her, by allowing her to move to a facility where she can regain some capacity to walk and swallow. Yet it is an involuntary measure that strips away her privacy and autonomy, two ideals she seems to have treasured above most others.
At the guardianship hearing, Judge Sokoloff observed that this “very sad case” has been made worse by Birgit’s “lifelong obsession — and it was an obsession — for keeping her life private.” The result, she said, has been “possibly getting herself cut off from her only income.”
But she promised: “We will do the right thing by Birgit Thyssen.”
What is the right thing? Ms. Faerber insisted that Birgit can swallow and is ready to return to her apartment, with help from attendants. “She said: ‘I want to go home. Can you take me home?’” Ms. Faerber sobbed. “It’s so painful to see her like that.”
In September she said Birgit had mentioned cash totaling $10,000 stashed around her home, and the name of a storage facility that may hold valuables, including paintings owned by her father.
After so many years of resolute independence, her every life choice — where she lives, where she goes, what happens to her — now belongs to a guardian she had never previously met, and never asked for.
Whether or not her guardian turns up an old master painting in storage that might enable Birgit to live an independent life, her most precious work may be a self-portrait that is still in her apartment. It shows her with her parents, years ago, in happier times.
At the end of a life spent avoiding intimacies, her one close relationship appears to be with Ms. Faerber.
“I’m still fighting for her,” Ms. Faerber said.
“I devote my life to her because she’s like a mother to me. I’m all in for Birgit. She’s my girl.”
Audio produced by Jack D’Isidoro.
About the Illustrations There are few photographs of the subject of this article; the illustrations used here are an artist’s interpretation. They are not intended to be realistic depictions of events or individuals.
George Rush has contributed to Vanity Fair, Esquire, Rolling Stone and The Wall Street Journal. He and his wife, Joanna Molloy, wrote the Rush & Molloy column for The New York Daily News for 15 years, an experience they recall in their book, “Scandal: A Manual.” Mr. Rush is also the author of “Confessions of an Ex-Secret Service Agent.”
Rutu Modan is an Israeli Illustrator, comics artist and professor at the Bezalel Academy of Art & Design, Jerusalem. She is the author of several award-winning graphic novels, including “Exit Wounds” and, most recently, “Tunnels.”
John Leland, a Metro reporter, joined The Times in 2000. His most recent book is “Happiness Is a Choice You Make: Lessons From a Year Among the Oldest Old,” based on a Times series. @johnleland
A version of this article appears in print on Oct. 23, 2022, Section MB, Page 1 of the New York edition with the headline: The Baroness in Hospital Room 23. Order Reprints | Today’s Paper | Subscribe