Keep Your Religion In Medicine

Keep Your Religion In Medicine

Originally delivered as the d’var Torah for Parashat Mishpatim 5782 on January 29, 2022 at Congregation Beth Shalom, Pittsburgh, PA. Portions of this talk originated or were adapted from lectures given at Ohev Shalom of Bucks County, Richboro, PA and for the Maimonides Society of the Jewish Federation of Richmond, VA in February, 2020, and from my post “My Stethoscope is Praying” from February 2019, but this is the first time all of this material came together as one.

I was on suicide watch for a patient a few years ago.  After a long series of emails and text messages and phone calls, the psychiatrist, the therapist, the patient and I were all satisfied they were safe.  After the dust settled, I mentioned to the therapist that I had recommended a book to the patient by Rabbi Naomi Levy.  “Are you mixing religion and medicine?” she texted back.

“That’s my brand…” I replied. 

So in early 2019, when #medtwitter began blowing up with the phrase, “Keep your religion out of medicine,” it hurt me.  The Department of Health and Human Services had just released guidelines allowing healthcare providers to refuse to provide any services they found morally offensive.  Purportedly, this was a rule needed to combat the epidemic of doctors, nurses, and pharmacists being bullied into performing abortions, dispensing contraception or gender-affirming hormones, or engaging in other care they felt to be reprehensible.

The people I usually see on that hashtag are mostly docs and other healthcare providers, deeply interested in the medical humanities, in stories and poetry and emotions and meaning.  Large numbers of them are also fierce advocates for better gender equality in medicine, LGBTQ+ rights, reproductive freedom and a host of other issues.  The new guidelines had them up in arms.  In their rage, one by one, they shouted, “Medicine is no place for your religion.”

It’s well known that after Rabbi Abraham Joshua Heschel marched in Selma, Alabama, in 1965, he remarked afterward to his daughter, Susanna, “Legs are not lips and walking is not kneeling. And yet our legs uttered songs. Even without words, our march was worship. I felt my legs were praying.”

Less well known is that in 1964, Heschel spoke before a meeting of the American Medical Association, as part of a discussion entitled, “The Patient as Person.”  At that conference, he spoke as reverently of medicine of his work in Selma the following year.

“The Mother of medicine is not human curiosity,” he declared, “but human compassion.  What constitutes being human, personhood?  The ability to be concerned for other human beings.”

Mutual concern was so important to Heschel that he felt that its absence might endanger the whole enterprise.  “Without a sense of significant being, a sense of wonder and mystery, a sense of reverence for the sanctity of being alive, the doctor’s efforts and prescriptions may prove futile.”  Heschel tells me that my stethoscope is praying. 

And yet Heschel already saw the seeds of the crisis we are in today, as the unique trust and reverence medicine used to enjoy among the professions had already begun to erode.  “While medical science is advancing,” he observed, “the doctor-patient relationship seems to be deteriorating.”  He saw medicine suffering from what he termed a “spiritual malaria,” a disease in which the patient becomes nothing more than “a human machine in need of repair . . . an ingenious assembly of portable plumbing.”  And if that’s the case, then the doctor becomes nothing more than a plumber.

Despite what my online community says, religion and conscience in medicine don’t begin and end with whether someone believes a fully human life begins at the moment of conception or the moment an infant’s head emerges from a mother’s body.  I’ve mostly steered clear of Twitter since early in the pandemic, but I can guarantee that with the many abortion cases now before the Supreme Court, medtwitter is taking shots at religion again.

The abortion debate allows one hotly contested issue in medicine to obscure a greater truth – medicine is exactly the place for my religion.  It says so right in this week’s parsha: rapo yirape, “he shall surely heal,” a phrase that forms the basis for the Jewish permission, and indeed obligation, to practice medicine to relieve suffering and restore health.

We need it to keep hospitals that still bear religious names focused on their religious mission of healing and compassion, instead of on the revenue that has become a false idol for the whole healthcare system.  We need it to ensure that healthcare is a safe space for the homeless, the refugee, and the victim.  We need it to prevent the progressive medicalization, dehumanization and objectification of people into patients (or worse, customers) caused by technology and medicalizing normal human experiences.  And yes, we need it to inform our discussions about when life begins – and when and how it ends, like the discussion in which I was honored to participate last month, at Rabbi Perlman’s invitation, on physician-assisted suicide.

So when I went looking for a cure for malaria, I went all the way back to the beginning – and by that I mean Beginning, with a capital B.  Bereishit, Chapter 1, verses 26 and 27: (26) And God said, “Let us make man in our image, after our likeness. They shall rule the fish of the sea, the birds of the sky, the cattle, the whole earth, and all the creeping things that creep on earth.” (27) And God created man in God’s image, in the image of God, God created him; male and female God created them.

And what are we to do with this information?  “Walk in God’s ways,” taught the prophets, and after them the rabbis of the Talmud: do the acts of kindness that God does in the Bible, like clothing the naked, burying the dead, visiting the sick – and yes, healing them.  In a world where God does not come face to face with us, the closest we will ever get is face to face with another human being.

Mishpatim focuses on exactly this expression of our relationship to God.  After realizing in last week’s parsha that direct experience of God’s presence at Sinai is more than they can handle, Mishpatim focuses on the details of how individual human beings, and larger groups of us, can live in relationship.  Long time Beth Shalom veteran Adam Shear wistfully lamented in a Library Minyan d’rash years ago that in becoming Bar Mitzvah on Shabbat Mishpatim, he had a little bit of “Yitro envy.” Instead of giving his Bar Mitzvah d’var Torah about the dramatic event of Revelation, Adam got stuck with a laundry list of commandments that to a 13-year-old boy may have felt “obvious.”  But it is in that laundry list that the rubber of good intentions hits the road of real life.

True, one of the mitzvoth in the list is the crucial Jewish text in the discussion around abortion (Exodus 21:22).  Instead, let’s look at two passages that express a fundamental truth of Judaism: Exodus 22:20 and 23:9 are both versions of the commandment not to wrong the stranger that appears at least 36 times in the Torah (according to an accounting in Bava Metzia 59b).

A while back a person I was caring for lashed out in frustration, “You doctors all come from such perfect lives, you don’t understand broken people like me.”  That person, and many others I’ve cared for over the years, sometimes literally don’t recognize themselves in the mirror.  It was an insight first shared with me by a woman who had undergone gastric bypass surgery for weight loss; she looked in the mirror one day and just didn’t see herself.  Similarly, people with skin diseases, amputations, or sudden loss of mobility can look at their reflections and wonder, “Who is that?”

In their illnesses, they have become strangers to themselves, unknowable, unrecognizable.  How much stranger must they feel in the land of medicine, eerily separate from their Lifeworlds, with its foreign language, strange rules, and upside-down priorities?

Sadly, the land of medicine treats strangers much the way the people of Sodom and Gomorrah did: it abuses them.  Our parsha commands us not to take a poor person’s garment in pledge for a debt; the podcast An Arm and a Leg recently documented a health system (Methodist Hospital in Memphis) that was so aggressive in collecting debts it would garnish the wages of its own employees.  Medical debt is the single largest cause of personal bankruptcy in the US and has been for at least my entire career in medicine.

Were that not enough, the land of medicine holds grudges against strangers.  I care for a lot of people who have been labeled “difficult” elsewhere, because of raising complaints, failing to follow medical advice, or insisting on doing things in an unconventional way.  Often, they are people whose diagnosis is unclear or who are failing to respond to standard treatment.  Rather than labeling them as patients with difficult illnesses, they are labeled as difficult patients.  Why “difficult” is such a negative term for doctors, of all people, is hard for me to fathom; as Jimmy Dugan (Tom Hanks’ character in A League of Their Own) put it, “It’s supposed to be hard!  If it were easy everyone would do it.”

The “difficult” label spreads through the system, too.  Put in the medical chart, it never leaves a person; one specialist after another sees it, forms an opinion before even meeting the person, and closes ranks with their colleagues.  I have seen the effect it has on people, effectively shutting them out of care anywhere, gaslighting them to the point that they appear paranoid, and may indeed believe that they are losing their minds.  Exodus 23:1 admonishes us, “Lo tisa shema shav” – do not carry false rumors, or in another meaning of the word, do not “elevate” false rumors, meaning do not raise them to the level of truth – “al tashet yadecha im rasha l’hiyot ed hamas” – do not join hands with the wicked to become a malicious witness.

Sforno, commenting on that verse, takes it to be a prohibition on co-signing documents with one who is maliciously spreading rumors.  As I add my insights to a person’s medical charts, I think what it must mean to “join hands” with those who are propagating labels, maligning a person in a record that now lives forever and can be instantly duplicated.  One person I cared for over 8 years found themselves waiting hours for supplemental oxygen when they had pneumonia – because their chart documented a history of prescription drug abuse years before.  I’ve become very careful how I describe my interactions with people, how I refer to them and how I interpret even their bad behavior – always “al kaf z’chut”, with the benefit of the doubt in mind, so as not to add fuel to the fire of these false rumors, and where possible to set the record straight.

When you’re difficult, the land of medicine treats you like Marvin K. Mooney in the Dr. Seuss book: “Would you please go now?”  A far cry from Exodus 23:5, which commands us to raise up our enemy’s donkey if it collapses under its load.  Rashi looks at that verse and poses the rhetorical question, “Who could see that animal suffering under its burden and not be moved to help?”  Kal va’chomer, who could see a human being, even a “difficult” one, suffering and choose to dismiss them rather than set aside their dispute and try to heal them?

The events of the last two years have highlighted what these “difficult” folks are going through.  On the purely clinical front, the discovery of a “long COVID” syndrome, which by some estimates affects 10-40% of COVID survivors for months after “recovery,” if not longer, with sleep disturbances, brain fog, breathing and cardiac impairment, and crushing fatigue.  It marks the first time we have seen massive numbers of people simultaneously develop a “functional illness” that bears a strong resemblance to disorders like chronic fatigue syndrome, post-treatment Lyme disease syndrome, functional neurologic disorders and other frequently stigmatized illnesses.  My hope is that the massive amount of research being done on this phenomenon with bear fruit for people with those other misunderstood, mistreated illnesses.  Yet some researchers are already questioning the existence of this condition, despite literally millions of people who are experiencing it, and suggesting that the condition is caused by believing that one had COVID more than by actually having it.  In other words, it’s all in their heads.  All ten million heads.

At the same time, we’ve learned a lot about illnesses of a different sort – societal, systemic illnesses.  Being sick while Black has long carried a risk of poor access to care, lower likelihood of receiving all evidence-based treatment, and much higher risk of spending more time with hospital security, CYF or some other punitive treatment than with one’s own doctor or nurse.  Speaking up about these risks carried a risk of having the patient labeled as paranoid, and their belief that the system or the treatment they received was racist weaponized against them. 

I have patients so traumatized by the care they received at our flagship health system in this city that seeing the telltale emblem on a badge, even in my unaffiliated clinic, has caused them to berate the student wearing the badge and storm out of my office.  Black faculty members at medical schools around the country have spoken up about systemic racism and found themselves out of work, accused of various kinds of misconduct that took place “before” they spoke out and yet somehow was never brought to their attention.

So if Mishpatim calls out the bad behavior in the healthcare system, what does it say about how we should behave?  Let’s go back to the patient who castigated me about us healers with the perfect lives.

Now, it’s true that as a group, people entering medicine (and here I mean becoming doctors, not healthcare as a whole) are privileged.  As overt and hidden costs of applying to medical school, paying tuition, and achieving licensure continue to rise, that privileged status has only gotten worse.  Let’s assume that this person meant we were privileged, not perfect.

Because perfect, we’re not.  The process of training for a career in medicine, nursing, or rehabilitation science almost certainly involves some kind of trauma.  Aside from the obvious trauma of witnessing extreme suffering, there is the sleep deprivation, the strain on family and social relationships, the ever-present impostor syndrome, and sadly, the ubiquitous abuses of power throughout the hierarchy in the form of discrimination, sexual harassment, assault, and hazing that persist to this very moment. 

Twitter may make me angry, but the #medtwitter community also provides a window into what is motivating, troubling and occupying my fellow healers in other corners of the world.  So I offer, as evidence of the trauma of training, the resident who posted that her male cardiology attending had offered the group an opportunity to do some additional learning about echocardiography (ultrasound of the heart), provided she would act the part of the patient – unclothed from the waist up.  Dateline?  January 2020.

If you survive the trauma in training, there’s trauma in practice, in the past two years more than most.  Professional healers found themselves simultaneously celebrated as heroes with impromptu clanging of pots and pans, like some sort of medical Bastille Day, and hunted as villains, receiving death threats for their support of COVID mitigation measures and losing longtime patients who preferred to believe anti-vaccine conspiracy theorists over a trusted family physician.  Theologian Kate Bowler likes to use the word “shiny” to describe how she felt about herself and her life before she was diagnosed with advanced cancer in her thirties.  In 2022, I don’t think there’s a physician left in the world who still feels shiny.

Mekhilta d’Rabbi Yishmael sees this non-shiny stuff as the equalizer.  That text understands the words of Exodus 22:20, “lo toneh,” do not wrong or afflict, a stranger, as meaning not to afflict them with words, meaning not to throw their past (as an idolater, a sinner, or what have you) in their face.  It even gives them permission to taunt you in return if you do so: “Hey, weren’t you also a stranger?  A slave?  Aren’t you supposed to be kind to me?”  MdRY understands that if we allow ourselves to remember who we are, beneath the shiny, we’re better able to understand them.

This admonition is sorely needed today.  More disturbing to me than the “keep your religion out of medicine” line is a the suggestion that people who have chosen not to be vaccinated for COVID shouldn’t be offered treatment when they (nearly inevitably) get sick with the disease.  Coming from committed healers, it suggests to me that they have kept their own religion as far away from medicine as they could get it.  I completely understand that the anti-vaccine movement (by which I mean those for whom being unvaccinated is not a private choice but an ideology) feels to us like the enemy, endangering themselves, our other patients, and our whole society by pretending the virus doesn’t exist and the vaccines are the real threat.  The parsha has an answer here, too: “When you encounter your enemy’s ox or ass wandering, you must take it back to him.  When you see the ass of your enemy lying under its burden and would refrain from raising it, you must nevertheless raise it with him.”

Do I disagree with them?  Sure.  Do they frustrate and anger me?  Absolutely.  Are they human?  You bet, and that is all the reason I need never to withhold care from them.  We treat lung cancer in smokers, head injuries in people who ride motorcycles without helmets, and hepatitis C in people who use injection drugs.  For that matter, given that the World Heart Foundation now says any amount of alcohol increases the risk of death from heart disease, most of us will someday need saving from something that we “self-inflicted” by raising a shot of Crown Royal in a l’chaim in the Samuel and Minnie Hyman Ballroom.  Is that how we want our doctors to treat us

A different frequent flier on #medtwitter, Dr. Londyn Robinson, who used to go by the name “rheuminate” when she was a third-year med student, provided a very different take on so-called “self-inflicted” illness.  Robinson grew up in a town rural enough that the land of medicine really did seem like a foreign country, one she and her neighbors almost never visited, and for sure none of them did or would ever live there.  In February 2020, she posted a story about having a conversation with a homeless patient about the joys and fond memories of McDonalds, and about how one of her urban-born, well-off classmates chided her for seeming to endorse the fast-food giant that has become synonymous in modern medicine with all that is unhealthy about our society.

What Robinson realized, and her classmate did not, is that McDonalds can be a lifeline for a homeless person: clean bathrooms, cheap, hot food, and a warm place to sit that is not in much of a hurry to kick you out.  They spoke a common language, and part of that language for Robinson included Rabbi Nathan’s admonishment, “Do not attribute a blemish of your own to a stranger.”  When both of you have suffered the same indignities, you bond over what you have in common.  The encounter ended with Robinson showing the patient how to use the McDonalds ordering app, including how to maximize funds to actually get the healthier options for just as cheaply as the burger and fries.

There will be times, whether at the very beginning (or very end) of life, when the mixture of religion and medicine will lead us to conflicting conclusions – and when it does, hopefully that same religion will help the people in the debate to remember to treat each other with as much humanity as they do the people they care for professionally.  But get rid of it altogether?  Careful what you wish for – you might get it.  And we’ve already seen what that looks like.  It isn’t pretty.

Darkness and Dawn

Darkness and Dawn

Parashat Bo 5782/January 8, 2022

This post is a continuation of “Wood, Fire and Water” and “Blood in the Water,” posted in the previous two weeks.

The beginning of Parashat Bo feels like the kind of long slide into the abyss I wrote about two weeks ago.

With the plague of fiery hailstones just ended, God sends the locusts.  “They shall cover the surface of the land, so that no one will be able to see the land. They shall devour the surviving remnant that was left to you after the hail,” Moshe and Aharon warn Pharaoh (Shmot 10:5). 

In the months after the October 27th, 2018, terror attack in Pittsburgh, I had one consistent source of solace, the site of the last hopeful thing that happened to me immediately before the attack: the newborn nursery, where scarcely an hour before the shooting started I made my rounds with my tiniest, most precious patients.  I was often late to work those months, lingering extra minutes in each room, snuggling every baby for no reason other than to bask in the calm of a sleeping newborn.  I would leave the house for rounds some days and tell my wife I was going to therapy.

Seventeen months later, when the pandemic began, “the surviving remnant that was left to me” after the shooting was devoured.  Rounds became a nerve-wracking experience.  With my outpatient practice converted swiftly and almost completely to telehealth, the hospital was now the only place I ever encountered human beings in groups.  I avoided elevators, closed spaces where we assumed the virus could be most easily transmitted, in a hospital designed to actively discourage the use of stairs.  Faithfully clad in my green N-95 mask, I became an obligate mouth-breather because while the mask allows oxygen to flow just fine, it only stays sealed if it is pinched tight enough to block my nose. 

As a result, I huffed and puffed my way down long corridors and up ancient spiral staircases at top speed, anxious to quit the place as fast as possible.  My actual visits required the additional use of a face shield, gloves, and copious amounts of Clorox wipes.  I liberally borrowed patient gowns to cover my street clothes; there were no fluid resistant gowns for the pediatricians, even though we probably ought to have them for newborn rounds all the time as those little ones are liable to go off at any minute.  Whatever therapeutic effect newborn rounds had once had for me evaporated.  The locusts ate it.

From that perspective, the next plague, darkness, follows almost seamlessly.  The plague begins, in Shmot 10:21, with the words, vayamesh hoshekh, which is widely translated into English as “darkness which can be felt.”  It was a darkness so thick that it was not just an absence of light, but a positive presence unto itself, so heavy that “for three days no one could get up from where he was (Shmot 10:23).  My new teacher Dan Smokler shared the description from the Torah Temimah that, “The verse comes to teach that when an Egyptian stood he could not sit, and when he sat he could not stand because of the substance/thickness of the darkness.”  I think we all know how that feels now.  Even my mornings in the nursery, despite being far less fearful (or far more numb) than two years ago, start with me in bed feeling thick, weighted down, and immobilized.

Historian and author Kate Bowler has spent the years since being diagnosed with metastatic colon cancer at age 35 learning, writing, and podcasting about dealing with this feeling of sliding – about losing the thing you were holding on to, and eventually getting to a place where even moving took too much effort.  In her 2021 book No Cure for Being Human, Bowler concludes by narrating the experience of learning that most of the people in her clinical trial, the one that allowed her access to the immunotherapy that enabled her to still be alive to write that book, had died by early 2020.  Just as she was learning this, the pandemic struck. 

Bowler observes: “I had nothing to do but survive the feeling that some pain is for no reason at all.  It becomes clearer than ever that life is not a series of choices.  So often the experiences that define us are the ones we didn’t pick.  Cancer.  Betrayal.  Miscarriage.  Job Loss.  Mental Illness.  A novel coronavirus.” (No Cure for Being Human, p. 183)

Part of the power of the Exodus narrative is the element of the Hand of God directing events, of believing that there is a carefully laid plan hundreds of years long coming to fruition.  Part of the power of the Western narrative of history in our own time is the element of inexorable progress, moving toward a perfected society, a perfected humanity.  It’s hard for most people to square their own experiences with these narratives.  “This is the strange cruelty of suffering in America,” says Bowler, “its insistence that everything is still possible… I must accept the world as it is, or break against the truth of it: my life is made of paper walls.  And so is everyone else’s (p. 186).”

Never have I reached this point in the Torah reading cycle that tells of the moment of the Exodus and felt like I was identifying more with the Egyptians than the Israelites.  It’s telling that in the next parsha God will scold the Israelites for dancing and singing as the Egyptian soldiers drown in the Sea of Reeds, as if we are meant to empathize with their suffering, even as the text tells us they are “the bad guys.”  And perhaps, if I can see that darkness, understand that weight, comprehend what it was to have locusts devour the little bit leftover from the hail, then that is an answer to the baseless hatred I wrote about last week.  Indeed, some interpretations about the plagues is that they were lessons in empathy – for the Egyptians, to force them to feel what the Israelites had experienced on the descent into slavery.  It’s hard to be angry at someone whose life is made of paper walls when yours is, too. 

A year ago, I posted a blog titled, “It Ain’t Over…”, about historian Doris Kearns Goodwin’s advice to allow ourselves to live in tension and not try to interpret the history we are living through while it is still happening.  In that piece I quoted from Lord Rabbi Jonathan Sacks, who had died only a couple months earlier.  This week I also want to end with Rabbi Sacks, speaking on the very subject of how to interpret a historical moment we’re in.

In his essay on Bo entitled, “The Far Horizon,” from his book Lessons in Leadership, Rabbi Sacks describes an exercise in which he asks people to share what they would say to a people on the verge of leaving Egypt.  Some reference the Promised Land, some adopt a tone like Lincoln in the Gettysburg Address, and some cleave to Nelson Mandela’s theme of the “long walk to freedom.”  Moshe’s response, according to Rabbi Sacks, does none of these things, but rather focuses on the distant future, the “far horizon” of the essay’s title.  He identifies three times where Moshe invokes the education of the children, and interpreting the events of the Exodus for future generations, at the very moment that the event unfolds (Shmot 12:26-27, 13:8 and 13:14).

He leaves one out, and it is a telling omission: Shmot 10:2, the second line of this parsha, spoken right between the hail and the locusts.  God tells Moshe and Aharon that the next plagues will occur, “that you may recount in the hearing of your child and of your child’s child how I made a mockery of the Egyptians and how I displayed My signs among them.”  Rabbi Sacks, whose books include Not In God’s Name, a brilliant work dismantling the theology of vengeance and religious violence, was no triumphalist, and dancing on the graves of the Egyptians was not in his vocabulary.  Nor does the Haggadah quote this line in describing the four children, referring instead to Sacks’ three and a line from D’varim.

What will we tell our children years hence about this moment, about how we survived the weight of the darkness or the locusts consuming the little we had left after the hail – or for many of us, about losing our first-born children?  If we’ve learned nothing, we might continue telling our children about how it was all “the other guys’” fault, about how this policy or that failed and destroyed lives, or this person or that got what they had coming to them when they died. 

Or we might learn from Rabbi Sacks, who frequently says that the most important mitzvah in the Torah, repeated 36 times by his count, is “Do not wrong the stranger, for you were strangers in the land of Mitzrayim.”  You, too, were stuck in that narrow place.  Your life also has paper walls.  When the darkness finally lifts, it is morning.  How do we know when the darkness has lifted?  According to the Jerusalem Talmud Berachot 1:2:4, day begins (and we are allowed to say the morning Shma) when we can recognize a casual acquaintance from four cubits away.  Total strangers, says Rav Hisda, we would not recognize, in daylight or darkness, even from up close, and a close friend we know even in the dark from far away.  But when the dawn is just beginning to break, we can begin to see those in between, who may have been at arms-length, estranged but not strangers, and recognize that they, too, have been suffering through what we have endured.  And you will tell your child on that day, “This is because of what all of us endured, together and yet apart from each other.  Give the guy a break.”

Blood in the Water

Blood in the Water

December 31, 2021/27 Tevet 5782, Parashat Vaera

Originally posted at

Early in the pandemic, we said and did a lot of things that made little sense.  Recommendations changed almost daily.  We gravely took specific precautions that turned out to be useless, like hanging plexiglass shields and buying stores out of toilet paper.  And we talked a lot about “silver linings,” like how glad we were to take a break from working in offices or wearing dress clothes.  Twenty-one months on, the recommendations still change faster than we can keep up with, precautions we thought we finally had figured out now turn out again to be minimally effective, and the only silver lining I see is in my hair.

According to my friend and teacher, Rabbi Danny Schiff, one of the nonsensical things a lot of involved Jews did then was to compare the COVID19 pandemic to one of the plagues visited upon Egypt.  In a Facebook post dated April 1, 2020, yet not intended as a joke, Rabbi Schiff implored his audience not to compare our present situation to the “Eleventh Plague” or to mention it at seder.  “This is the wrong parallel,” he wrote.  “Let’s remember: the Ten Plagues were delivered by God deliberately as a punishment for Pharoah’s obstinacy.  Does anybody seriously believe that God deliberately delivered this current pandemic as a punishment?  I don’t.  No thoughtful Jewish theology would support such an idea.”

He went on to suggest that the better comparison would be to the plague that killed 24,000 of Rabbi Akiva’s students, which the rabbis in tractate Yevamot compared to diphtheria, a natural, infectious plague that caused loss and calamity which we still mourn in our own time during the period of the Omer.

Unfortunately, the parallel to the plague in Rabbi Akiva’s time runs deeper than the analogy between diphtheria and COVID.  In April 2020 we were only beginning to see the rifts that have opened in our society, and indeed in most countries, around every aspect of the pandemic: masks, lockdowns, vaccinations, treatments, and even whether the virus itself exists at all.  These rifts mirror fundamental, cultural-political rifts that predate the pandemic and that appear, unfortunately, to be about the only thing that is wholly immune to COVID19.

Yevamot explains the plague as follows: “They said by way of example that Rabbi Akiva had twelve thousand pairs of students in an area of land that stretched from Gevat to Antipatris in Judea, and they all died in one period of time, because they did not treat each other with respect.”  In other words, the plague was the result of baseless hatred between individuals.

SARS CoV-2 is not a Divine punishment for baseless hatred.  But we know that the virus is not the only plague circulating in 2021.  Secondary pandemics, and pre-existing ones, have been running in parallel to the coronavirus pandemic: drug overdoses and addiction: loneliness and other serious mental health crises; disruptions in our education system, our judicial system, and the other parts of our healthcare system; racial, gender, and economic inequality exacerbated by both the disease burden of the virus and its societal impacts.  And woven through all of these is the plague of political tribalism, which in most cases stakes a person to a fixed position on each of these other pandemics, a position from which they are prone to view anyone who disagrees with them as not only wrong, but evil.  And regarding these plagues, we are not blameless. 

These plagues invite a new, different comparison to the plagues of Egypt.  I’m not speaking of the theology of God punishing the Egyptian enslavers, but the symbolism of what happened to Egyptian society during the plagues, and how similar it is to what ails us now.

The plagues struck Egypt in the ways that hurt Egyptian society most, attacking the god-figures and the sustaining forces in Egyptian life – the animals, the crops, the Nile, and ultimately the first-born children on up to Pharaoh’s own son, the incumbent godhead of all Egypt.  They turned Egyptian society upside down, in one case literally turning day to night.  And here, in pandemic-era America, our gregarious society known for its abundance, its never-ending activity, and its show-must-go-on spectacles has become a place of empty streets, scarcity, cancellations and staffing shortages.  We barely recognize ourselves.

In the case of the river, water, the sustaining force of all life, in Egypt and everywhere on the planet, turned to blood.  In modern English, when we say there’s “blood in the water,” we mean it as a metaphor for “the sharks are circling.”  A fitting description of our time.  It doesn’t matter which side of the political divide you fall on; there are sharks circling, both ones that are angling to eat you, and ones you are hoping will eat the people you hate.

This is not water you can drink: “The fish in the Nile died. The Nile stank so that the Egyptians could not drink water from the Nile; and there was blood throughout the land of Egypt.” (Shmot 7:21) 
In my last post I lamented how much I have begun to feel like the Burning Bush, perpetually on fire, and wondering how much longer I can burn, how much longer I can push through the pandemic life, before finally being charred beyond recognition.  I need water to drink to refresh me, to keep me from being consumed. 

Like everyone else in America, I fell into the pattern of believing that water with blood in it was just fine to drink, that righteous, or self-righteous anger, snark, vitriol, and acid wit was going to buoy me up.  I bought into the fiction that not only was the pandemic a punishment, but it was a punishment that someone else deserved, that someone else was causing.  I got angry, very angry, at people who wouldn’t mask, wouldn’t stay home despite Samuel L. Jackson reading them a vulgar bedtime story that instructed them to do so, wouldn’t get vaccinated, or insisted on telling me that I didn’t know anything about medicine.  It made things worse.

Drinking this “bloody water” turns everything upside down.  The hatred is so thorough that people turn themselves inside out in their criticism of the other side, espousing viewpoints they can’t possibly agree with:

  • People who once called the end-of-life provisions in the Affordable Care Act “death panels” and protested to keep Terry Schiavo on life support rallied behind a lieutenant governor who suggested it would be okay to sacrifice some grandparents’ lives to get the economy going again.
  • People who marched in the streets to remove the stigma and victim-blaming around HIV, drug addiction and mental illness broadcast their schadenfreude whenever someone prominent gets COVID after mocking the disease, publicly refusing vaccination, or touting disproven treatments.
  • People who steadfastly serve in the US military, support our troops, and welcome strict security measures at our borders, in the airports, and on our city streets to guard against terrorism and crime cry that the government is infringing on their freedom when it asks for individuals to wear masks, get vaccinated, or limit activity to protect thousands of vulnerable lives.
  • People who support universal, single-payor healthcare issue calls on social media for hospitals to refuse care to unvaccinated individuals with COVID19.
  • People who support reducing government regulation on just about everything because “regulation stifles innovation and slows down progress” won’t use highly effective, efficiently developed vaccines because they feel they were developed too fast without enough oversight and they don’t trust what’s in them – the same argument their opponents have made for years about chemicals that leach into the environment due to lack of regulation of their development or use.
  • People who support equity in education and are sensitive to issues of racial and economic inequalities in school resources supported sudden, prolonged closure of schools and a move to digital platforms while most disadvantaged students had no reliable way to access those platforms.
  • People who deny the existence of systemic racism and keep Confederate memorabilia are suddenly very concerned about the Tuskegee experiment and its relevance to vaccines.

People advocate for actions they normally despise, use language they would normally despise, champion ideas they normally ridicule and undermine ideals they normally cherish for the sake of winning this debate, as if it can be won.  The water gets bloodier, and the whole thing stinks like dead fish.

I’ve engaged in more than my share of this behavior myself, despite knowing better and even trying to write myself a different script in some of my previous posts.  It keeps happening, a plague no less contagious, no less persistent, than the pandemic virus itself.  Worse, it keeps mutating; every new issue becomes a new battleground, every point of policy a new cause for fighting.

So no, the SARS CoV-2 virus is not a Divine weapon of retribution.  But the other societal illnesses swirling around it are undoubtedly due to our inability to treat each other with respect, and we are trapped in a darkness where a person cannot recognize their fellow from mere inches away.  There is most certainly blood in the water.

More telling still is the fact that the plague of the bloody Nile is never officially declared over.  Moshe does not plunge his staff back into the blood and turn it back to water, nor does the text clearly state that it reverted on its own.  We learn only that after seven days of the first plague, the plague of frogs begins.  The river can sustain life again – but the kind of life that usually lives in a foul swamp.  Pittsburgh’s polluted rivers sustain life – but they are the type of mutant, heavy-metal-laden carp that don’t belong on the dinner table.  The hateful speech will not go away on its own, nor can it be forcibly contained.  Only a slow, steady trickle of clean, fresh water, a stream of goodwill and compassion, brought forth from the ground by a sustained effort, can dilute away that blood and filth.

Tradition holds that the groundwater in Egypt was spared the plague of blood.  In Shmot 7:24 we learn that, “all the Egyptians had to dig round about the Nile for drinking water, because they could not drink the water of the Nile.”  We need to dig deeper to find some clean, untainted water, and pour it out liberally for those around us.

Wood, Fire and Water

Wood, Fire and Water

Parashat Shmot 5782, 20 Tevet/December 24, 2021

It was the smokiest backyard fire I have ever built.

We had an unseasonably warm, dry day in the middle of last week.  Through sheer force of will I caught up on work, cleaned up after the dog, and hauled out the fire pit one last time before winter.  We still have an enormous pile of cut firewood from the limb of our neighbors’ tree that crashed into our backyard on June 13th, sitting unused due to an excessive amount of rain, stress, and general exhaustion that has kept us from using it.

Unfortunately, the kindling, “dry leaves” that I had gathered in armfuls from the yard, wouldn’t light.  Only the tops were dry; the lower surface where they had been in contact with the grass was wet and already composting in place.  This didn’t become clear until they were already on the fire.  I managed to salvage the endeavor by finding some newspaper indoors (not easy in 2021 – we’re reduced to burning junk mail coupons), but what resulted was a roaring fire that gave off so much smoke I was still smelling it the next day inside a facemask that hadn’t even been next to the fire.

Building that fire was part of my attempt to climb out of a well of depression, the latest in a series I have experienced since the start of the pandemic.  I wasn’t just building fires: I was playing music, finishing a collaborative piece of writing I’d been working on with Rick Light, even going out a few times to places that were vigilantly checking vaccine cards.

And then I got Omicron.

This has been the pattern: the sheer weight of responsibility, of loss, adds up until I start to spiral.  I reach what feels like the bottom, and like Yosef in prison I decide I just can’t give myself over to despair.  So I rally.  I reach for inspiration.  I write.  I use my favorite Freudian defense mechanism, mastery, to gain a feeling of control over my work, gaining strength from knowing when I’ve made an astute diagnosis, said exactly what someone needs to hear, or gone the extra mile to make some difficult arrangement for a person I’m caring for.  I connect with friends, live life to the reasonable limits of what is possible and safe in this time, even attend weddings.  I feel alive again.

And then something happens, and I spiral again.  Or in the case of this week, I just plummet.

After two years of this, it is reasonable to ask, “How much are we meant to endure?”  By we, I could mean me, my family, our community (remember, I live in Pittsburgh, where we were barely a year into recovering from a terrorist attack on a synagogue when the pandemic started), the health professions, or the world as a whole.  It doesn’t matter anymore; there is no one who has been untouched by the rolling series of disasters.  How many more of these are we supposed to experience before it is reasonable to cry, “Stop!  We can’t take anymore!”? 

The last verses of chapter 2 of Shmot, which we read this week, show us a glimpse of the enslaved Israelites at a similar breaking point.  “The Israelites were groaning under the bondage and cried out; and their cry for help from the bondage rose up to God.”  A new Pharaoh had just taken power – not the one from Yosef’s time, who we learn at the beginning of Chapter 1 is long gone, and not the one who decreed the policy of infanticide, but a third (at least) Pharaoh.  While good for Moshe, since the warrant for his death expired with the death of the second Pharaoh, it was terrible for the Israelites since the new ruler had further worsened the conditions under which they worked.  So they cried out for help.

There are three possible answers to this cry, ones that I have rolled over in my mind for 21 months since the full weight of the pandemic settled on us here in Pittsburgh.  First, and most sobering, is that we are meant to endure all of this and more.  Life takes place in a Hobbesian state of nature, is “nasty, brutish, and short,” and all our 20th and 21st century hopes that we were on the cusp of defeating disease, war, pestilence, famine and drought were not just premature but delusional, diametrically opposed to an increasingly chaotic, entropic reality. 

This view runs counter to everything I want to believe, to the view from Rabbi Yitz Greenberg I adopted long ago that Shmot, and indeed the whole saga of the Jewish people, is that God does not want humans to be enslaved, God does not want humans to suffer, God sees and hears people’s pain when they cry out, and God expects other human beings to rise to the challenge and do something about it.

The second, most hopeful, answer is, “Not much more, just a little bit longer.”  And indeed, in those moments just before the spiral, this is the answer I’ve willed myself to believe throughout the pandemic – the initial lockdowns had curtailed the disease, vaccines were coming, boosters were coming, case counts were in the single digits per day.  It couldn’t be much longer. 

This is the answer, I think, that Shmot 2:24-25 would have us believe as well: “God heard their moaning, and God remembered God’s covenant with Abraham and Isaac and Jacob.  God looked upon the Israelites, and God took notice of them.”  The covenant, of course, was that the enslavement had a predetermined time limit, and was now coming to an end.  If they could just hang on, they would see their fortunes turn.  Yes, some of the suffering was Divinely ordained, but it has its limits.  The Malbim’s commentary on Shmot 2:23 is that God took note of the fact that many Israelites had been slain in the course of their slave labor, falling from scaffolds or crushed under the bricks of the pyramids.  Slavery had been foretold and necessary, but not this meaningless death.  The Haamek Davar follows that God had been hearing the individual cries of suffering since the beginning of enslavement, but that now God also hears the people crying in a collective prayer – I believe, meaning that now, the point has been made and further enslavement is not needed.

But there is a third possibility, disturbing in a different way than the first.  That possibility states that we are not meant to accept the suffering, but to fight against it – yet despite our resistance, the suffering, the torment, will not end.  Which brings me back to firewood, in the form of the Burning Bush.

While I was sending smoke signals from my yard last week, I realized that the image of the bush was bothering me this year.  My teachers have always used the bush as a symbol of our, meaning “the Jews’,” continued endurance in the face of hardship.  Through this recent cycle of dashed hopes, however, one driver of my frustration has been the inability to wear any other “we” or “us” except “doctors” or “health professionals.”  And “we” are often assumed to be like the bush, carrying an endless reserve of fuel so that we can keep burning forever, without burning out – or burning up.  The typical explanation of how the bush could have burned without being consumed, “black fire” vs. “red fire,” is so otherworldly that it only reinforces this idea that somehow we are meant to be superhuman, magical beings who don’t wound, fall ill, or get tired like normal people.

Worse still is the possibility suggested by Rabbi Ovadia Sforno: the bush represents not the Israelites, but the Egyptians, and the fire is the plagues.  S’neh, the specific word for bush in Shmot 3:2, doesn’t mean any bush at all, but a thorn bush native to the desert.  Just as Egypt in Hebrew is Mitzrayim, a narrow place, or “dire straits” as I have called it in the past, a thorn bush is a place where animals in the desert get stuck and injured.  The Israelites in Egypt were like an animal caught in a thorn bush, unable to escape.  God sent the fire of the plagues – and the bush was not consumed!  The tormentor, the suffering, the source of our agony, is going to survive this whole mess intact!  “COVID is going to be with us for a long time,” say the experts now.  I’d like to disregard the message – but like the Sforno, these are the people whose interpretation of the facts I usually find to be spot on.

If there is solace, and I’m not sure there is, it is in the much more naturalistic explanations of the Targum Yerushalayim and Ibn Ezra.  Targum Yerushalayim renders, “was not consumed” as “remained moist.”  Moist?  Ibn Ezra explains that, as we said above, s’neh is a thorn bush native to the desert – specifically, the kind of thorn bush after which Mount Sinai (from the same root as s’neh) is named.  In a totally dry environment, how on earth did the bush get there?  Clearly, there must be water underneath somewhere.  But it is hardly adequate; as I struggled to light my damp fire here in the Eastern US, I thought of the bitter irony of how what I was doing is illegal in most Western states, where a single errant spark can burn down entire counties.

Ibn Ezra, the linguist, has such people in mind as he brings in another verse that uses the word, D’varim 33:16, “the goodwill of the one who dwells in the bush.”   Not The Bush, says Ibn Ezra, but the one who dwells where there are a lot of s’neh – one who dwells in the desert.  And what does that person, the denizen of Midian, or Colorado, or California, will?  “A person living in such a place entreats and prays that God do his will and wet the land that he lives in. He prays that God change it from a dry place, a place where the seneh grows, to an amply watered place so that it becomes like a wet and well-watered garden.”

We need water.  I can no longer believe that there is a definable end in sight; I’ve had too many lights at the end of too many tunnels turn out to be oncoming trains.  And as much as I would like to, I can’t give in to despair.  I let slip to my boss on Monday that I was “about done with this.”  “What do you mean, done?” she replied.  I didn’t have a ready answer – it’s not as though there is a single fiber of who I am that would let me give up even the most futile fight to try to protect someone, somewhere, from the ravages of this mess.  The only choice is to be like the bush.  But how?  Where is the water?

I am hoping this is the first in a four-part series of posts. Check back over the next three weeks to find out if I made it – and whether I find water at the end.


My Times of Israel piece from October 27, 2021, published in the print edition of the Pittsburgh Jewish Chronicle on November 5, 2021. Never got around to posting it here for some reason, but two months later, as maintaining daily gratitude again becomes a real struggle, it’s worth re-reading.

Beloved Friends

Beloved Friends

A while ago my rabbi asked a group of us if we had ever had the experience of feeling our prayers soar up to heaven.  Most of us, myself included, had some point of reference for that feeling.  But I can think of no prior experience so joyous as the one I had last week.

I was attending my first wedding since prior to the outbreak of the pandemic, fresh from a breakneck week of work, panic over getting my papers to cross the border into Canada, forgetting numerous items including my regular mask and both of my computer chargers at home, and hours of solo driving that included an overnight at a sketchy hotel in Erie, PA, and a 15-lane traffic jam entering metro Toronto. 

Yet when I took my place under the chuppah to recite the sixth of the seven wedding blessings, it all melted away.  There are times when we put every ounce of effort we can into praying, where all our muscles and all of our breath goes into each word.  Then there are times like that moment when we simply open our mouths and our souls come flowing out effortlessly

Sameah t’samah re’im ha-ahuvim k’samehakha y’tzirkha be’Gan Eden mikedem.  Barukh atah Hashem, m’sameah hatah v’khalah.

“Bestow complete joy on these beloved friends just as you made your creations happy in the Garden of Eden of old.  Blessed are you God, who makes the bride and groom rejoice.”

Later, at my table, a non-Jewish guest remarked at how intensely joyful and energetic the celebration was, and on the fact that the purpose of a Jewish wedding was not to put on a show for the guests, but for the guests to imitate God in creating joy for the couple.

Hours later, alone in my car on the QEW in the rain, I drove toward the border with the sound of that blessing, and the dancing, and the band singing the beautiful, plaintive tune of the Piazetzner Niggun during the ceremony, all echoing in my head.  It reminded me of a comment I had seen just the previous day in Siddur Lev Shalem, from the Hassidic master Simcha Bunim, that the phrase haboher b’shirei zimra, that desires poetic songs, should be read as haboher b’shay’rei zimra, that desires remnants of song.  Even more than God wants us to sing and rejoice, God wants us to carry with us the echoes of those songs, the ones that linger with us even after the sound of the music has faded away.  I was bringing remnants of song home with me from Canada, treasures I would not need to declare at the border and that CBP could not confiscate if they tried.

Just as Simcha Bunim opened a whole new meaning by changing one vowel, I thought of the fine line, literally, separates re’im, dear friends, neighbors, loving companions, from ra’im, bad things or bad people.  And yet changing that vowel does not shatter the joy but deepens it.

Sameah t’samah ra’im – cause the bad things to be joyful.  God, and our friends, can turn sorrow into joy, by bringing laughter, by forcing us to look out at the rainbow that formed over my neighborhood the afternoon of Shabbat Noach, by bringing a baby to a shiva minyan.  Time elapsed can cause the apparent disasters to morph into fond memories of indignities suffered and endured.  Perspective can allow us to see the good that we displayed in the face of the real tragedies and unspeakable evil, and derive a measure of joy from being surrounded by such worthy people.

Ra’im ha-ahuvim – bad things which are beloved to us.  How many people do we fall in love with, as friends or as life companions, who have become what they are only because of the experiences that have tested them?  And how many people do we love, despite, or even because of, their qualities that still cry out for betterment, but we love them anyway?  I may have already written a piece in which I quote my friend Chuck Diener’s wedding wishes to my wife and me, regarding the broken glass, “Beloved, even your imperfections are holy to me, even they I love.”  But it bears repeating.

And finally, re’im ha’ahuvim, not with an ‘ayin in re’im, but an aleph.  Not friends or loved ones, but mirrors.  Our friends, and even moreso our spouses, are our mirrors.  They reflect back at us our true selves, and more importantly the version of ourselves that the world sees, but tempered by the love they feel for us, like the mirror of Erised in the Harry Potter novels.  When we stand as a community under the chuppah celebrating a new marriage in Israel, the couple wrapped in white like it’s Yom Kippur (and in many circles just as hungry, having fasted all day), we see for a moment the best versions of ourselves, not driven there by guilt but drawn there by hope and joy.

We have suffered, individually, and collectively, so much over the past 19 months, and before.  I recommend vaccines, prescribe medications, urge people to go to therapy and exhort them to eat well and exercise regularly.  But I am now sending you all out on doctor’s orders for something you can’t find in the pharmacy.  Go rejoice, and make each other rejoice, in the company of your beloved friends, in the face of whatever bad might have befallen you, or that you might have done, and see your inherent goodness reflected in their faces.  We are long overdue for it.

Purple Hats

Purple Hats

It’s easy to think that the entire profession of medicine is doomed to failure.  In my last post I talked about my family’s Rule Number One: Don’t Die.  But everyone violates Rule Number One exactly once in the end (unless they get CPR – then it might be twice, or even three times).  If the whole goal is to keep people from breaking Rule Number One, then, in the final analysis, we have a 100% failure rate.  To quote Kohelet, the book from which we will read during this week’s Sukkot holiday, “Utter futility, all is futile.”

The pandemic hadn’t even hit yet when I began to feel this futility acutely.  From April 2019 through the first whispers of a global shutdown I had lost about half a dozen long-time patients, some of them kept alive literally for decades through the heroic efforts of my most respected colleagues.  The COVID-19 pandemic merely accelerated the process.  In the past two years I have lost patients to COVID and chronic respiratory failure, colon cancer and coronary disease. 

Many of my guiding lights have also died during that time.  Rabbi Dr. Abraham Twerski, whose work in addiction medicine I read even before I chose this career, died in late January 2021.  Less than three weeks later, another mentor-from-afar, the cardiologist Bernard Lown, whose book The Lost Art of Healing influenced my practice of medicine more than any other I have read, died just shy of 100 years old.  And predeceasing them both by a few months, Lord Rabbi Jonathan Sacks, late Chief Rabbi of the United Kingdom.

I had just begun a year-long study of Rabbi Sacks’ series, Covenant and Conversation, his compilation of years of essays on the weekly Torah portion, about a month prior to his passing in early November 2020.  This week I reached the end of the line, completing the four essays on the final portion, V’zot Ha-b’racha, which tells the fate of each of the tribes and describes the death of Moshe.

Reading these essays, in which Rabbi Sacks grapples with the poignant tragedy of Moshe’s death, the end-without-an-ending that cuts him off in the middle of the story without a “happily ever after,” was like experiencing all of these losses again.  The loss of Rabbi Sacks’ wisdom, the loss of the professional compass of Dr. Twerski and Dr. Lown, and the loss of the people I had grown to love as I cared for them.

Yet these final essays also contained the balm for that sense of loss.  On the very last page of the book, in the essay titled “End Without an Ending,” Rabbi Sacks writes, “Life is not robbed of meaning because one day it will end.”  He is the anti-Kohelet.  Medicine is not a failure because it does not abolish death; it is a success because it enables life. 

Sacks’ essay, “Mortality,” the penultimate one in the book, reminds us that death is a necessary condition for the urgency that makes us live our lives with purpose.  The Torah, he says, is bookended by death: the loss of immortality by Adam and Eve in the Garden of Eden at the beginning, and Moshe’s death at the end.  “In both cases we are conscious of the beyond: the beyond of Eden, paradise lost, and the beyond of the Promised Land, paradise not yet gained.  These two define the human condition for us as individuals, and for homo sapiens as a species.  We live in the between, the liminal space between two eternities, the world of harmony that once was and the age of harmony that will be but is not yet.”

In that light, my job as a physician is not to vanquish that which cannot be conquered, but to allow a person to hold that liminal space as long, and as well, as they can.  I called my book Healing People, Not Patients because I wanted to restore focus to the human being, created in God’s image, and not to the minute technical details of physiology.  Nowhere does that distinction matter more than here, confronting death and trying to stave it off just a little longer. 

It means everything in the world that I am not simply adjusting dials and titrating medications to maintain a pulse, keep someone “breathing over the vent,” or sustain occasional blips of brain wave.  Rather, the work that I do as someone is failing, as we consider the possibility that this might be their last Thanksgiving, their final summer, my last visit with them, is meant to keep alive a person who still has more purple hats to knit.  It is intended to allow a person to hold on until they have said goodbye and happy birthday to a beloved child.  It is designed to allow a dying man to finish mourning for his recently deceased partner.

Rabbi Sacks strikes a rare balance between fighting death, even quoting Dylan Thomas’ famous “Do Not Go Gentle Into That Good Night,” in support of Moshe’s refusal to accept his decree, and accepting death as described above.  Of course we should fight; the world needs more purple hats.  The world needs more elderly fathers with hands folded over the handle of their canes, nodding sagely at their doctors.  The world needs people to rejoice, even just for a few days, over finally becoming Americans – or over discovering that, in fact, they had been citizens all along and never known.  We need not win the fight forever.  We just need to win today.

“Winning” has different definitions to each of these people and their families.  While the miracle of modern medicine often gauges its success on “outcomes,” people do not use such monolithic endpoints.  We use purple hats, hugs, witty remarks and wise words.  In an essay on Parashat Ha’azinu entitled, “Let My Teaching Drop as Rain,” Rabbi Sacks explains that the title line means that the teachings of Torah enable human beings to each grow into the unique individuals they were meant to be, the way rain enables each plant to grow and produce fruit the way it is meant to do. 

I like to think of my medicine this way, as sustaining life to enable the moments, the outcomes, the endpoints that have meaning for the people experiencing them, even if they don’t show up in the “metrics.”  If my goal is ending the pandemic with a metric of Zero COVID, then Kohelet was right, as right as he would be if I wanted to reach Zero Cancer, or Zero Death.  But if my goal is to enable one more family reunion, one more citizenship ceremony, one more purple hat – or one more meal in a sukkah – then let it fall like rain.

But don’t let the rain fall in my sukkah.  There will be time for that later.

Please remember that you, too, can help people knit their purple hats, or whatever makes their lives meaningful. Consider a donation to Hebrew Free Loan of Pittsburgh,

Photo by the author; hat by Jodie Black. This post is written in her memory, with permission of her family.

The Bedford Award and Hebrew Free Loan

The Bedford Award and Hebrew Free Loan

I’m honored to share that on October 7, 2021, I will be awarded the Nathaniel Bedford Primary Care Physician Award for 2020 by the Allegheny County Medical Society. Dr. Bedford was the first practicing physician in Pittsburgh, and namesake of Bedford Ave. in the Hill District (as well as the person who decided to name Carson Street after a friend who was a ship’s captain). You can read all about the award here. The award comes with $1000 to be donated to the charity of my choice, which I have chosen to give to Hebrew Free Loan Association of Pittsburgh.

Hebrew Free Loan provides interest-free loans for large, one-time expenses that can make the difference between a family forging ahead or falling to pieces. Purchasing a car, adopting a child, releasing a new album of music, or finishing graduate school are only a few of the things that this vital organization has helped provide for. One of the keys to primary care medicine for me is recognizing the role that a person’s lifeworld plays in their well-being, and the needs that HFLA-Pittsburgh helps to address are among the most important parts of that lifeworld – career, transportation, starting a family or pursuing a dream – and I have regularly referred people to them because I knew that their assistance might mean more to that person than any medicine I could prescribe.

My wife Vita Nemirovsky, a former HFLA board member with whom I am co-chair of HFLA’s fall fundraising campaign, likes to say that HFLA “recycles money.” Since these are loans, repaid typically over 2-3 years, one donation ends up helping a series of people over decades, with very little overhead. Not only that, but the loan continues to help the borrower even after it is repaid by serving as a way for someone who might not qualify for conventional loans to build their credit and make it easier for them to hold a credit card, rent an apartment, or purchase a vehicle on their own in the future.

I’ve already received a lot of well-wishes for the Bedford award, but what would really make me happy is if everyone reading this would consider a donation to HFLA Pittsburgh. Healing People, Not Patients doesn’t happen in isolation, and by doing so you would be directly contributing to the work I do, even if you can’t stand the sight of bodily fluids and don’t remember which side the liver is on.