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Healing People, Not PatientsWhat if medical encounters were meetings of two human beings, together forming a covenant to achieve healing?

Inside the Book

Take a peek inside Healing People, Not Patients to see how you figure into the message.

For People

Being sick or getting well doesn’t define you – it’s one thing among many in your life. Wouldn’t it be great if you could get healthcare that recognized that?

For Healers

You didn’t go into this line of work to be a “service provider.” You don’t hook up internet connections, you heal human beings. It’s time to reclaim that territory.

For Change

Whether you are a person struggling with an illness, or a healer struggling to help that person heal, the way things are in healthcare today doesn’t make it easy. What might the future look like?

Healers Who Listen

Come explore how you can be a part of the solution.

Blog

3,000 years of Jewish wisdom, 3,000 people seeking healing, and one nice Jewish doctor with messy, curly hair trying to use one to make sense of the other. Take two stone tablets and call me in the morning?

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

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, www.hflapgh.org.

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

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.