“And You Shall Surely Heal…”

“And You Shall Surely Heal…”

“And You Shall Surely Heal…”

If I had a hero in my life, it was Bernard Lown.  I was one year into my medical education when I “met” him, by way of discovering his book, The Lost Art of Healing, in a Half-Price Books on McKnight Road on my way to Montreal in the year of the millenium.  That chance meeting was the real beginning of my medical career, whatever other stories I might tell to the contrary.

I devoured that book even before I returned to Pittsburgh at the end of that week.  It changed the way I looked at my studies, clarified the way I envisioned my career, and answered the burning question I had been asking myself all summer: “What does it mean to really be a nice Jewish doctor?”

My answer has always been, “To recognize the divine spark in each person, to see that they are created in God’s image.”  Lown helped me to see how to operationalize this concept into concrete practices of listening, questioning, speaking, and working within a system of partners to heal that person and restore them to health.  He taught me the power of words – not only of kind ones or hateful ones, but of seemingly innocent ones that can do great damage, or unknowingly provide immeasurable hope.  And he spoke a language that I could speak – real words, despite being a highly trained physician and researcher, words that people could understand, and words that welled up from the endless waters of our shared Jewish heritage.

I never met or spoke to Dr. Lown; by the time I connected with the Institute he had founded, in late 2016, he was well into his nineties, and while still writing occasionally was not easily reachable.  I settled for sending him a copy of my book when I finally published it in 2018, a mere lifetime (18 is life in Hebrew, after all) of years after first reading his.  He died February 16 at ninety-nine years old, and would have turned 100 years old one week ago today, June 7, 2021.  Our meeting in print will have to suffice until the olam haba

Nevertheless, he guides my hand every day; my mind is ever turning to the principles I learned from that book, wondering how he might approach a situation or answer a question that faces me.  I have more than once quoted his story of prescribing a patient a two-egg omelet every Sunday, in the days when eggs were still the bad guy, when I tell a parent to negotiate one can of Coke every Saturday night with their grade-schooler or plan the “cheat days” with my patient who is trying to lose weight. 

The Lown Institute continues to pursue the idea that we are in the practice of healing, not the business of medicine.  Lown, in his own lifetime, pushed new developments that freed heart patients from the Mitzrayim, the narrow place of bondage, of their beds and allowed them to sit in chairs, and eventually even to walk.  He stood up against the proliferation of nuclear arms and shared in a Nobel Peace Prize for his efforts.  And he founded the Institute with the aim that it would pursue goals of getting the right care to the right people with the goal of healing humanity held higher than the aim of profiting financially. 

As a result, the Lown Institute and its offshoot the Right Care Alliance champion causes like calling out shameful behavior in the pharmaceutical industry with their annual Shkreli awards for impunity.  They convene councils on realigning primary care and other specialties with patient needs.  They advocate for testing and other needed initiatives to end the pandemic.  And they shine the spotlight on the tragedy of the financial and human cost of skyrocketing insulin prices while reminding us that the original patent holder sold his rights to that miracle for a single US dollar in 1924.

It is the custom when a Jew dies that those who survive study Torah in their honor.  In Dr. Lown’s honor, I share with you the phrase from Parshat Mishpatim, read this year on the Shabbat immediately before his death: rak shivto yiten v’rapo yirape.   The full verse answers the question, “What is the responsibility of one who injures his opponent in a fight but does not kill him, if that opponent eventually recovers to the point where he can walk outdoors with the aid of his staff?” 

Most translations render these words as, “Except that he must pay for his idleness and his cure,” and otherwise go unpunished, as opposed to what would have happened if the opponent had died.  But the Targum Yonatan translates the obligation more broadly: “only for his cessation from labor, his affliction, his injury, his disgrace and the hire of the physician; he shall make good until he be cured.”

Targum Yonatan is looking at the world the way Bernard Lown (and, I like to think, I) saw his patients.  The medical issue was only one aspect of things; the hire of the physician only one facet of the healing, of rapo y’rape, which others translate as, “He shall surely be healed.”  If he was so sure to be healed, it would only be with attention to how this person had missed work, how he was afflicted, the pain he had suffered, and indeed, the disgrace he must feel at having lost the fight.  How can someone be healed if these other wounds are still open?

Sometimes, the bruises from the accident only tell a tiny part of the story.  As painful as those mottled purple, yellow and green eyewitnesses to chaos might be, they are nothing compared to the memories of the approaching vehicle, the noise of impact, or the ultimately futile attempt to retain consciousness in the immediate aftermath.  They do not tell the story of the staunch refusal to get behind the wheel again, or the panic of what might happen returning to work at a noisy bar or a computer screen with flashing lights.  And they do not convey the fear of what might happen if the long-dormant sicknesses we thought were gone would reawaken just at this moment of weakness.

Even moreso, rapo y’rape assigns personal responsibility for healing.  The Or HaChaim quotes Maimonides that if the victim tells the attacker to give cash so the victim can find their own doctor, the attacker should refuse, because it is their own obligation to see that the victim is healed.  As a primary care doctor in a safety net health center during a pandemic, I can relate.

The week before Dr. Lown died, my student asked me where my role came in with a patient who had Parkinson’s disease for which they were seeing a neurologist and prostate disease for which they were seeing a urologist (I hate having to say those specialties out loud when the same person is seeing both, by the way).  He implied that there was nothing left for me to do, since all the problems were managed.

“I take care of the person,” I explained.  It’s my job to make sure they get better, not that their individual diseases are “managed.”  Rapo y’rape means that as hard as it gets sometimes to know what to do, as little as I sometimes have to offer, as much as I may want to pass and let someone else have a turn, I cannot hire someone else to take my place.  They will surely be healed, and just as surely it is my responsibility to see that it happens.

That’s a heavy load, one that waves of primary care doctors decide every year they just cannot handle anymore in an environment that asks them to surely heal ever larger numbers of people with ever fewer resources and ever less time.  It is a load I legitimately do not know how long I will be able to carry, but that I continue to carry because they shall surely be healed – and if not me, then who?  Apres moi, la deluge is not a very Jewish sentiment.

Bernard Lown was a doctor who helped others to carry the load.  He was a cardiologist – like God Almighty, he was a rofe lish’vurei lev, a healer of broken hearts.  But he was a rare breed of cardiologist, the kind who could regularly say to someone, “Your heart is healthy, but your heart is broken,” and care equally about both.  As long as I am able I will try to be the same.  Yehi zichro baruch – may his memory be for a blessing, to all of us.

Dr. Jonathan Weinkle

Dr. Jonathan Weinkle is an experienced primary care physician seeking to fix our broken healthcare system by returning the focus to the relationship between human beings. His new book, Healing People, Not Patients, gathers together ancient wisdom, medical science, and the experiences of one doctor to draw a portrait of a partnership—a medical covenant—not just between doctor and patient, but also including receptionist, nurse, transporter, and radiology technician.

1 comment so far

David Weinkle Posted on12:44 am - Jun 24, 2021

Jonathan,
Very nice write up. Wonderful way to honor a person who was an inspiration to you.
Best Regards,
Uncle David

Healers Who Listen would love to listen to what you have to say, too.

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