At Arms Length?

At Arms Length?

There’s a reason I’m not a surgeon.

Last month our handyman came by to definitively fix our shower doors. I’d been “fixing” them almost as long as we’ve had them: hanging them back on the track when they fell, reattaching the wheels when the screws came out, or reattaching the bottom bracket when it wiggled completely off, and the interior door swung loose.  They were installed crookedly on day one, owing partly to my entire house being crooked (old mine shafts and shifting Western Pennsylvania bedrock) and partly to shoddy workmanship. I could never buy us more than a couple of months of being able to use both doors before I had to tell everyone not to touch the interior door or else. I know how to think, not so much how to wield tools. I could see where the problem was coming from, but in the implementation, something always went wrong. I needed Mark to bail me out.

The day after the handyman left, I timidly pulled on the handle of that pesky interior door – and felt it slide smoothly to the left, just like it was supposed to, with no threat of falling into my face while the water was running.

God gives Moshe detailed instructions on the construction of the Mishkan, the portable sanctuary, beginning in Exodus 25. Six chapters later, it is still unbuilt, when we read, “See, I have called by name Bezalel the son of Uri, the son of Hur, of the tribe of Yehuda. And I have filled him with the spirit of God, in wisdom, and in understanding, and in knowledge, and in all manner of workmanship, to contrive works of art, to work in gold, and in silver, and in brass, and in cutting of stones, to set them, and in carving of timber, to work in all manner of workmanship.” (Exodus 31:2-5) Bezalel and his buddy Oholiav spend the rest of the book of Exodus hard at work hammering, smelting, weaving, and assembling God’s home on Earth.

Moshe is many things: a shepherd, an upstander, a judge, and a prophet. Yet we already know he has his limitations. He has a bad temper, a speech impediment, and apparently, he is no better with tools than I am. Someone else, Bezalel, is needed to implement the plans for this miraculous Divine mobile home.

Modern medical knowledge is available to whoever wants it. Not just WebMD, the original online source aimed at the lay public, but a sizable percentage of PubMed, the largest database of original medical research, is open access, and with AI-powered search engines it is a matter of nanoseconds for literally anyone to “diagnose themselves.”  The fear among clinicians is that we will be reduced to simply fulfilling orders (in a role reversal from centuries of “doctors’ orders”) like we are working the counter at Dunkin’ Donuts, or just replaced altogether by those very search bots.

There’s a second, opposite fear, that human doctors will soon be in such short supply that there will be no one to provide care at all. I’m writing during “Match Week,” when US medical school graduates find out the results of the massive math problem known as the residency Match, which lets them know where they will train for the next three-to-eight years to become fully licensed doctors. With a looming shortage of as many as 124,000 doctors in the next ten years, there are too few residency positions available to accommodate everyone matching[i] – and yet too few people for some specialties, like emergency medicine in 2023 and pediatrics this year, which both had hundreds of unfilled residency spots.[ii]

Bezalel is the hope for all of us.

Bezalel doesn’t just project manage – he builds the structure and everything in it by himself (Exodus 38:22). All the furniture, the vessels, the ark, everything. As the workforce shrinks, and the knowledge required to serve our patients grows, more of my colleagues will be called upon to stretch way beyond our comfort zones. Working in a community health center, I’ve been doing this for years, diving deep into rare or complex diseases for which my patients need specialized care that they can’t access – so I learn how to do it for them.

Bezalel isn’t just a “chakham lev” – a wise heart, as the Torah describes all the Israelites who were moved to help build – he has many different intelligences. Ibn Ezra teaches, “Bezalel was endowed with every wisdom. He mastered the science of mathematics, geometry, proportions, astronomy, biology, and the secret of the human soul. He also towered over the people of his generation in that he knew all manner of workmanship. Many intelligent people do not possess even one practical skill.” (Ibn Ezra on Exodus 31:6.) “The secret of the human soul,” the ability to understand the person that we are treating, is not a one found on WebMD but only through training, experience, and repeated breaking of a healer’s wise heart.

Bezalel doesn’t just take his orders verbatim from Moshe; he has the confidence, and the dedication, to question, to verify, and to correct when he needs to. The Kedushat Levi (Rabbi Levi Yitzchak of Berditchev) writes, “Betzalel had divined even the sequence of ‎things that Moses had not revealed to him either deliberately or ‎because he had forgotten.” (Kedushat Levi Pekudei 10, comment to Exodus 38:22). Apparently, Moshe gave Bezalel instructions in the wrong order and Bezalel had to correct him. With all the knowledge of Western medicine at everyone’s fingertips, it still takes a chakham lev to notice when someone is demanding a treatment that will harm them, a test that isn’t available outside of three research labs, or a diagnosis that you’ve already demonstrated five times they don’t have – and to tell them so with a sensitivity that will not betray the trust they place in you.

Bezalel wasn’t just doing a job, he was answering a divine call (Sforno on Exodus 31:2).  One factor in those unfilled residency slots is the corporatization of medicine, with private equity firms buying physician staffing groups, pediatric practices, and everything else they can get their hands on. I detoured into medicine after being told being a rabbi was no job for a nice Jewish boy, determined that it would still be an authentically Jewish career – that I would practice my craft with the honor of God’s creations (kevod ha-briyot) always in mind.[iii]  Bezalel elevated mundane tasks like polishing and sanding into holy service – and we need to do the same with charting and ordering colonoscopies.

Bezalel didn’t just get that way on his own. His name means, “In the shadow of God.”  As special as he was, he owes his skills to his Creator – a fact that physicians often forget, as we gain confidence and lose humility.

The job of a healer gets exponentially harder every year, for all the reasons above. As the newest class of rising MDs and DOs prepares to graduate, I want to share one final thought about Bezalel, courtesy of my friend Ilanit Helfand, a math teacher, and our Shabbat afternoon study group at Congregation Beth Shalom in Pittsburgh (the dumb joke at the end is all me):

Sometime next year, one of those graduates will have to figure out how to follow hospital rules about early discharge, residency rules about work hours, and medical standard of care about their rapidly deteriorating patient all at the same time.  Another will either need to explain to a pharmacy why they prescribed an elderly patient a medicine that is high-risk to older adults or to an accountable care organization why they didn’t prescribe the same medicine which is “standard of care.”  A third will need to learn the skill of staying on schedule with fifteen-minute clinic slots while having 45 minutes worth of required items to get through for each visit, a quality report card telling them all the things they missed, and at least one patient who arrives an hour late whom they are not permitted to turn away.

Enter Ilanit, who was teaching in honor of the upcoming Pi Day about the occurrences of Pi in Jewish texts, and about the importance of the cubit, a measurement traditionally equated to the length of a person’s forearm from elbow to the tip of the third (middle) finger. However, we learned that there were two standards for the length of a cubit – one equal to five handbreadths, the other to six handbreadths, or as the text put it, “A cubit plus a handbreadth.”  Five plus one equals … Five? Where did we use these alternate cubits? Why, in the mishkan, of course! In addition to all the different skills he had, Bezalel needed to know which cubit to use for which different thing – which rule to apply in what place, with even the great Moshe Rabbenu not always an accurate source – and he got it right!

“Maybe,” I volunteered, “Bezalel’s arms were two different lengths.”

My dear, newly minted colleagues:

May you never see any part of the job as beneath or beyond your responsibility. May you be of wise hearts so you can understand not just the medical science you practice, but the people for whom you are practicing it. May you be conscientious enough to recognize when you are being asked to do something that doesn’t make sense – and both confident and tactful enough to say something constructively. May you remember that this is not a job but a sacred profession, dedicated to the preservation and enrichment of the gift of human life. In practicing that profession, may you always be humbly conscious of the Shadow in which you labor. And may you always know which arm to measure with.

And should your shower doors come off the rails, I know a guy.



[iii] For a deeper dive into this idea, see my article for The Conversation from earlier this year:

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.

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