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Even when you are a “Healer Who Listens,” there is a time to stop listening and speak up.

King Solomon, writing under the pen name of Kohelet (Ecclesiastes), said, “There is a time to speak and a time to be silent.”  Normally, this is excellent advice for doctors who have been shown in study after study to interrupt our patients after somewhere between 11 and 23 seconds after they begin speaking.

But what if you sit on the board of a health system that routinely engages in “upcharging” insurances? Employs physicians who routinely provide care that is marginal at best and unsafe at worst in order to maximize revenue?  Is more interested in patient “throughput”than human input?

Last Monday I sat with the combined boards of the Jewish Healthcare Foundation and its three operating arms trying to answer exactly this question.  How do healthcare boards, made up of powerful,influential, knowledgeable people in the community, suddenly become bystanders to all sorts of malfeasance by the hospitals and healthcare systems they purport to control?

You can guess at the answers.  People see these appointments as ceremonial rather than hands-on.  The group-think stifles dissent.  Medical providers on the board don’t feel qualified to comment on financials and the finance people don’t feel qualified to comment on clinical matters.  The financial bottom line is the real mission,regardless of the mission statement.

But one recurrent answer struck me: the way the whistle-blowers are ostracized.  Boards maybe passive bystanders, but there’s usually one squeaky wheel that speaks up.  You know the one – and you know what happens to their career afterward.

The phenomenon isn’t new. A famous story in the Talmud, which I had the opportunity to examine again this past week, tells of a new type of oven that is supposed to be constructed so that it cannot become ritually impure.  The problem is that the rabbis deciding whether it meets that standard all say that it fails – except for one, Rabbi Eliezer.

Eliezer tries every line of argument he can think of to convince his colleagues that the oven does what it claims.  When all logic fails, he resorts to miracles – rivers flowing backward, trees uprooting themselves, even literally bringing the house down.  The other rabbis hold fast, even when a heavenly voice calls out to them, “Eliezer is right!”  “It’s not up to Heaven anymore,” they say.

They don’t stop there, though.  They invalidate every ruling Eliezer has ever made on ritual purity and ostracize him from the community – and the consequences are dire, both for him and for the community, eventually leading to the death of the rabbi at the head of the group (this is the part usually left out of the story when it’s told in school).

What is missing from Eliezer’s story, and what is missing on bystander boards, is a second voice.  One person screaming about the evidence and the morality of a position, no matter how correct, is a nuisance and a crackpot. But as several people at the board retreat pointed out, a second – or God willing, even a third – voice, saying, “Hey, wait a minute, I think they may have a point,” changes the conversation. Are they both grandstanding?  Are all three of them over the rainbow?  Not as likely.

The Foundation, and particularly its Pittsburgh Regional Health Initiative arm, has made its mark in the patient safety movement.  A hallmark of that movement is listening when a patient, a nurse, a surgical tech, or a doctor says, “Hold everything, something’snot right here.”  Just as important is recognizing that the person calling a halt isn’t trying to sabotage the surgery or cost the hospital money – they are trying to prevent harm to a human being.

How much damage could have been prevented if one other rabbi would have said, “You know, Eliezer’s pretty smart.  Maybe we should take another look at this oven?”  How many lives could be saved if the next time someone states an uncomfortable truth at a hospital board meeting, someone would say, “You know, Dr. Jeremiah really knows her stuff.  We need a task force to look into this problem right now?”

Healers, our job, wherever we are in the system, is to be that second voice – not a bystander, but a stand-by-her, if you will.  Just like we need to avoid anchoring in our first diagnosis and ignoring the signs of some other brewing trouble, we need to avoid anchoring in the-way-we-always-do-things, or the-way-everyone-else-is-doing-things-now, and listen for signs of trouble in the system.  Everyone has an interest to serve – our interest is with the people we care for.

People often ask me about burnout, both colleagues and laypeople.  I appear to them to be asking so much of the healer, to give each day from the depths of their soul and to bring light into darkness.  How can I possibly keep from burning out?

Because when I need it most, the people I care for bring the light right back, that’s how.  On this last day of Chanukah, I thank everyone who has shared their light with me, no matter how much they were hurting at the time, to rekindle my own flame.  You are the reason my oil keeps burning, long after it should have burned out.

Shabbat evening, Friday, October 26, 2018.  I am sitting in the stone-floored lobby of my synagogue, afloat in music, feeling my week’s tension being carried away on a wave.

Leonard Cohen’s melody for “Hallelujah” is being transformed and elevated as we fill it with the words of “Lecha Dodi,” welcoming the Shabbat Queen.  I remember the exact moment at which I felt the release, the peace of letting go of everything that vexed me:

Rav lach shevet b’emek habacha – “You have dwelled too long in the valley of tears.” Read More

It’s Thanksgiving Day and my house is bursting at the seams – and this isn’t where we’re having dinner.  Even with runny noses and upset tummies – and standing in the cold waiting for one of my children to cross the finish line of the Turkey Trot – there is love and warmth everywhere.

That’s not true.  Not everywhere.  Caren called my office this week to refill her blood pressure medication, and she was in a foul mood.  “My family doesn’t want me around for the holidays.  This season is really hard for me.”  Later that same afternoon, Michael, an anxious man in his early thirties, confided in me that he was trying hard to stabilize a housing situation that was beyond his means, “but it’s really tough – I have no one to lean on and I’m doing this all myself.”  They are not feeling the love.

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I had a sobering exchange Sunday afternoon with a new friend.  We had met recently at a conference and we were talking about suspicion and distrust between doctors and patients.

“I’d love to do a presentation showing the little thought bubbles above the doctor’s head,” he laughed.  “You can’t possibly be paying attention the whole time.”

I didn’t have to answer him for him to know he hit the nail on the head.  We can’t possibly be paying attention the whole time.  I know the feeling of distraction all too well – from extreme fatigue, from worrying about how far behind schedule I am, from ruminating over a bad interaction with the previous patient, or most recently from massive emotional trauma (see the “Three Healers Who Listen” posts from earlier this month). Read More

My siddur, my prayerbook, is now part of a crime scene, a killing field.

The slim, cloth-bound, all-Hebrew book is called Va-ani T’filati, “I am my prayer,” and was the one I carried with me in the same bag as my tallit and tefillin wherever I took them.  On October 20, I returned home from celebrating our friends’ daughter becoming a Bat Mitzvah in the Tree of Life sanctuary to realize that my bag felt lighter than it should.  About one small, hard-cover book lighter.

It was, of course, in the book rack on the back of the pew, in the center-left section of the sanctuary about 10 rows back, just where I left it.  No worries.  I had a busy week, but on Thursday, October 25, I remember to e-mail the Tree of Life office to ask if someone could locate it.  I would pick it up . . . later. Read More

The Hebrew letters often hint at a common object: bet hints at bayit, a house.  Gimel hints at gamal, a camel.  And shin?  Why, shen, of course – tooth.

I like to think that the reason for this is that shin, or rather sin, which is the same letter with the dot moved to the other side, is also the first letter in sameach, happy.  And what do we do when we are happy?  We smile and show our teeth.

My colleague Rich Gottfried smiled all the time; as people spoke at his funeral, or around the office this week, almost all took note of his smile.  He was the Hines Ward of dentists, it would seem – always smiling. Read More