A Technician Not a Doctor

B''H

William Osler examining a patient.

I recently read an article in JAMA[1] wherein a transplant surgeon describes his consultation with a patient.
From my reading, the surgeon almost accidentally finds out the man had been shot seven times and tortured. Much to my surprise, the surgeon does not want to ask any personal questions for fear that he would be "pry(ing) too much". As far as I can tell the patient was never examined by this highly specialized surgeon at an elite Medical Center. Instead, our protagonist discovers that the patient, a Visiting Professor of Theater, has written plays about his experiences in his native land in Africa by "Googling" him rather than taking the simple human expedient of asking questions. He then orders the patient's play from Amazon.com, reads it, and is justly disturbed. His mother notices this (during Mother's Day) but he ducks her questions for fear of "violat(ing) my patient's privacy". Remember this patient has published all of this. I found this entire story quite disturbing: this physician seems to deny both his and his patient's humanity. He seems to miss the whole fun of medicine: meeting people from all walks of life and helping them. When I discussed this incident with several of my colleagues, one of them very astutely said, "Perhaps we should call him a transplant technician rather than a surgeon".

The Perfect Student

B''H

Hannah Rose told me many times that she was the "perfect student": doing everything the teachers asked in an overly thorough way. She felt thinking independently only came to her after a professor in graduate school rightfully, in her view, called her a "silly little girl" (lucky he he did this 30 years ago). This occurred when she was doing a presentation on Bach and the professor pointed out how she had stumbled on a very important question. My perfect student then continued with her pedantic report at which point the professor stopped presentation with the above exclamation and told her not to go on. This was a life-changing episode. I ask you, would this happen today? Are we too afraid to correct?

I recently read an article published in the New England Journal of Medicine roughly three years ago[1] recounting in first person singular an event that happened on an airplane to the author. A passenger coded. The author, a neurologist, and his wife, a hospitalist, began resuscitation assisted by an AED, and an Ambu bag, and other equipment. Three other physicians, passengers, an oncologist, a surgeon,  and an anesthesiologist, rapidly volunteered to help. A dang good code team.

After 25 minutes, despite the efforts of, and in the opinion of, these highly qualified physicians, the man was dead. They turned to his wife and informed her that further efforts would be useless. They called the code. At this point in time, the stewardess informed the physicians present that airline policy insisted that CPR be continued until the plane landed and that she and the other flight attendants would take over from five board-certified physicians.

Yehudit bat Aharon

B''H

Hanna Rose's actual name was Joanne Galler Rubin (Yehudit bat Aharon v'Esther V'dorah-Judith daughter of Aaron and Esther-And-Her-Generations).  She died on 24 April 2013 peacefully surrounded by friends and family.  Below are the notes Rabbi Jonathon Bienenfeld used to deliver her eulogy.

Joanne Rubin – Yehudit bat Aharon

·       We pay tribute today to Joanne Rubin, to Yehudit bat Aharon v’Esther Vedora—wife of Steve Rubin, mother of Isaac and Rachel, daughter of Mr. Aaron and Mrs. Esther Galler.

·       Joanne’s was a life that was cut far too short, finally succumbing to a protracted battle with cancer. Yet it is a life that one cannot do justice to—for she accomplished more and touched more souls in her shortened life than most people possibly could in ten lifetimes.

·       And it is difficult to speak of Joanne for another reason—because of her complexity. If you knew one facet of Joanne’s personality, you’d make certain assumptions, only to be thrown completely off guard by another facet. If you knew her from angle A, you’d soon be blown away by angle B.

·       Joanne was brilliant. Growing up in Chicago, she attended Northwestern University, then receiving a masters in musicology from University of Chicago. She was fluent in numerous languages. I was recently having a conversation about studying Talmud with Isaac, and she mentioned that she had a wonderful textbook we could use—the subject matter was ancient Aramaic, the instruction in modern German. She was a deep thinker and an avid reader—studying both secular and religious subjects passionately. If you knew Joanne’s brilliance, you would expect the cynicism that often goes along with it—a philosophy that all can be studied and all can be explained. And you would be completely taken aback by the simple, pure faith in G-d that such an intellectually sophisticated person could possess. Her brilliance made her shrewd and thoughtful, not cynical, never disbelieving. Her faith was awesome and awe inspiring. True faith is not the belief that something will happen, but that anything can happen. True faith realizes the G-d can do anything, that G-d can make miracles, but that the miracles don’t always unfold the way we might like them to.. Joanne’s take on miracles is best expressed in her own words, words she shared as “Hannah Rose,” her blogging pseudonym:

"Oxygen is smooth and comforting.  It is the breath of G-d, the elixir of life when the lungs are filled with fluid.  Oxygen keeps the body at peace while the siphon drains liters of fluid from the pleura.  Then the pleasure of coughing begins.  It is important to puff up the lungs so they may work again.  There is nothing boring about breathing.

There is nothing boring about any aspect of life.  Miracles are multi-dimensional and have nothing to do with that little purple and pink wand with the star and the ribbons and the glitter that sings a song when you tap or whack someone. Miracles assign many responsibilities.  It is difficult business to rise to the occasion of this gift." 

A Last Entry*

B''H

"Courage, courage, courage, courage, courage.... This mystery is not so great."

This is what Rachel said as she cradled my head and whispered into my ear. She stroked my head and kissed me on the kepe.

Life as a doctor

B''H

Dear Readers,

Hanna Rose has been very ill and thus has not been able to place any entries for several months.  Her husband, the "Historian", yours truly, as you can guess (vide infra) is a physician and is taking up her cudgel.  I do not write as well or as easily as she which will result in far less frequent entries. One final note, please pray for her.

Reflections on William Halsted

William Stewart Halsted (1852 – 1922) was, and still is, the most famous American surgeon. He was one of the founding faculty members of Johns Hopkins University, which was consciously set up to be the finest medical institution in the world. Instrumental in pioneering aseptic technique, use of rubber gloves in surgery, wearing surgical garb rather than street clothes, wound healing, vascular surgery, mastectomies, hernia work, and excision of goiters, he was, and is, the father of modern surgical training. Many of the finest physicians of the first half of the 20th century considered him to be their mentor.

For example, William Sidney Thayer said, "In Halsted's little operating room with the old wooden table, the antiseptic technique was so perfect that there was never a moment of anxiety. I could not believe my eyes. It was like stepping into a new world. At this time Halsted's technique was unique, the sureness and perfection of his results seem to me then… The nearest thing to a miracle that it has been given to me to witness."[1]

There is no such thing...

B"H

...as a part-time person

Ready or not here you are, a brand new baby plopped into my arms. 

You looked up at me with those big dark eyes scrutinizing every attribute of me.  You were wide awake.  After twenty five hours of labor I was exhausted, thirsty, and very hungry. You were hungry too.  You were always hungry during the day but at night you always slept, thank G_d!

Two years later your little sister was born.  The miracle of you is that you always treated her as the complete person she has always been. ... perhaps more complete than most.  And that little baby girl with Down Syndrome, our Rachel, showed you another way to experience life.  

Everywhere...

B"H

...acts of life

She did not look very strong.  Her steps were tiny and deliberate.  Most people who need oxygen constantly either wear the canister in a back pack or roll it on wheels.  This older lady was holding her metal canister like a beloved baby.  I understand.  

Oxygen is smooth and comforting.  It is the breath of G-d, the elixir of life when the lungs are filled with fluid.  Oxygen keeps the body at peace while the siphon drains liters of fluid from the pleura.  Then the pleasure of coughing begins.  It is important to puff up the lungs so they may work again.  There is nothing boring about breathing.  

There is nothing boring about any aspect of life.  Miracles are multi-dimensional and have nothing to do with that little purple and pink wand with the star and the ribbons and the glitter that sings a song when you tap or whack someone.  Miracles assign many responsibilities.  It is difficult business to rise to the occasion of this gift.