Thursday, December 14, 2023

Human Flourishing: Judaism, Medicine, and a Life Well-Lived

From the December 16, 2022 issue of the Transformational Times




Human Flourishing: Judaism, Medicine, and a Life Well-Lived


Sarah Root




The Kern Institute believes that human flourishing is central to the health of physicians, caregivers, patients, and society. In this essay, initially published one year ago in the Transformational Times, medical student Sarah Root shares some family stories that highlight her thoughts on faith, flourishing, and the practice of medicine from the perspective of Judaism ...


How can one do the most to help others and uplift the world?

 

Unlike in many religions, Judaism does not generally concern itself with what happens spiritually after death. As a seventeen-year-old reeling from the loss of her grandmother to cancer, this was a surprising comfort to me. From my dad’s eulogy where he reminisced about some of her best traits (the dedication of her life in support of the arts) and her most eye-rolling (her unwavering belief that Melba toast and cream cheese represented a complete breakfast), to the shiva services in which family, friends, and extended community gathered to share anecdotes, quirks, and fond memories (and of course, food), the focus was not on grief. 

That’s not to say that there weren’t tears, but they were intermixed with laughter as we sat there together, eating bagels and lox in celebration of a life well-lived. This emphasis on life is not unique to the Jewish mourning process, but is a central tenet in Jewish philosophy as a whole. Moreso than simple recognition, Judaism holds the preservation of life as one of its highest values. By Jewish law, the pursuit of saving a life supersedes all but four of the 613 mitzvot, or G-d’s commandments, in the Torah. It is this regard that exempts the sick from fasting on Yom Kippur (the Day of Atonement), permits Jews who might go hungry otherwise to break kashrut (the dietary laws), and allows abortions to save the life of the mother. But the simple concept of preserving life is meaningless without a Jewish concept of what it means to live, and perhaps even flourish.

In the Pirkei Avot (teachings by rabbis throughout the ages), Shimon the Righteous coined the idea of al shlosha d’varim, or the three principles on which the world stands: studying Torah, performing avodah, and practicing gemilut hasadim (Pirkei Avot 1:2). To study Torah is to read the fundamental Jewish religious text and learn how to live an honorable life. Historically, avodah referred to sacrificial rites performed in the temple. Throughout the centuries its religious meaning expanded more broadly to worship and divine service, while in modern Hebrew, avodah simply translates to work. Finally, gemilut hasadim are acts of loving kindness, a spiritual calling for Jewish people to help others.

There is interplay between the concept of an individual’s actions in following the al shlosha d’varim and the flourishing of broader society. In Jewish teachings, it is clear that the personal and the community are intrinsically linked concepts, and that one cannot find meaning without the other. From the Torah, we Jews learn the mitzvot and the stories of our people, providing an ethical framework and bringing us closer to our communities, our history, and to G-d. This is the fundamental basis for the Jewish concept of l’dor v’dor, a phrase which translates to “from generation to generation,” and encompasses the sharing of traditions, stories, and values between generations. In participating in l’dor v’dor, we enrich both our own lives and those of our communities by building bonds of love and respect.

In practicing avodah, we Jews find spiritual fulfillment, which may seem personal at first. However, communal worship is a requirement in religious Judaism. For public prayer, a minimum of ten people (historically men) must participate in order for the obligation to be met. 

But I would also like to point out that avodah means more than just worship; it also refers to divine service and work. These two concepts remind me of a story that my rabbi used to tell, in which every week a man would bring a loaf of bread as an offering to G-d and leave it in the ark, where the Torah scrolls are kept. And every week, another man would come pray to G-d, asking for food to feed his family. When he would open the ark, the bread would be there, his prayers answered. When the two discovered each other, both were initially upset; the first because G-d was not receiving his offerings and the second because G-d was not answering him. But their rabbi simply laughed. G-d, he said, was listening to their prayers. By offering the bread, the first man was acting as the hand of G-d to fulfill the prayers of the second.

The story illustrates that divine service is not passive, and that true prayer is not just holy words, but actions that emulate the divine. This understanding is fundamental to the third pillar of al shlosha d’varim: gemilut hasadim, or acts of loving kindness. The scope of this is broad, encompassing anything from caring for the sick, to volunteering at a food bank, to waking up to drive your brother to school at 6:00 AM so he doesn’t have to bike in the rain. Gemilut hasadim is about dedicating your actions to uplifting your community in a way that is personal. 

Gemilut hasadim is notably separate from tzedakah, generally translated as charity, one of the most important mitzvot. It is explicitly commanded in in the Torah to “open your hand to the poor and needy kin in your land” (Deuteronomy 15:11). But in modern translations, tzedakah means more than just charity. The root of the word is tzedek, meaning justice and righteousness. Giving charity can thus be seen as a facet of restoring justice to the world. With this interpretation, tzedakah has extended to not just mean giving money, but also giving time, reiterating the importance of actions in Judaism. This concept underlies Jewish support for many social movements: if we ourselves are to flourish, then we must ensure that everyone can flourish.

The concepts of al shlosha d’varim, l’dor v’dor, and tzedakah come together in turn to form the spiritual foundation for tikkun olam, the Jewish imperative to repair the world. In Kabbalistic Judaism, this moral mandate is explained through the shattering of the vessels, a revision of the creation myth. In this story, when G-d is creating the world, he puts his divine light into several vessels. These vessels were intended to be spread throughout the universe and make it perfect.

But the vessels were unable to contain G-d’s divinity and they shattered, sending sparks far and wide. Tikkun olam, Kabbalistic Judaism states, is the process of finding the sparks and gathering them, by acting as the hands of G-d in helping others. When enough of these sparks are gathered, the vessels can be restored, and the world can once again be made whole. Tikkun olam, in essence, is a directive for how to live a meaningful life. The concept of human flourishing in Judaism then becomes a simple question: how can one do the most to help others and uplift the world?

It is this cultural mindset that encourages many Jews, such as me, to pursue a career in medicine and informs our perspective on providing care. Medical practice inherently encompasses many critical Jewish values, namely an ultimate respect for life and acts of loving kindness. Healthcare workers dedicate their time, on nights, holidays, and weekends, to ensure that the ill can continue to receive life-saving care. Medical education is itself l’dor v’dor, as knowledge, passion, and ritual are passed down from each generation of physician to incoming medical trainees. And the medical field is a community intended to uplift patients, families, and healthcare workers, a direct extension to the communities that we as Jews are morally called to participate in.

The Jewish physicians that I know flourish when their patients flourish, but only so much can be done by the bedside. Thus, the concept of tzedek teaches us that as physicians we have a responsibility to ensure that patients are being treated with justice, both in the clinic and in the broader world. This is ever more important in a society where the cost of care continues to increase, and people are threatened with lack of access. We must strive for tikkun olam, to repair the parts of the system that are broken and advocate on a broader level as a community.

This past Thanksgiving, my grandfather pulled me aside to give me some words of wisdom as a lifelong physician himself. Remember, he said, that medicine is not just a practice, but a privilege. In this, I see a redefinition of the word avodah. Perhaps the distinction between worship, divine service, and mundane work is far smaller than one might initially imagine. When the work is serving others, is that not a form of worship in its own right? I hold all of these Jewish principles close when learning to provide care, when advocating for my patients, and when approaching difficult situations with respect and an appreciation for life. In becoming a medical practitioner, I am laying the groundwork for my own Jewish flourishing.


Sarah Root is an MD/PhD student at the Pritzker School of Medicine at the University of Chicago; she was in her second year of the program when this essay was published in December 2022. She is a graduate of the University of Pennsylvania and is passionate about the intersection of Judaism and ethics. Email: sroot@uchicago.edu

Monday, December 11, 2023

Who Are We? Beyond Earth at the Intersection of Bioscience and Religion

From the December 16, 2022 issue of the Transformational Times


Who Are We? Beyond Earth at the Intersection of Bioscience and Religion


Annie Friedrich, PhD and Ryan Spellecy, PhD


In December 2022, the Medical College of Wisconsin, Marquette University, and Viterbo University hosted its first seminar on ‘Big Questions’ at the intersection of bioscience and religion. A perhaps unlikely pairing of a theologian and an astronomer explored what it means for humans to be unique in the vastness of the universe…


A theologian and an astronomer walk into a room…while this may sound like the beginning of a joke, this was the scene on December 5, 2022, for the inaugural session of a new seminar series called "Big Questions," which explores the intersection between bioscience and religion. Moderated by MCW’s Aasim Padela, MD, this series aims to foster interdisciplinary humble and fruitful dialogue, build bridges of understanding, and spark curiosity at the juncture of religion and science. The series seeks to replace the question of science or religion with “where do science and religion find common ground?”


More than 50 MCW faculty, staff, medical students, and community members heard from Astronomer Jennifer Wiseman, PhD and theologian Jonathan Crane, PhD, MPhil, MA. Dr. Wiseman is the Emeritus Director of the Dialogue on Science, Ethics, and Religion at the American Association for the Advancement of Science. Dr Crane is the Raymond F. Schinazi Scholar of Bioethics and Jewish Thought at the Ethics Center, and Professor of Medicine and Religion at Emory University.

The question that began this series is a simple one: if there is life on other planets, what does that mean for human significance? Dr. Wiseman explored this question in light of astronomical discoveries, while Dr. Crane offered a Jewish perspective on the question of human uniqueness in the context of life beyond earth. While these perspectives may seem to be at odds, Drs. Wiseman and Crane had more in common than one might think, which is perhaps the point of interdisciplinary dialogues such as these.


In the vastness of the universe, are humans significant?

As Dr. Wiseman approached the podium, the lights were dimmed as a breathtaking photo of thousands of stars filled the screen. Thanks to technology like the Hubble Telescope, stars are no longer just small pinpricks of light; the image on the screen showed bright flashes of red, blue, and yellow. According to Dr. Wiseman, there are more than 200 billion stars in our Milky Way galaxy alone, which may lead one to feel small and insignificant.

Astronomer Carl Sagan may sum up this feeling of insignificance: “Who are we? We find that we live on an insignificant planet of a humdrum star lost in a galaxy tucked away in some forgotten corner of a universe in which there are far more galaxies than people.” And yet, Dr. Wiseman did not find this insignificance or smallness deterministic or fatalistic. Rather, she saw this as an opportunity to be inspired. Space exploration provides an invitation to explore what we don’t yet know or have not yet encountered, and Dr. Wiseman accepts that invitation gladly.


Betzelem Elohim: A Jewish perspective on human uniqueness

At the end of her remarks, Dr. Wiseman offered a counter to Dr. Sagan’s quote in Psalm 8:3-4 which says, “When I look at your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is the man that you are mindful of him, and the son of man that you care for him?” Dr. Crane picked up the Psalms, as well, acknowledging that Jewish tradition recognizes that things outside of this earth are significant because God created them.

Yet, their significance is not a threat to our own. Humans are particularly unique, according to Dr. Crane, because humans are betzelem Elohim, made in the image of God. But what if other beings who are also “made in the image of God” are discovered? Would human uniqueness and superiority fail? We may not be the exclusive owners of betzelem Elohim, but we were given revelation, and Dr. Crane notes that this dialogue with God is what matters.


The significance of human significance

While questions of human uniqueness and significance are surely important questions worthy of exploration for their own sake, one might well be skeptical of the importance of these questions when our pediatric hospital is at—or over—capacity due to a triple threat of COVID, RSV, and influenza. When pressing deadlines or clinical responsibilities overwhelm, taking time for philosophical reflection may seem trivial at best or irresponsible at worst.

But, as Dr. Crane argued, being “made in the image of God” provides a certain comfort that allows us to “take risks” about science, healthcare, and the pursuit of knowledge. Reflecting on human significance—whether from a religious or scientific perspective—encourages us to push forward in our research endeavors and to take risks in our teaching as we develop a new curriculum and employ teaching techniques and modalities that may stretch us. As we seek to transform medical education, surely, we could all use comfort and the permission to take risks, as transformation does not come without challenges and risks.

Perhaps some of us are already confident of human significance. When a learner comes to us for help, overwhelmed by the subject matter or stresses of life, we take time to listen because we know they are unique and significant. If we did not believe in human significance and the intrinsic value of human beings, perhaps we would not have chosen this field in the first place.

Yet this affirmation of human significance, whether from a scientific or religious perspective, reminds us to approach our work with a spirit of service and compassion that can transform the practice of medicine, medical education, and the biomedical sciences.


Annie Friedrich, PhD, HEC-C is an Assistant Professor of Bioethics and Medical Humanities in the Institute for Health and Equity at MCW.

Ryan Spellecy, PhD, is the Ursula von der Ruhr Chair in Bioethics and Professor of Bioethics and Medical Humanities, and Psychiatry and Behavioral Health, at MCW.

Thursday, December 7, 2023

Remembering the Earliest Days of the Pandemic: The Institute Responds to Times of Transition

From the April 24, 2020 issue of the Transformational Times



Remembering the Earliest Days of the Pandemic: The Institute Responds to Times of Transition


Adina Kalet, MD, MPH


This April 2020 essay was originally published six weeks after classes shut down at MCW. Despite the unknown risks, our physicians, nurses, and front line workers stayed on the job. 

During the very earliest days of the COVID-19 pandemic, we were all scared for our lives; the danger was very, very real and the future was uncertain. Despite this, the Kern Institute's leaders and educators shifted the Institute's focus to make certain students were supported and prepared. As you read, recall those days when we worried about the transitions and the future. 

In the coming months, the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education will transition again. Those of us associated with the Institute hope that whatever iteration emerges will continue to provide a sustained, innovative, and character-driven platform that influences the future of health sciences education. 

 

The COVID-19 pandemic has hit our economy hard. On our own campuses, saving and protecting lives has caused unprecedented revenue shortfalls within our community, to our hospitals, and to the Medical College of Wisconsin. Ironically, just when health care provision, education, and research are needed most, our work is threatened. Those on the “front line” of the pandemic deserve hazard pay for taking on risks for the rest of us, yet our staff is facing salary reductions and furloughs. 

Along with many of our peer institutions, MCW is implementing a financial austerity plan. We have hit a very rough patch and more changes are coming. Our futures are uncertain. People are scared. In this context, the Kern Institute is working to be good citizens by aligning emerging needs with our resources.


There can be opportunity in adversity

Historians point out that even devastating crises offer opportunities to societies. We have already seen unprecedented innovations in the face of immediate problems. Unable to deliver required clinical rotations, faculty and students are co-creating ways to fill curricular gaps through telehealth and service learning. New levels of collaboration and cooperation among medical schools and with accreditors have broken-down traditional silos, suddenly changing systems and shifting long-held policies. 

We must leverage these transformative opportunities for the better. If we work together to retain our senses of mission, purpose, and meaning, we will increase our individual and organizational well-being and resiliency. 


Pivoting what we do, yet remaining thoughtful

In our pre COVID-19 lives, the Kern Institute had been working to clarify our philosophy of medical education transformation. We referred to this as our “topology of transformation,” seeking to best understand why we are doing what we are doing. By thinking, dialoging, reading, and writing, we wrestled with uncovering which experiences are essential as a student transforms into the “good physician.” Then, and only then, would we allow ourselves to talk about the instructional or pedagogical evidence that drives the design and implementation of programs that achieve this transformation. For most of us, especially impatient physicians, it takes discipline not to jump into the “doing” too soon.


Suddenly, COVID-19 accelerated our work

Plato is credited with the phrase, “Necessity is the mother of invention,” sometimes translated more literally as, “Our need will be the real creator." While I prefer the more feminine flourish, now is the time when innovation is needed most. Over the past few weeks, Kern has pivoted to assist MCW’s rapidly transforming educational programs in response to immediate needs and we are designing ways to streamline and sustain the best of these changes. 

We are collaborating with partners in Academic Affairs and Student Affairs to support well-being, prepare students to meet their graduation requirements, provide meaningful clinical experiences, sustain and strengthen MCW’s long-term investments in diversity and inclusion, and speed the design and implementation of a dynamic, state of-the-art fully virtual curriculum.


Some things are the same in both 2020 and 2024

These are historic times globally and locally. As we adapt our educational work to the new reality, we will study the outcomes, learn from our successes and shortcomings, and look for the new topology of transformation. 


The essay was originally published on April 24, 2020 as, "Transforming Educational Strategies on a Dime."

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Monday, December 4, 2023

MCW's Seventh MedMoth Storytelling Evening

  

MCW's Seventh MedMoth Storytelling Evening


MCW MedMoth, a student-initiated and student-led storytelling event, was held on November 30, 2023. Over 100 appreciateive listeners came to support the ten storytellers as they shared tales on everything from the lifelong scars left after shoplifting to lessons learned from running a food pantry program to a death in the ICU. 

Some of the stories will soon be featured on the Medical Education Matters podcast

Thanks to the Kern Institute, the Kern Family Foundation, and the Charles E. Kubly Foundation for support of MCW MedMoth over the past four years. These events reflect human centered design principles and character. MedMoth supports students, staff, faculty, and health care professionals in human flourishing and resilience.

Big props to the MedMoth team: MCW students Meg Summerside, Linda Nwumeh, Amber Bo, Meghan Schilthuis, Corey Briska, and Maya Martin, and to Kern faculty/staff Shannon Majewski, Devarati Syam, Adina Kalet, Bruce Campbell, and Cassie Ferguson. 

Look for the next MCW MedMoth evening in Spring 2024!