Monday, December 25, 2023

Christmas Morning Rounds

From the December 21, 2023 issue of the Transformational Times



Christmas Morning Rounds




Bruce H. Campbell, MD FACS


In the days running up to the Christmas Holiday, the Transformational Times editors offered reflections. Here, we publish an essay by editorial board member, Dr. Bruce Campbell.


Many years ago (even before HIPAA), my family was visiting for the holidays. On several occasions I had tried, without a lot of success, to explain to my father what I did for a living as a head and neck cancer surgeon. On this day, I looked at him and said, "Dad, I have to see a couple of people in the hospital this morning. Do you want to come with me?" He readily agreed.  

A few minutes later, we arrived at the inpatient floor. One of my patients that day was a man in his early 30s who had undergone cancer surgery to remove part of his cheekbone the day before. He had done well overnight and was recovering. I stuck my head in his room.  

“Merry Christmas!” I said. “I know this is unusual, but my father is with me this morning to make rounds. He is not a doctor—actually, he is a retired dime store owner—but he would love to meet you. Do you mind if he comes in with me?”  

“Really?” replied my patient. “Sure! That would be fine.” 

I returned to the hallway and explained that the patient’s face was pretty swollen but that he was otherwise doing fine. My dad nodded and we went in. I introduced them to each other. If my father was surprised by the man’s early post-operative appearance, he did not let on.    

“Good morning!" said my dad. “Nice to meet you! How are you doing today?”  

Despite his swelling, my patient replied, “Actually, I’m doing very well, thanks. Better than I expected.” The young man was lying in bed with one eye nearly shut and his cheek full of packing material. His upper lip was swollen, making conversation a bit of a challenge. Nevertheless, as I checked his surgical sites and looked through the notes in his chart, my dad asked the patient about his cancer, his hometown, and his family. My dad, a distinguished looking gentleman with graying temples, nodded and smiled, absorbing the story.  

The patient asked my dad, “So, how long do you think I will be in the hospital?” My dad smiled and glanced at me.  

“I don’t know what my dad thinks, but I think you’re doing great,” I said. “I predict you’ll be ready to go home the day after tomorrow.”  

“Thanks again, Doc. I’ll let my family know.” We all said goodbye and Dad wished him well. After we finished seeing my other patients, Dad and I headed home for our family’s Christmas meal. 

For years, my father recalled the day we made rounds together. He would remind me what he had seen and would ask how the patients were doing. Those few minutes had given him a glimpse into my life and work that I had never, ever been able to adequately share by trying to tell him what I did. 

A few years ago—and long after my dad had died—I received a holiday card from the patient, marking the anniversary of his hospitalization. “I remember you and your father even came in to see me on Christmas Day! I will never forget that,” he wrote.  

I was surprised by how much that one brief Christmas morning rounds encounter had impacted both my father and the patient. The shared experience had preserved the memory and sharpened our senses. I wrote back to the man, now a long-term cancer survivor, that I was very grateful I had been able to share that moment of insight, healing, and presence, both with him and with my dad.

It is a Christmas present I have always treasured.



Bruce H. Campbell, MD FACS is a retired professor in the Department of Otolaryngology and Communication Sciences at MCW. He has been on the Transformational Times editorial board since March 2020. www.BruceCampbellMD.com 



Thursday, December 21, 2023

'Twas the Night Before Christmas: Love, Grief, and Snowflakes

From the December 21, 2023 issue of the Transformational Times




'Twas the Night Before Christmas: Love, Grief, and Snowflakes



Kathlyn Fletcher, MD MA


In the days running up to the Christmas Holiday, the Transformational Times editors offered reflections. Here, we publish an essay by editorial board member, Dr. Kathlyn Fletcher.


My mom loved snow.  When she was alive, she would always call me on the first snow of the year, even when we lived in different states, and it was only snowing where she was.  Having a white Christmas was very special to her--almost sacred--and I wished for snow every year because she loved it so much.  I grew to love it, too.   

One year when I was in high school, we had a stubbornly brown landscape right up to the time that we stepped into the Presbyterian Church on Christmas Eve for the 11:00 PM service.  I loved that church service; we sang favorite Christmas carols and ended with Silent Night by candlelight; magical in its consistent simplicity.   

We left church that night to find that it was snowing beautiful, large flakes, and the streets were already completely blanketed with the quiet, peace of heavy snow.  My mother and both had tears in our eyes as we looked around.  It felt like a small gift meant just for us. 

My mom loved the Christmas season, and writing this remembrance makes me teary that she is gone and grateful that I had her at all.  The holidays will do that to a person.  A few years before she died, she recorded herself reading Twas the Night Before Christmas and gave it to my daughter.  

Every Christmas Eve, we open the book and listen to her voice reading to us as we sit together in our matching Christmas pajamas.   Every year, I feel simultaneous grief and love.  It's a hard place to live, but it's worth it.  Miss you, Mom.    


Kathlyn Fletcher, MD, MA is a professor in the Department of Medicine at MCW and program director of MCW's internal medicine residency. She is a longstanding member of the Transformational Times editorial board. 



 

Monday, December 18, 2023

A Message from the One Who Stays Home while the Resident is Working

 From the December 24, 2021 issue of the Transformational Times




A Message from the One Who Stays Home while the Resident is Working




Clare Xu


Hospitals don't slow down just because the calendar says it is time for a holiday. This essay, originally published in December 2021, shares how the spouse of an internal medicine resident altered her family Christmas plans so that her resident-spouse would also have a special celebration. Remember, this was when COVID-19. vaccines were just becoming available ...



When my husband and I got married in November 2021, our officiant had us make a list of the five things that we love most about the other person. My husband shared that I “live in the moment and celebrate the small things.” Fair enough, though he didn’t mention that I also love to celebrate the big things. By that I mean all the festive holidays: Thanksgiving, Christmas, New Year’s, Valentine’s Day, Easter, and Halloween (plus a few more!).

Christmas is probably my favorite “big thing” to celebrate. Unlike me, my husband didn’t grow up celebrating Christmas. When we got together, he went from living without a single Christmas decoration adorning his dwelling to a home popping with red, green, gold, and silver. He now enjoys our felt garlands hung across the mantle, snowmen, reindeer, and whatever else I bring home. I introduced him to many other Christmas traditions enjoyed by my family, including Christmas crackers, blintzes, and The Muppets Christmas Carol. It brought me joy to share my family Christmas traditions with my husband.

Last Christmas, Zhu was scheduled to work on Christmas Day. I started planning early, considering ways that I could include him in the festivities. My goal was to maximize my participation in my family Christmas celebration while still preserving a special bit of the Christmas magic for Zhu. After conferring with my family on the matter, we opted to have two Christmas celebrations: one on Christmas Day with everyone except Zhu, and one in early January with Zhu as the guest of honor.

On Christmas Day, after celebrating with my family, I dashed back home, through the snow with our two dogs sitting in the back of the car, determined to be there to greet Zhu when got home. My husband never wants anyone to make a fuss over him. He said that he wouldn’t have been bothered if I had chosen to stay on at my parents’ house for Christmas dinner, and I am sure that he was sincere. I explained to him that above all, Christmas is about giving; not just presents and food and all of the other trappings, but of ourselves. He’d spent his Christmas giving to his patients who, on this special day, deserved the utmost care and compassion. By being there for him, at home, on Christmas Day, I was able to show him how much I love and value him.

For our January-Christmas, I arranged with my parents to leave all of the gifts for and from Zhu unopened, and the holiday decorations up exactly as they were on Christmas Day. This day was for Zhu. Of course, the attention made him feel a little shy, but we all knew how much he appreciated the gesture and the opportunity of joining in the festivities.

I believe that preserving celebrations and tailoring them to Zhu’s work schedule helps him to focus on his patients. He doesn’t have to feel that he is missing out and give into feelings of loneliness. He might not be able to celebrate with his loved ones on Christmas Day, but he is helping people who are struggling on Christmas Day. This might be the worst day of their lives and their families. They’re scared and maybe in pain. I like to think that the staff who are taking care of the patients will be able to bring joy and healing, even on holidays.


This essay was written while Zhuchen Xu, MD was completing his internal medicine residency. Dr. Xu is now on the MCW faculty. 

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