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Avi, a close friend of Jake’s, once described him as a ‘balaganist.’ Which, of course, would not mean much to someone who learned Hebrew in order to study the bible in the original. A ‘balaganist’ is someone who carries his ‘balagan’ with him wherever he goes. A common enough word in modern Hebrew (that Amos Oz suggests may be Persian in origin, meaning the back balcony where you throw all the junk), ‘balagan’ means, ‘disorganized situation,’ or, in a word, mess. Avi was referring not only to Jake’s tendency to mess up any office he sat in, but also to Jake’s preference for working on several projects at once and his willingness to start a new one with almost no regard for how many projects were already running or what state they were in.
All of which did not dampen Avi’s appreciation for Jake as a fine rheumatologist ( despite his being religious) who was especially talented at population research and designing new teaching programs. Avi’s perception of Jake as a balaganist only meant that he himself, a quite organized, systematic, though not uncreative person, did not feel he could ever share an office with him. You might guess that Avi tended to fit people into his plans, while Jake let them develop their own.
On a particular New Year’s Day, which is not much of a Muslim or Jewish holiday in Israel, Jake sat in the office chair he had carefully adjusted to keep his high knees at a comfortable level. He was scanning a new article on Juvenile Rheumatoid Arthritis, while stringing together four paper clips he had found on the floor, when his desk phone rang.
“Professor,” said a familiar breathless voice, “ I know, I’m 15 minutes late. So sorry. But I’ll be there in 3!”
“Tzofia, I understand, “he answered, “but I have to be in clinic in 40 minutes.”
“I’ll be there! I’m almost there,” she shouted.
Tzofia appeared at the door, phone in hand. Without waiting for hello’s, she plopped into a chair opposite Jake, and said, “ I have the most amazing idea for a new curriculum!”
Jake peered out at Tzofia, whom he had met several times in his capacity as education dean. Clinically, he would have described her as above average in height, slightly heavy, flushed, a wide smile (ingratiating? no, she frequently smiled when she spoke) and long, dirty blonde braids. Married, he remembered, no kids. Her husband runs an electronic parts business that allows him the luxury of managing online during months’- long stays in Israel, but also sometimes keeps him in Asia or California for weeks at a time.
When he spoke to students, Jake frequently thought about their personal circumstances, those details about family and personal history he went to some trouble to elicit. ‘Teaching,’ he once said at the end of rounds, ‘is like caring for patients. We imagine that caring for patients mainly requires detailed scientific knowledge—and it does require that knowledge, it certainly does—but along with that must come genuine caring for people. Similarly, teaching seems to be revolve around communicating a subject, whether it’s obstetrics or maths or literature—and that’s quite true—but great teaching always involves concern about the student as a person and whether the student is actually learning.’
Jake suddenly realized that musing over those remote rounds had sidetracked him from attending to most of Tzofia’s introduction. Thinking, ‘here we go with another bright, impractical idea,’ he clicked on to her train of thought.
“—so,” she was saying, “ since students and residents get almost no education about caring, which of course means learning things about their own spiritual selves, so this woman—I think she’s in Texas ( ‘Just so happens you’re from there,’ Jake thought) has developed a really terrific, cool course—“
“Doctors and their feelings?” said, as he lost control for a few seconds. He thought perhaps she didn’t notice his skeptical tone.
“No,” Tzofia continued, seemingly unperturbed, “it’s called ‘Caring’. Maybe you’ve heard of her, Dr. Miriam Ahashdarpnim—I think that’s how you say it—she is originally Persian. I met a student from the US –
“From Texas?” Jake burst in again.
“--No, from Oregon-- who took the course. He said it opened up a whole world for them. That now they were different people.” Tzofia rushed on, feeling that she had to finish before he torpedoed the idea, “ and we could send a few faculty and they would learn how to teach it. Dr. Ahashdarpnim insists that faculty learn at the source. And then they would bring the course here, which requires Dr. Ahash’s permission.” She paused.
“Big expense,” Jake said.
“Yes, of course, it would take some money, but I think I could help come up with that.”
‘Oh, lord,’ thought Jake, ‘another bright idea, from a student with a rich parent, that is based on a perception that’s not entirely wrong. Spent so much time, I, trying to learn this very thing, as did many who learned with me.’
But, as he had done many times previously when feeling himself carried away by his own skepticism, Jake looked straight at Tzofia and said,
“Sounds like it could be a great idea, Tzofia. Let’s work on it.”
“Oh!” She let out a shrill, sharp sound, “Great!! When do we begin?” And then, she admitted in spite of her reluctance to talk about negative feelings, ““ I am a bit surprised. I thought I was picking up negative vibes.”
“Perhaps you were,” Jake said. “But that doesn’t mean we don’t proceed. You know, I’ve had many unusual experiences—“ Tzofia flashed a perception of Dr. Jake as the caring physician she suddenly realized he was, “—when students take the lead in teaching.”
As Tzofia left Jake’s office, a picture of her infant nephew, Johnny, flew into her mind. He was lying in the ICU in Los Angeles, 7600 miles away from Israel, just as her sister’s photo pictured him. Turning the corner at the end of the corridor, she crossed in front of the twin elevators, rushed into an empty classroom, threw her books down and sobbed uncontrollably.
Deep down, Mikaela knew the baby wasn’t OK. She remembered getting the crazy news that their baby—her own 32 week old baby—had a bad heart problem. Hole between two sides of the heart. All those months of watchful worrying. Ultrasounds. Blood tests. Doctors, different doctors. In and out of strict bed rest. Then the decision to deliver early because the baby seemed to be low on oxygen. And then, the news. They had missed it! Johnny had a big heart hole and needed an emergency operation.
She shifted him to the other breast on the special nursing pillow that she was not used to but Edie, her sister, said was best thing that ever happened to breastfeeding.
--Ouch, she thought. Even with his weak suck, my nipples hurt! Weak after the big operation that went so well. Fixed everything but that leaky valve, he said. She pictured Dr. Greystone resting his immaculately manicured fingers on the desk as he spoke to them after the operation. ‘Fixed everything—success—leaky valve leaky valve leaky valve.’ Baby did so well he was home with us on the fifth day.
Tiny Johnny, still under 3 kilograms, looked a deeper shade of blue grey.
Mikaela shouted to her husband, “Pinny, we have to take him to the ED! He’s looking blue-er!
Pinny, who had been dozing in the living room, appeared at the door in his undershirt and shorts. He seemed calm, as usual.
“OK, Miki, let’s go. I’ll get the car. Wrap him like they said.”
The baby looked the same to him.
– But what do I know about babies, he thought. My head is falling off. No sleep. Army never as bad as this. Looks the same, but that shithead cardiologist was such a starched white coat knowitall…
Thinking about his army driver training, about bullshit movie chases, Pinny drove to the Emergency Room as fast as he could without speeding. Miki held the baby close and called the emergency number they had given her at the children’s hospital. Pinny pulled up right in front of the ER doors. He jumped out and opened the back door of the car. As Miki slid out of the car and started walking towards the automatic glass sliding doors, he glimpsed the grey baby she had almost covered up with a blue plaid blanket.
Someone said, “Sir, you’ll have to move your car right away—“
But Pinny, grasping his car keys tightly, slipped through the closing doors just in time to see a blue-suited woman look down at the baby.
“Baby code! Baby code!” She said very loudly.
Sitting in the empty classroom, sobbing occasionally, Tzofia imagined her sister as she sat, half a year ago, talking on skype at one in the morning in Israel (only 3 PM in California, she suddenly realized). Miki had looked very tired, but also peaceful, as if maybe things were a bit better.
“So he’s in the ICU now, but they say he’s doing very well after the operation, or whatever they do to put in a pacemaker,” Miki said. The word pacemaker recalled to Tzofia the man she saw die in hospital miyun last week, who they said was found lifeless with a dead pacemaker.
“Yesterday morning, you know, we took him to the pediatrician in the walk-in clinic, but he said not to worry, the baby looks fine, he said. And later in the day, he still seemed off to me, so I insisted to Pinny that we go back and the guy—he was a real stuckup asshole, you know—said he looked pretty good, not to worry. You know, Tzoph, that man barely looked at me when I told him the baby seemed weaker. Said he was really somewhat pressed and had to get back to the hospital. And Johnny almost died…”
Creaking classroom door interrupted Tzophia’s musings. Its latch clicked and it opened a crack. Tzofia quickly wiped her eyes on her sleeve and picked up her book bag.
Elie Ben David, a well-liked teacher who happened to be a psychiatrist, was not convinced. She looked around the compact conference room in which their meeting was taking place. Horse shoe- shaped table ringed by roundback wooden chairs. Kind of comfortable, she thought. Elie caught herself scanning the mostly black and white pictures of well- known faculty guests that hung on the walls. Yet another clever trick of Moshe’s, she thought for a few seconds about the founding dean’s uncanny skill at providing surprising educational experiences. She had learned so much from working with 29 of the consultants who hung, posed permanently, in their portraits. Elie focused again on Tzofia, sitting opposite her, nervously clicking her pen, flanked by Sarah and Joe, two other students. On Elie’s right sat Abe, a white bearded psychiatrist, to whom students seemed always to be confessing and on her left was Aliza, a prim, carefully made up pediatric endocrinologist, who seemed totally absorbed by what Tzofia was saying.
“So,” Elie smiled at Tzofia, “if I’ve got this straight, you feel sure that students need a special course that focuses on their dealing with their own feelings and those of their patients?”
Tzofia clicked her pen twice. “I’m certain of it,” she said. “It would help improve our communication skills so much. And would make us into different, more sensitive care professionals.”
‘Clever girl,’ thought Elie.
‘Wow,’ passed through Aliza’s mind.
‘What’s there to discuss, for heaven’s sake’? Abe thought.
Elie said, “And you don’t think we are teaching these things now?”
Tzofia sensed the skepticism she had felt from Jake and something more. Resentment?
“What about—“ Elie started to say.
“Communications in the first year?” Tzofia cut her off.
“Yes,” Elie insisted quietly. “And ‘The Family’ and ‘Introduction to mental illness’?”
“Actually, they are all good,” Tzofia answered, “and ‘Communications’, in my opinion, is one of the best courses I’ve had. But those are more skills and knowledge oriented. And ‘Caring’ concentrates on our feelings.”
Elie noticed that Tzofia had stopped clicking. Abe, who since the beginning of the meeting seemed to be playing with his Iphone, suddenly spoke.
“Listen, I know what she’s talking about. Last year, one of my students, a woman whom I’d come to know a bit better, called in the middle of her surgery rotation. She was terribly upset about her patient, who, like her mother, had just lost a breast. And another kid just could not handle the death of a child with Tay Sach’s. They had no one to talk to, to process. So what Tzofia is talking about is real. We need to train faculty about this and of course students as well.”
Aliza listened to Abe’s passionate argument with one ear and thought, --If I don’t get to the lawyer in fifteen minutes, that asshole, my dear husband, will convince him of some other nonsense. (like ‘my seething anger’ against everyone, including Imma). Got to finish this!
“So, if we summarize,” Aliza said aloud, “are we agreed to propose to Jake that the school should introduce this ‘Caring’ course by sending two faculty for training in San Antonio?”
“I’d like to be there when we propose this,” Elie said.
“Oh?” Aliza and Tzofia said, simultaneously.
Abe saw Tzofia’s concerned look, and added. “Sure. We should all three be there. But let’s make it soon as possible, so we can get on with this.”
Jake’s secretary, Irit, scheduled and rescheduled until, two weeks later, Jake sat in the small conference room on the comfortable armchair facing Elie, Aliza and, once again, Tzofia. Abe had just called that something had come up with a patient. He won’t be here, Tzofia thought, with a fleeting pang of regret in her tummy.
“So,” Jake said, and stopped.
“Right,” Elie said. “Let me summarize. Tzofia is representing several other students—two, I think—who have worked hard over the last few months at researching the ‘Caring’ course that Dr. Miriam Ahashdarpenim teaches in Texas and that has now been adopted by quite a few US schools. They feel that, despite good courses on communication skills and family dynamics that we require in our curriculum, this course would add significantly to students’ ability to deal effectively with their own and their patients’ feelings. Dr. Ahashdarpnims’s course is unusual because she requires faculty to come to Texas to take it and since it’s copyrighted, she has made training faculty a pre-condition for giving the course.”
“And how much does she charge for attendance?” Jake asked.
“Actually,” Elie began to answer.
“Very little,” Aliza mumbled. “She’s pretty serious about the training.” She tipped her chair back on its hind legs.
“Yes,” Elie continued, “about five hundred dollars for a five and a half day course. Probably not much more than it costs to provide meals.”
“And what is the faculty committee’s opinion?” Jake looked directly at Elie. He missed having Abe there.
“I think we agree it’s worth a serious shot. It would cost a couple of thousand dollars for each of two faculty, but they can then train others and we could try out the course for, say, twenty or so volunteers.”
Aliza thought she wasn’t sure what the course was about, but maybe it would have helped her deal with Mrs. Braun after that first c-section when she was a first year pediatric resident and they had gone in a bit late and the baby—she saw the grey blue baby and felt that slight nausea she always felt when recalling her panic ten years ago.
– And my dumb engineer of a husband when I told him what happened. Her anger began to rise. --Shmuck!
“So, Dr. Kahn, what do you think? Dr. Kahn?”
Aliza realized that Jake was repeating his question. She clicked back in to the meeting room.
“Yes. Right. Sorry. Worried about something at home. But it’s OK. I’m definitely in favor of this. I was skeptical at first, as I think we all were, especially since we’ve tried to teach similar stuff. But Tzofia and friends showed me the website and I’m convinced.”
“And Abe?” Jake asked. “I imagine he may have been most in favor?”
“Strongly,” Elie answered.
Tzofia had been told by Dr. Elie not to say anything until Jake asked her a question. Leave the initial presenting to me, Dr. Elie said. Tzofia felt uncomfortable and wanted to say something, but she remembered how Professor Jake had told her about his negative feelings and she waited.
--Why am I upset here, Jake thought. We have really been trying to teach stuff like this. So they think we’ve failed? But maybe that’s not it. Maybe they’re right. It’s different. Feelings are not where we’ve put the emphasis. For just a few seconds, Jake heard again his daughter eight years before, quietly saying that she would not be following any Jewish observance for at least a time. He felt he had lost her that she was lost he kept saying to himself accept it accept it and he answered her I see I see.
Jake said, “What does the rest of the class think?”
“Does it matter?” Elie anwered.
Tzofia shifted in her seat and clicked her pen once.
“I guess not,” Jake said. “Why don’t we try it?”
He picked up the two linked paper clips he had been trying unsuccessfully to detach, slipped them in his right pants pocket and smiled his most face-transforming, beaming smile.
Tzofia said loudly, “Terrific!”
“Great,” Elie said.
Aliza Kahn was already out the door.
Carmi Zvi Margolis
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About the Author
Carmi Zvi (Z.) Margolis
BA, English, Columbia College (1964); MD, New York University (1968); MA, Educational Psychology, Michigan State University ('73). US Army M
Story, based on real events. Elie, a medical student studying in Israel, tries to initiate a course in caring that she feels is missing from her medical studies. Her motivation: her baby nephew's brush with death because an expert but uncaring cardiologist disregarded warning symptoms.