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The Medicine of Friendship
Judith Bolton-Fasman / Boston
 GROOPMAN'S OTHER MYTH: A Yiddish sign in his office urges, 'Never say you are walking on the last road' |
(April 24, 2000) A cutting-edge cancer specialist urges doctors to return to the type of healing prescribed by Maimonides eight centuries ago
Over 800 years ago, Maimonides established timeless guidelines for the care and treatment of patients in his oath for physicians. It begins:
"The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all times; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.
"May I never see in the patient anything but a fellow creature in pain."
Maimonides, who was moved to draft the oath for his fellow Jewish doctors because the older Hippocratic Oath asked practitioners to swear by Apollo and other gods and goddesses, clearly intended medicine to be patient-centered and administered with empathy. Maimonides deepened Hippocrates� ideas by acknowledging the tension between the mandate to do no harm to the patient and the physician�s fallibility. "Today [the physician] can discover his errors of yesterday," wrote Maimonides. "And tomorrow he can obtain a new light on what he thinks himself sure of today." That humility has proven to be enduring and effective, so much so that today it is regarded as the enlightened way to train the next generation of doctors.
Examples of this renaissance in compassionate, personal medical care animate Jerome Groopman�s new book, "Second Opinions." As with his first, "The Measure of Our Days," this latest volume is a collection of case histories about the patients that Groopman, 48, has met and treated over the years in his capacity as chief of the division of experimental medicine at Boston�s Beth Israel Hospital and professor of medicine at Harvard Medical School. Trained as a specialist on cancers of the blood, Groopman is also a leading authority on AIDS: Research he headed up at Harvard in the early 90s contributed to the discovery of protease inhibitors, antiviral drugs that disrupt the process by which the HIV virus invades healthy cells.
As its title suggests, "Second Opinions" focuses on the efficacy and oftentimes necessity of seeking outside consultation for difficult, life-threatening medical situations. Soliciting secondary advice is something that Groopman encourages in both theory and practice. His narratives consistently rise above the level of anecdote to function as midrashim, or interpretations, on the salutary effects that another opinion can have on a patient�s well-being. These accounts also establish Groopman�s strong opinions on topics such as the tortured politics of managed care, the tenuous diplomacy between doctors who disagree over a diagnosis and the art and intuition underlying effective medical outcomes.
In a recent interview with The Report, Groopman noted that his latest book urges readers - patients and doctors alike - "to look for the prevailing wisdom" in each and every diagnosis. Part of his life�s work has been to encourage patients to trust their intuition and to support colleagues in integrating information with their instincts. It�s a delicate balance, an art that is continuously refined. Groopman also takes this mandate a step further by treating his patients with what he calls the "medicine of friendship." The inspiration for this mindset, he says, comes from his lifelong study of Talmud, which he describes as a veritable "compendium of second opinions and opinions on opinion itself."
To prove that no one is immune from misdiagnosis or poor judgment, or even panic in medical situations, Groopman begins the book with a personal cautionary tale. If he and his wife, Pamela Hartzband, had not insisted on a second opinion for their son, he might have died of an acute intestinal blockage. Although both are physicians, they were operating on pure parental intuition when they brought baby Steven into the emergency room of Boston�s Children�s Hospital in 1983. It was the same intuition that led them both to sense that the overworked resident on duty was more interested in catching a few hours of sleep than in listening to the details of their child�s symptoms. That led the couple to reject the resident�s advice to wait until morning to take action and to insist that their son be examined by the senior physician on call. As it turns out, Steven required emergency surgery that night to remove the blockage. Today he is 17.
JEWISH LEARNING and ritual form the nexus between Groopman�s professional and personal lives. He traces his early and enduring love of Judaism to his paternal grandmother, a native of Vilna who lost her extended family in the Holocaust. Groopman lovingly describes her as "very pious. She wasn�t rigid, but she was imbued with a love for people, and she believed that kedushah - holiness - was in every recess of life and in every soul. [Consequently] I grew up with a profound sense of humaneness that was linked to tradition."
Groopman initially experienced that tradition during services at the Conservative synagogue he attended as a child growing up in Queens, New York. Though he attended the local public high school, he kept up his Jewish education through regular tutorials in Yiddish as a teenager. At Columbia University, from which he graduated in 1972, he majored in political philosophy, writing an undergraduate thesis on the influence on the kibbutz movement of Marx�s early writings.
However, science also beckoned in college. After studying chemistry in his sophomore year, he was convinced he�d found his vocation, and spent a summer at the Weizmann Institute in Rehovot.
Ultimately, though, Groopman came to understand that he needed to interact with people. "Chemistry," he says, "was too removed from the real world. I thought medical school might be the right path. When I started seeing patients in my third year in [Columbia] medical school, I realized that this was what I wanted to do."
Groopman began to forge the way that he would actually practice medicine after his father�s untimely death. In his second year of medical school, he was summoned to his father�s bedside in the emergency room of a Queens community hospital. His father, in the throes of cardiac arrest, was not properly diagnosed by the intern on call. After watching his father die at age 55, he vowed to treat his own patients to the best of his ability with the utmost respect. "From that point on," he says, "I wanted to function as a doctor from an emotional standpoint while also providing the best care. By doing that, there is a special form of love that develops with many patients."
Groopman acknowledges there is a divide between science and faith, but rather than walk away from that growing chasm, he continuously searches "for points of connection between [both sides]. There is so much wisdom, so much thought in Talmud and Tanakh on the subject." He says that patients - Jewish and non-Jewish alike - "are both interested and moved by my seeking wisdom from the Jewish tradition." He describes his own observance as "Conservadox" in that he keeps strictly kosher, regularly attends synagogue and doesn�t travel on Shabbat. But he notes that he frequently consults non-Jewish sources and is particularly moved by the Protestant theologian Paul Tillich, who said one core of faith is doubt. "Faith does not mean that you never doubt. Our ancestors were constantly challenging God."
There is also prayer as both an attempt to alter and ultimately to accept fate. "Think about the �Misheberakh� prayer," says Groopman. "It asks God to heal the soul first and then the body. Why is physical healing secondary when petitioning God? I think it�s because asking God for spiritual insight focuses you. Maybe we have to understand that the first priority is the healing of the soul. There will come a time when the healing of the body is impossible, so it�s almost illusory to make it our first request."
To emphasize the point, Groopman notes that he teaches residents "to talk, to draw out subtle aspects of past history. I tell them not to jump and order a CAT scan because they could miss an important diagnosis by not listening to the patient." Groopman emphasizes that both doctor and patient need time "to talk, think, reconsider." Echoing one of his theological influences, Abraham J. Heschel, he calls this time "sacred."
It comes as no surprise then, that a physician who places so much importance on seemingly aesthetic details takes his cue from rabbinic literature in order to understand a patient�s complete autobiography as the intersection of both oral history and medical fact.
To make sense of it all, Groopman, who lives in suburban Boston with his wife, an endocrinologist, and their three children, turned to writing in late 1995, when he penned what became the first three chapters of "The Measure of Our Days." With his wife�s encouragement, he worked on numerous drafts in which he purged his language of medical jargon and jumbled impressions. The result became the hallmark of his literary art - illuminating complicated, convoluted medical situations in clear, direct language.
Groopman�s work in the clinic and the laboratory, to both of which he devotes equal amounts of time, is clearly a passion that he also regards as "a deep mitzvah. I�m lucky in that I can take my observations back from the clinic to the lab and work along paths of research." His current project focuses on "smart therapies," or treatments dedicated to targeting cancer cells and eradicating them exclusively. If successful in breast cancer, the therapy could eliminate the current practice of "bombing" women with chemotherapy that also kills healthy cells.
Potential breakthroughs like that sustain Groopman as a physician and a scientist. But it is contact with patients and colleagues - which he considers both holy and rejuvenating - that bolster his faith and his humanity. That is borne out by a saying prominently displayed in both Yiddish and English in his office: "Never say you are walking on the last road." While this motto of the Jewish partisans in Vilna during World War II may be a memorial to his beloved grandmother as well as to the relatives whom he lost in the Holocaust, it is yet another oath that Jerome Groopman has taken.
Judith Bolton-Fasman is an associate editor for the on-line magazine Jewish Family & Life!
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