"I

forgive you,” Nachum said as he looked at me from his hospital bed.

“Thanks, Nachum,” I responded. “It means a lot to me.”

“I mean, you didn’t do anything wrong. It was that other doctor, and he was wrong. I don’t even have to forgive you because you didn’t do anything wrong.”

“But you know that I blame myself for not advocating stronger on your behalf at the outset, so I appreciate you forgiving me.”

“Of course, Dr. Freedman. Machul, machul, machul. Don’t worry.”

Nachum smiled and his eyes slowly closed, as the multiple medications flowing through his IV tubes provided him with more than enough sedation. He drifted off to sleep, leaving me to consider the past few months.

Every psychiatric clinic has their “Nachum” — ours was a beloved fellow with chronic schizophrenia who showed up every day with a different request or complaint because he was in need of some loving attention. Back when I was learning psychiatry, we had Mr. Daniels, an overweight Jamaican man who wore the same camouflage hunting jacket whether there was 90-degree heat plus humidity or freezing rain outside. My first job out of residency had Captain Chuck, an ageless Vietnam vet who wrote me letters telling me to make sure there was a pack of cigarettes for him at our next appointment.

Nachum himself was a 49-year-old chassidish man with schizophrenia whose tremendous personal disorganization was surpassed only by his lovability. While he’d rubbed the secretaries and staff the wrong way more than once, everyone had a soft spot for Nachum — even though he left the bathroom door open, helped himself to other people’s lunches out of the refrigerator when no one was looking, and proposed marriage to every new therapist or intern who wasn’t wearing a tichel or a sheitel.

There was no use in changing his medication regimen, as it had taken him as far as it could. Baruch Hashem, the days of hospitalizations and refusing treatment were long gone. Despite his extreme lack of social graces, I loved Nachum for his emesdig approach to life and the fact that you’d never find him without divrei Torah from Sheim MiShmuel, Sfas Emes, or one of the previous Belzer Rebbes. So while he didn’t need to be seen for any medication adjustments, Nachum came to his weekly appointment anyway, because he liked to have someone listen to his drashos. From my perspective, it was a welcome break from pure psychiatry and allowed me to hear a nice vort on the side.

Not that it was always easy having Nachum show up. Periodically he’d bother the staff or would upset a patient by barging into the office or spilling his coffee on the floor. He was loud, didn’t have great hygiene, wasn’t afraid to tell “Tzionim” that he didn’t agree with their politics, made sure to tell Litvaks that chassidus was the true path, yet always told his fellow chassidim that they shouldn’t be scared to learn a bit of Tzioni or Litvak Torah once in a while.

And then his stomach started hurting him, and instead of leading off our weekly session with a chassidishe vort, Nachum told me that he needed to have his stomach removed.

“Did you tell your primary-care doctor?” I asked.

“Sure. But he told me I was fine, so I thought I’d tell you.”

A quick review of his last blood test didn’t seem to show any red flags, but I wasn’t prepared to tell him he was healthy without making sure he’d been taken seriously.

“Here’s a note for your family doc,” I said, handing him a note detailing his vague stomach complaints.

“I’ll run over there and show it to him now!”

And Nachum did. I knew, because the family doctor called our secretary to say that he thought Nachum was fine.

But Nachum came back the next week with the same complaints, so I figured I’d call the family doctor myself. I introduced myself and let him know that Nachum had returned with the same stomach pain.

“He’s fine, Dr. Freedman,” was the response. “I have many patients and this one is fine. I looked at his stomach, I did an X-ray, he’s fine.”

“I hear you. But he’s getting toward the age where they do standard screening colonoscopies, and he’s not eating as much as he used to,” I said. It occurred to me that he hadn’t helped himself to anyone’s lunch recently.

“Dr. Freedman,” the primary care doctor said, “he’s fine. Maybe he needs more antipsychotics. He comes here every day with a different complaint. He’s fine. He needs to stop bothering me and my staff.”

I thought about the time back in my training when I saw a woman with schizophrenia who came to the hospital because she claimed her neighbor was shooting lasers into her left arm. The emergency room physician didn’t take her symptoms seriously and instead called the psychiatrist — me — although I told him I was pretty sure she was having a heart attack. Why? Because the pain was on her left side, she had the risk factors of diabetes and was a smoker, and her heart rate was irregular. Boy, was that ER doc sorry when the cardiothoracic surgeon chewed him out as he arrived to rush the patient off to a triple-bypass surgery.

As I remembered this case, I decided to try once more. “Are you sure he’s okay? I’m just saying, I mean, Nachum is definitely a character, but he never complained about stomach pain up until recently.”

“Dr. Freedman, I’m busy. I’m sure you’re busy, too. Have a great day.” Click.

Nachum missed our next few appointments and I was getting nervous, so I asked the secretary to call and make sure he’d be in the following week. When he showed up, Nachum looked pretty grim and told me his stomach was hurting him again. I decided to take things into my own hands, and wrote him a letter to bring straight to the emergency room. The diagnosis lit up bright on the CT scan that was ordered, and he was admitted with a plan to start a course of chemotherapy before the end of the evening.

And because I had no one else to tell me a nice chassidishe vort the following Thursday in the clinic, I decided I’d bring Nachum a few pieces of pizza out of the refrigerator and see how he was doing. And that’s how he ended up giving me mechilah as I sat with him by his bedside while the next round of his chemotherapy medications went in through one of the many tubes connected to one of my most beloved patients.

“Hashem,” I cried out loud as Nachum drifted in and out of a delirious sleep. “Forgive me for anything I might have done this year and send a refuah sheleimah for Nachum Yitzchak ben Blima and all of Am Yisrael.”

Nachum looked over and smiled at me, mouthing the words “Amen, Amen, Amen,” before his eyes closed once again.

Originally featured in Mishpacha, Issue 728. Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in The Old City or hiking the hills outside of Jerusalem.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.