It was pretty late already, and I was just sitting down to chazer the daf when I heard the knock. My neighbor Yitzi was hoping to discuss something, and I didn’t have the heart to tell him that I’d finally wrapped up for the day, especially since it looked like the matter was serious.

He proceeded to tell me the story of his son — a nice, serious bochur in his last year of yeshivah ketanah. From what his father told me, it sounded like he had a classic case of panic attacks and was in need of competent psychiatric care the sooner the better, before things spiraled out of control.

“So, can you treat him?” Yitzi asked hopefully.

Of course I could. But I’d actually made some rules for myself about these kinds of situations, and I didn’t think it was proper to take the risk , even though many of my patients are bochurim, I’ve had extensive experience treating panic attacks, and Yitzy felt comfortable enlisting the help of another frum American. So why was I hesitant to schedule an appointment?

For starters, as much as Yitzi was a nice, regular fellow and certainly not someone I would suspect of deviant or dysfunctional behavior, there was always the off-chance that something would surprise me. What if the anxiety was due to some sort of abuse? Would Yitzi’s son feel comfortable telling me that his father was an alcoholic and would bring out the belt on a bad night?

On the other hand, how would I feel if he felt perfectly comfortable telling me such things — or worse — and it ended up that I was now holding this information about my neighbor? Could I conscionably avoid telling the other families on our street about this behavior if I felt Yitzi was a danger? Or, would I be able to take payment for services if I knew that this was a family who had major debts?

These are just some of the reasons that I’ve made a policy of not taking clients whose families I know. Furthermore, I recalled my sixth-grade English teacher, Mrs. O’Leary. Not for her painful Boston accent as she corrected our grammar, the horrendous detentions she gleefully handed out, or the time she yanked a hapless Joey Felder out of the room by his left ear for some unclear infraction. Anyone who crossed her could expect a formulaic curse: “So what good are you anyway!?”

Seventeen years after she threw me out of class, I was moonlighting in the detox ward at the old Lincoln Hospital, when the nurse paged me about a 56-year-old Irish-American lady with a long history of drinking and detoxes. Apparently she’d called an ambulance and brought herself into the emergency room after slipping down a few steps outside of her house following a night at the local bar.

She had been cleared in the emergency room — just a few bumps and scrapes and nothing that required any serious treatment. But she’d been drinking enough on a daily basis to warrant a detoxification admission at Lincoln, where I was on duty.

I walked onto the ward and took the chart to read about a woman who was likely still intoxicated and — based on her lab results — would need at least ten days of treatment to come off the alcohol.

O’Leary is a pretty common name in Boston, so I didn’t think anything of it until I entered the room to see a battle-scarred inebriated version of my sixth-grade English teacher. I was at least a foot taller and with a full beard, so Mrs. O’Leary didn’t seem to put two and two together as she immediately proceeded to beg me for Percocet.

“You know I can’t give that to you, ma’am. You’ve been drinking too much to take anything with Tylenol in it or your liver will give out,” I replied.

“How about some pure Oxycodone to take the edge off while I’m drying out?” she begged.

“I can’t do that either, Mrs. O’Leary. You might pass out from the combination of opiates and alcohol and wind up needing to be monitored in the intensive care unit.”

“Then what good are you anyway, Freedman!” she snapped. “I’m going to bed to sleep off this round, and I’ll see you in the morning!”

This was fine by me. In fact, she’d be seeing the regular team in the morning as I’d be back at my day job by the time she woke up. I left the room after rechecking her vital signs to write a standardized set of admission orders and told the nurses to call me if there were any problems.

Baruch Hashem that she’d fallen asleep and could wait for a psychiatrist until the morning. I didn’t know if I could be too impartial as her doctor and certainly didn’t want to test my professionalism should she continue to curse me out over denied requests for unnecessary and potentially dangerous painkillers.

The night went as fast as it had come, and by morning, I’d resolved to try and avoid treating folks I knew. Not because I didn’t want to help, but because of the feelings it would bring up: Call it transference and countertransference if you’d like to use the fancy psychological terms.

With all of this in mind, I followed my standard playbook and told my neighbor Yitzi that I’d make a better friend than doctor, referring the case to my colleague Dr. Shmuel, reassuring him that he was both frum and highly competent, and that we even cover for each other if one goes on vacation.

The truth is that I have treated sons and daughters of colleagues and friends, but only if there was a good enough reason to justify the possibility of things getting awkward and uncomfortable. Still, it was better this way, especially after remembering Mrs. O’Leary.

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Originally featured in Mishpacha, Issue 742. 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