“I hear,” Ari acknowledged, “but then why do I feel like such a terrible failure?”

"Yaakov!!” was the first message. It was followed by a flurry of other flustered communications.

“I quit!”

“I’m done!”

“Finished!!”

“No more psychiatry — I’m out!!”

Ari was one of my closest colleagues, so I wanted to help him through whatever crisis he was dealing with. Something must have really pressed his buttons, because he was one of the calmest, most thought-out guys I knew. He was also never afraid of a challenge, took on cases other doctors thought were hopeless, and became somewhat of a rebbi to several fellows the world simply labeled “crazy.” This was also the guy who covered for me when I had to take a few weeks off after my wife had a complicated birth, and the person who told me where to get a prescription pad after I’d made aliyah.

I sent him a message letting him know I was on my way to Minchah and that I had a few patients afterward… could it wait a few hours?

“Yeah, it can wait — lawsuits don’t get settled in 24 hours!”

I thought for a moment before I responded to this barrage of messages. Clearly something had gone wrong with one of his cases and he was either being sued or had been threatened with legal action. It was a terrible feeling for any physician to have. And for Ari, it was devastating. Ari is a gifted, compassionate psychiatrist who can see the holy neshamah of every Yid under the layers of psychosis, but he had once confided in me that the one thing he could never deal with was a lawsuit — he said the betrayal would crush him. Before I could respond, he began firing off angry messages again.

“I could have gone into real estate with my brothers and avoided this headache!!”

Poor guy. Ari was clearly suffering. But he was still the same old Ari I knew and loved as evidenced by his next message.

“Can we get a burger at 5ish?”

Ari and I had been frequenting the same iconic burger joint halfway between our offices at least once a month since I’d made aliyah back in 2016. It was like our own little Knesset, where we’d solve the world’s problems, discuss new developments in the field, and brainstorm various public-health initiatives.

But Ari didn’t look too happy this time, playing with a straw dejectedly at our table.

He launched right into the story: “Married woman, 35 years old with a history of borderline personality disorder, who came to me for a psychopharmacology evaluation. I did the right thing, minimized her list of seven medications to two or three pills that were actually helpful, and got her off of benzodiazepines and stimulants over the course of six months. Her husband was close to the end of the rope after her last hospitalization, but it was now going well and she was in a much better place than when we’d first met. And then one of their kids got in trouble at school and the teacher called her in, made some kind of comment about difficulties in parenting, and by the time she returned home, she’d lost it. She made a superficial cut on her arm — she’d been a self-harmer for years — and then I get a phone call from the husband saying he’s taking her to the hospital to be locked up again, and that he’s suing me for causing this by changing her medications.”

“Was she hurt? Did she die?”

“Nope.”

“Any permanent damage?”

“Nope,” Ari said as the spicy fries and chicken wings came out. “I hope you don’t mind that I ordered for us in advance.”

“Baruch Hashem no permanent damage, and baruch Hashem you ordered spicy fries,” I said, trying to lighten the mood.

Ari cracked a hint of a smile, packing in the comfort food.

“No damage at all, baruch Hashem. She actually just scratched her arm superficially — it was a throwback to her old patterns — and was feeling fine by the time they got to the emergency room. No suicidal stuff, no stitches, nothing. She was discharged home and even sent me an email to let me know she was fine and that she’d made a follow-up appointment with her therapist. I was really happy to hear that, but then the husband calls and tells me he’s suing me anyway because he had to take a day off of work and his wife could have had a serious injury.”

“But she didn’t. And it sounds like taking her off of stimulants and benzodiazepines helped to prevent self-medicating addiction and other nasty side effects. Plus you said she had a great six months. That’s fantastic for a chronic case like the one you described.”

Ari shook his head. “Yeah, but her husband is suing me.”

“For what? Nothing happened, there was no negligence, and there wasn’t even a bad outcome. There’s no case. Wrongdoing on the part of the doctor, plus patient damage, are both requirements for a malpractice suit,” I reminded him.

“I hear,” Ari acknowledged, “but then why do I feel like such a terrible failure?”

“Because this husband has had enough with his wife’s illness and he’s out there with a sniper rifle looking for a target to blame. His wife was doing better for a while so he thought she was cured. He forgot that she has a chronic condition with ups and downs. You were a legendary savior when all was well, but then you came crashing down to the lowly level of the rest of us mortal psychiatrists when she had to go to the emergency room once again.”

Ari seemed to calm down a bit, especially since the hamburgers arrived.

“Ari, we have a tough job. And sometimes the most challenging person in the room isn’t the patient, but their spouse, parent, or another angry family member who’s furiously seeking someone to lay the blame on. But hey, I don’t need to tell you that. You’ve been doing this for over two decades.”

Ari nodded. “You know me, Yaakov. I deal with a lot of heavy stuff in my practice, but for some reason, facing malpractice just feels like a betrayal of it all. Like, what was it all worth? Makes me wish I’d have joined my brothers raking it in in real estate. Seems like it would be easier on my neshamah.”

“And I wish I were a shepherd in the Golan playing my harp with the flock. Ari, Hashem put us here to take these cases and give them high-quality psychiatric treatment. And you’re the best of the best. If you hadn’t done the good work you do, who knows where this lady would be today? Hashem put us exactly where He needs us. You did right by this patient, irrespective of her husband’s disappointment. And I promise you that the next patient who walks into your office will surely bring you great joy.”

“How do you know that, Yaakov?”

“Because right before I left, I got a call from the lady’s husband, looking for a second opinion — and I told him that he already had a great doctor and needed to follow up with you. And then I took a moment to call your secretary and schedule them in for 8 a.m. tomorrow!”

Ari cracked up, sending his lemonade spritzing all over. He was going to be fine. —

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

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

(Originally featured in Mishpacha, Issue 814)