B etter than the godless-plumber-enemy-doctor

Dov was in his first year of medical school and being an efficient and industrious sort of guy was already looking into different specialties within the field. He had limited experience with psychiatry but he was a nephew of the nice guy who sits next to me in shul so when I got an e-mail asking if he could come in and speak with me about the profession I thought the best thing would be for him to spend an afternoon in the clinic.

He showed up on time and was dressed professionally which won him a few points off the bat. We shook hands and discussed a few basic rules that would apply like introducing himself as my student for the day asking the client permission to sit in on the visit (if they were to say no he’d have to sit out the session) and making sure to turn off his iPhone.

“That’s doable ” he said placing his phone on vibrate mode.

“No Dov… turn it ‘off-off.’ ” I smiled sternly. If Dov felt nervous or deprived about that he didn’t show it. He was a good sport.

“You know ” Dov told me before my first patient came in “the only other psychiatrist I ever knew was a guy who lived down the street from me growing up. Everyone else would pay me at least $20 to mow their lawn and he’d try to get me down to $15 even though he had a big backyard.”

“We only have AstroTurf here in Israel Dov. So if you mow my lawn you’ll have to pay me for it.”

“No but seriously. I didn’t mean you were like him. I just mentioned this guy because psychiatry is one of the available disciplines so I figured I’d come and see what you do all day. I thought I’d learn something and maybe have a better understanding of why people would want to do it as a career.”

“Sure just watch and learn ” I said opening the door for our first patient.

A young bochur with a history of panic disorder entered and sat down across from me in the comfortable chair. He’d been receiving a combination of cognitive-behavioral therapy and a low dose of an antianxiety medication to treat his symptoms. The session was very straightforward and included a review of his history and a few questions about appetite and sleep. In the end he seemed largely stable and so I used the last ten minutes to focus on what Gemara he was learning — and he was able to give over a beautiful Tosafos from Kiddushin before he left for afternoon seder.

After the patient left Dov seemed surprised and asked me “Why were you talking about Kiddushin with him?”

“Because he wasn’t learning Pesachim anymore ” I retorted. Dov looked confused. “Because we don’t really have blood tests or X-rays to know how our patients are doing in psychiatry. All we have are our discussions with our patients to gauge their level of functioning. In this young man’s case he was really struggling at one point and could barely get anything done in his learning. If he’s able to give over a Tosafos from the Gemara he’s studying that means he’s present on a daily basis in shiur. And that means he’s doing well.”

“Psssssh. Nice Dr. Freedman ” said Dov.

“Plus on Wednesdays I’m here all day in the office and I can’t get in any learning. Anytime a bochur comes in I like to hear a shtickel Torah. It keeps me growing instead of just paying the bills.”

The next patient was an older woman who was diagnosed with depression but mainly suffered from the tremendous tzaar of having lost a son in the past year while living far away from her other grown children. During the session I tried to steer things away from a discussion about medications and rather focused on ways to remain connected with her family during this challenging time.

After she left Dov was curious as to why I didn’t want to increase the dosage of her antidepressant.

“Because antidepressants don’t treat loneliness Dov ” I replied. “Most good physicians will treat diabetes with more than just insulin — they’ll also encourage a multidimensional approach that includes a healthy diet and exercise. But for us psychiatrists we also have to be conscious of the need to help our patients strengthen their interpersonal relationships and to appropriately utilize their support networks. A friend of mine from medical school who became a cardiologist used to joke that physicians from his specialty are basically plumbers who are stuck figuring out how much pressure is in the pipes. If that was his mashal perhaps psychiatrists are more like architects in our quest to help our clients design their dream home beyond the plumbing electric wiring and roofing.”

Our final patient was a middle-aged homeless man with chronic schizophrenia who unfortunately didn’t take such good care of himself. Because the patient was very paranoid he generally refused to meet with me in the office setting and so we’d developed a ritual of greeting each other in the clinic before walking to the corner together to buy a drink. My patient was naturally wary of Dov but trusted me enough to let him follow us. Dov was a good sport and walked alongside us as we talked about the weather whether falafel or shwarma was tastier and a half dozen other benign topics. I paid for everyone’s drinks and we sat in the park for a few minutes watching the birds. At the end of the visit my patient wished me a good day looked at Dov and mumbled goodbye then walked back to the park bench he called his home.

When our patient was safely out of range Dov had the courage to ask “That was a psychiatry appointment?”

“Yep ” I responded nonchalantly.

“But you bought him a soda. What does that have to do with psychiatry? Are you his friend or his doctor?”

“Well I’m his friend because as you can imagine he doesn’t have too many friends. But he’s my patient first and my job as a doctor is to ensure that he trusts me enough to ask for help when he needs it. He might not be too talkative in general but if he’s feeling sick or needs a hand he knows that he can rely on me. If I forced him to sit with me in the office we’d never develop a true relationship. He’s way too paranoid for that.”

“So you meet your patients where they’re at?”

“Do I have any other choice?”

Dov thought for a moment and tried to take it all in before telling me “So you’re kind of like the chavrusa-architect-friend-doctor then.”

“It’s better than being the godless-plumber-enemy-doctor any day.”

Dov sipped his soda and then asked “Can I come back next week?”

I whacked him on the back and told him “As long as you pay for your own soda.”

Originally featured in Mishpacha Issue 671. Jacob L. Freedman is a psychiatrist and business consultant based in Jerusalem. He serves as the medical director of services for English-speakers at Bayit Cham a national leader providing mental health treatment and outreach within the religious community. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.