| Off the Couch |

Safety First

I may have made an enemy in Reb Ruvy, but I had just saved Mahyer’s life. The tradeoff was worth it


Reb Ruvy was a shady medical askan from Bnei Brak who ran a “yeshivah” for troubled bochurim to keep them out of hospitals. When he brought Mahyer to my office so that I could quickly fix him up with some strong meds, I knew I had to take matters into my own hands. PART II



hen Reb Ruvy pushed an envelope with a wad of cash in it toward me as payment for getting his charge, Mahyer, medicated without hospitalization, it was clear to me that he was in way over his head and endangering Mahyer in the process.

“Call his father now,” I told Reb Ruvy, insisting that the bochur, who was severely dehydrated and delusional, needed urgent, acute care. “Call him now or I’m calling an ambulance.”

“They’re chassidim, they don’t want a hospital,” Reb Ruvy begged, obviously desperate for this not to happen. “They came to me to help him.”

“I know chassidim. I’m the unofficial psychiatrist for a number of chassidic courts and have been zocheh to treat people referred to me by the Admorim themselves. Call his father or I call the ambulance myself,” I said once more as I took my phone out of my pocket.

“Fine, here you go.” He had no choice but to give in, taking one of several cellphones from his pocket and dialing as he handed it to me, looking flustered and nervous. “These are choshuve people, Doctor. Treat them with kavod.”

“I will,” I responded, coolly taking the phone from the slowly shriveling askan.

I introduced myself to Rabbi Zusha Geiselman as the psychiatrist who had seen his son at Reb Ruvy’s request.

“Well, I hope you’re good. This appointment cost us nearly 3,000 shekels,” he told me as I nearly choked. If Reb Ruvy wasn’t running a particularly safe operation, at least it was sure lucrative.

“Listen, kevod haRav, I don’t know who charged you that fee, but it certainly wasn’t me,” I told him straight. “But more importantly, your son at this point is catatonic. That means that his psychosis is quite severe and that the situation has become an emergency.”

“I know,” came the voice on the other line. “That’s why I raised the 20,000 shekels to pay for his treatment at Reb Ruvy’s private hospital for the month.”

Whoa! I was about to boil over, but knew I had to remain calm in order to get this young man the help he needed, “Rabbi Geiselman, your son needs to get to a hospital immediately. He needs intravenous fluids and medications. This is an emergency.”

Mahyer’s father understood, “You’re the doctor. I mean, I thought we had gotten him to the right place, but I don’t want to mess around with the safety of my son. If you say get him to a hospital then that means we get him to a hospital as fast as possible. Thank you for your help, Doctor. Please let me know if I owe you anything extra for your time.”

“This one’s on the house,” I said as I picked up the envelope Reb Ruvy had tried to hand me and put it into Mahyer’s coat pocket for him. “Just make sure you get your money back for the yeshivah tuition with Reb Ruvy and that your son goes straight to the hospital.”

Reb Ruvy took the phone and began to speak a kind of Yiddish that was way too fast for me to understand. By his tone, it was clear that Mahyer’s father had gotten the message and was sending his son to the hospital as fast as possible.

I wrote a quick note recommending intravenous medications and fluids for the bochur in front of me and put the note in his hand, encouraging him to give it to the staff at the emergency room.

Mahyer thanked me slowly even as Reb Ruvy glared at me as they left my office.

“You don’t understand the frum velt, Dr. Freedman,” he muttered in a quiet fury.

“I respectfully disagree with you,” I told him bluntly. “But both of us can agree that I’ll call the hospital in 30 minutes and if my patient hasn’t arrived yet, I’ll be calling the police.”

I may have made an enemy in Reb Ruvy, but I had just saved Mahyer’s life. The tradeoff was worth it.

Ten days later, I received an update from Mahyer’s father. Mahyer had been brought to the hospital and began receiving emergency treatment in the intensive care unit. Intravenous fluids to treat his dehydration and intravenous lorazepam to treat his acute psychiatric condition saved the bochur’s life. He’d subsequently been transferred to a psychiatric hospital and been started on antipsychotic medications, which had helped his speech, behavior, and appetite return to normal.

Mahyer was in an infinitely better place and was able to verbalize the strange experiences he’d had in the weeks leading up to his hospitalization. He had limited memory of the moments leading up to our meeting and his subsequent stay in the ICU, but was talking about his current situation with tremendous insight. His understanding of the need for ongoing treatment and his desires to avoid such an experience ever again were tremendous predictive factors for a better long-term future, and I let his father know it.

“You saved his life, Dr. Freedman,” Mahyer’s father told me gratefully. “And he’s getting back to his old self again, b’ezras Hashem.”

I accepted the compliment gracefully, but the truth is that this was Psychiatry 101. Any third-year medical student — whether they went into my field, became a cardiologist, or even a radiologist — would remember the signs and symptoms of a catatonic patient. It was on every licensing examination.

But while these symptoms of catatonia could be due to depression, bipolar disorder, or schizophrenia, similar symptoms also present in other medical emergencies such as stroke, seizures, or meningitis. By masquerading as a medical director, Reb Ruvy had put this bochur at a terrible risk.

This fellow had taken the Geiselman family for a very expensive and even more dangerous ride with his promises of high-quality private hospitalization. How many more families would be at risk with this reckless behavior?

To be continued…

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, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 853)

Oops! We could not locate your form.