| Off the Couch |

Tu Quoi? 

No, he’s not crazy like he’s a psychiatric patient, more like he’s broken. It’s like something happened to him and his brain is broken.


The phone call from my good friend Rav Ratzabi took me by surprise.

He wanted to book an appointment for his elderly Uncle Yichye, who had lived his entire life in Yemen before moving in with his nephew and their French-speaking household in 2013, when he arrived with one of the last groups of immigrants from that country.

Uncle Yichye was suffering from PTSD due to the stresses and oppression the kehillah faced in the years before he left, even though the community was officially protected. Somehow, although he’d survived many decades under the radar, finally being safe triggered haunting fears.

“The thing is,” Rav Ratzabi continued, “is that he doesn’t speak Hebrew, so I’ll come along as his translator. And the second thing is that he’s blind, and I want to make sure you’re okay with him bringing his seeing eye dog.”

I generally don’t let folks bring their animals into my office as it can get messy, allergic, or frightening for the other humans in the building. But I was more than willing to make an exception. It was a wonderful thing that his uncle was able to be more independent with the use of one of Hashem’s creations.

About a quarter of an hour before our scheduled appointment, as I was walking back to my office, Rav Ratzabi called to tell me that he’d be delayed due to a family emergency he needed to take care of, but meanwhile he would drop his uncle off so that we could get started and not delay the schedules of subsequent patients.

Under most circumstances it wouldn’t be an issue, but I was not going to be able to get started without a translator. Rav Ratzabi didn’t seem to think it was such a big deal, though.

“I appreciate your perspective, Dr. Freedman,” he told me, “but in truth, his Hebrew is probably better than I initially told you. Plus, I think his case is pretty straightforward.”

To his chagrin, I told him we’d wait until he arrived about 25 minutes late.

As I rounded the path behind the King David Hotel and neared my office, I remembered a case from medical school close to 20 years ago. I was a med student working the weekend shift in the psychiatric emergency room and the staff was completely overwhelmed in the aftermath of a gang-related shooting and the mix of intoxicated, violent patients who sat opposite the sober and traumatized ones.  A page came in from the medical floors to see a Moldovan man with acute schizophrenia.  As the attending psychiatrists were too busy to see the case, they sent me up with my trusty stethoscope and clipboard to speak with the medical team.

The cardiologist wasn’t particularly interested in the poor fellow’s situation, as was evident by his tone on the phone as I answered the page.

“The guy was admitted to our service on cardiac monitoring because he had an elevated heart rate, but he’s completely insane, can’t communicate at all in a sensible fashion and keeps flapping his hands and slapping his head. We have an orderly by his side because he fell out of bed. We thought maybe he was drunk, but his toxicity screen came back negative. Can you just get him off of our service already and admit him to the psych ward?”

I tried to slow things down and get a better picture but I wasn’t getting too far. How did he get to the hospital? Don’t know. Who is involved from his family that can provide us some history? No idea. What does the patient think is wrong with him? “No idea — don’t speak Moldavan. And we definitely don’t have a Moldovan translator in the hospital,” the cardiologist snapped.

“Maybe we can get a Romanian translator via the telephone-translator service?  I’m pretty sure it’s the same language.”

“You can do whatever you want with him. I’m a cardiologist and this guy doesn’t need a valve replacement or an angioplasty. He needs a psych hospital.”

I could tell we weren’t getting anywhere fast and decided to go upstairs to meet my first Moldovan patient. He was sweating profusely and thrashing around in his hospital bed as the orderly at his side periodically made sure he didn’t fall out.

“You have any idea what’s wrong with this guy?” I asked.

He didn’t. Apparently, he was even less interested in the case than the cardiologist.

I brought in the telephone-translator device and dialed up a Romanian translator. It wasn’t of much use though, as my new patient was making unintelligible noises as he rolled back and forth and repeatedly slapped his head with his left hand. The translator told me very quickly that the patient wasn’t making any sense.

“Something is wrong with this guy,” the translator told me.

“The doctor who checked him in thinks he’s crazy,” I offered. “What do you think?”

“No, he’s not crazy like he’s a psychiatric patient, more like he’s broken. It’s like something happened to him and his brain is broken.”

It all made sense. This guy hadn’t moved his right side since I entered the room. Something was absolutely wrong and it wasn’t an acute psychiatric illness.

I pulled out my stethoscope and began to examine the patient. But before I could even listen to his heart, the poor fellow made eye contact and my jaw dropped.  The pupil in his right eye was the size of a grapefruit.

“Call the doctor, immediately!” I yelled to the orderly.

A nurse came running in and I told her, “This patient needs an urgent evaluation by the neurosurgeon. We need to make sure his brain is okay.”

Coming back to the present, I turned onto my street and saw an elderly Yemenite man sitting with a white cane on the bench outside of my building.  A huge Belgian Shepherd was by his side, wearing the harness of a seeing-eye dog.

“Uncle Yichye,” I said calmly and put my hand on his shoulder lightly.  “I’m Doctor Yaakov. Do you mind if I sit down next to you?”

In broken Hebrew, he responded that his nephew would be late and that he needed a translator, so he hoped we would wait until Rabbi Ratzabi arrived.

I tried to make small talk but Uncle Yichye had a hard time transitioning between French and Arabic as he struggled to speak Hebrew.

“It’s okay,” I said. “It’s a beautiful day so we’ll just sit here and wait for your nephew.”

I wasn’t sure if he understood me, but I understood that he wanted to wait and that he was grateful I agreed. Life was confusing enough for him being blind in a new country. My Moldovan patient from two decades ago taught me how important it is to get a good translator on board.

Rabbi Ratzabi eventually arrived to find us sitting on the bench, where I was keeping his uncle company in companionable silence and petting his dog.  He smiled at me and apologized profusely. And his uncle, who had lived through so much, was obviously awash with relief.

“I see that even if you don’t speak French or Arabic, you’ve found a commom language,” Rav Ratzabi said. “And that you’re not afraid of the dog.”

It was my turn to make light of the situation and for this I was grateful for my high school French. “Actually, les chiens ont peur de moi (dogs are afraid of me).”


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.  His new children’s book — Me and Uncle Baruch — is available through Menucha Publishers.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.


(Originally featured in Mishpacha, Issue 910)

Oops! We could not locate your form.