| Off the Couch |

We Can Handle It

A great way for me to lose my license, the bochur to get hurt, and Reb Ruvy to get arrested


While there are dozens of tzaddikim out there selflessly helping Yidden navigate the medical world, using their contacts for intervention and treatment that might not have happened otherwise, the nature of the medical askan business — when dealing with a vulnerable, desperate population — unfortunately sometimes lends itself to exploitation as well.

My own chavrusa, a longtime hospital physician, has infinite praise for the dedicated people who play a pivotal role in healing Klal Yisrael, but he also had decades of stories to share regarding pseudo-medical askanim. There was the fellow who was recommending expectant women to go for prenatal surgeries in Netherlands, while the doctor was actually experimenting on a dangerous new technique. Then there was the askan directing people to an ophthalmologist in Romania who was charging Israelis 50,000 shekels for a laser treatment that could cure glaucoma, while this Romanian doctor had learned his method from the chief eye surgeon at Shaare Zedek Hospital in Jerusalem who was offering the same surgery for free through Kupat Cholim.

With this in mind, I was a bit wary when my next appointment showed up. Instead of a solo patient accompanied by his rabbi — the appointment had been booked by a fellow named Rabbi Reuven Abramson, who said he’d be coming in with a talmid who’d been acting strangely and needed an emergency evaluation — an entourage of young chassidishe men entered the room surrounding a bewildered-looking young man whom they shoved into a seat. This case had “bad askan story” written all over it.

I was prepared to meet a concerned rabbi and his talmid and, G-d willing, develop a plan of action to help the bochur recover from his disabling symptoms. But what actually happened was different from anything I could have expected.

A fiery-looking chassid slammed the door closed as he juggled two cellphones and introduced himself frenetically as “Reb Ruvy from Bnei Brak,” asking to speak with me alone.

I brought Reb Ruvy into my office from the waiting room and asked him outright, “What is going on here? I thought you were a yeshivah rebbi who was bringing in a talmid for an evaluation, and instead I have a minyan of chassidishe orderlies sitting around a very sick-looking bochur in my waiting room.”

Reb Ruvy smiled knowingly as he explained, “I am a yeshivah rebbi, and you see, I have a hospital of sorts, a yeshivishe kind of place in Bnei Brak where I help bochurim to avoid the hospital and help them to learn Torah in the meantime. I wasn’t lying to you when I said I needed to bring a talmid of mine in for an evaluation. I brought him in and I also brought in a few team members to make sure he’d be safe in the meantime.”

I gazed back into the waiting room to see the bochur drenched in sweat as one of the five “team members” tried to convince him to drink a cup of a water. The bochur refused and Reb Ruvy tried to continue his story as I felt more and more uncomfortable with the developing situation.

“You see, this bochur here has been having terrible dimyonos, delusions and hallucinations, for the past week, and doesn’t want to eat or drink. His parents were terrified to take him to the hospital, but they’re willing to trust me to bring him to you to get the care he needs. So, can we get him some medicines and get him on the way back to our yeshivah and back to health? Let’s just get a prescription and get moving — I have a lot to do today and I’m sure you do too.”

The sheer ease with which Reb Ruvy told me this story and the manner in which he expected this fellow to receive treatment made me nervous. This felt like a great way for me to lose my license, for the bochur to get hurt, and for Reb Ruvy to get arrested all in one.

On one hand, I wanted to tell him to leave my office, as I had no desire to become legally responsible for this young man’s care. If something would happen to him back in Reb Ruvy’s yeshivah, I’d be the psychiatrist of record answering to a jury of my peers.

On the other hand, who knows what would happen to this poor kid if I didn’t make an intervention and try to steer the case in the right direction. Clearly the young man needed help, and when a fellow is so psychotic that he isn’t eating or drinking, it can be a symptom of a process called catatonia, a medical emergency potentially requiring treatment in the Intensive Care Unit.

“Let me sit with the bochur and see what makes sense,” I told Reb Ruvy as I peered out into the waiting room and saw a very sick young man surrounded by a group of guys trying to hold him up.

“Give him some Zyprexa, maybe also some Ativan, whatever you think, Doctor,” Reb Ruvy said almost jovially.

My anger was rising. Forget that the two medications he named could cause death by over-sedation when used together. A proper, professional diagnosis was needed to determine an appropriate treatment plan — and fast.

I left Reb Ruvy unceremoniously behind me as I walked out into the waiting room. He didn’t even seem to notice as he answered one cellphone and was texting away with the other.

The “team members” parted before me as I approached my newest patient, bending down to look at the young bochur who sat in front of me. His face was drenched in sweat and his clothes hadn’t been changed in days. But more concerning was the glazed look on his face, together with an open mouth and dry tongue.

“What’s your name, tzaddik?” I asked in as calm a tone as I could muster given the circumstances.

The bochur’s response was significantly delayed. It took about 30 seconds for him to whisper, “Mahyer.”

“Mahyer,” I asked as I tried hard to connect with the severely ill young man, “Are you feeling okay?”

It took another half a minute until he mumbled, “No.”

I asked Mahyer if I could take his hand for a moment and he eventually nodded. I took his pulse which was racing and then took it again after I helped him to stand up. Mahyer wobbled at first and the precipitous drop in his heart rate was a serious sign of dehydration.

“Mahyer, we’ve got to get you to a hospital now,” I told him as I helped him to sit down again and he slowly slumped into his chair.

Mahyer nodded slowly in agreement, as I felt a tapping on my shoulder and turned to face a nervously grinning Reb Ruvy.

“Can I talk with you for a moment in private?!” he demanded anxiously.

“Say it here, Reb Ruvy,” I told him. “But I want you to know that I’ve already made up my mind regarding how this situation is getting handled and it no longer involves your yeshivah.”

Reb Ruvy was now the second-most unraveled person in the room. “Well, we are a hospital — we’re a good private hospital and the family has trusted us to take care of their son. We have this special neshamah here, we can’t let anything happen to him like a hospitalization.”

“Call his father now,” I demanded in that calm-authoritative voice I try to muster for such occasions.

Reb Ruvy shook his head and almost begged me, saying, “I will take care of him, you don’t need to send him to the hospital. I’ll even still pay you for the consult,” as he handed me an envelope that I refused to acknowledge even as he inched it toward me.

“Call his father now,” I repeated. “Call him now or I’m calling an ambulance.”


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 852)

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