Attitude and Gratitude: Chapter Thirty Four

At this juncture, I’m going to digress a bit from my chronological order of writing my memoirs. It is now the High Holiday season – September 2004 – and I must relate my great joy and happiness in listening to Kenny being the cantor in the auxiliary minyan of our synagogue, Cong. Ahavath Torah in Englewood, N.J.

For the past few years, he led the schachris service on the first day of Rosh Hashana, the Kol Nidrei service and the mussaf service on Yom Kippur. To listen to your child sing in a beautiful voice and chant many melodious songs accompanied by me and most of the congregation instilled in me and Hilda a tremendous sense of pride that cannot be described.

Also, being invited by Jeannie and Kenny to their home for all the Jewish holidays for many years and being joined by our grandchildren and their spouses evokes in both of us a great feeling of gratitude to the Almighty. There is no material achievement that can surpass the joy of sitting at the holiday table with those whom you adore and love.

The delicious and plentiful food prepared by our darling “daughter” Jeannie, the constant group singing of liturgical songs at the table and the sincere respect and love given to us by our children and grandchildren produces an oneg yomtov (joy of the holiday) to be admired. God has been good to us throughout our lives and may He continue to do so for many years.

To be together with Karen, her husband Mark and their precious child, Noah; Joshua and his wife, Lauren; Benjy and his wife, Dahlia and Tamar and her partner, Arielle is the quintessence of happiness.

Although our other son Dennis lives 3000 miles from us, he phones us several times during the week inquiring as to our health and what’s going on in our lives. His wife, Fran, never neglects to e-mail us with info regarding their lives and what is going on with Anya and Aaron, their children. David, Dennis’s son by a previous marriage has given us joy since he was born.

In November 1991, “New York” magazine began an annual series entitled “The Best Doctors in New York.” Kenny was selected as one of New York City’s Best Pulmonologists. He received this honor in 1991, 1998 and 1999. He has been Clinical Professor of Medicine at Columbia University College of Physicians and Surgeons for the last 30 years. Also, he has been the Director of Clinical Ethics and Chairman of the Medical Ethics Committee of Columbia-Presbyterian Hospital for 10 years or more.

Kenny held clandestine medical clinics in the Soviet Union. During a visit in 1986 and later set up the first U.S.-Soviet medical student exchange program between Columbia P&S and the First Moscow Medical Academy.

As soon as he arrived in Russia, word got around that there was a physician from the U.S. His Soviet acquaintances immediately organized makeshift clinics in various apartment houses so that he could examine patients and dispense medical advice. Even though he expected Soviet medicine to be below American standards, he was appalled by what he saw.

One of his first patients was an 80-year-old man in severe pain because he was unable to urinate. His bladder was distended and needed to be catheterized immediately. The urologist who had been summoned to his home complied with Kenny’s request for a rubber glove to examine the patient’s prostate gland. After examining him, my son was startled when the physician requested that Kenny wash the glove so that it could be reused. She then relieved the patient of his distress by passing her only, reusable catheter into his bladder after lubricating it with butter. She sterilized the catheter by boiling it in a pot of water in the patient’s kitchen.

There was a virtual absence of such disposal items as syringes, needles, catheters and intravenous tubing in hospitals and clinics. Reused items increase rates of infection, while intravenous needles and scalpels that have become dull as a result of wear and tear increase pain and discomfort.

Another patient he met was a 28-year-old man with a well-documented heart attack two years earlier who was still experiencing chest pain when he exerted himself. His entire evaluation by Soviet physicians consisted of an ECG stress test, and his only medication was nitroglycerin to be taken as needed for chest pain. A coronary angiogram, which might have disclosed a surgically correctable reason for his premature heart attack and persisting angina, was never suggested. Also, he was not treated with any of the potent cardiac medications that might lessen his pain, and possibly increase his longevity. A select few in the Soviet Union have access to angiograms and life saving drugs. So much for the workers’ paradise.

Kenny is heavily involved in teaching pulmonology and medical ethics to medical students and nurses. He received the Columbia-Presbyterian Medical Center House Staff Award for Excellence in Clinical-Senior Faculty Teaching in 1999-2000. In 2003, he was elected to the Marqui’s Who’s Who in America and to the Guide to America’s Top Physicians, Consumers Research Council of America. That same year he received the Physician of the Year Award, Department of Nursing, Columbia-Presbyterian Medical Center.

In 1984, he was honored with the Rafael Award for Medicine by the Sanz Medical center in Netanya, Israel. For many years he was the personal physician to the Klausenberger Rebbe both in Union, N.J. and in Netanya, Israel. The Rabbi, a holocaust survivor who lost a wife and children in the ovens of Hitler, reconstructed his life forming a new family and, most importantly, creating a religious community in Kiryat Sanz in Israel.

He was selected as “One of the Best Internists/Pulmonologists” in the Castle Connoly Guide: How to Find the Best Doctors, New York Metro Area, 1994, 1997, 1999, 2001-2003.

His writings on medicine and medical ethics have appeared on the OP-ED pages of The New York Times and The Wall Street Journal as well as in medical journals and textbooks. He lectures extensively on medical ethics. He is on the admissions committee and is a regular guest lecturer at the Ben Gurion University MD program in International Health and Medicine in collaboration with Columbia University Health Sciences.

Last year -2003- he delivered the commencement address at this school. He is also on the Board of Directors of the American Council on Science and Health.

Among his many written articles, one that he wrote in the Journal of American Medical Association (JAMA), and is the mostly read to this day is entitled “For Everything A Blessing.” This article was reprinted in many Jewish and non-Jewish publications and produced a large number of “letters to the editor.” The number of e-mails and letters that Kenny received from his medical colleagues, again Jews and gentiles, was a pleasant surprise to the author. I will now insert the entire article.

When I was an elementary school student in yeshiva – a Jewish parochial school with both religious and secular studies – my classmates and I used to find amusing a sign that was posted just outside the bathroom. It was an ancient Jewish blessing, commonly referred to as the asher yatzar benediction, that was supposed to be recited after one relieved oneself. For grade school children, there could be nothing more strange or ridiculous than to link to acts of micturition and defecation with holy words that mentioned God’s name. Blessings were reserved for prayers, for holy days, or for thanking God for food or for some act of deliverance, but surely not for a bodily function that evoked smirks and giggles.

It took me several decades to realize the wisdom that lay behind this blessing that was composed by Abayei, a fourth-century Babylonian rabbi.

Abayei’s blessing is contained in the Talmud, an encyclopedic work of Jewish law and lore that was written over the first five centuries of the common era. The Jewish religion is chock-full of these blessings, or brachot, as they are called in Hebrew. In fact, an entire tractate of Talmud, 128 pages in length, is devoted to brachot.

On page 120 (Brachot 60b) of the ancient text it is written:

Abayei said; “When one comes out of a privy he should say: Blessed is He who has formed man in wisdom and created in him many orifices and many cavities. It is obvious and known before your Throne of glory that if one of them were to be ruptured or one of them blocked, it would be impossible to survive and stand before You. Blessed are You that heals all flesh and does wonders.”

An observant Jew is supposed to recite this blessing in Hebrew after each visit to the bathroom. We young yeshiva students were reminded of our obligation to recite this prayer by the signs that contained its text that were posted just outside the restroom doors.

It is one thing, however, to post these signs and it is quite another to realistically expect preadolescents to have the maturity to realize the wisdom of and need for reciting a 1600-year-old blessing related to bodily functions.

It was not until my second year of medical school that I first began to understand the appropriateness of this short prayer. Pathophysiology brought home to me the terrible consequences of even minor aberrations in the structure and function of the human body. At the very least, I began to no longer take for granted the normalcy of my trips to the bathroom. Instead, I started to realize how many things had to operate just right for these minor interruptions of my daily routine to run smoothly.

I thought of Abayei and his blessing. I recalled my days at yeshiva and remembered how silly that sign outside the bathroom had seemed. But after seeing patients whose lives revolved around their dialysis machines, and others with colostomies and urinary catheters, I realized how wise the rabbi had been.

And then it happened: I began to recite Abayei’s bracha. At first I had to go back to my siddur, the Jewish prayer book, to get the text right. With repetition – and there many opportunities for a novice to get to know this blessing well – I could recite it fluently and with sincerity and understanding.

Over the years, reciting the asher yatzer has become for me an opportunity to offer thanks not just for the proper functioning of my excretory organs, but for my overall good health. The text, after all, refers to catastrophic consequences of the rupture or obstruction of any bodily structure, not only those of the urinary or gastrointestinal tract. Could Abayei, for example, have foreseen that “blockage” of the “cavity,” or lumen, of the coronary artery, would lead to the commonest cause of death in industrialized countries some 16 centuries later?

I have often wondered if other people also yearn for some way to express gratitude for their good health. Physicians especially, who are exposed daily to the ravages that illness can wreak, must sometimes feel the need to express thanks for being well and thus well-being. Perhaps a generic, non-denominational asher yatzer could be composed for those who want to verbalize their gratitude for being blessed with good health.

There was one unforgettable patient whose story reinforced the truth and beauty of the asher yatzer for me forever. Josh was a 20-year-old student who sustained an unstable fracture of his third and fourth cervical vertebrae in a motor vehicle crash. He nearly died from his injury and required emergency intubation and ventilatory support. He was initially totally quadriplegic but for weak flexion of his right biceps.

A long and difficult period of stabilization and rehabilitation followed. There were promising signs of neurological recovery over the first few months that came suddenly and unexpectedly: movement of a finger here, flexion of a toe there, return of sensation here, adduction of a muscle group there.

With incredible courage, hard work, and an excellent physical therapist, Josh improved day by day. In time, and after what seemed like a miracle, he was able to walk slowly with a leg brace and a cane. But Josh continued to require intermittent catheterization. I know only too well the problems and perils this young man would face for the rest of his life because of a neurogenic bladder. The urologists were very pessimistic about his chances for not requiring catheterization. They had not seen this occur after a spinal cord injury of this severity.

Then the impossible happened. I was there the day Josh no longer required a urinary catheter. I thought of Abayei’s asher yatzer prayer. Pointing out that I could not imagine a more meaningful scenario for its recitation, I suggested to Josh, who was also a yeshiva graduate, that he say the prayer. He agreed. As he recited the ancient bracha, tears welled in my eyes.

Josh is my son.

As I write these words, I too, have tears in my eyes because I remember the unfortunate episode very clearly. When all the renowned doctors informed my grandson, Josh, that he would never walk again, you can just imagine my grief at hearing that terrible prediction. Unfortunately, our medical schools are only interested in teaching science and not having a course in faith. In my 86 years of life, I have been witness to many instances of the physicians giving no hope to the patient and not realizing that, perhaps, sometimes God has something to say. Fortunately, I have seen a good many patients recover and survive despite the gloomy predictions of their doctor.

I sincerely believe that our Creator had something to do with Josh’s ability to walk again. Perhaps, this “miracle” was due to schuss avos – intervention by our ancestors who were pious and performers of good deeds. When I was present with Josh and heard the neurologist give him the shattering verdict, I knew immediately that this particular physician was either an atheist or agnostic and, probably, never attended services at a church or synagogue. When all hope fades, faith is what sustains us.

Dennis, as well has given us a great deal of joy and pride in his many accomplishments. Listening to him on the radio for three hours 5 days a week when he broadcasts nationally over close to 70 cities, reading his weekly articles on “World Net Daily” and “Town Hall”, listening to his many tapes of his lectures given throughout the world, viewing him on the most popular TV news shows and, last but not least, emceeing the 7 hour annual Chabad telethon gives his parents nachas (joy and pride).

In 1972, Dennis taught Jewish history and religion at Brooklyn College for one year and in that same year in October he formed the Tze Ulmad Institute with his best friend, Joseph Telushkin. They decided to write an introduction to Judaism and publishing the book themselves under the name of Tze Ulmad- which means in Hebrew, (go forth and learn.}

The book was published in 1975 with the title “The Eight Questions People Ask About Judaism.” It was so successful that Simon & Schuster asked them to add a question and it was published by them in 1976 with a new title “The Nine Questions People Ask About Judaism.” It was dedicated to their parents, “who provided environments conducive to asking questions and seeking answers.” Today it is the best selling introductory text to Judaism, used by rabbis from Reform to Orthodox. Also, it has been translated into twelve languages and is read throughout the world.

The second book authored by the two friends was “Why the Jews-The Reason for Antisemitism” which was published again by Simon & Schuster in 1983. It was dedicated to Raul Wallenberg, the Swede who saved thousands of Jewish lives from being exterminated by Hitler. Dennis’s third book was “Think a Second Time” which was published by Regan Books (Harper Collins) in 1995. The book consists of 43 essays that Dennis had previously written in his quarterly journal “Ultimate Issues” which he started in 1985.

In 1998, he wrote his fourth book, “Happiness is a Serious Problem” published again by Regan Books. Dennis had been lecturing on the subject of happiness for several years and this particular subject captivated him.

These lectures were more than sprinkled with humor; in fact, they were a deluge of comedy. The dedication was to his second wife, Fran, of whom you will read later on in my memoirs.

Proficient in four languages, Dennis has lectured in Russian in Russia and in Hebrew in Israel. As for English, “Toastmasters” voted him one of America’s five best speakers. He has been teaching the Hebrew Bible verse by verse at the University of Judaism in Los Angeles for many years. He has engaged in interfaith dialogue with Catholics at the Vatican, Muslims in the Persian Gulf, and Protestants at Christian Seminaries throughout the United States.

He was appointed by President Reagan to the U.S. delegation to the Vienna Review Conference on the Helsinki Accords. He has made and starred in “For Goodness Sake”, a half-hour video directed by David Zucker shown on public television and purchased by thousands of major corporations. Two other films were produced and starred in by Dennis; “Character, Who Needs It” and “Diversity Through Character.”

Dennis always loved music and, fortunately, when he was not the ideal student around the age of 11 or 12, we decided to give him another outlet other than school. We purchased a piano and he, for some reason, opted for the accordion in addition. I do not remember the chronological order of purchase; whether the piano came before the accordion. At any rate, we engaged teachers in both instruments and he became quite good playing both.

He, today, periodically conducts symphony orchestras and through his writings and broadcasts has introduced thousands of people to classical music. I remember him, as a teen-ager, going to classical music concerts with the entire score in his possession to be able to follow the music from the conductor’s standpoint.

Several years ago, while still being a Democrat, he was asked to enter the Congressional primary against the incumbent. I, not caring for the sleaze of many politicians, tried to talk my son out of running. When he asked me to give him $1,000 for the application fee and to prepare a financial statement, I did so reluctantly. After a month or two, he had a change of heart and the fee went down the drain.

Both our sons have a great love for traditional Judaism which imbues in Hilda and me a strong sense of achievement with the help of the Almighty. Fortunately, they both have created in their children that same feeling. Thus, when I included the word “gratitude” in the title of my memoirs, you can now understand the reason therefore. We pray that our Heavenly Father grant us good health and longevity to continue to enjoy our wonderful children and grandchildren.

Jeannie and Fran are our daughters and not only spouses of our sons. The love and respect they have for us and we for them could not be more sincere if they were our biologic children. Thank you God for all that you have bestowed upon us.

At this point I would like to digress and relate what happened to me in the last 5 months – it is now November 24, 2004.

In April of 1996, I went to my primary doctor, Jonathan LaPook at the 60th Street branch of Columbia-Presbyterian Hospital for my annual physical. Since I complained about some abnormality in my gastro-intestinal area, he immediately had me take a CT scan. After a few days, he called to tell me that the radiologist discovered an aortic aneurysm in my abdomen. Since it only measured 3.4 x 3.8, it was not severe and I would have to have an ultra sound examination annually to monitor the size. When it reached over 5 cm I would need surgery to prevent a rupture of the aorta which in 75% of the occurrences leads to death. Among celebrities who died from this malady were Albert Einstein, Lucille Ball and George C. Scott.

Most cases are caused by hypertension which I have suffered with all my life; evidently inherited since my father and both sisters had this condition. My father died at the age of 72 from heart failure caused by a lifetime of hypertension. My sister Irene died at the age of 32 having a bad heart and hypertension and my sister, Anne, died at 55 from heart failure as well.

75% of aneurysms occur in the abdominal aorta. This blood vessel becomes less elastic with age and the vessel wall thins in spots. Pressure on these spots causes ballooning, which increase over time. The most serious threat posed by an aneurysm is rupture. Depending on the severity of bleeding, shock and death follow quickly.

The success rate for surgery for a ruptured abdominal aortic aneurysm is only 50%. More than 200,000 abdominal aortic aneurysms are diagnosed annually. If detected in advance (with a CT scan or a sonogram) the condition is treatable in 95% of the cases.

My annual ultra sound procedure in 1997 showed no change; in 1998 and 1999 it increased to 4.0 x 3.7, in 2000, 2002 and 2003 it increased to 4.3 x 4.4, and in June 2004 it increased to 5.3 x 5.0 which I jokingly told my doctor it was time to sell. My primary doctor, Frank Livelli, told me it was time to have surgery performed to remove the risk of sudden death.

I spoke to Kenny, my son the doctor, who consulted our good friend, Dr. Jonathan Sussman who is a vascular radiologist at Columbia-Presbyterian and is a member of a team that performs surgery to bypass aneurysms. Although I would have preferred to have the surgery at Columbia, where Kenny and Jonathan are on the staff, Jonathan recommended Dr. Michael Marin at Mt. Sinai Hospital for a very good reason.

While treating an elderly patient for this problem at Montefiore Hospital, where Dr. Marin was an attending surgeon in 1992, he realized that this patient was too ill for conventional surgery and he began looking for alternatives. After a few months of searching, Dr. Marin found an Argentine surgeon named Juan Parodi, who had invented a new, minimally invasive technique, which Dr. Marin brought to Montefiore.

A stent-graft -a sort of artificial artery made of polyester fitted over a stent – is inserted into the abdominal aorta via two small incisions in the patient’s groin. The graft is positioned at the site of the aneurysm, where it pops into place and serves as a sort of artery within an artery – the aneurysm is bypassed, and blood flows through the graft instead. Surgery that used to involve a two-week hospital stay and several months’ recovery time now has patients out of the hospital the next day, and recovery takes less than two weeks.

On July 6, I went to see Dr. Marin, who was now at Mt. Sinai, for consultation and he advised me that if an angiogram would show the exact location of the aneurysm to be below the renal arteries in the kidney area, I would be a candidate for a stent-graft. That very same day he scheduled me to have a CT scan and X-Rays and two days later he sent me to Dr. Squire on Park Avenue for an EKG. On July 20, I went for a stress test; these procedures were to determine the condition of my health and to assure my ability to undergo surgery. On July 28, an angiogram was performed and, fortunately, I could have an endovascular aortic aneurysm repair and not have to endure an open-chest procedure.

Luck played an important part in my life for several reasons. Since having an aneurysm is insidious with absolutely no symptoms whatsoever, had I not had a CT scan in 1996 for a GI problem, I would never know that I was a “ticking time bomb.” Secondly, I was fortunate in having the location below the kidney so that I could have a stent-graft instead of regular surgery.

On October 13, I went for surgery. Because I had an epidural anesthesia, I was awake during the entire procedure and was even able to speak to Dr. Marin and his associates throughout the procedure. At least six or seven times, I was asked to hold my breath while they were taking X-Rays. The operation lasted for 2 ½ hours and the sewing and clamping staples on the incisions lasted for another ½ hour. The two incisions on each side of my groin were around 2 inches in width.

I was then wheeled into the recovery room where I spent 6 hours. The entire lower part of my body remained numb for the entire time that I was there. Not ever experiencing this inability to move my legs nor feeling anything when I touched my abdomen, it certainly became a grave concern to me. I couldn’t believe that it would take 6 hours to regain normal feelings; however, the nurse, Jeannie, kept reassuring me that I would be fine.

About three hours after the surgery, I was delighted to see my family enter the recovery room; Hilda, my daughter Jeannie, grandson Joshua, grandson Benjy and his darling wife, Dahlia. Later on, Kenny arrived and all couldn’t believe that I had surgery only three hours previously since I looked so well, thanks to the Almighty.

After my stay in the recovery room, I was taken to a down-graded ICU which contained 4 beds and a nurses’ station with 2 nurses in attendance. I remained there over night and the following morning, after an examination, was released to go home. I was told by the doctors that I could begin to take the three medications that I had been taking previously to control my hypertension; they were nadolol (a beta blocker), lisiniprol (an ace inhibitor) and dyazide (a diuretic). Unfortunately, these three drugs lowered my blood pressure so severely that I became very dizzy.

This condition lasted for 2 weeks and, fortunately, when Kenny told Jonathan Sussman at shul what my problem was, Jonathan told him that, as a result of my operation, blood was flowing more freely to the kidneys that automatically reduced my blood pressure. Kenny, after shul, visited me and took my pressure and was shocked to find that my pressure had gone down to 68/23. He immediately advised me to take only nadolol and, sure enough, my pressure returned to normal.

When Ryan Surmay, RPA (registered physician’s assistant), Dr. Marin’s associate, called me to ascertain how I was recuperating, I informed him about my past problem and told him that he should have informed me what Jonathan told Kenny and that I should have not taken all 3 drugs. He agreed and said “You are wise beyond your years.” I also told him that he, in the future, should advise patients undergoing vascular bypasses to contact their primary physicians immediately to prevent problems that I encountered; he readily agreed. I must commend Ryan for being unusually solicitous about my health and cooperative from my first visit to Dr. Marin to my last conversation with him. In fact, all the nurses who attended me at Mt. Sinai were exceptionally kind and helpful during my stay at the hospital.

I am very grateful to God that I now feel great and no longer have to be fearful about a condition that could have been fatal.продвижение оптимизация сайтовhttp://myxpresscams.com/otkritie-raschetnogo-scheta-v-sberbanke.php