Friday, January 24, 2014

Israel - Then and Now

Rhonda and I have just returned from a 10-day trip to Israel - a trip designed for "first-timers."  Now though Rhonda was a first-timer, I was actually a "third-timer," having visited Israel in 1966 and 1980.  When I visited as a "first-timer" I was in my late 20's and Israel was 18.   How did my sense of the country change over this 48-year span.

I still remember the words of our guide Max, in 1966, as he addressed our group on entering Tel Aviv after having landed at Lod Airport.  He pointed out to us (a group of US Military officers) that the people cleaning the streets were Jewish, even the criminals were Jewish and, yes, the prostitutes were also Jewish!  There was no West Bank. There was no East Jerusalem to visit. There was no Western Wall to approach  There were armed Jordanian soldiers readily visible in towers overlooking us as we walked the streets of Israeli Jerusalem.  Most of the Israelis we met were European by birth.  So many questioned why we were still part of the Diaspora and refused to emigrate to the State of Israel.  Israelis would accost us in the streets to lecture us, with a classically Israeli uninvited insistence, that the place for Jews was Israel - all Jews should feel an obligation to emigrate.   I felt disrespected as a Jewish-American.  I was made to feel less Jewish, made to feel that Israelis did not consider me a committed Jew unless I committed to an intention to emigrate.  I was clearly uncomfortable.

Fast forward to 2014.  I'm in my mid-70's and Israel is 66.  It's a different place - not only physically, but also in its sociologic and self-sustaining evolution.  I'm also a different "place" - not only physically but also in my sociologic and self-sustaining evolution.   Israeli "street cleaners" do not appear to be Jewish (I must admit, I did not knowingly meet any prostitutes, so can't be sure about their backgrounds) and  there are noticeably now people of color!  The cities seem much more cosmopolitan.

That sense of being a derided, uncommitted Diaspora Jew was no longer.  No one encouraged emigration.  No one even suggested it.  Diaspora Jews were Diaspora Jews and Israelis were Israelis!  We have a common history, but not necessarily a common commitment.  That's good.  A feeling of Israeli "dependency" no longer existed.  The word "miracle" is often used in describing this extraordinary, vibrant country.  "Miracle" is a word that I find hard to accept in describing anything, but somehow the word may apply here.  I venture to say that if there is such a thing as a "miracle," Israel may be the unique paradigm.

Israel - Mature, Modern, Madcap, Majestic, and - simply aMazing!

Thursday, January 16, 2014

A Fetal Life in a Dead Mother

A woman who is legally dead, is being kept on "life support" in a Texas hospital against the wishes of her husband and parents.  She is being maintained on "life support" solely to sustain the viability of her 21-week old fetus.  Physicians have refused to honor the wishes of the family, arguing that Texas law prevents them from withholding "life-sustaining treatment" from a pregnant patient.  The family contends, however, that since the mother has been declared "brain-dead" she can no longer be considered a pregnant patient, since a "patient," by definition, is someone who is alive.  Physicians intend to continue the present regimen until the fetus has reached the age when a caesarian section can be performed.

This fetus is now approaching extra-uterine viability - a fact which makes this case difficult to morally adjudicate.  However, if the fetus were as little as 4 weeks of gestational age, or if the fetus were as much as 30 weeks gestational age, how one would feel about this tragic set of events might be quite different.

If the fetus is to be the sole consideration here, then perhaps a caesarian section should not even be considered, there being no question that a fetus has a far better chance of survival in-utero than ex-utero.  Assuming no complicating medical factors, would it be ethical to continue to maintain this "natural" form of fetal nurturing rather than proceeding with a C-section?  Would it be ethical at 4 weeks gestation?  Would it be ethical at 30 weeks gestation?

Friday, January 10, 2014

Whose Medical Record Is It Anyway!

A recent article in the prestigious New England Journal of Medicine discusses the usefulness of giving patients full access to their medical records, including the physicians "notes," which had previously remained inaccessible.

A medical record includes laboratory results, radiology results and pathology results - all of which I concur should be made available to a patient - after all, they are his lab results, his radiology results, and his pathology results.  However,  it had always been my feeling that what I entered into a medical record (my "notes") was only for my eyes and for other eyes to which I wished to show them.  And when I translated these notes into a formal letter, most commonly to a referring colleague, the letter was a private communication between my colleague and me.

Medical record "notes" often contained personal reflections on the patient, possibly his family, his attitude, and maybe even some quirky anecdotes to help recall a a previous encounter.  I never regarded my "notes" like those that would be part of a personnel record or subject to the Freedom of Information Act.

But I guess those are bygone days.  Now, were I to enter information into a patient's record - it would be limited to "the facts." Any "color" would have to be withheld from the written record and restricted to some non-written form of communication (if deemed necessary).

Progress - onward and upward.