Why Are We Here? Thoughts From a Life in Medicine

Etan and Lia, my young adult grandchildren, and I were finishing our frappes. They were visiting my campus, lingering at the coffee shop, and enjoying another beautiful day in California.

“Zeide,” they asked (our family uses the traditional Yiddish Bubbe and Zeide for grandmother and grandfather, respectively). “Why are we here?”

I paused and replied, “Funny you should ask. I’ve actually been thinking about this, about what I’ve learned from being a doctor for almost 60 years and how it applies to life. I’ve wanted to write a ‘living’ or ‘ethical’ will (tzava’ah, in Hebrew) for you, my other grandchildren, and my children. You appreciate that it’s a tradition in many religions to sometimes create a document with one’s life lessons and blessings. You know of the letter written by your great-great-grandmother when her daughter’s family left Europe for America, nearly 100 years ago, which was remarkably emotional and poignant. We quoted from this at family celebratory occasions. It’s important to know your family history and values.

“So, I’ve reflected on this. Especially as I’ve aged. I think maybe we’re here to do the best we can, to try to make the world better. To be the best of us that we can be. We don’t quite get there but the trying and becoming is what’s important. We do this in small steps in our own worlds and hope that will be meaningful.

“In doctoring, I believe that caritas, a kind of biblical loving-kindness, is at the essence of clinical medicine, but also probably life, perhaps of fully ‘being alive.’ It’s important to ‘care,’ truly, for patients, your profession and principles, and how we practice, teach, learn, lead, and live. Too, of course, for our families, those we love, certainly others, our society, and our world. It’s part of aspiring to do good. Care. Meaningfully. For everyone and everything.

“It’s my extraordinarily good fortune to have not been born in the villages of my parents in Poland (where I would have perished in the Holocaust) and to have (mostly) enjoyed good health (so far). I have lived the American Dream, finding a profession I loved, achieving a measure of success and a comfortable life—with a wonderful wife (now married 60 years), children, and grandchildren (and dogs)—and able to offer much of the same to my children. I have exceeded what ambitions I had, with opportunities to serve and assume leadership roles and to be appreciated for my activities. It’s amazing being a physician in the United States, participating in the lives of others, when there are billions destitute, starving, homeless, or virtually homeless. Few are given the opportunities to attain the education, stature, and income in order to care for others. We are not (usually) the ones at the other end of the stethoscope, without means, shelter, or health insurance. Cherish what you have. Make the most of your opportunities. Realize our failure to provide equitably to all and our obligation to try to do so.

“There are still things I want to do. More of what is purposeful and meaningful. More to write. Formally present to my peers and colleagues. Shoot baskets and run a bit, as I can, with my grandchildren, Jake, 7 years old, and Rose, 9 years old. Kiss the most beautiful women in the world, again, Lia and Rose (my granddaughters), and my wife (Rena), daughter (Rachel), and daughter-in-law (Nicole). Visit with old friends. And continue charitable work. Have goals. Revise them. Aspire to do what’s good and right. You will likely fail at something sometimes; persevere and, despite successes, continue trying to improve.

“I’ve read about the meaning of life, the universe, its origins, the existence of God, and life’s profundities, finding most answers elusive, unknowable, or beyond my abilities to comprehend. I returned to my own version of the comfort of the faith and traditions with which I grew up, and have lived, accepting their inherent epistemological uncertainties. Have or find faith, if possible, and certainly values to affirm and live by.

“Try to live in the present and savor the moment, mindful of the story of the sage who, when asked about the most important thing he ever did, wisely replied that it was what he was doing now. The past and the future are ephemeral. Exploit and enjoy the present; it alone belongs to us. We can’t know what comes next; we should try to think of ‘now’ as our heaven.

“Have a passion other than your profession. Mine was running. There was a haunting beauty, quiet, serenity, and solitude of running, alone, just me and the dogs (Monty and Toby), contemplating everything and nothing, through the streets and along the beach, usually while the world was sleeping. Those were times of deeply satisfying and refreshing reflection. Moments when I felt running was inextricably part of who I was. Running enriched my life and still does. Though now slower and shorter, my runs help keep me fully alive into my ninth decade. Find your equivalent and be better from it.

“Another love has been writing. This has enabled me to express the wonders and joys of doctoring and life, and attempt to address some of their challenges. Writing presents opportunities to reach and move others and in turn be moved by them, with words and ideas rather than with the deeds of the office, the bedside, the clinic, or hospital. Words, well-crafted, can soar, affecting hearts and minds, and inspiring dialogue, understanding, and connection in a world now so lacking in respectful discourse. People will never forget how you made them feel; this is shaped, certainly at least in part, by words. Words matter not only in our care of patients and in medicine, but in our interactions with colleagues and indeed throughout life.

“Do good. And right. I’ve had opportunities to express my thoughts about nonmedical topics, particularly perceived injustices, and wrongs. I’m proud to have contributed to the expungement of Nazi eponyms from the medical lexicon, calling attention to this taint in medical history and thought, and to have achieved at least some measure of justice for victims of Nazi atrocities, including our own family. I have advocated for equity in the health care of our patients, for integrity and preservation of science amid pernicious present threats, for sustaining our democracy, and for high standards of ethics and professionalism. Do not be silent in the face of injustice.

“Relationships are important. A few years ago, Bubbe and I attended my 50-year anniversary medical school graduation reunion. One of the wonderful aspects of that weekend was seeing classmates and old friends again. Medicine, like most things, indeed life, is a ‘team sport’—better, easier, and more gratifying when shared. It is good to have friends and loving family, and important to sustain and nurture relationships.

“Respect others. There is a beautiful parable about respect, common to most religions, in which it is expressed the notion that ‘one among us is the messiah.’ It could be any of us. If we entertain that possibility, it follows that we treat both ourselves and one another with exceptional respect. If we could do this, would the world not be a better place? Ancient scholars exalted the worth of ‘a good name.’ Integrity. Learn the appropriate humility, dignity, and integrity, respecting all. Paraphrasing Maimonides’ prayer for physicians, be inspired to seek at all times to expand your knowledge and to see within each only the human being.

“Have values. Find meaning in life. We all must define our own values, determine what is important for ourselves, and identify what will give our lives meaning. I hope my thoughts and experiences help you as you contemplate your lives. I am honored to have been part of your journey. I know your parents have prepared you to choose well and choose wisely. Make us proud of you and be proud of yourselves.

“And remember how success was portrayed in The Iliad. When Hector left for war, he said to his wife about their infant son, ‘may people someday say, “this man is far better than his father.”’ That expresses my hope for you—not only that you continue to thrive and prosper; not only that you have long, successful and fulfilling lives; not only that you make us proud; but that you surpass all of us.

“Last, do not forget our own family’s traditions. Your great-great-grandmother wrote to her daughter, my grandmother, leaving for America from Poland in 1929 and whom she would never see again, entreating her to follow the traditions and values of our family and people, pass them on to her children, and enjoy a life of health, peace, and fulfillment as she kept these words and wishes in her heart.

“So, does that answer your question?”

“No, not really, Zeide.”

“No? No?? Why not?”

“No, because what we meant was ‘why are we here’ when your grand rounds started an hour ago?”

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