Wednesday, November 27, 2013

See You Later, Brother

On November 19, 2013, my middle brother Shlomo (I am the youngest of three boys) passed away at the age of 59, after a valiant 14 month struggle against kidney cancer.  Below, please find the eulogy I delivered at his funeral.

Shlomo always began all his simcha (happy occasion) speeches with the words, “what can a father say to his child on the occasion of....” In respect, I will begin my comments with “what can a brother say to a brother’s friends and family.” 

I have always found it amazing that people seem to be their best at their bar/bas mitzvah and at their funeral. That’s the time when we sing their praise and highlight all the wonderful things about them. The rest of the time, as we all know, everyone is not quite so perfect. So I’m sure you will all expect me to say how wonderful Shlomo was and I will not disappoint.  But I think that those of us here who really knew Shlomo, will know that I am not exaggerating such words of praise.

Shlomo, or Eba, as I affectionately called him when I could barely speak, was truly the perfect older brother in every sense of the word. I can remember as a small child Shlomo always offering me his lap on long car trips, no matter how hot or uncomfortable the trip may have been. With my head nestled in his lap, he gave me a sense of security and warmth.  Shlomo and I shared a bedroom for most of our childhood and Shlomo would often tell me bedtime stories. We would play baseball together in our small room using a rolled up sock. On my birthday, I remember one year Shlomo purchasing me two small racing cars that he knew I so terribly wanted. How he paid for them, I will never know because he had little money of his own to speak of. When I was entering college after having taken high school for granted, it was both my older brothers, Yehuda and Shlomo, who inspired me to work hard. It was Shlomo, in particular, who changed my life by making success in college a reality. In fact, I remember clearly as if he just said it, “It is possible to get an A in every class you take in college. You just have to work hard” And I believed him.

When I complained during a lifeguard instructors course that I could not perform a necessary skill, it was Shlomo who immediately chastened me with a much needed and well-timed sharp rebuke of “stop it already, of course you can do it.” This much-needed verbal blow compelled me to stop wallowing in self-pity and get it right.

Shlomo’s favorite words to me that always got me motivated to work hard and stay the course, whether in school or otherwise, was always "bust, bust, bust." It meant to just keep going hard towards any goal and I say to Aliza, Esti, Avivi, and Donny, as well as Dov, Neil, and Eitan, that if your father and father-in-law was here today, I am sure that he would say to you that when confronted with any of life’s challenges, the answer is always to bust, bust, bust.

Shlomo’s thoughts were always about everyone but himself. He has been the dutiful son that took care of our parents by always having them live nearby, helping them with medical problems, and always welcoming them to his home. When our father, z”l (of blessed memory) passed seven years ago, Shlomo became the doting son to our mother who continued to live nearby. And Shlomo and Meryl always warmly welcomed her to their home every Shabbat and yom-tov (holiday). I know that Shlomo would want you Ema to take good care of yourself even now that he is gone. Of course, Shlomo was also grateful for your Herculean efforts to feed him well to keep his cancer at bay. He appreciated the never-ending flow of fresh fruits and vegetables smoothies, which was your labor of love for him, and all the time you spent at his bedside.

Shlomo also always saw himself as a problem solver, often offering advice on how to reconcile differences between family members and he was a big believer in always doing the right thing.  One day, a few weeks ago, after I changed his bedpan, Shlomo turned to me and said it is good you are doing this. I asked “why is that?” He answered because it will make you feel better after I am gone. That’s the way Shlomo was; always thinking about how some action would have a positive or negative influence on somebody’s wellbeing.

This concern for the welfare of others extended to his medical practice as an internist and cardiologist. Working to ten or eleven at night was a constant for him and that is why his patients loved him and thought so warmly of him. (In fact, during the shiva (mourning period), dozens of his patients came to his house to express how much they loved him as their doctor, particularly how he made each of them feel like he or she was his only patient. Many also claimed that he had saved their lives with his medical care.)  Everything I know about how to make a patient feel special, I learned from him.

A few weeks ago, Shlomo decided to make a farewell video to his family, which I will share with them in the very near future. When he finished the part about his kids, I said to Shlomo that all he said to each kid was how great he thought they were and didn’t distinguish between them. He immediately answered that it was true that he thought that each of his kids were truly amazing and he was so proud of each of them. He also thought he was the luckiest father-in-law in the world that each of his three girls had met and married such incredible and loving sons-in-law, Dov, Neil and Eitan, who were welcome additions to the family.

For Meryl, however, he had no shortage of words of praise of what an amazing wife she had been to him, particularly during the last few months.  I often tell patients to print out the serenity prayer and keep it by their bed side. Meryl epitomized this prayer. She had the serenity to accept the things she could not change such as at the end the inevitability of Shlomo’s passing. But she also had the courage to work hard to keep him alive when we all thought that was still possible. And in the end, she showed the wisdom in knowing the difference between the two. As a first-hand witness, I cannot imagine a wife showing more grace and poise during the most difficult of times, who never wavered for a moment in her love for her husband of 35 years, who spent her every moment at his beck and call, sleeping by his side every evening, even if it meant sleeping in a chair in a cramped hospital room.  And did all of this with the most optimistic and positive countenance at all times.

So I say to Meryl and all the kids and sons-in-laws, from Ema, Yehuda, Yael, Danielle, Justin, Nicole, and I, thank you for being such a wonderful wife and children to the brother I loved so much and who was truly a tzadik (man of virtue) and a wonderful person. My brother could not have had a better family than you and I know he always felt lucky and grateful for having all of you in his life. With Shlomo gone to Olem Habah (heaven), a place I am sure he has earned, I hope that all of you will look to Yael and I as someone you can rely upon and that from this point on we celebrate many simchahs together, which I am sure will make Shlomo extremely happy as family meant everything to him. as he looks upon us from high above.  

I love you Shlomo, I will miss you, I will miss your bust, bust, bust, and I hope to see you again after meah v’esrim (120 years).

Sunday, November 17, 2013

Stop The Weight Loss Madness

This past week, I saw no less than ten patients who wanted to lose weight. Each described in their own unique way how the extra weight was contributing to some perceived problem they had with the weight's effect on their image, energy level, health, etc.

To each patient, I said the same thing. Stop focusing on losing weight and start focusing on what you can and cannot do to your body to help it function at its optimal level.  To each, I conveyed how the human body was developed over millions of years, with its most latest form, homo sapiens being around two hundred thousand years old. Over this period of time, human biology has evolved a full host of protective mechanisms to ward off disease. Of course, we all know these mechanisms sometimes fail miserably. It is very unfortunate when it does, and my heart goes out to those who suffer seemingly happenstance illness. Nevertheless, these mechanisms work for most and that is why the human body can usually protect itself fairly well against poor eating, lack of exercise, inadequate sleep, mounting stress, etc. for at least the first five or six decades of life.  It's not that damage isn't being done, it's just that the damage isn't always so obvious until later.

I often share with patients the story of the my growing up in Brooklyn, NY and how one day the red lights turned on in on the dashboard of my father's old car.  I share how my father drove it to a nearby gas station and spoke to the attendant and asked if he could help with the red light, to which he replied, "yes, I can disconnect it."  Now even to a young boy that was a ridiculous statement. Little did I realize that during medical school and my residency, my teachers and mentors would primarily educate me on how to turn off patients' red lights. As doctors have become successful in eliminating symptoms without addressing the underlying problem, akin to turning off a red light warning of problems, patients have been confused into thinking they don't really have a problem. A case in point is a patient this week telling me that he was very healthy with normal blood sugar despite the fact that he was a diabetic on high blood sugar medication and nearly morbidly obese.

For some reason, Americans seem to disassociate the reasons they gained the weight with the effects such reasons have on their health beyond the number on a weight scale.  They gain weight because they ate too much, they ate the wrong food, they barely moved, they slept poorly and were always hungry, etc. That is why I tell people to stop worrying about the numbers on the scale and to start paying close attention to the details of their lives. Although there is no perfect plan for staying healthy as the old Yiddish saying goes, mensch tracht un Got laft, men plan and G-d laughs, it still pays to plan. Therefore, by focusing on those elements of your life that you do have control over, you can shift the odds of staying and getting healthy in your favor. By doing so, one of the benefits is usually weight loss.

I have always believed that for virtually all problems, there are solutions.  Over the past three years, by investing the time and listening carefully to what patients are telling me, in partnership with them, I have helped them identify such problems and come up with workable solutions.  It has been a three year whirlwind and I am so grateful that I had the opportunity to so positively effect so many lives.  However, as clinically successful and emotionally rewarding this endeavor has been, the time has come for me to move on to my next challenge. I will always be grateful for all that my patients have taught me and the wonderful personal stories they shared.

I know that those who embraced my philosophy about taking care of the one body they had by eating healthy foods in moderation, avoiding unhealthy foods altogether to the extent possible, physically staying  active over the course of a day as much as possible beyond simply going to a gym for a specified work-out, improving sleeping habits, managing stress more effectively with good meditation and relaxation techniques, nurturing relationships and being grateful for the good things in life, have and will continue to reap great benefits from developing such good health habits.

To the rest of you I say, while good health is never guaranteed, a healthy lifestyle can shift the odds in your favor. Choices do have consequences so please choose wisely. Stop chasing weight loss like a lost puppy and focus on what really matters--your overall well-being.