SCIENCE AND SENSIBILITY
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SCIENCE AND SENSIBILITY

Jerome Groopman’s approach to healing may be best summarized in a framed print of Maimonides’ physician’s oath that hangs in his office: "Inspire me with the love of my art and for thy creatures. In the sufferer let me see only the human being."

When Groopman is not in his lab at Boston’s Beth Israel Deaconess Medical Center (part of Harvard Institutes of Medicine), where he is chief of experimental medicine, he focuses his expertise as a hemotologist and oncologist — and perhaps equally as important, his compassion — on the inner workings of his patients. It is this unusual blend of science and spirituality — a nexus of medicine, healing, and faith in the preciousness of life — that not only characterizes Groopman’s career but also defines his deepest essence. Eleven years ago, at the age of 44, Groopman turned his gentle yet meticulous lens to writing about his patients’ courage, endurance, and resilience.

His approach may be best summarized in a framed print of Maimonides’ physician’s oath that hangs in his office: "Inspire me with the love of my art and for thy creatures. In the sufferer let me see only the human being."

"In Judaism we ask for r’fuat hanefesh u’rfuat haguf — healing of spirit and healing of body," Groopman says. "Why is `healing of spirit’ before `healing of body?’ There comes a time when medicine has its limits, when there is no healing of body. We work hard in the lab to change that, but until the last breath there’s always the opportunity for r’fuat hanefesh. I try to apply that kind of sensibility as a doctor."

Though he considers himself first and foremost a scientist and doctor, his eloquent pen captures the pace and pathos of medical mysteries and human dramas. His book "The Measure of Our Days" was published to critical acclaim and inspired the ABC drama "Gideon’s Crossing." In 1998, The New Yorker asked Groopman to become a staff writer in medicine and biology.

Other books followed: "Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine" and "The Anatomy of Hope: How People Prevail in the Face of Illness." Groopman’s most recent book, "How Doctors Think" (Houghton Mifflin) examines how doctors arrive at the correct diagnosis and treatment, and why they may not. He has also published more than 150 scientific articles, holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School, and
teaches writing at Harvard College every spring.

Groopman’s own experience as a patient has charged his perspective with a radical dose of empathy. While training for a marathon in 1979, he suffered an injury to his back and opted for quick and disastrous surgery that left him debilitated for years, until he regained function with arduous physical therapy. Like his patients, as he wrote in "The Measure of Our Days," he found himself "vulnerable, confused, and suffering, struggling to cope with a shattered world that appeared out of control." Last year he reinjured himself and is still recovering from reconstructive surgery.

During much of our interview, Groopman lies on the floor in a purple shirt, grayish vest, and honey-brown corduroy pants, his head resting against a pillow. His lanky 6’5" frame, narrow face, and beard suggest a white-haired Lincolnesque double. Despite his obvious pain, he smiles often and genuinely. "In ‘1 years, I’ve never heard him raise his voice," says his assistant, Youngsun Jung. "He is a real mensch."

Groopman’s powerful commitment to his patients and their loved ones also stems from the painful memory of his father Seymour’s death from a massive heart attack 33 years ago in a local New York hospital with no intensive care unit and no cardiologist. The family was devastated by the lack of expertise and care. "I was a second-year medical student," Groopman recalls. "It was the greatest loss of my life and also the greatest motivator." His father was a dentist, whose legacy as a "stable and even-keeled" person in whom people confided helps Groopman maintain his own calm. Treating patients with serious illnesses also puts the trivia of day-to-day life into perspective.

Another searing incident occurred when his first son, Steven, was 9 months old and became sick on an out-of-town visit. Groopman and his wife, Pamela Hartzband, an endocrinologist, took Steven to a pediatrician, but he dismissed their concerns as the neurotic worries of first-time parents. Steven was later rushed to the hospital for intestinal surgery. Because the pediatrician made a snap judgment, Groopman says, Steven could have died.

His favorite among the pictures that line his bookshelves is one of baby Steven lying on his young father’s chest. Steven is now ‘5 and a law student; Michael is ”, and Emily, 14. The books that are piled everywhere represent a mix of science, spirituality, and literature (Tolstoy, Chaim Grade, I.J. Singer, and Romanian author and survivor Norman Manea are among his favorite authors); there is a small memorial plaque to an early AIDS victim. Other photos line his desk, including one of Jordan’s King Hussein in a red keffiyah. Groopman was one of the eight doctors who treated him for lymphoma; he also cared for Hussein’s nephew, Prince Talal, whose lymphoma is now in remission.

Healing is key to Groopman’s work, but he is not content to let doctors remain on a pedestal. In a starred review in Publishers Weekly, author and pediatrician Perri Klass — who grew up in Leonia — describes "How Doctors Think" as an "incisive and sometimes agonized inquiry into the process by which medical minds … synthesize information and understand illness" and praises Groopman and the other doctors he interviews for their "passionate honesty" and their willingness to "anatomize their own serious errors."

He opens the book, for example, with this story: "Anne Dodge had lost count of all the doctors she had seen over the last fifteen years. She guessed it was close to thirty." Dodge had been diagnosed with anorexia nervosa and bulimia, as well as irritable bowel syndrome, but it was not until gastroenterologist Dr. Myron Falchuk uncovered her true problem did she find relief: she suffered from celiac disease, an allergy to gluten.

By conservative estimates, says Groopman, 15 percent of all patients are misdiagnosed, and the vast majority of misdiagnoses are not related to technical mistakes like mislabeled blood specimens but to errors in thinking. "All of us in medicine think and act simultaneously. We take shortcuts in cognition and are prone to biases." Since each patient’s case is a series of overlapping puzzles, doctors must decipher first what’s wrong, then what the best course of action would be, paying attention to everything they see, hear and touch, as well as considering the patient’s values, goals, and beliefs, says Groopman.

The idea for the book came to him during supervisory rounds with medical students, residents, and interns who "failed to question cogently, or listen carefully, or observe keenly. They were … being conditioned to function like a well-programmed computer…." Despite the "dazzling array of technologies" today, the real art of medicine requires communication and dialogue, Groopman stresses, one that should be valued more and taught better. But patients and their families should take a front seat, helping doctors think better by engaging in constructive and positive dialogue. "That," says Groopman, "is a radical proposal."

Groopman has a long history of pioneering breakthroughs in medical science. "He has helped to revolutionize the way the world treats diseases," says Dr. Abe Steinberger, a long-time friend and assistant clinical professor of neurosurgery at Mount Sinai Medical Center in New York. "On all counts — character, integrity, brilliance, humility, and academic achievements, he is outstanding," Steinberger adds.

"In cancer research, to protect the blood against the toxic effects of chemotherapy, we identify the triggers in the body that normally cause blood cells to grow and exploit those triggers therapeutically," Groopman explains. Partly because of his research on AIDS, the death rate for AIDS has dropped by almost 80 percent in the developed world where medications are available. His was one of the first groups to characterize on the virus, and with other research groups and pharmaceutical companies, helped identify lifesaving drugs like protease inhibitors.

A self-admitted workaholic, Groopman wakes at 5 a.m., writes, davens, and walks before going to his office, alternating days between lab work (60 percent), patient visits (30 percent), and administration (10 percent). He swims or exercises before returning home by 7 p.m. On the occasions when he is worn down by the anguish of his patients’ suffering, his lab functions as a kind of rejuvenating refuge. But most of the time, Groopman says, his patients inspire him: "The human spirit under the most difficult circumstances is extraordinary in terms of its reservoir of strength."

Portraits of patients characterize his books. He describes Rachel Stein’s arduous flight home from Vietnam with her new baby Shira, whose weakened immune system almost causes her death. At Boston Children’s Hospital, Shira is subjected to a battery of tests and then placed in the ICU. "Rachel felt as if she were in one of those amusement park rides that spins you around in circles, turns you upside down, then flings you to the edge of the rail, so your eyes blur, your stomach heaves, and your mind goes blank," Groopman writes in "How Doctors Think." Though doctors later diagnose Shira with SCID, a rare disease, Stein does her own research and suggests instead that her daughter has a nutritional deficiency. Stein’s instinct proves to be correct, preventing what could have been a disastrous bone marrow transplant.

Groopman augments his vivid memories by writing down pertinent details on the index cards he keeps in his pocket and with permission, retrieves information from patients’ charts. The most difficult aspect of the writing, he says, is adding his own personal angle. "It’s very hard to put myself on the `operating table,’ but it’s important to open myself up if I want to be authentic. Otherwise it will be like describing only half the journey."

"Jerry writes with unusual vividness and lucidity about timely medical issues and is able to untangle the complexities of important questions for readers," says Emily Eakin, senior editor at The New Yorker. "He has the rare ability to translate medical jargon into layman’s English. But perhaps his most distinctive trait as a writer is an extraordinary compassion for patients and their suffering." Eakin, who talks to Groopman frequently by phone, praises his "incredible antenna for the human condition."

While Groopman is not working on a new book of his own, he will soon be editing an anthology of the best American scientific and medical writing. He’s come a long way from the assessment his fifth-grade teacher made of him: She advised his parents that their child wasn’t college material. To this day, he regrets that, based on her advice, he took metal workshop instead of typing.

At Columbia College Groopman majored in political philosophy and discovered a love of chemistry, but his feeling that lab work was "too cloistered" led him instead to medicine, which he studied at Columbia College of Physicians and Surgeons. In 1970, he spent three months in the hemotology division of Hadassah Hospital in Ein Kerem, a "formative time" in his life he remembers with gratitude. "It’s one of the reasons I became a hematologist," he says.

A midlife crisis motivated him to write three chapters of what later became "Measure of Our Days." After years of practice, he says, he had grown interested in how a person changes when facing mortality. His colleagues gave the draft glowing reviews, but his wife told him it was awful. Though he reworked it, it was rejected by 11 agents until one decided to take a chance on it. He and Hartzband will pool their efforts as consultants for a new HBO medical drama pilot, based on "The Anatomy of Hope," that explores the battle against cancer.

In his own life, the role of hope is "absolutely central," he says, defining it not as optimism, but as a "clear-eyed and realistic" outlook that recognizes obstacles and hurdles yet sees the potential path to a better future. In fact, hope and faith ground his comfortable Jewish identity, though much of his mother Muriel’s extended family — Satmar chasidim from Hungary — perished in the Holocaust. His great-grandmother sponsored the remaining survivors and brought them to the United States after the war. His father’s family, from Vilna, were Orthodox but not chasidic. As a child growing up in Queens, Groopman was tutored in "grammatical Yiddish" (it wasn’t just shmoozing, but conjugating, he recalls), imbibed an openness to the outside world, a deep love of Israel, a strong work ethic, respectfulness, honesty, and a generosity of spirit. His sister, Judith Silberstein, is now a kindergarten teacher, and his brother Leonard, a psychiatrist.

Raised in a Conservative home, he made a compromise with Pamela, who grew up Reform, when they married ‘7 years ago: "She’d keep a kosher home if I learned how to ski."

He is a "shul-goer," belongs to Conservative Cong. Kehillat Israel in Brookline, and doesn’t work on Shabbat, which he describes in Abraham Joshua Heschel’s terms as a "palace in time." He has been awarded an honorary degree from the Jewish Theological Seminary and serves on the board of the Charles Revson Foundation, a major funder of science research and education in Israel, Jewish education, and women’s projects.

"Judaism respects and also questions authority," Groopman says. "It has no fixed dogma, but constantly interprets and reinterprets. In medicine, you need to challenge and be skeptical of what appears to be a given and try to always generate a diversity of views. From that diversity you go forward with what’s best for your patient." He quotes Maimonides again: "The Rambam said there are four things that advance knowledge: chochma, wisdom; gevura, strength; osher, material resources; and anava, humility. That’s what I try to live by."

 

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