Treating the whole patient
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Treating the whole patient

Englewood Hospital and Medical Center’s Jewish doctors, administrators, and donors talk about what they do, and why

Like just about everything else in this world that matters, there is some tension about how best to treat a patient.

Someone with an illness needs a specialist who has devoted years of study, apprenticeship, thought, emotion, and single-minded devotion to it. The more unusual or specific the condition, the less a generalist can contribute to curing or even containing it.

On the other hand, a person with an illness is not a symptom or body part, or even a biological system whose main purpose is supporting that symptom or body part. A person with an illness is a person, and has to be treated by other people who understand that basic human truth.

Englewood Hospital and Medical Center’s goal is personalized medicine; it is on the cutting edge of a movement to look at patients first as people, albeit as people with challenging illnesses that must be treated as thoroughly and as well as possible.

Fine, you think, but what’s so Jewish about that?

First, there is the basic, overarching Jewish mandate to value life. From the Deuteronomic demand that given the choice between life and death, between blessings and curses, that we choose life, from the talmudic assertion that saving one life is like saving the entire world, from the necessity of redeeming prisoners because their lives matter to themselves and to their community, we are taught that we must care about every single person, every single patient.

And then there are the specifics. Englewood Hospital and Medical Center’s president, Warren Geller; Dr. Steven Brower, the surgeon who is the head of its new Cancer Treatment and Wellness Center, and Jen Graf, who with her husband donated the Graf Center for Integrative Medicine there and is intimately involved with it, all are Jewish. All of them are deeply devoted to personalized medicine, and each one of them sees his or her values displayed through that work.

Humanism is the philosophy that makes the medical center run, Mr. Geller said. “It is about the whole patient and the whole family. You can’t just look at the patient. And that’s truly how we differentiate ourselves.

“Anyone with a few shekels can buy the latest and greatest technology, but you need the right vision to attract the right experts, and you have to do things in a different way, and in a humanistic environment.

“We have these words on our building — the Russell and Angelica Berrie Center for Humanistic Care. We live by that — by humanistic care — every day.

CEO Warren Geller talks with a patient.
CEO Warren Geller talks with a patient.

“You have to treat people the way they want to be treated,” Mr. Geller continued. “It can be a cultural or a personal thing. Some people want a warm hand on their back, others want a handshake, and others don’t want to be touched.” And once you’ve figured out that someone does like a more intimate approach, “it takes the same amount of time to sit on the edge of a patient’s bed, give their foot a squeeze, and ask how they’re doing as it does to lean against the doorway and ask the same question, but you’ll get a completely different response.”

The medical center has made a huge investment, “well north of $90 million,” Mr. Geller said, in new space, technology, and departments that further its goal of humanizing medicine and emphasizing wellness, encouraging relationships that go well beyond illness to encompass much more of life. The wellness center, which is part of a new addition to the Berrie Center, will house “all the experts and the latest and greatest diagnostic tools, all under one roof, for a collaborative approach to care.”

Everything will be in one place, he said; at least some of the stress of managing an illness, the logistical part of it, will be reduced.

“We look at three components, the experts, the technology, and then humanism, wrapping them together. “We want to be here to answer your questions; we know that when you are in crisis mode, that is a difficult time to make decisions.”

The experts and the technology are the purview of Dr. Brower, whose innovative work in genetics and demographics, supported by grants from the National Institutes of Health, reach out into the community. The humanism is exemplified by the Graf Center, “which is a perfect example of offering not just what people would consider traditional medicine, but looking at the whole person and the wellness side of their care, from massage and stress management to yoga for patients and caregivers.

Dr. Steven Brower, chief of surgical oncology, and Dr. Mark Shapiro, chief of radiology, review images before presenting the case at a cancer conference, where the patient’s treatment plan will be discussed with the disease management team.
Dr. Steven Brower, chief of surgical oncology, and Dr. Mark Shapiro, chief of radiology, review images before presenting the case at a cancer conference, where the patient’s treatment plan will be discussed with the disease management team.

“We want to treat people outside our four walls, and the way to do that is to look not just at the illness but at their overall lifestyle, and help them make better decisions. To really be seen as partners in care.”

Mr. Geller is part of the community too, he said. “I live in Demarest, and I belong to Temple Emanu-El of Closter. I love running into our constituents, the patients we serve, our donors, our board members — the whole community. It’s a great position to be in.

“We decided to launch this modernization project several years ago, and we wrapped a capital campaign around it,” he added. “It is not a traditional campaign. Usually you go out and raise some funds, and then the buildings start to go up. But the need for the cancer and wellness center is pressing. We are an aging population in Bergen and Hudson counties. We’re not growing quickly — we are aging more quickly than we are growing, more quickly than in other parts of the country. We are densely populated, and the birthrate has been relatively flat.”

That means that our need for health care is rising too. “When you are over 65, your chances of having to fight even one form of cancer go up exponentially,” Mr. Geller said. But, he added, there is no need to give up hope. “The wonderful scientists and clinicians of the world have taken what traditionally was a terminal illness and made it chronic for many disease sites.” That also means that we need more doctors, more health care workers, more medical facilities, and more ways to treat the stresses, fears, and implications of long-term illness.

“So our leadership took a bold step; in June we announced the public phase of a $50 million capital campaign. We are incredibly grateful to the community, which already has raised $26 million. We are well on our way, and the extraordinary generosity of our benefactors and friends is overwhelming. We are way ahead of schedule and below budget, and that helps us make sure that we can deliver services to the community more quickly.” In fact, some of the new offers were available a good year and a half early.

“Medicine is changing,” Mr. Geller continued. “We traditionally have been in a transaction-oriented service business, and now we are moving to more proactive care managing. We are making sure that it’s a two-way dialogue, that patients understand the plan of care, that we are getting to them faster, giving them more efficient care, reducing the cost of health care — and that we’re using a collaborative approach.”

To that end, in April Englewood Hospital and Medical Center “signed a strategic partnership agreement with Hackensack University Hospital,” he said, and the partnership will be both academic and clinical. “We are proud to work together with Hackensack to reduce the overall cost of care, collaborate across disciplines, and help people stay at home.

“We are going to be a teaching hospital, and we are going to increase the number of medical students and interns we have, in coalition with Hackensack and the medical school that Hackensack will open at Seton Hall.” (That also means that Englewood is ending its affiliation with Mount Sinai.)

Part of his responsibility, he added, is creating an environment that will encourage “the next generation of doctors,” the young people who grew up here, went off to college, and are now graduating from medical school, “to stay at home.

“Five years from now, a quarter of the physicians in our community could be 65 of older, so we have an inherent responsibility to recruit the next generation of experts,” he said.

Mr. Geller acknowledges that it’s far easier to talk a good game than to deliver one. “We can’t say that we are going to do things in a certain way and then have patients have a completely different experience, or not have access to the experts,” he said. “We challenge ourselves every day, and we pride ourselves on efficient engineering. We bring in outside pairs of eyes to everything we do — from the earth-tone color of the walls, through natural light, to more private rooms, state-of-the-art operating rooms. When technology can flow beautifully and seamlessly in one operating room, that’s transformational. When you come out of hip replacement surgery and you go to a large private room, with rehab on that floor, and beautiful views from the window, that’s a healing environment.

“We are treating more people than ever before in our history,” Mr. Geller concluded. “For the second consecutive year, we were rated number one by the Leapfrog Group, a key rating agency, for patient safety outcomes. It’s no longer about the traditional four walls of a hospital. It extends far beyond that.”

Dr. Brower, who came to Englewood from Beth Israel in Manhattan, via a path that started in Valley Stream on Long Island and wound through Scarsdale, Atlanta, and a great deal of work at the NIH, was drawn to his work by two different magnetic pulls.

As a medical student at the University of Buffalo, “I saw an incredible doctor,” his mentor, “examine patients with compassion and empathy like I’d never seen before,” he said. And the patients this doctor was examining had cancer, “and I had been interested, even as an undergraduate, in how normal cells became abnormal.” Put those two things together, “and that did it for me.

“I cared about both those things, and I became passionate about surgery, and about my ability to impact on patients with cancer by doing my craft,” Dr. Brower said.

Compassion is critically important, he added, and that is particularly true now. “It used to be that a doctor would sit at the end of a patient’s bed for a very long time, watching the vital signs go down,” he said. Now no doctor would have time to spend all those hours just sitting — but now vital signs do not always decline, and doctors have more in their toolboxes than patience and sitzfleisch.”

The cancer center is focusing on personalized medicine. “I came here to Englewood because it is an amazing cancer center that is totally committed to special populations,” Dr. Brower said. “Ashkenazi Jewish people, and Korean and other Asian Americans with high-risk disease.

“There are various risks associated with these populations, so I have the opportunity to hone in on them. And I inherited a team committed to laser focus at niche diseases.

“It’s all about personalized medicine, he continued. No one therapy can be “a magic bullet. It’s a ballet. We have to offer the appropriate therapy at the appropriate time, and to withhold treatment that might not be as effective for some patients or have intolerable side effects.

“So we look at the population, and focus on genetics.

“It’s unique to this cancer center,” Dr. Brower said. “Others are looking toward this kind of focus, but with our genetics program we have the experts in genetic counseling.

“One in 40 Ashkenazi women will have the gene that is responsible for the development of breast cancer,” Dr. Brower said, talking about the BRCA1 and BRCA2 genes. “I believe that any woman with breast or ovarian cancer should seriously consider being tested for the gene.” That’s because the likelihood of her developing another cancer goes up if she has the gene, and so does the chance of her close relatives being diagnosed with one of those cancers.” It is not rare for non-Ashkenazim to have the mutation, he added, it’s just more rare for them than for us.

And it doesn’t stop there. “We are starting to uncover a whole array of genes that are related to high risk that are not BRCA but still affect the Jewish population.”

Because the patents on the tests that look for BRCA genes have run out, the procedure now is far less expensive and easily available, he added.

Jews also should be aware that colon cancer “is very common, perhaps the second most common, and there are genetics that relate to this,” Dr. Brower said. “We call these genes Lynch syndrome or mistake repair genes, and they are found in both men and women. If you are identified as having it, you also incur a significant risk of endometrial or breast cancer.” It is important to be tested for colon cancer, he said; this is not news but should be said again and again because it matters so very much.

So far, about 10 to 15 percent of cancers are known to have a genetic component, “and I wouldn’t be surprised if one day that is as high as 50 percent,” Dr. Brower said. That’s why any patient considered to be high-risk is urged to work with a genetics counselor on drawing up a sort of family tree, called a pedigree, and match that with the result of blood tests to determine what action to take and who else in the family might be at risk and should become vigilant.

“We have a unique relationship with the National Cancer Institute, doing research on men and women with breast and colorectal cancer,” Dr. Brower said. “We do research to see how they react to specific drugs, radiation, chemo, even the timing of their surgery.” It’s an in-depth look that produces a lot of data, all highly personalized, all sent to the lab for further analysis.

Dr. Brower and the staff at the cancer center also perform trials. “You are trying to extend life and survival,” he said, but the trials do not always help the patients themselves, instead adding information that will help other patients, down the road. Patients know that, Dr. Brower said, and he always wants to thank the patients whose courage and selflessness add to the store of knowledge from which we all can draw.

The program at Englewood Hospital and Medical Center has three pillars, he concluded. “Clinical excellence, research, and education.”

Dr. Brower’s Jewish background — he grew up Conservative, joined the local Reform synagogue in Scarsdale because its rabbi was the remarkable Rick Jacobs, who now is president of the Union for Reform Judaism, and now is a member of the East End Temple, close to his Manhattan home — is never far from his surface. Of course, the center focuses on Ashkenazi Jews, among other groups. Beyond that, “I think about how music and art can carry you through difficult times,” he said.

There often is a musician in the hospital’s main lobby. That’s because of Dizzy Gillespie, the legendary jazz trumpeter who lived in Englewood and died in the hospital there in 1983. His gift to local musicians was a memorial fund that helps provide medical care to un- and under-insured musicians; his gift to hospital patients and visitors is the musicians who play there every day.

Patients’ art is displayed throughout the building, in a program that the hospital runs with the Old Church Cultural Center in Demarest.

“Music and art are related to the question of how you get through the most challenging aspect of your life,” Dr. Brower said; Jews confronted those questions across our history, and patients confront them during the course of their illnesses.

CIM_EntryThe Graf Center for Integrative Medicine, another new wing of the Berrie Center, is a calm place, with beautiful dark cyprus floors, large windows, subdued lighting, restrained colors, soothing New Age music, textures that make a visitor want to touch them, massage rooms, yoga rooms, and an overwhelming feeling of refuge and peace.

Jennifer Graf and her husband, David, who live in Cresskill, donated the center. Ms. Graf, who started her career as an advertising copywriter, is a licensed social worker who has been leading stress management programs for 7 years and has been in private practice for about 15. “I do mind-body mediation, relaxation training, mediation-guided imagery, stress reduction, and couples therapy,” Ms. Graf said. “Even before that I had been a life coach. I also have training from the Albert Ellis Institute in cognitive behavioral therapy. It all falls into the same mind/body connection. It’s what we do to and for ourselves.”

Jennifer and David Graf
Jennifer and David Graf

Until September 11, 2001, the Grafs lived in Manhattan, but after the terrorist attacks, “I said, ‘You know what? Let’s move to the burbs,’” Ms. Graf recalled. “I grew up in Teaneck, my husband grew up in Englewood, and I had resisted, but we were coming back home.

“David has a marketing company, my mother lives in Teaneck, his mother lives in Fort Lee, and we love Bergen County,” she added. The family — the Grafs have two daughters, Amanda, 14, and Caroline, 10 — belong to Temple Sinai in Tenafly, where they are “fairly active,” Ms. Graf said.

Settling down into suburban life, the couple starting “looking around to see where we could make a difference, and we got a phone call from the foundation office,” she said. That’s the Englewood Hospital and Medical Center Foundation. “This was our hospital growing up, and I am health-minded and so is my husband, so it just made sense,” she said. Establishing integrative medicine at the hospital became her cause.

“Integrative medicine is anything that complements traditional medicine,” Ms. Graf said. “It’s anything that restores the body’s balance; the nervous system balancing the parasympathetic system with the sympathetic system, so reducing stress. It could be acupuncture, Reiki, massage, eating well nutritionally and holistically. It could be exercise, whether it be yoga or any kind of movement, or meditation-guided imagery. All of these things are different routes to get to the same place — balance in the body and in the mind.

So she started the center, teaching a few courses herself. “At first, it was amorphous, just a couple of rooms,” she said. “There was no real physical center for it, and no one really knew about it. I have a friend who is a party planner, and she said, ‘why don’t you do some fundraising?’ I didn’t know what I was getting into, but the first fundraiser we did blew the doors out, and the hospital said, ‘Wow. People really want this.’

“We raised money, and we also raised awareness,” she continued. “Warren Geller always was a big supporter.”

The Graf Center offers massage therapy to patients, their families, and the community.
The Graf Center offers massage therapy to patients, their families, and the community.

About two years ago, the stakes were raised when Mr. Geller and some board members called Jen and David Graf to a meeting. “We walked in and sat down, and they showed us the David and Jennifer Graf Center for Integrative Medicine,” she said. “And I was like, ‘Whaaaat…’ I got chills. And they said that you could have this, all for the very low price of eeeeehhhhhhhh……

“And then my husband said, ‘Oh God! We have to think about it.’ And we thought about it. And it was my dream. My husband is very philanthropic, very generous, and for me, professionally and personally, to be able to help provide this to the community…” Momentarily wordless, even retelling the story years later, she threw her arms open instead.

“And I also had my own run-in with breast cancer, and during my own surgeries I used Reiki, acupuncture, and other things. Medical research shows that it speeds wound healing, reduces cortisol levels, improves the body’s immune functions, and makes you feel better and get through the process better. So aside from all the research that shows that it’s effective, I also know that it works for me.”

Ms. Graf worked with architect/designer David Lawrence to design the center. “I have a particular vision and style, and I know that aesthetics matter,” she said. “I wanted it to feel very Zen. Very peaceful, as if you’re not in the hospital. The ambiance, the music, the water features, all the natural materials, the stone and wood. It feels very organic. We sprinkle magic dust.”

The center offers its services to patients, caregivers, families, hospital staff, and the entire community. “Physician, heal thyself,” Ms. Graf said. Hospital staffers often use the space as a place to find some peace, to take a few minutes to themselves, to process whatever horror or trauma or simply intense emotion they’ve seen or felt. Before the center was built, often they’d look for refuge in the chapel, but increasingly they seek it in the center’s natural, serene space.

And then there’s the Jewish aspect. “Giving back to the community is a Jewish value,” Ms. Graf said; part of the joy she takes from her gift is because of that value.

Learn more about the Graf Center at (201) 608-2377.

Abbey and Steve Braverman
Abbey and Steve Braverman

Yet another Jewish family, headed by Steve and Abbey Braverman, of Englewood Cliffs, is about to open the Braverman Family Executive Wellness Program. That program, slated to begin on January 13, offers a concierge service that allows time-stressed people a day of health evaluation, entirely personalized and absolutely thorough. It’s a service — a luxurious one, to be sure — that allows people who often do not give themselves the luxury of time to make only one appointment and through that appointment have all their health risks assessed. To learn about the Braverman program, call (201) 608-2344 or email bravermanwellness@ehmchealth.org.

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