Preface

This is a book of memoirs. Its building elements are stories from my life, my experiences. Some touched my very soul and influenced the most important decisions in my life; others carry a simple message or a moral.

Many people contributed to my professional career: teachers, pupils, colleagues, patients under my care and my family. I owe all of them a debt of gratitude and would like to express my feelings of appreciation and thanks for their contribution. Among these, my wife Milka and my children Yifat, Dorit, Limor and Avishai occupy the most prominent place. They gave me all their love and support, and accepted with patience and understanding the harsh reality that kept me busy and usually away from home. They encouraged me to write this book and helped me to edit the material.

Throughout the entire text I tried not to offend anyone. For the most part, I believe, I succeeded; although criticism could not always be avoided. If, in spite of my efforts, some individuals will take offense, I ask for their understanding and forgiveness.


I do not remember whether I ever consciously “decided” to become a doctor. This decision must have been inborn, although there were at least two factors that helped strengthen it. One was my mother. She was a strong-willed woman, with a legendary power of persistence. It was clear to her, even before we were born, that both her sons (my younger brother and I) must and will be physicians. Any other turn of events was out of question. Any thought that we may, perhaps, choose some other profession or occupation, simply did not cross her mind.

In pre-war Poland it was difficult for Jews to be admitted to universities, particularly to medicine. Many were rejected because of “numerus clausus” - limitation on the number of Jews that were permitted to study at universities. Friends asked my mother: “What if they will not be permitted to study in Poland?”. To this my mother had a ready answer: “Then I will send them to England or to Switzerland. Here or there, they will study medicine”. Such were her dreams. But life refused to cooperate. Instead of studies in Switzerland, came World War II and the Holocaust (Fig. 1).


The second factor was my uncle Joseph (Józek), my mother’s younger brother. He was not accepted for studies in Poland and studied medicine in Italy. Józek was a charming person, friendly and full of joy. He played the guitar and the violin, painted (some of his paintings decorated our walls), sang beautiful Italian songs, and in a most entertaining way, explained secrets of the human anatomy or of the Italian language. Everybody loved him. I was attracted by his company and, as a matter of fact, saw in him a prime example of an ideal human being. Whenever he came to Poland for vacation, I had a real holiday.

I believe that somewhere in the depth of my subconscious, this self-identification with Józek, my love and admiration for him were of crucial influence in my decision to become a doctor.
During the war and the German occupation, in his assumed new identity as a Polish-Christian, Józek became a member of the Polish underground movement Armia Krajowa. He participated in the Warsaw Uprising and, regrettably, was killed in September 1944. He was awarded the Polish Cross of Valor (Krzyż Walecznych) posthumously. To him I dedicate this book (Fig. 2).

During my studies in high school, my mind was already made-up. I wanted to study medicine. Nothing else would do. For the time being, the general term “medicine” sufficed, without further analysis. However, at that time I read several books about famous physicians and their discoveries. A particularly fascinating one was Paul de Kruif’s “The Microbe Hunters”. Dramatic descriptions of tropical diseases and the excitement surrounding the discovery of microbes and parasites, all these brought me dreams about a career of science and exploration. Why shouldn’t I become part of the wonderful worlds of discovery? Why couldn’t I be one of those who uncover these worlds and thus save thousands of lives? Later, during bacteriology studies at the University, I saw this exciting field in an entirely different perspective. Bacteriology appeared to me a boring routine of inoculating colonies of microorganisms on agar plates and growing cultures; plenty of dull routine and very little drama. I enjoyed studying anatomy, histology and pathology and at some time even considered making them my career. But bacteriology and parasitology, as seen closely, did not attract me. I studied enough to pass the examinations, but a career of preparing culture media for microorganisms had no appeal to me.


A dramatic change took place at the outset of my clinical studies. Contact with patients, listening to their histories and examining them, and finally, clinical analysis and treatment spoke directly to my soul. All remnants of my dreams about research and discoveries vanished without a trace. It is impossible not to relate this change to my teacher, Professor Moshe Rachmilevitz, chief of the Department of Medicine in Hadassah. He engraved his unmistakable mark on students’ minds: the understanding that there is need for clear thought and simple logic (“clinical logic” - his favorite expression). In particular, he taught his pupils how to distinguish between the clinically important and the insignificant. “Retain the important and dispose of the rubbish”. Moshe Rachmilevitz taught me to love clinical medicine. During my studies under him, there was almost no doubt in my mind that in the future I will be an internist.

Surgery was different. I was not nearly as attracted to it as to internal medicine. As a surgeon, it is now embarrassing for me to confess, but after the period spent in the Department of Medicine, my rotation through Surgery was rather dull. This was not due to the nature of surgery itself, but rather because of the way we were taught. On Medicine, every student was in charge of a number of patients, had to participate in their diagnostic workup, try to diagnose the case and suggest treatment. On Surgery, the students were supposed to admit patients, obtain their clinical history, do complete physical examination, and then present them at the bedside rounds. During presentation we were asked questions supposed to arouse interest and to help in our studies. But in contrast to Medicine, the clinical workup was limited, and entirely in the hands of physicians. Students could ask questions and received instructions. But the feeling of being part of the team was missing. Our role was passive. My function as a student in the Department of Surgery did not stimulate a desire to become a surgeon.

This changed completely upon my return to the Department of Surgery two years later, as an intern. All patients on the service were now under my care, and I had to suggest their diagnostic workup and treatment. Participation of interns in operations was very limited, and usually not beyond holding retractors, sometimes for long hours. However, if I prepared myself beforehand by reading relevant material, I understood what was going on and the procedure itself was interesting.

Moreover, in Surgery I could immediately see the results of treatment, and they were much more definitive. On the medical service a patient discharged after treatment for a congestive heart failure can return two weeks later with the same problem. Feeling of disappointment is then unavoidable. But a patient, who undergoes resection of a gallbladder full of gallstones, does not return with the same stones and the same pain. Surgery is much more dramatic and decisive, features that befitted my taste and temperament. My rotation as intern in the Department of Surgery was therefore crucial in choosing the field of medicine appropriate for me.