Dr. Jonathan Weinkle talks with Dr. Nina Butler about Bikur Cholim of Pittsburgh (Friends of Jewish Patients), the deep obligation of visiting the sick, coordinating practical and spiritual support for patients and families, building volunteer networks, and concrete ways clinicians can create presence and trust before diving into medical tasks.
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What does true bikur cholim, visiting the sick, look like beyond a quick hospital drop-in, and how can ordinary people (and clinicians) turn personal hardship into structured, compassionate support?
In this episode of Healing People, Not Patients, Dr. Jonathan Weinkle welcomes Dr. Nina Butler, holder of doctorates in special education and educational administration/policy, former school principal, nonprofit veteran, and the driving force behind Bikur Cholim of Pittsburgh (also known as Friends of Jewish Patients). Nina shares how her family’s multi-generational tradition of hosting transplant patients, combined with two decades of intensive hospital experience with her late son Mikey (who lived with cystic fibrosis and later received a double lung transplant), led her to formalize a 501(c)(3) volunteer network that now supports hundreds of patients from around the block and around the world.
They discuss pre-arrival Zoom intakes that turn terror into the feeling of having family nearby; coordinating meals, grocery runs, “Person of the Day” helpers, Shabbat cabinets, accommodations, and highly individualized needs (down to white vs. dark meat or gluten-free preferences) via tools like Lots of Helping Hands and WhatsApp; advocacy with hospital systems on kosher (and now interfaith) dietary and spiritual needs; collaboration with the Muslim community at Children’s Hospital; and the transferable model of grassroots community infrastructure. Nina also offers concrete, low-tech practices clinicians can use to build trust and presence before any clinical agenda, language access, team transparency, primary nursing continuity, open-ended attentiveness to what this patient actually needs, and partnership with community support systems that extend far beyond the hospital stay.
The conversation highlights patient-centered care in its fullest sense: ordinary people acting in extraordinary ways, and the power of connection against isolation and loneliness.
Top 3 Takeaways:
About the Show:
Healing People, Not Patients explores ways to enhance medical practice by infusing it with compassion, humanity, and a deeper sense of purpose, aiming to help healthcare professionals rediscover the "soul" of their work. Framed around the four questions of the Passover Seder, it probes how to transform medicine for the better, promoting an empathetic and supportive approach that empowers patients to create meaningful, sober lives, while drawing on Jewish teachings about community and friendship.
"Our theme song, 'Room for the Soul,' is available on Bandcamp at https://jonathanweinkle.bandcamp.com/track/room-for-the-soul."
About the Guest:
Dr. Nina Butler holds doctorates in special education and educational administration/education policy. A former school principal and longtime nonprofit leader, she is the face and organizer of Bikur Cholim of Pittsburgh / Friends of Jewish Patients, a 501(c)(3) volunteer network that provides material, logistical, and spiritual support to patients and families receiving medical care in Pittsburgh, whether they live nearby or travel from across the country or the world. She draws on personal experience navigating prolonged illness and hospitalization with her late son Mikey, as well as a multi-generational family tradition of hospitality and care.
Connect with the Guest / Organization
Website: https://www.bikurcholimofpittsburgh.org/
About the Host:
Dr. Jonathan Weinkle is an internist and pediatrician who practices primary care at a community health center in Pittsburgh. He strives to be a "nice Jewish doctor" focused on patient-centered healthcare, emphasizing effective communication and holistic well-being.
He teaches the courses, “Death and the Healthcare Professions” and “Healing and Humanity” at the University of Pittsburgh, authored the books Healing People, Not Patients and Illness to Exodus, and runs ‘Healers Who Listen’, where he blogs on healing and Jewish tradition. Once an aspiring rabbi, he now integrates faith and medicine to support other physicians and his own patients.
🌐 Website: healerswholisten.com
🔗 LinkedIn: linkedin.com/in/jonathan-weinkle-3440032a
📸 Instagram: @HealersWhoListen
📘 Facebook: @JonathanWeinkle
[00:00:00] While my medical school classmates were busy doing bench research between their first and second years of medical school, I decided to spend the last summer vacation of my life shadowing in the hospital, not doctors, but chaplains. My mentor that summer, Rabbi Larry Hymer, kicked off the summer the way any good rabbi would, by giving me lots of reading material.
One book in particular still frames my whole practice of medicine, Rabbi Joseph Azarovsky's To Walk in God's Ways. In it, Rabbi Azarovsky describes the practice of bikur cholim, visiting the sick, as he practices it in his role as a hospital chaplain. One story in the book made the difference. He relates a story from the Talmud, Tractate Nadarium 40a, in which a student of the great Rabbi Akiva falls ill and none of the other students go to visit him.
Finally, the rabbi himself visits the student, opens his curtains, and washes his floor. The student responds by saying, "Rabbi, you have [00:01:00] revived me." What I've taken to heart from that story is that we never know what will heal a person. There's so many needs a person has during an illness, and the 30 minutes in my office are often the least impactful thing anyone does for that person.
If the other needs are not met, my treatment won't work. Rabbi Akiva's student gets better for two reasons, the very presence of another human being coming to be with him, and the fact that someone attends to the needs that have fallen into neglect because of his sickness. If, in addition to my medical knowledge, I can provide some of that presence or relieve one of those daily needs, I'm a better healer for that.
Today on Healing People, Not Patients, we'll be hearing from Dr. Nina Butler, who has made bikur cholim the latest chapter in her life's work. My hope is that she can teach all of us how to do a little Rabbi Akiva-style healing, even us medical professionals who thought we were the experts. Stay tuned after the break
[00:00:00]
I wanna welcome everybody back. This is Dr. Nina Butler. I know Nina in more contexts than I can count. But on one foot, she is a holder of two different doctorates, one in special education and one... educational administration and education policy?
a former school principal, a veteran of the nonprofit world, where as she said she went from asking for money to giving money away, and currently is devoting her energies to the B'Cor Holim Group, which is a Pittsburgh group that is dedicated to the obligation to visit the sick.
But as we'll talk about, this is not just a matter of dropping by the hospital making small talk, or even worse, haranguing somebody- Mm-hmm ... about all the details of the medical care that they've received. This is a much deeper obligation. And you've got this whole network of people held together by WhatsApp, not a paid sponsor, although I wouldn't object if they wanted to become one.
[00:01:00] And You're doing things that go way beyond that initial visit that I talked about a second ago. So I'm curious to know how you got to this place, how you built this organization into what it is, what I know it to be today. Sure. Thank you for asking me, inviting me to be part of this podcast. It's really exciting what you're doing.
Thank you. I'm thrilled to be here. So I married into a remarkable family. You sure did. My husband, the Butler family, has been here now our grandkids are the fifth generation living in the same property actually. So Aunt Consie and Uncle Donald, the patriarch and matriarchs of this property with my in-laws were taking in patients when we first got married.
Mm-hmm. At that point, Dr. Thomas Starzl was experimenting and then perfecting liver transplant. So people were coming from all over the country, and really all over the world, for liver transplants, and Consie and Donald just [00:02:00] naturally invited them into their homes to stay, some of them for weeks, some of them for months.
Mm-hmm. So I saw Beaker-Colum modeled in a way that touched my heart quite deeply. When we ended up spending a lot of time in hospitals, our eldest son
had cystic fibrosis
and eventually got a double lung transplant and the new lungs gave him cancer, so he actually passed away from cancer. But after spending two decades in the hospitals, he was a frequent flyer, they called him.
He spent a lot of time there. I really wanted to do something constructive with feelings that, ... were really debilitating. So turning it around to become something constructive where I could do good for other people was really a blessing and, not a burden at all. I have to break in because- Yeah
I think my first real memory of your family as an adult was being on the list of [00:03:00] Mikey's emails that were coming out- Yes ... while he was still alive and in the hospital, and the joy and positivity that he brought even as he was going through this and y- I know he lost hearing from some of the medications that he had to take and just such an inspiration.
during my first couple of years of med school. So the idea of learning from a patient and being inspired by them instead of the other way around really kind of started for me with him. Aw, thank you. That's kind of you to say. Mikey, always said that he was a kid who had cystic fibrosis.
Cystic fibrosis didn't have him. Right. And he lived his life day by glorious day, and he said that so much and so often that it's actually on his tombstone. So it really is some lesson that we take with us forward and is quoted back to us by people who remember him. So being able, for example- to look a parent in the eye and from my heart, having been there, and say, [00:04:00] "Oh, your child's in the ICU? Your child's gonna get so much attention." ... it's twisting. Right. But yeah, there are some positives to being in an ICU. Mm-hmm. But only someone who's sat there before can say it in a way that creates a closeness and a comfort rather than- Mm-hmm
just sounding totally strange. Right. It's just a little bit strange. But Knowing my way around hospitals and not being intimidated by any of the medical situations that they're gonna throw at me is, something that I've been able to pay forward. Mm-hmm. And that's really what this is. It's in one way paying forward a lot of people who I like to say they were typical people who acted in extraordinary ways.
And now I'm just the ringleader bringing together people in our community who were typical people acting in an extraordinary, in extraordinary ways. Yeah. So our organization [00:05:00] started very much as a grassroots effort. And I formalized it now to be a 501[c][3]. And we now have a few hundred volunteers who are helping patients who travel here from across the country and across the world, or just from a block or two away.
Who are happy to help patients and their families with anything but what the, you do, what the doctors do. Yeah. We handle everything around that. For sure. Although there is some overlap. But so talk about what some of those extraordinary ways are.
Oh, sure. I guess where it starts, with people who are coming from out of town, especially people coming from out of the country who in many cases don't speak a word of English, and have never been out of their home country- is with a Zoom call. And I ask for the call to be on Zoom even for people who don't have the internet.
Mm-hmm. That's, and you find someone who does, and we have to meet this way. Right. I [00:06:00] start the conversation with Everyone who's coming to Pittsburgh has to be on this one call. I'm happy to deal with whoever you wanna designate after this one call, but for our intake conversation- everybody who's coming has to be on one call because it's really too much of a responsibility for any one person to tell over- ... what we discussed to the next person. And I start saying "I want you to list off all the questions you have about this trip and coming here. I'm going to list them, I'm going to read them back to you to make sure I have the whole list, and then I'm going to talk for a while.
And by the end of the discussion part, hopefully I will have answered all your questions." And time and time again even in wonderful, beautiful marriages that are so close, if you ask one spouse for their list of questions, the other one has different questions. You forgot to ask about that. Exactly.
Exactly. I can absolutely hear that happening. So that [00:07:00] Zoom call where their questions are answered- ... and I give them a realistic view of what our organization can do to support them It just makes such a difference, and I hear this from patients every single time- Mm-hmm ... that this changed the experience because they were walking in with terror- and now they felt like they have family here. That's part of the goal. So, I should say, that it seems so obvious to the two of us, but for the audience, a lot of them may be from outside the Jewish community, that for a lot of people coming in who are more observant Jewishly, finding a place where they feel comfortable to stay, to eat, to spend Shabbat, to have, especially if they're here over a holiday- those spiritual needs met. One of the things about illness that I talk about is how much that it uproots somebody- Mm-hmm ... and kind of entraps them in this narrow place where they can't be who they wanna be. And you're really providing them a moment to take a breath and expand back into themselves and into the [00:08:00] person they wanna be.
But- You know, it's interesting. Mm-hmm. Do you know that there's now data that supports- ... that if you address spiritual needs it improves patient outcomes? Oh, yeah. It's- That's why I interview so many chaplains on this podcast. Oh, well, hey, yeah. It... That's really exciting that it's not just a hunch we have.
Actually- Oh, yeah ... it's hard data. So we don't just handle spiritual needs. Very often the people who are coming is even people who are coming from the country of Israel- Mm-hmm ... might not be religious at all. So for people who are observant, they of course have issues with their food and with their observance.
But for the totally irreligious, when I offer them, "Okay, so you don't need our help with food. You'll eat anywhere." "But would you like a home-cooked meal at least for Friday night?" And they all
say, "Oh my goodness ,
that would be priceless." Because hospital food is terrible. Oh, I thought it was because they liked the warm hug we were giving them.
No. Had nothing to do with the food. It's interesting that as a policy- [00:09:00] Mm-hmm ... Beaker Home does not provide food for the hospitalized patient. Yeah. Because their healthcare insurance is paying good money for that food. And if I were to provide their food, then the hospital could turn around and say, "We don't really need- For sure
to provide kosher food. Someone in the community's doing it." So I will provide for everyone else in the family- Mm-hmm ... but for that, patient. Also, in that phone call, one reason I ask for it to be on Zoom is because I like to show them the way that I organize volunteers. And that's something that other people who are watching this podcast might wanna be in touch because it might help them in their organizations.
And I'm using a free website that we've retrofitted for our needs. But I'm so happy to share it with anyone who organizes- Right ... volunteers for any reason. And this is the Lots of Helping Hands website. Lots of Helping Hands- Which we will- ... which was originally created for patients with cancer.
But we've been using it for decades now. I think we're their biggest user. so- That's amazing ... it takes a lot of words to describe it, but I can just show it to the patients- Right ... in real [00:10:00] time, and they can see automatically what it is. So even patients who are very apprehensive about the internet and do not want any social presence will allow me to organize our volunteers that way, which- Mm-hmm
really helps because we're able to be very specific about what their needs are, right down to white meat or dark meat chicken, and they don't like raw onions. you know, and one of them is gluten-free- Yes ... and one of them's vegetarian, whatever it is. Mm-hmm. We can put every, nuance about their diet down.
it's not Meal Train. It's kind of Meal Train on speed because- Mm-hmm ... I can request anything we need this way. Mm-hmm. So we actually do use WhatsApp groups, but we also of course have Listservs, we have email addresses because we also have people who don't necessarily, sign into WhatsApp.
And so some of the things that I've seen with this is, you know, people are going grocery shopping for someone who maybe just had a surgery and, they're thinking clearly and, they might be able to do a little bit of light cooking in the [00:11:00] house.
But getting to the store and bringing the groceries to the car and all of those sorts of things is a bridge too far for the first couple of weeks and things like that. But what we actually do for that- Mm-hmm ... which I really like, and again, there's a learning curve. This came after years and years of experience.
For local people, we serve them a little differently than for the out-of-towners. So for the local people, their problem is that all their friends and neighbors are saying, "If there's anything you need, please be in touch." And all of them wanna send flowers and fruit baskets. Mm-hmm. Not helpful.
The first one is, but not the second fruit basket- Right ... and the third. Or if someone brings soup and the next person brings soup and the next person brings soup and they get nothing but, you know. Mm-hmm. So just- Of course ... coordinating it so the people who love and care about them- ... are actually doing something that's constructive.
We do organize those meals so they're what the patient wants, when they want it delivered, right down to the nuance of how it's packed. We actually did this for one of the rabbis affected from the Tree of Life [00:12:00] shooting right afterwards, and again, so many people wanted to help. Right. So being able to organize it, and when we delivered to him, he wanted it dropped off in a box outside his front door.
We can do that. We can do whatever they need. For local people, I've come around to this thing I've called Person of the Day.
So I wanna tell you about person of the day because it's something that evolves over time because there's a learning curve, and we're learning from patients and people who are supporting them how we can better be supportive. Person of the day is something we totally made up, but it's a person who calls the patient the night before or that morning, and they are there to help for the silly things that a patient might not wanna ask anybody else to do.
But they know this person volunteered- ... to be their helper for something small, something big. It could be giving the person a ride to therapy. But it can also be returning their [00:13:00] library books or picking up cleaning or going shopping at a store that doesn't deliver. it has a wide timeframe even though I write in the notes that it could be a five-minute task or it could be a two-hour task.
Usually not more than that. But it's become a real comfort to people because sometimes what they want more than anything is for someone just to come over and be there for them. Or someone to be there when they take a shower, so there's someone answering the phone and they're- present in case the person wants to feel secure in case they fall.
That there's someone right outside the door who can run in and help them. Yeah. But they're not gonna hire a nurse for that, and the spouse might be working or for some reason not there. Mm-hmm. So it's really whatever that patient needs. And we've been told again that this is something that [00:14:00] means more than the meal sometimes.
The meals on the other hand are such a warm hug. There are Bikur Cholim organizations across the country and across the world, and if you're going somewhere that you have no idea what you're going to do in that place, you can look up that term. That's why we kept the words Bikur Cholim in our name- Mm-hmm
but our other name is Friends of Jewish Patients- Mm-hmm ... in English. I do a lot of advocacy in this organization with, uh, non-Jewish administrators of hospitals. Mm-hmm. And Friends of Jewish Patients is something they understand and they can say. Mm-hmm. They can't necessarily say Bikur Cholim, and they don't understand it.
Right. But advocacy and education is a big part of what we do. Sure. So among things the organization does is, the pre-visit- ... to answer those questions, get them feeling a little more comfortable coming to town. we help with accommodations. in that phone call explain the benefits of staying right near the hospital [00:15:00] versus staying in the Jewish community.
Mm-hmm. And I say, "These are two options, but you can't do both at the same time." Right. You have to choose one or the other. And I tell them about Family House. I'm a person who's really disappointed that they- Bought and refurbished one place- Mm-hmm ... instead of having three smaller places, 'cause it served us better when they were in other hospitals Right.
we do hospital visits. We provide kosher food if they need. We have Shabbos cabinets. We have cabinets in several of the local hospitals, which are just if a family finds themselves in the hospital too close to Shabbat to run home and get what they want- ... they know there's a cabinet of emergency supplies there.
So a children's hospital includes even non-electronic toys- ... and you have no idea how hard that is to find in a hospital. And it has, Or anywhere these days. Yeah. Candles and britches. We used to look for those for regular weekdays [00:16:00] because we forbid my in-laws to get things that had buttons on them that said, "Try me.
Push me." Yeah. "Hear what I can do." Yeah. No, we don't wanna hear anything. Yeah. We have different kinds of things in the different hospitals. And this advocacy and education comes in very handy because the hospitals really do want to care about, the cultural needs of different groups- Mm-hmm
but they need some basic training. So even if they provide, as UPMC does, UPMC has kosher food you can order, but they don't totally get yet that on a meat tray they can't put yogurt and cream for the coffee. So it's a small thing, but it makes a big difference to a patient who might come from a Hasidish community that-
how could they do this? I have to calm, take a breath. The tray's still kosher. You don't have to eat that. Right. When I try to explain the Hasidish people- ... to the hospital, it's really helpful that we're in Pennsylvania, where there are [00:17:00] Amish people- ... 'cause they understand Amish.
And so these are kinda like Jews who are kind of- ... like that. Yeah. Yeah. And, I mean, you know from other conversations that we've had that I'm working with people from a huge variety of different traditional communities, from South Asia and from East Asia and from Africa and, from the Middle East.
And so there are dozens of other flavors of exactly what you talked about and folks are, maybe living here, but going into the hospital in a very foreign environment. Absolutely. Um- Can I just follow up on that for a moment? Sure. Yeah, absolutely. At Children's Hospital, we actually applied for a grant to be able to beef up the ritual supplies and the Shabbat cabinet- there, And the Steel Tree Foundation- Mm-hmm
was very generous in granting us that money. So we started to meet with hospital administrators about how to spend the money and to fulfill what we had actually proposed. And we ended up meeting [00:18:00] monthly, and with heads of
departments- ... at Children's, and
with the chief medical officer. I mean, we're meeting with important people.
And after meeting for several months, one of the people said, "Well, this would help the Muslim community too." Mm-hmm. "Because they're having trouble with halal food." Yeah. "And we probably need to be doing- Mm-hmm ... more for them." So now for a year-
the Jews and the Muslim community have been meeting together peacefully. Mm-hmm. We could be an example for Mideast peace with- Oh ... hospital administrators because their efforts to support us- Inshallah. Yeah. Yeah. What can I tell you? Yes. Mm-hmm. Their efforts to support us and improve the kosher s- standards and- Mm-hmm
availability and our support of their halal dietary needs, we just benefit one another, and we understand one another. Now, at- Yeah ... Children's, it's going to be [00:19:00] actualized in an experiment that's going to be very rare across the country, and that's the Shabbat room is not going to be just a Shabbat room.
Mm-hmm. It's going to be a room to accommodate Muslims also who like to pray in a supine manner. Mm-hmm. They need a full space that the chapel doesn't have for them. I'm not quite sure how this is going to work, but I'm willing to try anything. That's great. So that's, uh, kind of the road we're going down- Mm-hmm
at Children's, which is different than the road we're going down at the new Presbyterian Tower- ... where we have a full Shabbat room in the blueprint that's part of the plans- Mm-hmm ... and is really incredible. We're so excited about it. Right. You mentioned that that was being actually designed into the hospital.
It is, and I'm so excited. I actually asked them about it "Is there a certain number of patients or number of users you want to see in order for you to feel that this is a worthwhile investment?" And [00:20:00] they said something so shocking to me. I was told, "No, it's not about numbers. It's now, when constructing new hospitals, considered to be best practices."
Thank God. 'Cause you never know who's gonna walk in the door. and you don't wanna find out after the fact that you didn't serve one. So I can understand why it is that way. I'm really relieved to hear that it is actually that way and that it's not something that should be but isn't.
I had a very short second question I'm gonna skip over because we're still on the first one. Oh, sorry. but I wanted to come back to the subject that we've started to dip our toe in because we've heard so much over recent years. Vivek Murthy, when he was surgeon general the first time around, had his campaign against loneliness.
We've been hearing about people during pandemic time and the terrible isolation that they suffered. And this Harvard longevity study that points to relationships and social connections as one of the real elements of the glue that holds people's lives together and keeps them rich for a [00:21:00] long time.
this is pretty critical, and I get the impression that part of the secret sauce of this Bikur Holim group not that it's all about food, right? The secret sauce besides the WhatsApp is creating those connections both between the people who are volunteering and the patients that they're serving, and also among the volunteers.
so talk a little bit about how... You've already started to talk about how you've teamed up with the Muslim community in Pittsburgh for the hospital patients, but how transferable is this to other communities that may have some of the social cohesion but don't have this model, or that may be needing that social cohesion and that infrastructure that, as you said, you married into the infrastructure.
But how do you build that maybe from the ground up? You know, it's the most common comment that we hear from doctors, nurses, therapists, and from [00:22:00] the patients on either side of our patients- ... is, "Why
doesn't my community have
this?" I don't know enough about how other communities are organized.
Ours was very grassroots. And that's why I tell anyone I can, "If you want to try this, if you want to start this, I can help you. Please be in touch. Let me know- ... how I can help your community to start this." But even talking to the people in the pastoral care departments- ... they say that their communities aren't organized, other communities.
They don't know of another community. Now, at Children's, we actually started with the Muslim community because they had this dietary need. But we're in discussions about expanding to the Indian community- and some of the Asians. But they don't have an automatic cohesion like we do- Right
I think 'cause we have needs that are geographic. Mm-hmm. People need to be within [00:23:00] a certain area. Depending on their level of observance they need to congregate in a place where they can actually walk to places of worship. And our food requirements are different and stricter, it seems, than some of the others practice.
Yeah. All the same, I do see a value in particularly this, not so much the hospital, but really There's an address where you can go and say, "I need help with something." And as long as you know one person on that list, one person in the WhatsApp group, it suddenly becomes everybody's problem and everybody's job.
What I would suggest is if anybody who's watching this podcast is part of a faith community- ... this could be done in one church. and then other churches might pay attention and say, "Well, we want it too," because those churches do talk to one another, and the- Mm-hmm ... congregants might not go to just one, but might go to- Mm-hmm
two of them, or their kids might go to another one, and it can grow in that [00:24:00] grassroots way, the way that we've grown it here. I'm happy to share the websites and how we organize, but it's so easily transferable to other faith groups. Yeah. That's great. I think just knowing that, well, I have two friends, and they have two friends and we're- Exactly
and we all show up in the same place on Friday or on Sunday, we're all eating in the same restaurant with our families two or three times a week because that's where the community gathers. Having a list on the board of these are the folks that need something or they, whatever it is.
With that said, what are the biggest obstacles that you've run into over the life of this organization, the things that get in the way of doing this work? One is really for your side of the community out of mind, the doctors, and there's so much turnover in a hospital. Oh my goodness.
We have wonderful conversations. We build fabulous structure. We have- ... perfect process, and then everyone moves to other hospitals in other cities. So making lasting change is something- Right ... that's gonna continue to evolve, and the job's never done. [00:25:00] And that's, that's what I've learned, that it's refreshing to have been able to train, one hospital, but I feel like this has to just be an ongoing process forever.
And I am kind of a unicorn for having been in
the same job for 18 years. Yes. Definitely a unicorn. Another challenge is, Listening carefully enough, being sufficiently sensitive. And I'm gonna tell you a story that'll illustrate it that I'm sure people will understand right away.
This is a local patient. A local woman had cancer, and she just did not want everyone's sorrowful eyes and concerns. She wanted to be extremely private. She was actually, born in Russia- ... and part of her makeup was this privacy, which she wanted to hold- ... onto so strongly. On the other hand she was in the hospital and needed to be in the hospital over Rosh [00:26:00] Hashanah, over our high holiday, where there's a tradition to hear a shofar being blown- Mm-hmm
a ram's horn being blown. So she had two adult sons, and they said, "What are we going to do? She doesn't want anyone to know she's in the hospital." So I told the brothers to do something that's not easy, go look around her whole floor at the hospital and find one window that opens, any window that opens, one.
And then look out the window at what piece of grass is outside from there. And then I went to local guys I knew who were going to be blowing shofar for the high holidays, and I asked, "Would you be willing to walk 45, 50 minutes each way- ... to Magee-Womens Hospital from Squirrel Hill and blow shofar outside on a piece of grass- Mm-hmm
for someone who I can't tell you who she is, you won't see her, and she can see you, but- Mm-hmm ... you won't see her. You won't know who you're doing it for." I can't tell you how many of them volunteered, and they would [00:27:00] be leaving their families right before lunchtime. Mm-hmm. Their families would have to wait over an hour for them to come back, but they just felt so honored to be able to help
someone in this situation.
It didn't matter
who the person was. It really didn't matter, 'cause they wouldn't know who that person was. And that's one of the examples of things we do- And hospital security didn't come out and say, "Hey- No ... cut out the racket." No. No, I mean, That's an amazing story ... it's not about meals, and it's not about transportation.
Mm-hmm. It's about what does this patient want and need? Yeah. How can we help them to fulfill their physical and spiritual needs- ... that the
hospital isn't handling?
Yeah.
that is the essence of patient-centered care. Which brings me to the last thing that I really wanted to ask, and the real reason that I invited you is that I wanted you to bring this home, not for other communities, but for me and for my colleagues.
You know, I think you may know that I spent the summer between my first and second year of med school with hospital chaplains- Mm-hmm ... with Rabbi Haimer, who I'm sure you know well, and with [00:28:00] others in the Pittsburgh community, both Jewish and non-Jewish chaplains. And one of the things that he gifted me was a book that I referenced in my introduction to this episode about the concept of Bikkur Holim from a chaplain, from Rabbi Ozerovsky
and, who I think was, at the time in Minneapolis ,
now in Chicago. And- I wanted to think of my career from that point as, each visit being kind of like a bikor holon, even though people are visiting me and not the other way around, that you start with that connection, that creation of a shared space first, and then the medical science comes.
I think it makes the
medicine more potent. My
guest last week was talking about how letting somebody, get their lament out in the open, getting their shrining and their weeping out in the open would then allow them to heal better. And I think creating this kind of a connection is the same thing.
So what are some sort of [00:29:00] concrete things that, whether it's things that you experienced when Mikey was sick or things that you've experienced as you've been doing this work, that a healing professional can do, a doctor, a nurse- Mm-hmm ... a pharmacist, anybody, to create that kind of sense that they are visiting with somebody and being present for them before they start saying, "Well, you need to take this medicine three times a day," or, "We're gonna cut here and take this thing out."
Mm. Before they get to that, what are some things that we can do? What a great question. Wow. Creating that trusted bond is so important, and language is so important. It's remarkable to me that even the admission and discharge directions have not been translated into other languages. How can someone sign a paper and say they understand what they should do when they leave the hospital if they don't understand the pages and pages they've just been handed?
So I will say that is getting better- I hope so ... [00:30:00] because my patients who speak other languages do bring me discharge instructions that I can't read. So it is improving. I hope so. Most of the time it does look like the language that they speak. I can't vouch for it being 100%. Well, there's a wonderful thing that just- Mm-hmm
started a couple months ago, and that's through dietary. There's a link to be able to order your food on your phone. You need to get that link from the dietary department, and even the nurses don't know this. Hmm. And a lot of people in dietary don't know this, but when it's on the phone, it will translate into whatever language is on the phone.
Because your browser is unable to do that. Yeah. is able to say, "Oh, this-" There's so many little things like that ... "Would you like me to translate?" I think it's really important for doctors to care, and that involves conversation. So our end of life practices, our priorities- ... and values really play into [00:31:00] their care, and a conversation- Mm-hmm
is just so important. I've heard from the pastoral care department that their job has gotten so much harder because they used to be able to walk down the halls and visit, and they don't do that so much anymore. They need to see that someone on their admissions papers is of a certain religion- and people aren't writing what religion they're a part of anymore. Some people, I mean, there's more atheists and non-believers than ever- ... but for Jews at least- Yes ... they've gotten really afraid to write that they're Jewish- Mm-hmm ... on anything. Antisemitism is a real thing. Mm-hmm. And I, I don't know if that's come out in the conversations with your Muslim patients as well, but I know that a lot of folks are- Right.
That's right ... hesitant about sharing that, Everyone's a little afraid of that. Yeah. So being open to a conversation, and partnerships. It seems like medicine was really at the forefront of, understanding that a team can accomplish more than any one, and [00:32:00] collaboration's a good thing. On the other hand, the doctors really don't understand that a patient coming in for the kinds of surgeries that our out of towners are coming in for are here for up to a week before surgery.
Mm-hmm. They're in the hospital for- Three to five to maybe seven days, and then they're asked to stay in town for a month, maybe more afterwards. So I'm taking care of that patient from the week before to the months afterwards. They've got the patient for five, six days. Don't you think we should work together maybe?
It wouldn't be so hard. Yeah. And it will improve the patient care. So being open to it doesn't have to be with the doctor themselves. It can be with the social worker on the team. Mm-hmm. It can be with someone else on the team. For sure. Just that they understand that working together can only improve their care.
and it's just so confusing to so many patients that they see a different doctor every day, or that the surgeon- Mm-hmm ... who they love, they met before [00:33:00] surgery, and oh, this was a great surgeon. Then they have the surgery, and they never see that person again. They feel abandoned. Mm-hmm. But I thought we had something going here.
Why do they keep sending strangers into my room to check on me? Mm-hmm.
a teaching hospital sometimes it's strange and you're like, this person who's taking care of me doesn't look old enough to drive." Right. And I know that can be disconcerting- Right ... so. I don't know why there isn't some kind of visual page of- Mm-hmm ... these are the people on our team, and these are their credentials- Mm-hmm
that they hand the patient so they could be told, "You're meeting with the surgeon, but the surgeon has so many people they have to- Mm-hmm ... operate on that you might not see the surgeon afterwards. All these other people are really well-trained- Mm-hmm ... and they're part of the same team, and we're still talking," 'cause they are not getting that message.
And I'm not talking about any one practice. I'm talking about all of them- The whole system ... that I come in touch with. I gotta tell you, I had that idea when I was a resident. I also had negative 100 minutes in my week to implement that [00:34:00] idea, and so it never happened, but I think it's brilliant. these are the folks that you're being cared for.
There were class pictures of all the residents on the wall in the nurse's station. Yeah. you would walk into the nursery at McGee where all the babies were hanging out together, and there was a picture of the first, second, third, and fourth-year OB residents. It wasn't in the room. It wasn't in the patient rooms.
Gosh. Yeah. It really should be.
It's the same thing with nurses. Mm-hmm. actually, there was a wonderful practice at Children's that has also disappeared- ... which was, for the frequent flyer kids, for the kids who found themselves in the hospital more than- Right
one time or two times. Mm-hmm. They got assigned a primary care nurse, a nurse that no matter where they were placed in the hospital- Mm-hmm ... at least one nurse knew their story, knew what they liked, and- Mm-hmm ... would be assigned to their case. Our son's primary nurse is now the head of Children's Hospital.
Wow. [00:35:00] So we're just delighted that she's there- Yeah ... and that she's coming from the trenches, that she's- Mm-hmm ... a nurse. It's so- Yeah ... exciting to us. So there's a lot of little things like that, that have very little to do with medicine and insurance. Seems like so much is driven by insurance these days.
And I think the thing that you said when you were describing how the WhatsApp group works, is probably most instructive, which is just realizing that everybody needs something a little different. And asking a totally open-ended question like, "What do you need?" Is overwhelming to a person, but so is not asking at all and saying, "We're gonna do this, and we're gonna do this, and we're gonna do this, and we're gonna do this, and it's okay.
Do you understand?" And there's no room to assimilate that. So I think that some of that sensitivity to this person might want their food delivered in a box. This person might not want food, but they could really use to have you take their books back to the library. This person is gonna want you [00:36:00] to,
carefully manage their social media so everybody gets the message, "I'm not doing well. Leave me alone." Yes. And I don't- ... have the energy to post that, so here's my password. Right. Go fix this for me. We had a- patient who, spoke no English, was from another country, and the mother was s- at that bedside 24/7, and the patient was a young adult.
And she was getting more and more nervous. Mm-hmm. And one thing the doctors do, and actually medical staff in general does sometimes, is they think if they talk louder and slower- ... now the patient will understand their language. But if I was in China- ... and they spoke louder or slower to me- Chinese
I would not understand Chinese. Mm-hmm. That does not help. and she was just surrounded by Chinese. She was surrounded by a language that was unfamiliar to her. Mm-hmm. We found out that she liked to knit So I could put out on my WhatsApp group- Mm-hmm ... who has yarn, who has needles- Mm-hmm ... and get that to the mother, [00:37:00] which really changed their life.
You know, just calmed her down. I have an- ... afghan up there, I can show you that. While she was there. Amazing. So we really appreciate what doctors are doing and that miracles take place. I'm so proud that in those phone calls before they come, I can tell those patients in so many instances that we know you're a doctor, we have had- Mm
other patients, and we've seen outcomes that go beyond medicine. They are- Mm ... miracles. You are coming to a great city. You're coming- Mm ... to an excellent city for medical care. You are coming to a superb physician. And you should feel really lucky that you're going to be able to come here. You're going to leave a different person.
That's amazing. You know, thank you so much for sharing all that. I just have this feeling that as this episode spreads, I think people are going to pick up that thread and start to knit their own afghan of- ... [00:38:00] warm hugs- Aw ... for people. This was amazing.
Thank you so much. Sure. And as you always sign off after the group has solved some difficult thing in a wonderful way, you know, ordinary people doing extraordinary things, "Tiskilu Mitzvot," may you merit many more wonderful deeds of kindness ... and love. So thank you so much for being on.
Oh, Jonathan, thank you. Yeah.
[00:00:00] The phrase that will stay with me from Nina's interview is, "Ordinary people doing extraordinary things." Anyone with a driver's license can pick someone up at the airport, give them a ride to the hospital. The degree of difficulty is pretty low, even if PennDOT has closed all three bridges into your neighborhood and the tunnel that runs under it, and routed the tunnel detour traffic through your main business district.
But doing that action for a total stranger at eleven at night or at three in the morning when the person doesn't even share a common language with you, anyone can do it, not a lot of people do. The act itself might not be extraordinary, but doing it in that circumstance for that person at that time certainly is.
The bar to entry into the medical profession is a little higher than getting a driver's license, but there's still plenty of things we do in the course of our day that aren't so hard to do. Making eye contact, offering someone a tissue when they cry, asking after someone's family member who we know they're worrying about.
[00:01:00] Anyone can do it. But when we're in a hurry or when we feel uneasy around the particular patient we're with, or when we're so deep in the medical weeds that we forget we're treating a human being, not a disembodied disease, we don't do it. Our medical treatment loses the element of visiting with the sick.
Mishnah Peah is a second-century collection of laws about the commandment not to harvest the corners of your fields so the poor can take for their needs. It opens by listing things for which, quote, "There is no definite measure." One of which is, of course, Peah, this commandment of leaving the corners of the field uncut.
The Mishnah then goes on to list some other things for which there is also, quote, "No definite measure," meaning there's no maximum or minimum amount of that action you're to do. One of those things is gemilut hasadim, deeds of loving kindness. What kind of deeds are these, you may ask? The Italian scholar, Rav Ovadia Bartnura, he of the blue bottle of wine, explains, [00:02:00] "Deeds of loving kindness one does with one's body, like Bikkur cholim.
There's no limit, but even doing it once is better than nothing. To that one person, it's everything." There's another connection between Peah and Bikkur cholim. Even though there's, quote, "No set amount for Peah," eventually, someone did standardize it, one-sixtieth of the total harvest, about one point six seven percent if you're doing the decimal math.
That number shows up a lot in Jewish law, including just before the Rabbi Akiva story I talked about at the cold open. In Talmud Nedarim 39B, in that context, one-sixtieth is the amount of a person's suffering we take away when they visit them. Before you say, "Well, then just send 60 people in, the person will be cured," know that the rabbis of the Talmud already thought of that dodge.
Each visitor removes one-sixtieth of the suffering that still remains after the previous visitor left. Or as my Rav, [00:03:00] Michael Worboys, says, "It's like a mathematical limit. You can get close, but you're never gonna get all the way there." And only if it's the right sort of visit. What makes someone the right sort of visitor?
There's a phenomenon in medicine known as concordance. People build more trust and experience greater healing with a healer who is similar to them in gender or in ethnicity. But in the Darium 39B, Rav Ahar Bar Hanina speaks of a different kind of concordance necessary for effective healing when visiting a sick person, to be, quote, "Ben Gilo."
One translation of ben gilow is that this actually means to be of the same astrological sign. But as always, there's other ways to read this. Gil can mean age. One of the same age may be more co- of a comfort than someone too young or too old. Gil also means joy. One of the same temperament who enjoys the same things can provide greater comfort than someone with whom [00:04:00] we have nothing in common.
Whether that's music, prayer, or the Pittsburgh Steelers, even a seemingly trivial connection can build a bond. Gil can also be conjugated in the verb legolot, to reveal. If we're vulnerable, broken, and willing to share that vulnerability with the others, we connect in a way that armored stoicism and charmed innocence don't allow.
Galui, exposed, what happens when you decide to reveal something about yourself. Doctors are often advised to take after William Osler and exhibit aequanimitas. That's from another foreign language, Latin. It means calm, gentle detachment. Osler missed his own son's funeral, so count me out of that. Sharing some humanity, some vulnerability, while taking care not to make the visit about us can be a superpower, and that exposed vulnerability is our strength, our newfound ability to be there for each other.
It allows us [00:05:00] legolot, to discover strength we didn't know we had. I first explored these ideas about ben gilow in a talk I gave one year after the synagogue shooting in Pittsburgh to an audience of my friends and neighbors who had all experienced the tragedy from a vantage point too close for comfort, including some of the survivors.
Sometime before that, a patient had chided me that, quote, "You doctors all live such perfect lives." Well, I knew even then that it wasn't true, that the very process of becoming a healer is often a gauntlet of trauma. I had gone relatively unscathed. No longer. But I was blessed to experience post-traumatic growth and grew into, I think, a ben gil for a lot of people who used to see me in that too good to be true light To return to where we started, perhaps this is the secret sauce of the Bikkur Holim group.
These are indeed ordinary people, which means all of them have lived lives of both joy and pain, of comfort and of [00:06:00] challenge. They know what the people they're helping are experiencing because they've experienced things too. Maybe not the same things, but the larger experience that Reverend Holmen talked about in the last episode, the truth that, quote, "All of humanity has suffered."
Humanity is better when the response to that suffering is to lend a hand to another suffering person. So for my colleagues, remember, there is no fixed amount. Hand a person who isn't moving well their purse and coat as they leave the exam room, or even help them put it on. Put a hand on a shoulder while they cry and shut your mouth for a minute.
Escort them to the door and make sure they get what they need at checkout, but don't hover over your office staff. They need to know that you trust them to also be good healers. You are, of course, an extraordinary person. But today, try doing an ordinary thing in an extraordinary way and watch how much better it makes your patient feel