Practice what you preach. Put your money where your mouth is. Do unto others as you would have others do unto you. Love thy neighbor as thyself.
Any of these sayings sound familiar? I came up with them in about two seconds, but I’m sure there are many more of a similar sentiment. They are intended as rules to live by. As far as following the rules go, I have generally been pretty good with the ten biggies - one God, keep the sabbath separate, don’t kill, steal, covet, or commit adultery - and I’ve managed some of the other 603 also - my sons are circumcised, I give to charity according to my means, I did not intermarry with a gentile, especially not a Moabite or an Ammonite, I have not even castrated my dogs, and as a physician I try to use all means available to me to heal my patients. All of these are included in the 613 commandments in the Torah. And interestingly, I am not much of a biblical scholar. I looked up the list of the 613 to see which ones apply to me (as I am not a Cohen or a Levite or a Nazarite or a man), I found that of the ones that do apply to me, I’m doing a fairly decent job. And I think I do a fairly decent job because I happen to be a fairly decent person, and the Torah asks us to be just that: fairly decent people.
When we follow the commandments, what do we receive in return? Well, nothing really. We receive the benefit of having a good life in which we follow the rules, honor and respect ourselves, each other, and God, and know that we are doing our best to “guard diligently [our] soul[s].” (Yet another commandment).
In recent years, I have been working doing many different types of evaluations for different types of courts: family court, immigration court, sex offender court, even municipal court on one occasion! All sorts of cases come my way, and I always tell the lawyers the same thing: “I will be happy to evaluate your client, but I may not see the case the same way that you do, and I may not be able to help your case.” Shakespeare recommended that we kill all the lawyers, and it may have not been a bad idea (with the exception of the thou-shalt-not-kill part), but in the morass of amorality out there, I have encountered quite a few attorneys who manage to practice ethically and sometimes even amazingly. So I continue to accept cases with the possibility that I might disagree with what the lawyer needs, and they must take that chance. Most are fine with the concept, and of course, some are not. That’s okay, because there are so many suffering humans out there that there will always be another case to evaluate for the court.
But here’s the thing: After years of making extremely specific recommendations for what people need in order to be better mothers, or less dangerous, or less depressed, stoned, or drunk, I have discovered that many times the recommendations get only as far as the court. They are used for some legal purpose, and once that purpose is achieved, the individual whom I’ve just evaluated gets none of the interventions or treatment that he or she needs in order to improve his or her life.
So a few months ago, or maybe even a year ago, I made a fairly drastic decision. I would accept for treatment only, or primarily, those patients who could never afford a doctor like me on their own. I would not build my treatment practice around the worried well who were convinced they had adult ADD and would pay through the nose for their monthly stimulant prescription, or pretend that I could cure grief with Prozac. Instead, I would see adolescents and young adults from a group home, and make sure they got not only the medications they needed but an ear to listen to them. I would see the abused children or battered women who had lost everything and who were being “treated” with nothing but mountains of pills. Occasionally I could see some patients for free, or get paid something out of someone’s grant, or accept a token $10 as payment. This treatment practice would be a sideline - something that I could do for the sheer pleasure of it, like having a third child.
Eventually, I realized I had to start accepting Medicaid, because I had to at least pay my overhead for these cases, and that’s about what Medicaid covers. Should I be actually donating money as well as time to these patients - in other words, paying my assistant and my rent and everything else and getting nothing for it? Would that make me a better person? I don’t think so. These patients are lucky to have some kind of health insurance, and believe me, no clinic that has a nurse see eight psychiatric patients an hour and bills for a full psychiatric appointment with the psychiatrist who was not even there that day is worrying about not being considered “nice.”
Referrals poured in. Some very damaged and traumatized individuals came to my office. I did what I could for them, and they kept coming back. They got better. They got jobs and graduated school. And I admit it - I felt good. The way I understand the commandments, you are not supposed to do them so that you feel good for doing them - you are supposed to do them just because you are supposed to do them. But there is something about helping people who are less fortunate, really helping them, on an individual level, that just makes me feel good. Don’t get me wrong - I love to make money and I’m happy to get patients who can pay - but if they don’t have a real psychiatric problem, I won’t tranquilize or stimulate them and then lie on the insurance form. I prefer to make less money and know that I am making a difference.
Is this false pride, or hubris - something that definitely is not part of the 613 commandments? Is it wrong to take pleasure in making somebody else feel good? I certainly know lots of people who take pleasure in making other people feel bad - after all, I am a forensic psychiatrist and I’ve been around psychopaths and sadists my whole career, on both sides of the security perimeter. But there is something about being able to actually treat the patients who need the help the most, and who are the least likely to get it, that is very satisfying for me as a psychiatrist. I wish more of my colleagues would do what I do. I hear too many stories about people who lost their jobs and insurance and can’t afford to pay the psychiatrist the $150 he wants so that the patient can fill his $4 prescription at Walmart. How can any doctor be so cold? I was already 21 before I ever heard the expression “What comes around goes around,” but I started teaching it to my children when they were born. I think that the creator of the 613 commandments understood this idea. Whether you believe that the Torah is the direct word of God or made up by people, those 613 rules have a logic to them that is inescapable. Treat the world as you would like it to treat you. There will always be bad guys. But ultimately, in some small way, what comes around will go around again. So if you’re a doctor, sign up for Medicaid, and do something for those people who cannot do for themselves. If you’re a lawyer, don’t steal your clients’ escrow money. If you are a vet, do what our vet did, and let the grieving family stay in the room and cry while you gently inject permanent sleep into the sick and dying dog. If you are a waitress, know that calling the customers “hon” goes a long way! Do what you can to make someone else’s day a little better, even if you are feeling horrible. You will feel better. And you will even sleep better at night. I do.
