Acharai! (Follow me!)

One fixture in our household during my formative years was the World Book Encyclopedia, which was sold to us by my Mom’s Uncle Saul.  One day, Uncle Saul gave us a pre-print of the upcoming World Book article on Lyndon B. Johnson, who, as prescribed in the United States Constitution, had recently taken up residence in the White House following the assassination of President John F. Kennedy.

My penmanship was poor even back then (a trait I have traced back at least four generations in the course of my family history research), and it was subjected to much chronic report card critique by my teachers at school.  In perusing the World Book preprint, I immediately noticed that President Johnson’s specimen signature did not comply with the Zaner-Bloser penmanship standards that were part of the student curriculum for all grades one through six.

Shortly thereafter, the inevitable teacher’s comment anent to my penmanship was proffered; my response was, “President Johnson’s handwriting is not so great either.”

Positions of authority or privilege carry expectations of responsibility, and the shortcomings of those who occupy such positions rarely escape notice.  It goes beyond an American schoolboy such as my younger self rationalizing poor penmanship by using the President of the United States as an exemplar; here in Israel the recent flouting by governmental officials of their own emergency COVID-19 orders has gained notoriety.

And the responsibilities percolate down far below the high levels of presidents, prime ministers, and Health Ministry heads.  The United States Tax Court makes note of the fact that the taxpayer whose tax disputes it adjudicates are current or former Internal Revenue Service employees, including Revenue Agents or Tax Compliance Officers (as a former IRS attorney, this also would apply to me if my own tax issues ever were to come before the Court); indeed, the fact that a criminal tax fraudster happened to sit on the bench of that very Court played as a particularly egregious factor in computing the jail time to which she was sentenced.

Before collecting the taxpayers’ monies as an attorney for the IRS, I was spending the US Government’s dollars as a Contracting Officer and analyst for the Department of Defense; this included (in what I can only surmise to be some sort of punishment for some misdeed in a previous gilgul) a year as a Branch Chief to whom 28 people directly reported.  In addition to the 28 annual evaluations of my respective subordinates, it was my obligation during the fire drills to ascertain that all of my people had safely departed before I myself could exit to safety outside of the building.

Being a physician carries its own set of obligations and expectations.  It is true that the technological advancements in medicine over the past half-century have shifted the doctor’s role from the model of an autocratic authority whose word is questioned at one’s own peril to a collaborative leader whose decision process must give due regard to input from specialized non-physician professionals.  That shift has placed increased responsibilities and expectations upon the shoulders of diverse healthcare professionals, including but not limited to nurses, physicists, technicians, and administrators.  Healthcare is delivered ever increasingly by organizations and less by physicians alone.

Physicians still direct the healthcare delivery process and are still subject to some weighty obligations and expectations, but members of their supporting casts now have greater input into the process than they did a half-century ago.  The current COVID-19 situation has boosted the visibility and import of the entire healthcare system, and has enhanced the societal visibility not only of physicians, but also of the allied healthcare professionals with whom they work.  Nurses and others who treat CoronaVirus patients are now viewed in a heroic light.  Concomitant with the elevated visibility of the allied healthcare professionals are obligations and expectations.

Dr. Tamara Weiss, a radiation oncologist at Beilinson Hospital in Petach Tikva, is unique as far as Israeli physicians go, even when discounting the fact that I have been married to her for more than 30 years (and still at it); I claim neither modesty nor objectivity when discussing Tammi.

My wife happens to be the first – and thus far, the only – person in Israel to receive the Certified Professional in Patient Safety (CPPS) designation.  Her patient safety focus is the lens through which she has long viewed almost all aspects of medical practice.

The Jerusalem Post’s Monday 20 April 2020 “Letters to the Editor” column included three letters written by medical doctors, including a letter from Tammi.  When reading the Post of the previous Friday, Tammi, with her patient safety bent, could not help but notice that the photograph illustrations of various articles depicted people wearing –  properly and otherwise – the now mandatory face masks.

[As mentioned in the prior posting of 17 April, the issue of the use of face masks pervasively recurs in the ubiquitous discussions regarding the WuFlu virus; mandatory masking is likely to be with us for at least another year and possibly quite longer.].

Tammi’s letter to the Post notes that an article regarding the COVID-19 testing by the Health Ministry is illustrated with a photograph that showed a MDA paramedic improperly wearing his own face mask.  The letter goes on to say, “In the same edition, the picture in Mahaneh Yehudah shows people demonstrating correct mask use. The picture in the High Court article shows the chief justice and stenographer with masks under their faces, another judge with the mask under the nose, and a judge and attorney wearing masks correctly.”

[It is parenthetically noted that courtrooms do not seem to be among the places that are exempted from the mask requirement.].

Tammi’s letter concludes, “We as healthcare providers need to model the behavior that we want the population to follow.”

Israel has chosen to take a high and rough road in order to maintain its military effectiveness.  While officers in other armies order their troops to “Charge!” ahead, Israeli officers order “Acharai!” (“Follow me!”). This entails high personal risk for a military officer; indeed, the officers corps of the Tzahal have paid dearly for Israel’s military superiority, nay, Israel’s very continuing existence.

It is the healthcare providers who lead us in the war against the COVID-19 pandemic; the very fact that they work in hospitals increases their risk of contracting the disease even if they do not directly treat COVID-19 patients.  Family members of healthcare professionals, myself included, are derivatively at increased risk.

Physicians, nurses, paramedics, and other leaders in the COVID-19 war do not increase their risk of infection by properly deploying their masks, nor do the honorable judges of the courts.   The risks they would take by properly deploying their face masks (i.e., leading by example) are miniscule compared to the risks of leading by example taken by military officers such as Yoni Netanyahu at Entebbe.

The juxtaposition of the Jerusalem Post articles in its 17 April 2020 edition is noteworthy. There is something amiss when the nation’s Chief Justice, let alone an unnamed MDA paramedic, are not correctly using their face masks, while common people in the Machaneh Yehudah market are.  But it paradoxically is most reassuring to know that even as people in high places simply are not yet onto the program, instruction in proper face mask usage is now being brought to the hoi polloi in Machaneh Yehudah, the leading exemplar of the Israeli agora marketplace.