Dr. Michael Kleinman in the ER

Holocaust Memorial at
the York JCC

Childhood sweethearts Lili and Josef became separated while they were in the concentration camp, the work camp, during the Shoah, the Holocaust.  When the prisoners at Auschwitz were liberated by the Soviets in early 1945 Josef went to find his love again. He walked throughout Germany for six months anxiously asking anyone if they had seen her.  When some claimed that they heard she was dead Josef refused to believe them. He didn’t give up; he kept searching.  And he eventually ran into an old friend who told him that she was recuperating in a nearby hospital.  He found her and nursed her back to health. 

Ready to start a new life, they got married.  The longed-for State of Israel was created on May 14, 1948, and Josef and Lili moved there to help build the nascent country and to start their family.  

Dr. Kleinman

Lili and Josef are the "two dear parents" of Dr. Michael Kleinman, York Hospital ER physician. Dr. Kleinman said of his parents; “They rarely talked about the horror they saw and were not bitter.  Instead, my parents were protective of me and my sister.  (They were) nurturing, but not stifling.”  This awareness of their actions instilled in him a strong desire to be kind and fair to others.  He did not want to see “the other side of humanity” that his parents had witnessed and lived through.  

They often reminded him to “never forget” the Golden Rule.  The traditional Jewish version of this foundation for all ethical conduct is, “That which is hateful to you, do not do to your fellow.” He said that this deeply-felt belief steered him in the direction of providing service to his community. “And so the path of medicine became clear,” he offered.

“How did you decide to become an emergency room doctor?" I asked

He went to the Des Moines University College of Osteopathic Medicine and graduated in 1979, and after his internship, he went into a general medical practice with Dr. Kieren Knapp.  He enjoyed this, and after seeing patients in the office he spent some time “moonlighting”  in the Emergency Department at the York Hospital. 

How could Dr. Kleinman work in an ER without special training?  

Through the early years of the last century (did I really just say that?) and into the 1970’s the ERs were typically staffed by a general surgeon, a general internist, or a general practitioner

Busy Hectic ER Team

who called in specialists when they required help.  Over time, and seeing the need for improved care, and the benefit of specialization, the American College of Emergency Physicians was born on August 16, 1968, by eight maverick physicians in Lansing, Michigan.  The first dedicated ER Residency program was started in 1970 and the American Medical Association quickly recognized emergency medicine as a distinct specialty in 1972.  

Early in his career, Dr. Kleinman experienced this change in approach firsthand; emergency physicians became specialists.  Falling in love with the experience in the ER and the privilege of taking care of a wide variety of patients, Dr. Kleinman realized that if he was “going to do this” he had better get further training.

Dr. Kleinman did his emergency medicine residency training at Memorial Hospital in York, the first such program in the county.  He completed this in 1982 and received his certification in 1984. With a broad smile, he said, “My certificate is number 11.  I treasure this."  Following this, he and several other physicians including Drs. Ron Benenson, Merrill Cohen, Dave Eitel, and Lynn Jensen developed the program at the York Hospital in 1988.  What did he and the others need to know?

An excellent Wikipedia entry (1) notes: "The emergency physician requires a broad field of knowledge and advanced procedural skills...They must have the skills of many specialists--the ability to resuscitate a patient, manage a difficult airway, suture a complex laceration, reduce a fractured bone or dislocated joint, treat a heart attack, manage strokes, work up a pregnant patient with vaginal bleeding, stop a severe nosebleed, place a chest tube, and to interpret (imaging studies).  They also provide episodic primary care to patients during off hours and for those who do not have primary care providers" (whew, that was a mouthful!).

“After all of your years in practice was there, maybe, a single event that especially moved you?" I asked.

"As an intern, all the patients affected me equally,” he said.  Yes, they were all important to him.  But, he went on,“I clearly remember this one patient, a young woman in her early thirties with metastatic ovarian cancer.  She was married with two small children.  She was admitted to the hospital and never left.  She died quickly.  There was nothing we could do. This was in 1981 and there were no tools to help her back then, and I remember feeling so helpless." 

"That was me in 1981, but I lived, I left the hospital," I said, frozen in fear.

I asked Dr. Kleinman to repeat the story, and he did.  Though he was taken off guard by what I had just told him. Yet, I still couldn’t take in what he was saying. When I listened to the recording of the interview later I was jarred by my deafness.  Why did I not hear what he said? I don’t know. (I guess that’s why doctors learn to repeat themselves, repeat themselves, repeat themselves.)

Calvin and Hobbes

Yes, denial.  "Something horrible happens, and our mind plays tricks on us, tells us that it never happened, that it occurred differently than it really did, that it isn't quite what it seems.”  This often works for what has happened in the past. According to Dr. George E. Vaillant, “such trickery can reveal the mind at its most creative and mature, soothing and protecting us in the face of unbearable reality, managing the unmanageable, ordering disorder...putting out in the world what was not there before."  But in the ER the truth must be faced directly; denial is a poor option.

Dr. Kleinman knows this.  In his decades of work, how many thousands of times has he had to give unwelcome news to his patients?  How many times has he imparted unbearably sad information to loved ones?   How many times has he been forced to give up and admit failure?  That Josef will not find Lili.  But how many more thousands of times have things turned out well, much better than expected?   

Maybe, like the Swedish diplomat Raoul Wallenberg or Oskar Schindler, he is just trying to

One of many such plaques

save as many souls as possible.

References:

1.   "Emergency Medicine." https://en.wikipedia.org/wiki/Emergency_medicine

2.  George E. Vaillant. The Wisdom Of The Ego. Harvard University Press, Boston, 1993.

by Anita Cherry 2/17/18