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| Jonathan Liss, M.D. |
“Why medicine?” I asked. He told me that his father left the multi-generational family baking business, changed directions entirely, and went to medical school. He built a solo obstetrics practice in Phoenixville where he had “respect in the community and did good things,” Dr. Liss recalled. But Dr. Liss, himself, wasn’t set on a career in medicine until he was in college at Muhlenberg after his father arranged for him to “hang out” with a few (carefully-chosen, I assume) physicians.
After college, he went to Temple University Medical School (as his father had done). He told me that he liked “all the rotations except psychiatry.” When he was undecided about his direction after medical school he asked his wife Andi for her advice. She quickly reminded Jon that he was happiest during his time in pediatrics, joyous no matter how the day went. He saw, of course, that she was precisely right, and he was fortunate to be able to do a residency in pediatrics at Temple and at St. Christopher’s Hospital for Children.
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| David Rubenstein, M.D. |
Within the field of pediatrics, the diseases of the neonates “were (especially) interesting” to him, and he liked the excitement and drama of the unknown in the delivery room as the newborns were handed off to the waiting pediatric specialist by the obstetrician. This was a perfect fit, he noted, it “felt right.” So he did a highly-coveted neonatal fellowship at St. Chris, where Dr. David Rubenstein, “a brilliant clinician and a very compassionate physician,” served as an inspiring role model. (Dr. Rubenstein, by the way, is still in practice, but in New York City.)
What would be the next step for Dr. Liss? Let’s see...His dad had a solo practice delivering babies all hours of the day and night; he was highly regarded in his small town; he seemed to have (at least some) time for Jon and his four siblings. Yes, that sounds about right. Solo practice. Build something on your own. Serve the community.
Dr. Liss moved to York, Pennsylvania in 1985 to start the York Hospital’s neonatology unit (they had been sending the sick babies to Hershey). “It was kind of crazy when I first started,” he let on, as he was the only physician with his training, but he told me that he made a commitment and would follow it through.
For nearly two years he parked himself in the neonatal ICU (the N.I.C.U. or “Nick-U”) day and night, weekdays and weekends, holidays and non-holidays. He was there whenever a baby and mother needed him as he waited patiently for the hospital to recruit his first partner, someone with the needed skills and the same ideals of caring as Dr. Liss.
(This talk of a solo practice, envisioning Dr. Liss in scrubs all alone tending to tiny babies while calming the frayed nerves of their deathly-frightened mothers, brought to mind images of the obsessive and fearless rock climber Alex Honnold in the 2019 Oscar-winning documentary “Free Solo” as he carefully scaled the slick vertical wall of El Capitan. He chalked his hands to dry his fingers and improve his grip as he carefully inched his way upward, but there were no ropes or other devices to protect him from a slip and a fall to almost certain death. Fortunately, I realized, Dr. Liss had plenty of well-trained support staff; he wasn’t truly alone on the climb.)
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| A really scary scene from "Free Solo" |
Jon admitted that he was probably remiss in not fully understanding the impact of exhausting 120+-hour work-weeks on his (growing) family (they already had two children and had one on the way on arrival in York). On the other hand, he reflected, “My kids saw me working hard, and that was a good role model.”
Continuing his thoughts on his career here, he reflected, “Neonatology has been a good niche for me. It’s been a comfort zone. It has given me more than I’ve given it.”
As we talked I sat on a deep sofa across from Dr. Liss and his wife. On the floor, at our feet, lolling on their backs with toys in their mouths, were Steve and Norm, their two very relaxed golden retrievers. Funny names for dogs, I thought. It turns out that years ago they had one called Frank, the name of Dr. Liss’s first partner (Frank Ferrentino). Steve (Shapiro), the next physician to join the group, was “envious” of that, so they dutifully named a dog after him. (“Norm,” I believe, has no such connotation.)
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| Norm and Steve waiting patiently to come inside |
Over the three-plus decades, the hospital’s neonatology team has grown to include six physician neonatologists, multiple neonatal nurses and nurse practitioners, residents, medical students, nutritionists, respiratory therapists, occupational therapists, and social workers, etc. The neonatologist guides them to carefully coordinate the care of our tiniest and most vulnerable members of the human family.
The premature babies, those born before 37 weeks, are desperate for help, having left their mother’s protection, the temperature-controlled and nourishing womb too early, sometimes way too early (even at the very limits of viability, at 22-23 weeks).
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| Stages in prenatal development |
Dr. Liss mastered the technical skills; using incubators keeping newborns from losing too much heat; giving artificial surfactant to open the distal airways, and using new ventilator settings and medicines to ensure adequate oxygenation for those with the common respiratory distress syndrome; applying advances in neonatal nutrition, including inserting miniature catheters for intravenous feeding when the baby’s GI tract is still too immature to absorb nutrients. Progress in quickly identifying a long list of genetic disorders has helped Dr. Liss offer a more precise diagnosis (and prognosis) of unusual conditions.
There is much more to his craft. The parents of preemies, especially the mothers, of course, are often “scared to death” as they see their helpless babies hooked up to machines and tubes and the like. The “lack of knowledge” is greatly “anxiety-producing” as they “don’t know what to expect.”
Dr. Liss quickly discovered that he could often help by shedding light on the dark unknown, on what the future might hold. He learned that “people tell you how much they want to know, and in what depth.” So he listened, and read their body language, and responded to their distress. It has been “very rewarding” for him to be able to help parents anticipate what’s next as their baby struggles to survive.
He remarked that these “social aspects” of his practice have been the “most pleasing” for him, as he quells fears and unease (well, I thought, so much for his “not liking psychiatry”).
Why are so many babies born before term? The “accident” of preterm birth may be associated with hypertension and the dreaded pre-eclampsia, a variety of maternal infections, many genetic abnormalities, obesity and diabetes, pregnancies with twins or triplets, and in vitro fertilization, among other and often unknown causes.
Unfortunately, while some medicines may help a bit (e.g., progesterone), there is “no great treatment for premature labor,” according to Dr. Liss, though progesterone supplementation may help. This is a very serious problem, as nearly 10% of babies born in the U.S. in recent years have been premature, and the percentage is slowly increasing.
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| 2016 Prematurity data from the March of Dimes |
Changes in gene activity that occur in premature babies as a result of their particularly stressful experience in the NICU may have long-lasting consequences that are not fully understood. There are major effects on the endocrine and nervous systems and the immune response. Dr. Liss told me that Todd Barron monitors some of the NICU-graduates in his neurodevelopmental clinic.
Andi noted that, over the years in York, as she ran into mothers and fathers of preemies and heard from them how her husband helped them, she realized that he had “excelled at getting people from point A to point B,” and that he did this with obvious compassion. Parents, it seemed, found that with Jon’s guidance “whatever happened, they could get through it,” despite facing some “terrible times.”
Dr. Liss noted that when “you develop a rapport with patients and families they trust you” and that this trust is invaluable. As Dr. Eric Cassell has written, “Trust in others is one of the central human solutions to the paralysis of unbearable uncertainty,” (Cassell).
As Dr. Liss looks forward to his “retirement” (he will still probably fill-in at the hospital occasionally, he said) in June of this year, I wondered what leisure activities might fill his time. What does he enjoy apart from his life’s work and his family?
He told me that he likes pedaling his bike alone for miles on quiet back roads, he fashions formless lumps of clay into beautifully finished pottery, and...wait for this...he mixes flour, water, and yeast (and sometimes eggs) and bakes bread. Yes, He bakes bread, as his father and grandfather did many years ago in their corner Jewish bakery.
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| An example of Dr. Liss's handiwork |
And Dr. Liss told me that he could not have done what he did without his wife.
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| Dr. Jonathan Liss, Andi, and their family |
Reference:
Cassell, Eric J. The Nature of Suffering and the Goals of Medicine. 1991. New York. Oxford University Press, p.76.
Cassell, Eric J. The Nature of Suffering and the Goals of Medicine. 1991. New York. Oxford University Press, p.76.