If I Get TO Five D'var Torah By Rabbi George Nudell

I would like to tell you a story about a remarkable man I had the privilege to meet. What brought us together was unfortunate, but the meeting was a blessing, indeed a lifesaving thing. His name was Fred Epstein. Fred was a pediatric neurosurgeon who invented revolutionary surgical procedures to deal with brain and spine cancers that were previously considered “inoperable.” He also pioneered a delicate procedure to detangle the nerves of the spinal chord from scar tissue, a common problem for children born with spina-bifida. It was this procedure that brought me to Dr. Epstein’s office.

My first son, Elazar, was born with spina-bifida. Immediately after he was born, a surgeon closed a lesion on his back. That surgery healed well on the surface, but over the next six years, scar tissue from that surgery became entangled with Elazar’s spinal column. It became apparent when Elazar developed a progressive scoliosis. If left untreated, the tethered chord and scoliosis would have compromised our son’s ability to stand, sit, and possibly even to breath, or eat food. Elazar’s doctor referred us to Dr. Epstein, and we were fortunate enough to get an appointment very quickly, to see him at the Rusk Institute of New York University Hospital.

This was back in 1988 when we lived in Central New Jersey. We drove to Manhattan, and pulled into the hospital parking lot to park. A sign said parking would be $23. Welcome to New York. But we needed that appointment. When I got a closer look at the sign, I saw that is read: $23 per half hour… That was the easiest part of the day to deal with.

We met Dr. Epstein, and found him to be a very friendly man. He greeted us warmly. He gave us his undivided attention, and spoke sympathetically to us. He kibitzed with then six-year old Elazar, and spoke directly to him, as he explained the surgery to us. Elazar, no stranger to doctors and hospitals, held his own, and the two of them hit it off. Dr. Epstein gently warned us of four serious considerations. First, the tethering could be so severe there would be no way to untangle the chord. Second, the procedure could leave Elazar more impaired than he started, and he was already paraplegic, unable to walk without braces and crutches. Third, the tethering could come back in the future, but Dr. Epstein told us there were ways to try to prevent that. Fourth, the usual risks of surgery and anesthesia; which are never to be underestimated. But, he added, if the surgery worked, Elazar would have a decent chance of avoiding the complications of the scoliosis.

Dr. Epstein let us ask our questions, and then told us we should think it over for awhile. He shook Elazar’s hand and gave him a wink. Then he insisted we get a second opinion. And I tried for the next two weeks, to no avail. I called every neurosurgeon in New Jersey, and could not even get an appointment. When they heard we had already seen Dr. Epstein, they all said the same thing- “Why are you calling me? You already saw Epstein. He’s the one who does this.” Frustrated, I called Dr. Epstein’s office back, expecting to get his assistant or a nurse, but instead, I found he had given me his personal number, and he came on the line himself. He listened to my tale of frustration, and barked. “Whattaya mean they won’t give you a second opinion?” He was annoyed, but it also made him chuckle, and he put me at ease. I asked him - “Let me ask you this. Who disagrees with you? Who is your rival? Who is the Shammai to your Hillel?

”That really made him laugh. He totally got the Talmud reference. He asked if I could
make my way to Philadelphia. No problem - we lived about halfway between Philadelphia and New York City. So he gave me the phone number of his “rival” at the Children’sHospital of Philadelphia. I recognized the doctor’s name, but couldn’t remember why, just then. Years later, I discovered that the Philadelphia doctor had invented a shunt that had been implanted in Elazar’s body a week after he was born. The box the shunt came in, along with a set of instructions for installation, actually came back with Elazar after surgery, caught in the folds of his blankets. The Philadelphia doctor’s name was on the box. We held on to that box for years, not knowing if it was something important we needed to keep - and then I wondered - do surgeons read those instructions on the job, the way I read instructions to put together furniture from IKEA?

Anyway, a few days later, we drove down to Philadelphia for our second opinion. It was a very different experience. Parking was a lot cheaper. But the doctor in Philadelphia was gruff and impatient. We had gingerly carried x-rays and MRI’s with us, and he gave them a quick look and tossed them onto his desk. He read Dr. Epstein’s report, and he shook his head and tossed that on the pile of scans. Then, with very little sympathy, he gave us the same somber warnings about the potential risks of the surgery. He painted a very bleak picture. Then he kind of dismissed us; and we packed up our scans and prepared to go. I don’t remember him saying anything to Elazar. But, as we got the door to leave, the doctor said, “One more thing! If you choose to do this surgery - don’t let anyone but Epstein touch your kid.”

It was all we needed to hear. A few weeks Elazar was admitted to NYU Hospital for the surgery. The morning of the surgery, Dr. Epstein came to speak with us, smiling, gentle, reassuring, but he also came with an apology. He said he had a speaking engagement in Cleveland that night, and if the surgery ran too long, he would have to call in a favor, and another doctor would close Elazar’s back. He felt awful about it. But he assured us that he alone would do the untethering.

It was a very long surgery - about five hours. He did need to leave before finishing. But, it turned out, he called in a top micro-surgeon to do the closing, who did a brilliant job, leaving almost no scar. After the surgery, we stayed in Elazar’s room, camping out on chairs, watching him sleep. To our surprise, the phone rang late that night. It was Dr. Epstein, calling from Cleveland. He finished his lecture, and he called to see how things were going. I proceeded to give him a detailed update on Elazar’s condition, and he laughed. “I know all that stuff. I already spoke to the nurses. But how are you doing?” From Cleveland.

That phone call was a true act of hesed. The biblical term hesed is difficult to translate into English, because it really has no precise equivalent. We usually try to translate it with words like “loving-kindness,” or “mercy,” or “steadfast love,” but those words always seem to fall short. Hesed is a broader value. Hesed is something you could possibly do with money, like tzedakkah, but it is more precisely done with one’s person - with one’s neshama. It can be given to the rich and the poor, the living and even the dead. It is measured by the tirchah involved - by how much a person puts himself or herself out, to do some act of kindness. 

I’ve thought about that phone call for many years. It makes me think about how hard or easy it is to be nice, to be a mensch. How much energy does it really take? A simple phone call, a gesture of kindness…can make such a profound difference in someone’s life. Ironically, it was Shammai who taught this lesson in Pirke Avot (1:15)

“Shammai said: Make your Torah fixed, say little but do much, and receive every person with
a cheerful countenance.” It makes such a remarkable difference when a person makes that
extra effort. There is even a little lesson about hesed in this week’s Haftarah:

In all of Israel’s tzurris, God was too troubled, the angel of his presence delivered them. (Is.63:9)

The verse speaks about God’s compassion for Israel during their exile in Babylonia, and how that loving presence helped them through that ordeal. It is a paradigm for empathy and compassion. As God watched us suffer in our ordeal of exile, it hurt God’s heart, too. God identified with Israel’s pain.

Acts of hesed are built from empathy; the active representation of the covenant between Israel and God, and when we do acts of hesed for each other, it defines our social contract as a people. It brings a little God into our relationships, into the world. We can be a presence of caring for each other, when we help each other face the inevitable ordeals of life.

The Talmud establishes hesed as one of the core pillars of human behavior. “The world rests upon three things,” it says in Pirke Avot, on Torah, on avodah, and gemilut hasadim.” (Pirkei Avot 1:2) No matter how learned we are, or how devout and observant, without hesed, the world falters, like a three-legged stool that can’t stand without one of its feet. Fred Epstein showed us hesed when we truly needed it; and it helped us enormously.

Over the next few years after we met him, Dr. Epstein went on to build a unique pediatric neurosurgery center where the patients, all children of course, many of them cancer patients, were given a comfortable, child-friendly place to live as they healed. He encouraged his patients to be playful during their stays in the hospital. There were stories of stolen surgical gloves that turned into water-balloons, with occasional ambushes of the doctors and nurses in the ward. And Dr. Epstein loved it. He built a place of hesed.
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Thirteen years after Elazar’s surgery, in September of 2001, soon after the devastation of 9/11, Dr. Epstein went for his daily 20-mile bike ride near his home in suburban Connecticut. His front tire hit a depression in the pavement. He pitched forward, over the handlebars, landing on the pavement, helmet first. The impact knocked his brain against the back of his skull, tearing a blood vessel, causing a bleed over the surface of his brain. He was rushed to a trauma center, emergency surgery was performed, and he lay in a coma for 26 days.

He was weaned from his ventilator, and when he was well enough, he went to the rehab center at NYU hospital. After six months, he was able to return to his practice, but, for the rest of his life, he was unable to perform the life-saving procedures that he had developed. Thankfully, he had trained other surgeons who could carry on his work, and they do so, to this day.

Becoming a patient in his own hospital, Fred struggled, physically and emotionally, to reclaim his career. He attended surgeries, but had to stand on the sidelines, offering advice and assistance, but from a distance. But he never stopped trying or learning. He visited the children’s ward often, to interact with the children, and found he gained insight and courage from the resilience of those little patients, who, like my son, came to his office seeking miracles.

One of those inspirations came a patient named Naomi, who Dr. Epstein had treated before his accident. When Naomi was only four years old, she came to his attention in grave condition. She had a complicated brain tumor that was wrapped around two arteries, one of which had already bled, putting her in a coma. This was long before today’s sophisticated imaging capabilities, and before there was a lot of surgical experience to draw upon for reference. Fred knew that Naomi’s chances were poor, but if he did nothing, she would surely die.

He planned two surgeries. In the first, he reduced the swelling from the bleed, hoping to address the tumor after she gained some strength. A few days after her first surgery, she came out of her coma. With her head wrapped in bandages, he found her standing up in bed, announcing defiantly, “If I get to five, I’m going to learn to ride a twowheeler!” 

If I get to five. Already at age four, she had surmised that getting to five was more of an if than a when. That reality calls to mind the haunting liturgy we will soon recite on Rosh Hashanah, the Unetaneh Tokef, where the Mahzor intones: On Rosh Hashanah it is written, and the Day of Atonement it is sealed:

How many will pass on, and how many will be born, who will live and who will die, who will live a long life and who will come to an untimely end, who by fire and who by water, Who shall live to four, and who will get to five… Life can be so precarious, and life is always precious, and this is all the more apparent when the life is at the tender age of four years old…

Each day, on his rounds, Fred would check on Naomi, only to find her bouncing on her bed with more declarations. “If I get to five, I’m going to beat my brother at tic-tac-toe!” Another day: “If I get to five, I’m going to learn to tie my shoes with a double knot!” Naomi never asked if Dr. Epstein thought she was getting to five. She had more conviction about that, than he did.

Naomi declared her intention to learn to jump rope - backwards - and to learn how to read. Her determination inspired him then, and the memory of it, after his bike accident, continued to inspire him even more.

Naomi survived her second surgery. She got to five…and to six, and seven, and then some. But she suffered some brain damage when the tumor was removed. At age 33, she was able to hold down a job as a grocery clerk. She wrote letters to Dr. Epstein faithfully over the years, and he, ever the mensch, wrote back. Now, the job of a grocery clerk might not seem impressive compared to the careers other young women attain these days, but for Naomi, it was like climbing Mt. Everest. Backward.

During his own recovery, Dr. Epstein thought about how Naomi continually raised the bar in her life; going from challenge to challenge, with determination and a smile, if not joy. He reflected on her resilience, and wrote the following about it:

“Naomi taught me that the child’s determination to embrace the next stage of life, to become more powerful and master new skills, can be a lifetime asset. She reminded me that whenever I ran up against a tumor that had “inoperable” stamped across it, I had to focus on the child whose life was on the line. That was a crucial lesson for me at a formative stage of my career. It strengthened my resolve never to give up on a child, no matter how daunting the course appeared.

Children are geniuses at raising the bar for themselves, clearing it, and then setting it one notch higher. Working with children raises the bar for me, (he wrote) and for everyone else whose lives they touch. They inspire us to dig deeper for the strength to do what feels hardest, what’s scariest. And to do that, we have to again become young at heart.

Much has been written about how important it is for adults to model behavior for children. What I’ve discovered again and again, (he wrote) is that children can model courage and character for adults…”Dr. Epstein, alav ha-shalom, passed away from melanoma in 2006. I guess all that time he spent riding his bike in the sun, took its toll. Or, it could have been the many summers he spent on the beach of Fire Island, where he, while on vacation, volunteered to help fellow vacationers, many of them physicians (those who paid attention in Hebrew School) run a pop-up Conservative Synagogue, so they could daven while spending time on the beach.

Elazar and I were blessed to have met him, and to have enjoyed the benefit of his genius and his hesed. I will never forget his menschlich-keit, his optimism, his kindness to us, and his determination. I still think of Dr. Epstein from time to time, especially at this season of the year, when Rosh Hashanah approaches. It’s at this season that we think back and think forward - to the year that passed and the year that we pray we will be granted. We think about the challenges we faced last year, and about those we might encounter next year. How should we face a new year, especially after this last one - with all of the uncertainty and loss, and fear? How do we find the spirit of optimism we need to grab hold of the new year, and use it for all it is worth?

I like to think that Rosh Hashanah is our wake-up call to remember never to take a day of life for granted. We are, even with the tzurris of life, lucky to be alive. The future is always uncertain. We fool ourselves into thinking we know that the future holds. Who predicted 2020 was going to be such a disaster? In reality, none of us knows what pain or pleasure will come tomorrow. But what a gift it is, to recapture that child-like optimism, that imagines that the future can be brilliant, that we can learn to jump-rope backwards, or conquer a pandemic, or have some other, life-enhancing breakthrough. It takes courage to think that way. After the past year and half of pandemic, and the violence in our streets, and for many, the economic hardship, we’ve been through a lot. It will take courage to move forward.

In the Torah, when Moses passed the torch of authority to Joshua, he imparted a message about courage. Moses blessed Joshua, saying chazak ve’ematz “be strong and courageous.” You will lead the Israelite people into the Promised Land: chazak ve’ematz. We find a similar charge at the end of every Jewish year. For the month of Elul and a few weeks beyond, we have been reciting Psalm 27, daily. It ends with these very words of encouragement: chazak veya’ametz libecha, “be strong, and strengthen your heart.” The Psalm encourages us all to cultivate the inner strength we need to meet whatever challenges emerge in the new year.

The New Year begins Monday night. It is time to raise the bar another notch. If there is one imperative for the Jewish people this coming year, it should be to bring more hesed into the world. We have seen such rancor between opposing political sides, such terrible things said on Twitter and horrible words spoken in Congress. We need more words of kindness and deeds of hesed in the world. And we can all do that! We may not be world class neurosurgeons, but we can all be purveyors of hesed.

Acts of hesed redeem the world, say the Rabbis. So this Rosh Hashanah, let’s push ourselves to do better with the time God has granted us, and to bring a little more hesed into the world.

So let’s plan to learn new things, or plan to study really old things from our tradition; let’s pledge to embrace new challenges, and face the uninvited challenges of life with courage. We can remind ourselves to be more of a mensch than a grouch. We can challenge ourselves to go forward in the face of uncertainty; a willful act of human optimism we once knew so well, when we were children.

It’s far easier to list the many ways, or many outcomes that could be disappointing and frustrating in the year to come. We can’t let that stop us from dreaming. After the past year and a half, we deserve a happier, kinder new year. May it be a year of achievement and learning and joy, and discovery, and hesed.

“If I get to five…” That is the name of the book Dr. Epstein wrote about his recovery from his bicycle accident. It is subtitled, “What Children can Teach us About Courage and Character.” It’s a tear-jerker, but it’s a good read.

If I get to five.
If I get to tomorrow.
If I get the chance.
Take that chance.
Make those plans.
Raise that bar.
Never lose hope.
God willing, we will all get there, in health and in happiness, this coming year.