In Review: 

This Narrow Space

A Pediatric Oncologist, His Jewish, Muslim, and Christian Patients, and a Hospital in Jerusalem

By Elisha Waldman

Schocken

Buy from Bookshop.orgBuy from Amazon

What is the most important skill a doctor can have? For Elisha Waldman, it’s care rooted in observation. Drawing on Susan Sontag’s insight that when a person looks at a photograph of a suffering or dying person, “the interaction differs when the subject is making eye contact with the camera and when he isn’t,” he reflects on how he observes his patients. Is he a “dispassionate clinician, observing a patient solely to determine the best course of medical intervention? Or am I also engaging with the patient I’m looking at, and in the process trying to imagine what she is feeling and thinking?”

The value of observation in palliative care, Waldman notes, depends on several things: "noticing the details, whether it’s the icons on the windowsill, the glances between the worried parents, or in the pregnant silence before a question is asked. . . . But observing them, exploring them, those little hints and details are what allow us to develop the smallest opening into the most meaningful spaces."

What Waldman is describing here is the simple but profoundly spiritual act of listening and being aware of what others are trying to say.

Waldman wrote This Narrow Space mainly as a memoir of the seven years he spent working on the pediatric oncology ward at Hadassah Hospital in Jerusalem. It’s partly an account of the sociology of Jerusalem, as patients from all parts of the country and sectors of society are stricken by a disease that fails to discriminate. It’s partly an account of Waldman’s training in palliative care and the lessons he learns from that experience. And it’s partly a chance for those of us without medical backgrounds to learn how doctors think.

Patients and their families often wonder why the disease has occurred, and doctors usually have no adequate answer. But as Waldman told me in a phone interview, a doctor’s job goes beyond pain and symptom management; the task is also “to navigate to a place of meaning.”

To this end, Waldman writes about the value of helping patients reframe hope: “When hope for a cure is lost one can redefine what one is hoping for.” He admits, “this always feels hollow to me, like patting someone on the back for winning a second-place prize.” However, he later writes:

Hope as a thing, as an object can be shattered or lost. But hoping as an act doesn’t ever really have to stop. . . . Often I find myself talking with parents who explain that yes their hope once was that their child would be cured and they would certainly love for that to happen. But if that is no longer a realistic possibility, then they are hoping for other things for their child.

Even in the cases where patients are cured, Waldman finds that he must work to listen to their spiritual needs. He discusses the case of a young modern Orthodox Jewish patient who has just completed her last course of chemo­therapy. Waldman, wanting to reflect with her on what has happened, asks her how her sense of community and belief system has changed. Un­expectedly, she bursts into tears and tells Waldman that she has a sense of alienation from her community, she is seen by others as “damaged goods,” and she fears she won’t be able to have children, despite having her eggs frozen before the chemotherapy. Wald­man writes, “I am mortified. . . . But more than that, I think that being attuned to the spiritual needs of our patients has simply been trained out of us as clinicians. I have no idea how to respond to Elisheva’s outburst.”

After explaining the difficulties of addressing patients’ spiritual needs, Waldman reiterates how important it is. “Adult patients, even those self-identifying as non-religious, report that they want their spiritual needs explored. Adults who feel their spiritual needs are being addressed say they feel better and are more satisfied with their care.” Waldman is the son of a rabbi, so this aspect of the physician’s work may come more naturally to him than to doctors who are less rooted in a life of faith. Still, it is not easy.

Waldman ends the book with a conversation he had with the ultra-Orthodox father of a dying four-year- old. The father notes that Waldman’s biblical namesake, Elisha, in the book of Kings, both unl­eashes a bear on children who mock his baldness and resuscitates a child who appears dead. The father continues, “The trick is just to know vhen you’re supposed to try to raise the dead and vhen you’re supposed to let the bears come!” The biblical Elisha, like healers who can both heal and harm, encapsulates the human struggle to discern between our various impulses.

This Narrow Space is an excellent book not only for clergy and physicians, but for anyone who wants a thoughtful account of how families deal with the devastation of childhood cancer. It takes its place alongside Kate Bowler’s Every­thing Happens for a Reason for those who seek to understand how to cope with tragedy and how to help others find hope.