Yom Kippur 5781

Good afternoon.  

During the peak days of the pandemic, I frequently thought of my being tested by God. What do we meditate on during Yom Kippur when we must look deeply into ourselves to do better in our lives? How should we behave in our daily interactions, routine and not so routine, with others? What could we have personally done differently in these daily interactions to make the world a better place? In my own experience being on the front lines fighting COVID-19, I certainly tried to bring out my best and had to think about this throughout the experience.  

I came of age at first as a medical student and then as a doctor, as a physician, during the 1980s when the AIDS epidemic first descended upon our world. At that time, we did not know what we were running into. At that time, all we knew was that we needed to treat suffering and dying people with compassion. Other than some palliative measures, antibiotics, pain medications, etc., compassion was our only tool available. Can we catch this disease from casual contact with a patient? Will we suffer from the same affliction and end up like the unfortunate souls we were treating? We did not know. The younger version of myself was deeply moved by the experiences of what I saw and what I did to combat this affliction, and I ended up making a career of it. You could say that this is where I learned to internalize what the expression “running into the fire” means and act on that when called upon.  

At first, I was naïve about coronavirus and thought that it would not reach us in New York City. Once it hit me that catastrophe was headed our way, I knew what needed to be done. I knew that it was time to run into the fire again and that all that mattered was saving lives. 

The leadership of Downstate Medical Center quickly put together plans to convert the hospital into a COVID-only facility. We struggled to find our own personal protective equipment/PPE, the N95 masks, the protective garments, gloves, hand sanitizer just to respond to the call. The personal risks were high. We heard ambulance sirens wailing outside continuously throughout the day and night. We heard “Code 99” called out on the PA system over and over again every hour. This constant assault on the psyche was overwhelming.  

In the face of these horrible circumstances, I was deeply moved one evening watching a CNN special on Downstate’s response to COVID-19. One of the ER doctors was quoted saying: “We are going to do what we have to do to fight this thing or die trying.” I was inspired by the courage shown by front-line providers to put their own lives at risk. 

What did I really expect of myself? I considered it my duty to respond and volunteered to work with a group of pediatricians who were tasked to convert a pediatric floor into an adult COVID ward. I say that I volunteered because many did not want to take these duties on. Some refused to come to work at all. I went on daily rounds with my fellow doctors, called family members who could not visit their loved ones and gave daily updates, and experienced the camaraderie of what felt like soldiers in wartime. While we did have some guidance from adult medicine physicians, we literally had to relearn medicine on the spot.  

I did this on top of my other daily duties of trying to manage my HIV clinic. At one point later on, one of the pediatric chief residents personally thanked me for doing what I did. I responded by telling her that I didn’t really think I did that much. She quickly corrected me saying that volunteering in the first place was what mattered when many of the residents were terrified to be assigned to caring for COVID patients. The very fact that I was there by choice, when others knew that I didn’t have to be there, was what mattered and gave some inspiration to others to be there as well and perform their duties.  

I adapted to the new world we were confronted with by giving up my daily commute on the subway and biking to work every day, a ride I needed to de-stress and prove to myself that I was still alive and in good health. It was on these bike rides that I thought about how much every little act of kindness to others matters in making the world a better place. That led me to think about how I would be reflecting back on my COVID-19 experience during this year’s High Holy Days. In discussing this with Rabbi Sam, I was reminded of Maimonides’ Laws of Repentance where he writes:

It is, therefore, necessary for every man to behold himself throughout the whole year in a light of being evenly balanced between innocence and guilt, and look upon the entire world as if evenly balanced between innocence and guilt; thus, if he commit one sin, he will overbalance himself and the whole world to the side of guilt, and be a cause of its destruction; but if he perform one duty, behold, he will overbalance himself and the whole world to the side of virtue, and bring about his own and their salvation… 

When a friend from medical school, Dr. James Mahoney, a pulmonologist at Downstate who was teaching us pediatricians how to take care of adult COVID patients, died in the line of duty from catching coronavirus himself, the grief was both singularly for me and collectively across the hospital extremely palpable and unbearable. I believe that James’ courage and commitment to others is what Maimonides was referring to in overbalancing the whole world to the side of virtue and I dedicate this talk to him.  

The words of Maimonides resonate deeply with me; everything you do and every action you take matters. Whether it is a positive act or a negative act, it all has an impact on the lives of others. This became something immediately and profoundly self-evident for me during the early days of COVID-19. I remind myself of this every day, I teach it to my medical students, I say it to my children and hope that my few words have helped Maimonides’ teaching resonate with all of you as well.   

Thank you. 

© Jeffrey M. Birnbaum 2021

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