This Narrow Space

This Narrow Space
Elisha Waldman
Schocken Books, New York 2018, 245 pp.

This memoir deals with mortality and challenges and complex situations but it's such a good read you just can't put it down.

Elisha's given name is an inspiration: the biblical Elisha healed a child.

The book's title is taken from a poem by Yehuda Amichai dealing with loss:

Try to remember some details.
For they have no face and their soul is hidden and their crying
Is the same as their laughter,
And they have no life outside this narrow space…

Born in Connecticut to a Conservative rabbi's family and trained in pediatric oncology in New York (Sloan Kettering, Mt. Sinai, Columbia), Waldman spent time in Israel as a teenager and graduated from the Sackler School of Medicine. Accepting a position at Hadassah Hospital in Jerusalem was the culmination of a dream and a fitting challenge for a compassionate man who revels in mountain climbing. Here was his chance to contribute to the Jewish state in his chosen field, right at the hub of the regional conflict: his patients would be children from Jewish, Muslim and Christian communities and the medical staff would be a dedicated Jewish and Arab team.

The job lasted for just seven years, disintegrating after the body blow suffered by Hadassah in the wake of the Madoff financial crisis, just when Waldman – now wiser about how Israel functioned - was about to activate his recently acquired expertise (from Boston) in palliative care by founding a new department within oncology at the hospital.

It is clear throughout the cameos of the cancer patients brought in from Rehavia, Mea Shearim, Ramallah and the Gaza Strip - and the nuanced conversations which ensue - that the doctor cannot focus exclusively on a physical cure or alleviation of symptoms: it is the spiritual aspect of treatment which can offer hope and quality of life. This idea leads Waldman to reconsider the modern estrangement of religion and healing and to delve into the workings of palliative care.

"All you do is talk?" asks a colleague. Waldman recalls Susan Sontag's remark that if you take an interest without helping, you are no more than a voyeur.

At what age can children really understand the concepts of serious illness and death? How much can what Joan Didion described as magical thinking help?

"Never forget," said the senior physician. "If you accompany your patients only until the battle is lost and they are dying, if you abandon them at that point and leave them alone, you have done only part of your job, and not done it well. Your job is to accompany your patients until they are either better or safely on the other side."

In this new discipline, Waldman finds redemption for the failures, the losses, the disappointments and the sadness which accompany the efforts of a caring physician. And through his sensitive observations, the reader learns a little about the personalities and qualities of these young people whose lives are curtailed and of their desperate families who try to cope within the limitations of religious precepts, travel restrictions or the stigma of deformity.

"Being comfortable with not coming up with concrete answers becomes a new skill set in my clinical toolbox."

Waldman also learns the value of silence. And to understand how a sigh can express the ineffable.

"I've heard many families say that the two hardest days in their child's oncologic care were the day when they were first informed of their child's diagnosis, when their world was forever changed, and the day of discharge, when they had to leave the security of our clinic, with its treatment plans and charts, for the uncertainty of life 'after' cancer."

He also shares his experiences of living in Tel Aviv, commuting to Jerusalem, making friends and serving in the army: Israel in peace and at war. He offers his personal take on the events of those seven years – including Operation Cast Lead in Gaza and the Gilad Shalit negotiations - and charts his own development through "identity politics" in a most engaging way.

"I think back to the patients I had cared for as an oncologist who had been removed from treatment protocols because of the inexorable progression of their disease… I am able to articulate now what I only intuited back then, that no matter how scary it is not to have a map, in being 'lost' there is also opportunity."

It takes meeting a special young woman (in Israel) to spur Waldman to surmount his impasse: after their marriage, he returns to the US to work and settles in Chicago to raise his family.

Awaiting a realistic opportunity, they would still like to call Israel their home…

"This book is in part about those children who don't survive. But it's also about those who do survive, though in a manner that leaves them changed in ways that are hard for most of us to grasp…. It's about their families, who are also changed forever, and the clinicians who care for them. And because it's set in Israel, one of the most complex places on earth, it's also about individuals, communities, and even entire nations for whom things don't work out according to hopes or expectations. And, ultimately, it's about how all of these experiences changed me and my own expectations."