October 7, 2023

Saturday morning, a week ago yesterday.

I woke up early and looked over at Rachel lying in bed beside me. It was Shemini Atzeret, a little known Jewish holiday that caps the festival of Succot, itself a seven-day period known as “the time of our joy”. Her face was bathed in the soft blue light of her phone as she scrolled down.

She looked stricken. Israel is at war, she said.

Hamas had breached a section of border fence allowing over a thousand heavily armed militants to infiltrate from Gaza into Israel. Overrunning nearby army bases, they killed everyone inside and fanned out unchecked into the surrounding area, mostly populated by small villages and kibbutzim. A couple of miles away, thousands of young Israeli men and women were attending a music festival in the desert with little to no security.

The news started out bad and got progressively worse – as it is still is doing now, over a week later. The numbers piled up. Over a hundred killed, which grew to over a thousand. Scores abducted and kidnapped to Gaza, which grew to hundreds. Hundreds injured, then a thousand, two thousand, three thousand, more….

It is impossible to overstate the shock. The way the world was knocked off kilter.

The Hamas attack has been called Israel’s Pearl Harbor because of the way the military was caught unprepared. It has been called Israel’s 9/11 because of how it was an act of mass terrorism. And it has been compared to the Yom Kippur War because of when the surprise attack occurred, during a religious holiday.

Those comparisons are all apt. But the shock runs deeper and darker. As the details of what transpired came out – barbaric acts, wanton murder, torture and brutality committed against men, women and children – the elderly and their caregivers, babies and their mothers – it all seemed to come from a different era.

Rather than names like Pearl Harbor, 9/11, or The Yom Kippur War, other names floated up from the depths of Jewish consciousness: Khmelnytsky, Kishinev, Babi Yar, Kristallnacht. The more we learned, and the way we learned it – through gleeful and boastful posts online – the less it seemed like a war, or even an act of terrorism, and the more it felt like a classic pogrom – a nightmarish ghost from the Jewish past come back to haunt us.

Isn’t this supposed to be a medical blog?

I’m sorry – I really am. But the reason I write – not the only reason but the underlying motivation, if you will, to devote the time and effort – is from a peculiar compulsion to puzzle out the truth and try to put it into words. To live an examined life – which mostly means the life of a family doctor in New York City. But not always….

Feel free to stop reading here – I promise I won’t be offended. But here’s how I see it: if I don’t try to write about this, I may as well not write at all.

All sense of security turns out to be a false sense of security. In that way, at least, this post does relate to medicine.

You may read Peter Attia and follow his recommendations. Eat your vegetables, avoid sugar, go to the gym, get enough sleep. And he’s right – you feel great. Maybe there’s something to this longevity deal.

Then, one day, you find a lump and the mammogram comes back positive. Or indigestion that won’t go away and the CT scan shows a pancreatic mass. Or trouble swallowing and the endoscopy finds an esophageal malignancy so advanced that the scope can’t reach the stomach.

How could this happen? Why me? Why now? And the world is knocked off kilter.

Or let me get more personal. You marry and have kids. You go on vacation to the Dominican Republic. The baby gets a cold. That’s ok – you are doctors. It’s no big deal. But she gets worse. And worse. Until she has to be airlifted out, grey and tachypneic, and rushed straight from the airport to the hospital. And then your wife calls from the ICU and says, “Everything is not OK”.

And the world is knocked off kilter.

In his famous soliloquy, Shakespeare’s Hamlet describes death as having “shuffled off this mortal coil”. What a perfect metaphor – that Shakespeare had a way with words.

Life, mortality, the human condition, really is a coil. It encircles us like a snake, sometimes so loosely we barely know it’s there, allowing us to live as if life will last forever; sometimes so tightly we can barely breathe, until we’re not sure if we will make it through the day.

Usually, though, the coil constricts to somewhere in the middle – where we can feel it present but also push it away. Never completely, though. Our mortal coil – the knowledge of our basic vulnerability and inescapable death – informs a lot of what we do. According to Freud, everything we do – from procreation to artistic accomplishment. But Kafka put it best: The meaning of life is that it ends.

We passed Saturday in a fog of horror and dread. Night fell, marking the beginning of another Jewish Holiday (there are a lot of them at this time of year), Simchat Torah. This one is supposed to be the most joyous of them all. All around the city, synagogues host crowded celebrations, sometimes with dancing in the streets.

I was curious. What would people do?

Rachel couldn’t bring herself to leave the apartment, so I went out alone. I visited three synagogues that night. Two of them hosted muted events – prayer circles and hebrew songs. The third took the opposite approach, with unfettered singing and dancing.

I can see both sides.

On the one hand, it’s inconceivable to celebrate anything in the wake of what occurred. On the other hand, maybe celebrating is exactly what’s required – not in denial of what happened but in bold defiance of it.

In that vein, there have been a rash of Israeli weddings in the last few days, with people pushing up their dates. For one reason because, with war looming and grooms called up for duty, it may be now or never, but also to cultivate an unbroken spirit.

If our mortal coil is human frailty – the central transience and impermanence of life – then maybe it also carries the seed of its redemption. We mortal beings are subject to change, entropy, cause and effect. But so is everything else. In a material world we at least have human agency. The world may act on us, but we can also act on it.

The problem with shock is its paralyzing effect. It causes us to freeze when we most need to act. Cancer can be terminal but it can also be treated. Congenital heart disease can be deadly, but it can also be repaired. We can act.

With all due respect to Shakespeare, To be or not to be is not the question. In the lower world, at least, To act is what’s required. Action is both our primary duty and our main consolation.

So why does it not feel that way?

Maybe because while cancer and disease can pose mortal threats, they are blind forces of nature, lashing out like hurricanes or fires. Very different from the implacable gaze of intentional human evil. What, if anything, can counter that?

We shall see.

The coming weeks and months will bring a flood of words and actions. The survivors of this pogrom are not helpless shtetl Jews. Israel will regain its footing. It will decide what must be done and it will act accordingly.

Will any of it help?

Perhaps, as a cold consolation. After 10/7 it feels as if there really are no words; like what was lost can never be recovered; like our bereaved are out of comfort’s reach.

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
This blog will be a mix of stories, advice and discussion – topics will diverge widely, but they will all share a point of view!