People are more interesting than bacteria: The Dr. Cyril Sherer saga
Scientific progress has led to the concept of evidence-based medicine where everything must be proved objectively.
By JUDY SIEGEL-ITZKOVICHUpdated: OCTOBER 1, 2017 16:15Dr. Cyril Sherer(photo credit: Courtesy)
When a 92-year-old declares that he plans to write a book, one can be forgiven for having doubts about whether it will be published. But Dr. Cyril Sherer, who made the promise in an interview with The Jerusalem Post four years ago, has indeed published a volume at the age of 96 about his 73 years as a physician – 56 of them since moving to Jerusalem.Although he has closed his well-equipped clinic a few steps away from his apartment at 10 Rehov Jabotinsky, he still sees about half a dozen private patients per month, some of whom who are about the age of his grandchildren. He is apparently the oldest practicing doctor in Israel.Except for a few months as an employee working in a health fund and the Hadassah Medical Organization – both of which were unsuitable to his work style – he has always seen patients privately, mostly dealing with medical tourists, foreign journalists, musicians, diplomats and some well-known dignitaries. For some four decades, thanks to recommendations from the legendary late Jerusalem mayor Teddy Kollek, he was house physician at the nearby King David Hotel. Evidence of the satisfaction of his patients is provided by signed photographs on his desk and memories of Mikhail Gorbachev, the Dalai Lama, Isaac Stern, Pablo Casals, Jimmy and Rosalynn Carter and others.Titled Cases and Crises: A Physician’s Saga from Japan to Jerusalem (Mazo Publishers, available via Amazon), the 267-page, soft-cover volume is not strictly an autobiography but a collection of stories from his birth in the East End of London in 1921 through medical services in post-war Japan, doctoring in New Zealand and his patient care in Jerusalem. Inspiring, engaging and often amusing, the book is jam-packed with details of people he has encountered and events he has experienced – remembered, incredibly, without keeping notes.THE GENERAL practitioner’s major life observation is that “people are more interesting than bacteria.” He recalls in the preface a famous medical cartoon in which solemn- looking surgeons in long white gowns gather around a bed. A frightened patient looks out from under the covers, while one of them – index finger raised as in judgment, says: “I say let’s operate. What have we got to lose?”This, notes Sherer, “was an attitude among doctors who, while they worked diligently to cure disease, paid little attention to the person himself, even less how he felt. The neglect was not volitional – it was how doctors were trained in most Western countries.”But they were not taught until recent years things that are vital to modern medicine, such as biostatistics, meta-analyses, genetics, epigenetics and auto-immune diseases, to name only a few. The author studied at England’s Middlesex Hospital Medical School, graduating in 1945 when he was only 23. At medical conferences and reading a lot of medical journals and newspapers, Sherer has since learned a lot to make up for the lacunae.With his flat belly, mental and physical energy and phenomenal memory for dates and details going back eight decades, Sherer obviously has practiced what he preached about good health.“I’m in very good shape, thank God,” said the traditionally observant doctor.“I still have a good memory. I had attention- deficit disorder as a child but it was unknown then to doctors, and cardiac vasoconstriction that I was diagnosed with at 31 that is controlled with medications. I have problems with my feet and have to go to sleep at 8 p.m. But I am currently reading up on nuclear physics, mostly over the Internet.”He gave up smoking – which for decades had been endorsed by physicians as being “good for concentration” out of ignorance or because they got paid off by tobacco companies.“When [the late British physiologist Sir] Richard Doll published the association between smoking and lung cancer and heart disease, I realized cigarettes were bad for you. I had already given them up in 1948. The whole thing of risk factors and side effects weren’t part of medicine until that time.”Growing up in a poor, mostly ghetto-like Jewish part of London, he recalled that “there wasn’t even a fruit tree in sight; I didn’t see one until I was 22. Only when I was seven did I realize that not everyone in the world was Jewish,” he related.“I had no role models. I was talented, a good mimic with a good voice, reasonably good looking and able to talk to people. I wanted to be an actor, but my father dreamed of saying: ‘My son, the doctor.’ He was very domineering; living with him was like being under martial law.”At 17, in the autumn of 1938, he was dragged by his father to see Dr. Clark-Kennedy, the dean of the London Hospital Medical School located in their neighborhood.“The atmosphere was anything but friendly. He gave a cursory glance at my pathetic CV and looked at me down his long nose with ill-concealed distaste. He focused his eyes somewhere behind me as though I had brought a decaying carcass into the room. In an arctic tone of voice, he then said in an obviously pre-prepared way: ‘Sorry, Sherer. I already have my two Jews for this year.’”The young man was relieved. But his father never gave up and turned for help to their family doctor, who had connections and had graduated from Middlesex. Sherer was accepted in early 1939 and managed (by the skin of his teeth) to pass the entrance exam the second time around. But as always, studying was tough for him. In his epilogue, Sherer belatedly thanks his father.“I’m sorry that my father didn’t live to see how my career turned out. He had pushed me into the right profession, if for what seemed to me at the time the wrong reasons.” His theoretical courses consisted of reading medical books, dissecting deceased bodies treated with formaldehyde and examining organs stored in jars; his clinical studies involved listening to professors and examining patients’ chests for defects, asymmetry, lumps and deformities.“Then we palpated it, putting our hands on to feel if there were abnormal heart or lung sounds. We percussed it using the right index finger tapping on the third finger of the left hand… We listened with the stethoscope. We learned to identify heart murmurs... The normal heart sounds are supposed to be ‘Lub-Dub.”Before 1945, medicine was observational, he related, adding that “evidence-based medicine began as a term only in 1990. In my time, you sat on a case and you knew the patient. You made an observation about him that you couldn’t explain, wrote it down and maybe would use it sometime.” Between the middle of the 19th century and for nearly the next century or so, there weren’t many important new developments.The main ones, said Sherer, were the use of ether and anesthesia; understanding of the importance of washing hands with soap and water; pasteurization; the understanding of thyroid function; insulin; tetanus antitoxin; smallpox vaccinations; x-rays and the use of intravenous fluids, especially on the battlefield.There was no attempt to teach a methodology of learning.“In the 1930s and 1940s, there were no exciting lectures, no PowerPoint presentations, no color illustrations. Three-colored chalk was the most advanced technology.”In autumn 1944, the Nazis attacked London with rockets.“We had only a few casualties at the hospital,” he recalled. “The British people adapted, as always, especially as the long-awaited second front had been opened with the successful landings in Normandy.”Not long after, he graduated and became a licensed physician. He informed the hospital director, who grunted and said: “Now you’ve got a license to kill.”After working for a short time in hospitals, in September, 1946, before his call up to military service, he saw an ad looking for young doctors to serve in the medical corps of the New Zealand army of occupation in Kiwa, Japan. He took the job in lieu of British national service and arrived via his first-ever airplane flight. On December 20 of that year, he wrote, remembering the exact date, there was an earthquake registering 8.1 on the Richter scale, shaking the earth for 45 seconds. He also had a shocked glimpse at Hiroshima – totally devastated – a year after the atomic bomb was dropped by the Americans.On leave in Tokyo the following April, Sherer went to a concert at an officer’s club and by chance sat next to an American woman.“She wore a jade-green suit... and I thought she was very pretty.” When she took her glasses off, she seemed “movie-star beautiful.” Virginia Lee Roeder, born in San Francisco to a non-religious Christian family, became Jewish in an Orthodox conversion – taking on the name of Ruth, the daughter of Abraham. They married on March 10, 1949. After living and working in New Zealand, they decided to move to Israel.“Ruth and I had talked of doing so for years. So it was natural that we were bitten by the aliya bug. We went to ulpan to learn Hebrew. The Jewish Agency’s functioning was terrible. Ruth had been here before, but I never had been.”She had given birth to three children in New Zealand – Sherer delivered them himself – who were aged 11, 10 and six when the family moved to Jerusalem.David became a chief of obstetrics at the Downstate University Medical Center in Brooklyn, New York; Michael, a professor of psychiatry and consultant in hospital management near Washington, DC, and Judith Shalvi works for the Yad Hanadiv Foundation in Jerusalem.Ruth, who served as a secretary to the late Rabbi David Hartman for 25 years, died five years ago at the age of 92. Ruth is a constant presence and warmly praised by Sherer in the book. Their descendants are five grandchildren and five greatgrandchildren.As a widower, Sherer has a live-in housekeeper from Moldavia who cooks excellent kosher meals and takes care of the apartment.The book is full of stories of well-known and ordinary patients who came to his clinic or whom he examined and treated at the King David Hotel and other sites. Speaking a little bit of French, he received women from African countries related to diplomats who felt unwell.When the president of Gabon died, he wanted to show his respects and tried to express his condolences in French. Only later, an Israeli diplomat told him that he had inadvertently “congratulated the government of Gabon on losing their president by using the word “felicitations” instead of “mes condoleances.”He treated friendly Persians before Khomeini took over Iran; cellist Casals, whose stomach grumbling turned out to have been caused by parasites and bacteria; a Thai princess of whom he was too embarrassed to ask her age or to disrobe (fortunately, he easily diagnosed her problem as a fungal infection on her skin and treated her). Roslyn Carter, who arrived in the King David when her husband Jimmy was no longer president, developed a mild respiratory infection, which Sherer easily relieved.“I didn’t charge the rich more than I did other people. It wouldn’t be honest. I didn’t want to hurt Israel’s reputation by taking advantage of foreigners. A sick person is vulnerable, especially away from home, and a caring physician can make such a difference in their attitudes about Israel.”He encountered one of the earliest cases of “Jerusalem syndrome,” in which a tourist suddenly thought he was the messiah after being struck by the holiness of the city. One of the most tragic and traumatic cases in his career was in New Zealand when a 19-yearold youth was electrocuted when a storm toppled an electric wire that killed him.He concluded with his amazement at how medicine has changed since he was a student. Laboratory medicine “was superimposed on clinical medicine as never before. Communications, including the Internet, played a central role in making international cooperation possible in real time. English became the common language. To doctors and patients, more journals, emails, instant phone calls and the like brought great benefits. Nowadays, I can stand at the bedside of a tourist and do a video conference with his regular doctor in New York while comparing data in real time.”Scientific progress, he continued, has led to the concept of evidence-based medicine where everything must be proved objectively.“While undeniably important, evidence is also provided by the observations of a physician with time and interest in listening to the patient. A doctor can be a sensitive measuring instrument.”Sherer concludes his advice to a younger generation of doctor. Remember that the patient is another human being. Listen carefully to what he says, and especially what he feels. Keep the computer in another room. A laptop on the desk for reference is allowed, but keep it closed until needed. Take note of the last thing a patient says as he leaves.“It’s probably the key to a difficult problem.”Dear Dr. Sherer, all your tens of thousands of patients and readers wish you a warm “till 120.
