The heart's reward

Prof. Mervyn Gotsman, who has been at the cutting edge of heart and patient care for decades, is today receiving a 'Distinguished Citizen of Jerusalem' award.

heart 88 (photo credit: )
heart 88
(photo credit: )
Israel, Jerusalem and cardiology are the triple passions of Prof. Mervyn Gotsman - the "complete cardiologist" who trained generations of specialists, cared for presidents, prime ministers, chief rabbis - and treated tens of thousands of ordinary people with the same respect. By being presented with a "Distinguished Citizen of Jerusalem" award by the municipality today, Gotsman has officially received some love in return. The 72-year-old South African-born physician was honored by the Israel Heart Society more than four years ago, when it dedicated a whole issue to him, with many articles written by physicians who followed him to Israel after his aliya in 1973. For an unprecedented 27 years, he was chairman of the cardiology department at Hadassah University Medical Center, a department that had only four inpatient beds when he was hired. But getting the Jerusalem award, for which only residents over 70 who have contributed significantly to the city are eligible, was a crowning achievement, as the capital means so much to him and his family. "I regard myself as 'Gotsman from Jerusalem. I used to travel a great deal abroad and always brought my message from Jerusalem," he declares in an interview with The Jerusalem Post. Gotsman, an observant Jew with a crocheted kippa, is probably best known to the general public for being the personal physician of the late Menachem Begin during his premiership and for a while during his years of self-imposed isolation opposite the Jerusalem Forest in Jerusalem's Rehov Tzemah after he resigned. "This brings back memories," says Gotsman, interviewed in my home one street above Rehov Tzemah in the Yefe Nof quarter. But Gotsman also participated in a world-famous event in 1967 - the first-ever heart transplant, performed on Louis Washkansky, a 54-year-old Jewish grocer who suffered from incurable heart disease. "Washkansky was my patient," Gotsman recalls. The transplant team was headed by the dashing Prof. Christiaan Barnard of Groote Schuur Hospital in Cape Town, with the heart donated by a woman critically injured in a car accident. The operation was a success, recalls Gotsman, but the patient had a weakened immune system and died of double pneumonia 18 days later. Gotsman was born in 1935 in a small village, the son of a geophysicist who also served as his son's principal teacher. Mervyn went on to the University of Cape Town, getting his M.D. and remembering highly intelligent classes, stimulating teachers and a "superactive teaching hospital where one lived with acute human medicine." But his internship was halted suddenly when his father died of a heart attack, and Mervyn had to support his ailing mother and two younger siblings. He moved to a mining town in Southern Rhodesia (Zimbabwe) to work as a general practitioner in exchange for a decent income. "General practice in the country taught me how to treat patients as people rather than as diseases, and how to manage families and their social problems. The town had two small hospitals without any specialists, and this left me to deal with major emergency surgery, obstetrics, orthopedics and anesthesia." He had planned a career in tropical medicine, dealing in exotic diseases such as malaria and schistosomiasis, but his mentors persuaded him to drop the idea, as with the "winds of change in Africa," it would be "unsuitable for a white Jewish physician" to return there. Instead, he went to London and Birmingham to study cardiology. He was a medical resident in the morning, a research fellow in the catheterization and pulmonary labs in the afternoons and ran the newly developed heart-lung machine in the cardiac surgical theater at night. "The motto for the department was to use the five senses and supplement it with a stethoscope in the right pocket and a slide rule in the left." How different from today's technological, often no-touch physician-patient relationship! From that he went into children's cardiac surgery and returned to Groote Schuur. After Washkansky died, Gotsman participated in three more transplants before being appointed chief of cardiology in Durban. At Wentworth Hospital, he and colleagues "started cardiology from scratch" with clinics, catheterization and open-heart surgery. "Cardiology is a very precise science and a really interesting specialty. I often worked 24 hours a day doing all types of things." BUT IN 1971, he came to Hadassah in Jerusalem for a six-week sabbatical. "The boys [the professors] decided I should be the next chief," and he brought his wife Aileen (a nurse) and five young children on aliya in 1973. Today, the oldest is 42, and they work as a nurse, a cardiologist, a bank accountant, a computer science professor and a computer analyst. He has 10 grandchildren. Not long after, the Yom Kippur War broke out, leaving him without several physicians who had to go into service. Later, his South African residents Basil Lewis, Avi Bakst and Justin Silver answered his call to make aliya, and today all are important Israeli cardiologists. Within a year, even though then-Hadassah Medical Organization director-general Prof. Kalman Mann said he couldn't afford Gotsman's "expensive wish list," the department had a modern cardiac cath lab, an expanded intensive care unit, more beds, and the country's first echocardiography machine and nuclear scanner. Some of his many other "firsts" was Israel's first digital cath lab, and the idea of treating acute heart attacks and opening clogged arteries in Magen David Adom ambulances or at home even before the patient reached hospital. One of his beloved students at MDA was the late Dr. David Applebaum, head of Shaare Zedek Medical Center's emergency department, who was murdered by terrorists in Jerusalem in 2003. GOTSMAN IS an interventional cardiologist, the kind who diagnoses and treats with drugs, minimally invasive angioplasties and the like but without operating. At Hadassah, "we did 2,000 angios a year." When patients died despite his best efforts, Gotsman found it "very difficult. I felt I failed to give my best treatment." He also did a lot of clinical research, writing papers at night. Some 500 were published by Gotsman and his colleagues during his Hadassah career. His relationship with Begin was "one of the most interesting periods" in his life. Just five years after settling in Israel, he was introduced to the new prime minister. "We had a wonderful medical symbiosis. He was then in excellent shape," recalls Gotsman, who always called him "Mr. Begin." As the prime minister's personal physician, he travelled abroad with him about a dozen times to the US, and even within Israel when Begin left Jerusalem. He recalls that in 1982, when the 68-year-old Begin was hosting then-French president Francois Mitterrand at a King David Hotel dinner, the prime minister fell ill. Begin, whose medical history by then included two heart attacks, a minor stroke and a broken hip, had an upset stomach. "He thought he should take a pill under the tongue, but this didn't help, so Mitterrand gave him one of his own pills. His blood pressure dropped and he collapsed. It was the wrong treatment." But after Gotsman attended to him, Begin rested and did not need hospitalization. Previously, Gotsman had inserted a pacemaker into the president of South Africa and treated Golda Meir, Yitzhak Shamir, Zalman Shazar and Ovadia Yosef, among many other very important patients. But "after taking care of Begin, looking after any VIP was very easy." Begin, he says, became depressed toward the end because he was not with her when his beloved wife Aliza died (Gotsman was with Begin in California when the terrible news arrived); because of the loss of life in the First Lebanon War and because "he hadn't been fed correct information when Sabra and Shatila happened. He heard it from the BBC." Begin "collapsed emotionally. He was a fine man, a real gentleman. He was a very good patient as well, always saying I was the doctor and accepting instructions." But after his self-imposed retirement in Rehov Tzemah, he almost always refused to leave the house." CARDIOLOGY HAS changed over the decades. There are new tests, and we live in an era of technology. The present phase of research consists of running very big controlled clinical trials, which doesn't require a lot of intelligence but brings in money from drug companies. There is little money for pure research. Israel has three or four centers doing molecular biology and a little genetic cardiology, and several very good scientists, but "more money is needed for research by the younger generation. We need dedicated research institutes funded by the government. Doctors come back from post-doctoral research abroad and need room, a technician and a starting grant so they can do here what they started abroad. But there is so little money." Privatization of many services and the growth of private hospitals, he says, has "polarized patients into two groups - paying patients and the amorphous masses. Non-paying patients get good care at Hadassah, but in private hospitals they get a more personal approach. There is less equity in the country's health system. The only way to deal with this is to change the attitudes of doctors and health funds and put less emphasis on cost cutting. The Health Ministry merely has its finger in the dike. They are always trying to solve short-term problems rather than building long-term programs. I was head of the national advisory council on cardiology for nearly 10 years, but there was very little implementation of our recommendations. There was always the excuse that there is not enough money. But prevention of heart disease is the most important priority," Gotsman declares. With today's prevention and better treatment, he says, there are "too many cardiologists in Israel, too much decentralization and duplication of services, and probably too many heart surgeons." Hadassah University Medical Center, for Gotsman, was "a great place. It was the acme of my career. I had many offers to work abroad, to head big departments in the US, England and elsewhere. But I felt I didn't want to move away. The HU-Hadassah Medical School was excellent and is so today as well, with very high standards of admission. About 95 percent of the students are excellent, and turn out to be very good doctors. I don't think they have changed at all from my day - not in medical school. Some change later, when they encounter the hard facts of life and its financial considerations. "Cardiology in Israel is very good, very accessible," continues Gotsman. The Hadassah Medical Organization, he says, has gone through three phases. "It was human medicine under Prof. Mann, then technocratic medicine under Prof. Shmuel Penchas, and now consolidation and a lovely spirit under Prof. Shlomo Mor-Yosef. A breath of happiness came into the hospitals with Shlomo." Gotsman still treats some of his old patients, and a few new ones. He has not abandoned teaching, as taught for four years in Clalit Health Services clinics, setting up teaching programs on cardiology for general practitioners throughout the country, including poor areas from Dimona, Sderot and Tel Sheva to Kiryat Shmona. He still does it in the Jerusalem area. He has also become a dedicated Talmud scholar in his golden years.. The Jerusalem prize, he concludes, "means recognition. I've arrived home with this prize." The best summation is at the end of the article Gotsman wrote about himself in the Journal of the Israel Heart Society: "Fifty years of medicine and 30 years at Hadassah have taught me many lessons: Care for patients and not diseases, expert medical care for all patients, scrupulous medical honesty, the search for truth in medical research, scanning, understanding and introducing new developments and a disregard for a large income.... "I have been fortunate to raise generations of physicians who understand the constant paradigm shifts of an evolving art and science, and who will continue to progress in the world of molecular biology, globalization and instant communication... "I have only two regrets: Patient care occupied too much of my time, and the busy schedule deprived my family of a father. Would I do it differently if I had another opportunity? Probably not."