Was it for Love or Money?

The last eighteen years of my life in the United States were spent shepherding the development and growth of the Aliquippa Hospital cardiac care unit (CCU).  Preventing deaths of cardiac patients was an almost daily occurrence for me and my staff.  Those were heady days as one medical advance followed quickly on the heels of another, and consequently, death rate from heart attacks fell from thirty to fifteen percent.  If I wasn’t involved with each individual incident, at least those I had trained were.

 For the many hours of service to the unit, I received no financial remuneration, not a nickel; at least not until the final five years when I did receive a token stipend.  I won’t deny though that as the reputation of the CCU sprouted, so did the size of my cardiology practice and my income. 

Since Aliquippa Hospital had no interns or residents, almost nightly a CCU nurse woke me with a question about either one of my patients or that of another doctor.  Three or four nights a week a visit to the hospital was necessary, which made my living a few hundred yards down the road an advantage.  From time to time my visit would entail a time-consuming insertion of an intravenous cardiac pacemaker wire or a catheter into a pulmonary artery to aid the treatment of shock.  These visits were medically fulfilling while frequently yielding significant fees.  Many times I asked myself, “Am I getting out of bed for the money?”  And if it was for a non-paying patient, “Was this one just to ease my conscience?”  I usually answered myself; “I’m doing it for the love of my work.”  But I had to admit that the money and the adulation of the nursing staff didn’t hurt.  There was no way to pass judgment on my motivation, that is, until I got to Israel.

During the first four months of my aliyah (move to Israel), I was totally dissociated from medicine.  My time was consumed with the study of Hebrew. The memory of the previous eighteen years of frequent night visits to the hospital remained pleasurable but finally I experienced the joy of uninterrupted sleep – and obviously I wasn’t being paid for that night’s sleep.  For the ensuing four months I worked an eight-hour day as a senior hospital resident upgrading my skills in nuclear medicine. Subsequently I was appointed Director of Nuclear Medicine at Wolfson Hospital.  The department consisted of one nuclear camera, one technician named Shula, and me.  It was my task to build the department into both an active ancillary service and a teaching facility.  I encouraged the appropriate requesting of nighttime emergency scans; their performance fell to Shula and me.  In time, since I had to be present to interpret the nuclear scan, I excused Shula from helping me.  I also routinely arrived at the hospital each morning an hour and a half before Shula in order either to carry out quality control measures or to begin a time-consuming patient study, all in order that the day’s work would flow smoothly.

And now to my point.  I received a fixed salary with no extras for additional effort.  More than that, after six months passed, I received tenure; my job was guaranteed at least another five years, when I would be sixty-five.  I could have sat back and done very little, even wander into work at ten in the morning and leave at three.  Nor would I have been the first to take concurrent private jobs to earn more than my hospital salary.  Even though I didn’t need to prove myself or answer to anyone, I never took advantage of any of these perks.  And for all my extra work hours and the emergency night calls I received not an extra penny.   A few colleagues praised me.  Others called me a friar, a Yiddish word meaning, “sucker.” 

Again I ask, “In Aliquippa did I get out of bed at night for the money?”  My continued zealousness in Israel indicates, “No.”  And yet as I try to exonerate myself, I have to admit that in Israel, whatever I did, including moving here and taking emergency calls, was predicated on a strong Zionist urge to help build my new homeland.  So I’m hardly off the money-motivation hook yet.

Was I so conditioned by the capitalistic reward-for-work ethic so that even after the reward was taken out of the equation, the work habit persisted?  If so, does that mean that Israeli doctors raised in a socialistic society extend themselves less and justify it because of their poorly compensated and under-appreciated workday?  I have no statistics.  I can only assume that there is no difference between us as to character and that the answer to the last question is, “No.”  My daughter, Raina, who witnessed my medical style while growing up in America but received all her medical training in Jerusalem, validates that assumption as a tireless, underpaid Specialist in Family Medicine. 

In both my Aliquippa and Wolfson Hospital offices, I hung photographs of my esteemed Boston mentors.  Was I afraid that some evil spirit would emanate from them if I didn’t perform nobly?  And I remember two of my Beth Israel Hospital teachers who spent countless unpaid hours with me and other fellows during evening and nights.  We were the children they never had.  

In the last analysis let me be unscientific.  I shall beat my breast no more.  I conclude that I was and remain primarily motivated by the love of my profession.