Dr Judith Guedalia

We 'Get' Pachad Yitzchak, But What about Avraham?
    When my kids were younger I used to say, "My sons keep me in stitches," meaning of course, that they were great fun and also frequently needed to get "sewn-up" after their various exploits.  One particularly harrowing time the nurse at the school my children attended called very apologetically to say that one of my sons had been injured at school while the other had been injured on a school outing.  They were at two different ERs with two different teachers.   
    She kept saying, "I'm so, so sorry." As soon as I found out it was only stitches, I was sort of okay.  This of course only happened (as all things of this sort) when my husband was out-of-town.  I took the baby with me and went to the younger of the two boys, called the other teacher at the ER (pre-cell phone days) and said I'd be there in 20 minutes.  Then, with two in hand, went to the second ER for the "stitching" there. 

   The nurse said, "No children allowed in the room." "Fine," I said. "Here, take these two and I'll handle my son in the ER."  Needless to say the rules were bent and after finding more rubber gloves to blow up into little balloons, we got down to the business at hand - so to speak - and helping my second son through the ordeal of shots to anesthetize the area and then stitches. 

   Not every parent should or does "attend" when a child gets stitches, but I knew from previous experience, that my sons would be better patients if I could take care of their heads, while the doc took care of their stitches. 

   Attending children who need to undergo medical procedures, no matter how minor, is always difficult for parents.  When children undergo psychological evaluations at the Neuropsychology Unit at Shaare Zedek Medical Center, Jerusalem, I usually have the parents in the room for a few minutes, and then I try to "go it alone" with the child; this is for both the parents' sense of calm as well as the children's.  

   There are several reasons for the purposes of this article. The most cogent reason is that it is very hard for a parent to watch his/her child not perform as well as they had hoped.  Most of the tests require finding a basal score - lowest level at which the examinee succeeds, and a ceiling score, level of first consistent set of failure.  The fact is, though, parents do not know what the "average" performance on the specific test is, and may see any failure as meaning their child (who I might add they brought in because of some problem) is worse off than they had thought.
   This whole long introduction is to Yitzchak* and his father Avraham. (*Not their real names but the choice of these names will be apparent; the names are garnered from the Bible.)
  They came for assessment of Yitzchak's cognitive level after over a year of severe intractable epileptic seizures.  An estimated 2 million Americans of all ages have epilepsy, and most of them are successfully treated with medications that keep their seizures well controlled. As many as 35% of epileptic patients are termed drug-resistant, experiencing frequent, sometimes disabling, seizures.

    As the medical history unfolded (both in the many papers that were brought and the almost robotic repetition of dates and procedures endured), I understood that this had been a period of severe "dis-control."  Not only the unending seizures but also visits to specialists, more and more tests, more and more medications - all of which did not produce the sought after relief. I sensed that both father and son were joined in a "knot" of fear, helplessness, anxiety, frustration and pain. 

   I had "magical" hopes that this knot would lend itself to unraveling or cutting in a helpful fashion, similar to the Gordian Knot, which is a legend associated with Alexander the Great. The Gordian Knot is often used as a metaphor for an intractable problem, solved by a bold stroke - as in "cutting the Gordian knot"(Wikipedia). 

    Now they were in my office - medically things had calmed down somewhat - to "only" a few dozen seizures a day, down from a hundred or more! 

    They came in and sat opposite me. I did my standard interview of Yitzchak, trying to get a read on his cognitive, expressive and receptive language, and abstract reasoning abilities.  I was watching how father and son related with each other and with me. What seemed obvious was they were both in need of help. My "triaging" made me place Yitzchak, the boy, in front of our portable sand box with soldiers and tanks, etc., and the father in a seat opposite me. 

   As I started to "engage" Avraham, the father, in conversation, I noticed Yitzchak's body becoming less stiff and his "work" with the soldiers in the sandbox taking shape.  Avraham, on the other hand, began to be more and more agitated.  "What are you doing just talking to me? Shouldn't you be talking to Yitzchak? Why are you sitting here near me and not next to him?"

    As he spoke, Yitzchak's back (which was facing me) became stiff and he seemed to hold his hand above the sand and wait.

    "I am thinking how difficult this year has been for you - all those hospitalizations. Winston Churchill is quoted as saying, "They also serve who sit and wait," and you certainly didn't sit, you were an active participant in your son's journey to better health.  I am watching Yitzchak play with the soldiers, he too is a fighter and won many battles, and you fought side by side with him."

   Out of the corner of my eye, I see Yitzchak's hand return to the sand and move a tank up a "hill" he fashioned.

    "Why do you speak to me, I am not the patient here!" 

    "You know," I say, "in English the word for 'savlanut' is patience, and it is a 'homophone,' sounds the same even though it is spelled differently, as the word 'patients.'"

     I sense the dad's anger; Yitzchak is again holding his hand above the sand.  I try a different tack.

   "When Avraham had his biggest test of faith, he had to hold his beloved son down on the Holy Altar.  Yitzchak was an extremely pure and faithful son, he knew how hard it was for his father to do what had to be done, and he helped in every way he could.  I see that your son is very sensitive to you, too. He is sitting here and letting us speak, not interrupting."

    Yitzchak's shoulders dropped a bit from the "high alert" position they were in, just seconds before.

    "This is not working; I don't think you are doing the job I brought my son here for you to do.  I think this meeting is over and I don't think we will be back."  

   Though there is quite a lot in the commentaries about Yitzchak's fears and behavior after his "almost" sacrifice, we know that Sarah, his mother, died upon hearing about it.   Abraham's emotional state is not discussed.  Yes, he seemed to continue on with his life, in fact he "started anew" remarried (Keturah) and fathered five more sons.  But what were his "scars" from the thwarted Akeidah (sacrifice)?

   As they left the room Yitzchak gave one last longing look at the sandbox.  Maybe this battle was over for now, but the siege and war were still raging.  

   I felt I had "messed-up" an opportunity to help them both.  Sadly, I made a mental note to call in a month in order to find out how things were going and if they would like a referral to someone else, or would possibly return to where we had left off.
Originally published in the Jewish Press on December 17, 2008.

Tags: Epileptic Seizures | Gordian Knot | Jewish Press