Alan L. Gass, M.D., FACC, is Director of Advanced Cardiac Failure and Transplantation at Westchester Medical Center. From 1991 to 2005, Dr. Gass served as the Medical Director of Heart Transplant Services at New York’s Mount Sinai Medical Center, where he personally followed hundreds of patients – including the author – in various stages of heart failure, 400 of whom were transplanted, achieving survival rates among the top in the country.
Dr. Gass completed a residency in Internal Medicine at Long Island Jewish Medical Center, a Cardiology fellowship at Newark Beth Israel Medical Center, and a fellowship in Cardiac Transplantation at Stanford University. He is well published in peer-reviewed journals and is an investigator in studies on transplantation and cardiac assist devices. His work in tailored, minimal immunosuppresion after transplant has gained international recognition.
Dr. Gass has appeared in Life Magazine, The New York Times, and on CNN, NBC, CNBC, and local New York news affiliates as a medical expert. He was featured in a one-hour documentary special, “A Change of Heart,” on Dateline NBC, which chronicled the poignant wait of several of his patients for a suitable donor heart. He is on the advisory board of HealthCorps – Dr. Mehmet Oz’ new program aimed at combating childhood obesity using college students as mentors and teachers to raise awareness of the benefits of diet and exercise – and Dr. Gass was recently appointed Integrative Medical Education Director for the National Institute of Whole Health.
Dr. Gass continues to be inspired by patients who have experienced dramatic recoveries through lifestyle changes, and he believes that, ultimately, the way to prevent disease and minimize the need for medical or surgical intervention is through exploring the connection between spirit, mind and body.
Although most of us prefer not to venture outside our comfort zones, a health crisis can jolt us out of that complacency. If we’re smart though, we can create value from these unforeseen events, using them to reflect on questions like, “How might this contribute to me?” “What is the life lesson?” or “What quality am I being called upon to develop in order to produce peace of mind?”
As a student of human potential and someone who has benefited first-hand from mental imagery, I believe we have a lot more to do with “creating” our lives and the situations we find ourselves in than ever imagined. This is not to evoke guilt or cast blame, but rather to look purposefully to see why things happen and in what way we have actually caused the condition of our own health. Cause and effect are not always obvious, as they are in cases of true pathology related to observable abuses; however, if we make a subtle shift in perspective, we can often see how we bring about the events that change our lives.
Because of my unique vantage point, I have been privileged, over the past two decades of medical practice, to share my patients’ most private moments: their highest highs and their lowest lows. One skill I have worked on diligently over the years is to make full use of the history-taking process to connect with my patients beyond the boundaries of their medical condition. Whether through a religious or spiritual venue, a favorite sports team, or whether by actively seeking out some other common channel through which to relate, I do my best to find a point of contact for each individual. Holding a patient’s hand while taking a pulse can convey human tenderness; looking into their eyes – or the eyes of the loved one who accompanied them – can do much towards establishing trust, passing along a sense of security and successfully enrolling the patient as a partner in his or her own recovery. More than any diagnostic test, these basic skills have given me the foundation upon which to build a bridge, a common bond, a point of entry. Only when that rapport has been established, only when the relationship has transcended “doctor-patient,” can the medical interventions begin to do their job.
Sam Krause is the type of patient who makes a doctor’s work both enjoyable and rewarding. He came to me in January 2003, a tall, bearded, 50-something-year-old Orthodox Jew with end stage heart failure. His movements were slow, and his complexion was pale – a hint that his heart was not pumping enough oxygen-rich blood – but otherwise, he displayed a ready sense of humor, firing off one-liners like a stand up comic. His wife Terry was at his side. Both were nervous, both authentically concerned, because Sam’s local New Jersey cardiologist had referred him to me for transplant evaluation. We took to each other instantly, in that wise-cracking sort of way, and I soon discovered that beneath the playful exterior, and even beneath his being in mystery about what would become of him, lay an intensely devout man steeped in the mystical tradition of a discipline called Chabad Chassidut. Here was a soul that thrived upon complex philosophical inquiry.
Beyond that, he was pleasantly receptive as I laid out the transplant evaluation process. We would first do everything we could to avoid transplant: we would change his diet, modify his medications and get him on an exercise regimen. Since he showed an openness to metaphysical concepts, we also discussed some positive affirmations and visualization techniques that would benefit his spiritual core. Sam still seemed apprehensive, so I explained that, even if transplant were indicated, when all was said and done, he could expect a successful surgery and a very good quality of life afterwards. I told him about a patient who had received a new heart over the past two years and who had just run in the 2002 New York City Marathon. Sam was in disbelief that something as radical-sounding as a heart transplant could turn out to be “no big deal,” but he willingly accepted my explanation, and when it came time to leave, I sensed a spirit of optimism overtake him as he said goodbye.
After our first meeting, I continued to think about Sam, and I looked forward to seeing him again. Sam’s zest for life was deeply moving: he had things to do and places to go; he wanted to get on with it and be well – really well. He was sick of being sick, and nothing was going to get in the way of his plans for the future – not even a heart transplant. I found myself profoundly touched and actively engaged in wanting to help him get better.
Over the next several months, Sam and I embarked on something of a symbiotic relationship. Although our lifestyle approaches were very different, they complemented each other. From my side, a zealousness to treat my patients, not just medically, but personally, had brought me to a point of inquiry into the spiritual component of healing, compelling me to seek out the guidance of some very close, like-minded people. It was serendipitous for me, then, that Sam came along with his knowledge of Kabbalah and mysticism. From Sam’s point of view, my ability to inform and educate him with concrete medical facts proved to be of tremendous comfort. Visits to his room during rounds became a pleasant part of my day, and I recall that the house staff – the nurses, residents and interns – felt similarly enlivened by Sam’s presence in the hospital. Many times I was asked some version of, “How does he stay so upbeat while lying in bed, waiting for a heart transplant?”
Despite Sam’s obvious medical needs, he was not a “needy” personality. My time with him was never one-sided, but was always an exchange of ideas and interests. It became almost like a courting session, where we each shared our desires and committed to supporting the other towards our respective goals. We reached a point where we were still speaking words, but moved more with sentiment or feeling rather than actual words, almost as though we didn’t need to speak at all.
Conversations with Sam fueled my examination into the nature of healing: what is the unknown force that factors into a patient’s ability to recover? As an example, I’ve often wondered why, if ten patients have been transplanted with ten well-matched donor hearts, does the outcome vary so dramatically. The surgery and the medications are the same, what is the variable, then, that enters into the equation, bringing about that broad spectrum of results, most of them unexplained by traditional medicine?
With these questions forming, I was reminded of some unique vignettes from my own experience. I recalled a Hindu patient who, while waiting for transplant, used to hang a picture of his deity, the Mother, over his hospital bed. In his culture, the Mother is a divine being who expresses love and caring in a very personal, direct way, like a loving mother who cares for her children. The Mother’s picture accompanied this patient to the O.R. during his transplant surgery and to every follow-up biopsy after his heart transplant, and I tell you that he thrived in every way: he didn’t have to wait too long for a donor heart, his surgery went extremely well, and he is the only patient I can recall whose biopsies never showed even the mildest rejection – not one single white blood cell ever – which is rare, extremely rare.
Another patient, a Latina woman who came to me for transplant, also displayed an amazing integrity of faith. Interestingly, she never seemed particularly concerned with how she was doing, but rather how I was doing or how the nurses were doing, or even how our families were doing. It was never about her. As bad a predicament as she was in, she looked at her life as though there were nothing wrong. “Oh, I’m here for a transplant? Ok, no problem.” The circumstances did not faze her. In her case it was almost an assumption, “I will do well.” She was so connected with her spiritual source and so in touch with divine goodness at every moment, that “I’m fine” was not a platitude for her, but more like the space in which she lived life. This patient also did extremely well throughout her wait for a heart and her transplant, and although in her case there were some bumps along her journey to wellness, she had a simple, overriding trust that carried her through. Hers was the purest form of faith I’ve ever seen.
These stories inspired me through their unquestioning examples of the power of positive thinking and of living in harmony with the energy that sustains life. In contrast, Sam’s show of faith did not always fit my picture. Although his religious affiliation was more outwardly visible – he wore the yarmulke and tzitzit of the Orthodox Jew – there were times when I witnessed something I would characterize as a lapse of faith. For Sam, medical facts were important; he was desirous of a statistical prediction of the outcome. From my point of view, this went against faith, for as I saw it, true and total faith does not question, nor does it base itself upon knowing the outcome.
When I asked Sam about this seeming discrepancy, his eyes brightened. “Many spiritual disciplines strive towards an undisturbed, immutable state of bliss, but Judaism is not one of them,” he answered. “For a Jew, it is not enough to say ‘I believe in God even though I don’t understand His ways.’ Maimonides directed us to use our intelligence to try our hardest to understand God, for isn’t our love for another enhanced by our ability to understand and relate to them? If you accept that God is a Superior Intelligence, then your manmade questions can never threaten the relationship. So you do not fear intellectual inquiry; instead, you pursue it in order to connect with something as dear and precious and Sovereign as your Creator. When your faith comes from the soul, which is an actual part of God, questions do not represent doubt, but rather, an attempt to get closer to your Source. Jewish tradition encourages us to ask, inquire, learn, think, and understand. In fact, our sages have taught that accepting matters on faith alone is not necessarily a virtue.”
This intriguing approach was unfamiliar to me, but I could not deny that whatever path Sam was on, he was sure to reach his desired destination.
And reach it, he did. What follows is the fascinating account of how medicine and mysticism intertwined to bring Sam from illness to vibrant good health. I invite you to read his story and judge for yourself whether science and spirituality must necessarily oppose each other or whether they have the potential to dovetail perfectly, producing a balanced, harmonious blueprint for living.