Dbs at Rambam

ISSUE No.4 SEPTEMBER 2009 Rambam Health Care C a m p u s on Call MEDICAL ETHICS A person who seeks medical care hopes for and expects intelligent, compassionate and ethical problem-solving skills from the physician. This expectation is grounded in the elevated behavioral norms to which physicians have held themselves going back in history at least as far as the Hippocratic Oath. The spiritually and psychologically wide-ranging 12th or 18th century CE Prayer of Maimonides – historians dispute the date and authorship – revised and expanded upon that ancient oath. In the wake of the gross perversion of medicine practiced by Nazi-German physicians and scientists, the international community produced a flurry of documents re-codifying the norms of civilized behavior: the Nuremberg Code of Ethics on Medical Research (1946), the UN Declaration of Human Rights (1948), the UN Declaration of Pictured at Rambam are, L to R, guest surgeon Dr. Mark La Meir, Department of Cardiothoracic Surgery at Academic Hospital, the Rights of the Child (1959), and two World Maastricht, the Netherlands; Dr. Avishai Ziser, Director of the Cardiothoracic Anesthesia Unit, RHCC; and Dr. Gil Bolotin, Medical Association (WMA) edicts – the Director of the Department of Cardiac Surgery, RHCC. Related story p4, top left. International Code of Medical Ethics (1949), which is broadly concerned with the duties of clinicians toward patients and colleagues, and the 1964 Declaration of Helsinki (revised 2008), which regulates biomedical research involving PORTRAITS OF COURAGE human subjects. cont. p8 “It’s like an iceberg,” N, the patient, says and adds This would be achieved by bilaterally implanting two grimly, ”and iceberg doesn’t even begin to describe it.” leads consisting of four cylindrical electrodes apiece in the subthalamic nucleus of N’s brain and two GREETINGS FROM ”It’s like jammed cogwheels,” says Prof. Menashe battery operated neurostimulators in N’s chest, and Zaaroor, Director of the Department of Neurosurgery, connecting each neurostimulator to its lead by PROF. RAFAEL BEYAR manipulating the patient’s wrist to demonstrate the running two subcutaneous, insulated extension wires tock-tock-tock-tock of shackled motion. up N’s nape, behind his ears and into his brain. Dear Friends of Rambam, Each seeks a metaphor to describe the rigidity that The therapy is called Deep Brain Stimulation (DBS) Our dynamic healthcare campus Parkinson’s disease imposes on normally fluent body and is bilateral because the brain’s left side influences continues to shape-shift before our eyes movements. the body’s right side and vice versa. as we make progress toward realizing our Vision of Adam master development plan. In March, they met in the OR at Rambam determined DBS is tough on a patient for numerous reasons: it Most visible – and audible – are the to restore to N relatively normal physical movement calls for two surgeries within a week of each other – renovations of existing facilities and the and freedom from high doses of Parkinsonian the first to implant the leads, and the second to construction work on the site intended medications and their side effects. implant the neurostimulators and extensions; the for our new West Campus hospital cont. p3 complex (related story, p7). Less obvious but as significant is the ongoing recruitment to our hospital staff of gifted physicians and innovative In the midst of so much change, the constant at researchers (related stories, p4). Rambam is our commitment to saving and PROFILE: healing lives. Please join me in congratulating Most recently, the State of Israel’s Supreme bride and groom Avital and Asael Lubotzky PROFESSOR AARON Hospitalization Authority (SHA), which includes (pictured L, below, in June 2009) and Senior Orthopedic representatives of the Ministry of Health, the Surgeon Dr. Alexander Lerner (pictured below, dancing CIECHANOvER Home Front Command of the Israel Defense with the groom). During the Second Lebanon War of Forces (IDF), and other officials responsible for Summer 2006, Lieut. Lubotzky was airlifted to us CHAIR, SCIENTIFIC ADVISORY BOARD national emergency and disaster preparedness, at Rambam in critical condition, having sustained RAMBAM HEALTH CARE CAMPUS has requested that our planned underground grave leg injuries in the Battle of Bint Jubayl. Dr. facility serve as the county’s Northern Regional Lerner insisted that the young man’s legs could be Cancer and Vascular Biology Research Center Underground Emergency Hospital and that its bed saved and attended Lieut. Lubotzky through twenty Rappaport Faculty of Medicine & Research Institute capacity be revised to meet the needs of Haifa orthopedic and cosmetic surgeries. Technion-Israel Institute of Technology and the surrounding neighborhoods. He wheels forward a bright-red, wooden school bus the approximate size of a Kleenex box, which is parked on his desk beside a filing tray. “Think of how simple and expressive is this toy hand-made by a carpenter that works in a market in Holland; he wrapped it for me in a newspaper.” He lifts off the lid to reveal parallel rows of children with painted blocks for bodies and smoothly carved knobs for heads, each schoolchild nestled into place like an egg “With great excitement and emotion, I stood at Asael’s individually coddled in the carton – lifts out one doll, wedding and watched him stand on his own two legs under the chuppah, break the glass on his very ﬁrst try holds it, then replaces it gently and closes the lid: Proﬁle of Prof. Aaron Ciechanover P2 and dance with his family and friends and even with “I want to play a little bit and I take one kid and me – the joy was great.” Dr. Alexander Lerner play with it. Here, we use virtuality to help our Portraits of Courage P3 imagination; there are things that we need to see and Prizewinning Synergy P4/5 In these pages, we are pleased to share with touch in order to imagine how more complex things you many such stories of courage and work. In science we use frequently the opposite Friends Help Build A Hospital! P6 optimism on the part of patients and approach – we use our imagination to track reality Star Spangled Events P7 caregivers. down. The bus has a role in this wonderful cycle.” Author! Author! P8 Story, p2 PROFILE: PROFESSOR AARON CIECHANOvER P2 rofessor Aaron Ciechanover stands the culture of food here,” he comments, taking t is late December 2008, and Professor in the center of his small office obvious pleasure in naming the kinds of sushi: Ciechanover, 61, has just returned from playing catch with a Super FlipOut, anago, ebi, tamago, ikura, uni and toro. a brief trip to Kobe, Japan, where he a three-dimensional skeleton ball lectured to a joint meeting of the of metallic green, blue and gold And clocks. “You see? This one tells the time Japanese Societies for Molecular Biology plastic that expands each time he counterclockwise, and that one” – he indicates a and Biochemistry, and Sydney, Australia, tosses it toward the ceiling, contracts as he handsome cabinet of dark wood containing where he was awarded an Honorary Doctorate Pgrabs it during its fall, and changes surfaces and mechanical innards exposed behind glass – “is an Ifrom the University of New South Wales and met colors with every flight. electromagnetic clock for workers to punch their with leaders of the Jewish community there, [time] cards. discussing with them the apparently paradoxical “I bought it on the Internet,” he says. “It is a subject of how to carry out high quality research sophisticated toy that looks like a virus. I’m “Time is a very elusive concept,” he muses, in a small country still fighting for its existence. searching the Internet for such toys and am a “a philosophical question that many have frequent visitor to toy stores.” discussed for centuries and have written about. On this cold Haifa morning, he wears a charcoal- What is time? Is it something that we have gray cardigan, a checked cotton shirt in citrus The office is tucked into a corner of his modern invented in order to be on time? If there were no hues, faded blue jeans, white gym socks, and laboratory in the Cancer Center, high up in the clocks, would there be time? Are we progressing? navy-blue Crocs (powdered with a layer of dust, Technion’s Rappaport Faculty of Medicine building Is it about aging, is it birthdays, days and nights, presumably from the major excavation of land on the Rambam campus, and is crammed with what is time?! I’ve always been fascinated by currently underway at Rambam directly outside toys, pictures and other tidily displayed treasures. time, [and] clocks are a superficial expression the building). of my fascination.” Who dusts this stuff? A wavy current of graying hair flows over the top Most obvious among these many treasures, of his head and tumbles down his brow, further “From time to time, I do. [These things] are all however, are the tens of miniature vehicles expertly suggesting a boyish aspect to this large man with precious in the sense that they come from all over parked atop metal cabinets. They are toy the weathered face, slow-paced voice, and dark, the world, from places I have visited, and each automobiles mostly, but also include two New York profound eyes. One might mistake him for an holds meaning for me,” he replies. Checker Cabs, a double-decker London bus, a sleek outdoorsman if not for the delicate white skin of Japanese bullet train, model airplanes, and a Sun those large and animated hands. There are five ceramic cows, “all from Chicago, Star 1/48th-scale Apollo Lunar Excursion Model. all replicas of the [civic] Chicago cows, and “No, I’m not at all in love with cars in my real life,” I have another sixteen to twenty of them at “Each is either from a place that I have visited or he replies to a question.

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