It is really quite hard to absorb the killings that took place last week in Connecticut and truly heartbreaking to think about the pain of the parents and families, indeed of the entire community. My heart goes out to them and their loved ones at this traumatic time. As doctors, we are often called upon to make the emotional switch from death to life – in our personal lives, it is much more difficult. Here I would like to share with you my visit to the Endourology and Lithotripsy Unit and my conversation with its Director, Dr. Mordechai Duvdevani. I think you will find it most inspiring.
Some medical fields are often in the news, while some diseases and conditions remain beneath the radar, so to speak. Kidney and bladder stones are among those conditions and endourology one of those specialties. Yet Hadassah's physicians invest the same amount of caring and research regardless of their specialty's profile. Dr. Duvdevani is one of those.
"Many doctors are good at many things; a few are very good at something," he says. "I want to be that one." By all accounts – and most certainly from my perspective – he is that one. As head of HMO's, Endourology and Lithotripsy Unit he has received international recognition and many honors. But during my visit with him, I could see that the awards he enjoys the most come from the success of an operation or treatment – like the procedure he performed on a six-month-old baby or the kidney stone he removed from a man who believed he was 105. "He was uncertain about his exact age, Dr. Duvdevani says with a smile, "but his 80-something son who accompanied him felt the figure was more or less accurate."
￼Endourology is usually associated with an extracorporeal shockwave lithotripsy, a minimally invasive approach to treat kidney stones and other urologic conditions. Indeed, that is the case for the majority of the Unit's patients. But it can also involve endoscopic surgery for other disorders that obstruct the urinary flow. The state-of-the-art lithotripter Hadassah received in 2010 from generous donors provides the possibility of moving between the two.
A week ago before my visit, Dr. Duvdevani had successfully operated on the baby boy. The baby came to Hadassah with a very severe infection and with very small kidney stones. "I was worried about treating such a small child," he told me. His youngest patient previously was two years old. "Then I asked myself if there was another place in the world that could do it better than we – and scheduled the surgery." He and Prof. Ezekiel Landau, Director of the Pediatric Urology Department, conducted "a one hour bloodless procedure. When I saw the baby the next night, I saw a happy, smiling baby."
At the other end of the age spectrum, the man who came to Hadassah with his son was treated for his kidney stone. "I still don't know exactly how old he is, but he came back three years later for a check-up," Dr. Duvdevani says with a grin. "I found some small stones but no significant one."
Dr. Duvdevani is immensely proud of Hadassah's accomplishments in the field and credits much of the success to his dedicated team and colleagues. Hadassah was one of the first hospitals worldwide to acquire a lithotripter in 1985 – and when we did, he says, Arie Latke, the Unit's Administrative Manager, moved from cardiology to lithotripsy. "Nothing here would exist without him. He is the heart of this Unit. I don't know many other places that have such a person. He is available around the clock, every day of the year. I think he is more devoted to the Unit than to his family."
￼As the number of patients continued to grow and Hadassah acquired its second lithotripter, the endourology and lithotripsy service officially became a Unit with its own four-room suite, the only one in the country that combines both lithotripsy and endourology. In 2012, the Unit treated 600 patients using the lithotripter and another 400 more patients underwent endoscopic surgery to remove painful kidney stones and growths in the upper urinary tract.
International recognition takes many forms. Under Dr. Duvdevani's leadership, in 2008, the world Endo-Urological Society recognized Hadassah as a center for fellowship training—the first such unit in the Middle East and one of very few outside North America and Europe. Two years later, in March 2010, Dr. Duvdevani was appointed to the society's seven-member fellowship committee, the body that essentially determines the scope and direction of the specialty for years to come. He is its youngest member and the first and so far the only Israeli to serve on any of the society's committees.
"It all began when I realized there were no programs in Israel that could train people to handle the volume and provide the quality of care," he says, noting that he had to leave the country for certification and training, completing his fellowship at the University of Western Ontario in London, Ontario with Dr. John Denstedt, a world leader in the field.
"It is an honorable mission to run this program – especially since it is the only active fellowship program in Israel," he says. The very first fellow came from India and the second an Israeli. I was really proud that now Israelis can be certified here at home. Next month, another Israeli will come to be trained and in July, a fellow from Greece. "The Unit functions because of them – everyone treats patients and everyone conducts research. At the moment, there are eight ongoing research projects.
Dr. Duvdevani's belief in the importance of the fellowship program is so intense that when funding for the program decreased, he stepped and assumed the cost, donating the money he receives for working overtime. "Not all investments are immediately productive – nothing is free."
He himself has invested an enormous amount of time and energy, including seven years of commuting from Ramat Gan. "When I came to Hadassah, I was advised to move to Jerusalem," he says, "but I didn't want to uproot my family. I still don't," he adds, noting he has no intention of leaving Hadassah for a location closer to home.
"Hadassah is my home. I don't see any opportunity in any other hospital that would convince me to leave – even with the commute. I feel there is no ceiling here – that nothing stands in our way of helping more people and becoming even more excellent."
The hour I spent with Dr. Duvdevani in our Endourology and Lithotripsy Unit, reinforced my conviction that we are blessed with outstanding doctors and nurses – committed to their patients, committed to their profession and committed to Hadassah. As Dr. Duvdevani said: "Many doctors are good at many things; a few are very good at something." We are fortunate to have both.
Prof. Ehud Kokia