EP. 170: MEDICINE IN THE NARROW PLACE
WITH JONATHAN WEINKLE, MD, FAAP, FACP
An internist at a safety-net clinic offers insights from one of the world’s oldest stories to suffering patients and physicians alike – and emphasizes the importance of understanding a patient’s idioms of distress.
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Many patients interpret their illness through the lens of their religious tradition. Sometimes this process brings hope, comfort, or growth – but other times it compounds their suffering. What are patients supposed to do when they don’t see their lives reflected in the religious stories they cherish? And how can physicians recognize and respond to spiritual suffering that is layered on top of the physical?
Our guest on this episode is Dr. Jonathan Weinkle, clinical assistant professor at the University of Pittsburgh School of Medicine. Dr. Weinkle practices Internal and Pediatric medicine at Squirrel Hill Health Center – a health center focused on overcoming economic, cultural, and logistical barriers to health care. He serves as a consultant to the Jewish Healthcare Foundation and as the medical director of the Physician Assistant Program at Chatham University. In 2025, he published his book From Illness to Exodus with the goal of helping patients and healers navigate illness – using one of the world’s oldest stories.
Over the course of our conversation, Dr. Weinkle shares insights from the story of the Jewish Exodus that may help patients feeling trapped in the “narrow place” of illness. We discuss the spiritual and emotional complexity faced by patients whose own illness stories don’t end with a miraculous escape. Finally, we reflect on the importance of healers who understand their patients’ “idioms of distress” and who can attune to their suffering.
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Jonathan Weinkle is an independent consultant at the Jewish Healthcare Foundation and serves as a medical advisor to projects on end-of-life, Jewish genetic diseases, and teaching effective communication to health professionals. He is an Internal Medicine and Pediatric physician at the Squirrel Hill Health Center, a multi-specialty practice focused on overcoming economic, cultural, and logistical barriers to health care.
Dr. Weinkle has been a clinical assistant professor at the University of Pittsburgh School of Medicine in the Departments of Family Medicine and Pediatrics since 2008. He has served as the Medical director of the Physician Assistant Program at Chatham University since 2014.
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On this episode, you’ll hear about:
2:45 - How Dr. Weinkle found his way to a career in Med-Peds, and the many hats he wears in his current work
9:00 - Dr. Weinkle’s views on balancing faith and science in medicine
16:00 - The cultural importance and traditions of Passover in the Jewish faith
21:30 - How the lessons of the Passover can be connected to medicine and healing
28:45 - Why Dr. Weinkle chose to write a book for healers
40:00 - Dr. Weinkle’s advice for identifying and responding to a patient’s taxonomy of distress
47:30 - Attending to suffering when it cannot be ‘fixed’
52:25 - How healers can use ritual to center themselves in their work
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TDA 170 final1.mp3
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The doctor's Art, a podcast that explores meaning in medicine throughout our medical training and career. We have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives. Those who have collected a career's worth of hard earned wisdom, probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Tyler Johnson: [00:01:02] Many patients interpret their illness through the lens of their religious tradition. Sometimes this process brings hope, comfort, or growth, but other times it compounds their suffering. What are patients supposed to do when they don't see their lives reflected in the religious stories they cherish? And how can physicians recognize and respond to spiritual suffering that is layered on top of the physical? Our guest on this episode is Doctor Jonathan Weinkle, clinical assistant professor at the University of Pittsburgh School of Medicine. Doctor Weinkle practices internal and pediatric medicine at Squirrel Hill Health Center, a health center focused on overcoming economic, cultural, and logistical barriers to health care. He serves as a consultant to the Jewish Healthcare Foundation and as the medical director of the Physician Assistant Program at Chatham University. In 2025, he published his book From Illness to Exodus with the goal of helping patients and healers navigate illness using one of the world's oldest stories. Over the course of our conversation, Doctor Winkel shares insights from the story of the Jewish exodus that may help patients feeling trapped in the narrow space of illness. We discuss the spiritual and emotional complexity faced by patients whose own illness stories don't end with a miraculous escape. Finally, we reflect on the importance of healers who understand their patients idioms of distress and who can attune to their suffering. We are really grateful to have you here, Jonathan. Thank you for joining us and welcome to the show.
Dr. Jonathan Weinkle: [00:02:39] Thank you Tyler. I really appreciate being here.
Tyler Johnson: [00:02:42] You do wear a number of different hats. Why don't you tell us a little bit about your day job? What is it that you do?
Dr. Jonathan Weinkle: [00:02:48] So I'm a primary care med-peds physician. I trained at University of Pittsburgh, both for med school and residency and straight out of that residency program, took a job at a federally qualified health center, which was one of the only places I could find where I could do general medicine and general peds under one roof and not have to get two separate jobs, which, if anybody's ever worked two separate part time jobs, they know that it quickly adds up to more than a full time job. So I've actually been at that site ever since. It's grown around me from a job where I was only four days a week, because that's all they needed to being busier than I could possibly handle. And now, a year and a half ago, I became the chief medical officer there. So getting to help shape the place, that's really been like I tell people, my only real job. So that's piece number one. And it's sort of that's the identity you want to know about the other hats though. So I do teach medical students from Pitt, PA students from Chatham University, which is a small little college folks may know of it because that's where Rachel Carson, the environmentalist, graduated from. It's a little liberal arts college nestled in my neighborhood of Pittsburgh.
Dr. Jonathan Weinkle: [00:03:59] I can walk there. They started a PA program about 30 years ago and we've had a lovely relationship. I was the medical director there for a while, and somewhere early in my career, when I was only four days a week, I worked for a local organization called the Jewish Healthcare Foundation, which was really interested in end of life and doing sort of community engagement around better treatment, better practices around end of life, around discussing death and dying, and built up enough material in two and a half years of doing that job that I ended up approaching the Pitt Honors College about teaching an undergraduate class, which I still do, which grew into a second class. And so that that's a third piece of my identity is that that undergraduate education. And it's really it's really gratifying to be able to catch people kind of at the beginning of their arc, because most of those folks are pre-health professions students. And instead of them filling out every last credit with biochemistry and neuroscience. We're getting to talk about real deep issues that otherwise they would probably confront for the first time in the middle of the night of second year residents and not know what to do.
Tyler Johnson: [00:05:08] So let's also back up a little bit. And how is it that you ended up in medicine in the first place? What what was the path like that led you there? And particularly, how did you get involved in med peds? I think we've had 1 or 2 people over the course of the program who were in med peds, but it's not a particularly common combination specialty, and we have not talked to a lot of people. And I don't know that we've talked to anybody about it in detail. So tell us, how did you end up in medicine and how did you end up in that specialty?
Dr. Jonathan Weinkle: [00:05:33] The med peds part is easy. It's because I'm indecisive. I hate ruling things, ruling things completely out. I hate closing doors. And so Med-peds allowed me to do nearly everything under the medical sun except deliver babies and do surgery. And those were things that I was willing to get rid of. The. Delivering babies was because every time I was in the in the delivery room or in the operating room for a C-section, I always immediately sort of gravitated over toward the newborn and one of the late night C-sections I scrubbed in on. As a third year med student, the attending turned to me. She's like, you're going to be a pediatrician. I was like, how do you know? She's like, nobody in OB ever asks how the baby is until the incision is closed. So she was kidding, of course, but I took that to heart and I did, in fact, end up as a pediatrician. So and it's also why I ended up in primary care because I there weren't any specialties that I liked enough to stop doing all the other things to, to the exclusion of the ones that I wouldn't be doing as far as ending up in medicine. That's the interesting story, right? So I, I've been involved with my Jewish community my entire life.
Dr. Jonathan Weinkle: [00:06:45] My mother was the executive director of our synagogue growing up. My father was on the board of the synagogue growing up. He grew up Orthodox, but my parents belonged for the whole time. The last 40 years belong to a reform synagogue in Pittsburgh, and I started getting more and more involved in Jewish practice and Jewish youth groups and things like that through high school. And I thought I was going to rabbinical school. I thought I was going to be probably a conservative rabbi, and I was very interested in a lot of the philosophical and theological ideas. I got more ritually observant, and then I literally had multiple people, some relatives, some friends of the family who might as well have been relatives at some point. My future father in law of blessed memory, who passed last last winter. If he were here to speak for himself, he would gladly endorse the story I'm telling. All came to me in more or less the same words, said a Rabbi. That's no kind of a job for a nice Jewish boy. And there is this problem in. In the liberal Jewish world where the people who are most involved sort of all get pushed to be religious leaders. You have a congregation who are more or less involved, and the leader is really sort of the exemplar of what you could be doing, as opposed to an orthodox world where we're sort of more and more people are practicing.
Dr. Jonathan Weinkle: [00:08:09] I don't consider myself orthodox, but this is this is a key element. And I did at some point come to the conclusion what I actually wanted to be was one of the people who wasn't the rabbi, who wasn't the leader of the community, but who was fully engaged. And I had trained as a medic. I had started to get interested in the sciences, even while I was doing my philosophy degree as an undergrad. And I said, you know what? Maybe maybe this is what I want to do. I want people and I want conversation and I want meaning, but I like the science and maybe medicine is the path. But already within the first year of medical school, I was like, but it needs to have that calling to it. It needs to have that religious element for me that I would have had if I had gone into the clergy. So that's sort of where I ended up and how we got to the part that we're going to talk about soon.
Tyler Johnson: [00:09:02] So we're here primarily today to talk about your most recent book. But before we get to that, specifically to kind of open a path to get there, let me ask you this question. There's this funny, interesting dichotomy that has, or at least perceived dichotomy that has opened up over the past many years in the United States, which is the idea that faith and science are somehow inherently at odds, right? So if a person is the kind of person who believes in science and data and statistics and rigorous analysis in the scientific method and. Et cetera, et cetera, you must therefore not be the kind of person who believes in the kind of silly fairy tales that go along with religion. Right? So maybe, Maybe you have some kind of a, broadly speaking, some kind of a spirituality or a sense of the numinous or whatever. But certainly you wouldn't be the kind of person who is a practicing adherent of any particular religion. And so before we get to the content of your book, specifically, how do you reconcile your identity as a person of faith with your identity as a doctor in medicine or a person of science? How do you think about those two parts of you coexisting together? Sure.
Dr. Jonathan Weinkle: [00:10:20] So I want to address the dichotomy in a couple of different ways. One is to say that, you know, I'm looking at it through a different lens. I think a lot of that dichotomy comes from understanding things, particularly through a Christian lens, which is the lens that's most commonly available in the US. And that goes back to, you know, Renaissance and early enlightenment times. It goes back to Galileo being imprisoned and, and forced to recant his views. And, you know, Copernicus waiting until he was basically on his deathbed to allow his works to be published. And, you know, the early modern church really having been behind the curve on modern science. And there's certainly still a stream of that in in other areas. I think that the Catholic Church has long moved past that point. But. So there's not the same opposition in Judaism, certainly not in the US, and really not worldwide either. So you'll often find folks who are deeply orthodox, who are scientists and all sorts of different realms in physics and in chemistry, certainly in medicine, you know, leading, leading advances. And I feel like this is true to a large extent in Islam. That's one way of looking at it. But the other thing is to think about the dichotomy is often around these very hot button issues, most of them at the beginning and end of life.
Dr. Jonathan Weinkle: [00:11:46] Things like abortion, things like euthanasia or beginning and end of life conditions. And 98% of the time, faith is a major driver of what makes us do medicine in the first place. The idea that somebody who is not already the perfect specimen of humanity, defined by who ever got to choose what made someone perfect, is deserving of our love. And our care is a religious idea. And that's the bedrock of the Abrahamic faith. It's the first thing we learn about humanity is that human beings are created in God's image. Genesis 126 and 127. And that was actually the basis of the first book that I wrote and said, well, that's a that's a great, huge idea. And I love it and I want to live by it. We need to operationalize that if there's any hope of making it a way to practice. And so I spent a lot of time thinking about, well, what does that mean for how two human beings in dyad Talk to each other, listen to each other, ask each other questions. And what a system of human beings practicing medicine does for each other. You know, and you see it like if you look at the kind of institution I work in, we're not a religious institution specifically, although we did grow out of a religiously funded institution out of the Jewish Healthcare Foundation.
Dr. Jonathan Weinkle: [00:13:04] But many of the fqhcs and fqhc look alikes and community health centers and organizations that are supporting people in health crises are faith based organizations. And they're doing that because they really care deeply about people's well-being. And the other thing is that even if I and my colleagues, we and our colleagues weren't particularly religious as a group, although I know you and I both are our patients are right. And their spiritual needs and the questions that they're asking when they're suffering are deeply, deeply, both spiritual and religious. Spiritual in the sense of asking the big sort of why questions. Looking for meaning and then specifically religious. Like, what's God's plan for me in allowing me to, in my practice? You know, why am I dealing with this very annoying thing like diabetes or heart failure or COPD, where I'm constantly having to think about this illness every day, and my patients are coming at this from all, all of the religions and patients who are angry at God or have determined that they don't have anybody to be angry at.
Tyler Johnson: [00:14:14] Yeah, I think there is an unfortunate perception which, to be clear, it's not like the perception comes from nowhere, right? There is an unfortunate perception that religion is all about neatly formulated answers. And I think that, ironically, one of the things that can get religion into trouble, broadly speaking, is that often those neatly packaged answers arrive at a place where they no longer seem sufficient to the demands that life places on us, and to the positions into which life places us. And so then, if the only thing that you understand religion to be is a series of neatly packaged answers, then it can be easy enough to say, well, as I referenced earlier, those are just kind of silly fairy tales. And, you know, obviously grown ups don't believe in those things, but I agree with something implicit in much of what you're saying, which is that I think rightly understood faith is much better thought of as a a series of endless questions. It's a way of probing into the things that really matter more than a series of neatly packaged answers. And the reason I bring that up in the context of the answer that you just gave, is because I think that at least in my line of work, certainly where I work frequently with people who are either facing very tough existential questions a la. What side effects am I willing to accept in trade off for an extra, you know, either two years of life or the increased probability of 15% of being cured of my cancer or whatever, right? Sometimes you're facing those things, and then other times they're facing the end of their lives, often much sooner.
Tyler Johnson: [00:16:02] And what seems to be a much fairer way than they anticipated when you come up against those kinds of questions. I think that if if we have abandoned the quest of spirituality and even religion entirely, we are left without a vocabulary with which to deal with some of those questions. And I think that that vocabulary matters a lot in ways that are not always intuitive to us. If we have walked away from religion or spirituality thinking that all it is is a series of fairy tales or neatly packaged answers. Let's turn then. Specifically, speaking of some of those unending questions to your book. Your book is entitled From Illness to Exodus A Passover Meditation on Empathy, health, and Healing. Before we get into the thesis of the book, per se, you know, many of our listeners may have a sense of this. I obviously, you know, those who are Jewish will know for themselves, but others, you know, may have at the very least, I don't know, seen fiddler on the roof or some television show or whatever. Right. But just give us a sense, you know, maybe growing up in a Jewish family and then establishing your own family, that's still, as you said, is very involved in your Jewish community and whatever. What is just kind of the cultural importance of the Passover tradition and what does Passover look like? Like if you invited me over for a Seder at your house, what would my experience be like?
Dr. Jonathan Weinkle: [00:17:38] Leisurely. You should plan on somewhere between 4 and 5 hours. You should plan to eat a lot, both of which are true, but I. So I buried the lead. So. Passover Seder is actually. All of the good Jewish demographers say that it is the most widely observed ritual of the Jewish year, and there's a few reasons for that. One is it's a home based ritual, right? So it doesn't involve going to synagogue. So if you're disengaged from a community, you don't belong there. Synagogue doesn't matter. Most of the people will be celebrating Passover with friends, with family. You know, maybe somebody in the community reached out to them and said, hey, do you have a place for Seder? No, come to my house. And there's two key components to it. One is the meal because there's always going to be a meal. You know, imagine Thanksgiving dinner, except take out all of the bread products, anything that had any opportunity to rise because it's the Feast of Unleavened Bread. Why is it that because we're commemorating leaving Egypt and for those who are going to go out and consult their Bibles. Book of Exodus, basically from Exodus one one up through about Exodus 137, you're going to get the story of of Passover, the enslavement of the Israelites to Pharaoh, the hard labor, the efforts that Pharaoh made to kind of extinguish that community, the birth and adolescence and growth of Moses into a leader.
Dr. Jonathan Weinkle: [00:19:02] And then the ten plagues, the pushing back and ultimately the triumphant exit right before they leave. There's this commandment from God to sacrifice a lamb to sit in the house, wait for the 10th plague to be over, and you should get rid of all the leavening from your house and make unleavened bread, and only eat that for seven days. And there's all sorts of different explanations for why, but that's kind of the key element of the holiday. And then it says, and when your children ask you, what is this? It says this four different times in the five books of Moses. When your children ask you about this, you should tell them, this is what God did for me when I went forth from Egypt. And often it's when they ask you, why are we eating this horrible piece of cardboard that you tell me is bread? But I know it's not bread. You say it's because we went out of Egypt. Now, is that because we went out really fast and the dough baked solid before it had time to rise? Or because we deliberately didn't let it rise? Is there something bad about rising bread? So that's that's the discussion. The idea of the Seder is to bring people together for this festive meal, and then do all sorts of weird things to get people to ask questions like that.
Dr. Jonathan Weinkle: [00:20:20] So you're actually commanded to have like a scripted set of questions, but you get out of that obligation if people start just randomly asking questions on their own. So a lot of people have heard of the four questions. It's actually how I format my own podcast because of having done all this work. And it's like, why do we eat matzo? Why do we eat bitter herbs? Why do we dip our vegetables? Why do we eat reclining to the left? And that's meant to trigger a discussion about that whole episode. So why do why is that so important? My favorite thing, which I, which I quote in the introduction to the book, is Rabbi Yitzhak Greenberg saying this story is evidence from the Bible that God did not intend for people to suffer. God did not intend for people to be enslaved, and that God's going to do something about it. And if God doesn't do anything about it, we're supposed to do something about it. And that's basically the foundation of the Jewish religion. We remember it every single day. We remember it every single Sabbath, Shabbat. You know, it's even though we're not remembering the Passover, we're remembering the Passover. We always say in memory of leaving Egypt.
Tyler Johnson: [00:21:27] So let me just read, actually from you were just mentioning the introduction of your book. So in the introduction to your book, you say, I've I'm in a physician for 20 years, which is admittedly less than 3000, but still long enough to know that illness, whether critical or chronic, mental or physical, is a narrow, straight. People suffering through an illness often feel as trapped as the Israelites must have felt during their time in Egypt. If this were the whole story that is the enslavement of the Israelites, it wouldn't be worth writing a book about enslaved Israelites suffered and you're suffering through your cancer. Why am I burdening you with stories about. Other people were miserable just like you. The story is worth telling, even for people who are in the midst of serious health crises, because the Israelites got out of Egypt. It's a story of hope, of possibility, of recognizing that while suffering may be a natural occurrence in our world, we don't have to accept it as unending or deserved. We can fight it. So let me ask two questions here that I'll ask you to to delve into. So the first one is a more general question, you know.
Tyler Johnson: [00:22:33] So this morning, as I was getting the kids in the car to take them to school, my 11 year old son saw me carrying my little bag that I have. I bike to work. And so I have a little bag that I put my microphone and my head's in when I'm headphones in, when I'm going to be recording a podcast episode. And he saw me carrying that and he asked me what it was, and I told him and he said, oh, you're doing a podcast today. They know that I have this podcast. And I said, yeah. And he said, what are you talking about? And I told him, and, you know, we have been invited by family friends a couple of times to Seders here in the Bay area. And so, which is just a, he knows what a Seder is and knows what Passover is, you know, a little bit. And I told him that. And he looked at the book and then kind of looked at me and kind of screwed his eyes up and said, dad, Passover. That doesn't have anything to do with being a doctor. What are you going to talk about?
Dr. Jonathan Weinkle: [00:23:23] Yeah.
Tyler Johnson: [00:23:23] No kidding. So let me ask you this question, though. I think a lot of people might look at a book like this, which is more than 300 pages long, and they might say, never mind, we'll get to in a minute some of the more direct parallels. But like, what is even the point of writing a book like this? Like, why is what is the point of even drawing these parallels? Especially because, you know, of course, there are many Jewish people who are in this country or in the world who pass through illness. But of course, the large majority of people in the world who go through illness are not Jewish. Right? Even as you said earlier, the large majority of your patients are not Jewish. So what is the point of an exercise like this, broadly speaking?
Dr. Jonathan Weinkle: [00:24:04] First of all, you know, I think of it very loosely in the category of narrative medicine. This is a narrative I know really well, and it helps me as a practitioner to understand both what patients are going through and also what my obligations are better. So when you're writing a book, your first audience is yourself. Like you want to write the book that you want to read. My colleague David Brant, who's a now retired And psychiatrist told a story like that about his brother, who was a musician. He's like, what are you listening to? He's like, I'm not because I'm writing stuff. I'm writing the music I want to hear. So I will certainly admit that this was a labor of love, that I needed to have these thoughts and put them to paper. But, you know, Judaism, we've been insular for a lot of our history, but at the core of it, there's actually very clear directives, like you're supposed to share these ideas that we have with the rest of the world. Like they don't have to follow everything. But this is instructive for people. This is inspiring for people. You're going all the way back to Abraham. So, you know, wherever you go, you will be a blessing to the people that you interact with. And so I want to share this with people because I think that this story is tremendously uplifting and it's tremendously edifying. Like, you know, it's not just this, oh, well, we, you know, we got out. It means maybe you can get out. Also, the Seder ritual is super complex, and there's all these little stops along the way. So maybe you only look at 5 or 10 chapters, but it's the 5 or 10 that you most need to see.
Dr. Jonathan Weinkle: [00:25:38] I've gotten this feedback, one of the one of the first people to pick up a copy of this directly from me was a guy who's a Baptist minister and is a chaplain at a hospital in Louisville, Kentucky. He said, I'm taking this to the hospital with me as a morning devotional. You know, pick a chapter for that day and see what it has to show me. So I really think of this as every day in medicine. I'm sure you've experienced this too. You're like, I just experienced something that I've experienced a hundred times, but I've never thought of in this particular way before, and it's not going to totally revolutionize everything I do. But the next time I'm in this situation, I'm going to look at it through different eyes. And what I did here was hope to provide step by tiny step through this journey of a Passover Seder. Little vignettes like that for The next time you are suffering through scut and having to figure out a way to sanctify that scut. Right? I've been using this abbreviation since I was a resident. It's subordinates completing unpleasant tasks, which is one that I made up. That's not what it actually stands for. But like those terrible clicking the boxes on your charts, doing your whatever audits you have to do, you know, all of the mundane paperwork, you know all of the trainings that you're required to click through to make sure your credentials stay current. It's like, why am I doing this? You're doing this because this is what enables me to heal people, right? This is what makes it legal for me.
Dr. Jonathan Weinkle: [00:27:06] This is what makes it possible in the system I'm in. This is the way to get people care. And so this is what I'm doing a different time. You might be thinking you might be encountering someone who's like, you know, Doctor Johnson, you cured my, my cancer. Now I've got a different kind of cancer. Like what good did all of that work that we did to cure my lymphoma do when? Now I'm back here with pancreatic cancer. And so I bring the story of Rabbi Yitzchak Abarbanel, who was exiled first from Portugal, then from Spain, and then from Naples, right in the course of about 15 years. And in his Passover Haggadah, he wrote, what good did it do us that we were freed from slavery when now we're living as exiles in the lands of Christianity and Islam. Like, why does it matter? And he answers the question, you know, he gives these things that you carry with you even through new sets of dark times that mean, yeah, that was actually worth it because something that happened once, even if it's deep in the past, that's always there. It's something that Viktor Frankl talks about in his laying out of his, uh, his ideas of logotherapy of existential therapy as opposed to Freudian therapy, is that everything, once it happens, is permanent. It's it's there in your memory, it's there in your soul. And you get to carry that with you, even if now is terrible, everything you don't do is gone forever. So I'm trying to bring that perspective.
Tyler Johnson: [00:28:44] So, you know, Jonathan, I mean, I have to say, I, as a religious and spiritual person myself, I resonate deeply with the idea of looking to something like a biblical text and then trying to sort of find ways that that echoes for modern life, right? Things that that can tell us about how to live in 2026. Having said that, though, I have to say that there is a part of, of the kind of big picture analogy here that I can imagine for a lot of my patients just would kind of fall flat or almost might even seem. Worse than no story at all. Let me tell you what I mean. Right. So, you know, just writ large the story of the Exodus. Yes. To be clear, involves a whole bunch of really tough stuff, right? Years of bondage and then the involvement and witnessing the plagues and, you know, all these things. And then maybe most dramatic of all, finally you feel like you're being led out of bondage, right by this prophetic leader. And then you come to this impassable body of water. And now what are you going to do? Which is just to say, I want to be clear that I get that there is a lot of tough stuff baked into the story. But then there is the moment of deliverance, right? The seas part. There is this exceptionally dramatic miracle. And Moses leads the children of Israel through the parted Red sea on dry ground. And then not only that, but once they get through, then the waters come together again to block the Egyptians from pursuing them across the ocean.
Tyler Johnson: [00:30:24] And so not only is their way cleared, but then they are now, in effect, separated from their captors and birthed into this new life of freedom. So the reason that I want to just sort of summarize that this way is because I can imagine, for example, there are some of I'm just going to put this into my world for a second. My, my medical world, some of my patients. I think that analogy would resonate deeply, right? If you're diagnosed with a locally advanced colon cancer and you have to have a surgery, and then that's really hard. And then you go to a doctor who says, oh, and by the way, you also need chemotherapy or in the case of rectal cancer, maybe radiation, right? And sometimes, like in, for many of my rectal cancer patients, that whole process can take, you know, sometimes at least 5 or 6 months, sometimes more like nine months to a year. Right. And during that entire time, they feel crummy, they're weak. They deal with all these side effects. It's really tough. But but on the far side of that. The reason, in large part, that they are willing to go through all of that is because on the far side of that, the waters part, if you will, the cancer is cured, and they go on to live the rest of their life and hopefully never have to, you know, have a any anticancer therapy again. So for them, I can imagine that this analogy would be deeply resonant.
Tyler Johnson: [00:31:45] But on the other hand, I also take care of a fair number of patients, including even patients in their their 30s and 40s who don't even know that they have cancer until they get a CT scan. That shows that the cancer has already spread to a bunch of places. And so when I meet with them and have a discussion, it's a very different discussion. It's not, hey, if you kind of pay this price and go through this really hard thing now, then on the far side, you'll be, you know, if you will, delivered from the Egyptians. But instead it's like, actually, I'm talking to you about chemotherapy. And even in the best case scenario, even if the chemo does what we want it to do, this is probably never going away. You will probably be dealing with this the rest of your life and probably be on chemo effectively, indefinitely. And so all of that is to say that I can imagine that if I were a patient in that context, and I encountered a book comparing the the Exodus or, you know, asking me to think about the Haggadah or whatever in terms of illness and all of that, that it almost might feel sort of like, well, yeah, but what does this story have to say to me? Because there is, you know, at least, you know, without talking about some, I don't know, heavenly destiny or something, there is no deliverance for me. Right? So what would you do with that set of concerns?
Dr. Jonathan Weinkle: [00:33:02] Sure. And I mean, you're you're echoing I think I brought up a few minutes ago the, the question that Abarbanel asked and he's like, I'm living in exile. Like, what good did it do me that that my ancestors were were freed from slavery? So it's a totally legitimate question to ask, you know, where is my deliverance going to be? There's some things that I could say to those patients, but I actually want to go back to my original intent in writing this, which we haven't really talked about yet. We're talking a lot about the the analogies to what a person's illness experiences, but I actually intended to title this the Healers Haggadah. It was sort of thinking through how to practice medicine, starting from the idea of people being created in God's image. This was an outgrowth of the last chapter of that, where I said, we need these rituals to be able to learn to practice that way. So much of this book is actually not directed at people who are going through illness. It's directed at their healers. It's directed at people who encounter exactly that sentiment that you were talking about, where, where a person is like, where is my deliverance going to be? What? Why am I even going through this? What's the point of me continuing to move forward, helping people like me and like you be with those folks and be helpful and not actually not do what you described, which is hand them a narrative and try to tell them how to interpret their pain and their suffering. Because I agree with you, that's about the most damaging thing that you can do to somebody.
Dr. Jonathan Weinkle: [00:34:29] There's a chapter in the book just in terms of talking about the damage called the Danger of Dienu. Dienu is the is probably the most well known song in the Passover Seder. If you've been to one, you've heard somebody say, Lou Hotsy Totsy. It's very poppy song, and it's all of the 15 steps from being released from slavery to coming into the land and building the temple. And at each stage it says, If God had done this, but not the next thing, it would have been enough. And like, no, no, it wouldn't have. This is a refrigerator magnet. Things like have an attitude of gratitude. Like, no, I can't have an attitude. You can't just pick your attitudes. When I was writing that chapter, I got a, an article sent to me by one of the students in my death in the health care Professions class. And it was an article from one of the core psychiatry psychology journals by a researcher named Jennifer Sheehy-skeffington from the UK, and she talks about the myth of free floating attitudes. And I struggled with it a little bit because it's the diametrical opposite of what Viktor Frankl talks about in Man's Search for meaning, where you do in fact, adopt an attitude towards unavoidable suffering. And, you know, I really struggled with, well, you know, you can't just take a new attitude, but Dino has a bunch of different valences. That word, it means it would have been enough for us, but it can also mean enough already. Like if you had brought us out.
Tyler Johnson: [00:35:50] No more blessings. I am blessed enough, right?
Dr. Jonathan Weinkle: [00:35:54] Carol Channing in Free to Be You and Me, which I grew up on in the 70s, as you say, like some kinds of help are the kind of help we all could do without. So you're walking in as a clinician to that to somebody who's like, Dino, I have had it and I don't want to hear any of your any of your, you know, rose colored glasses. I don't want to hear puppies and rainbows. I don't want to hear there's dry land on the other side of this Red sea because I know there's not. Doctor Johnson already told me I have a 2% chance of surviving to five years. I know I'm not going to make it out of this, so I don't want to hear about it. And a lot of the book is what do we do with that? And it's about the center has two goals. One is identity, right? A Passover Seder in general is about identifying yourself with this long strand of Jewish history. It's also about identifying with the individuals that actually came out of Egypt. And the second is empathy. Not only do you identify like, oh, these are my people, but there are other people in the world going through this kind of thing right now. And because my ancestors went through this, I have two choices. This is something I heard from Rabbi Shai held early last year, and I was going through a very significant medical issue in my family that I was really distressed about, and I went to hear him. And I love his theology.
Dr. Jonathan Weinkle: [00:37:17] So he says, you could come out of the Exodus with two different opinions. You could either say, we were there 400 years. We were enslaved for 210 years. We're out now. We don't owe anybody anything. Or you could come out of there and say, we were there for 400 years. We were enslaved for 210 years. We know what it was like. No one should have to go through that. So when I make this analogy about the narrow place of illness, I'm playing on that empathy thing. I'm playing on this. You know what it's like you've read this story. You've put yourself in that position. The Seder text says everybody, every human being should see themselves as though they themselves came out of Egypt. Take that and say, I know what this person must be going through. Even if I don't have direct experience of it, I have enough cognitive empathy to be able to think, okay, I see this and then do something with that, you know, enact some type of compassionate behavior where even if you know you can't fix the situation, it's ways of going and sitting with people, ways of addressing the things that you can fix even when you can't do some of the other things. So for example, like, you know, what kind of promises can we make people? There's a, there's a passage in the text about God made a promise and that God keeping the promise is what sustained the Jews through all the generations and all the persecutions and the Cossacks and the Inquisition and all of this.
Dr. Jonathan Weinkle: [00:38:41] And it's like, well, what can we promise people? Right? I have a terrible time with promises because, you know, I send somebody like, oh, go see this specialist. He's great. Right? And if I say you have cancer, I have this friend at Stanford who's a fabulous GI oncologist. You should totally go see him. What happens if I send them to somebody else, somewhere else for some other diagnosis? The person turns out to be terrible. They turn out to be malignant or malignant in the personality sense, not in the cancer sense. Or they turn out to not do what I said they were going to do, or I refer them for a social service. And as a person, the agency says, oh, you don't qualify for this service. I've made a promise I can't keep because I'm promising on someone else's behalf. So there's a chapter in there about being really careful, what kinds of promises we make people, and recognizing that we want to. We want to promise within the limits of what our ability is while still promising companionship, promising, caring, promising all of the things that we are supposed to do. That's really where the book was originating, was what does this story teach healers? You know, this idea that we're supposed to be working in God's image. What does it teach us from the story about what were the specific actions that God did that we could try to emulate from this story? And I think that's a lot more productive.
Tyler Johnson: [00:40:05] So one of my favorite authors and a friend and multiple time guest on the show is Sunita Puri, who wrote the book that Good Night and is a wonderful palliative care doctor. One of the things that she talks about is that when she's on service, there's this interesting phenomenon where, yes, of course, much of what she does is caring for patients. But what she has realized over time is that also a lot of what she's doing is caring for the teams who are caring for the patients. Right? So her and her team actually, you know, in the hospital, as most doctors in training or doctors know, you have team rooms, right? Which is kind of the place where you hang out. You have a bank of computers and maybe some snacks or whatever. And that's kind of where you hang out when you're getting work done, other than actually being in the room with the patients. And so she talks about how she and her team actually end up. Yes, of course, they spend a lot of time in their own team room and of course, in the room of patients, but they actually spend a fair amount of time and in the team rooms with the physicians. And one of the things that that I am thinking about as you're describing this, is if you are in a position where it was your job to, for lack of a better word, to minister to or to counsel with teams of. So like, I'm thinking of my team when I, when I attend in the hospital, I attend on a team of four House staff and often 1 or 2 medical students who are caring for patients with cancer, who are sick enough that they need to be in the hospital.
Tyler Johnson: [00:41:34] And almost by definition, there are a few of those patients who have, you know, easily fixable things, but the majority of them have terribly complicated problems. They usually have 7 or 8 problems, and often they are getting to a point where they've kind of exhausted chemotherapy options and are looking, you know, at least close to, if not at the end of their lives, which is just to say that in addition to all to an enormous amount of medical complexity, there is also an enormous amount of emotional and psychological weight involved in, in caring for these patients. So if you were going to take the Haggadah and sort of minister to one of these teams that are caring for these very sick patients. And you had to distill down from it a single thing that they might do, like right now, today, going into the hospital to care for these patients, like a way they could discernibly change their practice, that would kind of infuse some of the spirit of what you get from this ancient story into their patient care in 2026, along the lines of what you're talking about, what might be just one single thing that they might do.
Dr. Jonathan Weinkle: [00:42:40] So my first reaction was, where do I sign up? Because that is exactly what I wanted from this. My second thought was, that's not fair. One thing.
Tyler Johnson: [00:42:52] Okay, we'll allow you two.
Dr. Jonathan Weinkle: [00:42:53] I'll go to one thing. And I actually, I actually want to pull up the text from that chapter. So, you know, we talked about this promise even before we get to that though, right? So how does God even know? I mean, God sees everything, right? But how does God really know what's going on? Before anything happens with the story of the Exodus? People have to cry out. And then once they cry out, then there's a recognition and there's a beautiful interpretation of one of the passages. So it says, you know, the people cried out to God, and God hears them and sees them and responds. And the last thing it says, God knows, and it uses the word for intimate knowledge. And basically, one of the commentators, an Italian commentator in Menahem Recanati, who was a mystic, says, each of these verbs is sort of describing a different stage of God uncovering and God using, you know, not eyes and ears necessarily, but senses. If I were to use this, I would say pay attention with all of you to what the suffering is so that you understand. Ultimately, you you want to know this intimately, not to the point where you feel like you're suffering in the suffering with them, right? That emotive empathy where you walk out of there and you're a wreck because that's not healthy. Brian Miller talks about standing next to the fire. So it's sort of remembering that you are caring for this person, that you aren't. You are not this person, but to be there with them and to have that knowledge of really having sat with them and gone with them, but not just to like, okay, yeah, I get it, but look around the room and see who's there with them and what is their, what is their community look like? Listen to the subtext of their words, all of those sorts of things.
Dr. Jonathan Weinkle: [00:44:48] And don't be afraid to be in there for a while to be in that mess. You know, I could go on about, um, counseling about, you know, what to do with the emotions. Uh, I have a chapter about what to do with anger and what to do with that frustration of not getting better and so forth. But I think the beginning is, is knowing the first thing that somebody has to do is cry out. And hearing the cry in the first place is actually a challenge. When I was writing that chapter, I went back to an infographic from an article about eight years ago by somebody named Brandon Hruska, and he had done a lot of research in Bhutan and Nepal with Bhutanese refugees, which happens to be the main population I take care of. And one of the reasons I wrote this is because that refugee experience that they were going through so closely mirrored what I read every spring. And I was like, this is this is a modern day. There was a Pharaoh and there was an exodus and there was a wandering through a well, it wasn't wandering through a desert. It was sitting in a refugee camp in the, you know, in a war torn country. But it was a similar kind of thing. And Oscar writes about idioms of distress. Hear somebody cry of distress. You have to know how they cry. You have to know what their idioms of distress are.
Dr. Jonathan Weinkle: [00:46:04] And he talks about all of these different physical complaints that are culturally acceptable, but that are often tied to illnesses of different parts of the mind body continuum. Right. And there's sort of in the traditional Nepali understanding of the, of the mind body, there's sort of five different pieces. There's a soul, there's a heart mind, there's a brain mind, there's a body, there's a spirit. And each of those has different kind of sicknesses and different ways that you express those sicknesses. And so, right, some of it's a cultural humility situation, which is to say, I don't know this person's culture. I need to understand more about how this culture expresses itself before I can really understand. But some of it could be, you know, your friend who said, you're my friend, you're my doctor. And then they get really, really sick. How does your friend you think about like, well, you know, in the ten years that I've known him, how does he how does he show me when he's upset, when he's hurting, when he's just kidding, right? When he's toughing it out through something that he should be upset about but isn't. How does the person express themselves? When we hear sound waves going through the air, get into our eardrum? When God hears. God understands what the idioms of distress are and knows them. And so if I want if I want to circle back and put a bow on that, figure out what the person's idioms of distress are, what all the different things that they're doing, what does that mean to them, and what should that mean to you?
Tyler Johnson: [00:47:29] Yeah. And I think that the one way that I would extend that from work that I've done with trainees in the hospital is that it's tricky because the Western medical mind will largely look at the process that you just described as a preparation for then saying, let's identify all of those forms of distress so that we can fix all of them, and ideally, so that we can fix them with medicine, right? I think what is important is recognizing that you have to have a sort of a as a doctor, you have to have kind of a taxonomy of distress, which is to say there will be some forms of distress that are precisely the reason you're there. Right. If they have pancreas cancer blocking their biliary duct, well, then you need an ercp. And that's why they're there in the hospital. Right? So there are those things. Or if they just have terrible pain, they may need opiates or whatever the thing is. So there's that. Then there is a second set of parts of distress that are things that can be addressed, but probably not very well by you. Right? So for example, if a person is suffering from spiritual or existential distress, I think one in the same way that I would never say, oh, you need your gallbladder removed.
Tyler Johnson: [00:48:51] Let me take that out for you because that would be a bad idea for all involved, right? It's important to know who has what expertise. And so sometimes you may that may be precisely when you call a palliative care doctor, or when you call the chaplain, or when you call the social worker or whatever it is. And then there is a third form of distress, which is the distress that there may not be a quote unquote cure for an answer for right? That there to the point of what we're talking about, that there may not be an obvious, easy, immediate answer to or escape from. Right. And I think that one of the difficulties of being a doctor is grappling with that idea that there are certain problems woven into the human condition that cannot be easily fixed. And knowing sort of what to do with that is part of what is involved in being able to grapple with that idea of encountering suffering.
Dr. Jonathan Weinkle: [00:49:54] You know, one one of the later chapters in the book, there's the halal service, which is the six Psalms from 113 to 118. We sing it in synagogue every morning of any of our major holidays, the first of every month we do it. It's a you know, it's a big part of our celebratory rituals. You sing it at the Seder table, kind of split into two pieces, a couple of them before the the before the dinner, and then the rest of it. After the beginning of Psalm 115, a few lines in the Hebrew is Azza Zahav. Now ask him there. Something is supposed to mean there. Idols in modern Hebrew and itself isn't an idol. It's a nerve. Their nerves are silver and gold, right? So their idols are silver and gold. Now it's their nerves are silver and gold. And when I was studying that, working on the book, I was like, their nerves are silver and gold. And I remembered it's an old Kurt Vonnegut story called fortitude. It's actually a play like a short, like one act. And fortitude is about this doctor who has one patient who he's being paid an ungodly amount of money to keep alive. She's a very wealthy woman, and he's got her like well past 100. Having replaced basically all of her parts except her head and has had to.
Dr. Jonathan Weinkle: [00:51:13] You discover later on in the play, I'm giving a spoiler because this thing is 50 years old, so if you haven't read it by now, you're out of luck. Um, he actually has to fix her mechanical arms so that she can't point a gun at herself because she tried to shoot herself in the head once. And he's like, you can't do that. And so, you know, Sunita Puri talks about that. There are kinds of suffering that we just we can neither can fix nor should we attempt to. And aging and dying is one of those things. Like to a point. Sure. Your 30 year old patients who have aggressive cancer, you should be trying to fix that. Sure. There's an event horizon that you pass where there's really no return at that point. And this idea that, you know, that's the point at which our nerves become silver and they become idols of silver, like replacing ourselves with non-human, idolatrous parts. Even that sentiment, there's room, there's humility in there for it. And I think once you once you start from that, you can work your way back and say, oh, there's a lot of things we can't fix. We're actually not that powerful.
Tyler Johnson: [00:52:18] Yeah.
Dr. Jonathan Weinkle: [00:52:18] The god of the Exodus is that powerful. We are not that powerful.
Tyler Johnson: [00:52:22] Yeah.
Dr. Jonathan Weinkle: [00:52:23] You know, we have these little things we can do.
Tyler Johnson: [00:52:25] Well, I think that practical application is important. So now with that in mind, let's turn our attention to something else. So if we have a young resident on the wards having a hard time, you know, going through their own trial of fire, just trying to get through training and they say, okay, so great. Doctor Weinkle, Doctor Johnson, you've had this long philosophical, existential discussion, but boil this down for me to something that I can do tomorrow on the wards in the middle of my 30 or 18 or whatever it is, our call day, you know, 30s or less. I don't want a philosophical treatise. I just want a thing I can do tomorrow.
Dr. Jonathan Weinkle: [00:53:04] I'm going to give them three things and they can pick any of them. Number one, so that you start every holiday observance with a kiddish you pick up a glass of wine, you say a thing. There's usually things that you bless the wine, you bless the memory of coming out of Egypt, and you bless the day. I wrote a kiddish that I'm not going to recite it here for first thing in the morning before I go to work, or when I get to work, except I'm not picking up a glass of wine. Obviously, I'm picking up a cup of orange juice or a cup of coffee, usually the latter. And I say, you know, thank you God, for this thing I'm about to drink. Thank you, God, for all of these times. When you showed up for people who were ill. Thank you, God, for commanding me to heal the sick, which is in Exodus 22, that we are commanded to bring somebody who's injured back to health. That's one. So you could actually focus your day by reminding yourself what you're supposed to be doing and why and why you're doing it with with a concrete ritual. Number two is all the way at the end of the Seder, there's two songs at the end. One is called Gadya, which means one little goat. And it's this very silly, like basically it's a different version of an old lady, the old lady who swallowed the fly. It's that kind of a song, except that it goes from the goat to the cat to the dog, and ends up with God killing the angel of death, who killed the butcher, who killed the cow like.
Dr. Jonathan Weinkle: [00:54:29] And what are we supposed to remember? That the goat is inconsequential like cost to the two little coins? But in another way, the goat is consequential enough that the whole sequence of events that that goat started is important enough for God to be directly involved in. There is nobody inconsequential. The very next song is who Knows one which is about, you know, one is God and the heaven and the earth. It's not about God being numerically one, it's about God's oneness, God's uniqueness. I go back to what I said at the beginning. People created in God's image. If everybody you see doesn't matter how small they are, they are unique and holy. If you can remind yourself of that when you walk into the room to see them, then that's worthwhile. And then the third thing is what I said before be okay with giving people permission to be angry. And for people not not always being grateful and, you know, recognizing that they're on their way to recovery because they might not feel that way. Not, not asking people to be grateful for things that they don't currently feel grateful for. They'll come to that in time, if that's meant to be. Give them permission to be where they're at right then.
Tyler Johnson: [00:55:44] Perfect. Thank you so much, Doctor Winkel, for all of these thoughts and for your many years of study and erudition, and for being willing to bring these different parts of yourself into conversation, to write this book. And for this conversation with us, we thank you so much, and we have gratitude for you being here on the show.
Henry Bair: [00:56:04] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctor's art.com. If you enjoyed the episode, please subscribe, rate and review our show. Available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:56:23] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:56:37] I'm Henry Bair.
Tyler Johnson: [00:56:38] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.
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Explore Dr. Weinkle’s website Healer’s Who Listen.
Learn about the philanthropic mission of the Jewish Healthcare Foundation.
