What Was He Thinking?
Speaking with Dr. Simon Gelman on His Recently Published Book, What I Was Thinking…

Author: Bram N. Harris

December 11, 2020

Dr. Simon Gelman recently published a book titled What I Was Thinking… In it, he details decisions he made throughout his life, the thinking that led him to those decisions, and how his thinking around them changed over time. A former Board member and longtime donor to the Foundation for Anesthesia Education and Research (FAER), Dr. Gelman has chosen to generously donate a portion of the proceeds from What I Was Thinking… to FAER. Eager to share Dr. Gelman’s perspective, both about his book and beyond, I reached out to learn more.

First, for those unfamiliar, a little background. Simon Gelman was born in 1936 and raised in Leningrad in the Soviet Union. It was there that he began his medical career. He then emigrated to Israel in 1973, before moving again in 1976, this time to Cleveland, Ohio. From there, Dr. Gelman made his way to Birmingham, Alabama, where he finished his anesthesiology residency in 1979 before becoming chair of his department in 1989. This in turn led to his role as Chair of the Department of Anesthesiology at the Brigham and Women’s Hospital of the Harvard Medical School from 1992 to 2002. As professor and chair emeritus, Dr. Gelman continued his clinical and research work at the Harvard Medical School through 2015. In 2015, Dr. Gelman ceased his clinical work, though has continued to serve as professor and chair emeritus as well as conduct research to this day.

Even such a condensed account of Dr. Gelman’s life and research implies the wealth of experience at his fingertips. Experience that he happily shares with his audience.

“In the first chapter, I describe certain events and the reasons I made one or another decision,” said Dr. Gelman. “Sometimes I say that decision was wrong. For example: after defending my theses I was offered a wonderful position in a respected institution. I was in my late twenties, in 1964 - 1965. I did not take the position because I loved and wanted to be a doctor and because I always felt that I would finish my life in a concentration camp, in a “gulag.” The thought, a relatively rational one, was that by being a doctor in a camp I would have more chances to survive. I explain reasons for such thinking in the book. Such tragic thinking was always with me but never, or rather very rarely, was affecting my mood. It was like we all knew we would die, but postponed thinking of the reality of this to a later day.”

Hopefully, you now begin to see what to expect from What I Was Thinking… However, for a better sense of what this book has in store and the basis of Dr. Gelman’s decisions, look to his thoughts on practicing medicine in three distinctly different countries.

“The effects of a new environment, new place, and new people around were tremendous. It was a combination of being very mature but still a child; it was absolutely wonderful to learn a lot, to be a child and be a mature personality. My views were changing very fast or very slowly.

“Let me give you one example. In Soviet medicine, at that time, the prevailing notion was that every patient after talking with a physician must feel better.  If he or she didn’t, this meant that it was a bad, ineffective doctor. Following this thinking, we, physicians, were lying to the patients.  When a patient had cancer, then in the Soviet Union, it was a death verdict. We were lying to the patient, saying that he or she had an ulcer, and it will be gone soon, and the patient will be as good as new. We were lying and we were proud of our lies. We were thinking that we took the burden off the patients and onto our shoulders. We knew that the patient would become worse and would blame me as a physician that couldn’t help him. But that’s where the pride was coming from: we would take this burden because that’s our duty as physicians. In my life as a physician in the Soviet Union, this started to change, and some senior physicians started to tell the truth to the patients. Sometimes they were accused by colleagues of being insensitive. 

“You are a physician, and you have to make your patients comfortable. To my surprise, in Israel and in the United States the truth was accepted by the patients not as horribly as we were afraid. My mother-in-law had cancer of the esophagus. It was extremely difficult to convince her physicians not to tell my mother-in-law what she had. We were explaining the differences in cultures and so on; we succeeded but it was difficult. Now, looking back, I am not sure that it was right, that our, mine and my wife’s decision, was correct. In the end of her life, my mother-in-law understood what was going on; she was taking it in a very stoic way.

“Another illustration of changing views and even my emotional attitudes were remarkable: when I was leaving the Soviet Union in 1973, the dialysis for advanced renal disease didn’t exist there. We physicians knew that it existed in the free world, that patients could live on dialysis for years. However, we couldn’t imagine how it could be done. We couldn’t imagine because we didn’t have good imagination. We lived with the following rules: your heart stops working, you die. Your cancer is developing, you die. Same thing with kidneys: if your kidneys stop functioning, you die. We certainly had sympathy for a patient, but it was not professional suffering, it was not a feeling of guilt.  

“Then suddenly, in a few months, I was working in an Israeli hospital and I went for consultation to a room where chronic dialysis was done. The room was big, with many beds. People were lying there attached to a dialysis machine. They were watching TV, reading a book or a newspaper, talking to neighbors and looking happy. Then, when dialysis finished, they, smiling, would get off the bed and drive home. I was speechless, I couldn’t understand how it was done.  And then … why did not I suffer emotionally when my patients were dying while I knew then that in other countries they could live; why didn’t it bother me?”

That Dr. Gelman’s perspective would shift when confronted with such drastically different views of the same conditions makes sense. At the same time, this shift is also indicative of part of his goal in writing What I Was Thinking…

“I wanted to share my experience of drastically changing opinions. The changes were due to completely different peoples, with different histories, different political regimes and religions in these three countries. The combination of these, plus effects of the development of my maturity and experience, led me to change my views many times. Many changes occurred under pressure of new observations. This process was exciting and rewarding. What can be more rewarding than saying to myself: ‘Hey, I did not know this; now I do and will think to do this differently.’”

Fulfillment through growth: a familiar sentiment. Simultaneously, a logical origin for Dr. Gelman’s goal in writing this book. With how satisfied he felt through his own growth, it’s little surprise that he’d want to share these experiences with his audience.

Now equipped with a better sense of Dr. Gelman’s intent here, we also begin to see what ties him to FAER. Many recognize the value of FAER’s efforts to support future investigators. Dr. Gelman personifies this mission through his dedication to growth.

As for the origin of Dr. Gelman’s ties to FAER, his experience is a familiar one, at least in part.

“My first grant was from FAER. It had tremendous effect on me: it was my first grant in the United States (actually in my life because in the Soviet Union, such a system did not exist). I was working with a new chairman. The department historically didn’t have any grants before Dr. Ernst, my chairman, arrived. It was the first grant in the department. People around started to look at me with some respect: ‘Simon has some ideas that people are willing to give money for.’  It had serious psychological impact on me, being a very old resident, around 40 then. Also, it was an important and needed experience in my life: I wrote papers, articles but never wrote a grant.”

Just as FAER supported Dr. Gelman, he now supports FAER. In this case, by donating a portion of the proceeds from his book. Dr. Gelman has a long history with this type of giving, having donated portions of the honoraria from his many visiting professorships to FAER. This isn’t the only reason he donates, though. He further attributes his support to the vital role research, and by extension FAER itself, plays in anesthesiology. Sentiments capped by his lead-by-example outlook. Dr. Gelman donates not only because he knows firsthand the impact FAER funding can have, but because he hopes others will see his example and be inspired to follow suit.

Through this article, I hope to have conveyed at least a fraction of the fascinating life Dr. Gelman has lived, and in turn some of what readers can expect from his book. Whether friend, colleague, or mentee of Dr. Gelman, or even wholly unfamiliar with this paragon of anesthesiology research, What I Was Thinking… promises an engaging read for one and all.

On behalf of FAER, thank you, Dr. Gelman, for your enduring support of FAER’s efforts. We could not be more grateful for your generosity and join you in your hope that others will follow the example of giving you set here.

We will end with a final quote. I asked Dr. Gelman if he had any advice he wanted to share with FAER’s grantees and program participants in their pursuit of anesthesiology research. As should come as little surprise following the rest of this article, Dr. Gelman was more than happy to oblige.

“It happened close to the mid 1990’s. At that time, the media was full of ideas that there are no jobs for anesthesiologists and never will be. This wrong prediction was based on the introduction and development of so-called managed care. At this time, to recruit American graduates into anesthesiology was close to impossible. One of those recruited to our program was Klaus; and then he became chief resident. Later, I was curious and asked him why he selected our program over others. He said, “Simon, during our interview you mentioned 16 times the word passion”.  So, it was an interesting lesson for me, and since that time whenever I would interview someone for residency or for a job, I would look for someone with passion.

“The reason is that passionate people are contagious, passionate people are wonderful, with passionate people you will be focused on success if their passion is similar to yours. Therefore, my first answer to your question is, try to work with passionate people. Make them passionate. Passion is like an infectious disease, contagious.

“Second, extremely important: try to give to young people good mentors. A mentor is crucially important in all regards and if you want to have good mentees in your program, have good mentors."

For those interested in other books with some or all of their proceeds donated to FAER, visit our Purchase Support page.