How Failure in Science Nurtures Success in Medicine

Dan Slipakoff: So, Shabbat Shalom, everyone. You might have noticed that I have been joined up here with – I wouldn’t say guest, because you’re right here where you belong – but with Nora Renthal, who is here as a part of our continuing program, Scientists in Synagogues. It’s a grassroots initiative run by Sinai and Synapses. Once again, Sinai and Synapses runs Scientists in Synagogues (there’s a quiz later). But it’s in consultation with the American Association for the Advancement of Science, Dialogues on Science, Ethics and Religion, and funded by the John Templeton Foundation, along with other individual donors. We’re really grateful to have the opportunity to put on a few of these over the course of the year. And tonight is no different.

As I was getting ready for tonight, I was thinking about a 7th grade program we do here, and you might have done it with your kids as well, where we ask our 7th graders to come up with “big questions.” We do that a lot. And on the floor we have two big circles in a Venn diagram – one says “science” and one says “religion.” And then they take their big questions and see where they might fit. What’s going to answer this question? Is it science or is it religion? Where do you think most of the questions land? They are mixed, right in the middle. A lot of the questions our kids are asking can be answered by both science and religion. And as we’re going to get into it, to talk with Nora a little more about your work, I want to set our scene just a little more with a quote from a rabbi and a well-known scientist.

The first is a quote from Rabbi Micah Kelber, who mentions the rabbis of the Talmud by saying: “They made observations, they tested their hypotheses, they classified their results. This was in large part because it helped them know how to perform the mitzvot most accurately. In order to apply the mitzvot of the Torah to the world, the chief project of the Talmud, the rabbis had to know the world.”

And this quote from Albert Einstein: “The pursuit of knowledge for its own sake, an almost fanatical love of justice, and the desire for personal independence – these are the features of the Jewish tradition which make me thank my lucky stars I belong to it.”

So without further ado, I want to introduce Dr. Nora Renthal, Medical Director of the Bone Health program at Boston Children’s Hospital. Is that an accurate role? Is there another? You have a lot of things going on. I want to just take a second to share a little bit about your role, your work, and what you do when you’re not here?

Nora Renthal: Yeah, sure. Thank you. I’m glad to be here. Like Rabbi Slipakoff said, I work at Boston Children’s Hospital. I’m obsessed with skeletons, so every part of my day is kind of about the bones, and I’m trying to make kids’ bones healthier, I guess. I work in the lab, mostly – 75% of my life is the lab – and I study how chondrocytes proliferate and mature, because chondrocytes, I think, are the unsung heroes of the skeleton. Like, you wouldn’t have a skeleton if it weren’t for chondrocytes. Because the way our bones grow is – we make a cartilage mold, and then we fill it in with mineral. And we don’t understand enough about how that cartilage forms. And if we could understand it more, maybe we could help kids with skeleton diseases.

And then I’m a doctor, and I see mostly patients with bone disease. I also have projects working on equity and inclusion for kids with musculoskeletal disease, because if you need to use a mobility assistance to get places, sometimes you’re left out. And sometimes if you have a lot of medical complexity, things about your life that maybe other people take for granted, like the education you get around puberty or “adolescent education,” big umbrella term. You get left out of that, too. So I try to bring those people, those children and young adults, into the fold, too.

Dan Slipakoff: Beautiful. Speaking about “in the fold,” you shared with me when we were prepping a really interesting story about how you kind of came to Judaism, and what your connection is. And I’m wondering if you could share that as well, as that part of your foundation.

Nora Renthal: I super-promise that I will. Can I do an experiment with you?

Dan Slipakoff: Oh, my gosh. Yeah.

Nora Renthal: I was just thinking about it as I was watching you guys, and you’re inspiring me so much. And you’re talking about the scientists in the synagogues, right? Wouldn’t it be fun to know how many scientists are in the synagogue right now? I don’t think I’m the only physician or scientist. I bet I’m looking at many different

Dan Slipakoff: Onsite, online – do we have any? Come on, self-identify.

Nora Renthal: Okay, so you guys know that mostly when you give a talk, like an academic talk, a doctor talk, or a scientist talk, you have to give your disclosures. And so my disclosure for this is that just, these are my opinions. They’re not everybody’s opinions. I’m going to say, like, “This is how I feel as a scientist,” or “This is how I feel as a doctor,” or even “as a person.” And just, like, big disclosure is, it’s just my opinion. Okay?

So I trained in Texas. I grew up in Dallas, Texas. My parents are Easter/Christmas people, and my parents are actually Christmas decorators. That’s how they earned a living from the time I was a baby until – they just retired. And there are not a ton of Jews in Texas, but I always wanted to be, like, a scientist. And then I saw how together science and medicine were. And so then I went to UT Southwestern. My husband and I both went there. We met in undergrad at UT Austin (go Longhorns), and then we went to MD/PhD together, and we graduated. And during my PhD, we had two kids. And then I was in residency. And I was always really drawn to endocrine pathways and feedback loops and how fun it is to try to do the sudoku of the endocrine, where you’re like, “Oh, well, if it’s this, then it can’t be this other thing.”

But I was in that time in your life when you’re in your medical training – and many of you know it – where you have to do all of it. And I chose pediatrics, and I had little kids, and it was hard. It was hard to be sleep-deprived. It was hard to have tiny babies, and it was hard to see other people having tiny babies that weren’t well. And I didn’t have a language for that part, and I didn’t have a community for that part.

And I started – well, we had to wake up so, so early, like four in the morning, and drive, because it’s Texas, to the hospital, a really long highway in the dark. And I started listening to these podcasts by Rabbi Artson. And I don’t know if any of you listen to him, but he’s fabulous, and you should Google it after this if you haven’t. And I think he’s actually really involved with Scientist in Synagogues, because if you google that, you see many of his talks. But any case, he’s like a process theologist and a really awesome rabbi in California. And I just connected with it. He talked a lot about “Why?” Why the suffering? Why do bad things happen to otherwise good people, and how do we make sense of it? And how do we get better, and how do we understand and conceptualize a God that would let that kind of thing happen? And I guess that’s how I sort of came to it.

And then at the same time, like, I shared with you, my daughter, who was like, I think five or six at that time – maybe five. She got really inspired by one of these Hanukkah moms that comes to the kindergarten class and shows about the menorah. And she came home with it and was like, “Could we please do this?” And I had already been listening to this podcast, and then, as it just turned out, one of my co-residents was a Modern Orthodox woman with five kids, and she had kind of been talking to me about the “whys” of why she did, what she did, and she seemed really cool. Obviously, I didn’t become Modern Orthodox, but then Amber wanting to do the Hanukkah, and me listening to the podcast, I don’t know, it just kind of like, that all coalesced, I guess. But I’m extremely fearful of people, which is why I don’t know why you asked me to do this. And it took so much, like – I had to connect on such a deeper level with these teachings that I could overcome my fear of walking into what felt like a really – maybe justifiably in Texas – like, closed community. That was intimidating, right? To be like, “Hi, Jews, would you please let me in? I’ve listened to many podcasts, and I have this menorah.”

Dan Slipakoff: Walking into that space. Okay, yeah, absolutely. Walking into space is a really important theme for this, and wanting to find your Jewish community. And as you kind of shared, that shared language and conversation around tough conversations, loss and suffering – and you shared that you’re a patient-facing scientist, a patient-facing doctor, and that question of “Why is this happening? How is this happening?” When we discussed it, you kind of answered: there’s a very desire to find the actual scientific, here’s the whys that we know, but also to hold that “Why is this happening to me?” especially when we’re talking about young kids. I wonder if you can speak to the ways that you try and approach that question of “why,” and how it’s grounded in your Judaism.

Nora Renthal: I mean, I think we don’t know the answers, right, why kids get sick, and it’s tough. Let’s see. I found comfort in the explanation that – and it’s kind of like an evolutionary explanation – that there’s value in creativity, and that means we’re not all the same thing. I guess if there were a God that just could create a perfect thing, then we would all be healthy and we would all be perfect, and we would all be maybe the same, even. But if you want the ability to mutate, if you want the ability to evolve, if you want the ability to get better and grow and learn and be creative, then you have to have also that ability to mess up. And I think that’s what happens sometimes with cells and with bodies, is that the bodies get messed up. But that’s maybe the price of having the creativity and the ability to evolve.

So I try to think about it like that, but like I said, it’s just the way I’m trying to conceptualize it and make sense of it. And I found that being here and having a community to talk about it, and all of us together acknowledging that sometimes things don’t make sense and sometimes things are crummy, and then having a place to go and be together and reflect and say, like, “This crumminess is happening.” I mean, you all were just saying that just now, right? There’s this immense suffering, and it can be really overwhelming.

So I think feeling like you have a community backing you up, and that you share some values together, that is really fortifying when you then want to go represent and be like, I don’t know, good in your job and taking care of people.

Dan Slipakoff: Yeah, you talked about the expectation or the need to be the logical, level-headed person in the room in these moments of crisis, coupled with that, like, “Yes, these are hard conversations,” people in crisis, and the ability to search for knowledge, to go back to the lab, the studies, and try to find some more whys on the side of, “Well, we can crack this code, we can find this answer, and we don’t have answers for everything.” We talked about Rabbi Kushner’s book, not “Why do bad things happen to good people?” It’s “When bad things happen to good people.”

Harold – twist, there are lots of Kushners – Harold Kushner, who talks about in the book, like, how can we believe in a God who allows these bad things to happen? And one of the theologies he comes up with is this idea of a God that might not be able to control the outcomes, but is able to be there with people in their moments of suffering. And the way you’ve described your Jewish community and your ability, in the room, to deliver the news, to say, “This is the thing that’s happening. But we have a plan moving forward. We have a team that is going to be here with you, and we’re going to get through this” – I was reflecting with some of my colleagues. We might be the second stop, and we might be saying a very similar thing to people. And I just love how you spoke about, yes, that Jewish space, to say the same thing that you’re saying in a medical field.

One of the things we also talked about – I want to make sure I get your words right. You said to me, “‘Science asks, how did I fail?’ And medicine asks, ‘How did I succeed?'” So I wonder if you can say a little something on that, and then I’ll add the third level to it.

Nora Renthal: Well, to be fair, anytime you try to simplify stuff and put it into a binary, you’re probably messing it up. But I do think the experience of being a scientist is like one where you’re testing yourself all the time and you’re testing other people, right? You’re looking at it and being like, “You said that. But I can think of three ways that you didn’t really show what you think you showed, and that you need to go back, and do the right controls, and really be more parsimonious with what it is that you’re going to claim.” So it’s a tear-down. I mean, after a while you might feel like this, right when you were doing your science training, or if you’re still a scientist, you’re like, “This job is hard.” It’s 1,000 different ways to see: How could you mess up that grant? How could that experiment go wrong? There is a section in all the grants we write of, like, “How could it go wrong?” And so that’s what I meant when I said we think about “What are the ways that you fail?” Whereas, sometimes being a physician is not like that. I notice a distinct difference when I leave the lab, where everybody’s equal and we’re all trying to see where you could have had a better control, to go to the clinic where people are kind of like, “Thanks for being here, and you’re so good and you helped us,” and it’s really validating. But science keeps me not having a big head.

But I don’t really think that one says “success” and the other says “fail.” It’s just that that’s the experience of being a person who’s a scientist and then going over and being a physician, where people – they almost want you to play that role, because if you assume that it’s comforting in the moment, you want to feel like you’re in good hands, and hopefully you are. So I think they’re complementary, and I hope that I bring a lot of logic to my clinic. Like, I always want parents to understand what’s going on with their kids, and if I can’t make it make sense, then I haven’t done my job. And that comforts me. Like, logic comforts me. In addition to Judaism, but also logic.

Dan Slipakoff: We like to leave people with even bigger questions than they came in with sometimes. So my question then is to add into this, “Does Judaism ask a question in that realm?” How did I fail? How did I succeed? What is the question? Maybe it’s in that area. What is the question that Judaism asks you?

Nora Renthal: Yeah, well, I think it’s interesting to step back and say, “What does science ask?” Because I think they’re asking the same thing. People frequently say, “Well, science asks ‘how’ and religion asks the ‘why,'” which I guess is sometimes true, but sometimes science asks why and sometimes religion asks how. And I think that they’re really similar and overlapping modalities.

So what does science do? Well, you have to have something you can measure, so it has to be a measurable thing. And then it has to be replicable – because if it’s a thing that only happened once, I’m not going to be able to measure it again and again and tell you anything about it. And then it has to be detectable. Like, we can only do science on things that we can detect and measure, and that will happen several times. Three – you always have to replicate things by three, but probably more than that, right? And you like doing it three different ways and replicate it at least by three so that you end up with – like, okay, fine.

So there are things that we all experience in our lives that aren’t those things, right, that happen in a way that you can’t detect. I can’t measure, like, the love I feel for my kids. I can’t measure my connectedness to this community. That’s a private thing. I can never measure it. So it’s not science. There are things that are going to happen only once in my lifetime that probably have a logical explanation – like, boom! – but it was not going to happen more than once. So I kind of feel like religion is just also asking the stuff, but for the questions that fall outside of those domains.

Dan Slipakoff: Yeah. And I think there are some of the things that we talk about. Love is a great thing. Can we measure love? Well, we have our v’ahavta, and we have the ways that we kind of say, “Well, can we measure love in the way we act when we’re on the street, and when we come into our home, and when we’re in community with this person, and we’re doing this thing?” We can kind of check boxes in that way.

And I’m thinking – the “fail and succeed,” I think about, like, getting ready for Yom Kippur, getting ready for a heshbon ha nefesh, which you should do all the time, not just before Yom Kippur, but that self-check – “Where did I take a misstep? What could I tweak? What could I do a little differently? What could I do a little better? Where do I feel good about the things I did in the world? Can I be in conversation with somebody who’s honest and authentic to give me that feedback as well?”

And that’s another piece, and we’re going to kind of wrap up on that. And if we have maybe time for a question or two, we’ll take it. But you talk a lot about the power and your team. I was reading the website about collaboration – very key, and multifaceted, a lot of different departments. And I was thinking about two types of Jewish collaboration. One is chavruta – the idea of study. We do it in partnership. We do not study in isolation and also in minyan, in prayer. We don’t always pray in isolation either. We pray in community.

So I wondered if there are any reflections you have on that value of collaboration in your life in all facets, as a way to kind of wrap us up.

Nora Renthal: It’s a really good question. I think this community, like knowing all of you and all the good things that you’re doing, and I read about it and I get the newsletter and all the things, it makes me try to be braver, and feel like when I run up against something where someone tells me “No,” or they don’t think that idea is good, or they want to exclude that kind of patient, or “We don’t have enough money,” usually that’s what they say, then I can think back to my community and say “No – I can’t just take no for an answer. I have to keep pushing for this, and I feel empowered because I know about all these people who are doing good in my community.”

So I think that that’s really important, because it’s hard to be brave, especially when people are telling you “no.” And then when you don’t know the answer or something bad happens – we also talked about how just having Judaism to fall back on when one of these life-altering moments happens and you don’t know what to do in that moment. There is a tradition. I think that’s really helpful, because you don’t really know what to do. And then all of a sudden, it’s like, “No, this is my obligation. Somebody died. It’s my obligation. I’m going to go talk to their family,” when maybe your instinct is to freak out and just ghost everyone.

So I think, I don’t know. That’s the power of community. Obviously, in science, the more we collaborate, the less we silo data. Put all your data on the Internet, everyone, and then we can collaborate with each other and learn faster, because that’s really important.

Dan Slipakoff: Beautiful. I’m wondering if we have time for a question, if anyone has one… We solved it. Good job.

Nora Renthal: (No, we didn’t.)

Dan Slipakoff: But, really, Nora, I really want to thank you. Oh, we do have one [question].

The question was, “How often do you see miracles in your work – something you can’t explain?” Good question.

Nora Renthal: Yeah. I mean, there are a lot of things we don’t know. I think that in that Hallmark-special definition of “miracle,” probably not. But it could be that I’m not looking the right way, because, like I said, I’m really logical and focused – but I see so much connectivity between people, and certainly being a physician that takes care of severely ill, chronically ill kids, I’ve changed the way I think about people a lot since I was younger, and [I’m] much more humble and much less like, “Oh, this doesn’t have a good outcome. It’s not worth it.” I change the way I talk all the time, because kids will recover in a way that I couldn’t have predicted and how terrible it would be to be the person who is like, “Don’t invest in that. That’s not worth it.” I never say that, even though maybe I thought that 20 years ago or something.

But I do think that’s how I approach patients, like, “Hey, this is the max of what we know, but we don’t know everything.” So I can tell you some things are black and white. If you have diabetes, I recommend insulin. You need that. Type 1 diabetes, you will die if you don’t take insulin. But there are a lot of things that aren’t that black and white in what we do. And I know that also inspires me to be a scientist, because I want to help advance that frontier. It’s a good question.

Dan Slipakoff: It’s a great place to leave. I think about our former rabbi, Rabbi Gittelsohn, who I saw in one of those books that we give b’mitzvah students, about the text. And he was talking about, “You think that crossing the Red Sea and the plagues and wonders in Egypt was a miracle. If you want a true miracle, then look in a microscope, look at the finely balanced network of the human body that allows us to get up and breathe air and go about our day. That is a miracle.”

Nora, it’s been a true joy to share with you. Thank you so much for giving your time to us, and I wish you Shabbat Shalom.

Nora Renthal: Shabbat Shalom.