I can remember the morning but not the year – it was around
1999 or 2000 -- when my boss, Al Minahan, and I drove from downtown to Brookline
to meet a prospective client. We had an
appointment with a recently retired surgeon at his home.
His house was on a quiet side street just beyond the
Brookline Reservoir, to the left of Boylston Street (Route 9) as you’re leaving
the city, and up a hill. The neighborhood had been built on or near what had
once been the Lowell Estate.
Dr. Robert Berger answered the bell and ushered us in.
He seemed a little hesitant or distracted. Maybe he didn’t like the look of us, I
thought, or was having second thoughts about hiring a lobbyist. We’d been referred to Dr. Berger by a friend
and fellow lobbyist, a gentleman who could not accept Dr. Berger’s assignment
because the goal conflicted with the interests of an existing client.
The three of us were soon in Dr. Berger’s first-floor den,
where the doctor began searching the shelves and a closet for a videocassette. The subject of the video was lung volume
reduction surgery (LVRS), an option used by some surgeons to treat patients
with chronic obstructive lung disease, many of whom have advanced emphysema
caused by years of smoking. In LVRS, a
surgeon removes the most diseased parts of a patient’s lungs in order to give the
less-diseased parts more room to work in.
Post-surgery, the patient is supposed to have less shortness of breath,
more comfort, less pain.
Dr. Berger was going to decide if we were the ones who could
help him secure state-controlled funds for a randomized clinical trial on the
effectiveness and optimal application of LVRS.
The project was formally known as the Overholt Blue Cross Emphysema Surgery
Trial, OBEST for short. It had been
designed to yield useful results in as little as six months.
Dr. Berger was the OBEST project director when he came up
with the idea of funding OBEST via a one-time allotment from the continuous,
multi-million-dollar revenue stream flowing to Massachusetts under the 1998
Master Settlement Agreement of the lawsuit against the major U.S. tobacco
companies by Massachusetts and 45 other states.
He believed that somewhere between two and three million dollars could
do the job. [NOTE: Here's an example of how much money still comes to Massachusetts through this agreement: In 2014 alone, the Commonwealth received $282 million from the tobacco companies.]
We watched the video, which lasted maybe 10 or 12
minutes. Dr. Berger asked some questions
and so did we. We chatted about our work,
our contacts on Beacon Hill and our normal fees. Then we parted company without
coming to an agreement on his hiring us, although it seemed he was leaning in
that direction.
In a previous position, I had worked with physicians and
surgeons for nearly 15 years. I remember
thinking that Dr. Berger lacked the hard edge and driven personality I’d come
to associate with most doctors. I
wondered if what I perceived as hesitancy or tentativeness was not a sign of
fatigue or even disillusionment.
Later, I realized how wrong I was. I saw that Dr. Berger did not have to summon
much energy or attention to take the measure of a person or situation. He was kind of on cruise control the day we
met.
Within a week, we were hired and began setting up a series
of meetings with legislators and policy makers in the state health care
bureaucracy. We also arranged meetings
with folks from the American Cancer Society and what was then the Coalition for
a Healthy Future and has since become Tobacco Free Massachusetts.
Dr. Berger came to all of those meetings and never failed to
make a good impression. It turned out
that he had ample reserves of charm and wit, which he could call upon at
will. Making the case for OBEST, he
always got to the point and hammered it home passionately. You never had to pull him back from a meandering
digression. He liked putting his
charisma to the test.
As we made the rounds, and as we had coffee and lunches with
him between appointments, some details of Dr. Berger’s highly unusual and remarkable
life would come out.
He had been born in Hungary in 1929. When World War II began, his family was
caught up in the Holocaust. Barely in his teens, he had to flee to Budapest, where he lived in the shadows with other displaced and hunted Jewish
boys. One
day, in a near-fatal encounter with a Nazi soldier, he was clubbed in the
forehead with a rifle butt, but managed to run away.
Dr. Berger survived the war and lived afterwards in camps
for displaced persons administered by the allied powers. In 1947, he was resettled in New York City,
and then in Boston, under the auspices of Jewish Family and Children’s Services
(JFCS).
When he arrived in Boston, Dr. Berger spoke no English and
had the equivalent of a seventh grade education. Within a year, he had earned enough credits
to graduate from Boston Latin, and had gained admission to Harvard College. After Harvard, he attended and graduated from
Boston University School of Medicine. He received training in internal
medicine, general surgery and cardiothoracic surgery.
Dr. Berger became a surgeon and ascended rather swiftly to
the top tier of the profession. The
positions he held included: director of cardiothoracic surgery at St.
Elizabeth’s Hospital, chief of cardiothoracic surgery at Boston City and
University Hospitals, and professor of surgery at Boston University School of
Medicine. The first surgical team to
perform heart bypass surgery in Boston had Dr. Berger as its chief.
Dr. Berger was the kind of surgeon who’d be paged at
Symphony Hall on a Friday night and be driven by police at breakneck speeds to
City Hospital, where a gunshot victim, inches from death, badly needed his
services.
Most of the above information was not conveyed to me by Dr.
Berger but rather came to light through my own research. I’d be intrigued by something he’d say in
passing, like how he’d gone to Israel during the 1967 war to make his skills
available to the wounded and would be willing to go back in the event of
another war, where “I would treat anybody who was hurt, any Palestinian as well
as any Israeli,” and I’d go back to the office and search the Internet for
information on him and his accomplishments. Then I’d ask him questions later about
what I’d learned. He really did not like
talking about himself; the good stuff I had to pull out of him.
Three or four months in, it was becoming apparent there was
no appetite in Massachusetts for funding OBEST from the tobacco
settlement. No one liked the possible
precedent it would set. No matter who we
met with, that person would basically tell us:
“These patients have been harmed by smoking and you make a
good argument that tobacco company money should be used to help them, but where
do you stop? How do you refuse the next
group that steps up and asks for money from this pool? The Master Settlement Agreement is supposed
to be reimbursing the state for the cost of caring for Medicaid patients harmed
by smoking and paying for smoking prevention.
It makes no provisions for clinical trials, no matter how good they may
be or how much they may be needed.”
Our interlocutors had a strong conviction that Massachusetts
should use its Master Settlement Agreement money only for anti-smoking advertising
campaigns and smoking cessation programs.
When a proposal fails to gain traction, when a cause that
once gave you hope turns gloomy, it is hard to acknowledge that fact. It’s hard to say you cannot win when you’ve
been hired and paid to earn a victory. It
is especially hard when you’ve been hired by someone like Dr. Berger and
you’ve come to realize he is one of the finest human beings you’ve ever
met, and that the project in question could have been a fitting coda to a glorious
career in medicine. But acknowledge it
you must, as soon as you see the outlines of a loss emerging. You have to give clients the bad news as
quickly as you give them the good.
During that last conversation with Dr. Berger, he was quite
disappointed, and reluctant to accept that the mission was over. He showed his disappointment the most, I
think, in how he grew distant. He was polite
but the change in his voice, the perceptible cooling of his customary warmth,
made it plain that he felt let down.
On Tuesday, January 5, I opened The Boston Globe to find that Dr. Berger had died on New Year
’s Day of complications from a heart attack.
He was 86 years old. The
disappointment of the OBEST assignment sprang to mind but was quickly subsumed
in the gratitude I felt, and will always feel, for having once known a man as
strong, a healer as skilled, a humanitarian as large as Bob Berger.
NEXT: A look at
the Master Settlement Agreement, 18 years later, and how Massachusetts has utilized
this multi-million-dollar, constantly replenished resource.
