At a time when many people are at the prime of their career, Deborah Horenstein is just beginning hers. After raising three children, she will become a doctor at this stage of life – mainly because of her youngest daughter, Ariella, who died at the age of 8 1/2 following a bone marrow transplant in 2007.
“I chose to embark on this path to become a pediatrician because I felt I could offer a unique perspective to patients and their families, having been on the receiving end of medical care,” said Horenstein, who graduates from Rutgers' New Jersey Medical Schoolthis month. “Throughout Ariella’s illness, I saw what truly exceptional physicians can do for a family with an ill child. I strive to be that kind of physician myself.”
Medicine was not on Horenstein’s early trajectory. She was an economics major at Barnard College and worked in finance during her early 20s. After having children, she stayed at home with two young daughters, Shoshanna, now 21, and Talya, 19.
But then Ariella was born. She had complicated medical problems from the start – low muscle tone and immune problems and, later, Crohn’s disease and epilepsy. By the time she was 4, Ariella had seen more than 50 doctors in 12 areas of specialty.
"She had an immune dysfunction and a constellation of symptoms that doctors had never seen,” Horenstein said. “Because of the intricacies of her case, I became an integral part of the medical team. The doctors relied heavily upon my input as I knew Ariella so well.”
Ariella received much of her treatment at Children’s Hospital of Philadelphia, which required the family to commute from Fair Lawn, New Jersey, and later Monsey, New York, where they moved when Ariella was 6. When her doctors determined Ariella would need a bone transplant at Duke University Hospital, Horenstein moved to Durham, North Carolina, with Ariella and her other two daughters, home schooling them with the help of her husband, Avrom, a manager in financial systems technology.
Over the next year and a half, Ariella struggled with complications from the transplant.
“The apartment turned into a mini ICU. I administered her IV medications, did sterile dressing changes, drew her blood daily and managed the intricate details of her care,” Horenstein said. “Ariella had an amazing spirit – happy, laughing, singing – despite enormous pain.”
Initially, there was hope, but ultimately graft versus host disease and severe infections overcame her and Ariella died in November 2007. Her family brought her back to Monsey and buried Ariella at a cemetery two blocks from their home.
Horenstein’s grief not only encompassed the loss of her beloved child, it also included the loss of her constant occupation. “For eight and half years, 24 hours a day, seven days a week, I had been involved in my daughter’s medical care. I realized that not only did I miss my daughter, I also missed the intellectual challenge of seeking solutions to medical problems.”
A year after Ariella’s death, Horenstein enrolled in Columbia University’s post-baccalaureate premedical program, and four years later was accepted as a first-year student at New Jersey Medical School.
“I decided to go to NJMS, in part, because of its emphasis on humanism,” Horenstein said. “The school places a great deal of importance on compassion, respect and empathy, values to which I am deeply committed.”
At first, Horenstein thought she would become a pediatric oncologist, but a third-year neurology rotation changed her focus. “It combined what I liked about oncology – long-term relationships with families, acute and chronic medical problems,” she said. “But I also liked figuring out the puzzles of brain dysfunction and correlating the neuroimaging with the physical exam.” She will stay at NJMS for pediatric residency and hopes to do a pediatric neurology fellowship beyond that.
This year, Horenstein was inducted into the Arnold P. Gold Humanism Honor Society which recognizes medical students and physicians for their excellence in clinical care, leadership, compassion and dedication to service. Twenty students out of 175 in the NJMS graduating class of 2016 have this distinction.
Andrew Berman, professor of medicine at New Jersey Medical School, said Horenstein exemplifies every character trait we think of when we reflect on what humanism means. As the attending physician in the medical ICU, Berman supervised Horenstein during a rotation, and one case she was involved with in particular stood out: A patient with AIDS who had not revealed his status to his family. “Intuitively, Deborah was able to bring out the patient’s concerns and conflicts, relate to him on an emotional plane, while attending to his acute medical needs. She was an advocate for the patient’s voice. We could hear what he was thinking through her,” Berman said. “That’s humanism.”