I want to share two thoughts. Of the two, the second is the more important. So ask a friend if you fall asleep during the first one that he should nudge you and wake you up for the second. The second is the more important of the two. There's a challenge which every Oved Hashem has which is tremendously magnified for anyone in a health profession. The challenge which any Oved Hashem has is to a large degree just a question of attitude, but balancing Hishtadlus and Bitachon. Balancing the Chiyuv that we have to make Hishtadlus with the understanding that מי יחיה מי ימות is not in our hands, but is in the hands of the Ribono Shel Olam. So again, it's a challenge that everyone has. If a person is making Hishtadlus for Parnassah in any field, so a person also has to figure out, both in terms of attitude and how that translates Halacha L'maaseh. And it's a balancing again: I'm supposed to be Mishtadel, on the other hand it's Biyedei Shamayim. This challenge is magnified many, many times over when one is in the health profession. One of the reasons for that is the Chazon Ish is quoted as saying that even though generally he was rather Meikel on Hishtadlus, but that when it came to Pikuach Nefesh, so there he was a tremendous Machmir in terms of the degree and the effort of the Hishtadlus that a person's supposed to make. So first of all, how does one understand that? How does one understand why the Chiyuv Hishtadlus should be different? So the Peshat is like this. The Peshat is that what underlies that approach of the Chazon Ish is that maybe משל למה הדבר דומה. I think in this new multi-volume biography of Reb Velvel, they tell the story that Reb Velvel was having an Esrog sent to him from Chutz La'aretz. I'm not sure what his Chashashos were about the Esrogim in Eretz Yisrael. I don't know if it was Shmita year and because of that he had Chashashos, but for whatever reason he had Chashashos about the Esrogim in Eretz Yisrael and he had an Esrog sent to him from Chutz La'aretz. But the problem is that whenever you try to bring fruit into the country, so they're afraid of all kinds of bugs, whatever it may bring in, so for whatever reason the Esrog had been impounded and they weren't letting it into the country. So Reb Velvel had a certain contact and he was asking him to be Mishtadel to get the Esrog because he wanted it. And they describe in very vivid detail how it was down to Hoshana Rabbah, he still hadn't gotten hold of the Esrog and every half hour, every twenty minutes, Reb Velvel was calling him to be Mezareiz him and maybe a different ploy, a different tactic. And then finally, finally, K'shkia, okay, finally when he realized that even if they would release it he couldn't get it in time, so then he relented. But until then he was relentless. Why? Because the Peshat is that the Hishtadlus to be Mekayeim a Mitzvah has a different standard than the Hishtadlus, let's say, in Milei D'alma. The Hishtadlus in Parnassah is one Din, but the Hishtadlus to be Mekayeim a Mitzvah is a different sort of Hishtadlus that a person is Mechuyav in. When a person works in the health profession, so then it's not just Hishtadlus for Parnassah, it's that also, but it's Hishtadlus for a Mitzvah. To help heal someone is Avada a person is being Mekayeim a Mitzvah והשבותו לו השבת גופו etc. So because of that the Chiyuv Hishtadlus is greater and therefore על אחת כמה וכמה when it comes to Pikuach Nefesh. even though the chiyuv hishtadlus is greater, a person can't lose sight again of what bitachon tells us that ultimately he's not in control. And it's a very the more intense the chiyuv hishtadlus is, the more of a challenge it is to maintain that balance between between the hishtadlus, between the the frenzied activity in the ER and between knowing that the Ribbono Shel Olam calls the shots. That's one that a person has to I think work to maintain that balance. You know that's why there's a din in Shulchan Aruch and the Gemara in Berachos, it's described from the the patient's perspective but the same is true from the doctor's perspective that I think the Mishna in Gemara gives the example of hakazas dam. Right they used to in those days they used to do a lot of bloodletting they thought that that was very very healthy. So before a person goes for a procedure so a person is supposed to be mispallel יהי רצון שיהיה עסק זה לי לרפואה. And that same tefillah should be should be shagur befi the rofe as well, not only in the mouth of the patient, but in the mouth of doctors as well to try to maintain that balance again between the the intensified hishtadlus and and not losing sight of the bitachon. Now that's one facet. The other one I wanted to share, talking specifically about about pikuach nefesh, so I guess this is likely to be relevant more often to pre-med than pre-dental although it does say that min hashinayim velifnim that you can have the halacha does say you can have pikuach nefesh based on on on a problem with a tooth also maybe it means an abscess or something or whatever whatever it refers to but but pre-dental can also be confronted with with pikuach nefesh. So obviously Chazal say by pikuach nefesh כל הזריז הרי זה משובח. And and mitzvah hatzalas nefashos is is ein lisha'er. And yet the challenges and nisyonos in terms of hilchos Shabbos are ones that you absolutely have to be aware of and you absolutely have to be prepared for. And that's on two levels and it's it's I think impossible to exaggerate this point. I don't think one can exaggerate this point and it's on two levels. First of all as the poskim point out about hilchos Shabbos the need that we should be baki in hilchos Shabbos is because so often you find yourself in a situation where you can't ask a shaila. It's not as if okay so some shailos you can okay can I can I put the cholent back on the blech? Can I not put it back on the blech? I don't know okay so I won't put it back on the blech and I'll ask my Rav and I'll know what to do next week for some but sometimes in hilchos Shabbos so again a person does על אחת כמה וכמה if we don't know what's a shaila. If that's true for every Jew on every Shabbos על אחת כמה וכמה it's true for again whether a person is a medic in Hatzalah and again obviously the implication is not that Hatzalah shouldn't function on Shabbos chas veshalom that's not the that's not the implication. But the bekius that one has to have in hilchos Shabbos is just is is tremendous and in the same way it's unfathomable that a person would practice medicine, practice dentistry, be a medic without being a tremendous baki in in all the refuah and metzius of refuah and anatomy and and everything to be involved in in medicine on Shabbos again whether it's as a doctor, whether it's a dentist dealing with with an abscess. So what does that mean halacha lema'aseh? What that means halacha lema'aseh I think is the following. I had a talmid many years ago he was at the stage of of medical school where he was applying for for residency and he was choosing which which branch of medicine he was going to go into. And at that time he asked the shaila you know do I have to get a Shomer Shabbos residency? I'm And he was told yes. And when he when he got that psak, so for him, that foreclosed the options that he had all along been interested in. That that in that avenue of medicine, he couldn't, I think it was at the time he told me again, I don't know whether this is many years ago, maybe maybe the metzius has changed since, but I think at the time it was he had been on a track for dermatology. And and in dermatology one does get called on Shabbos, one does get called on Shabbos, and the chances of it really being pikuach nefesh are very very slight. And and he said to me, how come no one ever told us when we were pre-med and we were thinking of of going to medical school, that this is what was down the horizon, that this is what was down the road? So it's very very important even though the shaylos aren't nogea now, but you're making the investment now, you have to go to again you have to go to a moreh hora'ah, you have to go to someone who has the pleitses, the shoulders, to to pasken these types of shaylos and and you have to know when I get to that stage, do I have to take a shomer Shabbos residency? Even if I if I you have to know also when I get beyond that, again, this is it's hard for you to think about this now, but it it affects and again and if you have a shomer Shabbos residency and then you you're called once, you know there's a pinch, you know, and we really need you, we've been accommodating you this whole time, but we need you once to pinch hit, you have to be ready for the nisyonos. You have to be ready for that kind of for that kind of pressure. And and the person has to has to build himself up for for and the nisayon that that he knows is is pending. A person also has to know with how do I deal with once I get beyond that and I get to private practice? And sometimes doctors do have emergencies. So how do I deal with the fact that that the answering service will page me for non-pikuach nefesh? Do I have an achrayus to give my answering service orders that if it's clearly not pikuach nefesh they shouldn't page me on Shabbos? If I do, what's that going to do to my practice? Let's say as a parent, so I can tell you that parents will call the doctor off hours legitimately for non-pikuach nefesh, for non-pikuach nefesh. Your your child is acutely uncomfortable with with something and it's after the regular office hours. So what do you do? You call, you call to see what what you can do and the answering service sends that call to the doctor and whoever's on call gets that call. So someone who's on call on Shabbos is going to be getting those calls and the system is designed that they should get those calls. It's not as if well you can't design the system, no, some again sometimes obviously the judgment can't be made by the answering service, they're not the the trained doctors, so any anything which is questionable obviously you're not leaving the judgment call to them. But on the other hand, there are cases which are clearly clearly nothing to do with with pikuach nefesh that answering services do send through to doctors on off hours. So am I allowed to be in private practice with such such a a setup? Am I allowed to... there are many other permutations on these questions and hayos that whatever it is that that you aspire to, you know, how you'll be able to realize it, you know, is going to hinge on on the answers, on on the piskei halacha that you get. You have to find that out now so you know exactly what what you're going to be allowed to do, what you're not going to be allowed to do, to know again how that's going to impact your your professional options and besides the the gravity of the shayla in and of itself of shomer Shabbos residency, there are painfully... Many cases of people who again originally maybe with a psak or maybe with a psak that they heard repeated go with non-Shabbos Shomer Shabbos residencies. And again, if you get that psak from a Moreh Hora'ah, no one can fault that. But it's very very hard, it's very very hard once you're in the hospital on Shabbos to not write a kutzos shel yud more than has to be written. The nisyanos are unbelievable. So you have to be aware of that now. Again, this doesn't mean don't go into medicine but what this means is be awake and have your eyes open to the nisyanos that exist. And if a person ends up in the hospital on Shabbos, again, you just have to know so so clear what you can do. You also have to know what kind of pressure you can be subjected to, you know, maybe in terms of protocol to do something that you can't do and how at the early stages of your career you can feel like your career hangs in the balance. Talk to people who have been through it. It's very real. And there are people who haven't omad b'nisayon. There are people who come out of this rachmana litzlan mechalel Shabbos. It doesn't have to happen and I'm not telling anyone that they can't do it, that's not the point obviously, but hachacham einav berosho to understand what nisyanos there are and to be prepared for them. Hachacham einav berosho to realize what shaylos will need to be asked and in case those answers, had I known, had I known, so then I would have done things differently, had I known, so that's a legitimate tayna. So find out now. Find out now before even more is invested. Find out now. Talk, there are Moreh Hora'ah here or maybe you know Moreh Hora'ah elsewhere that you have a relationship with. But talk, find out what the guidelines are and make sure again A, that you know that rachmana litzlan again, it shouldn't be anything less than sakanos nefashos but rachmana litzlan not I'm a doctor I can do anything, not I'm a doctor so this is what's required. Let's say you go into someone was telling me recently about a doctor in he's an OBGYN and a fertility specialist. So you need to so part of their responsibilities are they have to monitor the women on a daily basis and they have to monitor them on Shabbos also. Again, a tremendous mitzvah to help a couple who are infertile to have children but there's no sakanos nefashos here. And people otherwise frum are being mechalel Shabbos. It's not the case as choshuv as hatzolas nefashos is, it's not the case that I'm a doctor so therefore I do whatever medically needs to be done. Not everything medical pertains to hatzolas nefashos, not every hospital protocol relates to hatzolas nefashos and a person has to get mamash mamash expert guidance and A, to know what your professional options are going to be and B, to know when you find yourself in that situation what you can do and what you can't do. If a person goes in with his eyes open and is mechazek himself so then there are doctors who are yirei'im u'shleimim and they make a kiddush Hashem and they do wonderful things and I'm sure that that description will match each and every one of you. But it only will if a person prepares himself and a person goes in knowing what to expect. So Hashem should give you much much hatzlacha and that you should always know and be able to do the ratzon Hashem in your professional lives and elsewhere as well.