Those Long-Ago Desert Evenings
To keep clear the view of the mountain
the dancers were cut down.
Calf-powder scalded our insides
a castigation of embodiedness.
Song surged up to the summit
silence wafted down in rings.
What they say: He had gone up
and come down; he'd let them slip, no
hurled them like a sandal.
The mountain had split in two
like a roasted lamb and taken him in.
Children mock through the camp.
Wh-wh-who is for God come to meeee!
All around something is called out
a cross between You will and You never.
12/25/05
12/22/05
Poetry blogged
Yes or no? Yes and no.
I was talking with a friend the other day -- he's a great poet and a perfect mix of critique, appraisal, and support -- who asked me why didn't I, after all, post my poems on my blog. Part f it is my snobbery: there are venues for poetry, and I hope someday for my poems to be allowed into them. On the other hand, if my readers (the Daily Three-Dozen, as it is these days), would be interested in poems, then I would post them. In reality, I think most are here for the Jewish beat or the medicine beat. If you feel otherwise, lemme know.
On the other hand, I suppose I should give myself more credit: if I posted my poems, my readers might become interested in them by their very postedness. Who knows what could happen?
And, just to dig up on old post: I like Christmas trees.
Yes or no? Yes and no.
I was talking with a friend the other day -- he's a great poet and a perfect mix of critique, appraisal, and support -- who asked me why didn't I, after all, post my poems on my blog. Part f it is my snobbery: there are venues for poetry, and I hope someday for my poems to be allowed into them. On the other hand, if my readers (the Daily Three-Dozen, as it is these days), would be interested in poems, then I would post them. In reality, I think most are here for the Jewish beat or the medicine beat. If you feel otherwise, lemme know.
On the other hand, I suppose I should give myself more credit: if I posted my poems, my readers might become interested in them by their very postedness. Who knows what could happen?
And, just to dig up on old post: I like Christmas trees.
12/20/05
12/15/05
Ikhl Shraibman
Khaval al d'avdin. What we have lost!
This Yiddish miniaturist, essayist, and writer of short stories based on Biblical characters was also an important figure among Jews in contemporary Kishinev, Moldova. He died on December 9th. [See the obituary in the Forward for more on his life and work.]
A Writer's Credo
[Shrayberisher ani-maymen; From the collection "Creation and Love", 2000. ]
My philosophy, from the first day I started to write until today: People should be good, and everything should be good for people.
Two little things. But a whole world could be founded on them, a new world where people would embrace each other and live in love and joy.
Would people be pleased with a world like that? Wouldn't they be bored? Wouldn't they even start dreaming about another world? I don't know. It's really hard to say and will never be possible to try out. Because -- a world like that will never be established.
But let's dream, at the very least, about a world like that.
Dreaming is also quite a fine thing of people's.
Never to this very day have people possessed such a fine thing as dreaming.
What else is a writer in this world, if not the most beautiful, the longest, the strongest dreamer?
1998
Khaval al d'avdin. What we have lost!
This Yiddish miniaturist, essayist, and writer of short stories based on Biblical characters was also an important figure among Jews in contemporary Kishinev, Moldova. He died on December 9th. [See the obituary in the Forward for more on his life and work.]
A Writer's Credo
[Shrayberisher ani-maymen; From the collection "Creation and Love", 2000. ]
My philosophy, from the first day I started to write until today: People should be good, and everything should be good for people.
Two little things. But a whole world could be founded on them, a new world where people would embrace each other and live in love and joy.
Would people be pleased with a world like that? Wouldn't they be bored? Wouldn't they even start dreaming about another world? I don't know. It's really hard to say and will never be possible to try out. Because -- a world like that will never be established.
But let's dream, at the very least, about a world like that.
Dreaming is also quite a fine thing of people's.
Never to this very day have people possessed such a fine thing as dreaming.
What else is a writer in this world, if not the most beautiful, the longest, the strongest dreamer?
1998
12/13/05
Metzitzah b'peh and neonatal herpes
Still real, still serious.
I received a message today from the New York City Department of Health and Mental Hygiene about metzitzah b'peh (MbP) and neonatal herpes, an issue that has been of concern for some months now. The complete message is below, but two points should be emphasized:
1. The New York City Department of Health recommends against the practice, but in any case suggests that parents be told before the bris if MbP is to be used, so that they can make an informed decision.
2. DOH has also prepared an "open letter to the Jewish community" on the issue.
The message also reviews the steadily accumulating evidence supporting the earlier fear that one mohel was behind the cases of neonatal herpes associated with MbP.
* * *
Dear Colleagues:
You may have heard about the Health Department’s recent investigation of several cases of herpes simplex type 1 infection in male infants following circumcision which included metzitzah b’peh.
Metzitzah b’peh is a practice performed by some mohelim (religious circumcisers) as part of the circumcision. After removing the foreskin, the mohel places his mouth on the baby’s freshly circumcised penis to draw away the blood. In 1998, the Health Department investigated two cases of neonatal herpes due to herpes simplex virus type 1 (HSV-1) – one of these infections occurred in 1988, the other in 1998. Both were associated with one mohel (Mohel A) who performed metzitzah b’peh during circumcision. Mohel A agreed to stop practicing metzitzah b’peh.
In November 2004, the Health Department was notified of 3 male infants with HSV-1. All were circumcised by one mohel (Mohel B), who performed metzitzah b’peh. The infants developed herpes infection in the genital area 8-10 days after circumcision and were hospitalized for several weeks. One baby died from the infection. Two cases were reported by physicians in 2005 and both are also consistent with infection from metzitzah b’peh. Every case occurred in the time frame consistent with transmission from metzitzah b’peh.
Our investigation found Mohel B to be the source of the 2004 cases, and metzitzah b’peh to be the means of infection for these and other cases, for the following reasons:
• The medical circumstances are inconsistent with infection acquired at delivery, in the newborn nursery, or from caretakers.
• Infection is consistent with acquisition of herpes at circumcision. For example, two infants who were circumcised several weeks after birth showed signs of infection in the time frame that would be expected were the infection acquired during circumcision.
• Several mothers tested negative for HSV-1, making it impossible for them to have been the source of infection.
• All infants tested culture-positive for HSV-1, which is found in the mouths of most adults.
• The location of herpes sores (on infant genitals and buttocks) is very unusual and strongly suggests that infection was introduced at the genitals.
With an estimated average of fewer than 30 cases of all forms of infant herpes infections occurring per year in New York City, the odds of one mohel being associated with 3 cases of neonatal herpes are infinitesimally small (about 6.9 million to 1). In the interest of allowing religious communities to address these health concerns first, the Health Department agreed to let rabbinical authorities ensure that the mohel stopped performing the practice at least until the authorities conclude an investigation. In addition, the connection between metzitzah b’peh and neonatal herpes has been documented in the medical literature. Three investigations published within the past 5 years (from New York City [1], Israel [2, 3] and Canada[3]) describe 11 cases of males with HSV-1 infections on their genitals following metzitzah b’peh. Among the 11 cases, there are 4 pairs of cases (including the 1988/1998 cases from New York City).
In the United States, approximately 70% of persons age 40 and older are infected with herpes simplex virus type 1. The mouth is the most common site of HSV-1 infection; HSV-1 spreads easily through infected saliva, especially when saliva comes in contact with a cut or break in the skin, such as occurs during metzitzah b’peh. Most adults with oral herpes do not know they are infected and do not have symptoms. Even without symptoms, however, people with oral herpes can spread the infection to others. If herpes lesions are present, they tend to occur (and recur) on the skin or mucous membranes at the site at which infection was introduced or in related dermatomes. HSV-1 infection is lifelong; antibody is evidence of infection.
Evaluation and management of an infant with suspected neonatal herpes infection
Infants in the first 6-8 weeks of life suspected of having herpes infections should always be hospitalized and treated with intravenous acyclovir [4, 5], a lumbar puncture should be performed at admission, and the infant should be managed in consultation with a pediatric infectious disease specialist. Herpes infection of the skin/eye/mucous membranes may progress to disseminated disease or central nervous system (CNS) infection. Infants with disseminated or CNS infection are at significant risk for death or serious sequelae even with treatment.
For infants suspected of having herpes infection, cultures should always be done on skin vesicles if present. Other sites that may yield positive cultures and should be cultured include blood, nasopharynx, anorectum, conjunctivae, urine, and stool. Direct fluorescent antibody (DFA) staining, if available, may provide a rapid and specific diagnosis. The yield of culture and DFA from HSV skin vesicles is very good if specimens are properly collected. To collect a specimen from a vesicle, unroof or open the vesicle with a sterile needle or scalpel and vigorously rub or twist a sterile swab on the exposed base of the lesion. Use the swab to inoculate sterile viral transport medium and send immediately to the laboratory. Samples for DFA staining should be obtained in the same manner with the material from the lesion smeared onto a glass microscopic slide.
Cerebrospinal fluid (CSF) and blood specimens should be tested by polymerase chain reaction (PCR) for HSV-1 and herpes simplex virus type 2 (HSV-2). CSF cultures for HSV are usually negative in a patient with HSV encephalitis, so if a limited sample of CSF is available, PCR testing on the CSF should be done in preference to culture. Because of the passive transfer of maternal antibody, type-specific herpes serologic testing is not useful in making a herpes diagnosis in an infant unless maternal serologies are also done and are negative. Consult your institution’s clinical laboratory director to identify a laboratory licensed to perform viral culture and polymerase chain reaction for HSV-1 and HSV-2.
Reporting neonatal herpes cases to the Health Department
Up to 20% of neonatal herpes cases never develop skin lesions, so providers must maintain a high index of suspicion for herpes infection following circumcision which includes metzitzah b’peh. Providers should suspect herpes infection in male infants presenting with vesicular or pustular lesions on the genitals, perineum, buttocks, or related dermatomes in the weeks after circumcision, or, in any infant with fever or other signs of systemic illness in the weeks following circumcision.
New York City Health Code section 11.03(b) requires providers to report ‘unusual manifestations of disease. Providers should report all suspected cases of herpes occurring in the weeks following circumcision to the Health Department. Call 212-788-4423 and ask for the ‘neonatal herpes desk’. After hours call the Poison Control Center at 1-800-222-1222.
Health Department Recommendations with Regard to Metzitzah B’peh
The Health Department has issued an open letter to the Jewish community regarding the recent cases of neonatal herpes linked to metzitzah b’peh and the risk of HSV-1 transmission with metzitzah b’peh, and has developed a fact sheet to inform parents about this public health issue which will be available online and through 311 in English, Yiddish and Hebrew.
During metzitzah b’peh the mouth of the mohel comes into direct contact with the baby’s circumcision cut, risking transmission of herpes simplex virus to the infant. While severe illness associated with this practice may be rare, because there is no proven way to reduce the risk of herpes infection posed by metzitzah b’peh, the Health Department advises against this practice. Some parents whose infants had metzitzah b’peh say they did not know in advance that the mohel would perform it. The Health Department advises parents to ask the mohel several days in advance of the bris whether he performs metzitzah b’peh. This offers parents a chance to weigh the risks of metzitzah b’peh and choose another option if they wish. While some mohelim consider metzitzah b’peh the only acceptable way to draw blood away from the circumcision cut, others use different means. For example, a mohel may use a sterile glass tube or a glass tube attached to a rubber bulb to suction the blood away from the baby’s cut. Other mohelim use a sponge or sterile gauze pad to wipe the blood away. Unlike metzitzah b’peh, there is no evidence that any of these practices cause herpes infection.
Sincerely,
Susan Blank, MD, MPH Julia Schillinger, MD, MSc
Assistant Commissioner Director of Surveillance, Epidemiology, and Research
Bureau of Sexually Transmitted Disease Control
New York City Department of Health and Mental Hygiene
25 Worth Street
New York, NY 10013
1)Rubin LG, Lanzkowsky P. Cutaneous neonatal herpes simplex infection associated with ritual circumcision. Pediatric Infectious Diseases Journal. 2000. 19(3) 266-267.
2)Distel R, Hofer V, Bogger-Goren S, Shalit I, Garty BZ. Primary genital herpes simplex infection associated with Jewish ritual circumcision. Israel Medical Association Journal. 2003 Dec;5(12):893-4
3)Gesundheit B, Grisaru-Soen G, Greenberg D, Levtzion-Korach O, Malkin D, Petric M, Koren G, Tendler MD, Ben-Zeev B, Vardi A, Dagan R, Engelhard D. Neonatal genital herpes simplex virus type 1 infection after Jewish ritual circumcision: modern medicine and religious tradition. 2004. Pediatrics. 114(2):259-63
4)American Academy of Pediatrics. Herpes simplex. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003: 344-353.
5)Kimberlin DW. Neonatal Herpes Simplex Infection. Clinical Microbiology Reviews. 2004. 17 (1): 1-13.
Still real, still serious.
I received a message today from the New York City Department of Health and Mental Hygiene about metzitzah b'peh (MbP) and neonatal herpes, an issue that has been of concern for some months now. The complete message is below, but two points should be emphasized:
1. The New York City Department of Health recommends against the practice, but in any case suggests that parents be told before the bris if MbP is to be used, so that they can make an informed decision.
2. DOH has also prepared an "open letter to the Jewish community" on the issue.
The message also reviews the steadily accumulating evidence supporting the earlier fear that one mohel was behind the cases of neonatal herpes associated with MbP.
* * *
Dear Colleagues:
You may have heard about the Health Department’s recent investigation of several cases of herpes simplex type 1 infection in male infants following circumcision which included metzitzah b’peh.
Metzitzah b’peh is a practice performed by some mohelim (religious circumcisers) as part of the circumcision. After removing the foreskin, the mohel places his mouth on the baby’s freshly circumcised penis to draw away the blood. In 1998, the Health Department investigated two cases of neonatal herpes due to herpes simplex virus type 1 (HSV-1) – one of these infections occurred in 1988, the other in 1998. Both were associated with one mohel (Mohel A) who performed metzitzah b’peh during circumcision. Mohel A agreed to stop practicing metzitzah b’peh.
In November 2004, the Health Department was notified of 3 male infants with HSV-1. All were circumcised by one mohel (Mohel B), who performed metzitzah b’peh. The infants developed herpes infection in the genital area 8-10 days after circumcision and were hospitalized for several weeks. One baby died from the infection. Two cases were reported by physicians in 2005 and both are also consistent with infection from metzitzah b’peh. Every case occurred in the time frame consistent with transmission from metzitzah b’peh.
Our investigation found Mohel B to be the source of the 2004 cases, and metzitzah b’peh to be the means of infection for these and other cases, for the following reasons:
• The medical circumstances are inconsistent with infection acquired at delivery, in the newborn nursery, or from caretakers.
• Infection is consistent with acquisition of herpes at circumcision. For example, two infants who were circumcised several weeks after birth showed signs of infection in the time frame that would be expected were the infection acquired during circumcision.
• Several mothers tested negative for HSV-1, making it impossible for them to have been the source of infection.
• All infants tested culture-positive for HSV-1, which is found in the mouths of most adults.
• The location of herpes sores (on infant genitals and buttocks) is very unusual and strongly suggests that infection was introduced at the genitals.
With an estimated average of fewer than 30 cases of all forms of infant herpes infections occurring per year in New York City, the odds of one mohel being associated with 3 cases of neonatal herpes are infinitesimally small (about 6.9 million to 1). In the interest of allowing religious communities to address these health concerns first, the Health Department agreed to let rabbinical authorities ensure that the mohel stopped performing the practice at least until the authorities conclude an investigation. In addition, the connection between metzitzah b’peh and neonatal herpes has been documented in the medical literature. Three investigations published within the past 5 years (from New York City [1], Israel [2, 3] and Canada[3]) describe 11 cases of males with HSV-1 infections on their genitals following metzitzah b’peh. Among the 11 cases, there are 4 pairs of cases (including the 1988/1998 cases from New York City).
In the United States, approximately 70% of persons age 40 and older are infected with herpes simplex virus type 1. The mouth is the most common site of HSV-1 infection; HSV-1 spreads easily through infected saliva, especially when saliva comes in contact with a cut or break in the skin, such as occurs during metzitzah b’peh. Most adults with oral herpes do not know they are infected and do not have symptoms. Even without symptoms, however, people with oral herpes can spread the infection to others. If herpes lesions are present, they tend to occur (and recur) on the skin or mucous membranes at the site at which infection was introduced or in related dermatomes. HSV-1 infection is lifelong; antibody is evidence of infection.
Evaluation and management of an infant with suspected neonatal herpes infection
Infants in the first 6-8 weeks of life suspected of having herpes infections should always be hospitalized and treated with intravenous acyclovir [4, 5], a lumbar puncture should be performed at admission, and the infant should be managed in consultation with a pediatric infectious disease specialist. Herpes infection of the skin/eye/mucous membranes may progress to disseminated disease or central nervous system (CNS) infection. Infants with disseminated or CNS infection are at significant risk for death or serious sequelae even with treatment.
For infants suspected of having herpes infection, cultures should always be done on skin vesicles if present. Other sites that may yield positive cultures and should be cultured include blood, nasopharynx, anorectum, conjunctivae, urine, and stool. Direct fluorescent antibody (DFA) staining, if available, may provide a rapid and specific diagnosis. The yield of culture and DFA from HSV skin vesicles is very good if specimens are properly collected. To collect a specimen from a vesicle, unroof or open the vesicle with a sterile needle or scalpel and vigorously rub or twist a sterile swab on the exposed base of the lesion. Use the swab to inoculate sterile viral transport medium and send immediately to the laboratory. Samples for DFA staining should be obtained in the same manner with the material from the lesion smeared onto a glass microscopic slide.
Cerebrospinal fluid (CSF) and blood specimens should be tested by polymerase chain reaction (PCR) for HSV-1 and herpes simplex virus type 2 (HSV-2). CSF cultures for HSV are usually negative in a patient with HSV encephalitis, so if a limited sample of CSF is available, PCR testing on the CSF should be done in preference to culture. Because of the passive transfer of maternal antibody, type-specific herpes serologic testing is not useful in making a herpes diagnosis in an infant unless maternal serologies are also done and are negative. Consult your institution’s clinical laboratory director to identify a laboratory licensed to perform viral culture and polymerase chain reaction for HSV-1 and HSV-2.
Reporting neonatal herpes cases to the Health Department
Up to 20% of neonatal herpes cases never develop skin lesions, so providers must maintain a high index of suspicion for herpes infection following circumcision which includes metzitzah b’peh. Providers should suspect herpes infection in male infants presenting with vesicular or pustular lesions on the genitals, perineum, buttocks, or related dermatomes in the weeks after circumcision, or, in any infant with fever or other signs of systemic illness in the weeks following circumcision.
New York City Health Code section 11.03(b) requires providers to report ‘unusual manifestations of disease. Providers should report all suspected cases of herpes occurring in the weeks following circumcision to the Health Department. Call 212-788-4423 and ask for the ‘neonatal herpes desk’. After hours call the Poison Control Center at 1-800-222-1222.
Health Department Recommendations with Regard to Metzitzah B’peh
The Health Department has issued an open letter to the Jewish community regarding the recent cases of neonatal herpes linked to metzitzah b’peh and the risk of HSV-1 transmission with metzitzah b’peh, and has developed a fact sheet to inform parents about this public health issue which will be available online and through 311 in English, Yiddish and Hebrew.
During metzitzah b’peh the mouth of the mohel comes into direct contact with the baby’s circumcision cut, risking transmission of herpes simplex virus to the infant. While severe illness associated with this practice may be rare, because there is no proven way to reduce the risk of herpes infection posed by metzitzah b’peh, the Health Department advises against this practice. Some parents whose infants had metzitzah b’peh say they did not know in advance that the mohel would perform it. The Health Department advises parents to ask the mohel several days in advance of the bris whether he performs metzitzah b’peh. This offers parents a chance to weigh the risks of metzitzah b’peh and choose another option if they wish. While some mohelim consider metzitzah b’peh the only acceptable way to draw blood away from the circumcision cut, others use different means. For example, a mohel may use a sterile glass tube or a glass tube attached to a rubber bulb to suction the blood away from the baby’s cut. Other mohelim use a sponge or sterile gauze pad to wipe the blood away. Unlike metzitzah b’peh, there is no evidence that any of these practices cause herpes infection.
Sincerely,
Susan Blank, MD, MPH Julia Schillinger, MD, MSc
Assistant Commissioner Director of Surveillance, Epidemiology, and Research
Bureau of Sexually Transmitted Disease Control
New York City Department of Health and Mental Hygiene
25 Worth Street
New York, NY 10013
1)Rubin LG, Lanzkowsky P. Cutaneous neonatal herpes simplex infection associated with ritual circumcision. Pediatric Infectious Diseases Journal. 2000. 19(3) 266-267.
2)Distel R, Hofer V, Bogger-Goren S, Shalit I, Garty BZ. Primary genital herpes simplex infection associated with Jewish ritual circumcision. Israel Medical Association Journal. 2003 Dec;5(12):893-4
3)Gesundheit B, Grisaru-Soen G, Greenberg D, Levtzion-Korach O, Malkin D, Petric M, Koren G, Tendler MD, Ben-Zeev B, Vardi A, Dagan R, Engelhard D. Neonatal genital herpes simplex virus type 1 infection after Jewish ritual circumcision: modern medicine and religious tradition. 2004. Pediatrics. 114(2):259-63
4)American Academy of Pediatrics. Herpes simplex. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003: 344-353.
5)Kimberlin DW. Neonatal Herpes Simplex Infection. Clinical Microbiology Reviews. 2004. 17 (1): 1-13.
12/5/05
Lipa-logy: Or, in which a reader does my research
Just like the big-name blogs!
Cut-n-pasted from an e-mail. No editing, no effort . . .
Just like the big-name blogs!
Cut-n-pasted from an e-mail. No editing, no effort . . .
Zackary,
A Google search on Lipa Schmeltzer unearthed a post of yours from this time last year.Truth be told, I myself, was not too much into either FJM (Frum Jewish Music) in general or Lipa Schmeltzer in particular until last week when someone showed me a clip of Lipa's Hebrew Academy For Special Children (HASC) 2005 concert video performance. Lipa did a Yiddish sendup of "The Lion Sleeps Tonight".
The song, as you may know, started life in 1939 in South Africa as Solomon Linda's "Mbube", was recast as "Wimoweh" by the Weavers in 1950, as the immortal, international chart-topping "The Lion Sleeps Tonight" by the Tokens in 1961 and from there, after many re-recordings finally made it into the epic Lion King. However, arguably it did not reach its true destiny until it got its first Yiddish rendition.While Lipa's version hues musically to the original, lyrically it does not. Interestingly though, the lyrics give two nods to the original. Suggestively, perhaps, the chorus "A-wee-ma-way" becomes the vaguely rhyming "Abi Me'Leibt" and more persuasively, the phrase "The Lion Sleeps Tonight" makes a cameo appearance in a scene at Penn Station.
In 2004 Lipa did a special rendition of "Gelt" for the HASC concert and both that performance and his "Abi Me'leibt" can be seen here. Additionally the "Abi Me'Leibt" video [can be seen here]. As something of an after-thought, if you wish, you may certainly use any of the above material for your blog, if you see fit, in which case I would prefer anonymity.
Birobidzhan dot gov
Random observations:
1. I don't see the name Birobizhan anywhere. The official abbreviation is now "JAR" (Jewish Autonomous Region). The title of the web site is written in Funky Jewish (or whatever that faux-Hebrew font is called). No Yiddish on the site.
. . . oh, wait. Mistake. Birobidzhan is the name of the main city, while the JAR is the name of the region. I think I knew that.
2. If anyone would like to further muse on the evil conspiracy between Yiddishists and gays-and-lesbians, feel free to note that the flag of the JAR features a rainbow stripe.
With regard to the region's heraldry [!], the following is noted: "The figure of the tiger is turned to the right toward a viewer that symbolizes an unusual history and original way of the Region’s development." "Unusual" and "original" is certainly one way to put it. ("Deportation" might be another, but let's not split hairs.)
3. In the matter of religious observance in the JAR, the site states:
Random observations:
1. I don't see the name Birobizhan anywhere. The official abbreviation is now "JAR" (Jewish Autonomous Region). The title of the web site is written in Funky Jewish (or whatever that faux-Hebrew font is called). No Yiddish on the site.
. . . oh, wait. Mistake. Birobidzhan is the name of the main city, while the JAR is the name of the region. I think I knew that.
2. If anyone would like to further muse on the evil conspiracy between Yiddishists and gays-and-lesbians, feel free to note that the flag of the JAR features a rainbow stripe.
With regard to the region's heraldry [!], the following is noted: "The figure of the tiger is turned to the right toward a viewer that symbolizes an unusual history and original way of the Region’s development." "Unusual" and "original" is certainly one way to put it. ("Deportation" might be another, but let's not split hairs.)
3. In the matter of religious observance in the JAR, the site states:
On January 1, 2003 in the region 27 registered religious organizations have been acted. The leading position belongs to Russian Orthodox Church (ROC) of the Moscow Patriarchy. Ten parishes of ROC function on the territory of the region. Two Judaic communities actively work also. Besides, there are several Protestant religious organizations.
12/1/05
No longer confused, not yet overwhelmed
After a year of my medical-student ramblings, what have I learned?
MEDICINE MENSCH: Taking Stock
By Zackary Sholem Berger
December 2, 2005
There's a joke about travel writers turning experiences abroad into publishable material. Spend two months in China, say, and you can write a book; spend two years, and you can write an article. But spend 20 years, and you find you can't write anything at all. I feel the same way about the past year of being a medical student. Every day is packed with thousands of stories. Every patient is an epic unto herself. The first few months of being a medical student were an encounter with the world of the hospital. In such a first encounter (with a new book, a new person, a new language), you can ignore the occasional troubling aside and focus on the big picture. But as you get used to things, you can't avoid the episodes that are harder to talk about.
As a beginning medical student, I was mostly confused. As a fourth-year student who's just completed his sub-internship (a sort of pre-residency), I've become less confused and more intimately involved in the contradictions of the hospital. Once I become a resident, I might become too overwhelmed by life and death to write at all. Now, at the end of this column's first year, I thought I should take stock of my reactions to what I've seen. "Love" and "hate" are the first words that come to mind for many things I've encountered this past year. Sometimes I hate and love the same thing in succession.
I hate going into rooms of people who are very sick. They lie in their beds, staring at the wall. What's the right thing to say to them? Most of the time, as little as possible: I already know this from visiting the sick as a layperson. But as a doctor-in-the-making, I'm no longer someone who visits the sick. I now intrude on them for their own good, asking them questions they would rather not answer and viewing their bodies in ways that they never would countenance when healthy. While I try to build rapport, strengthening the doctor-patient relationship through our basic human connection, more often than not our conversation doesn't exceed the bare minimum. I need to get my work done; they need to get their rest. So I leave the room feeling guilty, while they lie there feeling no healthier than before.
At the same time, there are patients I come to love even though I know them only slightly. An older, frum woman was admitted with pneumonia. The admitting team described her as demented. According to the technical meaning of the term, this was correct: She suffers from a constant, progressive decline in cognitive function. But too many assume that the demented patient is childlike, not deserving of the respect we would give anyone outside the hospital. I've seen more than one demented old woman called "sweetie," more than one writhing figure in the step-down unit called "nonverbal" while he's screaming in Yiddish for people to leave him alone. It takes extra effort to listen.
I walked into this woman's room last Tuesday and asked her how she was. She said something incomprehensible, and I bent closer to hear. "What's that?" I said, a trifle impatiently. "Ki tov," she said. "It's the day of ki tov." It was Tuesday, the third day, the day that God called good twice. I cried at that — not so anyone would see, of course. I loved that patient even though I didn't know her at all, because she had said something heartening.
I dislike walking the halls in a long white coat, hearing people call me "Doctor," running into relatives and families hungry for information that I don't have or can't give them. I am the "doctor figure" in whom they find comfort, even though there might be nothing I can do at the moment. At the same time, I try to tell them what I can — even if it's only the simplest details of the imaging study that's about to be performed or the tests that are about to be drawn.
There are other reactions that cannot be stopped and break into my best intentions like a freight train. At 5:30 in the evening on the last day of my sub-internship, half an hour before I was due to sign out to the night intern, I was called by a nurse who told me that over the past few hours a patient had become short of breath and incoherent. My first thought, you'll understand, was not, "Let's see what we can do to help this poor man." It was, "Why couldn't he have waited half an hour?"
But I drew the tests, asked the nurse for an EKG and took the man down for a CAT scan. We tried to figure out what the matter was, piece by piece. Maybe I've begun to acquire the everyday discipline that is more important than the drive to do good. Even if it's half an hour before you're due to go home, you go do what you're supposed to. (With your resident, or whoever your boss might be, providing a little push.)
I got into the elevator to go home, and a religious Jewish couple, seeing my yarmulke, gave me a smile. "What a Kiddush HaShem," they said, using the term for an act or person that shows Jews in a favorable light. I didn't feel like I had been sanctifying God's name — I was just learning how to do my job. Do the two overlap? We'll see.
Zackary Sholem Berger isn't a doctor yet. Complaints about how long it's taking should be sent to doctor@forward.com.
After a year of my medical-student ramblings, what have I learned?
MEDICINE MENSCH: Taking Stock
By Zackary Sholem Berger
December 2, 2005
There's a joke about travel writers turning experiences abroad into publishable material. Spend two months in China, say, and you can write a book; spend two years, and you can write an article. But spend 20 years, and you find you can't write anything at all. I feel the same way about the past year of being a medical student. Every day is packed with thousands of stories. Every patient is an epic unto herself. The first few months of being a medical student were an encounter with the world of the hospital. In such a first encounter (with a new book, a new person, a new language), you can ignore the occasional troubling aside and focus on the big picture. But as you get used to things, you can't avoid the episodes that are harder to talk about.
As a beginning medical student, I was mostly confused. As a fourth-year student who's just completed his sub-internship (a sort of pre-residency), I've become less confused and more intimately involved in the contradictions of the hospital. Once I become a resident, I might become too overwhelmed by life and death to write at all. Now, at the end of this column's first year, I thought I should take stock of my reactions to what I've seen. "Love" and "hate" are the first words that come to mind for many things I've encountered this past year. Sometimes I hate and love the same thing in succession.
I hate going into rooms of people who are very sick. They lie in their beds, staring at the wall. What's the right thing to say to them? Most of the time, as little as possible: I already know this from visiting the sick as a layperson. But as a doctor-in-the-making, I'm no longer someone who visits the sick. I now intrude on them for their own good, asking them questions they would rather not answer and viewing their bodies in ways that they never would countenance when healthy. While I try to build rapport, strengthening the doctor-patient relationship through our basic human connection, more often than not our conversation doesn't exceed the bare minimum. I need to get my work done; they need to get their rest. So I leave the room feeling guilty, while they lie there feeling no healthier than before.
At the same time, there are patients I come to love even though I know them only slightly. An older, frum woman was admitted with pneumonia. The admitting team described her as demented. According to the technical meaning of the term, this was correct: She suffers from a constant, progressive decline in cognitive function. But too many assume that the demented patient is childlike, not deserving of the respect we would give anyone outside the hospital. I've seen more than one demented old woman called "sweetie," more than one writhing figure in the step-down unit called "nonverbal" while he's screaming in Yiddish for people to leave him alone. It takes extra effort to listen.
I walked into this woman's room last Tuesday and asked her how she was. She said something incomprehensible, and I bent closer to hear. "What's that?" I said, a trifle impatiently. "Ki tov," she said. "It's the day of ki tov." It was Tuesday, the third day, the day that God called good twice. I cried at that — not so anyone would see, of course. I loved that patient even though I didn't know her at all, because she had said something heartening.
I dislike walking the halls in a long white coat, hearing people call me "Doctor," running into relatives and families hungry for information that I don't have or can't give them. I am the "doctor figure" in whom they find comfort, even though there might be nothing I can do at the moment. At the same time, I try to tell them what I can — even if it's only the simplest details of the imaging study that's about to be performed or the tests that are about to be drawn.
There are other reactions that cannot be stopped and break into my best intentions like a freight train. At 5:30 in the evening on the last day of my sub-internship, half an hour before I was due to sign out to the night intern, I was called by a nurse who told me that over the past few hours a patient had become short of breath and incoherent. My first thought, you'll understand, was not, "Let's see what we can do to help this poor man." It was, "Why couldn't he have waited half an hour?"
But I drew the tests, asked the nurse for an EKG and took the man down for a CAT scan. We tried to figure out what the matter was, piece by piece. Maybe I've begun to acquire the everyday discipline that is more important than the drive to do good. Even if it's half an hour before you're due to go home, you go do what you're supposed to. (With your resident, or whoever your boss might be, providing a little push.)
I got into the elevator to go home, and a religious Jewish couple, seeing my yarmulke, gave me a smile. "What a Kiddush HaShem," they said, using the term for an act or person that shows Jews in a favorable light. I didn't feel like I had been sanctifying God's name — I was just learning how to do my job. Do the two overlap? We'll see.
Zackary Sholem Berger isn't a doctor yet. Complaints about how long it's taking should be sent to doctor@forward.com.
11/20/05
Dreidel maximization
I'm not a genius at math, but I was sitting with a couple of friends who are naturally gifted. They are not Jewish, and I was explaining to them how one plays dreidel. (Or "the dreidel game," as most Googlable references seem to call it.) They started talking about how one could do best at it.
That is, how should one set about to win the most money through dreidel? (That not being the point of the game, but never mind about that for now.) Game theory generally involves maximizing expected earnings through decision making; the problem with dreidel is that precious little decision is involved. Let's try and describe the game and then see what variables one might be able to play with to tweak the expectations.
The four possible dreidel outcomes, together with what happens to one's earnings, go more or less like this:
N (nun): {null}
G (gimel): +x
H (hey): +x/2
Sh (shin): -2R
You get x (the size of the pot) if the dreidel lands on gimel, and 1/2x (half the pot) if it lands on hey; if the dreidel lands on shin, you put in some ante (usually an even number, in my experience), hence 2R.
Some simple things even people like me can see straight off. The first is that your earnings from gimel and hey depend on how much there is in the pot. That is, x changes with the progression of the game, so I really should have written it as a function of time, f(t,x). But that would be getting ridiculous.
One way of thinking would be that to maximize your earnings you should sit as far away from the luckiest (or craftiest) dreidelist as possible, so that the pot has a chance to fill up again after he or she spins his out-of-proportion gimels.
Another simple observation is that the relative "influences" on the game of gimel, hey, and shin depend on how much the ante is. If there's only a finite supply of money (or peanuts, raisins, or whatever currency you've chosen) available to the player, and 2R (the size of the ante required when Shin is spun) is a considerable fraction of that supply, then one shin can lay you low no matter how many nuns or gimels you've gotten.
One way of modifying the game might be to make the shin-ante (R) vary with the number of players, the size of the pot as it stands, or the time elapsed.
Or not. 35 days till Chanukah.
PS: Of course, a real mathematician has made some progress on the problem. He has conjectured, based on some simple simulations, that the length of a two-person dreidel game is on the order of the square of the number of nuts (or whatever tokens are used), and the length of a k-person game -- on the order of that number of tokens to the kth power.
I'm not a genius at math, but I was sitting with a couple of friends who are naturally gifted. They are not Jewish, and I was explaining to them how one plays dreidel. (Or "the dreidel game," as most Googlable references seem to call it.) They started talking about how one could do best at it.
That is, how should one set about to win the most money through dreidel? (That not being the point of the game, but never mind about that for now.) Game theory generally involves maximizing expected earnings through decision making; the problem with dreidel is that precious little decision is involved. Let's try and describe the game and then see what variables one might be able to play with to tweak the expectations.
The four possible dreidel outcomes, together with what happens to one's earnings, go more or less like this:
N (nun): {null}
G (gimel): +x
H (hey): +x/2
Sh (shin): -2R
You get x (the size of the pot) if the dreidel lands on gimel, and 1/2x (half the pot) if it lands on hey; if the dreidel lands on shin, you put in some ante (usually an even number, in my experience), hence 2R.
Some simple things even people like me can see straight off. The first is that your earnings from gimel and hey depend on how much there is in the pot. That is, x changes with the progression of the game, so I really should have written it as a function of time, f(t,x). But that would be getting ridiculous.
One way of thinking would be that to maximize your earnings you should sit as far away from the luckiest (or craftiest) dreidelist as possible, so that the pot has a chance to fill up again after he or she spins his out-of-proportion gimels.
Another simple observation is that the relative "influences" on the game of gimel, hey, and shin depend on how much the ante is. If there's only a finite supply of money (or peanuts, raisins, or whatever currency you've chosen) available to the player, and 2R (the size of the ante required when Shin is spun) is a considerable fraction of that supply, then one shin can lay you low no matter how many nuns or gimels you've gotten.
One way of modifying the game might be to make the shin-ante (R) vary with the number of players, the size of the pot as it stands, or the time elapsed.
Or not. 35 days till Chanukah.
PS: Of course, a real mathematician has made some progress on the problem. He has conjectured, based on some simple simulations, that the length of a two-person dreidel game is on the order of the square of the number of nuts (or whatever tokens are used), and the length of a k-person game -- on the order of that number of tokens to the kth power.
11/13/05
Para-rabbis and PAs
"Totem pole": descriptive, not prescriptive.
MEDICINE MENSCH: What Little I Know About Medicine
By Zackary Sholem Berger
November 11, 2005
I thought I would title this month's column "What I Don't Know About Medicine," but my editors want 800 words, not an encyclopedia. What I do know about medicine should fit nicely into the space allotted.
The rotation I'm starting this week is known in hospital jargon as the sub-internship; the registrar's office calls it "advanced medicine." In this rotation the medical student plays the role of an intern, a first-year resident. He can write orders on the computer, decide on a course of treatment and prescribe medications — all with the co-signature of a supervisor, of course. The main thing is that the student manages his own list of patients. In other words, I won't be following a resident around anymore; I will be a resident.
More precisely, I'll be pretending to be a resident. That's the catch of this rotation — it's the adolescence of medical education, in which one is something more than a senior student but something less than an intern. How much like an intern will I be? If one reasons by similarity of activity (lack of sleep; independent decision-making on behalf of actual patients), I could very well call myself the intern. Could I walk into my patient's room and say, "I'm Dr. Berger, and I'll be taking care of you during your stay in the hospital?" The second half of this statement is definitely true, but the first part (with "Dr.") isn't quite. I won't have my medical degree until my graduation in May 2006, and I won't have a license to practice medicine until I finish my boards, which stretch from now (while I'm still a medical student) until the end of my residency.
On this rotation, I don't plan to introduce myself as "Doctor" (that would be quite a stretch), but I understand why some of my colleagues would. While many patients don't understand the difference between senior medical students, interns, residents, fellows and attending physicians, they come to appreciate something of the hierarchy during their hospital stay. One thing soon becomes clear to them: Medical students are at the bottom of the totem pole of health care providers. (Or almost at the bottom —more on that subject, below.) If a sub-intern walks into a patient's room and starts out by saying, "My name's Joseph Brighteyes, I'm a medical student, and I'm here to take care of you," the patient is likely to respond, "That's great, Joe, but who's going to be my doctor?"
Is qualification defined more by knowledge or by capability? This larger question comes up when talking about the thousands of people whose elbow grease makes a big hospital run as smoothly as it can. Even lower on the pole than the medical student is the physician assistant. P.A.s train for fewer years than medical students, so they often get less respect from folks in medical academia. But in every rotation where, as a medical student, I've worked together with P.A.s or P.A. students, they have seemed more on the ball than the medical students — not as over-theoretically concerned with fascinating disease entities and more knowledgeable about what might immediately help the patient. Part of the reason is that the P.A. student spends more time in her early training (most P.A.s I've met are women) familiarizing herself with the way things actually are in the uncompromisingly practical universe of the hospital or clinic. Perhaps P.A.s can't name 12 different kinds of small-vessel disease. (I'm making up that number; I certainly can't name them, either — not off the top of my head.) But such encyclopedic knowledge is sometimes transcended, or rendered irrelevant, by practical considerations. On the other hand, you don't want to miss the rare diseases when they do pop up. So both kinds of training (practical and theoretical encyclopedic) are essential, even complementary. The trick is to appreciate both kinds of thinking at the same time, even though most people find one of them more congenial than the other.
A similar divide is evident in the Jewish tradition, especially with regard to Torah study. In previous generations — and even today in some circles — memorizing vast tracts of the Talmud is a prized skill. On the other hand, if you've dipped into any of the Talmud, you know that it takes considerable exegetical ingenuity to derive laws applicable to everyday life from the rich stew of magic, folklore, intellectual speculation, casual yeshiva talk and campfire tales about the destroyed Temple. (Even the strict constructionists, those who actually bury their fingernail clippings according to the magical practice of the rabbis, still have to exercise creativity in deriving everyday religious practice from Babylonian-Jewish digression.) The two skills — encyclopedic knowledge of the Talmud and the ability to apply the Talmud to everyday religious life — are complementary, but rarely are found in the same person. Many of the greatest talmudic scholars have famously refused to adjudicate Jewish law, protesting that they could see all sides of any issue.
Today's Jewish communities rely very much on what some people call "para-rabbis" — people who aren't religious scholars but are reliable, even expert, in the details of daily practice. You might have met some of them: the guy who knows everything about building a sukkah; the woman who is obsessed with reading Torah; the member of the local synagogue who knows exactly how to help a recently bereaved family.
In other words, Jews (at least religious Jews) depend on "rabbis' assistants." In the same way, a hospital must cobble together a vast number of people who have different abilities. Some sit in offices and absorb themselves in the study of disorders affecting 10 people in the entire world, while others, down amid the gore in the E.R., can contradict those same scholars with absolute certainty if they see in front of them a practical problem they know how to solve quickly and effectively.
Bit by bit, I hope to amass both kinds of knowledge till I can be considered a doctor (a learned person, according to the word's historical meaning) in at least one of these categories. But no matter what, there always will be plenty of material for my upcoming masterwork, "What Zack Berger Doesn't Know." I look forward to doing the research.
Zackary Sholem Berger is becoming a doctor, hour by sleepless hour. Feel free to write him about it at doctor@forward.com.
"Totem pole": descriptive, not prescriptive.
MEDICINE MENSCH: What Little I Know About Medicine
By Zackary Sholem Berger
November 11, 2005
I thought I would title this month's column "What I Don't Know About Medicine," but my editors want 800 words, not an encyclopedia. What I do know about medicine should fit nicely into the space allotted.
The rotation I'm starting this week is known in hospital jargon as the sub-internship; the registrar's office calls it "advanced medicine." In this rotation the medical student plays the role of an intern, a first-year resident. He can write orders on the computer, decide on a course of treatment and prescribe medications — all with the co-signature of a supervisor, of course. The main thing is that the student manages his own list of patients. In other words, I won't be following a resident around anymore; I will be a resident.
More precisely, I'll be pretending to be a resident. That's the catch of this rotation — it's the adolescence of medical education, in which one is something more than a senior student but something less than an intern. How much like an intern will I be? If one reasons by similarity of activity (lack of sleep; independent decision-making on behalf of actual patients), I could very well call myself the intern. Could I walk into my patient's room and say, "I'm Dr. Berger, and I'll be taking care of you during your stay in the hospital?" The second half of this statement is definitely true, but the first part (with "Dr.") isn't quite. I won't have my medical degree until my graduation in May 2006, and I won't have a license to practice medicine until I finish my boards, which stretch from now (while I'm still a medical student) until the end of my residency.
On this rotation, I don't plan to introduce myself as "Doctor" (that would be quite a stretch), but I understand why some of my colleagues would. While many patients don't understand the difference between senior medical students, interns, residents, fellows and attending physicians, they come to appreciate something of the hierarchy during their hospital stay. One thing soon becomes clear to them: Medical students are at the bottom of the totem pole of health care providers. (Or almost at the bottom —more on that subject, below.) If a sub-intern walks into a patient's room and starts out by saying, "My name's Joseph Brighteyes, I'm a medical student, and I'm here to take care of you," the patient is likely to respond, "That's great, Joe, but who's going to be my doctor?"
Is qualification defined more by knowledge or by capability? This larger question comes up when talking about the thousands of people whose elbow grease makes a big hospital run as smoothly as it can. Even lower on the pole than the medical student is the physician assistant. P.A.s train for fewer years than medical students, so they often get less respect from folks in medical academia. But in every rotation where, as a medical student, I've worked together with P.A.s or P.A. students, they have seemed more on the ball than the medical students — not as over-theoretically concerned with fascinating disease entities and more knowledgeable about what might immediately help the patient. Part of the reason is that the P.A. student spends more time in her early training (most P.A.s I've met are women) familiarizing herself with the way things actually are in the uncompromisingly practical universe of the hospital or clinic. Perhaps P.A.s can't name 12 different kinds of small-vessel disease. (I'm making up that number; I certainly can't name them, either — not off the top of my head.) But such encyclopedic knowledge is sometimes transcended, or rendered irrelevant, by practical considerations. On the other hand, you don't want to miss the rare diseases when they do pop up. So both kinds of training (practical and theoretical encyclopedic) are essential, even complementary. The trick is to appreciate both kinds of thinking at the same time, even though most people find one of them more congenial than the other.
A similar divide is evident in the Jewish tradition, especially with regard to Torah study. In previous generations — and even today in some circles — memorizing vast tracts of the Talmud is a prized skill. On the other hand, if you've dipped into any of the Talmud, you know that it takes considerable exegetical ingenuity to derive laws applicable to everyday life from the rich stew of magic, folklore, intellectual speculation, casual yeshiva talk and campfire tales about the destroyed Temple. (Even the strict constructionists, those who actually bury their fingernail clippings according to the magical practice of the rabbis, still have to exercise creativity in deriving everyday religious practice from Babylonian-Jewish digression.) The two skills — encyclopedic knowledge of the Talmud and the ability to apply the Talmud to everyday religious life — are complementary, but rarely are found in the same person. Many of the greatest talmudic scholars have famously refused to adjudicate Jewish law, protesting that they could see all sides of any issue.
Today's Jewish communities rely very much on what some people call "para-rabbis" — people who aren't religious scholars but are reliable, even expert, in the details of daily practice. You might have met some of them: the guy who knows everything about building a sukkah; the woman who is obsessed with reading Torah; the member of the local synagogue who knows exactly how to help a recently bereaved family.
In other words, Jews (at least religious Jews) depend on "rabbis' assistants." In the same way, a hospital must cobble together a vast number of people who have different abilities. Some sit in offices and absorb themselves in the study of disorders affecting 10 people in the entire world, while others, down amid the gore in the E.R., can contradict those same scholars with absolute certainty if they see in front of them a practical problem they know how to solve quickly and effectively.
Bit by bit, I hope to amass both kinds of knowledge till I can be considered a doctor (a learned person, according to the word's historical meaning) in at least one of these categories. But no matter what, there always will be plenty of material for my upcoming masterwork, "What Zack Berger Doesn't Know." I look forward to doing the research.
Zackary Sholem Berger is becoming a doctor, hour by sleepless hour. Feel free to write him about it at doctor@forward.com.
10/23/05
What a commentary means
We read Ecclesiastes (Koheles) this past Shabbos. Some read it (or heard it read) in a synagogue, others read it out loud to a two-year-old while she ran around the house babbling to herself. To each their own.
I read it from the Biblica Hebraica Stuttgartensia. When I'm studying part of the Tanakh which I find obscure, or full of impenetrable vocabulary, I often go to the BHS to find which variations in the Masoretic texts might explain a difficult word. This is one difference between, say, BHS and the traditional commentators. The latter explain why the text is the way it is. Historical-critical study of the Bible, on the other hand, often tries to suggest enmendations which help make better sense of the text. (The two sorts of commentary overlap, of course -- traditional commentators often suggest enmendations, though in a different language than modern critics; and Biblical critics for their part often use a literary approach which owes a lot to their traditional forerunners.) To put it very broadly: the BHS is critical while traditional commentary is aesthetic.
But is this really the case? Any resolution suggested by the BHS to a difficulty it points out must be judged on an individual basis. Some of these suggestions (based on alternative manuscripts and words in Akkadian) I can nod my head at and understand passively, but can't criticize with a firm base of knowledge, since Biblical criticism isn't my day (or night) job. On the other hand, when BHS makes a suggestion about the plausibility of one reading over another, I can say yea or nay more confidently. Then we're in the realm of aesthetics, where I feel more equipped with appropriate criteria.
In Ecclesiastes 1:15 it's said (King James translation) "That which is crooked cannot be made straight: and that which is wanting cannot be numbered." In the original: מעות לא־יוכל לתקן וחסרון לא־יוכל להמנות. On the last word (le-himonoys), which means "to be numbered," BHS says: "prp להמלות (cf bBer 16b)". In BHSese, this means "It has been proposed that the alternative reading "cannot be replenished" is more plausible; compare the reference in the Babylonian Talmud, Berachot 16b."
Now, once there, you won't find any reference to Ecclesiastes. This is what you'll find (from an on-line version of the Soncino translation):
The Hebrew of the relevant phrase above ("May the Almighty replenish your loss") is המקום ימלא חסרונך, where the noun for "loss" is the same as that in the Ecclesiastes verse, and the verb is the same as the one suggested by the BHS enmendation.
The question is: what criteria would one use to accept or reject this suggestion? The Talmud was not composed at the same time as Koheles, so what is the reference to the Talmudic tractate meant to show? We know that lashon mikra (the language of the Tanakh) and lashon Chazal (the language of the Talmud and associated texts) are not at all the same.
Perhaps the reference is merely meant to show that the phrase "חסרונות . . . להמלות" is plausible -- i.e. that it makes aesthetic sense. And in that sense, I'm convinced.
We read Ecclesiastes (Koheles) this past Shabbos. Some read it (or heard it read) in a synagogue, others read it out loud to a two-year-old while she ran around the house babbling to herself. To each their own.
I read it from the Biblica Hebraica Stuttgartensia. When I'm studying part of the Tanakh which I find obscure, or full of impenetrable vocabulary, I often go to the BHS to find which variations in the Masoretic texts might explain a difficult word. This is one difference between, say, BHS and the traditional commentators. The latter explain why the text is the way it is. Historical-critical study of the Bible, on the other hand, often tries to suggest enmendations which help make better sense of the text. (The two sorts of commentary overlap, of course -- traditional commentators often suggest enmendations, though in a different language than modern critics; and Biblical critics for their part often use a literary approach which owes a lot to their traditional forerunners.) To put it very broadly: the BHS is critical while traditional commentary is aesthetic.
But is this really the case? Any resolution suggested by the BHS to a difficulty it points out must be judged on an individual basis. Some of these suggestions (based on alternative manuscripts and words in Akkadian) I can nod my head at and understand passively, but can't criticize with a firm base of knowledge, since Biblical criticism isn't my day (or night) job. On the other hand, when BHS makes a suggestion about the plausibility of one reading over another, I can say yea or nay more confidently. Then we're in the realm of aesthetics, where I feel more equipped with appropriate criteria.
In Ecclesiastes 1:15 it's said (King James translation) "That which is crooked cannot be made straight: and that which is wanting cannot be numbered." In the original: מעות לא־יוכל לתקן וחסרון לא־יוכל להמנות. On the last word (le-himonoys), which means "to be numbered," BHS says: "prp להמלות (cf bBer 16b)". In BHSese, this means "It has been proposed that the alternative reading "cannot be replenished" is more plausible; compare the reference in the Babylonian Talmud, Berachot 16b."
Now, once there, you won't find any reference to Ecclesiastes. This is what you'll find (from an on-line version of the Soncino translation):
WHEN TABI HIS SLAVE DIED etc. Our Rabbis taught: For male and female slaves no row [of comforters] is formed, nor is the blessing of mourners said, nor is condolence offered. When the bondwoman of R. Eliezer died, his disciples went in to condole with him. When he saw them he went up to an upper chamber, but they went up after him. He then went into an ante-room and they followed him there. He then went into the dining hall and they followed him there. He said to them: I thought that you would be scalded with warm water; I see you are not scalded even with boiling hot water. Have I not taught you that a row of comforters is not made for male and female slaves, and that a blessing of mourners is not said for them, nor is condolence offered for them? What then do they say for them? The same as they say to a man for his ox and his ass: 'May the Almighty replenish your loss'. So for his male and female slave they say to him: 'May the Almighty replenish your loss'. It has been taught elsewhere: For male and female slaves no funeral oration is said. R. Jose said: If he was a good slave, they can say over him, Alas for a good and faithful man, who worked for his living! They said to him: If you do that, what do you leave for
free-born?
The Hebrew of the relevant phrase above ("May the Almighty replenish your loss") is המקום ימלא חסרונך, where the noun for "loss" is the same as that in the Ecclesiastes verse, and the verb is the same as the one suggested by the BHS enmendation.
The question is: what criteria would one use to accept or reject this suggestion? The Talmud was not composed at the same time as Koheles, so what is the reference to the Talmudic tractate meant to show? We know that lashon mikra (the language of the Tanakh) and lashon Chazal (the language of the Talmud and associated texts) are not at all the same.
Perhaps the reference is merely meant to show that the phrase "חסרונות . . . להמלות" is plausible -- i.e. that it makes aesthetic sense. And in that sense, I'm convinced.
10/13/05
Giggle-inducing machzor translations
Grand Prize.
A gut kvitl!
(Meaning: I hope your happiness, prosperity, and general bounty of Divine providence, signed and sealed upstairs this past Yom Kippur, are efficiently processed by the Upper Yeshiva's bureaucracy and legislated into law come Hoshannah Rabbah.)
I just wanted to comment on how unfortunate it is that the worst poem ever and the worst ever rhyming couplet (below) are both in machzorim of the Conservative movement.
Please turn to page 351 in your gray machzor:
A close second place (not a couplet, but would you really want a second line to this baby?):
Grand Prize.
A gut kvitl!
(Meaning: I hope your happiness, prosperity, and general bounty of Divine providence, signed and sealed upstairs this past Yom Kippur, are efficiently processed by the Upper Yeshiva's bureaucracy and legislated into law come Hoshannah Rabbah.)
I just wanted to comment on how unfortunate it is that the worst poem ever and the worst ever rhyming couplet (below) are both in machzorim of the Conservative movement.
Please turn to page 351 in your gray machzor:
Bandits have pursued me, fast and fleet
But none pursue me faster than my own feet.
A close second place (not a couplet, but would you really want a second line to this baby?):
My soul, my heart, and every inward part . . .
10/8/05
A happy, doubtful New Year from Katle Kanye
Saith the Yiddish blogmaster [my translation; read the whole post!]:
I don't have any answers [to these doubts], and I won't find any answer during the many holidays whose threshhold we're on now. On the first day of Selichot I hopped up on the wagon, and I'm riding until the end of Simchat Torah. Not because I want something, and not because I'm afraid that if I don't I stand to lose something. I can't say that I'm a willing passenger, but my fate is to go along for the ride. I won't justify it to myself by saying that it's the right path, but I'm still not jumping off. This is my portion from all my labors -- to look on as my traveling companions drag big bags of the four species and whole sukkahs, seeing only what's going on in the wagon, and I'm traveling lightweight and keep wanting to look out the window. I want to see who's pulling the wagon and who's driving the horses, and they just want to open their baggage, because they're so sure that the wagon will keep on going whatever happens. Will I stay till the end of the trip? For now I'm just happy that I'm not being thrown off.
Saith the Yiddish blogmaster [my translation; read the whole post!]:
I don't have any answers [to these doubts], and I won't find any answer during the many holidays whose threshhold we're on now. On the first day of Selichot I hopped up on the wagon, and I'm riding until the end of Simchat Torah. Not because I want something, and not because I'm afraid that if I don't I stand to lose something. I can't say that I'm a willing passenger, but my fate is to go along for the ride. I won't justify it to myself by saying that it's the right path, but I'm still not jumping off. This is my portion from all my labors -- to look on as my traveling companions drag big bags of the four species and whole sukkahs, seeing only what's going on in the wagon, and I'm traveling lightweight and keep wanting to look out the window. I want to see who's pulling the wagon and who's driving the horses, and they just want to open their baggage, because they're so sure that the wagon will keep on going whatever happens. Will I stay till the end of the trip? For now I'm just happy that I'm not being thrown off.
10/6/05
Get up!
Stand up for your rites.
MEDICINE MENSCH: Resetting the Spiritual Clock
By Zackary Sholem Berger
October 7, 2005
I've been getting up at five in the morning for the past two months. It would be nice if this new schedule granted me some insight into the human condition or the plight of the sick, but my observations are on a smaller scale.
A lot more people than you might think are up that early. On the way from my apartment building on the Lower East Side to my bus stop there's an unsavory-looking building that is shuttered during the day. When I stumble by at 5:45 in the morning, there's an improbably well-organized fruit stand out front, tables of oranges, apples and bananas under the streetlamps. The fruit seller is always wearing a T-shirt and shorts, no matter the weather. I say good morning to him, and to the MTA bus driver, but maybe it's the wrong thing to say — these people have been up for hours already and probably are ready to go to bed after their shift switch. "Sleep well" might be more appropriate. ("Sleep well" is something you never say to a medical resident, unless you're trying to taunt him.)
All the people getting to work at this hour can be divided into different subgroups, the most obvious being the 6 a.m. cell-phone talkers. (Who are they talking to? Other 6 a.m. cell-phone talkers, I guess.) There are those plugged into their iPods, the nurses chatting and joking away in friendly groups, and solidly built men in leather jackets carefully avoiding eye contact. Then there's the group of eccentrics you always find in the city: people mumbling to themselves.
I'm among the mumblers. According to Jewish law, there are times in the very early morning when it's just too early to daven. I can say certain prayers when I'm at home, certain prayers on the bus (when it's already slightly later, and the sun is scrambling into place) and certain other prayers in the chapel tucked away in one of the corners of the cavernous Long Island hospital where I'm now stationed. My davening is fragmented, and my morning feels that way too — something I start assembling at 5 a.m. and piece together, hour by hour, until I arrive at my destination and start my work day more or less a whole person.
The best way to describe davening, or, more universally, prayer, to those who don't generally engage in it is to say that it's a systematic stock-taking. Residents do this every day, when they visit their patients before they're expected to present them to the entire team. They pre-round, or round before rounding, making sure they're informed about what happened to their patients overnight and what these patients need during the new day.
More often than not, my mind drifts during davening, like someone walking down the street on the way to a familiar destination. I think about my day's responsibilities, what I'm going to eat for lunch, what I need to study. I manage to reduce thousands of years of stirring liturgical yearnings to a shopping list.
Then once in a while — or, more precisely, once a year — I start trying to pay attention to davening again, in the religious equivalent of getting up at five in the morning to go to work. A week or so before the High Holy Days, Jews begin to gather at ungodly hours to recite Selichot, impassioned vows of contrition and pleas for mercy on the part of the Almighty. The irony is that this liturgy is based on the piyyut, a medieval poetic form distinguished by its labyrinthine syntax and obscure biblical references. What happens, then, is this: A dozen or so half-asleep Jews mumble incomprehensible prayers with less than notable fervor, though in every minyan there's always the exception who makes a point of clenching his fists, staring at the ceiling and making other signs of overt piety. So what's the point of the poems? There might be one Jew in 50 who understands their content (English translations like Artscroll try their best, but end up sounding like a Brooklyn-accented imitation of "Masterpiece Theater").
But in this area (as in a number of others), it's not the content but the form that's important. Getting up early shocks the internal clock into a new and unfamiliar time zone. For the medical student, it takes this shock to move from everyday pursuits into the uncomfortable, cold and early-rising world of the hospital. You have to learn to pay attention to both your patients and the clock. For the Jew entering into a new year, getting up early can help realize the famous challenge of the shofar (as Maimonides understands it): "Wake up from your sleep!" Get up early to shock yourself into the new year. Get up early, or you might miss the shofar. And if you mumble your first prayers while you're still half asleep, you'll be perfectly understood not only by God, but by any medical student.
Zackary Sholem Berger hopes that in 5766 you never have to see the inside of a hospital — unless you work in one.
Stand up for your rites.
MEDICINE MENSCH: Resetting the Spiritual Clock
By Zackary Sholem Berger
October 7, 2005
I've been getting up at five in the morning for the past two months. It would be nice if this new schedule granted me some insight into the human condition or the plight of the sick, but my observations are on a smaller scale.
A lot more people than you might think are up that early. On the way from my apartment building on the Lower East Side to my bus stop there's an unsavory-looking building that is shuttered during the day. When I stumble by at 5:45 in the morning, there's an improbably well-organized fruit stand out front, tables of oranges, apples and bananas under the streetlamps. The fruit seller is always wearing a T-shirt and shorts, no matter the weather. I say good morning to him, and to the MTA bus driver, but maybe it's the wrong thing to say — these people have been up for hours already and probably are ready to go to bed after their shift switch. "Sleep well" might be more appropriate. ("Sleep well" is something you never say to a medical resident, unless you're trying to taunt him.)
All the people getting to work at this hour can be divided into different subgroups, the most obvious being the 6 a.m. cell-phone talkers. (Who are they talking to? Other 6 a.m. cell-phone talkers, I guess.) There are those plugged into their iPods, the nurses chatting and joking away in friendly groups, and solidly built men in leather jackets carefully avoiding eye contact. Then there's the group of eccentrics you always find in the city: people mumbling to themselves.
I'm among the mumblers. According to Jewish law, there are times in the very early morning when it's just too early to daven. I can say certain prayers when I'm at home, certain prayers on the bus (when it's already slightly later, and the sun is scrambling into place) and certain other prayers in the chapel tucked away in one of the corners of the cavernous Long Island hospital where I'm now stationed. My davening is fragmented, and my morning feels that way too — something I start assembling at 5 a.m. and piece together, hour by hour, until I arrive at my destination and start my work day more or less a whole person.
The best way to describe davening, or, more universally, prayer, to those who don't generally engage in it is to say that it's a systematic stock-taking. Residents do this every day, when they visit their patients before they're expected to present them to the entire team. They pre-round, or round before rounding, making sure they're informed about what happened to their patients overnight and what these patients need during the new day.
More often than not, my mind drifts during davening, like someone walking down the street on the way to a familiar destination. I think about my day's responsibilities, what I'm going to eat for lunch, what I need to study. I manage to reduce thousands of years of stirring liturgical yearnings to a shopping list.
Then once in a while — or, more precisely, once a year — I start trying to pay attention to davening again, in the religious equivalent of getting up at five in the morning to go to work. A week or so before the High Holy Days, Jews begin to gather at ungodly hours to recite Selichot, impassioned vows of contrition and pleas for mercy on the part of the Almighty. The irony is that this liturgy is based on the piyyut, a medieval poetic form distinguished by its labyrinthine syntax and obscure biblical references. What happens, then, is this: A dozen or so half-asleep Jews mumble incomprehensible prayers with less than notable fervor, though in every minyan there's always the exception who makes a point of clenching his fists, staring at the ceiling and making other signs of overt piety. So what's the point of the poems? There might be one Jew in 50 who understands their content (English translations like Artscroll try their best, but end up sounding like a Brooklyn-accented imitation of "Masterpiece Theater").
But in this area (as in a number of others), it's not the content but the form that's important. Getting up early shocks the internal clock into a new and unfamiliar time zone. For the medical student, it takes this shock to move from everyday pursuits into the uncomfortable, cold and early-rising world of the hospital. You have to learn to pay attention to both your patients and the clock. For the Jew entering into a new year, getting up early can help realize the famous challenge of the shofar (as Maimonides understands it): "Wake up from your sleep!" Get up early to shock yourself into the new year. Get up early, or you might miss the shofar. And if you mumble your first prayers while you're still half asleep, you'll be perfectly understood not only by God, but by any medical student.
Zackary Sholem Berger hopes that in 5766 you never have to see the inside of a hospital — unless you work in one.
10/2/05
9/24/05
Ashkenaz in Israel
An ideolo-blog.
Assaf Galay, the charismatic journalist and Yiddishist behind the "Hatenuah lezehut ashkenazit" (The Movement for Ashkenazic Identity), has a Hebrew blog that's well worth reading, though I can't say I agree with its post-Zionist slant.
An ideolo-blog.
Assaf Galay, the charismatic journalist and Yiddishist behind the "Hatenuah lezehut ashkenazit" (The Movement for Ashkenazic Identity), has a Hebrew blog that's well worth reading, though I can't say I agree with its post-Zionist slant.
9/22/05
(A)elul Aesthetics
"I'll ask one thing of God, one thing I'll request:
to dwell in God's house all my life;
to have a vision of God's pleasantness, to visit His palace."
A bit of Psalm 26, which we read during the month of Elul.
One could take the above verse to mean that we would like to be vouchsafed a vision of God through the merit of the commandments. The mitzvot would then be a ticket to the Palace, like an armband to a rock concert.
I think the point can be taken differently. God is pleasant. That is, God is beautiful, and during this time of year we would like to merit an appreciation of this beauty -- without unthinking anthropomorphisms or idolatrous projections, leaden fundamentalism or empty-headed laxities. The contemplation of the Divine should be a source of joy, not of confinement.
"I'll ask one thing of God, one thing I'll request:
to dwell in God's house all my life;
to have a vision of God's pleasantness, to visit His palace."
A bit of Psalm 26, which we read during the month of Elul.
One could take the above verse to mean that we would like to be vouchsafed a vision of God through the merit of the commandments. The mitzvot would then be a ticket to the Palace, like an armband to a rock concert.
I think the point can be taken differently. God is pleasant. That is, God is beautiful, and during this time of year we would like to merit an appreciation of this beauty -- without unthinking anthropomorphisms or idolatrous projections, leaden fundamentalism or empty-headed laxities. The contemplation of the Divine should be a source of joy, not of confinement.
9/18/05
The health of China
Almost exactly a year ago, this blog mused about China's shifting burden of disease - the term epidemiologists use (hey, I guess I am one now) to denote what happens when a country becomes more developed (i.e. less poor), and different causes of death become more, or less, frequent. A fascinating issue of the New England Journal of Medicine includes an important study on that very topic. The abstract is below.
Background With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China.
Methods Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent.
Almost exactly a year ago, this blog mused about China's shifting burden of disease - the term epidemiologists use (hey, I guess I am one now) to denote what happens when a country becomes more developed (i.e. less poor), and different causes of death become more, or less, frequent. A fascinating issue of the New England Journal of Medicine includes an important study on that very topic. The abstract is below.
Background With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China.
Methods Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent.
Results We documented 20,033 deaths in 1,239,191 person-years of follow-up. The mortality from all causes was 1480.1 per 100,000 person-years among men and 1190.2 per 100,000 person-years among women. The five leading causes of death were malignant neoplasms (mortality, 374.1 per 100,000 person-years), diseases of the heart (319.1), cerebrovascular disease (310.5), accidents (54.0), and infectious diseases (50.5) among men and diseases of the heart (268.5), cerebrovascular disease (242.3), malignant neoplasms (214.1), pneumonia and influenza (45.9), and infectious diseases (35.3) among women. The multivariate-adjusted relative risk of death and the population attributable risk for preventable risk factors were as follows: hypertension, 1.48 (95 percent confidence interval, 1.44 to 1.53) and 11.7 percent, respectively; cigarette smoking, 1.23 (95 percent confidence interval, 1.18 to 1.27) and 7.9 percent; physical inactivity, 1.20 (95 percent confidence interval, 1.16 to 1.24) and 6.8 percent; and underweight (body-mass index [the weight in kilograms divided by the square of the height in meters] below 18.5), 1.47 (95 percent confidence interval, 1.42 to 1.53) and 5.2 percent.
Conclusions Vascular disease and cancer have become the leading causes of death among Chinese adults. Our findings suggest that control of hypertension, smoking cessation, increased physical activity, and improved nutrition should be important strategies for reducing the burden of premature death among adults in China.
9/10/05
A Jew and a Cabbie
On the way to drop off some shipments of the new book (that would be George der Naygeriker, Curious George in Yiddish), I started chatting with the cabbie -- a Dominican, it turns out. I learned some stuff. First, my neighborhood (the Lower East Side) is not Dominican; the Latinos down here are from all over. (I had already known that the main Dominican concentration in the city is in Washington Heights, but a bakery, some soccer fans, and other manifestations had led me to the mistaken belief that the LES constituted a branch of the DR Diaspora.) Second is the interesting way he referred to my religious-ethnic affiliation:
Eres un americano judio, no?
Meaning:
You're a Jewish American, right?
Interesting, because no one would use this locution ("Jewish American") in English, at least not these days. (Not that it's inaccurate or suspect, just out of date.) So: is this the way Dominicans (habitually?) refer to American Jews? Was it an effort not to say something unintentionally offensive? Just this cabbie's idiolect? Inquiring bloggers seek Dominicanologists for explanations.
On the way to drop off some shipments of the new book (that would be George der Naygeriker, Curious George in Yiddish), I started chatting with the cabbie -- a Dominican, it turns out. I learned some stuff. First, my neighborhood (the Lower East Side) is not Dominican; the Latinos down here are from all over. (I had already known that the main Dominican concentration in the city is in Washington Heights, but a bakery, some soccer fans, and other manifestations had led me to the mistaken belief that the LES constituted a branch of the DR Diaspora.) Second is the interesting way he referred to my religious-ethnic affiliation:
Eres un americano judio, no?
Meaning:
You're a Jewish American, right?
Interesting, because no one would use this locution ("Jewish American") in English, at least not these days. (Not that it's inaccurate or suspect, just out of date.) So: is this the way Dominicans (habitually?) refer to American Jews? Was it an effort not to say something unintentionally offensive? Just this cabbie's idiolect? Inquiring bloggers seek Dominicanologists for explanations.
9/1/05
Medicine Monster
Time to find myself.
Medicine Mensch 9, in which I specialize, specialize, specialize.
MEDICINE MENSCH
Job Hunt: Choosing the Right White Coat
By Zackary Sholem Berger
September 2, 2005
I am 32 years old, and it's time to decide what I want to be when I grow up.
I do have things narrowed down somewhat: I want to be a doctor. But what kind? I don't have the luxury of thinking it over much longer. The time has come to apply to residency programs (the four-or-so-year stints of hospital-based indentured servitude marking the start of a doctor's career), and I need to decide on a specialty.
There are many different kinds of physicians. A Web site run by the American Medical Association lists more than 50 specialties, ranging from aerospace medicine to colon and rectal surgery. Each has its partisans and its detractors, but finally the decision is my own.
Many medical students ask themselves whether they should apply to one of the "lifestyle residencies" — specialties chosen because of desirable salaries or fewer demanding hours. There is a whiff of snobbery in this label. Medicine is, after all, still an attractive profession for many, precisely because it offers a comfortable living. Even those specialties that are not the highest paying certainly are no road to self-denial. By most definitions, doctors are still rich. Isn't lifestyle a reasonable criterion for choosing a career?
I won't even say which specialties are considered "lifestyle residencies," because the definition changes every five years. Each specialty, no matter how unpopular or looked down on at one time, is redeemed eventually through market forces. Take, for example, circus medicine (not a real specialty, as far as I know). It used to be that no one wanted to be a circus doctor, dodging screaming children all day and putting casts on unlucky trapeze artists. But the wheel of fortune turned, and some students discovered the attractions of the specialty. The pay is not bad, and the hours are reasonable: The shows are at regular times, and in between you can hang out with the Siberian tigers or do whatever else you want. Plus the popcorn's free. Suddenly it's a buyer's market, and circus showmen have more applicants than they can handle. How did circus medicine get more popular? The specialty didn't change at all, but more medical students discovered that they'd rather do something else during their residency than work 18-hour days.
Ideally, our passions and our needs would coincide. What we want to do would be precisely what we're trained to do, and a good bit of money would be made doing it. Sometimes, though, it works the other way: Money (and livable hours) point out a career to us that we wouldn't have thought of before. To go even further, there's nothing wrong with moneymaking as the chief criterion for one's choice of medical specialty or any other profession. The rabbis of the Talmud tell us to teach our children a trade, not a career. If our child can make a good living in something legal, nine to five, and completely dull, there is no reason (according to this strain of Jewish thought) for her employment to have a larger redeeming social value. Her redeeming value should come from her spiritual life, not her professional one.
But of course, work is more than work. It shapes our life. The stereotypes that medical students attach to various specialties are only partially untrue. Certain specialties are known to be impatient with abstractions, abrupt and unfriendly, while others are known for indulgent book-learning and a tendency toward long-windedness. Even if a doctor doesn't conform to these stereotypes when he enters these specialties, he might be brought more into line with them, both by working with his colleagues and by the particular kind of medicine for which these personalities make sense.
So instead of choosing a specialty (or a job) that makes possible the rest of your life, you can choose one that becomes your life. The rabbis were experts in choosing a "clean and simple trade," a profession that provided both sustenance and space for what they held to be life's most important pursuit: the study of Torah. But they didn't have as much to say about choosing careers that provide professional satisfaction, possibly because this wasn't relevant either to their historical moment or to their economic class. (The same rabbis also said, "The best of doctors are bound for hell." But that's a discussion for another time.) Later Jewish thought does see a place for intellectual and professional absorption in things other than Torah — a career for career's sake — as a worthwhile way to spend one's time.
The answer to all this is the punch line of an old joke: You're right, you're right and you're right, too. Someone who chooses a career (or a medical specialty) for the sake of personal satisfaction might find out years later, when it's too late, that his personal satisfaction depends not only on intellectual and spiritual sustenance but also on having time to spend with one's family as well as money to buy what one needs. But one who chooses a job that leaves time for the rest of life might discover that the rest of life feels boring without the stimulation of a demanding profession.
I'm still not sure what I'll be. Maybe I'll run off and join the circus to cure the age-old medical syndrome of big red noses and oversized feet.
Zackary Sholem Berger, a fourth-year medical student, accepts all well-meaning job advice at doctor@forward.com.
Time to find myself.
Medicine Mensch 9, in which I specialize, specialize, specialize.
MEDICINE MENSCH
Job Hunt: Choosing the Right White Coat
By Zackary Sholem Berger
September 2, 2005
I am 32 years old, and it's time to decide what I want to be when I grow up.
I do have things narrowed down somewhat: I want to be a doctor. But what kind? I don't have the luxury of thinking it over much longer. The time has come to apply to residency programs (the four-or-so-year stints of hospital-based indentured servitude marking the start of a doctor's career), and I need to decide on a specialty.
There are many different kinds of physicians. A Web site run by the American Medical Association lists more than 50 specialties, ranging from aerospace medicine to colon and rectal surgery. Each has its partisans and its detractors, but finally the decision is my own.
Many medical students ask themselves whether they should apply to one of the "lifestyle residencies" — specialties chosen because of desirable salaries or fewer demanding hours. There is a whiff of snobbery in this label. Medicine is, after all, still an attractive profession for many, precisely because it offers a comfortable living. Even those specialties that are not the highest paying certainly are no road to self-denial. By most definitions, doctors are still rich. Isn't lifestyle a reasonable criterion for choosing a career?
I won't even say which specialties are considered "lifestyle residencies," because the definition changes every five years. Each specialty, no matter how unpopular or looked down on at one time, is redeemed eventually through market forces. Take, for example, circus medicine (not a real specialty, as far as I know). It used to be that no one wanted to be a circus doctor, dodging screaming children all day and putting casts on unlucky trapeze artists. But the wheel of fortune turned, and some students discovered the attractions of the specialty. The pay is not bad, and the hours are reasonable: The shows are at regular times, and in between you can hang out with the Siberian tigers or do whatever else you want. Plus the popcorn's free. Suddenly it's a buyer's market, and circus showmen have more applicants than they can handle. How did circus medicine get more popular? The specialty didn't change at all, but more medical students discovered that they'd rather do something else during their residency than work 18-hour days.
Ideally, our passions and our needs would coincide. What we want to do would be precisely what we're trained to do, and a good bit of money would be made doing it. Sometimes, though, it works the other way: Money (and livable hours) point out a career to us that we wouldn't have thought of before. To go even further, there's nothing wrong with moneymaking as the chief criterion for one's choice of medical specialty or any other profession. The rabbis of the Talmud tell us to teach our children a trade, not a career. If our child can make a good living in something legal, nine to five, and completely dull, there is no reason (according to this strain of Jewish thought) for her employment to have a larger redeeming social value. Her redeeming value should come from her spiritual life, not her professional one.
But of course, work is more than work. It shapes our life. The stereotypes that medical students attach to various specialties are only partially untrue. Certain specialties are known to be impatient with abstractions, abrupt and unfriendly, while others are known for indulgent book-learning and a tendency toward long-windedness. Even if a doctor doesn't conform to these stereotypes when he enters these specialties, he might be brought more into line with them, both by working with his colleagues and by the particular kind of medicine for which these personalities make sense.
So instead of choosing a specialty (or a job) that makes possible the rest of your life, you can choose one that becomes your life. The rabbis were experts in choosing a "clean and simple trade," a profession that provided both sustenance and space for what they held to be life's most important pursuit: the study of Torah. But they didn't have as much to say about choosing careers that provide professional satisfaction, possibly because this wasn't relevant either to their historical moment or to their economic class. (The same rabbis also said, "The best of doctors are bound for hell." But that's a discussion for another time.) Later Jewish thought does see a place for intellectual and professional absorption in things other than Torah — a career for career's sake — as a worthwhile way to spend one's time.
The answer to all this is the punch line of an old joke: You're right, you're right and you're right, too. Someone who chooses a career (or a medical specialty) for the sake of personal satisfaction might find out years later, when it's too late, that his personal satisfaction depends not only on intellectual and spiritual sustenance but also on having time to spend with one's family as well as money to buy what one needs. But one who chooses a job that leaves time for the rest of life might discover that the rest of life feels boring without the stimulation of a demanding profession.
I'm still not sure what I'll be. Maybe I'll run off and join the circus to cure the age-old medical syndrome of big red noses and oversized feet.
Zackary Sholem Berger, a fourth-year medical student, accepts all well-meaning job advice at doctor@forward.com.
8/30/05
A yummy blog
Sit yourself down and have yourself a little something -- and, in the bargain, a window onto a delicious world of Jewish culinary aesthetics.
Sit yourself down and have yourself a little something -- and, in the bargain, a window onto a delicious world of Jewish culinary aesthetics.
8/13/05
A poem by Shmuel Halkin
In memory of the murdered poets and August 12.
To the Newborn Child
For the newborn: bless him.
With his mother’s milk, may he drink in
The thirst to bear a lamp for all people,
But the light should also be for his own people.
When he discovers for the world a new star,
May it for his own people not get any darker.
[translation: Z. Sh. B.]
In memory of the murdered poets and August 12.
To the Newborn Child
For the newborn: bless him.
With his mother’s milk, may he drink in
The thirst to bear a lamp for all people,
But the light should also be for his own people.
When he discovers for the world a new star,
May it for his own people not get any darker.
[translation: Z. Sh. B.]
Tisha B'av reflections
Non-rigorous, unfleshed-out: what I had to say this evening at my shul.
In the fifteen minutes I have allotted to me, I’m going to definitively answer some small, easy questions. For example: why are we here? What is life for? And why are we not having any lunch tomorrow?
The houses of Hillel and Shammai debated whether it would be better if the world had not been created. It was decided that it would have been better had the world not been created, but since it has been, we must examine our deeds.
This raises several questions. Would it be better for whom had the world not been created? If we are talking about God, then we have to understand what God takes to be “good.” But it might be, that given a particular definition of what God thinks is good, then a creation without our world might be better than a creation with it. What would it take for our existence to make the creation worse in God’s view?
Let’s put it another way. What would God’s criteria for good and better be, if our world did not exist? If none of us were here, would there be any morality left? If no one were around to behave rightly or wrongly, what would God care?
If the very existence of people, and, in more specific terms, the Jewish people, is enough to guarantee the Almighty the existence of a certain sort of moral calculus, then we’re already a step ahead – we can be confident, in a strange sort of way, that it’s better off that we are here. But only if our actions represent that sort of moral calculus. Perhaps that doesn’t mean that everything we do has to be right and proper, only that we have to be thinking about it. It means that whatever happens in a world inhabited by human beings is of moral import. Suffering is not just what God visits upon us, it is a phenomenon which must be understood and related to God’s blessings.
There’s another way of understanding “it would be better if the world not be created.” “Better” – as understood by people. How would this make any sense? But think of the imperfections of the world that people visit upon each other. One might think that our imperfections are so manifold, our death-dealing so innovative, that pain would be eliminated by getting rid of the source: people. We all know the midrashim in which God, or God’s angels, regrets having created people. People, on occasion, regret having been created, not because they get a raw deal from God, but because they give a raw deal to each other. Better far, perhaps, not to be around at all.
Why am I talking about the disappearance, or death, of all humanity, on the eve of a very specifically Jewish fast day? We are not enjoined to mourn the evil that human beings visit on each other; we are commanded to weep and sing dirges commemorating the destruction of the Temple in Jerusalem. We’re not mourning the famines in Africa, we’re not mourning the attacks in London. We are not even mourning the tragedies, the unnoticed deaths that happen every day to people we know and love and people we’ve never met. In a larger sense, true, every tragedy is relevant to our fast days, just as every joy is relevant to our holidays. Both these sorts of days are reflections of the joy and pain in God’s creation.
Only in a larger sense, though. In a smaller sense, Tisha B’av, which is really a small day, one small, not widely observed day in the Jewish calendar, represents one small corner of the dark world’s tragedy, perhaps an attempt by the Rabbis, or by God the Arranger of History, to make things manageable. It is an attempt to connect one part of our myth (that is, the way we understand our history) to another part.
This mythic connection goes something like this.
What do Jews do during their life in this world?
We build and create, imitating God.
We built a Temple, imitating the relationship of Jews to non-Jews and Israel to the rest of the world.
We collaborated with God on the Torah, a system of myth and law imitating the way in which God created the world.
What happened on Tisha B’av?
Our creation in imitation of God was destroyed.
Our Torah was burned.
What do we do on Tisha B’av now?
We cease from building and creating. We attempt to reproduce death as nearly as possible. It is a Shabbat from joy.
What is the traditional wish on Tisha B’av?
That we see the Temple rebuilt.
Which means: that we experience redemption.
Which further means: that we live in a world imitating God’s creation.
We experience death in order to transform life.
Non-rigorous, unfleshed-out: what I had to say this evening at my shul.
In the fifteen minutes I have allotted to me, I’m going to definitively answer some small, easy questions. For example: why are we here? What is life for? And why are we not having any lunch tomorrow?
The houses of Hillel and Shammai debated whether it would be better if the world had not been created. It was decided that it would have been better had the world not been created, but since it has been, we must examine our deeds.
This raises several questions. Would it be better for whom had the world not been created? If we are talking about God, then we have to understand what God takes to be “good.” But it might be, that given a particular definition of what God thinks is good, then a creation without our world might be better than a creation with it. What would it take for our existence to make the creation worse in God’s view?
Let’s put it another way. What would God’s criteria for good and better be, if our world did not exist? If none of us were here, would there be any morality left? If no one were around to behave rightly or wrongly, what would God care?
If the very existence of people, and, in more specific terms, the Jewish people, is enough to guarantee the Almighty the existence of a certain sort of moral calculus, then we’re already a step ahead – we can be confident, in a strange sort of way, that it’s better off that we are here. But only if our actions represent that sort of moral calculus. Perhaps that doesn’t mean that everything we do has to be right and proper, only that we have to be thinking about it. It means that whatever happens in a world inhabited by human beings is of moral import. Suffering is not just what God visits upon us, it is a phenomenon which must be understood and related to God’s blessings.
There’s another way of understanding “it would be better if the world not be created.” “Better” – as understood by people. How would this make any sense? But think of the imperfections of the world that people visit upon each other. One might think that our imperfections are so manifold, our death-dealing so innovative, that pain would be eliminated by getting rid of the source: people. We all know the midrashim in which God, or God’s angels, regrets having created people. People, on occasion, regret having been created, not because they get a raw deal from God, but because they give a raw deal to each other. Better far, perhaps, not to be around at all.
Why am I talking about the disappearance, or death, of all humanity, on the eve of a very specifically Jewish fast day? We are not enjoined to mourn the evil that human beings visit on each other; we are commanded to weep and sing dirges commemorating the destruction of the Temple in Jerusalem. We’re not mourning the famines in Africa, we’re not mourning the attacks in London. We are not even mourning the tragedies, the unnoticed deaths that happen every day to people we know and love and people we’ve never met. In a larger sense, true, every tragedy is relevant to our fast days, just as every joy is relevant to our holidays. Both these sorts of days are reflections of the joy and pain in God’s creation.
Only in a larger sense, though. In a smaller sense, Tisha B’av, which is really a small day, one small, not widely observed day in the Jewish calendar, represents one small corner of the dark world’s tragedy, perhaps an attempt by the Rabbis, or by God the Arranger of History, to make things manageable. It is an attempt to connect one part of our myth (that is, the way we understand our history) to another part.
This mythic connection goes something like this.
What do Jews do during their life in this world?
We build and create, imitating God.
We built a Temple, imitating the relationship of Jews to non-Jews and Israel to the rest of the world.
We collaborated with God on the Torah, a system of myth and law imitating the way in which God created the world.
What happened on Tisha B’av?
Our creation in imitation of God was destroyed.
Our Torah was burned.
What do we do on Tisha B’av now?
We cease from building and creating. We attempt to reproduce death as nearly as possible. It is a Shabbat from joy.
What is the traditional wish on Tisha B’av?
That we see the Temple rebuilt.
Which means: that we experience redemption.
Which further means: that we live in a world imitating God’s creation.
We experience death in order to transform life.
8/4/05
Hospital Food
It's always lunchtime somewhere.
Here's Medicine Mensch 8. Dig in!
MEDICINE MENSCH: Doctor's Orders: Fruit Salad and a Cheese Sandwich
By Zackary Sholem Berger
August 5, 2005
Despite the superpowers previously described in this space, medical students are normal people. They need places to lay their heads, white medical coats to keep out the rain, and three meals a day. Since their time for breakfast and dinner is sacrificed to sleep, three meals often means only one: lunch.
What's for lunch, and where do I eat it? On the ground floor of the hospital I'm working in, there's a diner with the same wishful-thinking menu of other diners — many things can be ordered and some of them are even available. I eat there occasionally. That is, I go with some other medical students, order an iced tea and a fruit salad, and eat my kosher bread and cheese from a bag I hide under the table. No one throws me out, and the iced tea is good.
The fruit salad, in a securely-fastened plastic box easily opened by surgeons or other coordinated people, is the same that's available just next door, over the partition at the hospital's coffee shop. But there, rules are different, and the hospital's stern hierarchy is topsy-turvied. Attending physicians and patients' cousins alike wait in line to grab the attention of the blue-shirted guys who take orders, man the cash registers and bag coffees and tuna wraps with frightening speed, calling women mi amor and discussing soccer with each other in Spanish. A sign over the cash register explains enigmatically: "All Kitchen Items Cannot Be Ordered Express." In practical terms, this means that the blue shirts have complete control over what they pack up quickly and what they prepare in their own good time. I'm not sure how long it takes to become a regular in their eyes, but if I go there often enough and order a homemade iced tea, no sugar, I hope eventually they'll start to recognize me.
As you move upstairs, the options change. There are vending machines with sweet and salty snacks, from a company that either has a dark sense of humor or doesn't realize how many patients here are suffering from diabetes or heart failure. On the 12th floor there's a dining room with a cafeteria that I've never seen open, a phalanx of vending machines, and a row of microwave ovens; at lunchtime the place is packed with nurses speaking Tagalog, Chinese and Spanish. Outside, above the door, there's an inviting Dante-esque sign: "Patients Not Permitted."
This is because patients are expected to stay in their rooms, awaiting care. Their care, like everything else in this hospital, is dependent on the combined efforts of thousands. And when something goes wrong, such mistakes are discussed exhaustively over lunch. At morbidity and mortality conferences, mishaps are analyzed over bagels and coffee. In line at the coffee shop, people whisper about the surgeon who operated on the wrong leg. These days, hospital administrators are terrified of the survey commission that's about to come through town, flashing remorseless, efficient smiles and catching careless errors in every chart. Some mistakes don't cost anyone's life or limb — they merely make the patient's dinner late. But even this can be a serious blow. As one resident told us students, "The best way to piss a patient off is not to feed them."
A couple of nights ago I was in the E.R. A patient had been sent there with an unexpected heart problem after what he had assumed would be an uneventful checkup. I took his history, did a thorough physical, and then thought: What more can I possibly do for this person before the resident has time to come see him? I had already done his EKG, and I'd already apologized to him for the confusion in the E.R., which, to the untrained eye, is the natural state of the big-city emergency rooms. (That particular night, the air conditioning wasn't working, a dozen or so cops were guarding their charges and the guy in the stretcher next to my patient was screaming, more out of churlishness than pain.) I asked, "Is there anything I can do for you?" The man looked at me, thought a bit, and said tentatively (in Spanish), "Well, I'm awfully hungry."
It was a rare privilege to lay down a hot meal in front of this sick man. I didn't stick around to see whether he liked the spaghetti, or, after he finished, how he managed to get his tray off the stretcher while staying attached to his heart monitor. I was too busy getting up to the 17th floor, where I would tuck into a saag paneer and drink some mango lassi. It was 9:15 p.m., finally time for lunch.
Zackary Sholem Berger looks forward to breakfast and dinner, too. Medical-student recipes and tales of past mistakes are available at doctor@forward.com.
It's always lunchtime somewhere.
Here's Medicine Mensch 8. Dig in!
MEDICINE MENSCH: Doctor's Orders: Fruit Salad and a Cheese Sandwich
By Zackary Sholem Berger
August 5, 2005
Despite the superpowers previously described in this space, medical students are normal people. They need places to lay their heads, white medical coats to keep out the rain, and three meals a day. Since their time for breakfast and dinner is sacrificed to sleep, three meals often means only one: lunch.
What's for lunch, and where do I eat it? On the ground floor of the hospital I'm working in, there's a diner with the same wishful-thinking menu of other diners — many things can be ordered and some of them are even available. I eat there occasionally. That is, I go with some other medical students, order an iced tea and a fruit salad, and eat my kosher bread and cheese from a bag I hide under the table. No one throws me out, and the iced tea is good.
The fruit salad, in a securely-fastened plastic box easily opened by surgeons or other coordinated people, is the same that's available just next door, over the partition at the hospital's coffee shop. But there, rules are different, and the hospital's stern hierarchy is topsy-turvied. Attending physicians and patients' cousins alike wait in line to grab the attention of the blue-shirted guys who take orders, man the cash registers and bag coffees and tuna wraps with frightening speed, calling women mi amor and discussing soccer with each other in Spanish. A sign over the cash register explains enigmatically: "All Kitchen Items Cannot Be Ordered Express." In practical terms, this means that the blue shirts have complete control over what they pack up quickly and what they prepare in their own good time. I'm not sure how long it takes to become a regular in their eyes, but if I go there often enough and order a homemade iced tea, no sugar, I hope eventually they'll start to recognize me.
As you move upstairs, the options change. There are vending machines with sweet and salty snacks, from a company that either has a dark sense of humor or doesn't realize how many patients here are suffering from diabetes or heart failure. On the 12th floor there's a dining room with a cafeteria that I've never seen open, a phalanx of vending machines, and a row of microwave ovens; at lunchtime the place is packed with nurses speaking Tagalog, Chinese and Spanish. Outside, above the door, there's an inviting Dante-esque sign: "Patients Not Permitted."
This is because patients are expected to stay in their rooms, awaiting care. Their care, like everything else in this hospital, is dependent on the combined efforts of thousands. And when something goes wrong, such mistakes are discussed exhaustively over lunch. At morbidity and mortality conferences, mishaps are analyzed over bagels and coffee. In line at the coffee shop, people whisper about the surgeon who operated on the wrong leg. These days, hospital administrators are terrified of the survey commission that's about to come through town, flashing remorseless, efficient smiles and catching careless errors in every chart. Some mistakes don't cost anyone's life or limb — they merely make the patient's dinner late. But even this can be a serious blow. As one resident told us students, "The best way to piss a patient off is not to feed them."
A couple of nights ago I was in the E.R. A patient had been sent there with an unexpected heart problem after what he had assumed would be an uneventful checkup. I took his history, did a thorough physical, and then thought: What more can I possibly do for this person before the resident has time to come see him? I had already done his EKG, and I'd already apologized to him for the confusion in the E.R., which, to the untrained eye, is the natural state of the big-city emergency rooms. (That particular night, the air conditioning wasn't working, a dozen or so cops were guarding their charges and the guy in the stretcher next to my patient was screaming, more out of churlishness than pain.) I asked, "Is there anything I can do for you?" The man looked at me, thought a bit, and said tentatively (in Spanish), "Well, I'm awfully hungry."
It was a rare privilege to lay down a hot meal in front of this sick man. I didn't stick around to see whether he liked the spaghetti, or, after he finished, how he managed to get his tray off the stretcher while staying attached to his heart monitor. I was too busy getting up to the 17th floor, where I would tuck into a saag paneer and drink some mango lassi. It was 9:15 p.m., finally time for lunch.
Zackary Sholem Berger looks forward to breakfast and dinner, too. Medical-student recipes and tales of past mistakes are available at doctor@forward.com.
7/31/05
7/19/05
7/17/05
A stethoscope and a plausible manner doesn't make me a doctor
Or: I'm a conman and you're a moron.
Sample dialogues like this are really my main source of medical education.
Or: I'm a conman and you're a moron.
Sample dialogues like this are really my main source of medical education.
7/11/05
Let's choose a new head
. . . and return to Egypt?
Concerned citizens of the Conservative movement would do well to look at this blog, with its blow-by-blow (or yawn-by-groan) account of JTS's search for a new chancellor. Sources tell me that the bylaws were changed just last week (more or less oligarchically) to include fewer academics on the selection committee. This means that an organizational non-entity will be chosen, one who will make Conservative Jews from Forest Hills to Jerusalem roll over as one and go to sleep. But if I ruled the world? David Golinkin, maybe. Perhaps a notable talmid-khokhem or Jewish academic scholar who happens to be a C. Jew. I didn't think Judy Hauptman would be interested in the job, but it looks like she's done some thinking on the subject. Is this a campaign editorial?
. . . and return to Egypt?
Concerned citizens of the Conservative movement would do well to look at this blog, with its blow-by-blow (or yawn-by-groan) account of JTS's search for a new chancellor. Sources tell me that the bylaws were changed just last week (more or less oligarchically) to include fewer academics on the selection committee. This means that an organizational non-entity will be chosen, one who will make Conservative Jews from Forest Hills to Jerusalem roll over as one and go to sleep. But if I ruled the world? David Golinkin, maybe. Perhaps a notable talmid-khokhem or Jewish academic scholar who happens to be a C. Jew. I didn't think Judy Hauptman would be interested in the job, but it looks like she's done some thinking on the subject. Is this a campaign editorial?
6/30/05
Medicine Mensch goes (Poly)Glatt
Number seven in a series.
Visiting Patients, With Dictionary In Hand
By Zackary Sholem Berger
July 1, 2005
Before I became a medical student, I thought I spoke Spanish pretty well. I spent six months after college researching minority languages in Spain and, after moving to New York, I've had many a friendly conversation with miscellaneous Spanish speakers I've accosted: random passersby from Puerto Rico, law students from Colombia, grocery packers from the Dominican Republic.
Having a conversation on the street or a chat in a café about politics or literature is one thing. If you don't understand a word, you can smile or nod and pick up from context what's going on. But say you've been called down to the E.R. to take a history and do a physical, and you find a drunk, toothless man in handcuffs gesturing frantically at something underneath his bed. If you could understand drunken, toothless Spanish a little bit better, it might not take you 15 minutes of sympathetic listening to understand that the man wants his cell phone (which the cops sitting nearby are not about to let him have).
The difficulty isn't simply a matter of decoding the speaker's register (someone from a different socioeconomic class can be hard to understand, even in one's native tongue), nor is it the fact that various dialects of the language are represented at any urban hospital. It's often the words themselves that make things hard. Like every other medical student, I have a command of several different kinds of medical terminology: the mind-numbing jargon of the scientific literature, the half-macho talk of rounds and last but certainly not least important, the normal words people use to talk in English about whatever's the matter with them.
It's this last kind of vocabulary that I lack in Spanish. I can talk a blue streak about genetic predispositions and infectious agents, about endoscopies and anesthesia — these are international terms, much the same in Spanish, English and many other languages. But lay language is different. I've already experienced a certain kind of linguistic blockage more than once. I've started a conversation with a Spanish-speaking patient, we've built up something of a rapport, she's complimented my Spanish, I've figured out why she's come to the hospital. Then, all of a sudden, I need to ask a specific question to narrow down the field of possible diagnoses. I use what I think is the right word, and one of two expressions appears on the patient's face: either outright incomprehension, or a polite glazed-over look that means, "I'm going to keep my mouth shut until I can figure out what the heck this nice doctor is saying." It's then that I have to search my dusty old neurons for a Spanish word I learned once, many years ago, or for a synonym that's used in the home country of this particular patient. During one memorable conversation, a patient and I sat through a long, awkward pause before she figured out that I was asking about her period.
Those familiar with the overscheduled life of the medical professional might wonder what's the point of trying to achieve "medical fluency" in Spanish or another foreign language. For most doctors it might be enough to master a minimal vocabulary, and the extra minutes spent figuring out the Colombian word for "tampon" or "leg splint" can more profitably be devoted to a more extensive history or exam of the other dozen patients that have to be seen today. It's also true that a translator is (usually) available. That's if one wants to take the legal route. Many doctors use the Spanish-speaking janitor, or the patient's sister who's waiting in the lobby; neither alternative would be applauded by medical ethicists.
It all depends on how the doctor sees her practice. If her task is to see clients who are visiting for necessary medical services, they probably can be more efficiently served (not to say "processed") with minimal communication. Many common complaints can be divined from the patient's presentation and demographic with only the bare outlines of a conversation. If this approach isn't warm and personal, it's certainly necessary when there are hundreds of patients to see in a week.
But since I'm still a medical student, I can still afford to let my personal tendencies influence the way I see medicine. I'm a person who doesn't mind sacrificing a little efficiency (or even a lot) to get a good conversation going with the person sitting in front of me. Will that make me a better doctor? Beats me, but I know I'll have more fun this way.
"You can't learn every language," a medical student friend of mine pointed out when she heard about my linguistic ambitions, i.e., trying to learn some Chinese. Many people at Bellevue know some stock Chinese phrases, but if I can avoid it I'd rather not storm into the hospital room of an 80-year old man and blurt out the Chinese version of "Did you piss today?" Most medical students wouldn't be caught dead asking an older person that question in English; clearly there must be another way to do it in Chinese. And I'm still trying to find the Yiddish speaker who doesn't assume that accented English will impress me more than mameloshn.
If you happen to speak English, I will make every effort to accommodate you once I'm a physician. Please realize, though, that since I'll be a doctor, my handwriting will be illegible — in any language.
Still a medical student, Zackary Sholem Berger has a bunch of dictionaries at home, but he never can seem to remember the word he needs. When he's a physician himself, he can have a medical student look everything up for him. Send him questions in the language of your choice at doctor@forward.com.
Number seven in a series.
Visiting Patients, With Dictionary In Hand
By Zackary Sholem Berger
July 1, 2005
Before I became a medical student, I thought I spoke Spanish pretty well. I spent six months after college researching minority languages in Spain and, after moving to New York, I've had many a friendly conversation with miscellaneous Spanish speakers I've accosted: random passersby from Puerto Rico, law students from Colombia, grocery packers from the Dominican Republic.
Having a conversation on the street or a chat in a café about politics or literature is one thing. If you don't understand a word, you can smile or nod and pick up from context what's going on. But say you've been called down to the E.R. to take a history and do a physical, and you find a drunk, toothless man in handcuffs gesturing frantically at something underneath his bed. If you could understand drunken, toothless Spanish a little bit better, it might not take you 15 minutes of sympathetic listening to understand that the man wants his cell phone (which the cops sitting nearby are not about to let him have).
The difficulty isn't simply a matter of decoding the speaker's register (someone from a different socioeconomic class can be hard to understand, even in one's native tongue), nor is it the fact that various dialects of the language are represented at any urban hospital. It's often the words themselves that make things hard. Like every other medical student, I have a command of several different kinds of medical terminology: the mind-numbing jargon of the scientific literature, the half-macho talk of rounds and last but certainly not least important, the normal words people use to talk in English about whatever's the matter with them.
It's this last kind of vocabulary that I lack in Spanish. I can talk a blue streak about genetic predispositions and infectious agents, about endoscopies and anesthesia — these are international terms, much the same in Spanish, English and many other languages. But lay language is different. I've already experienced a certain kind of linguistic blockage more than once. I've started a conversation with a Spanish-speaking patient, we've built up something of a rapport, she's complimented my Spanish, I've figured out why she's come to the hospital. Then, all of a sudden, I need to ask a specific question to narrow down the field of possible diagnoses. I use what I think is the right word, and one of two expressions appears on the patient's face: either outright incomprehension, or a polite glazed-over look that means, "I'm going to keep my mouth shut until I can figure out what the heck this nice doctor is saying." It's then that I have to search my dusty old neurons for a Spanish word I learned once, many years ago, or for a synonym that's used in the home country of this particular patient. During one memorable conversation, a patient and I sat through a long, awkward pause before she figured out that I was asking about her period.
Those familiar with the overscheduled life of the medical professional might wonder what's the point of trying to achieve "medical fluency" in Spanish or another foreign language. For most doctors it might be enough to master a minimal vocabulary, and the extra minutes spent figuring out the Colombian word for "tampon" or "leg splint" can more profitably be devoted to a more extensive history or exam of the other dozen patients that have to be seen today. It's also true that a translator is (usually) available. That's if one wants to take the legal route. Many doctors use the Spanish-speaking janitor, or the patient's sister who's waiting in the lobby; neither alternative would be applauded by medical ethicists.
It all depends on how the doctor sees her practice. If her task is to see clients who are visiting for necessary medical services, they probably can be more efficiently served (not to say "processed") with minimal communication. Many common complaints can be divined from the patient's presentation and demographic with only the bare outlines of a conversation. If this approach isn't warm and personal, it's certainly necessary when there are hundreds of patients to see in a week.
But since I'm still a medical student, I can still afford to let my personal tendencies influence the way I see medicine. I'm a person who doesn't mind sacrificing a little efficiency (or even a lot) to get a good conversation going with the person sitting in front of me. Will that make me a better doctor? Beats me, but I know I'll have more fun this way.
"You can't learn every language," a medical student friend of mine pointed out when she heard about my linguistic ambitions, i.e., trying to learn some Chinese. Many people at Bellevue know some stock Chinese phrases, but if I can avoid it I'd rather not storm into the hospital room of an 80-year old man and blurt out the Chinese version of "Did you piss today?" Most medical students wouldn't be caught dead asking an older person that question in English; clearly there must be another way to do it in Chinese. And I'm still trying to find the Yiddish speaker who doesn't assume that accented English will impress me more than mameloshn.
If you happen to speak English, I will make every effort to accommodate you once I'm a physician. Please realize, though, that since I'll be a doctor, my handwriting will be illegible — in any language.
Still a medical student, Zackary Sholem Berger has a bunch of dictionaries at home, but he never can seem to remember the word he needs. When he's a physician himself, he can have a medical student look everything up for him. Send him questions in the language of your choice at doctor@forward.com.
6/27/05
A new translation of Pessoa: a review
In the way of bloggers everywhere, I'm posting here a review of mine which was rejected by a journal.
Fernando Pessoa: Selected Poems
Translated by David Butler
Every translation of poetry should come with an introduction explaining the approach of the translator. David Butler does this with admirable forthrightness in his recent volume of selected translations of Fernando Pessoa: "I have resisted the temptation to tidy up the English syntax for the sake of readability. . . . The awkward syntax . . . of Pessoa's poetry is intended as a semantic corollary to his overwhelming sense of existential 'thrownness', and is ill-served by imposing definitive structures or meaning on the English." "A great advantage of a bilingual edition," continues Butler, "is that it is far easier for the translator to resist the urge to rewrite," since the original is available to the reader for easy comparison.
Thus on the one hand we can praise Butler for an important service: presenting the nearest English equivalents of Pessoa's existentially knotty Portuguese. But the translator of poetry has another responsibility (which does not necessarily exclude Butler's approach): creating poems in the target language. Translating a poem into Portuguese into a non-poem in English which respects the unclarity and strangeness of the original is a good deed of philology but not yet a poetic accomplishment.
First, though, to Pessoa. Anyone but the blasé Pessologist will warmly welcome a new selection of his poems, since some of it will be new to the average reader. The effect of his controlled and variegated confusion is that of someone thinking out loud, unsure about everything but his own unsureness: "I write in the midst/Of that which isn't to hand." Is this the modern predicament, or merely a modern version of that pain which we dismiss with the classification "the human condition"? Pessoa (this time under his own name and not one of his famed multiple-personality eponyms) has something to say about this ( p.39):
Autopsychography
The poet's a man who feigns.
He feigns so completely
That he comes to pretend pain
For pain that he actually feels.
And those who read what he writes
Feel also, in the pain they read,
Neither of the two that he had,
But only that which they don't have.
Thus, to entertain our reason,
Round and round in wheel-ruts
Revolves that clockwork engine
That is termed the heart.
The combination of cold mechanics and raw pain is invigorating, Larkin without the censoriousness. Pessoa implicates us in his poetry, a sort of imposter's game or dressing-up of feelings as other feelings – but the poet also points out time and again that only through such playacting do we see what might be true.
A short review of Pessoa would be as inappropriate as a one-page review of the work of Emily Dickinson. Here I'll just something about the translation. Though in agreement with Butler's theoretical possibilities, the reader might find it difficult to find anything poetical in his translations. From Butler's introduction, it seems that this might be what he wants, and the translations themselves seem to bear out this suspicion. The last lines of the poem above, for example, run this way in the original: "E assim nas calhas de roda/Gira, a entreter a razao,/Esse comboio de corda/Que se chama o coracao." The verb gira precedes the noun comboio; in Portuguese, as in other Romance languages, there is nothing particularly awkward or significant about this syntax. Preserving in English this Portuguese syntax ("revolves that clockwork engine") throws the reader off guard and does not allow her to finish reading the poem without thoughts of translation intruding into her attention. This is presumably not the sort of "thrownness" Butler has in mind.
One could go through these translations and quibble with a number of word and phrasing choices (for example, Butler tends to translate Portuguese basta as suffice, a word which in English is confined mainly to upper-register speech), but this is unfair. Translating Pessoa requires concentration and sensitivity, and by and large these are present in this edition. Indeed, these same qualities should be brought by the reader to every poem of Pessoa's represented here, a record of a personality nervously approaching and then withdrawing from the world:
That which pains me is not
What is in the heart
But rather those beautiful things
Which will never exist.
They are the forms without form
Which pass by, without pain
Being able to know them
Or love dream them.
They are as though sadness
Were a tree and, one by one,
Its leaves were to fall
Between the trace and the mist.
In the way of bloggers everywhere, I'm posting here a review of mine which was rejected by a journal.
Fernando Pessoa: Selected Poems
Translated by David Butler
Every translation of poetry should come with an introduction explaining the approach of the translator. David Butler does this with admirable forthrightness in his recent volume of selected translations of Fernando Pessoa: "I have resisted the temptation to tidy up the English syntax for the sake of readability. . . . The awkward syntax . . . of Pessoa's poetry is intended as a semantic corollary to his overwhelming sense of existential 'thrownness', and is ill-served by imposing definitive structures or meaning on the English." "A great advantage of a bilingual edition," continues Butler, "is that it is far easier for the translator to resist the urge to rewrite," since the original is available to the reader for easy comparison.
Thus on the one hand we can praise Butler for an important service: presenting the nearest English equivalents of Pessoa's existentially knotty Portuguese. But the translator of poetry has another responsibility (which does not necessarily exclude Butler's approach): creating poems in the target language. Translating a poem into Portuguese into a non-poem in English which respects the unclarity and strangeness of the original is a good deed of philology but not yet a poetic accomplishment.
First, though, to Pessoa. Anyone but the blasé Pessologist will warmly welcome a new selection of his poems, since some of it will be new to the average reader. The effect of his controlled and variegated confusion is that of someone thinking out loud, unsure about everything but his own unsureness: "I write in the midst/Of that which isn't to hand." Is this the modern predicament, or merely a modern version of that pain which we dismiss with the classification "the human condition"? Pessoa (this time under his own name and not one of his famed multiple-personality eponyms) has something to say about this ( p.39):
Autopsychography
The poet's a man who feigns.
He feigns so completely
That he comes to pretend pain
For pain that he actually feels.
And those who read what he writes
Feel also, in the pain they read,
Neither of the two that he had,
But only that which they don't have.
Thus, to entertain our reason,
Round and round in wheel-ruts
Revolves that clockwork engine
That is termed the heart.
The combination of cold mechanics and raw pain is invigorating, Larkin without the censoriousness. Pessoa implicates us in his poetry, a sort of imposter's game or dressing-up of feelings as other feelings – but the poet also points out time and again that only through such playacting do we see what might be true.
A short review of Pessoa would be as inappropriate as a one-page review of the work of Emily Dickinson. Here I'll just something about the translation. Though in agreement with Butler's theoretical possibilities, the reader might find it difficult to find anything poetical in his translations. From Butler's introduction, it seems that this might be what he wants, and the translations themselves seem to bear out this suspicion. The last lines of the poem above, for example, run this way in the original: "E assim nas calhas de roda/Gira, a entreter a razao,/Esse comboio de corda/Que se chama o coracao." The verb gira precedes the noun comboio; in Portuguese, as in other Romance languages, there is nothing particularly awkward or significant about this syntax. Preserving in English this Portuguese syntax ("revolves that clockwork engine") throws the reader off guard and does not allow her to finish reading the poem without thoughts of translation intruding into her attention. This is presumably not the sort of "thrownness" Butler has in mind.
One could go through these translations and quibble with a number of word and phrasing choices (for example, Butler tends to translate Portuguese basta as suffice, a word which in English is confined mainly to upper-register speech), but this is unfair. Translating Pessoa requires concentration and sensitivity, and by and large these are present in this edition. Indeed, these same qualities should be brought by the reader to every poem of Pessoa's represented here, a record of a personality nervously approaching and then withdrawing from the world:
That which pains me is not
What is in the heart
But rather those beautiful things
Which will never exist.
They are the forms without form
Which pass by, without pain
Being able to know them
Or love dream them.
They are as though sadness
Were a tree and, one by one,
Its leaves were to fall
Between the trace and the mist.
6/24/05
Mazl-tov, Beyle!
Beyle Schaechter-Gottesman, Yiddish singer, songwriter, and poet, has been awarded one of twelve National Heritage Awards from the NEA. The Awards are the nation's highest honor in the folk and traditional arts.
I haven't written nearly enough about her in this space. Below is my translation of one of her poems. You can also hear some of her singing (you wouldn't be amiss in buying one of her CDs, either).
Let me repeat, with joy: מזל־טובֿ, ביילע! איר האָט עס כּשר פֿאַרדינט. (Mazl-tov, Beyle! It couldn't have been given to a more deserving person.)
Nobody
Beyle Schaechter-Gottesman
Nobody loves the weak one,
quietly modest,
watching and waiting,
the small one.
Nobody loves the one who’s alone,
hid in himself,
lost
in the inner I,
the one alone with himself.
No one loves
the one who loses,
in constant collapse,
one and lonely,
the nobody –
nobody.
Beyle Schaechter-Gottesman, Yiddish singer, songwriter, and poet, has been awarded one of twelve National Heritage Awards from the NEA. The Awards are the nation's highest honor in the folk and traditional arts.
I haven't written nearly enough about her in this space. Below is my translation of one of her poems. You can also hear some of her singing (you wouldn't be amiss in buying one of her CDs, either).
Let me repeat, with joy: מזל־טובֿ, ביילע! איר האָט עס כּשר פֿאַרדינט. (Mazl-tov, Beyle! It couldn't have been given to a more deserving person.)
Nobody
Beyle Schaechter-Gottesman
Nobody loves the weak one,
quietly modest,
watching and waiting,
the small one.
Nobody loves the one who’s alone,
hid in himself,
lost
in the inner I,
the one alone with himself.
No one loves
the one who loses,
in constant collapse,
one and lonely,
the nobody –
nobody.
6/16/05
Son of Intermarriage
Or: What do we call those pesky non-Jews who insist on hanging around?
Eons ago, when most of midtown Manhattan was covered by a vast inland sea -- I refer to July, 2003 -- I started this blog with a post about intermarriage. My unoriginal claim was that intermarriage is by no means an unmitigated evil for the Jewish community, and that our institutions need to find positions which go beyond preachy boilerplate.
A related conversation (what do we call non-Jews who choose to ally themselves with our community?) is going strong in the J-sphere. Here is some miscellany you might find of interest, most shamelessly filched from friend and commenter Becca.
Perhaps the only newsworthy bit I have to offer is that the Federation of Jewish Men's Clubs has prepared a twenty-two page pamphlet on supporting the non-Jewish spouse (I can't seem to find the exact title right now), supposedly meant for circulation to the members of the Rabbinical Assembly for a meeting in July. Since I can't find any information on line about an RA meeting in that month, I wonder if something else might be meant. In any case, the Forward is supposedly going to print something about the pamphlet and reactions to it.
Rabbi Steven Greenberg, in an essay on intermarriage, talks about reinventing the ger toshav for modernity. On the other hand, the authors of the new book A Place in the Tent: Intermarriage and Conservative Judaism (also reviewed here) suggest the term karov* (קרוב, lit. "relative") for any non-Jew who allies herself to the Jewish people without seeking membership.
In a private e-mail correspondence I'm involved with, one of the participants suggested that using the term ger toshav might encourage tradition-minded Jews to give due respect to the roles played by non-Jews in a Jewish community. To this, I replied:
The aforementioned Becca also shared some general comments on the rhetorical tasks faced by liberal Jews in taking account of the importance of their non-Jewish friends and relatives. (Rhetoric shapes our actions, hence the attention I'm devoting to it here.) I'm going to add her e-mail as a comment in my name.
I look forward to all of your views on the issue. Please note that the comments link at the end of each post seems to be broken; if you click on "link" you should be able to use the Blogger commenting feature.
*Which I will, to no one's surprise, pronounce korev. Kadimah Ashkenazistim!
Or: What do we call those pesky non-Jews who insist on hanging around?
Eons ago, when most of midtown Manhattan was covered by a vast inland sea -- I refer to July, 2003 -- I started this blog with a post about intermarriage. My unoriginal claim was that intermarriage is by no means an unmitigated evil for the Jewish community, and that our institutions need to find positions which go beyond preachy boilerplate.
A related conversation (what do we call non-Jews who choose to ally themselves with our community?) is going strong in the J-sphere. Here is some miscellany you might find of interest, most shamelessly filched from friend and commenter Becca.
Perhaps the only newsworthy bit I have to offer is that the Federation of Jewish Men's Clubs has prepared a twenty-two page pamphlet on supporting the non-Jewish spouse (I can't seem to find the exact title right now), supposedly meant for circulation to the members of the Rabbinical Assembly for a meeting in July. Since I can't find any information on line about an RA meeting in that month, I wonder if something else might be meant. In any case, the Forward is supposedly going to print something about the pamphlet and reactions to it.
Rabbi Steven Greenberg, in an essay on intermarriage, talks about reinventing the ger toshav for modernity. On the other hand, the authors of the new book A Place in the Tent: Intermarriage and Conservative Judaism (also reviewed here) suggest the term karov* (קרוב, lit. "relative") for any non-Jew who allies herself to the Jewish people without seeking membership.
In a private e-mail correspondence I'm involved with, one of the participants suggested that using the term ger toshav might encourage tradition-minded Jews to give due respect to the roles played by non-Jews in a Jewish community. To this, I replied:
The benefits of the term "ger toshav" are also its dangers -- well, maybe "dangers" is an exaggeration. Call them "downsides." Most tradition-minded Jews who are knowledgable enough about the term "ger toshav" in order for it to mean something to them (and, even more, with enough familiarity to create a less-negative reaction to intermarriage) will also realize that there is a long halachic history behind the term. None of you have to be told that Rambam holds forth at great length on the privileges and responsibilities of the ger toshav. While it might be comforting to some to know that the GT is not a new category, they might be less comforted to know just how different our allied non-Jews are from the (frankly) subject population envisioned by medieval halachists.
It's Elliot Dorff, I think, who points out in one of his biomedical essays that sometimes halachic categories do not correspond to present realities - sometimes they're so out of joint that no amount of shoving will make things fit. He mentioned this in the context of goses and terefah, but I think for the liberal Jew it applies as well for the status of women, and, in our case, for non-Jews within the (liberal) Jewish community. That's why "karov" seems like a good try. Pretty vague, true, but then perhaps what's needed is not a formal naturalization for allied non-Jews, just (as was pointed out previously) a rhetorical acknowledgement of their positive existence.
The aforementioned Becca also shared some general comments on the rhetorical tasks faced by liberal Jews in taking account of the importance of their non-Jewish friends and relatives. (Rhetoric shapes our actions, hence the attention I'm devoting to it here.) I'm going to add her e-mail as a comment in my name.
I look forward to all of your views on the issue. Please note that the comments link at the end of each post seems to be broken; if you click on "link" you should be able to use the Blogger commenting feature.
*Which I will, to no one's surprise, pronounce korev. Kadimah Ashkenazistim!
6/9/05
MEDICINE MENSCH
Making Rounds: A Hospital Drama
By Zackary Sholem Berger
There is a drama performed in hospitals that is as essential and unchanging as davening, or eating breakfast. It's the doctors' twice-daily bedside perambulation, known to everyone as "rounds."
Whenever a medical student walks into a patient's room, it's an act for both concerned. Perhaps the metaphor is inexact. Each actually wants to tell the other something that is necessary to know; real life is going on here, not just a staged meeting. But performance anxiety is also a crucial element of the interaction. The student wants to demonstrate confidence in front of the patient, in the hope of hitting on a juicy finding to feed the intern; then the intern, thus fortified, might look good in front of the resident, who would be nice to the intern — who would then, in turn, the student devoutly hopes, be nicer to her.
The patient has his role, too. There are as many different sorts of patients as there are people in general, but many would like to be the "good patient," the one whom resident and attending alike mention with a smile or, at least, without an eye roll and a barely suppressed groan.
Patient and doctor meet on this sort of medical date thousands of times a day in hospitals everywhere, each hoping that, for the other's sake, the two of them will hit it off.
But what is it like to go on rounds? It's a performance with its own special set of characters, among them the Patient (lying in bed, trying to sleep), the Medical Student (short white coat, bleary eyes, clipboard), the Intern (long white coat, even blearier eyes, folded sheaf of paper, look of a hunted woodland creature) and the Attending (long white coat, very little paraphernalia, confident and well rested). Morning rounds are executed in two acts. The first, featuring the Medical Student and the Patient, is transcribed below. (The Patient's responses are omitted — because, among other reasons, he's tired, talking through a sheet pulled over his head and wishing the Student would go away.)
ACT I
The place: A raucous urban hospital.
The time: 6:45 a.m.
Enter Medical Student.
Medical Student (to Patient): Good morning! Did you make a bowel movement last night? ...
I realize it's a quarter to seven in the morning. I need to ask you a number of questions about how you're feeling. Someone else asked you a bunch of questions this morning when she took your temperature? That was the nurse. And another person asked you questions earlier this morning? That was the intern. Sometimes he likes to get here early to get a jump on things without me. I'm a medical student, and I have my own questions to ask you. ...
Why can't we all coordinate the questions we ask? That's a good question. I wish I knew the answer to that. I'll get back to you on that one. ...
I'm glad you're answering my questions, sir, but please don't say that I can "practice" on you. My resident tells me I'm a vital part of the team. ...
So, about those bowel movements. Made any? Great! That's good to hear. What about gas? Urinating? How's your pain? Where would you rank your pain on a scale of zero to 10? Any other complaints? Okay — I'll speak to someone about the food here. And, what's that? Too many people asking questions? Your sense of humor is very healthy, sir. ...
Now I'm going to examine you briefly. First your abdomen. Where does it hurt? All right. Let me just look. I'm sorry! I know it hurts. I know, but I wanted to see for myself. After I'm done examining you, I'll just check your incision. Let me listen to your heart and lungs now. Breathe deep, please. ...
Okay, thanks a lot! Any other questions for me? ...
Normal food? I think you'll be eating normal food by tomorrow, but I'm not 100% sure. I have to ask the doctors, who are coming by a little bit later. Have a good day.
END OF ACT I
* * *
The second and final act of Morning Rounds happens a little bit later, with the Attending presiding. The curtain rises:
ACT II
The place: The same.
The time: 7:30 a.m.
Enter Attending, Intern and Medical Student. The Intern and Medical Student are silent, attentive, almost worshipful.
Attending (to Patient, while moving very fast): Good morning! How's the belly?
(Attending performs a thorough examination of the patient's abdomen in 25 seconds, during which time the Medical Student drops his pen cap, which rolls under the bed; makes a split-second decision to go after the cap, without success, and finally resolves to use only ballpoints like everyone else has, which click in and out. During this same period the Intern makes notes on 10 patients, tries to guess what time he's going home tonight and wonders what the hell his student is doing under the bed.)
Attending: Great! Okay, I'll see you later. Keep on feeling better. (Directs a stream of instructions to intern.)
(Attending, Intern and Medical Student leave the room and head down the corridor.)
Patient (shouting after them): Can I eat tomorrow?
(Medical Student does not answer. He will ask Intern later in the day, after rounds. The answer will be furnished by the time they all round again in the evening.)
Patient: Hello?
(Tries to go back to sleep.)
END OF ACT II
CURTAIN
If you missed the first performance, don't worry. The cast will be waiting by the elevators at 5 p.m. for a return engagement. Bring your clipboard.
Zackary Sholem Berger plays the part of the Medical Student. He's lost many pen caps on morning rounds while much of the city is still sleeping.
Making Rounds: A Hospital Drama
By Zackary Sholem Berger
There is a drama performed in hospitals that is as essential and unchanging as davening, or eating breakfast. It's the doctors' twice-daily bedside perambulation, known to everyone as "rounds."
Whenever a medical student walks into a patient's room, it's an act for both concerned. Perhaps the metaphor is inexact. Each actually wants to tell the other something that is necessary to know; real life is going on here, not just a staged meeting. But performance anxiety is also a crucial element of the interaction. The student wants to demonstrate confidence in front of the patient, in the hope of hitting on a juicy finding to feed the intern; then the intern, thus fortified, might look good in front of the resident, who would be nice to the intern — who would then, in turn, the student devoutly hopes, be nicer to her.
The patient has his role, too. There are as many different sorts of patients as there are people in general, but many would like to be the "good patient," the one whom resident and attending alike mention with a smile or, at least, without an eye roll and a barely suppressed groan.
Patient and doctor meet on this sort of medical date thousands of times a day in hospitals everywhere, each hoping that, for the other's sake, the two of them will hit it off.
But what is it like to go on rounds? It's a performance with its own special set of characters, among them the Patient (lying in bed, trying to sleep), the Medical Student (short white coat, bleary eyes, clipboard), the Intern (long white coat, even blearier eyes, folded sheaf of paper, look of a hunted woodland creature) and the Attending (long white coat, very little paraphernalia, confident and well rested). Morning rounds are executed in two acts. The first, featuring the Medical Student and the Patient, is transcribed below. (The Patient's responses are omitted — because, among other reasons, he's tired, talking through a sheet pulled over his head and wishing the Student would go away.)
ACT I
The place: A raucous urban hospital.
The time: 6:45 a.m.
Enter Medical Student.
Medical Student (to Patient): Good morning! Did you make a bowel movement last night? ...
I realize it's a quarter to seven in the morning. I need to ask you a number of questions about how you're feeling. Someone else asked you a bunch of questions this morning when she took your temperature? That was the nurse. And another person asked you questions earlier this morning? That was the intern. Sometimes he likes to get here early to get a jump on things without me. I'm a medical student, and I have my own questions to ask you. ...
Why can't we all coordinate the questions we ask? That's a good question. I wish I knew the answer to that. I'll get back to you on that one. ...
I'm glad you're answering my questions, sir, but please don't say that I can "practice" on you. My resident tells me I'm a vital part of the team. ...
So, about those bowel movements. Made any? Great! That's good to hear. What about gas? Urinating? How's your pain? Where would you rank your pain on a scale of zero to 10? Any other complaints? Okay — I'll speak to someone about the food here. And, what's that? Too many people asking questions? Your sense of humor is very healthy, sir. ...
Now I'm going to examine you briefly. First your abdomen. Where does it hurt? All right. Let me just look. I'm sorry! I know it hurts. I know, but I wanted to see for myself. After I'm done examining you, I'll just check your incision. Let me listen to your heart and lungs now. Breathe deep, please. ...
Okay, thanks a lot! Any other questions for me? ...
Normal food? I think you'll be eating normal food by tomorrow, but I'm not 100% sure. I have to ask the doctors, who are coming by a little bit later. Have a good day.
END OF ACT I
* * *
The second and final act of Morning Rounds happens a little bit later, with the Attending presiding. The curtain rises:
ACT II
The place: The same.
The time: 7:30 a.m.
Enter Attending, Intern and Medical Student. The Intern and Medical Student are silent, attentive, almost worshipful.
Attending (to Patient, while moving very fast): Good morning! How's the belly?
(Attending performs a thorough examination of the patient's abdomen in 25 seconds, during which time the Medical Student drops his pen cap, which rolls under the bed; makes a split-second decision to go after the cap, without success, and finally resolves to use only ballpoints like everyone else has, which click in and out. During this same period the Intern makes notes on 10 patients, tries to guess what time he's going home tonight and wonders what the hell his student is doing under the bed.)
Attending: Great! Okay, I'll see you later. Keep on feeling better. (Directs a stream of instructions to intern.)
(Attending, Intern and Medical Student leave the room and head down the corridor.)
Patient (shouting after them): Can I eat tomorrow?
(Medical Student does not answer. He will ask Intern later in the day, after rounds. The answer will be furnished by the time they all round again in the evening.)
Patient: Hello?
(Tries to go back to sleep.)
END OF ACT II
CURTAIN
If you missed the first performance, don't worry. The cast will be waiting by the elevators at 5 p.m. for a return engagement. Bring your clipboard.
Zackary Sholem Berger plays the part of the Medical Student. He's lost many pen caps on morning rounds while much of the city is still sleeping.
6/1/05
Election Day!
In Kiryas Joel.
It's the Aharonites vs. the Zalman Leib-ists, round twenty-seven, as KJers go to the polls to elect a mayor and two members of the village council. The Times Herald-Record's crack KJ reporter, Chris McKenna, has a good roundup of who the candidates are and why they hate each other. McKenna writes:
I don't know what these figures are supposed to show, but I gather the claim is that the Alliance is getting stronger in KJ. I doubt it. I bet they'll get clobbered today too.
Update: This is why I don't make my living as a political pundit. The Alliance made a very strong showing (though they still lost).
In Kiryas Joel.
It's the Aharonites vs. the Zalman Leib-ists, round twenty-seven, as KJers go to the polls to elect a mayor and two members of the village council. The Times Herald-Record's crack KJ reporter, Chris McKenna, has a good roundup of who the candidates are and why they hate each other. McKenna writes:
[The KJ Alliance -- that is, the Zalman Leib faction in KJ] has established
itself as a significant voting bloc of its own but one that still occupies a
distinctly minority position.
In 2001, its candidates lost by 600-vote margins of more than 4,100 cast.
In 2004, when approximately 4,500 voted, the margins were closer to 800.
I don't know what these figures are supposed to show, but I gather the claim is that the Alliance is getting stronger in KJ. I doubt it. I bet they'll get clobbered today too.
Update: This is why I don't make my living as a political pundit. The Alliance made a very strong showing (though they still lost).
5/31/05
5/30/05
The Bridge
Anna Margolin
(from Yiddish: Z.Sh.B.)
The Williamsburg Bridge naps
in the heavy gold of the day.
The city's wild heart
is breathing quick and weary.
In the day's heavy gold
the ferry's a blue cord.
Feverish and sharp
the accompaniment of the cars.
The heavy gold of the day
is brilliant, between iron ropes
nets cast out
to capture happiness.
But I don't want happiness.
I want my pain and secret.
I am a golden bridge
over the steel city.
Anna Margolin
(from Yiddish: Z.Sh.B.)
The Williamsburg Bridge naps
in the heavy gold of the day.
The city's wild heart
is breathing quick and weary.
In the day's heavy gold
the ferry's a blue cord.
Feverish and sharp
the accompaniment of the cars.
The heavy gold of the day
is brilliant, between iron ropes
nets cast out
to capture happiness.
But I don't want happiness.
I want my pain and secret.
I am a golden bridge
over the steel city.
5/12/05
Public and Private
And sick and well.
Medicine Mensch 5 is below. Enjoy!
MEDICINE MENSCH: A Tale of Two Hospitals
By Zackary Sholem Berger
May 13, 2005
Fancy Private Hospital is conveniently located in Upper Manhattan, a few blocks away from a subway stop. If you like, though, you can stroll to the main building along Madison Avenue, perhaps stopping at some of the boutiques you'll find along the way. A few other students and I took such a relaxed trip to FPH for a recent rotation. On our first day we went to a well-appointed office in an embassylike building of white stone, with an interior decorated in brass and wood. We settled into plush chairs and waited for the administrator. When she arrived, she gave us all a big smile as she handed out our orientation packets. "Welcome to Fancy!" she said. She gave us each a sheaf of meal tickets ("Hold on to these. They're just like money!") and told us where the swimming pool was.
Needless to say, we all had had somewhat different formative experiences in Raucous Urban Hospital, another one of the health care facilities operated by my university. There you're not so much welcomed as acknowledged. The elevators don't work, efficiency is not rampant and budgets are tight — but all this has come to be expected by the people who work there. Otherwise, it wouldn't be raucous and probably wouldn't serve as much of the public.
Both Fancy and Raucous are teaching hospitals where medical students (not yet doctors) and residents (doctors at the beginning of their training) learn to perform procedures and make diagnoses on real patients — you and me and our relatives. Everyone would love to be treated by the expert in whatever malady she's currently suffering from, but there aren't enough experts to go around. So people are treated by teams, the long chains of white-coated big-and-little-fish the patient sees snaking into and out of the room. Although a couple of people in that big group are more responsible for what happens to the sick person, no single person carries out all of a given patient's care over the course of a month.
That is, once in a hospital, every sick person realizes that he or she is one of dozens treated by a team of interlocking personalities. The patients at Fancy Private and Raucous Urban deal with this realization in ways that are superficially different. Some at Fancy Private, used to the best in everything in other areas of their lives (or merely the upper-middle-class certainty that they will be properly accommodated — be it at the hairdresser's, their favorite boutique or their local restaurant), will insist that they be treated only by their personal physician or at least an attending physician — no residents for them. Little does the patient know that when the attending physician gets word of this request, she'll probably roll her eyes, pick up the phone and have a good laugh about it with one of the residents, the ones she relies on to carry out the day-to-day work of patient care in a hospital with hundreds upon hundreds of patients. The Raucous Urbanites, on the other hand, tend to address everyone on the team — from lowly medical student to seasoned attending physician — as "Doctor," and impute to each of them the same level of training and responsibility. According to strict accuracy and ethical practice, the medical student should remind his patient that he is not, after all, a doctor. But how many times can you remind someone of this, especially when it's eminently possible that the person doesn't want to be reminded?
Public and private patients have something very basic in common: the wish to know who's treating them and the illusion that they have detailed control over their daily care. Of course they have control over the general decisions relating to their medical treatment: Informed consent is one of the pillars of current medical practice. (How "informed" this consent really is, however, is another matter entirely.) But once the patient makes a decision about medical care, then the team takes over, general decisions are transmuted into professional jargon like liters of lactated Ringer's solution, and a view of the forest is lost as trees are thickly planted at the patient's bedside.
That's why I try to introduce myself to every patient and have something approaching a conversation so that the patients at least have some personal contact with someone on their team, even if it's only the most insignificant and least important member. The Raucous Urban patients get my best doctor imitation, while the Fancy Private patients, if necessary, get my solemn oath that I won't go near their bed. Both of these behaviors are not quite in good faith, but they make everyone involved feel better. Perhaps one day I'll have all the public patients up to Fancy Private for lunch so that I can use up my leftover meal tickets.
Zackary Sholem Berger is a medical student at both public and private hospitals, depending on his rotation. He is doing surgery now, but don't worry — he won't be operating on anyone anytime soon.
And sick and well.
Medicine Mensch 5 is below. Enjoy!
MEDICINE MENSCH: A Tale of Two Hospitals
By Zackary Sholem Berger
May 13, 2005
Fancy Private Hospital is conveniently located in Upper Manhattan, a few blocks away from a subway stop. If you like, though, you can stroll to the main building along Madison Avenue, perhaps stopping at some of the boutiques you'll find along the way. A few other students and I took such a relaxed trip to FPH for a recent rotation. On our first day we went to a well-appointed office in an embassylike building of white stone, with an interior decorated in brass and wood. We settled into plush chairs and waited for the administrator. When she arrived, she gave us all a big smile as she handed out our orientation packets. "Welcome to Fancy!" she said. She gave us each a sheaf of meal tickets ("Hold on to these. They're just like money!") and told us where the swimming pool was.
Needless to say, we all had had somewhat different formative experiences in Raucous Urban Hospital, another one of the health care facilities operated by my university. There you're not so much welcomed as acknowledged. The elevators don't work, efficiency is not rampant and budgets are tight — but all this has come to be expected by the people who work there. Otherwise, it wouldn't be raucous and probably wouldn't serve as much of the public.
Both Fancy and Raucous are teaching hospitals where medical students (not yet doctors) and residents (doctors at the beginning of their training) learn to perform procedures and make diagnoses on real patients — you and me and our relatives. Everyone would love to be treated by the expert in whatever malady she's currently suffering from, but there aren't enough experts to go around. So people are treated by teams, the long chains of white-coated big-and-little-fish the patient sees snaking into and out of the room. Although a couple of people in that big group are more responsible for what happens to the sick person, no single person carries out all of a given patient's care over the course of a month.
That is, once in a hospital, every sick person realizes that he or she is one of dozens treated by a team of interlocking personalities. The patients at Fancy Private and Raucous Urban deal with this realization in ways that are superficially different. Some at Fancy Private, used to the best in everything in other areas of their lives (or merely the upper-middle-class certainty that they will be properly accommodated — be it at the hairdresser's, their favorite boutique or their local restaurant), will insist that they be treated only by their personal physician or at least an attending physician — no residents for them. Little does the patient know that when the attending physician gets word of this request, she'll probably roll her eyes, pick up the phone and have a good laugh about it with one of the residents, the ones she relies on to carry out the day-to-day work of patient care in a hospital with hundreds upon hundreds of patients. The Raucous Urbanites, on the other hand, tend to address everyone on the team — from lowly medical student to seasoned attending physician — as "Doctor," and impute to each of them the same level of training and responsibility. According to strict accuracy and ethical practice, the medical student should remind his patient that he is not, after all, a doctor. But how many times can you remind someone of this, especially when it's eminently possible that the person doesn't want to be reminded?
Public and private patients have something very basic in common: the wish to know who's treating them and the illusion that they have detailed control over their daily care. Of course they have control over the general decisions relating to their medical treatment: Informed consent is one of the pillars of current medical practice. (How "informed" this consent really is, however, is another matter entirely.) But once the patient makes a decision about medical care, then the team takes over, general decisions are transmuted into professional jargon like liters of lactated Ringer's solution, and a view of the forest is lost as trees are thickly planted at the patient's bedside.
That's why I try to introduce myself to every patient and have something approaching a conversation so that the patients at least have some personal contact with someone on their team, even if it's only the most insignificant and least important member. The Raucous Urban patients get my best doctor imitation, while the Fancy Private patients, if necessary, get my solemn oath that I won't go near their bed. Both of these behaviors are not quite in good faith, but they make everyone involved feel better. Perhaps one day I'll have all the public patients up to Fancy Private for lunch so that I can use up my leftover meal tickets.
Zackary Sholem Berger is a medical student at both public and private hospitals, depending on his rotation. He is doing surgery now, but don't worry — he won't be operating on anyone anytime soon.
5/11/05
Helping a Chadian defender of human rights
A friend writes:
Many have been active in various efforts to call attention to atrocities in Sudan and Darfur. I'm writing to introduce you to a human rights defender from that region, and to ask for your assistance in helping with his medical needs.
I work at Human Rights Watch, where I currently have the great fortune of sitting in the office next to one of the most extraordinary people I've ever met, Souleymane Guengueng, a Chadian human rights activist who worksclosely with several colleagues. He's an amazing, kind, warm and brave man, who is in the U.S. now for medical treatment for injuries suffere dafter being unjustly imprisoned and tortured in the 1980s. My office has raised most of the money for his treatment, but needs to raise some more.I'm writing to share this appeal for funds -- please share it with others, as appropriate.
Reed Brody, the attorney who has been working with Souleymane, sent me the appeal below. If you're interested in learning more about Souleymane, see these articles.
Please contact Reed Brody, brodyr@hrw.org, for further information.
From Reed Brody: Request
We are seeking to raise the last $10,000 needed for medical treatment forSouleymane Guengueng, one of our 2002 Human Rights Watch Monitors (total $40,000).
Souleymane Guengueng
Souleymane is the founder and Vice-President of the Chadian Association ofVictims of Political Repression and Crime (AVCRP), and is the main force behind the landmark effort to prosecute Chad’s former dictator Hissène Habré. As the New York Times said in its moving portrait of Souleymane, "on acontinent where ordinary men are tortured, killed and forgotten without asecond thought, Mr. Guengueng has done something extraordinary: fought back. After being unjustly imprisoned and tortured for two years in the late 1980's, he spent the next decade gathering testimony from fellow victims and their families. The evidence provided critical material forChadian and international human rights organizations to pursue a case against the country's former dictator, Hissene Habre."
France’s Liberation remarked that “a surprising tug of war pits this modest civil servant against the ex-dictator who bathed his country in blood.” Souleymane, falsely accused of supporting Habré’s opposition, lost much of his eyesight and almost died of dengue fever during two years of mistreatment in Habré's prisons, and watched hundreds of others succumb tomalaria, exhaustion, malnutrition and torture. When Habré fell, Souleymane and other former prisoners founded the AVCRP and gathered testimony from 792 victims, widows and orphans, hoping to use them to bring Habré to justice. When the new government recycled many of Habré's accomplices, however, Souleymane hid the files underneath the mud-brick home where he lives with the 24 members of his family, including nine children. That is where the files stayed for eight years until Souleymane handed them to a Human Rights Watch researcher in 1999. Since then, Souleymane has been the driving force behind this case. He has devoted all of his free time to the case – indeed his life is devoted to the case. He was recently fired from his civil service job because of this work.
Suleymane’s medical condition
When we brought Suleymane to the United States in late 2002 for the Human Rights Watch dinners, we were also able to get him two very successful eye operations and Souleymane can now see like a normal person. Thanks to our friends at the Bellevue/NYU Program for Survivors of Torture, we were able to have the operations done extremely cheaply.The bad news is that he was diagnosed with Hepatitis C, probably the result of a transfusion years back. The good news is that he has the strain that has an 80% chance of responding to a 6 month course of interferon treatment, which is what the doctors have strongly urged him to do to prevent potentially serious liver damage.
Souleymane Guengueng has become beloved to the staff of Human Rights Watch,and we have brought him back to carry out the difficult and debilitating interferon treatment. He has responded well to the first months of medication, though he had developed anemia, for which the doctors have prescribed additional medication.The total estimated budget is $39,860, or which we have already secured $29,000.
Checks should be made out to Human Rights Watch -- memo line "Souleymane Guengueng" -- and sent to Reed Brody, Human Rights Watch, 350 Fifth Avenue 34th Floor, NY, NY 10118.
A friend writes:
Many have been active in various efforts to call attention to atrocities in Sudan and Darfur. I'm writing to introduce you to a human rights defender from that region, and to ask for your assistance in helping with his medical needs.
I work at Human Rights Watch, where I currently have the great fortune of sitting in the office next to one of the most extraordinary people I've ever met, Souleymane Guengueng, a Chadian human rights activist who worksclosely with several colleagues. He's an amazing, kind, warm and brave man, who is in the U.S. now for medical treatment for injuries suffere dafter being unjustly imprisoned and tortured in the 1980s. My office has raised most of the money for his treatment, but needs to raise some more.I'm writing to share this appeal for funds -- please share it with others, as appropriate.
Reed Brody, the attorney who has been working with Souleymane, sent me the appeal below. If you're interested in learning more about Souleymane, see these articles.
Please contact Reed Brody, brodyr@hrw.org, for further information.
From Reed Brody: Request
We are seeking to raise the last $10,000 needed for medical treatment forSouleymane Guengueng, one of our 2002 Human Rights Watch Monitors (total $40,000).
Souleymane Guengueng
Souleymane is the founder and Vice-President of the Chadian Association ofVictims of Political Repression and Crime (AVCRP), and is the main force behind the landmark effort to prosecute Chad’s former dictator Hissène Habré. As the New York Times said in its moving portrait of Souleymane, "on acontinent where ordinary men are tortured, killed and forgotten without asecond thought, Mr. Guengueng has done something extraordinary: fought back. After being unjustly imprisoned and tortured for two years in the late 1980's, he spent the next decade gathering testimony from fellow victims and their families. The evidence provided critical material forChadian and international human rights organizations to pursue a case against the country's former dictator, Hissene Habre."
France’s Liberation remarked that “a surprising tug of war pits this modest civil servant against the ex-dictator who bathed his country in blood.” Souleymane, falsely accused of supporting Habré’s opposition, lost much of his eyesight and almost died of dengue fever during two years of mistreatment in Habré's prisons, and watched hundreds of others succumb tomalaria, exhaustion, malnutrition and torture. When Habré fell, Souleymane and other former prisoners founded the AVCRP and gathered testimony from 792 victims, widows and orphans, hoping to use them to bring Habré to justice. When the new government recycled many of Habré's accomplices, however, Souleymane hid the files underneath the mud-brick home where he lives with the 24 members of his family, including nine children. That is where the files stayed for eight years until Souleymane handed them to a Human Rights Watch researcher in 1999. Since then, Souleymane has been the driving force behind this case. He has devoted all of his free time to the case – indeed his life is devoted to the case. He was recently fired from his civil service job because of this work.
Suleymane’s medical condition
When we brought Suleymane to the United States in late 2002 for the Human Rights Watch dinners, we were also able to get him two very successful eye operations and Souleymane can now see like a normal person. Thanks to our friends at the Bellevue/NYU Program for Survivors of Torture, we were able to have the operations done extremely cheaply.The bad news is that he was diagnosed with Hepatitis C, probably the result of a transfusion years back. The good news is that he has the strain that has an 80% chance of responding to a 6 month course of interferon treatment, which is what the doctors have strongly urged him to do to prevent potentially serious liver damage.
Souleymane Guengueng has become beloved to the staff of Human Rights Watch,and we have brought him back to carry out the difficult and debilitating interferon treatment. He has responded well to the first months of medication, though he had developed anemia, for which the doctors have prescribed additional medication.The total estimated budget is $39,860, or which we have already secured $29,000.
Checks should be made out to Human Rights Watch -- memo line "Souleymane Guengueng" -- and sent to Reed Brody, Human Rights Watch, 350 Fifth Avenue 34th Floor, NY, NY 10118.
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