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.


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):


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.


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.)

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,
in the inner I,
the one alone with himself.
No one loves
the one who loses,
in constant collapse,
one and lonely,
the nobody –


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 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!


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.)

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.


* * *

The second and final act of Morning Rounds happens a little bit later, with the Attending presiding. The curtain rises:


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.)



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.


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:
[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).