A likhtikn ganeydn zol er hobn*
Itche Goldberg dead at 102.

Even non-leftists (or non-socialist liberals like me) should mourn Reb Itche, or read about him if they don't know who he is.

*May he rest in peace.

The Great Charedi Smoke-Out
Cheers to Toldos Aharon!

I read here (via Yiddish Wikipedia) that the present rebbe of the Toldos Aharon sect issued two new edicts (takones) on Chanukah of this year - the traditional season for such things among this group of Chasidim. (I think the present rebbe is Rabbi Duvid Kahn, but Chasidic schismatics make my head spin.)

One takone has to do with not eating salad on Shabbos (I won't go into the reasons here). But the other is wonderful: it requires that adherents give up smoking for one day a week other than Shabbos (when religious Jews can't smoke anyway owing to prohibitions against burning). Maybe a few years from now smoking can be edict-ed out of existence in this group altogether!

Mass solemnization
Or: liturgy on deadline.

It turned out that this Shabbos (when I wasn't working) happened to be the day when our shul's rabbi talked about gays, lesbians, and marrying 'em off to each other. Being a rabbi, and a sober, thoughtful one at that, he said (I'm paraphrasing): "I'll think about it and let you know." No surprise there.

The decision for our shul about whether to solemnize (celebrate, kiddush-ify, etc.) gay and lesbian partnerships is not really up in the air; I'd be surprised if the rabbi's decision does not make use of the CJLS teshuvot allowing them. But one main thing, now that the decision has more or less already been made, is that these ceremonies be not lame.

By "not lame" I actually mean a somewhat higher standard: liturgically powerful. With traditional oomph. Let the first GL couple come up to our bimah and get married in the context of psukim thoughtfully and poetically framed. I want liturgical creativity but in a formalist vein. Let us not have fifty different versions of self-written vows, nor de-heterosexualized versions of kiddushin -- since homosexual marriages are bound to be something else. Why not a legal formula that challenges and surprises, as does the harei at every time I hear it said? Why not re-write the ketubah from scratch? Who says a glass has to be broken?

Super Jewish Historical Prediction Game
Anybody can play. And everybody wins!

I. circa 1980

Cathy Conservative: Women should read from the Torah!
Joe Modern Orthodox: Pshaw!

c. 1995

Joe M.O.: Look, everybody! Women can read from the Torah!

II. 2006

Cathy Conservative: Monogamous gay and lesbian relationships are kosher!
Joe M.O.: Pshaw!

c. 2025

Joe M.O.: __________ (you fill in the blank)

Hospital performance
Does it make a difference?

Maybe you know that you can now compare hospitals with regard to a number of "performance measurements." This does not refer to how well Mass General can play the hammered dulcimer, but to a number of indices that are considered basic to acute hospital care. Does the hospital give aspirin to everyone having a heart attack? Are people with heart failure encouraged to quit smoking when they leave the hospital? Et cetera. These indices are considered important not just on the experts' say-so, but because they have been associated in the scientific literature with improved outcomes. People who take aspirin after a heart attack live longer (and have fewer repeat MIs) than those who don't; smoking hurts heart failure; etc. These studies are, in general, randomized trials of large populations.

What's missing is the link between populations, outcomes, and hospitals. Do hospitals that perform better according to these indices reap the benefits (in terms of reduced morality for their patients) that the literature of populations would indicate? If a hospital gives more of its heart-attack patients aspirin than another hospital, will the first hospital have a lower rate of death due to heart attacks than the second? It seems plausible.

Comes a study by Werner and Bradlow to answer this question. In brief, the answer seems to be "Yes, but not much." To continue the MI (heart attack) example: eight percent of all hospitals surveyed were in the 75th percentile of achieving all reported measures. (That is, all the things that are supposed to happen before or after an acute MI in a hospital happened seventy-five percent of the time or more in these hospitals.) When these hospitals were compared to those in the 25th percentile, the mortality due to heart attacks at one year after the event was about two percent less. For pneumonia (another disease represented among the performance standards), the difference is about one percent.

So that's it? A hospital does everything right, more often than the other guy, and the mortality rate is only reduced by a few percentage points? The indices must be less closely related to mortality than we thought. The authors, however, as responsible scientists, take a more nuanced take. First, if you amortize the few percentage points' worth of difference over thousands of patients -- perform the thought experiment of moving all the patients who get seen at the "worst" 25th percentile to the "best" 75th -- the number of lives saved would reach the thousands. Secondly, we need to remember that wholesale improvements in mortality take societal and medical revolutions, like large-scale reductions in smoking, introduction of the intensive care unit, or (perhaps!) government intervention to reduce consumption of trans fatty acids. If "mere" organizational optimization (boring paper-pushing, hospital by hospital) can make a few percentage points' difference, then something small can be huge indeed.

There are the typical limitations and qualifications to attach to any study, of interest mostly to specialists like me. For instance, this is a "cross-sectional" study, overlaying snapshots of performance measures with snapshots on mortality -- not a more time- and resource-consuming, but potentially more rigorous, follow-up of a population over years to see if implementation of such performance standards leads in cause-and-effect fashion to improvement in mortality. And, of course, it's always problematic to compare the mortality rates of Raucous Public Hospital to Fancy Private Hospital, which differ for reasons much deeper than performance standards. It's possible (even expected) that even after controlling for every possible variable that could confound the relationship between performance and mortality, there are some factors still left out.

These caveats aside, this study may be a small but encouraging sign.

Conservosexuality NextGen
Where halachah meets the road.

It will be interesting to see what the rabbi of our liberal-but-observant Conservative shul says this Shabbos about the new teshuvot. Will he take the opportunity to affirm and sanctify the relationships of the many openly gay and lesbian balebatim? Or will he take a conservative tack? I won't be there; I'll be working then. Maybe someone else will fill me in.

Gay gezunt
A brief note about Rabbi Roth.

The decision of the Conservative movement's Committee on Jewish Law and Standards to approve three separate teshuvot with regard to homosexuality will satisfy no one completely. This baffles the extremists, who believe that no one should be satisfied at all. (For isn't the point of halachah an iron-bound maximalism?)

I wish Rabbi Roth weren't resigning from the Committee; I'm guessing this means that he will choose to no longer be affiliated with the movement. He is a towering scholar of unparalleled erudition. Perhaps though this a fitting moment to remind ourselves of two recent statements of Rabbi Roth's (made here):

I urge halakhically committed gay Jews not to reject the possibility that the severity of the halakhic demand of celibacy might be somewhat or significantly mitigated by some modes of therapy and treatment. Since the halakhic prohibition stands irrespective of whether there is treatment possible or not, there is little to be lost in giving a chance to treatment for which claims of marked success are made and attested.

As I mentioned before, the fact that Rabbi Roth believes such "attested" claims of "marked success" in the mitigation of homosexual behavior speaks more to his biases and unintentional ignorance than to any intellectual failing. More important however is his following claim:

. . . an inability to legitimate homosexuality halakhically makes no negative claim whatsoever about the humanity, sanctity, worth, and dignity of homosexuals.

The fact that Rabbi Roth sees no difficulty with this claim (or, at least, no necessity to defend it properly) casts light on a sharp disconnect between halachic strict constructivism and halachic compassion. (Note that this sentence itself makes no distinction between homosexual behavior and homosexuals themselves, a difference which Rabbi Roth dwells upon at length elsewhere.)

Update: A JTS source writes us.

Rabbis Roth and Rabinowitz left for different reasons. in Rabinowitz's case he believes there is not much point to the CJLS. Any rabbi can write a teshuvah and publish it on the web and any other rabbi can either follow that p'sak or not. Rabbi Roth left to make a point that "decisions have consequences". He thought the Dorff Nevins Reiser teshuvah was clearly a case of poskim considering an issue with a predetermined answer in mind. He sees nothing wrong with being predisposed to a certain answer as in the case with deciding someone is not a mamzer or not an agunah, but he says even then if the case is clear there is nothing to do. In his mind this a case where the answer was clear the other way. In particular he said the decision rested on three pillars--all of which would have to hold--and all of which are "tenuous at best". In particular he thought they made way too much out of an apparent makhlokhet between Rambam and Ramban about whether "everything else" is d'rabbanan. He said almost every rabbi since has said that Ramban simply misunderstood Rambam and thought Rambam was saying innocent touching was prohibited d'oraita. [I wish I could find a copy of Roth's teshuvah to better understand these arguments]. Roth also thought the principle of k'vod habrit was with only a few excpetions used for person X to violate a prohibition for the sake of person Y, and even when that was not the case it was always a social situation whereas private bedroom behavior was not a social situation.

Roth was asked how this decision was any worse than the driving teshuvah--and he served on the committee after that. Roth responded that he was a kid when the driving teshuvah came out. That this decision was not worse, but rather on par with the driving teshuvah and that he served on the committee to try to prevent anything like that from happening again, which it did. He notes that both the authors of the homosexuality teshuvah and the driving teshuvah had pure intentions, but were irresponsible. Roth said he will continue to pasken if asked his opinion on an issue. He also noted that many people asked him to reconsider his decision so he is doing that--reconsidering. He has not made any decisions yet about returning to the CJLS. Once again though it sounds clear that the resignation was solely from the CJLS and Roth does not seem to have any intention of leaving either JTS or the movement.

Imperfection and medicine
Or: You don't look well.

Here's a suggestion about one thing that makes being a doctor different from other professions, like playing the flute, writing poetry, or studying rattlesnakes. Each of these is concerned with the attainment of a perfect expertise -- or, at least, it's commonly thought by the practitioners themselves that there is such a thing as the most expressive flute player, the greatest poet, the most knowledgeable and groundbreaking herpetologist. Certainly it's true that one doctor can be better than another, but the trick is to define the right criteria. I'm not sure that doctors think that Jones, say, is a better doctor than Smith because she cures more of her sick patients than Smith does -- outcomes research notwithstanding. Because even if Jones cures all of her patients in one heady day of clinic, there are those of them who will get sick again -- some of them incurably. Some others will die. Some, to be sure, will get better again, through Jones's talents or in spite of them. But -- and this is what might distinguish doctoring from philosophizing or flute-playing -- much of Jones's professional life will be spent not attaining or even working towards perfection. Health is a doctor's goal, but only in a first-order sense. Most of the doctor's time is spent helping his patients deal with sickness. It would be strange to call the pianist an expert in missed notes, or the poet a coiner of slightly inapposite phrases, though such is their lot. It is more fitting to call the doctor a navigator of illness. If there's an aesthetic in the doctor's art, it's a negative one.

Rejoice like a hero running the basepaths

In a previous post I wondered how you say "home run" in Hebrew. Now I know how to say that, along with backstop, pivot foot, and RBI. If I cared at all about baseball I'm sure this would come in handy.

Verbal gymnastics at the Forward

Maybe it's just me, but the title of this article reads like an attempt at an anagram or a palindrome. It fails as the latter. I was never good at the former, and the phrase is too long for the Internet's various anagram servers -- but I'm sure some of my readers are more combinatorically talented than I.

The only other option is to take the article seriously.

Listen!

Miryem-Khaye Seigel has such a voice, I can only think our generation must be doing something right. She writes great Yiddish songs too. Now she has a Web page -- go look.

Defining the WikiJew
The ethnoreligious identity that anyone can edit: an article of mine in this week's Forward.

Who is a Jew? Let’s see what Wikipedia says about it. Or, rather, what the Wikipedias say, since the online encyclopedia is available in more than 100 languages. The answer to our question in English neither offends nor omits anyone: “[A] follower of Judaism, or [a member] of the Jewish people, an ethno-religious group descended from the ancient Israelites and from converts who joined their religion. The term also includes those who have undergone an officially recognized formal process of conversion to Judaism.” The Hebrew version (“Jews are an ethnic group of Semitic origin, in which membership is based on the Jewish religion”) is clearer, with a refreshing Israeli directness, but one will look in vain for the word “convert” — it isn’t mentioned in the article. And in Yiddish: “A Jew is a person who belongs to the Jewish people.” QED.

The English Wikipedia includes more than a million articles, and the Hebrew version about 45,000. Yiddish Wikipedia includes a little more than 2,000 articles, which makes it bigger than its counterpart in Tajik but smaller than Limburgian. So comparisons between these versions are not entirely fair.

Even so, the differences are illuminating. The English Wikipedia is a collaboration of thousands. Entries on non-trivial topics generally converge to a quasi-official style, with any unconventional stand revised out of existence. For its part, Hebrew is a Jewish language — but as far as Wikipedia (and modern Israel) are concerned, it is a national language, unceremoniously banishing to the sidelines the cozy bits of culture that Diaspora Jews hold dear. “Kugel” has no entry of its own, but languishes in the general entry “Pastries,” rubbing elbows awkwardly with “lasagna” and “pie.” Click on “Period of the Exile” in the Hebrew article “Jewish People” and you will be urged to (in Wikipedia-speak) “Edit ‘Period of the Exile.’” In other words, there’s nothing there.

And the Yiddish version? It’s Wikipedia moonshine, brewed by a bunch of bloggers, mostly Hasidic, with too much time on their hands. (I’m among the contributors.) Its entertainment-to-reliability ratio is far and away the highest of the three.

But there’s more to this comparison than clichéd Israel-Diaspora differences. The readers of each language have the benefit of a view denied to the others, so one can triangulate a version that benefits from all. What is Israel, for example? Says the English version, with overtones of propaganda: “The Middle East’s only parliamentary democracy and the nation state of the indigenous people of Eretz Yisrael.” Hebrew: “[A] parliamentary democracy found in the Middle East… defined as a Jewish, democratic state.” Yiddish Wikipedia reminds you first — before you’re even told about the State of Israel — that Yisroel can refer to a Jew, someone not of priestly lineage or a member of the Ten Tribes of the Kingdom of Israel. There is also a separate Yiddish article on what it means for there to be a Jewish state (a subject, as far as this reader can tell, undiscussed in the other Wikipedias).

Or, to take another example of a topic that gets different treatment, what is secular Jewish culture? The indulgent English-language article on the topic is apparently meant to catalog every movie, symphony, novel and TV show that Jews have had a hand in, while “Judaism as Culture” (in Hebrew) is a bare-bones — but useful — comparison of three philosophies of Jewish cultural peoplehood.

Other subjects, though not intrinsically Jewish, might be considered Jewish by association. “Homosexuality in Judaism” (English) is by and large given over to the positions of the three major Jewish movements, with obligatory hat-tips to Orthodox struggles with science, Conservative back-and-forthing and Reform cutting of the Gordian knot. Let us thank Herzl that there is no such article in the Hebrew Wikipedia. Homosexuality in (Israeli) Judaism is, in great measure, what the Jewish state makes of homosexuality. The items on the agenda in the United States are also matters of discussion in Israel. (The Yiddish reader looking up “Homosexuality” in her Wikipedia must first click through a notice that the content is only suitable for adults, before being told flatly that homosexuality “is not a Jewish concept.”)

The reader who uses these Wikipedias for Jewish research realizes that each of them has its particular virtues. The English Wikipedia is broad and detailed. The Hebrew version is relatively solid as a source for basic information on Israeli culture, literary and otherwise. The Yiddish version could be called Charedipedia. If you want the latest information on the Satmar succession struggle, the life history of the rabbis Teitelbaum, or diagrams of Hasidic dynasties, look no further. (Its treatment of religious topics, though fundamentalist, is also informative.)

But, as with any encyclopedia, Wikipedia (for Jewish topics as for anything else) should be used with care: There are large parts of the Jewish world that are ignored, glossed over or misunderstood in its pages. Hebrew Wikipedia knows nothing about the Jews of North America; until very recently, English Wikipedia was ignorant about Yiddish literature (as the Hebrew version still is); and Yiddish Wikipedia says little about nonreligious Jewish creativity, or intellectual endeavor in general. In the final analysis, the response to the user coming upon these deficiencies should not be a list of complaints, but a paraphrase of Hillel’s famous words to the convert: “Go and edit.”

Zackary Sholem Berger is a frequent contributor to the Forward. Wikipedia can change fast; some content referred to here might have changed since the article was written.

Annals of theocracy: special Jerusalem riots edition
Condemnation please?

It is probably too much to ask that Stateside religious Zionists (and I mean the Orthodox variety) distance themselves from this sort of loutish talk:

Israel’s chief rabbinate issued a statement Monday [against a planned gay pride parade in Jerusalem] calling Israel’s homosexuals the “lowest of people."

But it would be nice.

"Finish my pants!" "It's the New Yorker on the phone."
Tragedy, poetry, and Brooks Brothers.

For anyone who would like to publish a book of poetry, but doesn't think it will ever happen, I recommend this interview with Spencer Reece: a moving narrative of personal tragedy and poetic success (if not redemption).

How many people aged 20 to 39 do you talk to in a week?
Random epidemiology table.

Some authors from the Netherlands tried to improve estimates of the transmission of respiratory infections, by asking their study population: How many people did you have face-to-face conversations with during the past week? They asked this question separately for each age group: that is, the 20-39 year olds (e.g.) got asked how many people in each of the separate age groups (1-5, 6-12, 13-19, 20-39, 40-59, 60 or over) they had spoken to. This was done in Utrecht; see if your estimate matches theirs.

Why diagnose?

Just Google.

"You forbid!"
A few words about חלילה.

Abraham argues with God over the matter of Sodom and Gomorrah, and he says (Genesis 18:25):

חָלִלָה לְּךָ מֵעֲשֹׂת כַּדָּבָר הַזֶּה, לְהָמִית צַדִּיק עִם-רָשָׁע, וְהָיָה כַצַּדִּיק, כָּרָשָׁע; חָלִלָה לָּךְ--הֲשֹׁפֵט כָּל-הָאָרֶץ, לֹא יַעֲשֶׂה מִשְׁפָּט.

In the JPS 1915 translation:

That be far from Thee to do after this manner, to slay the righteous with the wicked, that so the righteous should be as the wicked; that be far from Thee; shall not the Judge of all the earth do justly?'

"That be far from Thee" translates the Hebrew חלילה לך (chalila lecha). How can we understand these words? Rashi quotes one of the Targumim, which glosses the word חלילה as "חולין הוא לך" -- "it is unfitting for you", or, more bluntly, "not holy." It is unholy for God to kill the just with the unjust. (R. David Kimchi euphemizes: "It is to be avoided with regards to Your glory to kill the just with the unjust.")

That is one understanding. On the other hand, Ibn Ezra writes that חלילה is "something impossible . . . some say that the word can be related to חלול [chalul] -- hollow." It is an impossibility -- not unholy or improper -- for God to kill the just with the unjust.

Slightly different again are the approaches of the vernacular translations. Targum Onkelos renders חלילה לך as קושטא אנון דינך. Literally I think this means "Your judgment is true," but perhaps it is meant in astonishment: "Is Your judgment not true?" That is, can Your judgment be reconciled with such a deed? Finally, the Septuagint renders the phrase with the Greek medamos. All I know about Greek is what I see in the dictionary, and mine says that the word means "not at all."

Thus we can understand indiscriminate slaughter as inappropriate to God's glory or as a basic impossibility of Divine behavior. Unfortunately, the latter understanding (which I find more attractive) makes an understanding of history, and the Bible, rather difficult. As the Torah Temimah says (I'm paraphrasing; the sefer is in my hospital locker): "How is one to understand this, when we know that when the Angel of Death is given permission to slaughter, he does so indiscriminately? But the purpose of this work is not to indulge in long excurses." I wish he had indulged here.

Yesh Tiqwa
Goodbye, Bene Beraq.

Why have the highway signs in Israel, until recently, featured strange transliterations of Hebrew place names into English? An article in Haaretz explains it all for you.

Momentous events
Details later. At least on point 3.

Gobo has kosher wine!

I got Fishbane's book (a few years old) on Biblical and rabbinic mythmaking.

Favorite words of this week's parshe: חלילה and עדנה. Not so obscure as to be "friendless," but open to multple interpretations.

Running language lightly over the sensorium
One fun poet out of three - not bad.
This week's Reading Between A and B made less of an impression than the last one I went to - maybe because I didn't have a nice chat afterwards to preserve it for later musing - but worthwhile nonetheless. Kathleen Ossip read from two thematic collections. The first, Cinephrastics, a book of movie poems, were at their best epigrammatic; at times I felt lost, because I don't know much about movies -- my fault, obviously. Another collection is set in the period of the Cold War. (So long ago!) It relied on an easy cliché, superficial suburban complacency beneath which roils a turbid undertow. (The work on the web site is more complicated and interesting than what she chose to read.)

Mary Jo Bang is well known and highly regarded, two risk factors for the Great Poet Syndrome: a tendency to orotund truisms (death is all around us, George Bush is a bad president), and an even more dreaded complication, the Great Poet Voice. (Imagine your most boring high school teacher. Then subtract intonation.) She also read from a thematic collection (these seem to be de rigueur), based on the letters of the alphabet. The most successful of these goes like this, in its entirety:

B is for Beckett
There is so little to say.

Here's another nice line of hers, plucked from context. It's about doctors. [I don't know where the line breaks go.] "How little else they know unless you tell them. I tell them I wish I could lie under the summer."

Chris Nealon, the middle poet, was entertainingly arch - qualities helped by his natural, fluid reading style. I appreciate poets that bring a persona to the microphone, and he was a jokester. Maybe his reading, his wit, his sexual jokes, can be identified with a "gay jester" type (Merrill, Powell). (If he's gay, that is. Maybe I'm wrong.) I wish I had more to quote, but he was reading pretty fast and I had had a bourbon to start the reading off (which I was well into by the time Nealon read. Maybe that's why I liked him the most?). A favorite line, again context-free: "She said: I want a tattoo. / She said, I want a thigh wound." Or the image of the city full of "instructible sparks." Or the title of this post, taken from a poem of his.

I would have bought his book, but the bourbon took up my free cash. I won't make that mistake again.

Insensitive introjection

I don't know if any of you remember my Medicine Mensch column way back in April, when I described a "code" on the ICU - that is, the death of a patient despite attempted resuscitation. I just now noticed a letter to the Forward written in response later that month, which I point out now as an instance of a common phenomenon: the tendency to ascribe to me, the columnist, an attitude in agreement with the attitudes described in the column. Thus:

In his April 14 Fast Forward column (“Springing Into Action”), Zackary Sholem Berger captures the unquestioning introjection of emotional insensitivity into the psyches of our physicians in training. As such, he seems unaware of the recurrent abhorrence to those outside his insider’s narrative: the initial “frown” by the resident whose chat was interrupted by a nurse’s concern over a dying patient; the “workplace banter” while the life of a husband, father, brother, friend… hung in the balance; the incompetent obscene specialist whom Berger feels compelled to shield, and finally, the reassurance of “the attending… that we should not beat ourselves up about the patient’s dying, that everything had been done the right way.”

Perhaps reflecting his own indoctrination, Berger attempts to anesthetize the reader’s pain with a reminder that those outside the code are the “uninitiated,” that the complete absence of any feelings whatsoever over a man’s death is sanctioned by a review and validation of the emergency protocol, as well as by the hollow reassurance of one’s superiors and peers.

The letter-writer, it seems, equates the depiction of emotional insensitivity with emotional insensitivity on the part of me, the writer. This is certainly possible but I think untrue in this case. Indeed, I share his concerns about the emotional insensitivity of many doctors; on the contrary, a careful reading of the article would not find a "complete absence of any feelings whatsoever" over the patient's death. In short: depiction of the status quo does not connote satisfaction with it.

Yiddishy doings
On Thursday, at the 92nd St. Y, a number of leading contemporary Yiddish vocalists will perform the songs of Beyle Schaechter-Gottesman. (Here's my most recent post about her.)

Also at the Y, on November 1st, Alana Newhouse moderates a discussion entitled "The Joys of Yiddishism." The question on the table (apparently): "Why are so many young Jews becoming interested in a language considered dead?" (Answers: (a) not so many; (b) superficial interest; (c) not dead.) More complicated, interesting, and articulate answers to be furnished by Alyssa Quint (literary scholar and Forward columnist), Itzik Gottesman (associate editor of the Yiddish Forward, and - by the way - Beyle Gottesman's son), and Allan Nadler (author and Forward columnist). Sense a trend? Newhouse is, of course, arts and culture editor at the Forward.

This Friday, for free!, you can hear Your Favorite Blogger talk about Yiddish and today's Lower East Side. I will also read a couple of my Yiddish poems, with English translations -- and then, separately and a bit later, read our Yiddish version of The Cat in the Hat. Davening at 6, a little smackerel of something at 7:15, I should be talking at 8 or so. This is all part of Synaplex at Town and Village Synagogue. (Actually, the most entertaining part of the evening should be the Yiddish sing-along led by Binyumen Schaechter, also at around 7:15. Schaechter, of course, is Beyle Gottesman's nephew and Itzik Gottesman's cousin. Who said the Yiddish world is inbred?)

Top Five Hospital Euphemisms* for "I Don't Know"
The suspense.

Number five: "It's unclear."

*Among doctors.

Beat on

Hug me, driving soak.
Leave no dry swatch.
Rained on this way
is perfectly wet.
One sea-pane's difference
from drowning.

Who owns human tissue?
Halachic parallels welcome. (זכין לאדם שלא בפניו?)

Federal regulations are based on a notion of voluntarism, but the right to refuse participation in research is based more on ensuring that subjects can be the ones to judge how to protect their own interests than on a pure form of autonomous decision making, which would include a right to refuse for any reason or no reason at all. Hence, no consent is required for research deemed to pose minimal risk to subjects — or for research in which identifying information is obscured or from which it has been deleted (which protects privacy and minimizes social risks such as stigmatization or discrimination, but does nothing to recognize subjects' autonomy). And when patients' preferences regarding the kinds of research that may be performed on their tissue are ascertained, this is done as a courtesy, rather than as recognition of patients' rights to prohibit the use of their tissues for purposes of which they disapprove.

From R. Alta Charo, Body of Research -- Ownership and Use of Human Tissue. NEJM 2006;355(15):1517-1519.

Snows of yesteryear
Gone, daddy, gone.

Says my daughter, looking at a picture of a snowy landscape: "S'iz gegangen a shney!" ("It snowed!"). Then she paused, and said in English, "The snow's gone!" I didn't have the heart to correct such a cute calque.

When friends become bloggers

Long-time friend and consistent commenter Becca now has her own corner of the Yid-o-sphere. Recent posts include a review of a new-ish Conservative machzor, and a spirited, enlightening defense of why Geshem, a liturgical poem of the season asking for rain, should also include women among the ancestors whose merit we're invoking.

Misc.
Some-nium gatherum.

1. Look, Ma, No Bathrobe!

I forgot to wear my kitl to work on the morning of Yom Kippur, so I could wear it to minchah if I got out of work early enough to go to shul that day. I also forgot to leave my favorite machzor at shul before the holiday. Ditto my tallis. Thus, since I no longer carry in the eruvless wonderland that is now Manhattan, I was sans kitl, wearing the same pseudo-silk, slippy-shoulder quarter-tallises that everyone else was. Davening from the same gack-inducing translations. In other words, I had to leave my snobbiness at home -- salutary.

2. Chinatown Clinic

I felt great that I helped my patients today in clinic. Getting home before ten o'clock at night wasn't bad either. But I really felt like a kid in a candy store interviewing a patient for the first time in Chinese -- and he understood me. (If he had more complicated medical problems, I would have resorted to the translator phones.)

A non-ingenious paradox*
What's (not) eating you?

We're supposed to afflict ourselves on Yom Kippur. But I like fasting (apart from the associated lack of milkshakes). Unsurprisingly, then, material affliction can lead to spiritual pleasure. Or what can be mistaken for spiritual pleasure -- dizziness from low blood sugar is not the same thing. You have to be self-aware enough to realize that a temporary religious high (from fasting, prayer, and the like) is not the same thing as spiritual progress. That bowing your head like a reed on a fast day does not necessarily give you a backbone you'll be proud of on the day after.

*Quack, quack.

Let us get what we want
And let us want the right thing.

Or what's a New Year for?

A gut, zis, gebentsht, and adjective-rich yor.

Crawling on the mountains
Shimon Adaf

You'll see,
my leaving will become my return to you.
Otherwise what's the meaning
of crawling on the mountains, the high stones
the stacks of wheat exhaling shadowy gold
into the night.

translation from the Hebrew: ZShB

To the Googler of "poem about milkshake"
We aim to please.

Working on it. But it might take me a while (what rhymes with "slurp"?).

Why did it happen?
Poem/שירה as witness.

[T]he song answers those who say "Why did all this befall us?"
--Ibn Ezra on Deuteronomy 31:19. (My translation. Loose, how I like it.)

The stick

When you finally got blood from the hard stick
You spotted the backflash (pulsating, red)
And said Thank God. The woman's legs and arms
Were everywhere; you were in the middle
Holding her down while wielding
A butterfly in the other. You stuck her and she bled.

You thank the Rock of Moses that she bled
And not you. He took a stick
To strike the rock, unwilling
To try his luck with persuasion. God read
This as rebellion. Here the test of mettle
Is not getting stuck. Fuck! you cry, and hold her arms

Again. Can she please quit moving her arms?
She's used and used. Most of her life she's bled
High, or been sick, or in the middle
Of other people's lives. Now she's screaming. Stick
It out or shut up, you could say. It's for your own good. Red
Is what you want from her. Would you help us? Are you willing?

You promise her a Snickers and she's willing.
Her drugs are stamped on her arms.
Her lips and nails are painted careful red.
Her AIDS showed on a blot of what she bled.
Moses lashed out with his stick
When he wasn't out front, but in the middle.

But that wasn't what you were thinking in the middle
Of multiple stabbings and wheedlings.
You'll send the labs. You'll treat. Will it stick?
Is Bellevue just another scar on her arm?
I'm sorry if you want suspense: you stuck, she bled,
She shrieked and thrashed, the gauze turned red.

Moses, stick in hand, didn't know he erred
Till God denied him. Force: it feels like meddling
To those on divine peaks away from blood.
But we down here see in the scars and whealing
Proof indirect that what we teach our arms
Is strength, not just intention. A stick

Read as a resting staff is idle; wielded
With strong arms is a try at mettle.
We bled her to cure. She was a hard stick.

Death and its complications

Jewish Ethics and the Care of End-of-Life Patients. Edited by Peter Joel Hurwitz, Jacques Picard, and Avraham Steinberg. KTAV Publishing House, Inc., in association with The Institute for Jewish Studies, University of Basel, Switzerland.

End-of-life decision making is now often left to specialists. This book presents their deliberations in a way meant to be accessible to the layperson. It is a dissection, perhaps over-specific, of general questions that many of us will face when we and our families get old and sick: when is the right time to die? What are the right criteria, and who decides?

Orthodoxy finds in the classic texts, Talmudic passages as well as later decisors, not just guiding principles but specific legislation, with one overarching conclusion: that every moment of life is to be actively preserved, even at the price of decreased quality of life. Every end-of-life decision is to be met with the same standards, and nearly every deliberation can find its relevant source in the classical texts. If the circumstances of terminal illness are different today, and death can be drawn out over long weeks of desperation and indecision, this should not divert our gaze but focus it even more intently on the principles that matter. On the other hand, Reform thinkers have pointed out for years that such texts are open to multiple interpretations – generalizations are risky, and every case should be considered according to its unique circumstances.

This book, in short, presents a canonical spectrum with familiar opposite ends: the Orthodox insistence on the eternal relevance of Talmudic passages (even to vastly changed modern circumstances) whose interpretation can change only glacially, and the classical Reform deconstructive approach to Jewish law.

A second question has to do with the many treatments which are given to (or foisted upon) the terminally ill. When the time comes to die, when there is nothing more to be done (or when what is being done is clearly inhumane or futile), how can we decide what to turn off? How can we stop impeding death without actively causing it – or is there a difference? In this book, the bioethicist Vardit Ravitsky considers Israel's new law concerning the terminally ill, which has something important to say about these matters.

The best-known element of this law is a technological compromise. Some explanation is in order. Many thinkers recognize a distinction between the hastening of death in the living patient (forbidden) and the removal of impediments to the death of a terminally ill patient (required). In other words, life must be maintained -- but death, once unavoidable, cannot be artificially kept at bay. This distinction, important in traditional Jewish law, is sometimes so unclear as to appear a contradiction.

These terms have been connected to a corresponding pair in secular bioethics: withholding treatment versus withdrawing treatment that has already been given. The claim is made that withdrawing treatment, once given, corresponds to "hastening death," while withholding treatment, in terminal illness, is just refusing to place an impediment in the path of a dying patient.

Here enters the technological compromise: a timer connected to a respirator. The timer converts a treatment continuous in time (and thus one impossible to stop without "withdrawing") into a "discrete" sequence of decisions whether to continue the use of the device -- that is, whether to "withhold" or not.

Ravitsky's analysis helps us understand why such a halachic-technological compromise is necessary. If the distinction between "withdrawing" and "withholding" were of ethical import, the timer -- designed to circumvent it -- would be an instance of deception. However, Ravitsky agrees with the position of the current Western bioethical literature, that this distinction is erroneous. There is no real difference between withholding and withdrawing. Therefore, "timers may be perceived as devices that enable individuals to overcome an emotional difficulty in order to do what is ethically right. They thus become an appropriate and clever way to bridge the gap between the desired moral outcome (death with dignity and respect for individual autonomy) and a cultural atmosphere (grounded in religious tradition and ingrained values) that does not allow renunciation of the distinction."

That is, Israel is confronting, albeit on a larger, public-policy scale, exactly what American Jews confront - a conflict between moral outcome and religious tradition. The editors have performed a valuable service in collecting thoughtful essays discussing this conflict from various points of view. It's another question whether laypeople -- who don't like to discuss death -- will pick up this book.

Has the bulb burned out on your Enlightenment?

Over at Gil's, they're still debating if it's okay to read books at YU.

Primeval compassion

. . . When the time has come for the renewal of the world, primeval compassion is awakened[.] Since the creation of the world was without any awakening on the part of humanity but only on the part of God, when that primeval compassion was awakened, the enslavement of Joseph and the slavery of our ancestors were annulled. It is thus favorable that every year the compassion of Creation awakes, as the Baal Shem Tov said in commenting on [a verse in Psalms]. Let there be light always keeps the world in existence. Therefore, when this compassion is awakened every year, and God is desirous, it is favorable for the people Israel.

--the Mei HaShiloach, aka R' Mordkhe Yoysef Leiner of Izhbits, on parshes Emor (my translation)

"And God is desirous"*: is this contingent?

*ולכן כשנתעורר בכל שנה זה החסד וחפץ השי"ת אז הוא ניחא לכלל ישראל.

False dichotomies
0 + 0 = 0.

Friend Becca in a recent Shefa post makes some points that I would like to reiterate - so let me do just that by cutting and pasting. (What my friend Lobachevsky calls "research.")

Apropos of Ariel's article (which I first read about from a Jewschool postin g about it) & responses to it:

[W]e should avoid false dichotomies & zero-sum perceptions both here & in general. There are plenty of other popular & pernicious ones--the one that comes first to my mind right now is:

outreach/less-affiliated enagement vs. inreach/core group engagement

but one could also consider (some of which we've discussed here before):

• egalitarian vs. traditional/halakhically serious
• GLBT-friendly vs. traditional/halakhically serious
• committed to social justice vs. committed to halakha
• welcoming to families of mixed religious backgrounds vs. committed to Jewish continuity
• encouraging of alternative structures for meeting Jews' needs (esp. young Jews' needs) for community ( e.g. independent minyanim) vs. committed to the USCJ and its member organizations (including synagogues)
• intellectual vs. social
• study (text) vs. ritual (action)
• respectful of others' practices & beliefs (among Jewish denominations; with regard to others' religions) vs. committed to one's own practices & beliefs

Whenever we treat one of these groups as "our side" and the other as "the enemy"--and ignore that these groups in fact are not separable except by ignoring all subtlety, complexity, and nuance--we all lose.

Concrete benefits to disseminated intelligence

Apropos of nothing (except perhaps my few days at the Yiddish Week which I am very much looking forward to) , I should say that Wikipedia is a fine thing. At least in this regard: the article on Yiddish, a few months ago just as laughable as anything you'd find in the lay press, is now something I can actually refer people to. Shkoyekh to those who are working on it!

Do Not Reconsider, II

On the whole it's a salutary thing for all health care workers to think about their patients' wishes when it comes to resuscitation and intubation. But selection bias is a killer. What I mean is that doctors start getting curious about DNR/DNI orders when their patients get very sick. Since no one thinks to ask about these orders when the patients are relatively healthy, you could be forgiven for thinking that on occasion these orders, rather than a way in which a hospital interprets a patient's wishes, are an acceptable method of declaring medical futility. But that's a big problem - you don't want these categories to be mixed up. (And, of course, any competent doctor would I'm sure be horrified at any suggestion that this is what she's doing, since - in fact and in law - there's a lot that can be done in terms of medical treatment that has nothing to do with resuscitation or intubation.) The solution, of course, is to have everyone's DNR and DNI status stamped on their foreheads the minute they're seen by their first doctor. Not only is this not happening, I even wonder if it could. If informed consent is laughable in its practical execution, what more can one expect from DNR/DNI?

My PhD thesis

In a short and snappy six pages.

In memory of August 12, 1952
An untitled poem.

* * *

I put on the darkness
Over my head, my arms, my feet . . .
I walk around in a big black tallis
With tattered black edges trailing
Clawing at black walls.

Black infinities drag after me
Tangled together with distance.
Worldly emptiness is open to me
And there I step on
Black wandering maids.

I’m walking in my crown:
Black heights springing from me
Black distance stretching from me
Black earth away from me
And from all sides
Black horses jumping on me!

Peretz Markish
1917

In the Imager

That irresistible attraction you feel is not the result of your spiritual striving; rather, you forgot to take off your yarmulke clips before loading Mr. Richards into the MRI.

Curriculum mori
...if my Latin is right.

Two or three courses in medical school could be usefully replaced by a course on death. We never learned much about it - its epidemiology (who dies, why, and when), its public health (how it can be prevented), its signs and symptoms in the hospital (how to know someone is dying), and, sometimes most important, how it's to be dealt with when nothing much can be done to prevent it. Who do you talk to? How do you approach a family of someone who's died? (Not all of them are "grieving," so I said it another way.) What will be your reaction? Who can you talk to?

It's one of the big subjects which we're supposed to learn on our own.

Less whiny

This blog is now three years old, more or less.

And I made it through the first month of residency without making a complete fool of myself. Barely.

Not the ones dead

It's not that we become used to death, it's that there's no halfway point where we have to struggle with it. We never learn how to express our horrors and hopes. We sit in the call room, most of us just out of college, not even knowing which questions to ask, or whom.

Shabbat and the residency: a rabbi advises

One posek I asked (I'm not going to say who it is, but you can probably narrow down the alternatives) said this:

If it were possible for all observant Jews to work in a shomer shabbos medical facility, it would surely be nice. I, however, do not believe that it is forbidden to work in a non-shomer shabbos facility. Do your best to avoid hillul shabbat, but when it must be done, do it be-shinui unless it is a case of pikuah nefesh or safek pikuah nefesh.

Irregulars of the Lost Ark

Newish: my review of Cecil Helman's book of prose poetry. (And if you don't like my review, here's another.)

The earth will be devoured by the sun

Ten billion years from now. That’s what they say.
Come on! Let’s think about what can be done.

It’s true, we’ve had an enviable run
Although it might not always seem that way.
Have you read how the ancients saw the sun

As a capricious god? You wanted none
Of that in school – now bend your knees and pray.
Surely there’s something more that can be done!

I guess that you could take a loaded gun,
Abduct professors of astronomy,
Demand solutions to the giant sun

That’s engulfing all our neighbors, first one
Then anoth – Look, the moon’s been swept away
By fire’s tides. Before destruction’s done

Let’s clutch our sides and laugh: It sure was fun
To be alive in those few heady days
Between the core of earth and molten sun,
Between our wishes and what can be done.

Do Not Reconsider

I signed my first DNR order today. I did not refuse, but I can't say I'm proud of it. The philosophical conumdrums that come into play are weighty enough not to talk about at length.
(And what follows, it should go without saying, is not a religious or halachic treatment.)

What confused me in this instance was that I, as one of the treating physicians, was asked to confirm that resuscitation of the patient in this case would be "medically futile."

I don't know what the phrase means. Of course, I could look it up, but it seems to me on first glance -- and what is a blog after all but a displaycase for first glances and uninformed impressions? -- that most possible understandings would be either truisms or impossibilities. Does medically futile mean that resuscitation would not return a patient to his baseline functioning (i.e. before the illness)? Or that it would not cure the diseases which originally caused the cardiopulmonary problems in this patient?

Perhaps the most likely meaning is that it would condemn the participants - patient, family, and doctor alike - to a process which renders medical decision making futile, since all end points are the same.

More Agriprocessors

For what it's worth to those not in my kehilah, the rabbi of our synagogue said today that Agriprocessors meat should not be eaten, though it is still kosher -- i.e. one can eat at another's house, or in a kosher restaurant, without inquiring into the provenance of their steak. He made the point that the slaughterhouse's current techniques, while receiving the qualified approval of Temple Grandin, still do not make the cut according to the Conservative movement's Committee on Jewish Law and Standards.

Good Shabbos. Now I'm really off to work.

I start work on July 1st, this Saturday. Wish me luck!

I don't know how many of you faithful readers have been following the discussion over at House Of Gil about "shomer-shabbos residency programs." I commented a few times there, but let me air my objections in my own daled ames (personal space), where I'm not afraid of injecting non-Orthodox heresies into a cozy Orthoblog. I assume I'll have my own Ortho commenters here, at any rate. (Hi, Dov.) And feel free to remember that I am very much not an unbiased party in this discussion (see the first sentence in this post).

I think it's yet another instance of confusing leshem shomayim (for the sake of Heaven, i.e. honest spiritual striving) with a race to Chumraville. Consider the following facts: nearly everyone in, for example, an internal-medicine residency will be taking care of dangerously ill patients the great majority of the time. ("Dangerously ill" is the relevant halachic category, allowing for translation losses. One can act in certain ways to treat such patients on the Sabbath.) Secondly the great problem with regards to shmiras Shabbos (keeping the Sabbath) in a hospital is electricity, the bane of the observant Jew's existence on Saturday. Yet there is room, on the left end of the spectrum, for leniency with regard to use of electricity. Lastly, it appears that at least some of the Orthodox poskim, well-respected and, naturally, massively erudite Torah scholars, who have weighed in on this issue are not fully informed about the metsies (the facts on the ground) that obtains in modern-day residency programs.

All of these would seem to militate for a reconsideration of what it means for a resident, or a residency program, to be shomer shabbos, Sabbath-observant. It would be wonderful for the Conservative movement to have a crack at it. Or, at the very least (from my way of thinking), it would be greatly preferable to aimless speculation if the two eminent Conservative poskim I have written about my personal situation would answer my e-mails.

Getting used (again) to medicalese

A man is (God help us) a "male". Patients "deny" some condition or other. A person with vascular disease is called a vasculopath. All such usages are defensible logically and, of course, save precious seconds here or there that can be used to get more coffee (or save lives -- whatever). But they grate. And I hope not to use them, unless, of course, my resident makes fun of me for talkin different. Then I will submit. Quickly and cravenly.

One yoke of servitude, check.
We who are about to be beeped salute you.

Secular conversion to JudaismOr Israelism?

The Head Heeb discusses the matter.

Devil take the translator
"Not really a translation, but a conversion, Judaization, or transference."

I didn't know that Baudelaire wrote something called Les Litanies de Satan ("le plus savant et le plus beau des Anges"). It's remarkable and off-putting to read a translation of that poem into Hebrew -- for those of us whose Hebrew is religious and literary, not vernacular, it causes a visceral reaction when literary tropes associated with the Divine are used to describe the "samekh-mem."

Green Squall
Is awesome.

Here, read this.

MEDITATION ON RUIN

It's not the lost lover that brings us to ruin, or the barroom brawl, or the con game gone bad, or the beating
Taken in the alleyway. But the lost car keys,
The broken shoelace,
The overcharge at the gas pump
Which we broach without comment -- these are the things that eat away at life, these constant vibrations
In the web of the unremarkable.

The death of a father -- the death of the mother --
The sudden loss shocks the living flesh alive! But the broken pair of glasses,
The tear in the trousers,
These begin an ache behind the eyes.
And it's this ache to which we will ourselves
Oblivious. We are oblivious. Then, one morning -- there's a crack in the water glass -- we wake to find ourselves undone.

* * *

You see from the above, too, that Hopler could be this century's redeemer of the poetic long dash.

Parsha question too late for Shabbos
As usual.

If Eldad means "beloved of God," what does Medad mean -- "beloved of water"?

Hiatus prep

It's not like I post that much anyway, but soon I'll be blogging even less, what with the start of my residency on July 1st and other writing projects. As General MacArthur did not say when leaving the Philippines in 1942, I really hope to be back here at some point soon -- with further hospital tales, poetry, Jewish curiosities, and the like.

A Valediction: Forbidding Rap Music

Schorsch's speech was strange, to be sure. Rap is not a devil whispering in the ear of Conservative Jews. It is, rather, a genre of popular music. (Perhaps Schorsch missed the essay in the back of Etz Hayim, written by R. Tupac Shakur, which makes this important distinction. Tupac is nothing if not inert.) Students writing random words in the snow is symptomatic of nothing but rabbinical students looking to have a little fun. Has the chancellor really forgotten his own yeshivah days?

But there is something very important that the rabbi said:

The history of Jewish spirituality is the never–ending effort to keep halakhah and meta–halakhah in creative tandem. Halakhah is the deed; meta–halakhah, the disposition. Halakhah is fixed, meta–halakhah fluid. Halakhah is legal, public and objective, whereas meta–halakhah is theological, private, and subjective. The intent of meta–halakhah is to inform, enrich and spiritualize our fulfillment of the mitzvot. Or to revert to my image of the aquifer, what is concealed is no less vital than what is visible.

The malaise of Conservative Judaism today . . . is that its adherence to halakhah is devoid of a spiritualizing meta–halakhah.

Perhaps he was too high-falutin in his language and snobby in his approach, but the problem is there and cannot be denied. There are many people working on pushing the cart of Conservative Judaism out of the theological-spiritual mud its stuck in, but the effort must be made. Criticising Schorsch for his criticism won't help us.

To the Rabbinical Assembly

I just had a chance to daven (as shliekh tsiber) from the newish Sim Shalom siddur for weekdays, known as "Slim Shalom."

One request, though. Can I ask you esteemed rabbis -- when you next publish a book, and it includes a Yiddish selection, can you please, please proofread it? Pick a spelling system. Any spelling system; you have several to choose from! (I have a soft spot for YIVO, but it is a sefer, after all, so you might go with Standard Charedi.) Even Soviet spelling. Anything's better than what-the-hell-it's-only-Yiddish-let's-spell-it-however-we-want. Ditto for the transliteration.

Pretty please? Look, I'll do it for free.

Readings

The 11th Street Bar was as packed as a herring barrel. The reading started on time, every reader stuck to the time limits, and no fakery was evident. Miraculously, everyone read work that was worth hearing. Hopler was vigorously lyrical, not as bawdy as he represents. Siken was knotty, associational. Strekfus was mythopoetic. Glück prophesied.

Afterwards, tipsy from a beer on an empty stomach, I walked and talked with a friend. At dinner, I read a poem to him. With generosity, good will, and enlightenment, this friend then ripped the guts out of the poem, splayed them out in front of me, and explained their pathology. Such criticism beats any praise.

On the bus home afterwards, I started some new poems. I didn't say they're good, but they're different.

Stately, plump Boaz Mirsky

Has Joyce's Ulysses been translated into Hebrew? My desultory searches are turning up nothing. (Same question goes for Yiddish, though it's easier to guess what the answer is.)

Tales of a Twenty-Sixth Grade Nothing
Not a student anymore. Can I handle it?

MEDICINE MENSCH: Bidding the Classroom Adieu

For some people, 12 years of school is enough. Add four years of college and 10 years of a long M.D.-Ph.D. program. Finally, at the end of all that, I can say that I'm no longer a student. I'm ready to enjoy the benefits of my new station in life: sleeping late, meals at my leisure, freedom from subordination to institutional requirements.

Just now, though, medical residency stands in the way. I will be working the hours I am told; my schedule of rotations includes more than a few lectures. During my three-year program, I'll have to pass several challenging exams, including the feared American Board of Internal Medicine certification. I'll have to make presentations, turn in written reports, be deferential to my instructors, and remember everything I'm told in case I have to repeat it at a moment's notice. I'll have a locker and eat in the cafeteria. The cool kids will wear better clothes. Sundays will be for laundry and homework.

Suddenly residency seems a lot like the past 26 years of schooling.

I could leap to the cliché that we are all life-long learners, and that my transition from student to residency is merely an example of the transitions we all undergo. More accurately, we are all both teachers and students, with the two roles assuming various proportions during different stages of our lives.

Becoming a resident doesn't mean that I quit being a student; it just means that the teachers, modes of evaluation and goals are different. It also means that I have become a teacher myself, counseling and tolerating medical students who are just like I was two weeks ago. Someone will throw themselves to the floor in a patient's room, trying to find the cover of a ballpoint pen, and I'll have to strike the teacher's balance between friendly sympathy and calibrated advice. ("Maybe you should get one of those clicker pens?" I'll suggest, and the student will nod dutifully.)

I'll have to teach each patient as I give treatment, not knowing if my words are making a dent — or if the patient is just smiling and agreeing with me in order to get the heck out of my examining room (or so that I can leave him at peace in his hospital bed). In return, every patient teaches the doctor, though it's often not immediately obvious what is to be learned from the umpteenth sick person you've just met.

Something else came to mind during my graduation from medical school, a carefully arranged, flowers-and-champagne event with more popping flashes than pomp and circumstance. The commencement address was the customary sort, reminding us that now is an extraordinary time in medicine: Unimagined advances in science and technology can be brought to bear in the struggle against disease, but, on the other hand, premiums for malpractice insurance are high, and the wolves of overregulation are at the door. (Because the acoustics weren't so great, I might have missed a metaphor or two.)

But there are many times when nothing is being taught or learned and no death-defying struggles are being waged, long stretches of workaday medicine where no high-tech progress is made. It's just doctor and patient waiting for the most recently agreed on medical strategy to take effect, saying hello to each other yet again — like co-workers who keep passing each other by the water cooler in the hall, wondering whether they have to say "Good morning" every single time.

There will be times over the next three years when I'll be neither teacher nor student, just an average guy doing a job day in and day out. But if I'm to keep a proper balance, this ordinariness carries with it its own sort of responsibility: to remember that my job is not, in the final analysis, an average one. This means, among other things — and with every bit of my well-earned humility, sense of insignificance in the larger scheme of things and healthy respect for my own fallibility — that what I do is important. Thus, even as I trip over myself countless times during the first year of residency, I still have value, and my patients need me. I want to remember this during the first night on call, when my first bonehead move makes a nurse slap herself in the forehead once I've turned my back. And since this is my final column, I hope I'll still have the opportunity to write about my mistakes — and have readers to point them out to me.

If you'd like to follow the Medicine Mensch through his residency, you can read his blog, http://zackarysholemberger.blogspot.com. Bye for now!

Taste and see: Shavuos foods from many lands
Plus, parve buffalo wings with blue-cheese sauce: a whimsical Torah derivation.

A tasty post, Becca!

Shabbos Dinner

On cleaning out some files, I found this account of a memorable Shabbos dinner with some disaffected Jews, originally published in the now-defunct journal Response in 1999 or 2000. Given the recent publication of Unchosen, I thought it might of interest for some. I know you're not supposed to publish long blogposts, but I couldn't figure out what else to do with it. This is exceptionally long, though; my apologies.

I should also say that I wrote this a number of years ago; I'm posting it unedited, because it's beyond editing. I wouldn't write the same thing now, and I probably wouldn't even have the same opinions.

Let's meet some disaffected Orthodox youth.

I've been invited to a Shabbat dinner in Brooklyn Heights by my visiting friend Yosl, an ex-Hasid, nigunim instructor, and occasional pizza boy living until recently in Omaha, Nebraska.

Although language is more often context than cause, you can say that I got to know Yosl through Yiddish. I was introduced to the language in high school, when my senior English teacher – a brilliant diabetic with thick glasses, little tolerance for fools, and a limited interest in pedagogy – suggested I study Yiddish, which she knew from home, as a filler for one of my free periods. She didn’t instruct me per se, but her suggestion was enough to get me started. Some of my most productive hours of high school were spent in the back of Ms. Donsky’s German class (she knew a half-dozen languages, I think), reading the Yiddish Forward while my recalcitrant contemporaries broke their teeth on German verbs. I’m not sure what everyone else thought I was doing. (I don’t know what Ms. Donsky is doing now, either. The last I heard she was living in Ohio with her sister. I don’t think of her enough, considering the importance of what she introduced me to.)

Thus I started up the slope, wanting to learn a little bit more, then learning that extra little bit and finding that the unknown extended even farther than I had thought. I read Yiddish books voraciously through high school and college (although my academic studies were not in Yiddish). I started writing Yiddish poetry, which has been published in most of the depressingly small-circulation journals that still exist in the secular (non-Charedi) world. I am active in Yugntruf, a Yiddish-speaking young people’s organization. In short, Yiddish-language promotion and creativity is a large part of what I spend my time on.

I am not one of those who became attracted to Yiddish as a means of escape from the religious community. I grew up in Louisville, Kentucky, and there – in comfortable suburbia, away from the infighting and unreflective extremism that characterizes New York Jewry – I was exposed to a self-confident if unpunctilious brand of Conservative Judaism. My parents, themselves quite proficient in Hebrew and very knowledgeable Jews, gave me the grounding I needed pursue my Jewish education on my own.

Since high school I have become considerably more observant than my parents; in the inaccurate and obsolete taxonomy favored by mass-market Jewish publications, I am “Conservadox” – that is, on the right edge of the Conservative movement. Some might call me a “baal teshuvah” (a “returnee” to the faith), but I avoid the term due to its unpleasant connotations of blind religiosity. If I might be allowed a more flattering self-description, I try to remain within halachah – the system of Jewish law – while recognizing its inconsistencies and remaining open to necessary, modifying challenges from personal intellect and modern morality.
And that’s why I’m so involved with Yiddish. Not because the language itself embodies any exceptional qualities: Yiddish is no funnier than, say, Portugese, with all due respect to the popularity of Leo Rosten and his ilk; and it’s no guarantor of peace and love, either, having been used as a means to intolerance on both the left (Stalinist) and right (ultra-Orthodox) ends of the spectrum. But Yiddish and Yiddish-language creativity have in modern times been inextricably associated with those wrenching historical transformations which have most indelibly affected the soul and the society of the Jew: from all-encompassing religion to all-challenging urbanization; from certainty to radical doubt; from “God, Israel, and the Torah are one” to a smorgasbord of competing ideologies.

As I make my way as a Jew, I find in the history of Yiddish and Eastern European Jewry a mirror – the old kind, with a decorative frame and mottled glass – of my own doubts and internal conflicts. Knowing Yiddish also affords me an appreciation of those Jews who are modern, but in a different mode – those dissatisfied Charedim who must pass from one sort of self-denying modernity, heavily accessorized to pass for what some imagine to have been 19th-century Eastern European Orthodoxy, into another modernity, broader and more confident, stripped almost bare of myth and religion.

So I follow with eager attention the goings on of Charedi society, and the often labyrinthine tales of those who pass from it into the wider world. (Charedi is a less pejorative and foreign-sounding term for “ultra-Orthodox,” the word often favored in the press. “Chasidic” is inaccurate, since many Charedim are not adherents of Chasidic philosophy and teaching.) That’s the passage my friend Yosl is traversing. He was born in Williamsburg, studied in a number of yeshivas in Brooklyn and Israel, got married – and decided, as the culmination of many years of theological doubt, that he did not want to have kids, because he did not want to raise any children as Orthodox Jews. He left the marriage and Charedi society, moving to Omaha.

I met Yosl at a Yiddish conference in New Jersey which was held (need you ask?) on the grounds of a Catholic college. I was fascinated by his personal history and drawn even more by his flouting of the rules of polite society. At this conference there was a book fair, and a certain newly-published volume on women and Yiddish was being offered for sale and autographs by the authors. Although I ended up buying the book, I expressed to Yosl some (I thought) subtle and quiet reservations about one of the essays. Yosl turned to one of the women and said in a loud voice, “Sholem says this book is bullshit.” There are more examples.

For a time I accepted Yosl’s unsubtleties with an ignorant tolerance: he’s an ex-Charedi, and must have “trouble adjusting.” He must not “be accustomed” to the rules that we follow on this side of the Williamsburg Bridge. In short, I made allowances for him (to myself) much as I would for an autistic child.

But not too long ago a friend pointed out the obvious to me: that’s just the way he is. “He gives the rest of us ex-Os a bad name,” said my friend. “He’s only drifting because he wants to drift.” Indeed, another ex-Charedi acquaintance of mine (who left that society at 16) is a rising young film-maker, well connected to just about anyone in the world of the Jewish culturally hip. Dislocation does not mean what I thought it would mean: sometimes it’s the perfect route to creative transformation; sometimes it amplifies the banalities already present; and sometimes it makes bottomless canyons out of little cracks in the psyche.

Why did I come to this dinner? I find the ex-Charedi crowd entertaining, and I think I might learn something about today’s Jews, a group close to my heart. In the circles I travel in, I know precious few people on the fringe of Jewish society – and observing the fringe gives a sense of what makes up the whole cloth. There’s a personal reason, too. I became more observant than my parents – what is Shabbat (or Shabes) like for someone who has gone in the other direction? The back-and-forth flux from O(rthodoxy) to C(onservatism) to R(eform) is what occupies the thoughts of many American Jews. What are the facts on the well-traveled ground between them?

(Yosl’s one of those who has made the cleanest break with his past, although he does maintain contact with his parents. I’ve changed the names of everyone else I’ve mentioned here, because for some of them being mentioned in an essay like this would have serious consequences.)

I arrive before sunset (so I don’t break the Sabbath by traveling) and bring a bottle of wine. Rachel, who's a non-Jew, a German student in the YIVO Summer Program, says by way of greeting, "I'm sorry, but I'm stoned." She learned Yiddish by listening to Kol Yisrael on her shortwave radio in Berlin, and now waits tables at Tavern on the Green to earn money.

I wait for the other guests to arrive. They all have a lot in common: ex-O (for Orthodox), Yiddish-speaking, versed in the texts of traditional Jewish study (and some in worldly learning as well), jobless, and disaffected. In Yiddish you'd call them apikorsim, that is, apostates. In English you'd call them slackers.

As the guests filter in, a few of us sit in the living room. The ketoyres (pot) goes around. Yudl, who is permanently high, talks with fervent enthusiasm about last night's Bob Dylan-Paul Simon concert. "'The Boxer' is a real Chasidic song," he avers. Through the segue music-entertainment-frum entertainment the topic turns to"Handl erlekh [Deal Honestly]," a Hasidic version of "Monopoly": "You're wearing a loud red dress. Pay fifteen dollars." "You're watching television. Go to hell. Do not pass Go."

The dining room fills up. Someone starts to sing "Shalom Aleichem"; a few join in, but there are some suppressed groans, and many eyes roll. Mendl, from a Vizhnitzer family and a former student at NYU, starts opening the wine for kiddush, while Yisroel Meyer, who works in the Brooklyn public library, says, "Oh, God, I can't take this" -- meaning kiddush, which he can't handle, along with all other appurtenances of tradition.

Why is Mendl able to appropriate the ritual for his own use, while Yisroel Meyer is not? I don’t know. But I do notice that Mendl – after he executes an imperfect opening of the bottle– takes hold of a strainer and begins to extract the bits of cork that have ended up in the wine. Suddenly I speak up: “That’s borer [sorting, one of the types of labor forbidden on the Sabbath].” And Mendl in response, respectfully, even chastened: “You’re right. I forgot. Maybe you should be doing this,” he says, gesturing with the bottle towards the kiddush cup. Why did I say anything? I am not that careful with that category of forbidden labor in my own kitchen, on my own turf. Why do I feel the need to emphasize my observance, when I bear no ill will towards these Jews for leaving observance altogether?

Caleb makes hamotzi, the blessing over bread. If you hang around with Yiddishists, you know Caleb. He dresses sharp, tonight in an outfit out of a 40s' movie (white shoes, white suit, thick, black-rimmed glasses), speaks and writes a fluent Yiddish, and is a goy gomer
-- a complete non-Jew -- on both sides. Nine and a half out of ten American Jews could not make hamotzi with his poise. He teaches Yiddish and earns some money (not an independent living by any means) as a Yiddish actor and public reader of poetry and short stories.

Berl arrives, tall, thin-boned, and with the remnant of a beard, and begins to spin a tale about his supposed profession: armchair terrorism, supporting despots, counter-revolutionaries, and all those who maintain the status quo. He is clever and cynical in the nihilst mold: "The Dalai Lama is worse than the Chinese, otherwise how could he stand by and let millions of people think he's a god?" He does not expect or receive any response to this claim, nor are there any cries of outrage at his choice of “profession.” It’s like a comedy routine without the audience, or any attempt to elicit laughter. The black humor is accepted as a matter of course as the currency of the evening.

Binyomin -- a long-haired, shambling, gesticulating eccentric -- is fascinated by the work of Elias Canetti, the Nobel laureate in literature born into a Ladino-speaking family in Bulgaria, and in particular his book "Crowds and Power." In a high-pitched, excited voice, much like Yudl in ecstasy over Dylan, he starts making fun of the yeshiva students who have just returned from protest gatherings in Brooklyn or Jerusalem: "There were thousands of Jews there! Thousands of Jews!"

Says Berl about Canetti, "That's what all religion is -- a fear of dead crowds: the rebbeim, the gedolim. Men take that fear and call it tradition." This is a quintessentially Berl-like statement: cutting yet overgeneralized, dismissive, dismissable, but fascinating. What can be said against this by one whose relationship to tradition is more positive? “No, I disagree! Religion is not a transformed fear of dead crowds!”? If I were to say something like that, I would be laughed at: not out of scorn, but out of the irrelevance of an argument on the pros and cons of religion. Religion, to these Jews, is not a selection on the menu or a component of one’s ever-shifting moral autonomy, but a determinant of one’s entire surroundings. By accepting this dichotomy between “religious” and “not religious”, they are employing the worldview of the very Orthodoxy they have in greater or lesser measure escaped.

As if to underline the point, someone proposes a debate on the value of religion between the late Bertrand Russell and the late Lubavitcher Rebbe; this leads to a suggestion for an advertising campaign for Smirnoff Vodka, which the Rebbe did not live to endorse.

The conversation, whose coherence is already sorely taxed, breaks into fragments. Binyomin brings up the Kotsker Rebbe, the eighteenth-century Hasidic leader whose philosophy is considered a forerunner of existentialism. What happened on that night, the night before the Kotsker's twenty-year seclusion? Is it true that the Kotsker deliberately extinguished the Shabbat candles by throwing his hat at them from the other end of the table, crying “There is no law and no judge!”? In a long, uninterrupted monologue, Binyomin analyses the treatment of this story in the writings of Abraham Joshua Heschel. Heschel – a Yiddish poet, historian of Chassidism, theologian, and ideologue of the mid-20th-century Conservative movement – considers the story to be generally true, a reflection of the Kotsker’s growing internal unrest. Binyomin finds little support for Heschel’s belief.

I can’t help but see Binyomin as a gilgul of Abraham Joshua Heschel. Binyomin’s knowledge is clearly encyclopedic, and I have been told he is a marvelous writer, although I have not seen anything of his myself. He still lives with his father, in a separate room piled high with books. What sort of writer must he be? If I were to guess, I would not put him with the self-consciously rebellious, sex-obsessed “children of immigrants” (Roth et al.), nor with the modern generation (Goodman, Bukiet), surer in its Judaism but conflicted. He has the speech patterns and casts the brilliant sparks of a European master, of a Thomas Mann or a Canetti. If there were a Left Bank, a Vilna, or a Warsaw to support him, what monuments would he compose?

Or perhaps he is like Yosl, and does not wish to compose anything.

Berl says that if sleep is a sixtieth of death, and sleep is so great, then death must be a real blast. "All I need in life," he says, "is a place to sleep and some nicotine. All the stuff in the Talmud is nonsense."

Berl’s throwaway phrase (“all the stuff in the Talmud is nonsense”) means not at all what you might think it to mean out of context. “All the stuff in the Talmud” is not a dismissive wave of the hand from a college student who has taken a few “X in the Talmud” courses from the Jewish Studies professors, but a deeply felt if casually expressed declaration of rootlessness. “The stuff in the Talmud,” for much of Berl’s life, had been presented to him as “all” – and not long ago he realized that much of what he had learned did not make sense to him. It is this doubt that Berl expressed – a doubt that has been part of the Jewish makeup since Moses Mendelssohn.

I head towards the Brooklyn Bridge for the walk home to Manhattan, but somehow I get lost and fumble around in the dark byways near the bridge for the better part of an hour. By the time I get home and mount the nine flights of stairs to my dimly lit apartment (I don’t take the elevator tonight), I have lost all Sabbath rest.

I thought that Shabbat meal would be an entrée into a fascinating world of tortured, European-style struggle between the man on the street and the Jew at home. In my more self-centered moments, I even thought that we more secular-minded Yiddishists could light the flame of a Haskalah redux which would burn through the divisions between the Charedi and secular worlds. We’d produce Yiddish creativity on a par with the best of the past, lighting the way to a future both more modern and more Jewish.

It’s now been many months. Yosl lives in Moscow learning Russian and teaching some Yiddish. Mendl is back at NYU, and Caleb and I were among the teachers at a Yiddish program this past summer. I don’t know what Binyomin and Berl are doing, but I have an idea it’s about the same – working at regular jobs, finding no purchase for the traction of their intellects. I still write in Yiddish and promote the language, and I still try to follow what’s going on with the Charedim – not to enter into their world but to get a better handle on my own.

Yet another reason not to buy Rubashkin's/Aaron's Best/Agriprocessors meat
It's kosher . . . but it's treyf.

See this remarkable article by Nathaniel Popper in the Forward. I hope not to buy any of their meat in the future, unless conditions improve, and I hope my congregation doesn't either. (For my previous post on the matter, see here.)

Batter batter batter
Swiiiiing philologist!

Favorite Yiddish neologism of the week (seen on a Charedi message board):
heymloyfekhts

The equivalent neologism in the circles I travel in:
kaylekhklap

Which will win? My money's on neologism number 1.

(If you don't know Yiddish, can you guess which English baseball word is being glossed here? And how do you say it in Hebrew? I dunno. If you don't feel like playing this game, here's another hint: English synonyms include big-fly, blast, clout, jack, shot, moonshot, and tape-measure shot.)