Those Long-Ago Desert Evenings
To keep clear the view of the mountain
the dancers were cut down.
Calf-powder scalded our insides
a castigation of embodiedness.
Song surged up to the summit
silence wafted down in rings.
What they say: He had gone up
and come down; he'd let them slip, no
hurled them like a sandal.
The mountain had split in two
like a roasted lamb and taken him in.
Children mock through the camp.
Wh-wh-who is for God come to meeee!
All around something is called out
a cross between You will and You never.
12/25/05
12/22/05
Poetry blogged
Yes or no? Yes and no.
I was talking with a friend the other day -- he's a great poet and a perfect mix of critique, appraisal, and support -- who asked me why didn't I, after all, post my poems on my blog. Part f it is my snobbery: there are venues for poetry, and I hope someday for my poems to be allowed into them. On the other hand, if my readers (the Daily Three-Dozen, as it is these days), would be interested in poems, then I would post them. In reality, I think most are here for the Jewish beat or the medicine beat. If you feel otherwise, lemme know.
On the other hand, I suppose I should give myself more credit: if I posted my poems, my readers might become interested in them by their very postedness. Who knows what could happen?
And, just to dig up on old post: I like Christmas trees.
Yes or no? Yes and no.
I was talking with a friend the other day -- he's a great poet and a perfect mix of critique, appraisal, and support -- who asked me why didn't I, after all, post my poems on my blog. Part f it is my snobbery: there are venues for poetry, and I hope someday for my poems to be allowed into them. On the other hand, if my readers (the Daily Three-Dozen, as it is these days), would be interested in poems, then I would post them. In reality, I think most are here for the Jewish beat or the medicine beat. If you feel otherwise, lemme know.
On the other hand, I suppose I should give myself more credit: if I posted my poems, my readers might become interested in them by their very postedness. Who knows what could happen?
And, just to dig up on old post: I like Christmas trees.
12/20/05
12/15/05
Ikhl Shraibman
Khaval al d'avdin. What we have lost!
This Yiddish miniaturist, essayist, and writer of short stories based on Biblical characters was also an important figure among Jews in contemporary Kishinev, Moldova. He died on December 9th. [See the obituary in the Forward for more on his life and work.]
A Writer's Credo
[Shrayberisher ani-maymen; From the collection "Creation and Love", 2000. ]
My philosophy, from the first day I started to write until today: People should be good, and everything should be good for people.
Two little things. But a whole world could be founded on them, a new world where people would embrace each other and live in love and joy.
Would people be pleased with a world like that? Wouldn't they be bored? Wouldn't they even start dreaming about another world? I don't know. It's really hard to say and will never be possible to try out. Because -- a world like that will never be established.
But let's dream, at the very least, about a world like that.
Dreaming is also quite a fine thing of people's.
Never to this very day have people possessed such a fine thing as dreaming.
What else is a writer in this world, if not the most beautiful, the longest, the strongest dreamer?
1998
Khaval al d'avdin. What we have lost!
This Yiddish miniaturist, essayist, and writer of short stories based on Biblical characters was also an important figure among Jews in contemporary Kishinev, Moldova. He died on December 9th. [See the obituary in the Forward for more on his life and work.]
A Writer's Credo
[Shrayberisher ani-maymen; From the collection "Creation and Love", 2000. ]
My philosophy, from the first day I started to write until today: People should be good, and everything should be good for people.
Two little things. But a whole world could be founded on them, a new world where people would embrace each other and live in love and joy.
Would people be pleased with a world like that? Wouldn't they be bored? Wouldn't they even start dreaming about another world? I don't know. It's really hard to say and will never be possible to try out. Because -- a world like that will never be established.
But let's dream, at the very least, about a world like that.
Dreaming is also quite a fine thing of people's.
Never to this very day have people possessed such a fine thing as dreaming.
What else is a writer in this world, if not the most beautiful, the longest, the strongest dreamer?
1998
12/13/05
Metzitzah b'peh and neonatal herpes
Still real, still serious.
I received a message today from the New York City Department of Health and Mental Hygiene about metzitzah b'peh (MbP) and neonatal herpes, an issue that has been of concern for some months now. The complete message is below, but two points should be emphasized:
1. The New York City Department of Health recommends against the practice, but in any case suggests that parents be told before the bris if MbP is to be used, so that they can make an informed decision.
2. DOH has also prepared an "open letter to the Jewish community" on the issue.
The message also reviews the steadily accumulating evidence supporting the earlier fear that one mohel was behind the cases of neonatal herpes associated with MbP.
* * *
Dear Colleagues:
You may have heard about the Health Department’s recent investigation of several cases of herpes simplex type 1 infection in male infants following circumcision which included metzitzah b’peh.
Metzitzah b’peh is a practice performed by some mohelim (religious circumcisers) as part of the circumcision. After removing the foreskin, the mohel places his mouth on the baby’s freshly circumcised penis to draw away the blood. In 1998, the Health Department investigated two cases of neonatal herpes due to herpes simplex virus type 1 (HSV-1) – one of these infections occurred in 1988, the other in 1998. Both were associated with one mohel (Mohel A) who performed metzitzah b’peh during circumcision. Mohel A agreed to stop practicing metzitzah b’peh.
In November 2004, the Health Department was notified of 3 male infants with HSV-1. All were circumcised by one mohel (Mohel B), who performed metzitzah b’peh. The infants developed herpes infection in the genital area 8-10 days after circumcision and were hospitalized for several weeks. One baby died from the infection. Two cases were reported by physicians in 2005 and both are also consistent with infection from metzitzah b’peh. Every case occurred in the time frame consistent with transmission from metzitzah b’peh.
Our investigation found Mohel B to be the source of the 2004 cases, and metzitzah b’peh to be the means of infection for these and other cases, for the following reasons:
• The medical circumstances are inconsistent with infection acquired at delivery, in the newborn nursery, or from caretakers.
• Infection is consistent with acquisition of herpes at circumcision. For example, two infants who were circumcised several weeks after birth showed signs of infection in the time frame that would be expected were the infection acquired during circumcision.
• Several mothers tested negative for HSV-1, making it impossible for them to have been the source of infection.
• All infants tested culture-positive for HSV-1, which is found in the mouths of most adults.
• The location of herpes sores (on infant genitals and buttocks) is very unusual and strongly suggests that infection was introduced at the genitals.
With an estimated average of fewer than 30 cases of all forms of infant herpes infections occurring per year in New York City, the odds of one mohel being associated with 3 cases of neonatal herpes are infinitesimally small (about 6.9 million to 1). In the interest of allowing religious communities to address these health concerns first, the Health Department agreed to let rabbinical authorities ensure that the mohel stopped performing the practice at least until the authorities conclude an investigation. In addition, the connection between metzitzah b’peh and neonatal herpes has been documented in the medical literature. Three investigations published within the past 5 years (from New York City [1], Israel [2, 3] and Canada[3]) describe 11 cases of males with HSV-1 infections on their genitals following metzitzah b’peh. Among the 11 cases, there are 4 pairs of cases (including the 1988/1998 cases from New York City).
In the United States, approximately 70% of persons age 40 and older are infected with herpes simplex virus type 1. The mouth is the most common site of HSV-1 infection; HSV-1 spreads easily through infected saliva, especially when saliva comes in contact with a cut or break in the skin, such as occurs during metzitzah b’peh. Most adults with oral herpes do not know they are infected and do not have symptoms. Even without symptoms, however, people with oral herpes can spread the infection to others. If herpes lesions are present, they tend to occur (and recur) on the skin or mucous membranes at the site at which infection was introduced or in related dermatomes. HSV-1 infection is lifelong; antibody is evidence of infection.
Evaluation and management of an infant with suspected neonatal herpes infection
Infants in the first 6-8 weeks of life suspected of having herpes infections should always be hospitalized and treated with intravenous acyclovir [4, 5], a lumbar puncture should be performed at admission, and the infant should be managed in consultation with a pediatric infectious disease specialist. Herpes infection of the skin/eye/mucous membranes may progress to disseminated disease or central nervous system (CNS) infection. Infants with disseminated or CNS infection are at significant risk for death or serious sequelae even with treatment.
For infants suspected of having herpes infection, cultures should always be done on skin vesicles if present. Other sites that may yield positive cultures and should be cultured include blood, nasopharynx, anorectum, conjunctivae, urine, and stool. Direct fluorescent antibody (DFA) staining, if available, may provide a rapid and specific diagnosis. The yield of culture and DFA from HSV skin vesicles is very good if specimens are properly collected. To collect a specimen from a vesicle, unroof or open the vesicle with a sterile needle or scalpel and vigorously rub or twist a sterile swab on the exposed base of the lesion. Use the swab to inoculate sterile viral transport medium and send immediately to the laboratory. Samples for DFA staining should be obtained in the same manner with the material from the lesion smeared onto a glass microscopic slide.
Cerebrospinal fluid (CSF) and blood specimens should be tested by polymerase chain reaction (PCR) for HSV-1 and herpes simplex virus type 2 (HSV-2). CSF cultures for HSV are usually negative in a patient with HSV encephalitis, so if a limited sample of CSF is available, PCR testing on the CSF should be done in preference to culture. Because of the passive transfer of maternal antibody, type-specific herpes serologic testing is not useful in making a herpes diagnosis in an infant unless maternal serologies are also done and are negative. Consult your institution’s clinical laboratory director to identify a laboratory licensed to perform viral culture and polymerase chain reaction for HSV-1 and HSV-2.
Reporting neonatal herpes cases to the Health Department
Up to 20% of neonatal herpes cases never develop skin lesions, so providers must maintain a high index of suspicion for herpes infection following circumcision which includes metzitzah b’peh. Providers should suspect herpes infection in male infants presenting with vesicular or pustular lesions on the genitals, perineum, buttocks, or related dermatomes in the weeks after circumcision, or, in any infant with fever or other signs of systemic illness in the weeks following circumcision.
New York City Health Code section 11.03(b) requires providers to report ‘unusual manifestations of disease. Providers should report all suspected cases of herpes occurring in the weeks following circumcision to the Health Department. Call 212-788-4423 and ask for the ‘neonatal herpes desk’. After hours call the Poison Control Center at 1-800-222-1222.
Health Department Recommendations with Regard to Metzitzah B’peh
The Health Department has issued an open letter to the Jewish community regarding the recent cases of neonatal herpes linked to metzitzah b’peh and the risk of HSV-1 transmission with metzitzah b’peh, and has developed a fact sheet to inform parents about this public health issue which will be available online and through 311 in English, Yiddish and Hebrew.
During metzitzah b’peh the mouth of the mohel comes into direct contact with the baby’s circumcision cut, risking transmission of herpes simplex virus to the infant. While severe illness associated with this practice may be rare, because there is no proven way to reduce the risk of herpes infection posed by metzitzah b’peh, the Health Department advises against this practice. Some parents whose infants had metzitzah b’peh say they did not know in advance that the mohel would perform it. The Health Department advises parents to ask the mohel several days in advance of the bris whether he performs metzitzah b’peh. This offers parents a chance to weigh the risks of metzitzah b’peh and choose another option if they wish. While some mohelim consider metzitzah b’peh the only acceptable way to draw blood away from the circumcision cut, others use different means. For example, a mohel may use a sterile glass tube or a glass tube attached to a rubber bulb to suction the blood away from the baby’s cut. Other mohelim use a sponge or sterile gauze pad to wipe the blood away. Unlike metzitzah b’peh, there is no evidence that any of these practices cause herpes infection.
Sincerely,
Susan Blank, MD, MPH Julia Schillinger, MD, MSc
Assistant Commissioner Director of Surveillance, Epidemiology, and Research
Bureau of Sexually Transmitted Disease Control
New York City Department of Health and Mental Hygiene
25 Worth Street
New York, NY 10013
1)Rubin LG, Lanzkowsky P. Cutaneous neonatal herpes simplex infection associated with ritual circumcision. Pediatric Infectious Diseases Journal. 2000. 19(3) 266-267.
2)Distel R, Hofer V, Bogger-Goren S, Shalit I, Garty BZ. Primary genital herpes simplex infection associated with Jewish ritual circumcision. Israel Medical Association Journal. 2003 Dec;5(12):893-4
3)Gesundheit B, Grisaru-Soen G, Greenberg D, Levtzion-Korach O, Malkin D, Petric M, Koren G, Tendler MD, Ben-Zeev B, Vardi A, Dagan R, Engelhard D. Neonatal genital herpes simplex virus type 1 infection after Jewish ritual circumcision: modern medicine and religious tradition. 2004. Pediatrics. 114(2):259-63
4)American Academy of Pediatrics. Herpes simplex. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003: 344-353.
5)Kimberlin DW. Neonatal Herpes Simplex Infection. Clinical Microbiology Reviews. 2004. 17 (1): 1-13.
Still real, still serious.
I received a message today from the New York City Department of Health and Mental Hygiene about metzitzah b'peh (MbP) and neonatal herpes, an issue that has been of concern for some months now. The complete message is below, but two points should be emphasized:
1. The New York City Department of Health recommends against the practice, but in any case suggests that parents be told before the bris if MbP is to be used, so that they can make an informed decision.
2. DOH has also prepared an "open letter to the Jewish community" on the issue.
The message also reviews the steadily accumulating evidence supporting the earlier fear that one mohel was behind the cases of neonatal herpes associated with MbP.
* * *
Dear Colleagues:
You may have heard about the Health Department’s recent investigation of several cases of herpes simplex type 1 infection in male infants following circumcision which included metzitzah b’peh.
Metzitzah b’peh is a practice performed by some mohelim (religious circumcisers) as part of the circumcision. After removing the foreskin, the mohel places his mouth on the baby’s freshly circumcised penis to draw away the blood. In 1998, the Health Department investigated two cases of neonatal herpes due to herpes simplex virus type 1 (HSV-1) – one of these infections occurred in 1988, the other in 1998. Both were associated with one mohel (Mohel A) who performed metzitzah b’peh during circumcision. Mohel A agreed to stop practicing metzitzah b’peh.
In November 2004, the Health Department was notified of 3 male infants with HSV-1. All were circumcised by one mohel (Mohel B), who performed metzitzah b’peh. The infants developed herpes infection in the genital area 8-10 days after circumcision and were hospitalized for several weeks. One baby died from the infection. Two cases were reported by physicians in 2005 and both are also consistent with infection from metzitzah b’peh. Every case occurred in the time frame consistent with transmission from metzitzah b’peh.
Our investigation found Mohel B to be the source of the 2004 cases, and metzitzah b’peh to be the means of infection for these and other cases, for the following reasons:
• The medical circumstances are inconsistent with infection acquired at delivery, in the newborn nursery, or from caretakers.
• Infection is consistent with acquisition of herpes at circumcision. For example, two infants who were circumcised several weeks after birth showed signs of infection in the time frame that would be expected were the infection acquired during circumcision.
• Several mothers tested negative for HSV-1, making it impossible for them to have been the source of infection.
• All infants tested culture-positive for HSV-1, which is found in the mouths of most adults.
• The location of herpes sores (on infant genitals and buttocks) is very unusual and strongly suggests that infection was introduced at the genitals.
With an estimated average of fewer than 30 cases of all forms of infant herpes infections occurring per year in New York City, the odds of one mohel being associated with 3 cases of neonatal herpes are infinitesimally small (about 6.9 million to 1). In the interest of allowing religious communities to address these health concerns first, the Health Department agreed to let rabbinical authorities ensure that the mohel stopped performing the practice at least until the authorities conclude an investigation. In addition, the connection between metzitzah b’peh and neonatal herpes has been documented in the medical literature. Three investigations published within the past 5 years (from New York City [1], Israel [2, 3] and Canada[3]) describe 11 cases of males with HSV-1 infections on their genitals following metzitzah b’peh. Among the 11 cases, there are 4 pairs of cases (including the 1988/1998 cases from New York City).
In the United States, approximately 70% of persons age 40 and older are infected with herpes simplex virus type 1. The mouth is the most common site of HSV-1 infection; HSV-1 spreads easily through infected saliva, especially when saliva comes in contact with a cut or break in the skin, such as occurs during metzitzah b’peh. Most adults with oral herpes do not know they are infected and do not have symptoms. Even without symptoms, however, people with oral herpes can spread the infection to others. If herpes lesions are present, they tend to occur (and recur) on the skin or mucous membranes at the site at which infection was introduced or in related dermatomes. HSV-1 infection is lifelong; antibody is evidence of infection.
Evaluation and management of an infant with suspected neonatal herpes infection
Infants in the first 6-8 weeks of life suspected of having herpes infections should always be hospitalized and treated with intravenous acyclovir [4, 5], a lumbar puncture should be performed at admission, and the infant should be managed in consultation with a pediatric infectious disease specialist. Herpes infection of the skin/eye/mucous membranes may progress to disseminated disease or central nervous system (CNS) infection. Infants with disseminated or CNS infection are at significant risk for death or serious sequelae even with treatment.
For infants suspected of having herpes infection, cultures should always be done on skin vesicles if present. Other sites that may yield positive cultures and should be cultured include blood, nasopharynx, anorectum, conjunctivae, urine, and stool. Direct fluorescent antibody (DFA) staining, if available, may provide a rapid and specific diagnosis. The yield of culture and DFA from HSV skin vesicles is very good if specimens are properly collected. To collect a specimen from a vesicle, unroof or open the vesicle with a sterile needle or scalpel and vigorously rub or twist a sterile swab on the exposed base of the lesion. Use the swab to inoculate sterile viral transport medium and send immediately to the laboratory. Samples for DFA staining should be obtained in the same manner with the material from the lesion smeared onto a glass microscopic slide.
Cerebrospinal fluid (CSF) and blood specimens should be tested by polymerase chain reaction (PCR) for HSV-1 and herpes simplex virus type 2 (HSV-2). CSF cultures for HSV are usually negative in a patient with HSV encephalitis, so if a limited sample of CSF is available, PCR testing on the CSF should be done in preference to culture. Because of the passive transfer of maternal antibody, type-specific herpes serologic testing is not useful in making a herpes diagnosis in an infant unless maternal serologies are also done and are negative. Consult your institution’s clinical laboratory director to identify a laboratory licensed to perform viral culture and polymerase chain reaction for HSV-1 and HSV-2.
Reporting neonatal herpes cases to the Health Department
Up to 20% of neonatal herpes cases never develop skin lesions, so providers must maintain a high index of suspicion for herpes infection following circumcision which includes metzitzah b’peh. Providers should suspect herpes infection in male infants presenting with vesicular or pustular lesions on the genitals, perineum, buttocks, or related dermatomes in the weeks after circumcision, or, in any infant with fever or other signs of systemic illness in the weeks following circumcision.
New York City Health Code section 11.03(b) requires providers to report ‘unusual manifestations of disease. Providers should report all suspected cases of herpes occurring in the weeks following circumcision to the Health Department. Call 212-788-4423 and ask for the ‘neonatal herpes desk’. After hours call the Poison Control Center at 1-800-222-1222.
Health Department Recommendations with Regard to Metzitzah B’peh
The Health Department has issued an open letter to the Jewish community regarding the recent cases of neonatal herpes linked to metzitzah b’peh and the risk of HSV-1 transmission with metzitzah b’peh, and has developed a fact sheet to inform parents about this public health issue which will be available online and through 311 in English, Yiddish and Hebrew.
During metzitzah b’peh the mouth of the mohel comes into direct contact with the baby’s circumcision cut, risking transmission of herpes simplex virus to the infant. While severe illness associated with this practice may be rare, because there is no proven way to reduce the risk of herpes infection posed by metzitzah b’peh, the Health Department advises against this practice. Some parents whose infants had metzitzah b’peh say they did not know in advance that the mohel would perform it. The Health Department advises parents to ask the mohel several days in advance of the bris whether he performs metzitzah b’peh. This offers parents a chance to weigh the risks of metzitzah b’peh and choose another option if they wish. While some mohelim consider metzitzah b’peh the only acceptable way to draw blood away from the circumcision cut, others use different means. For example, a mohel may use a sterile glass tube or a glass tube attached to a rubber bulb to suction the blood away from the baby’s cut. Other mohelim use a sponge or sterile gauze pad to wipe the blood away. Unlike metzitzah b’peh, there is no evidence that any of these practices cause herpes infection.
Sincerely,
Susan Blank, MD, MPH Julia Schillinger, MD, MSc
Assistant Commissioner Director of Surveillance, Epidemiology, and Research
Bureau of Sexually Transmitted Disease Control
New York City Department of Health and Mental Hygiene
25 Worth Street
New York, NY 10013
1)Rubin LG, Lanzkowsky P. Cutaneous neonatal herpes simplex infection associated with ritual circumcision. Pediatric Infectious Diseases Journal. 2000. 19(3) 266-267.
2)Distel R, Hofer V, Bogger-Goren S, Shalit I, Garty BZ. Primary genital herpes simplex infection associated with Jewish ritual circumcision. Israel Medical Association Journal. 2003 Dec;5(12):893-4
3)Gesundheit B, Grisaru-Soen G, Greenberg D, Levtzion-Korach O, Malkin D, Petric M, Koren G, Tendler MD, Ben-Zeev B, Vardi A, Dagan R, Engelhard D. Neonatal genital herpes simplex virus type 1 infection after Jewish ritual circumcision: modern medicine and religious tradition. 2004. Pediatrics. 114(2):259-63
4)American Academy of Pediatrics. Herpes simplex. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003: 344-353.
5)Kimberlin DW. Neonatal Herpes Simplex Infection. Clinical Microbiology Reviews. 2004. 17 (1): 1-13.
12/5/05
Lipa-logy: Or, in which a reader does my research
Just like the big-name blogs!
Cut-n-pasted from an e-mail. No editing, no effort . . .
Just like the big-name blogs!
Cut-n-pasted from an e-mail. No editing, no effort . . .
Zackary,
A Google search on Lipa Schmeltzer unearthed a post of yours from this time last year.Truth be told, I myself, was not too much into either FJM (Frum Jewish Music) in general or Lipa Schmeltzer in particular until last week when someone showed me a clip of Lipa's Hebrew Academy For Special Children (HASC) 2005 concert video performance. Lipa did a Yiddish sendup of "The Lion Sleeps Tonight".
The song, as you may know, started life in 1939 in South Africa as Solomon Linda's "Mbube", was recast as "Wimoweh" by the Weavers in 1950, as the immortal, international chart-topping "The Lion Sleeps Tonight" by the Tokens in 1961 and from there, after many re-recordings finally made it into the epic Lion King. However, arguably it did not reach its true destiny until it got its first Yiddish rendition.While Lipa's version hues musically to the original, lyrically it does not. Interestingly though, the lyrics give two nods to the original. Suggestively, perhaps, the chorus "A-wee-ma-way" becomes the vaguely rhyming "Abi Me'Leibt" and more persuasively, the phrase "The Lion Sleeps Tonight" makes a cameo appearance in a scene at Penn Station.
In 2004 Lipa did a special rendition of "Gelt" for the HASC concert and both that performance and his "Abi Me'leibt" can be seen here. Additionally the "Abi Me'Leibt" video [can be seen here]. As something of an after-thought, if you wish, you may certainly use any of the above material for your blog, if you see fit, in which case I would prefer anonymity.
Birobidzhan dot gov
Random observations:
1. I don't see the name Birobizhan anywhere. The official abbreviation is now "JAR" (Jewish Autonomous Region). The title of the web site is written in Funky Jewish (or whatever that faux-Hebrew font is called). No Yiddish on the site.
. . . oh, wait. Mistake. Birobidzhan is the name of the main city, while the JAR is the name of the region. I think I knew that.
2. If anyone would like to further muse on the evil conspiracy between Yiddishists and gays-and-lesbians, feel free to note that the flag of the JAR features a rainbow stripe.
With regard to the region's heraldry [!], the following is noted: "The figure of the tiger is turned to the right toward a viewer that symbolizes an unusual history and original way of the Region’s development." "Unusual" and "original" is certainly one way to put it. ("Deportation" might be another, but let's not split hairs.)
3. In the matter of religious observance in the JAR, the site states:
Random observations:
1. I don't see the name Birobizhan anywhere. The official abbreviation is now "JAR" (Jewish Autonomous Region). The title of the web site is written in Funky Jewish (or whatever that faux-Hebrew font is called). No Yiddish on the site.
. . . oh, wait. Mistake. Birobidzhan is the name of the main city, while the JAR is the name of the region. I think I knew that.
2. If anyone would like to further muse on the evil conspiracy between Yiddishists and gays-and-lesbians, feel free to note that the flag of the JAR features a rainbow stripe.
With regard to the region's heraldry [!], the following is noted: "The figure of the tiger is turned to the right toward a viewer that symbolizes an unusual history and original way of the Region’s development." "Unusual" and "original" is certainly one way to put it. ("Deportation" might be another, but let's not split hairs.)
3. In the matter of religious observance in the JAR, the site states:
On January 1, 2003 in the region 27 registered religious organizations have been acted. The leading position belongs to Russian Orthodox Church (ROC) of the Moscow Patriarchy. Ten parishes of ROC function on the territory of the region. Two Judaic communities actively work also. Besides, there are several Protestant religious organizations.
12/1/05
No longer confused, not yet overwhelmed
After a year of my medical-student ramblings, what have I learned?
MEDICINE MENSCH: Taking Stock
By Zackary Sholem Berger
December 2, 2005
There's a joke about travel writers turning experiences abroad into publishable material. Spend two months in China, say, and you can write a book; spend two years, and you can write an article. But spend 20 years, and you find you can't write anything at all. I feel the same way about the past year of being a medical student. Every day is packed with thousands of stories. Every patient is an epic unto herself. The first few months of being a medical student were an encounter with the world of the hospital. In such a first encounter (with a new book, a new person, a new language), you can ignore the occasional troubling aside and focus on the big picture. But as you get used to things, you can't avoid the episodes that are harder to talk about.
As a beginning medical student, I was mostly confused. As a fourth-year student who's just completed his sub-internship (a sort of pre-residency), I've become less confused and more intimately involved in the contradictions of the hospital. Once I become a resident, I might become too overwhelmed by life and death to write at all. Now, at the end of this column's first year, I thought I should take stock of my reactions to what I've seen. "Love" and "hate" are the first words that come to mind for many things I've encountered this past year. Sometimes I hate and love the same thing in succession.
I hate going into rooms of people who are very sick. They lie in their beds, staring at the wall. What's the right thing to say to them? Most of the time, as little as possible: I already know this from visiting the sick as a layperson. But as a doctor-in-the-making, I'm no longer someone who visits the sick. I now intrude on them for their own good, asking them questions they would rather not answer and viewing their bodies in ways that they never would countenance when healthy. While I try to build rapport, strengthening the doctor-patient relationship through our basic human connection, more often than not our conversation doesn't exceed the bare minimum. I need to get my work done; they need to get their rest. So I leave the room feeling guilty, while they lie there feeling no healthier than before.
At the same time, there are patients I come to love even though I know them only slightly. An older, frum woman was admitted with pneumonia. The admitting team described her as demented. According to the technical meaning of the term, this was correct: She suffers from a constant, progressive decline in cognitive function. But too many assume that the demented patient is childlike, not deserving of the respect we would give anyone outside the hospital. I've seen more than one demented old woman called "sweetie," more than one writhing figure in the step-down unit called "nonverbal" while he's screaming in Yiddish for people to leave him alone. It takes extra effort to listen.
I walked into this woman's room last Tuesday and asked her how she was. She said something incomprehensible, and I bent closer to hear. "What's that?" I said, a trifle impatiently. "Ki tov," she said. "It's the day of ki tov." It was Tuesday, the third day, the day that God called good twice. I cried at that — not so anyone would see, of course. I loved that patient even though I didn't know her at all, because she had said something heartening.
I dislike walking the halls in a long white coat, hearing people call me "Doctor," running into relatives and families hungry for information that I don't have or can't give them. I am the "doctor figure" in whom they find comfort, even though there might be nothing I can do at the moment. At the same time, I try to tell them what I can — even if it's only the simplest details of the imaging study that's about to be performed or the tests that are about to be drawn.
There are other reactions that cannot be stopped and break into my best intentions like a freight train. At 5:30 in the evening on the last day of my sub-internship, half an hour before I was due to sign out to the night intern, I was called by a nurse who told me that over the past few hours a patient had become short of breath and incoherent. My first thought, you'll understand, was not, "Let's see what we can do to help this poor man." It was, "Why couldn't he have waited half an hour?"
But I drew the tests, asked the nurse for an EKG and took the man down for a CAT scan. We tried to figure out what the matter was, piece by piece. Maybe I've begun to acquire the everyday discipline that is more important than the drive to do good. Even if it's half an hour before you're due to go home, you go do what you're supposed to. (With your resident, or whoever your boss might be, providing a little push.)
I got into the elevator to go home, and a religious Jewish couple, seeing my yarmulke, gave me a smile. "What a Kiddush HaShem," they said, using the term for an act or person that shows Jews in a favorable light. I didn't feel like I had been sanctifying God's name — I was just learning how to do my job. Do the two overlap? We'll see.
Zackary Sholem Berger isn't a doctor yet. Complaints about how long it's taking should be sent to doctor@forward.com.
After a year of my medical-student ramblings, what have I learned?
MEDICINE MENSCH: Taking Stock
By Zackary Sholem Berger
December 2, 2005
There's a joke about travel writers turning experiences abroad into publishable material. Spend two months in China, say, and you can write a book; spend two years, and you can write an article. But spend 20 years, and you find you can't write anything at all. I feel the same way about the past year of being a medical student. Every day is packed with thousands of stories. Every patient is an epic unto herself. The first few months of being a medical student were an encounter with the world of the hospital. In such a first encounter (with a new book, a new person, a new language), you can ignore the occasional troubling aside and focus on the big picture. But as you get used to things, you can't avoid the episodes that are harder to talk about.
As a beginning medical student, I was mostly confused. As a fourth-year student who's just completed his sub-internship (a sort of pre-residency), I've become less confused and more intimately involved in the contradictions of the hospital. Once I become a resident, I might become too overwhelmed by life and death to write at all. Now, at the end of this column's first year, I thought I should take stock of my reactions to what I've seen. "Love" and "hate" are the first words that come to mind for many things I've encountered this past year. Sometimes I hate and love the same thing in succession.
I hate going into rooms of people who are very sick. They lie in their beds, staring at the wall. What's the right thing to say to them? Most of the time, as little as possible: I already know this from visiting the sick as a layperson. But as a doctor-in-the-making, I'm no longer someone who visits the sick. I now intrude on them for their own good, asking them questions they would rather not answer and viewing their bodies in ways that they never would countenance when healthy. While I try to build rapport, strengthening the doctor-patient relationship through our basic human connection, more often than not our conversation doesn't exceed the bare minimum. I need to get my work done; they need to get their rest. So I leave the room feeling guilty, while they lie there feeling no healthier than before.
At the same time, there are patients I come to love even though I know them only slightly. An older, frum woman was admitted with pneumonia. The admitting team described her as demented. According to the technical meaning of the term, this was correct: She suffers from a constant, progressive decline in cognitive function. But too many assume that the demented patient is childlike, not deserving of the respect we would give anyone outside the hospital. I've seen more than one demented old woman called "sweetie," more than one writhing figure in the step-down unit called "nonverbal" while he's screaming in Yiddish for people to leave him alone. It takes extra effort to listen.
I walked into this woman's room last Tuesday and asked her how she was. She said something incomprehensible, and I bent closer to hear. "What's that?" I said, a trifle impatiently. "Ki tov," she said. "It's the day of ki tov." It was Tuesday, the third day, the day that God called good twice. I cried at that — not so anyone would see, of course. I loved that patient even though I didn't know her at all, because she had said something heartening.
I dislike walking the halls in a long white coat, hearing people call me "Doctor," running into relatives and families hungry for information that I don't have or can't give them. I am the "doctor figure" in whom they find comfort, even though there might be nothing I can do at the moment. At the same time, I try to tell them what I can — even if it's only the simplest details of the imaging study that's about to be performed or the tests that are about to be drawn.
There are other reactions that cannot be stopped and break into my best intentions like a freight train. At 5:30 in the evening on the last day of my sub-internship, half an hour before I was due to sign out to the night intern, I was called by a nurse who told me that over the past few hours a patient had become short of breath and incoherent. My first thought, you'll understand, was not, "Let's see what we can do to help this poor man." It was, "Why couldn't he have waited half an hour?"
But I drew the tests, asked the nurse for an EKG and took the man down for a CAT scan. We tried to figure out what the matter was, piece by piece. Maybe I've begun to acquire the everyday discipline that is more important than the drive to do good. Even if it's half an hour before you're due to go home, you go do what you're supposed to. (With your resident, or whoever your boss might be, providing a little push.)
I got into the elevator to go home, and a religious Jewish couple, seeing my yarmulke, gave me a smile. "What a Kiddush HaShem," they said, using the term for an act or person that shows Jews in a favorable light. I didn't feel like I had been sanctifying God's name — I was just learning how to do my job. Do the two overlap? We'll see.
Zackary Sholem Berger isn't a doctor yet. Complaints about how long it's taking should be sent to doctor@forward.com.
11/20/05
Dreidel maximization
I'm not a genius at math, but I was sitting with a couple of friends who are naturally gifted. They are not Jewish, and I was explaining to them how one plays dreidel. (Or "the dreidel game," as most Googlable references seem to call it.) They started talking about how one could do best at it.
That is, how should one set about to win the most money through dreidel? (That not being the point of the game, but never mind about that for now.) Game theory generally involves maximizing expected earnings through decision making; the problem with dreidel is that precious little decision is involved. Let's try and describe the game and then see what variables one might be able to play with to tweak the expectations.
The four possible dreidel outcomes, together with what happens to one's earnings, go more or less like this:
N (nun): {null}
G (gimel): +x
H (hey): +x/2
Sh (shin): -2R
You get x (the size of the pot) if the dreidel lands on gimel, and 1/2x (half the pot) if it lands on hey; if the dreidel lands on shin, you put in some ante (usually an even number, in my experience), hence 2R.
Some simple things even people like me can see straight off. The first is that your earnings from gimel and hey depend on how much there is in the pot. That is, x changes with the progression of the game, so I really should have written it as a function of time, f(t,x). But that would be getting ridiculous.
One way of thinking would be that to maximize your earnings you should sit as far away from the luckiest (or craftiest) dreidelist as possible, so that the pot has a chance to fill up again after he or she spins his out-of-proportion gimels.
Another simple observation is that the relative "influences" on the game of gimel, hey, and shin depend on how much the ante is. If there's only a finite supply of money (or peanuts, raisins, or whatever currency you've chosen) available to the player, and 2R (the size of the ante required when Shin is spun) is a considerable fraction of that supply, then one shin can lay you low no matter how many nuns or gimels you've gotten.
One way of modifying the game might be to make the shin-ante (R) vary with the number of players, the size of the pot as it stands, or the time elapsed.
Or not. 35 days till Chanukah.
PS: Of course, a real mathematician has made some progress on the problem. He has conjectured, based on some simple simulations, that the length of a two-person dreidel game is on the order of the square of the number of nuts (or whatever tokens are used), and the length of a k-person game -- on the order of that number of tokens to the kth power.
I'm not a genius at math, but I was sitting with a couple of friends who are naturally gifted. They are not Jewish, and I was explaining to them how one plays dreidel. (Or "the dreidel game," as most Googlable references seem to call it.) They started talking about how one could do best at it.
That is, how should one set about to win the most money through dreidel? (That not being the point of the game, but never mind about that for now.) Game theory generally involves maximizing expected earnings through decision making; the problem with dreidel is that precious little decision is involved. Let's try and describe the game and then see what variables one might be able to play with to tweak the expectations.
The four possible dreidel outcomes, together with what happens to one's earnings, go more or less like this:
N (nun): {null}
G (gimel): +x
H (hey): +x/2
Sh (shin): -2R
You get x (the size of the pot) if the dreidel lands on gimel, and 1/2x (half the pot) if it lands on hey; if the dreidel lands on shin, you put in some ante (usually an even number, in my experience), hence 2R.
Some simple things even people like me can see straight off. The first is that your earnings from gimel and hey depend on how much there is in the pot. That is, x changes with the progression of the game, so I really should have written it as a function of time, f(t,x). But that would be getting ridiculous.
One way of thinking would be that to maximize your earnings you should sit as far away from the luckiest (or craftiest) dreidelist as possible, so that the pot has a chance to fill up again after he or she spins his out-of-proportion gimels.
Another simple observation is that the relative "influences" on the game of gimel, hey, and shin depend on how much the ante is. If there's only a finite supply of money (or peanuts, raisins, or whatever currency you've chosen) available to the player, and 2R (the size of the ante required when Shin is spun) is a considerable fraction of that supply, then one shin can lay you low no matter how many nuns or gimels you've gotten.
One way of modifying the game might be to make the shin-ante (R) vary with the number of players, the size of the pot as it stands, or the time elapsed.
Or not. 35 days till Chanukah.
PS: Of course, a real mathematician has made some progress on the problem. He has conjectured, based on some simple simulations, that the length of a two-person dreidel game is on the order of the square of the number of nuts (or whatever tokens are used), and the length of a k-person game -- on the order of that number of tokens to the kth power.
11/13/05
Para-rabbis and PAs
"Totem pole": descriptive, not prescriptive.
MEDICINE MENSCH: What Little I Know About Medicine
By Zackary Sholem Berger
November 11, 2005
I thought I would title this month's column "What I Don't Know About Medicine," but my editors want 800 words, not an encyclopedia. What I do know about medicine should fit nicely into the space allotted.
The rotation I'm starting this week is known in hospital jargon as the sub-internship; the registrar's office calls it "advanced medicine." In this rotation the medical student plays the role of an intern, a first-year resident. He can write orders on the computer, decide on a course of treatment and prescribe medications — all with the co-signature of a supervisor, of course. The main thing is that the student manages his own list of patients. In other words, I won't be following a resident around anymore; I will be a resident.
More precisely, I'll be pretending to be a resident. That's the catch of this rotation — it's the adolescence of medical education, in which one is something more than a senior student but something less than an intern. How much like an intern will I be? If one reasons by similarity of activity (lack of sleep; independent decision-making on behalf of actual patients), I could very well call myself the intern. Could I walk into my patient's room and say, "I'm Dr. Berger, and I'll be taking care of you during your stay in the hospital?" The second half of this statement is definitely true, but the first part (with "Dr.") isn't quite. I won't have my medical degree until my graduation in May 2006, and I won't have a license to practice medicine until I finish my boards, which stretch from now (while I'm still a medical student) until the end of my residency.
On this rotation, I don't plan to introduce myself as "Doctor" (that would be quite a stretch), but I understand why some of my colleagues would. While many patients don't understand the difference between senior medical students, interns, residents, fellows and attending physicians, they come to appreciate something of the hierarchy during their hospital stay. One thing soon becomes clear to them: Medical students are at the bottom of the totem pole of health care providers. (Or almost at the bottom —more on that subject, below.) If a sub-intern walks into a patient's room and starts out by saying, "My name's Joseph Brighteyes, I'm a medical student, and I'm here to take care of you," the patient is likely to respond, "That's great, Joe, but who's going to be my doctor?"
Is qualification defined more by knowledge or by capability? This larger question comes up when talking about the thousands of people whose elbow grease makes a big hospital run as smoothly as it can. Even lower on the pole than the medical student is the physician assistant. P.A.s train for fewer years than medical students, so they often get less respect from folks in medical academia. But in every rotation where, as a medical student, I've worked together with P.A.s or P.A. students, they have seemed more on the ball than the medical students — not as over-theoretically concerned with fascinating disease entities and more knowledgeable about what might immediately help the patient. Part of the reason is that the P.A. student spends more time in her early training (most P.A.s I've met are women) familiarizing herself with the way things actually are in the uncompromisingly practical universe of the hospital or clinic. Perhaps P.A.s can't name 12 different kinds of small-vessel disease. (I'm making up that number; I certainly can't name them, either — not off the top of my head.) But such encyclopedic knowledge is sometimes transcended, or rendered irrelevant, by practical considerations. On the other hand, you don't want to miss the rare diseases when they do pop up. So both kinds of training (practical and theoretical encyclopedic) are essential, even complementary. The trick is to appreciate both kinds of thinking at the same time, even though most people find one of them more congenial than the other.
A similar divide is evident in the Jewish tradition, especially with regard to Torah study. In previous generations — and even today in some circles — memorizing vast tracts of the Talmud is a prized skill. On the other hand, if you've dipped into any of the Talmud, you know that it takes considerable exegetical ingenuity to derive laws applicable to everyday life from the rich stew of magic, folklore, intellectual speculation, casual yeshiva talk and campfire tales about the destroyed Temple. (Even the strict constructionists, those who actually bury their fingernail clippings according to the magical practice of the rabbis, still have to exercise creativity in deriving everyday religious practice from Babylonian-Jewish digression.) The two skills — encyclopedic knowledge of the Talmud and the ability to apply the Talmud to everyday religious life — are complementary, but rarely are found in the same person. Many of the greatest talmudic scholars have famously refused to adjudicate Jewish law, protesting that they could see all sides of any issue.
Today's Jewish communities rely very much on what some people call "para-rabbis" — people who aren't religious scholars but are reliable, even expert, in the details of daily practice. You might have met some of them: the guy who knows everything about building a sukkah; the woman who is obsessed with reading Torah; the member of the local synagogue who knows exactly how to help a recently bereaved family.
In other words, Jews (at least religious Jews) depend on "rabbis' assistants." In the same way, a hospital must cobble together a vast number of people who have different abilities. Some sit in offices and absorb themselves in the study of disorders affecting 10 people in the entire world, while others, down amid the gore in the E.R., can contradict those same scholars with absolute certainty if they see in front of them a practical problem they know how to solve quickly and effectively.
Bit by bit, I hope to amass both kinds of knowledge till I can be considered a doctor (a learned person, according to the word's historical meaning) in at least one of these categories. But no matter what, there always will be plenty of material for my upcoming masterwork, "What Zack Berger Doesn't Know." I look forward to doing the research.
Zackary Sholem Berger is becoming a doctor, hour by sleepless hour. Feel free to write him about it at doctor@forward.com.
"Totem pole": descriptive, not prescriptive.
MEDICINE MENSCH: What Little I Know About Medicine
By Zackary Sholem Berger
November 11, 2005
I thought I would title this month's column "What I Don't Know About Medicine," but my editors want 800 words, not an encyclopedia. What I do know about medicine should fit nicely into the space allotted.
The rotation I'm starting this week is known in hospital jargon as the sub-internship; the registrar's office calls it "advanced medicine." In this rotation the medical student plays the role of an intern, a first-year resident. He can write orders on the computer, decide on a course of treatment and prescribe medications — all with the co-signature of a supervisor, of course. The main thing is that the student manages his own list of patients. In other words, I won't be following a resident around anymore; I will be a resident.
More precisely, I'll be pretending to be a resident. That's the catch of this rotation — it's the adolescence of medical education, in which one is something more than a senior student but something less than an intern. How much like an intern will I be? If one reasons by similarity of activity (lack of sleep; independent decision-making on behalf of actual patients), I could very well call myself the intern. Could I walk into my patient's room and say, "I'm Dr. Berger, and I'll be taking care of you during your stay in the hospital?" The second half of this statement is definitely true, but the first part (with "Dr.") isn't quite. I won't have my medical degree until my graduation in May 2006, and I won't have a license to practice medicine until I finish my boards, which stretch from now (while I'm still a medical student) until the end of my residency.
On this rotation, I don't plan to introduce myself as "Doctor" (that would be quite a stretch), but I understand why some of my colleagues would. While many patients don't understand the difference between senior medical students, interns, residents, fellows and attending physicians, they come to appreciate something of the hierarchy during their hospital stay. One thing soon becomes clear to them: Medical students are at the bottom of the totem pole of health care providers. (Or almost at the bottom —more on that subject, below.) If a sub-intern walks into a patient's room and starts out by saying, "My name's Joseph Brighteyes, I'm a medical student, and I'm here to take care of you," the patient is likely to respond, "That's great, Joe, but who's going to be my doctor?"
Is qualification defined more by knowledge or by capability? This larger question comes up when talking about the thousands of people whose elbow grease makes a big hospital run as smoothly as it can. Even lower on the pole than the medical student is the physician assistant. P.A.s train for fewer years than medical students, so they often get less respect from folks in medical academia. But in every rotation where, as a medical student, I've worked together with P.A.s or P.A. students, they have seemed more on the ball than the medical students — not as over-theoretically concerned with fascinating disease entities and more knowledgeable about what might immediately help the patient. Part of the reason is that the P.A. student spends more time in her early training (most P.A.s I've met are women) familiarizing herself with the way things actually are in the uncompromisingly practical universe of the hospital or clinic. Perhaps P.A.s can't name 12 different kinds of small-vessel disease. (I'm making up that number; I certainly can't name them, either — not off the top of my head.) But such encyclopedic knowledge is sometimes transcended, or rendered irrelevant, by practical considerations. On the other hand, you don't want to miss the rare diseases when they do pop up. So both kinds of training (practical and theoretical encyclopedic) are essential, even complementary. The trick is to appreciate both kinds of thinking at the same time, even though most people find one of them more congenial than the other.
A similar divide is evident in the Jewish tradition, especially with regard to Torah study. In previous generations — and even today in some circles — memorizing vast tracts of the Talmud is a prized skill. On the other hand, if you've dipped into any of the Talmud, you know that it takes considerable exegetical ingenuity to derive laws applicable to everyday life from the rich stew of magic, folklore, intellectual speculation, casual yeshiva talk and campfire tales about the destroyed Temple. (Even the strict constructionists, those who actually bury their fingernail clippings according to the magical practice of the rabbis, still have to exercise creativity in deriving everyday religious practice from Babylonian-Jewish digression.) The two skills — encyclopedic knowledge of the Talmud and the ability to apply the Talmud to everyday religious life — are complementary, but rarely are found in the same person. Many of the greatest talmudic scholars have famously refused to adjudicate Jewish law, protesting that they could see all sides of any issue.
Today's Jewish communities rely very much on what some people call "para-rabbis" — people who aren't religious scholars but are reliable, even expert, in the details of daily practice. You might have met some of them: the guy who knows everything about building a sukkah; the woman who is obsessed with reading Torah; the member of the local synagogue who knows exactly how to help a recently bereaved family.
In other words, Jews (at least religious Jews) depend on "rabbis' assistants." In the same way, a hospital must cobble together a vast number of people who have different abilities. Some sit in offices and absorb themselves in the study of disorders affecting 10 people in the entire world, while others, down amid the gore in the E.R., can contradict those same scholars with absolute certainty if they see in front of them a practical problem they know how to solve quickly and effectively.
Bit by bit, I hope to amass both kinds of knowledge till I can be considered a doctor (a learned person, according to the word's historical meaning) in at least one of these categories. But no matter what, there always will be plenty of material for my upcoming masterwork, "What Zack Berger Doesn't Know." I look forward to doing the research.
Zackary Sholem Berger is becoming a doctor, hour by sleepless hour. Feel free to write him about it at doctor@forward.com.
10/23/05
What a commentary means
We read Ecclesiastes (Koheles) this past Shabbos. Some read it (or heard it read) in a synagogue, others read it out loud to a two-year-old while she ran around the house babbling to herself. To each their own.
I read it from the Biblica Hebraica Stuttgartensia. When I'm studying part of the Tanakh which I find obscure, or full of impenetrable vocabulary, I often go to the BHS to find which variations in the Masoretic texts might explain a difficult word. This is one difference between, say, BHS and the traditional commentators. The latter explain why the text is the way it is. Historical-critical study of the Bible, on the other hand, often tries to suggest enmendations which help make better sense of the text. (The two sorts of commentary overlap, of course -- traditional commentators often suggest enmendations, though in a different language than modern critics; and Biblical critics for their part often use a literary approach which owes a lot to their traditional forerunners.) To put it very broadly: the BHS is critical while traditional commentary is aesthetic.
But is this really the case? Any resolution suggested by the BHS to a difficulty it points out must be judged on an individual basis. Some of these suggestions (based on alternative manuscripts and words in Akkadian) I can nod my head at and understand passively, but can't criticize with a firm base of knowledge, since Biblical criticism isn't my day (or night) job. On the other hand, when BHS makes a suggestion about the plausibility of one reading over another, I can say yea or nay more confidently. Then we're in the realm of aesthetics, where I feel more equipped with appropriate criteria.
In Ecclesiastes 1:15 it's said (King James translation) "That which is crooked cannot be made straight: and that which is wanting cannot be numbered." In the original: מעות לא־יוכל לתקן וחסרון לא־יוכל להמנות. On the last word (le-himonoys), which means "to be numbered," BHS says: "prp להמלות (cf bBer 16b)". In BHSese, this means "It has been proposed that the alternative reading "cannot be replenished" is more plausible; compare the reference in the Babylonian Talmud, Berachot 16b."
Now, once there, you won't find any reference to Ecclesiastes. This is what you'll find (from an on-line version of the Soncino translation):
The Hebrew of the relevant phrase above ("May the Almighty replenish your loss") is המקום ימלא חסרונך, where the noun for "loss" is the same as that in the Ecclesiastes verse, and the verb is the same as the one suggested by the BHS enmendation.
The question is: what criteria would one use to accept or reject this suggestion? The Talmud was not composed at the same time as Koheles, so what is the reference to the Talmudic tractate meant to show? We know that lashon mikra (the language of the Tanakh) and lashon Chazal (the language of the Talmud and associated texts) are not at all the same.
Perhaps the reference is merely meant to show that the phrase "חסרונות . . . להמלות" is plausible -- i.e. that it makes aesthetic sense. And in that sense, I'm convinced.
We read Ecclesiastes (Koheles) this past Shabbos. Some read it (or heard it read) in a synagogue, others read it out loud to a two-year-old while she ran around the house babbling to herself. To each their own.
I read it from the Biblica Hebraica Stuttgartensia. When I'm studying part of the Tanakh which I find obscure, or full of impenetrable vocabulary, I often go to the BHS to find which variations in the Masoretic texts might explain a difficult word. This is one difference between, say, BHS and the traditional commentators. The latter explain why the text is the way it is. Historical-critical study of the Bible, on the other hand, often tries to suggest enmendations which help make better sense of the text. (The two sorts of commentary overlap, of course -- traditional commentators often suggest enmendations, though in a different language than modern critics; and Biblical critics for their part often use a literary approach which owes a lot to their traditional forerunners.) To put it very broadly: the BHS is critical while traditional commentary is aesthetic.
But is this really the case? Any resolution suggested by the BHS to a difficulty it points out must be judged on an individual basis. Some of these suggestions (based on alternative manuscripts and words in Akkadian) I can nod my head at and understand passively, but can't criticize with a firm base of knowledge, since Biblical criticism isn't my day (or night) job. On the other hand, when BHS makes a suggestion about the plausibility of one reading over another, I can say yea or nay more confidently. Then we're in the realm of aesthetics, where I feel more equipped with appropriate criteria.
In Ecclesiastes 1:15 it's said (King James translation) "That which is crooked cannot be made straight: and that which is wanting cannot be numbered." In the original: מעות לא־יוכל לתקן וחסרון לא־יוכל להמנות. On the last word (le-himonoys), which means "to be numbered," BHS says: "prp להמלות (cf bBer 16b)". In BHSese, this means "It has been proposed that the alternative reading "cannot be replenished" is more plausible; compare the reference in the Babylonian Talmud, Berachot 16b."
Now, once there, you won't find any reference to Ecclesiastes. This is what you'll find (from an on-line version of the Soncino translation):
WHEN TABI HIS SLAVE DIED etc. Our Rabbis taught: For male and female slaves no row [of comforters] is formed, nor is the blessing of mourners said, nor is condolence offered. When the bondwoman of R. Eliezer died, his disciples went in to condole with him. When he saw them he went up to an upper chamber, but they went up after him. He then went into an ante-room and they followed him there. He then went into the dining hall and they followed him there. He said to them: I thought that you would be scalded with warm water; I see you are not scalded even with boiling hot water. Have I not taught you that a row of comforters is not made for male and female slaves, and that a blessing of mourners is not said for them, nor is condolence offered for them? What then do they say for them? The same as they say to a man for his ox and his ass: 'May the Almighty replenish your loss'. So for his male and female slave they say to him: 'May the Almighty replenish your loss'. It has been taught elsewhere: For male and female slaves no funeral oration is said. R. Jose said: If he was a good slave, they can say over him, Alas for a good and faithful man, who worked for his living! They said to him: If you do that, what do you leave for
free-born?
The Hebrew of the relevant phrase above ("May the Almighty replenish your loss") is המקום ימלא חסרונך, where the noun for "loss" is the same as that in the Ecclesiastes verse, and the verb is the same as the one suggested by the BHS enmendation.
The question is: what criteria would one use to accept or reject this suggestion? The Talmud was not composed at the same time as Koheles, so what is the reference to the Talmudic tractate meant to show? We know that lashon mikra (the language of the Tanakh) and lashon Chazal (the language of the Talmud and associated texts) are not at all the same.
Perhaps the reference is merely meant to show that the phrase "חסרונות . . . להמלות" is plausible -- i.e. that it makes aesthetic sense. And in that sense, I'm convinced.
10/13/05
Giggle-inducing machzor translations
Grand Prize.
A gut kvitl!
(Meaning: I hope your happiness, prosperity, and general bounty of Divine providence, signed and sealed upstairs this past Yom Kippur, are efficiently processed by the Upper Yeshiva's bureaucracy and legislated into law come Hoshannah Rabbah.)
I just wanted to comment on how unfortunate it is that the worst poem ever and the worst ever rhyming couplet (below) are both in machzorim of the Conservative movement.
Please turn to page 351 in your gray machzor:
A close second place (not a couplet, but would you really want a second line to this baby?):
Grand Prize.
A gut kvitl!
(Meaning: I hope your happiness, prosperity, and general bounty of Divine providence, signed and sealed upstairs this past Yom Kippur, are efficiently processed by the Upper Yeshiva's bureaucracy and legislated into law come Hoshannah Rabbah.)
I just wanted to comment on how unfortunate it is that the worst poem ever and the worst ever rhyming couplet (below) are both in machzorim of the Conservative movement.
Please turn to page 351 in your gray machzor:
Bandits have pursued me, fast and fleet
But none pursue me faster than my own feet.
A close second place (not a couplet, but would you really want a second line to this baby?):
My soul, my heart, and every inward part . . .
10/8/05
A happy, doubtful New Year from Katle Kanye
Saith the Yiddish blogmaster [my translation; read the whole post!]:
I don't have any answers [to these doubts], and I won't find any answer during the many holidays whose threshhold we're on now. On the first day of Selichot I hopped up on the wagon, and I'm riding until the end of Simchat Torah. Not because I want something, and not because I'm afraid that if I don't I stand to lose something. I can't say that I'm a willing passenger, but my fate is to go along for the ride. I won't justify it to myself by saying that it's the right path, but I'm still not jumping off. This is my portion from all my labors -- to look on as my traveling companions drag big bags of the four species and whole sukkahs, seeing only what's going on in the wagon, and I'm traveling lightweight and keep wanting to look out the window. I want to see who's pulling the wagon and who's driving the horses, and they just want to open their baggage, because they're so sure that the wagon will keep on going whatever happens. Will I stay till the end of the trip? For now I'm just happy that I'm not being thrown off.
Saith the Yiddish blogmaster [my translation; read the whole post!]:
I don't have any answers [to these doubts], and I won't find any answer during the many holidays whose threshhold we're on now. On the first day of Selichot I hopped up on the wagon, and I'm riding until the end of Simchat Torah. Not because I want something, and not because I'm afraid that if I don't I stand to lose something. I can't say that I'm a willing passenger, but my fate is to go along for the ride. I won't justify it to myself by saying that it's the right path, but I'm still not jumping off. This is my portion from all my labors -- to look on as my traveling companions drag big bags of the four species and whole sukkahs, seeing only what's going on in the wagon, and I'm traveling lightweight and keep wanting to look out the window. I want to see who's pulling the wagon and who's driving the horses, and they just want to open their baggage, because they're so sure that the wagon will keep on going whatever happens. Will I stay till the end of the trip? For now I'm just happy that I'm not being thrown off.
10/6/05
Get up!
Stand up for your rites.
MEDICINE MENSCH: Resetting the Spiritual Clock
By Zackary Sholem Berger
October 7, 2005
I've been getting up at five in the morning for the past two months. It would be nice if this new schedule granted me some insight into the human condition or the plight of the sick, but my observations are on a smaller scale.
A lot more people than you might think are up that early. On the way from my apartment building on the Lower East Side to my bus stop there's an unsavory-looking building that is shuttered during the day. When I stumble by at 5:45 in the morning, there's an improbably well-organized fruit stand out front, tables of oranges, apples and bananas under the streetlamps. The fruit seller is always wearing a T-shirt and shorts, no matter the weather. I say good morning to him, and to the MTA bus driver, but maybe it's the wrong thing to say — these people have been up for hours already and probably are ready to go to bed after their shift switch. "Sleep well" might be more appropriate. ("Sleep well" is something you never say to a medical resident, unless you're trying to taunt him.)
All the people getting to work at this hour can be divided into different subgroups, the most obvious being the 6 a.m. cell-phone talkers. (Who are they talking to? Other 6 a.m. cell-phone talkers, I guess.) There are those plugged into their iPods, the nurses chatting and joking away in friendly groups, and solidly built men in leather jackets carefully avoiding eye contact. Then there's the group of eccentrics you always find in the city: people mumbling to themselves.
I'm among the mumblers. According to Jewish law, there are times in the very early morning when it's just too early to daven. I can say certain prayers when I'm at home, certain prayers on the bus (when it's already slightly later, and the sun is scrambling into place) and certain other prayers in the chapel tucked away in one of the corners of the cavernous Long Island hospital where I'm now stationed. My davening is fragmented, and my morning feels that way too — something I start assembling at 5 a.m. and piece together, hour by hour, until I arrive at my destination and start my work day more or less a whole person.
The best way to describe davening, or, more universally, prayer, to those who don't generally engage in it is to say that it's a systematic stock-taking. Residents do this every day, when they visit their patients before they're expected to present them to the entire team. They pre-round, or round before rounding, making sure they're informed about what happened to their patients overnight and what these patients need during the new day.
More often than not, my mind drifts during davening, like someone walking down the street on the way to a familiar destination. I think about my day's responsibilities, what I'm going to eat for lunch, what I need to study. I manage to reduce thousands of years of stirring liturgical yearnings to a shopping list.
Then once in a while — or, more precisely, once a year — I start trying to pay attention to davening again, in the religious equivalent of getting up at five in the morning to go to work. A week or so before the High Holy Days, Jews begin to gather at ungodly hours to recite Selichot, impassioned vows of contrition and pleas for mercy on the part of the Almighty. The irony is that this liturgy is based on the piyyut, a medieval poetic form distinguished by its labyrinthine syntax and obscure biblical references. What happens, then, is this: A dozen or so half-asleep Jews mumble incomprehensible prayers with less than notable fervor, though in every minyan there's always the exception who makes a point of clenching his fists, staring at the ceiling and making other signs of overt piety. So what's the point of the poems? There might be one Jew in 50 who understands their content (English translations like Artscroll try their best, but end up sounding like a Brooklyn-accented imitation of "Masterpiece Theater").
But in this area (as in a number of others), it's not the content but the form that's important. Getting up early shocks the internal clock into a new and unfamiliar time zone. For the medical student, it takes this shock to move from everyday pursuits into the uncomfortable, cold and early-rising world of the hospital. You have to learn to pay attention to both your patients and the clock. For the Jew entering into a new year, getting up early can help realize the famous challenge of the shofar (as Maimonides understands it): "Wake up from your sleep!" Get up early to shock yourself into the new year. Get up early, or you might miss the shofar. And if you mumble your first prayers while you're still half asleep, you'll be perfectly understood not only by God, but by any medical student.
Zackary Sholem Berger hopes that in 5766 you never have to see the inside of a hospital — unless you work in one.
Stand up for your rites.
MEDICINE MENSCH: Resetting the Spiritual Clock
By Zackary Sholem Berger
October 7, 2005
I've been getting up at five in the morning for the past two months. It would be nice if this new schedule granted me some insight into the human condition or the plight of the sick, but my observations are on a smaller scale.
A lot more people than you might think are up that early. On the way from my apartment building on the Lower East Side to my bus stop there's an unsavory-looking building that is shuttered during the day. When I stumble by at 5:45 in the morning, there's an improbably well-organized fruit stand out front, tables of oranges, apples and bananas under the streetlamps. The fruit seller is always wearing a T-shirt and shorts, no matter the weather. I say good morning to him, and to the MTA bus driver, but maybe it's the wrong thing to say — these people have been up for hours already and probably are ready to go to bed after their shift switch. "Sleep well" might be more appropriate. ("Sleep well" is something you never say to a medical resident, unless you're trying to taunt him.)
All the people getting to work at this hour can be divided into different subgroups, the most obvious being the 6 a.m. cell-phone talkers. (Who are they talking to? Other 6 a.m. cell-phone talkers, I guess.) There are those plugged into their iPods, the nurses chatting and joking away in friendly groups, and solidly built men in leather jackets carefully avoiding eye contact. Then there's the group of eccentrics you always find in the city: people mumbling to themselves.
I'm among the mumblers. According to Jewish law, there are times in the very early morning when it's just too early to daven. I can say certain prayers when I'm at home, certain prayers on the bus (when it's already slightly later, and the sun is scrambling into place) and certain other prayers in the chapel tucked away in one of the corners of the cavernous Long Island hospital where I'm now stationed. My davening is fragmented, and my morning feels that way too — something I start assembling at 5 a.m. and piece together, hour by hour, until I arrive at my destination and start my work day more or less a whole person.
The best way to describe davening, or, more universally, prayer, to those who don't generally engage in it is to say that it's a systematic stock-taking. Residents do this every day, when they visit their patients before they're expected to present them to the entire team. They pre-round, or round before rounding, making sure they're informed about what happened to their patients overnight and what these patients need during the new day.
More often than not, my mind drifts during davening, like someone walking down the street on the way to a familiar destination. I think about my day's responsibilities, what I'm going to eat for lunch, what I need to study. I manage to reduce thousands of years of stirring liturgical yearnings to a shopping list.
Then once in a while — or, more precisely, once a year — I start trying to pay attention to davening again, in the religious equivalent of getting up at five in the morning to go to work. A week or so before the High Holy Days, Jews begin to gather at ungodly hours to recite Selichot, impassioned vows of contrition and pleas for mercy on the part of the Almighty. The irony is that this liturgy is based on the piyyut, a medieval poetic form distinguished by its labyrinthine syntax and obscure biblical references. What happens, then, is this: A dozen or so half-asleep Jews mumble incomprehensible prayers with less than notable fervor, though in every minyan there's always the exception who makes a point of clenching his fists, staring at the ceiling and making other signs of overt piety. So what's the point of the poems? There might be one Jew in 50 who understands their content (English translations like Artscroll try their best, but end up sounding like a Brooklyn-accented imitation of "Masterpiece Theater").
But in this area (as in a number of others), it's not the content but the form that's important. Getting up early shocks the internal clock into a new and unfamiliar time zone. For the medical student, it takes this shock to move from everyday pursuits into the uncomfortable, cold and early-rising world of the hospital. You have to learn to pay attention to both your patients and the clock. For the Jew entering into a new year, getting up early can help realize the famous challenge of the shofar (as Maimonides understands it): "Wake up from your sleep!" Get up early to shock yourself into the new year. Get up early, or you might miss the shofar. And if you mumble your first prayers while you're still half asleep, you'll be perfectly understood not only by God, but by any medical student.
Zackary Sholem Berger hopes that in 5766 you never have to see the inside of a hospital — unless you work in one.
10/2/05
9/24/05
Ashkenaz in Israel
An ideolo-blog.
Assaf Galay, the charismatic journalist and Yiddishist behind the "Hatenuah lezehut ashkenazit" (The Movement for Ashkenazic Identity), has a Hebrew blog that's well worth reading, though I can't say I agree with its post-Zionist slant.
An ideolo-blog.
Assaf Galay, the charismatic journalist and Yiddishist behind the "Hatenuah lezehut ashkenazit" (The Movement for Ashkenazic Identity), has a Hebrew blog that's well worth reading, though I can't say I agree with its post-Zionist slant.
9/22/05
(A)elul Aesthetics
"I'll ask one thing of God, one thing I'll request:
to dwell in God's house all my life;
to have a vision of God's pleasantness, to visit His palace."
A bit of Psalm 26, which we read during the month of Elul.
One could take the above verse to mean that we would like to be vouchsafed a vision of God through the merit of the commandments. The mitzvot would then be a ticket to the Palace, like an armband to a rock concert.
I think the point can be taken differently. God is pleasant. That is, God is beautiful, and during this time of year we would like to merit an appreciation of this beauty -- without unthinking anthropomorphisms or idolatrous projections, leaden fundamentalism or empty-headed laxities. The contemplation of the Divine should be a source of joy, not of confinement.
"I'll ask one thing of God, one thing I'll request:
to dwell in God's house all my life;
to have a vision of God's pleasantness, to visit His palace."
A bit of Psalm 26, which we read during the month of Elul.
One could take the above verse to mean that we would like to be vouchsafed a vision of God through the merit of the commandments. The mitzvot would then be a ticket to the Palace, like an armband to a rock concert.
I think the point can be taken differently. God is pleasant. That is, God is beautiful, and during this time of year we would like to merit an appreciation of this beauty -- without unthinking anthropomorphisms or idolatrous projections, leaden fundamentalism or empty-headed laxities. The contemplation of the Divine should be a source of joy, not of confinement.
9/18/05
The health of China
Almost exactly a year ago, this blog mused about China's shifting burden of disease - the term epidemiologists use (hey, I guess I am one now) to denote what happens when a country becomes more developed (i.e. less poor), and different causes of death become more, or less, frequent. A fascinating issue of the New England Journal of Medicine includes an important study on that very topic. The abstract is below.
Background With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China.
Methods Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent.
Almost exactly a year ago, this blog mused about China's shifting burden of disease - the term epidemiologists use (hey, I guess I am one now) to denote what happens when a country becomes more developed (i.e. less poor), and different causes of death become more, or less, frequent. A fascinating issue of the New England Journal of Medicine includes an important study on that very topic. The abstract is below.
Background With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China.
Methods Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent.
Results We documented 20,033 deaths in 1,239,191 person-years of follow-up. The mortality from all causes was 1480.1 per 100,000 person-years among men and 1190.2 per 100,000 person-years among women. The five leading causes of death were malignant neoplasms (mortality, 374.1 per 100,000 person-years), diseases of the heart (319.1), cerebrovascular disease (310.5), accidents (54.0), and infectious diseases (50.5) among men and diseases of the heart (268.5), cerebrovascular disease (242.3), malignant neoplasms (214.1), pneumonia and influenza (45.9), and infectious diseases (35.3) among women. The multivariate-adjusted relative risk of death and the population attributable risk for preventable risk factors were as follows: hypertension, 1.48 (95 percent confidence interval, 1.44 to 1.53) and 11.7 percent, respectively; cigarette smoking, 1.23 (95 percent confidence interval, 1.18 to 1.27) and 7.9 percent; physical inactivity, 1.20 (95 percent confidence interval, 1.16 to 1.24) and 6.8 percent; and underweight (body-mass index [the weight in kilograms divided by the square of the height in meters] below 18.5), 1.47 (95 percent confidence interval, 1.42 to 1.53) and 5.2 percent.
Conclusions Vascular disease and cancer have become the leading causes of death among Chinese adults. Our findings suggest that control of hypertension, smoking cessation, increased physical activity, and improved nutrition should be important strategies for reducing the burden of premature death among adults in China.
9/10/05
A Jew and a Cabbie
On the way to drop off some shipments of the new book (that would be George der Naygeriker, Curious George in Yiddish), I started chatting with the cabbie -- a Dominican, it turns out. I learned some stuff. First, my neighborhood (the Lower East Side) is not Dominican; the Latinos down here are from all over. (I had already known that the main Dominican concentration in the city is in Washington Heights, but a bakery, some soccer fans, and other manifestations had led me to the mistaken belief that the LES constituted a branch of the DR Diaspora.) Second is the interesting way he referred to my religious-ethnic affiliation:
Eres un americano judio, no?
Meaning:
You're a Jewish American, right?
Interesting, because no one would use this locution ("Jewish American") in English, at least not these days. (Not that it's inaccurate or suspect, just out of date.) So: is this the way Dominicans (habitually?) refer to American Jews? Was it an effort not to say something unintentionally offensive? Just this cabbie's idiolect? Inquiring bloggers seek Dominicanologists for explanations.
On the way to drop off some shipments of the new book (that would be George der Naygeriker, Curious George in Yiddish), I started chatting with the cabbie -- a Dominican, it turns out. I learned some stuff. First, my neighborhood (the Lower East Side) is not Dominican; the Latinos down here are from all over. (I had already known that the main Dominican concentration in the city is in Washington Heights, but a bakery, some soccer fans, and other manifestations had led me to the mistaken belief that the LES constituted a branch of the DR Diaspora.) Second is the interesting way he referred to my religious-ethnic affiliation:
Eres un americano judio, no?
Meaning:
You're a Jewish American, right?
Interesting, because no one would use this locution ("Jewish American") in English, at least not these days. (Not that it's inaccurate or suspect, just out of date.) So: is this the way Dominicans (habitually?) refer to American Jews? Was it an effort not to say something unintentionally offensive? Just this cabbie's idiolect? Inquiring bloggers seek Dominicanologists for explanations.
Subscribe to:
Posts (Atom)
