Wi Mitzwha for a robber

If you use Google Translate to translate this paragraph of my Yiddish novel-in-progress

וווּ געפֿינט זיך הײַנט דער שׂכל-צענטער?

עס איז וויכטיק צו וויסן, ווי אַזוי דאָס באַוווּסטזײַן ווערט צונויפֿגערעכנט און דעפֿינירט. וווּ געפֿינט זיך דער נאַציאָנאַלער שׂכל פֿון עם־ישׂראל? דאָס איז ניט קיין נאַרישע שאלה. דעת־הקהל, ווייסט יעדער, איז גאָר אַ וויכטיקער פֿאַקטאָר. מע דאַרף פֿאַרשטיין וווּ ער געפֿינט זיך, פּונקט ווי (להבֿדיל) אין די אַלטע שרעקפֿילמען, דאַרף מען זיך דערוויסן דאָס אָרט פֿון צענטראַלן קאָמפּיוטער, דער וואָס קאָנטראָלירט די באַוועגונגען פֿון ריזיקן עלעקטראָנישן מאָנסטער, אויב מע וויל זיך דערפֿון ראַטעווען. פּונקט אויף אַזאַ אופֿן, אויב מע וויל איבעראַנדערשן דעם גורל פֿון אַחינו בני ישׂראל, דאַרף מען געפֿינען וווּ עס געפֿינט זיך יענעם פֿאָלקישן שׂכל־צענטער און אין אים זיכער און גלײַך אַרײַנדרינגען, ווי אַ גזלן לשם מיצווה.

. . . as if it were Hebrew, you get this:

Ouw געפֿינט vessel Heint Ear all - Contar?

Ose Eiz Wichtiq order וויסן, Wi Azwei Dase באוווסטזיין Ouoart Couanoifegarocnt On Eopinirt. וווּ געפֿינט זיך דער נאַציאָנאַלער שׂכל פֿון עם־ישׂראל? Ouw Egofint vessel Ear Nacianalear with all Von - Israel? דאָס איז ניט קיין נאַרישע שאלה. Dase Eiz Nie Kane Earisha question.דעת־הקהל, ווייסט יעדער, איז גאָר אַ וויכטיקער פֿאַקטאָר. Eoat - audience, Waise Eadar, Eiz Gaar a Wichtiqar Pactaar. מע דאַרף פֿאַרשטיין וווּ ער געפֿינט זיך, פּונקט ווי (להבֿדיל) אין די אַלטע שרעקפֿילמען, דאַרף מען זיך דערוויסן דאָס אָרט פֿון צענטראַלן קאָמפּיוטער, דער וואָס קאָנטראָלירט די באַוועגונגען פֿון ריזיקן עלעקטראָנישן מאָנסטער, אויב מע וויל זיך דערפֿון ראַטעווען. Mo דארף פארשטיין Ouw up Egofint vessel, Aponce Wi (distinguish) does not have enough Elto שרעקפילמען, דארף address vessel דערוויסן Dase Art von צענטראלן Campiotar, Ear Wasse Cantrelert enough באוועגונגען von ריזיקן עלעקטראנישן Manstaar, Mo Will enemy vessel דערפון ראטעווען.פּונקט אויף אַזאַ אופֿן, אויב מע וויל איבעראַנדערשן דעם גורל פֿון אַחינו בני ישׂראל, דאַרף מען געפֿינען וווּ עס געפֿינט זיך יענעם פֿאָלקישן שׂכל־צענטער און אין אים זיכער און גלײַך אַרײַנדרינגען, ווי אַ גזלן לשם מיצווה. Aponce אויף Aze way, the enemy of Mo Will איבעראנדערשן דעם von Ahino fate of Israel, דארף address געפינען Ouw Ose Egofint vessel יענעם פאלקישן all - On Contar not אים Azicar On גלייך אריינדרינגען, Wi Mitzwha for a robber.

For the Sausage Factory: Various Health Care Proposals as Fodder for Compromise

Even in the midst of the presidential campaign, we should remember that there are a number of health care plans other than those proposed by McCain or Obama. Given the vagaries of politics, any given plan is very unlikely to be passed. Thus we should become familiar with the details of a variety of them, since any compromise will look like a hybrid.

More in Clinical Correlations.

Needed renovations, or setting the roof on fire?

Our exposure to health care policy - as part of our primary care curriculum - ran the gamut recently.

Last week we went to Washington to advocate for increased support for the primary care workforce. (In brief: we need more primary care health care providers. There aren't going to be enough of them, especially if we start covering the uninsured. We need to create incentives to help people choose to go into primary care rather than the oversubscribed and overpaid subspecialties.) We spoke to young, fresh-faced, intelligent, and hyperinformed health care staffers of some of the Capitol's most influential senators - they were genuinely friendly and happy to see us.

One senator's office is working on a creative idea left over (so they said) from Hillarycare, a "foundation" to ensure a funding stream for primary care education, training, and loan repayment, paid for by a tax on insurance companies. Of course, no one in the room disagreed with that. Everyone realizes that primary care training needs to be dissociated from the current system, private insurance companies and hospitals included. (Our very friendly lobbyist, paid for by NYU Medical Center and along with us to make sure we didn't say anything stupid, was not very excited to hear about this idea.)

This week (thanks to a colleague of mine, whose father is a fundraiser for the senator in question) we went to the office of the junior senator from New York. We spoke to her for fifteen minutes about the necessity to improve funding for the primary care workforce - she was impressively informed, realistic about the political obstacles, and . . . oh, who am I kidding? We were giddy. We got a picture, too!

On Friday, we visited Jack Resnick, an internist (let's say it: a primary care doctor!) with a practice on Roosevelt Island. "[In Washington,] they're talking about payment reform, which is . . . pffphpht! You have to tear out the guts!" By which he means - you have to alter the incentives so as to drastically reduce hospitalization. It's an open secret that hospitals are not the best places for sick people. They breed infections, deconditioning, delirium, psychosis. Resnick's approach (and the approach of this organization) is to closely monitor the chronically ill patients in his practice, keeping the hospitals at bay by providing patients sophisticated but sensitive care at home. It's more feasible for Resnick because (a) he lives on an island; (b) he's ready to devote himself nearly 24-7 to his patients. But this, he says, is the wave of the future - money saving, intensive, personal primary care for the elderly and chronically ill, taking away money from hospitals where it's not usefully spent (or, rather, uselessly overspent).

Resnick, and the AAHCP (see the link above), are behind the Independence at Home Act, a bill introduced in September which would experiment with cash rewards for house-call physicians that trim Medicare outlays for high-cost patients with multiple chronic conditions.

[revised per comments]

Home for the holidays

I was eating a stale Danish in NYU Medical Center's sukkah this morning. On the wall, a notice painstakingly informing the sukkah user that the hut was built by heymishe yidn, the term used by Yiddish-speaking Chasidim to refer to themselves. (The English and Hebrew notices didn't include this fact, by the way.)

But what's this hanging from the ceiling? A red and gold plastic ribbon with a golden bell?

In the heimische sukkah, a heimische Christmas decoration!

Inheriting Radiance

Yiddish poems of home life: my translations of poems by Gella Schweid Fishman and Gitl Schaechter-Viswanath (taken from an upcoming anthology) in Words Without Borders.

Speaking Albanian

To Albany today with my fun-loving primary-care colleagues to advocate for streamlined consent for HIV testing - to make sure all New Yorkers get HIV diagnosis and necessary treatment as early as possible. 

Everyone was nice and I didn't trip over the furniture. 

Enjoy our position paper here. Spread the word!

In Which a Kesher Israel Member Waxes Ecumenical

Psst, Joe! Does Barry Freundel think you and Sarah Palin worship the same God?

reckless beauty
heedless joy
many
people never
panic

clamorous intoxi
cating spaces

living alone
dying embraced

Three and a Half Jewish Philosophers

ZSB: Is there a risk of the religious life?

Hilary Putnam: There’s always the risk of fanaticism. I spend part of every year in Israel at Tel Aviv University. There, the conflicts of certainties are appalling; that’s beginning to be the case in the U.S.

More in the Forward, where I interview Putnam about his new book, Jewish Philosophy as a Guide to Life.

America's Next Top Health Policy Problem

James Knickman, the unassuming and friendly health-policy analyst and CEO of the New York State Health Foundation, talked to our class of third-year primary care residents on Tuesday as part of our health policy course. Here is his list of the Top Ten Health Policy Crises.*

Solutions received by Monday at 7pm will get a free piece of apple-and-honey.

1.The lack of affordable and accessible health care for all Americans.

2. The need to develop methods to decide when to pay for emerging modalities and pharmaceuticals.

3. The need to move resources into prevention and public health.

4. The need to move resources into primary care.

5. How do we care for an aging population?

6. How do we expand physicians' use of evidence-based treatment approaches?

7. Great disparities across ethnic and income groups.

8. Malpractice!

9. Dental care.

10. The lack of health-care professionals.

*Okay, he didn't say "crises," he said "topics." But "crises" is more fun.

"Diagnosis of exclusion"

A zillion years of medical and graduate school, and nearly three years of residency, and I still don't understand what it means when people say that such-and-such is a diagnosis of exclusion. Any diagnosis is a diagnosis of exclusion!

Often, I think, people use that phrase as a retelling of the widespread myth that psychopathologies can't be diagnosed through testing. ("Anxiety is a diagnosis of exclusion.") Or a claim that only laboratory tests or imaging matter, not the history or physical. ("Hepatorenal syndrome is a diagnosis of exclusion.")

The next time someone calls a diagnosis a D of E, by gum, I'm going to ask them just what they mean.

Jewels of Elul CXVIII: A Month of Dreamers that Feels like a Year

with apologies to Craig 'N Co.

Since I have a lot of money, people are always sending me their crazy ideas. And I have to take them home on the train. I fall asleep and dream . . . dream of long vacations, plush terry-cloth robes, little bars of soap you always steal and then feel obscurely guilty about (unless you steal from the minibar, in which case you dream about credit-card bills in the mail and some meaty guy stomping through your front door with a large stick). When I wake up from my dream, I'm at the last station stop and the janitor has to sweep me out of the car with his broom. I wander outside and can't find the bus stop. Scared, I take a taxi.

That's my dream. To some people, it's trivial, stupid, a little cheap. But then I give them some money, and the word "cheap" is never mentioned again. The word "dream" is thrown around a lot, mostly by me. The prophets of Israel, I read, used to dream. Their dreams are full of sprouting sticks, rattling bones with ill-fitting skin heaving themselves reluctantly to their resurrected feet, women eating their newborns. Not Elul stuff at all.

When I think how far I have come, and how much money I have, I thank whatever gods may be for my dreams. I might write them down in a book someday. Dreams do come true!

Well that's all right then

Worried whether your favorite presidential candidate will defeat the other party's lying traitorous scum and save our nation this November? If you care about health policy, don't worry about it. Neither man's plan has a pig's chance at a barbecue of getting anywhere near passage.

Welcome to the hekhsher tzedek community, Orthodox Union!

Or: happy Elul!

So when will the OU withdraw certification entirely from Rubashkin's? When the case goes to court? When a conviction is handed down? When the sentence is served? How many "weeks" will this take? 1? 2? 6? 12? 52?

And why does there need to be a change in management? After all, these are just goyish legal structures we're talking about (ערכאות של גוים). "The law of the land is the law" is just Conservative liberal halachah, right?

Maybe there needs to be another trip to Iowa, company-paid. Make sure one of the rabbis involved "knows some Spanish." Look, the cafeteria is awful clean!

The Art of the Improbable

Today I voted for Paul Newell and Daniel Squadron. Nothing like casting your lot with the losing team! (And speaking of losing...)

* * *

You know what's useful? Reading political news.

Fresh fish for sale!

From there to here
From here to there
New Yiddish fish are everywhere!

Now available:
Eyn Fish Tsvey Fish Royter Fish Bloyer Fish
One Fish Two Fish Red Fish Blue Fish by Dr. Seuss
Yiddish translation by Sholem Berger
978-0-9726939-3-6
$15 + shipping (and tax in NY State)
yiddishcat.com

Don't forget:
Di Kats der Payats, The Cat in the Hat by Dr. Seuss, in Yiddish--$15
George der Naygeriker, Curious George by H. A. Rey, in Yiddish--$18
Colorful alef-beys poster by Stephen Cohen--$12

The futile slow code

I was involved in a slow code recently. (I won't say where, or when, or with whom.) They are slippery and repugnant. Rarely can any of the parties involved say with satisfaction or complete clarity when, or by whom, the slow code was suggested or agreed to. It is a substitute for an honest discussion of options with the patient and family, and it is a legal minefield.

Remind me not to get involved in them again ... when I have a choice in the matter.

The Politics of Kashrut: Kosher Food Boycotts then and now

An event at Town and Village Synagogue. No word yet whether the refreshments will be fleischig.

Join JFREJ, the AJWS-AVODAH Partnership, and Uri L'Tzedek for a salon-style, interactive program: learn about the complex intersections of immigrant rights, labor rights, and Jewish law - from the Lower East Side's kosher meat boycott of 1903 to the AgriProcessors boycott of 2008.

Featuring Professor Hasia Diner, NYU, and Organizers from the United Food and Commercial Workers Union, Uri L'Tzedek, and Hekhsher Tzedek. Presented through Jews for Racial and Economic Justice (JFREJ) and American Jewish World Service and AVODAH: The Jewish Service Corps.

This event is co-sponsored by Hazon, the Workmen's Circle / Arbeter Ring, and Jewish Labor Committee/United Hebrew Trades. For more information or to RSVP click here or call 212-647-8966 ext 10.

Without any negation

We confirm the amazing achievements of Yiddish without any negation at all of the importance of Modern Hebrew, Ladino, Zionism, secular Judaism, Jewish culture as a whole (yiddishkeit) or any other intimate, creative, and authentic Jewish entity and conviction. In addition, we are not all just Yiddishists, of the sort who are committed to Yiddish and only to Yiddish. Just the opposite. We are of various Jewish ideologies. "Whatever we are, we speak Yiddish" - Yiddish is our common property and an integral part of our anchoredness in a part of our identity, our past, and in a part of our future.

--Joshua Fishman, from אַ באַגריסונג־וואָרט לכּבֿוד דעם 100סטן יובֿל פֿון דער טשערנאָוויצער שפּראַך־קאָנפֿערענץ an article in the Yiddish Forward commemorating the 100th anniversary of the Yiddish Language Conference. Translation mine.

Dance of the Dripping-Hand Fairies

I'm no choreographer, but it is important to be meaningful in the movements you adopt in front of the motion-detector paper-towel dispenser. I do want this paper towel! I do! Look, here I am reaching my arms underneath it!