Tonight will be our last spent on East 24th Street; tomorrow will be our first spent on East Broadway. (As I pointed out earlier, pronounced East Broadway, accent on the second syllable, by most natives of New York that I've heard.) Downtown: more Cantonese, more Yiddish, still within striking distance of our shul. A return to the Lower East Side, a neighborhood our families (probably) didn't come over to and one we don't feel any nostalgia for. But we're sure looking forward to getting to know it.


Abundant kibitzing
In which I half-articulate what might be wrong with the Conservative movement.

This Shefa list I talked about earlier is turning out to be pretty interesting: a lot less personal bellyaching and a lot more considered and creative thought about where the Conservative movement should go from here. Here's an e-mail I sent to the list that might not make the moderator's cut:

1. One distinction which might be helpful is between LIBERAL and LAX. Conservative Judaism is very much a liberal movement, for the following reasons (all of which are discussed, or at least adumbrated/hat-tipped, in Emet veEmunah): recognition of the importance of individual decision-making as something which can't be coerced into homogeneity by communal institutions; or, relatedly, the notion of religious responsibility (mitsves) as intertwined with individual religious progress cum exploration and contingency. There is a connection to be made between the looser, layperson's meaning of "liberal" and liberal political theory, but "this is no place to be lengthy."

In general, C. Judaism is liberal because it tends to be meykil rather than makhmir. It is important to understand what "meykil" does not mean; it is NOT to be equated with laxity, lack of stringency for its own sake. (Those who equate laxity with the term "kule" [leniency] do not understand the latter.) Ideally, the C. movement should be a rigorous application of both liberal and (this is where we've differed
from our friends on the left) halachic ideas. Liberal *and* rigorous Judaism -- isn't this what we want?

2. However (and this is perhaps where rubber meets road, or theory meets Action Plans), this liberal stringency (or stringent liberality) must be based on a wide range of possibilities for vibrant Jewish life. For the past few years, I have harbored a suspicion that dare not speak its name: that the C. movement's loud protestations of its "halachic" nature are meant as a response to our critics on the right. Of course, halachah is the blood of our Jewish being, but it is not the all. There is much more in addition to halachah which goes into living a God-fearing and humane Jewish life. A convenient term for it is "culture." I don't just mean books on Jewish topics, or Woody Allen, or Jewish music (though all these have some role to play). I'm talking about the ways in which a Conservative sensibility can inform a Jewish religious culture. In other words: the Orthodox have their sub-culture, so why don't we have one? Why are we satisfied to participate in secular Jewish culture when Conservative Judaism has something both religious and worldly to bring to the table?

Let me give an example of where culture can play a role. (There are many other ways, of course.) Mishnah Yomit is a worthwhile initiative of the USCJ. But where's the promotion? Where's the advertising? Where is the pop-culture soupcon of kitsch which has made Daf Yomi a "smash hit" phenomenon among the Orthodox? (To head off an expected comment: adopting this strategy of the Orthodox does not at all mean agreeing with their religious approach.) Or another example: what does Conservative Judaism have to say about American secular Jewish culture? Is there any alternative to provide? I think our answers might be at once more congenial and more convincing than those provided by modern Orthodoxy.


Inauguration Day
Or: Double entendre, intentional variety.

As I was interviewing one of my patients, a schizophrenic, he was watching the proceedings on TV. His speech was delusional and disorganized.


By the Waters of Manhattan: Talks by/on Jewish Poets

Rocked myself today on the strap in the El
In time with the worn out Jews
The night was black, spirit enslaved.

Karen Weiser
Anna Margolin: Yiddish Poet of the Lower East Side
January 18, 2005

Teachers & Writers Collaborative, 5 Union Square West -- 7th Floor (above Staples)
Talks are Free to the Public
Committee On Poetry and Jewish Below Fourteenth Street
212 358 9534 (information)

These talks are made possible by a grant from Educational Alliance’s Jewish below Fourteenth Street Project, which is funded by the UJA-Federation of New York to enrich Jewish life in Downtown Manhattan.
Don't do Ragu!

Sighted at the Gristedes (a grocery store, for those of you living outside the Holy City of Five Boroughs): two women, probably from India or Pakistan going by their language and dress, in the pasta-and-sauce aisle. Even though I didn't understand their language, it was clear that one of them was learnedly explaining to the other exactly how one uses Ragu spaghetti sauce.

Now, on the one hand, everyone is free to make their own choices, the immigrant experience is something difficult and labyrinthine, I'm sure Ragu and pasta are cheaper than just about anything else you could buy (except for Ramen, maybe), etceteblah. On the other hand, I wanted to shake the Ragu-lover hard by the shoulders and cry out, "My God, woman! Your own food is so much better!"
And the ban played on

It's not surprising that some Orthodox Jews want to ban books. Every group has criteria of inclusion and exclusion; there are even some books which could put you outside the pale of Conservative or Reform Judaism by reading them (or believing in their contents). This is not just a matter of the lax left versus the stringent right; it also has to do with differing philosophies and criteria of acceptability.

The interesting thing about a given ban is whether the group, by and large, agrees with it. If a ban is controversial, the book touches on a fissure within the community. In short, the ban says more about the banner than the banned.
The language of medicine
Or, Escape from Planet Jargon.

There are some words I wish I weren't using now on the wards, but they seem to be part of the language here; any deviation would waste time or be misinterpreted as pretension. In this category are abbreviations like "meds [medications]," "ped onc [pediatric oncology]," and the like. I'll deal with them.

There are other expressions which I've promised myself I'll do my level best not to use. When a patient does not report the symptom the doctor is asking about, it is the practice to use the word "denies." E.g., "Mr. Campos denies chest pain." This is so distant from the ordinary meaning of "denies" that it attributes ulterior motives to the patient where none exist. (The twin of "denies" is "endorses," which in medspeak means "reports something." The same problem arises here. In normal English, could anyone really be said to "endorse" symptoms of depression?)

When a patient does not take his or her medication, the word used in medical jargon is "noncompliant." There's a similar problem here, because in normal English, "noncompliant" connotes defiance or noncooperation, while in medspeak, a noncompliant patient can simply be forgetful or confused.


Nurses: the importance of the (relatively) powerless

In response to the first installment of Medicine Mensch, I've received two e-mails from doctors aggrieved at what they see is a slight upon nurses. Owing to their misreading of the article or the unclarity of my prose, they mistook the term "hierarchy" for a ranking of importance. According to such a reading, I would hold that medical students are more important [sic!] than nurses, who in turn are more important than cafeteria workers, transporters, and the like.

Of course, nothing could be further than the truth. The hierarchy in the article was meant to be (and, in fact, my impression is that most readers understood it as) an informal characterization of the power and control each profession is vouchsafed within the hospital's many labyrinths. My iimportance to patients' medical care is approximately nil compared to the hospital's lifeblood which flows through the veins of every nurse. But who's going to get paid more in the future, and who has more access, even at this early stage in his career, to the decision-making apparatus of the medical center? Me. There are fair and unfair aspects of this sociological fact, but representing a state of affairs in prose should not be taken as an endorsement.

To any nurses who might have read the article: if you did take offense, feel free to assume that I know absolutely nothing about medicine and am a snotnose short white coat bumbling along the wards. After all, that was the point.

Next article, a month from now: all about psychiatry. In a thousand words or less.


Medicine Mensch

This new series of articles in the Forward follows me through my medical training and, I hope, out the other side. I hope to talk about Jewish and medical topics which are sometimes broad, sometimes narrow, and often interrelated with each other. The first installment is here.

Here it is below, as well:

MEDICINE MENSCH: Today I Am a Short White Coat
By Zackary Sholem Berger
January 7, 2005
My first day as a medical underling.

Today I am a short, white coat.

Until last week, I was locked up in the ivory tower to finish my doctorate in epidemiology. But now it's finally time to learn how to be a medical student. I'm going on the wards, where I'll learn all manner of things: how to put in an I.V., how to build a rapport with annoying patients and how to avoid rampaging gurneys. To understand a hospital, you need to understand its hierarchy: when it's followed, when it's hallowed and when it's violated. I'll try to explain it all, but forgive me if we get lost. It's my first day.

The dilemma of the medical student with the short white coat — am I wearing it, or is it wearing me? — is as important to the person as it is to her wardrobe. On the first day of a new job, or in a new school, it's hard to know where to fit. All the more so in the topsy-turvy hospital hierarchy, where the most important person, the patient, has none of the economic or directive influence that powers the huge institution.

Starting from the very bottom, we first have the janitors, the cafeteria ladies, the orderlies, the "transporters" (gurney pushers) — anyone who makes sure that the huge hospital organism can fulfill its basic needs. Those of you who watch the television show "Scrubs" are familiar with the show's wisecracking, joke-playing janitor. He's completely in control, and jerks around J.D. (the medical resident who's the show's main character) to his heart's content. But if you've ever been inside a real hospital, you've never met a janitor like that. Sure, the janitors are friendly; sure, there's a modicum of genial give-and-take between upper (doctor) and lower (custodian). But at the same time, there's the uneasy reality that one is Over and one is Under, and never the twain shall meet. There is no magical moment of cross-understanding that one finds in Hasidic stories, when the rebbe realizes that the coachman greasing his wheels is just as spiritually attuned as he is. They are janitors, and that's that; no enlightenment is expected from them.

There are two kinds of uniforms in the hospital: medical and nonmedical. Janitors wear the second variety. Orderlies often wear scrubs of a laughably loud color, to point out just how removed they are from the medical hierarchy — the same reason that clowns wear the getup they do, to signal their freedom from normal rules.

Moving up a step, we find one of the most necessary groups of people in the hospital, aside from the administrators and money wranglers (who are sometimes known, unsurprisingly, as "the suits"). These are the nurses. It used to be the custom for them to wear white, but as uniforms everywhere become more and more casual, they've chosen the minimum amount of white to look a little bit like angels: white coats, white pants, perhaps a pair of white sneakers. The sneakers make them look like they're always on the way to or from Kol Nidre, which makes sense: If you'd like to build a community that's compassionate and practical, you could do worse than to convince the nurses to join you. It's smart to be nice to nurses in the same way that it's advisable to be on good terms with God.

One step above nurses is the medical student. That's me over here, not waving but drowning, trying to find in this rambling hospital the bathrooms, the library, the cafeteria and, most important, the stairs (the elevators are crowded and slow). While a long white coat looks dignified, flowing and somewhat old fashioned — a kind of medical kittel — a short white coat makes anyone look like a barber or an ice-cream scooper. Whether to counteract or exacerbate this effect, every medical student fills the pockets of her coat with a bewildering array of slips of paper, handbooks, equipment, tongue depressors, alcohol pads, pens, pencils, Palm Pilots and the odd bit of snack food. The rationale here is, I guess, "If I don't know anything, at least the pockets of my coat can be stuffed with facts."

On top, of course, is the physician himself. (I would write "herself," but it would be unrepresentative. The top rungs of the hierarchy are mostly male, even at this late date.) Their coats are long, with pockets that don't have to be filled with anything (the clinical experience and diagnostic certitude are all kept in the head at this stage, not on PDAs or in quick-reference books). Some doctors don't even wear coats — their rank is obvious.

The above hierarchy is just an approximation. There are enough exceptions and exceptions-to-the-exceptions to impress any devotee of the Talmud. For instance, at my medical school, at least until recently, surgeons wore scrubs and no one else did. Then, in a heroic mass movement, medical students decided that scrubs were comfy. They wanted to wear them, too! Now everyone can have his own pair. For some reason, though, only a surgeon wearing scrubs looks like a surgeon wearing scrubs. Anyone else looks like an escaped convict or someone whose last set of sweats is in the laundry.

The sick person wears no coat at all — aside from the robes that open in the back, like misappropriated evening gowns — and can feel as ashamed as Adam and Eve, the first naked couple. The rabbis of the Talmud said that the prototypical act of loving-kindness was God's providing loincloths to cover their nakedness. Even if I don't know anything about medicine yet, maybe I still can help patients feel better, no matter how short and overloaded my coat is.

Zackary Sholem Berger finished his doctorate in epidemiology from New York University this month, and will complete medical school in 2006. This is the first column in a series tracing his transformation into that mythical figure: The Jewish Doctor. Comments and questions encouraged at doctor@forward.com. No medical advice given!


Confidential in Bellevue

I'm swimming in stories and outlandish speech, but I can't repeat any of it. Interviewing patients is a short-story writer's dream, with the layers of lives coming at you faster than you can write them down. (Said an attending to me today as I was doing one of my first interviews with a psychiatric patient: "Don't write so much down. You don't have to be Sigmund Freud starting out. Just try to talk to them as people.") But these are patients, and so their details must be kept confidential. Even if I disguised their names, it wouldn't be enough.

The most I can render, therefore, are general impressions of where I am and what I'm doing. I hope to have some time to do that over the next few days. On the 11th, I will be on-call (the whole night long) at Bellevue's psychiatric emergency room; I assume that something I see or learn there will be worth writing about.

If you'd like to know anything in particular about what medical training is like, please ask away. It will help me sharpen my eye and ear.

Postscript: My dad asks if "talking to [the patients] as people" is really enough; aren't I supposed to be trained in specific medical knowledge? Sure, but sometimes an over-eager medical student can narrow things down too quickly, when what's needed is a more open-ended inventory of the patient's state. This is particularly true in psychiatry, I think, where the pathologies are open-ended structural flaws rather than acute medical problems.


Yiddish in Spanish

A clear overview of Yiddish culture, without the distortions and crudities that characterize such things in most English-language publications, is to be found in a new article by Mercedes Cebrian in the Spanish-language, Barcelona-based newspaper La Vanguardia [subscription required]. There's a paragraph in there about me, too.


Big day tomorrow

I shouldn't be up this late. You see, last week I finished my PhD. This coming week, I return to my former identity as an MD student. My first rotation is psychiatry.

I will tell you all about it in fits, starts, dribs, and drabs over the coming weeks and months. But please stay tuned for my new series of articles for the Forward, tentatively titled The Making of a Jewish Doctor, about my adventures on the wards. The first article appears in this Friday's issue, and I'll link to all of them here.