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.


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.


I called the White House
What good it will do, I dunno.

Remind the President about Darfur.


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?

Left! Left!
Left, right, left.

Proletpen is a new anthology of American Communist Yiddish writers. (Three modifiers, no extra charge.) My review is mixed.


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.

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.


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 . . .


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:
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.


No longer confused, not yet overwhelmed
After a year of my medical-student ramblings, what have I learned?

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.