Lost and Found in the Call Room

Medicine Mensch 5 is here, so you can continue your vicarious medical-school education. (Study hard, there'll be a test later.)

Update: 4, not 5. You haven't missed one.

At long last: I'm posting the whole thing below (I had to ask my Forward folks if it was okay first), and I'll post my other Medicine Mensch articles on my blog over the next couple of days.

MEDICINE MENSCH: Has Anyone Seen a Wedding Ring?
By Zackary Sholem Berger
April 1, 2005

In between patients, each room in the hospital has a life of its own: The operating theater is prepped for another run; the delivery room is ready for another baby to come down the pike. Everything's sterilized and rearranged. While the attendants and residents wolf down their cheeseburgers, a medical student (that's me) retreats to the residents' call room to make quick work of his dependable cheese sandwiches and raisins. ("Oh!" a resident says admiringly. "You're so healthy!" "No," I respond. "I'm kosher.")

The call room is a place that many patients wouldn't want to see, since its workaday normality might disappoint those who expect their doctors to be something other than run of the mill. Imagine your break room at work, but without the stern hand and refrigerator-clearing punctiliousness of an office manager. This room is furnished with chairs that also have served as footstools and as impromptu beds; a refrigerator higgledy-piggledy with old lunches, and a TV talking to itself. Off the main call room is the back room, with a bunk bed; piles of white medical jackets, coats and other clothing, and a box of shoes that hasn't been touched since the Ford administration. Project onto this backdrop the rhythms of any workday: petty frustrations and jealousies, hot- and cold-running gossip, and unavoidable tedium, and you can understand why "ER" never could be called "Call Room."

Last week I lost my wedding ring in the back room. It's probably still there.

It happened like this. I had a week of observing surgical procedures. Surgery, like a symphony orchestra, is fascinating in the abstract but puts me to sleep after the first 30 minutes. I strain to keep my eyes open; I think of chapters from the textbooks I'm studying; I say Psalms under my breath; I eat a good lunch and sleep right; all to no avail. Luckily, my head jerked up with a start just as I was about to fall, face first, into the instrument tray.

Observing procedures is a lot less boring when your hands are allowed into the surgical field. "This is the aorta," a surgeon said during one procedure, and I said to myself, "Put it away before something happens to it!" Nothing untoward happened, even though I was only 18 inches away — partially because I wasn't allowed near any of the knives. My job was to retract, to pull apart the edges of the incision to allow the surgeons to see as much as possible.

Even for this minimal participation I had to get ready like the high priest entering the Holy of Holies. Before I donned the surgical gown and the surgical nurse held open the gloves so that I could stick my hands down into them, I scrubbed up just so. First fingernails, then sides of fingers, then fingers, palms, backs of hands and arms. I was cleaner than I'd ever been in my life. This reminds me of washing hands before breaking bread, which is similarly governed by precise detail but for a very different purpose: not cleanliness, but sanctification through the remembrance of Temple purity. In both sorts of washing, extraneous objects must be removed from the hands (although, relying on some fairly obscure leniencies, I don't take off my ring before washing for bread). I took off my watch and stuck it in the pocket of my scrubs. The first time I ever scrubbed in to a surgery (a long three weeks ago), I forgot to take off my wedding ring. As I stuck my left hand through the sleeve of the surgery gown, ready to meet the glove midair, the nurse raised her eyebrows as she glimpsed the band on my finger. "Uh-unh," she said. I retreated to the sink and started over.

Before long, I had come up with a place to store my wedding ring before scrubbing up — my Palm Pilot case — and had congratulated myself on my cleverness. Last week I was getting my things together after a long and frustrating day. I had gotten up at 3:15 a.m., arrived at the hospital at 4:30 a.m. to write notes on patients' progress after their surgery, and stood at drowsy inattention during a six-hour procedure at which I did not fall over onto the patient. I was standing in the back call room — the one with the bunk bed, piles of clothing, a box of neglected shoes and a general air of summer-camp disorder — ready to restore myself to everyday life, complete with wedding band, and go home. I opened up the Palm Pilot case, and, with a happy clink, the ring sprang free to find a new home. I haven't seen it since then.

Of course I got upset, like any normal person. But it's hard to stay annoyed about things you've lost when among the patients you see the next morning is Dolores, a woman who had a hysterectomy as a treatment for uterine cancer and (as a bonus) some of her very large stomach removed to make the operation easier. At 6 in the morning, awakened by a medical student's awkward questions, she was hardly even put out, and very happy with the belly button reconstructed for her by the surgeon. Here's to her new navel, and here's to whoever finds my wedding ring. May you use it on happy occasions.

Zackary Sholem Berger is a medical student, but someday (he hopes) he'll be a doctor. This series of columns traces his metamorphosis from one into the other. Send comments, complaints and lost-and-found notices to doctor at forward dot com. No medical advice given.

Empire of the Bland

Certain restaurants are the bedrock of existence (Chennai Garden, Mendy's). Some restaurants are like old friends who you know won't write or call more than once a year -- and that's okay. Whenever you meet, you immediately pick up again where you left off as if no time had intervened; phone calls or e-mails would just get in the way. Such a restaurant was Gan Eden Glatt, an Uzbekistani place (I think; I'm not knowledgable in Central Asian cuisine, but I know what I like) on 74 W 47th St. Whenever I found myself nearby, either for reasons of jewelry or buying Chasidic newspapers, I would drop by for a plate of plov, some spicy soup, or a skewer of grilled meat. All ridiculously cheap, and served up with a Soviet-style, um, nonchalance: "You don't like it, find another restaurant.' Usually there was a group of guys in the corner dressed in sweatsuits, talking tough and looking nasty. I'm sure they were perfectly lawful gentlemen whose dress was only an ironic tip of the hat to the prevailing stereotype. Once I (accidentally) stepped on the foot of one of them, and had to quickly apologize because I wasn't packing any heat that day.

I was in the Diamond District the other day to replace some jewelry I had lost (more on that in my next column), and I decided to satisfy my need for non-humanely slaughtered, kosher meat. I walked up the two flights of stairs and I stopped stock still at what I saw on the door:

Dougie's Express.

Now, you might know Dougie's on the Upper West Side. I'm probably one of about six or seven people on the planet who find it a somewhat unappetizing -- okay, gross -- testament to Orthopop* conspicuous consumption. But it serves a purpose. Then Dougie's opened a dairy place next door. Two is maybe one too many, but stil not out of the ordinary. This Dougie's Express, this extra slice of white bread added to a tasteless table of kosher alternatives in the city, is just too much. I (should have) immediately ripped a hole in my lapel and sat down on the floor, wailing and lamenting.

*Orthopop: Orthodox pop culture. I'm trying to find a good term for it. I know "Orthopop" sounds like it means pop music, though, so if anyone can figure out another good word -- or if there's one already I'm ignorant of -- speak up!

If you haven't heard enough about metzitzah b'peh
Please read on.

My instincts, both scientifically and halachically, tell me that those advocating metzitzah b'peh by suction tube (rather than direct oral suction) are in the right. But if the haredi community considers it important enough, another option might be to institute a stringent screening program for mohalim such that herpes would disqualify. Technical details of testing aside (which would be difficult to various reasons), ethical problems would still remain in this case. Even if a community were to accept upon itself some risk for deleterious outcomes (i.e. genital herpes) in circumcised children, such acceptance would not be legitimate, for the simple reason that the consent of these infants is impossible to obtain!

What comes to mind, however, is that such consent is exactly what we are not obtaining in (non-herpetic!) circumcision. There is an obvious difference, however. Normal circumcision (i.e. with a non-diseased moyel, or non-oral suction) is a medically safe procedure. Circumcision with oral suction, as demonstrated in this paper, is not. Of course, the case for circumcision still needs to be made, but it is prima facie defensible in a way that oral suction isn't.

בחורים וגם בתולות . . .
Young men and young women . . . (Psalm 149)

I don't have time to generate original thoughts, but I can share my stored-up thoughts that others have certainly had. For example: where are all the children's books which feature (or at least show) girls studying Torah? I've asked around at my egalitarian shul, I've Googled, I have "searched but not found." Help me?

Newborn medical students
And other miraculous beginnings.

My new Medicine Mensch article, written between deliveries.

And here it is in full:

MEDICINE MENSCH: Bringing Up Baby — and Doctor
March 4, 2005

Even God needs help when making miracles. He sent a wind to split the Red Sea rather than doing it directly; Moses took intensive elocution lessons before he could shout the Ten Commandments down to the Israelites, and the walls of Jericho could well have been jerry-built by history's first unscrupulous contractors. Add to this list the Miracle of Birth, which requires a number of gadgets that whir, beep and gargle to help doctors coax new life into the world. As I begin my rotation in obstetrics and gynecology (OB/GYN), I know to treat these machines with wary respect, stepping aside as the all-powerful nurses set them up, then copying down their flickering readings with equal parts diligence and ignorance. One new mother attached to a monitor wanted to know whether her blood pressure readings were good or bad. "They went up, and now they're coming down," I answered lamely, to her silent dissatisfaction.

A few days ago, for instance, I participated in the delivery of an ultra-Orthodox woman's baby. Most such women, though young, already have a number of kids, and respond to my questions either in blasé fashion or with outright impatience, aware that they know their own physiology better than I ever will — after all, it's served them for the past four or five children. Their next birth will be fine, God willing, and, in any case, they've got an experienced obstetrician waiting in the wings to help make sure the miracle proceeds as planned.

When I say "participated in the delivery," I mean that at first I stood in the corner, paralyzed with fear, hoping that if I were asked to catch the baby, it wouldn't slip out of my hands like a wet trout. (Newborn babies should come with grippable surfaces, as do basketballs or pistols.) As it turned out, I did leave the corner, when invited by the attending physician to help support the mother's body and the baby's emerging head in a way that made me think I was helping. (This is an essential part of teaching: making the student think he or she can be of service even when it's not the case.) I put three fingers on that warm, black-haired dome and, together with the doctor, gave a gentle pull. The newborn flopped out purply with a healthy cry, caught by the doctor, or — more important to my terrified self — someone other than me. I didn't drop anything! The baby was transferred carefully, but with great speed, to a couple of waiting pediatricians.

This is the point when the father swung into action with his own piece of equipment. As the pediatricians hovered around and above the child (I thought doctors and father were going to butt heads, but, by another miracle, they did not), Dad held his cell phone up to the squalling bundle, broadcasting its cries to a grandmother in Brooklyn. The father returned the phone to his ear, said "Mazel tov" and burst into tears. (He had been in the room the whole time, learning Torah, carefully training his eyes on the monitor or out the window when the mother-to-be, his wife, was convulsed in another epic round of pushing.) His wife asked him, in Yiddish, "Host yeder gekolt?" ("Did you call everyone?")

Off in the corner where I stood, another birth was taking place, helped by nature and by medical school, if not quite by God. A new medical student — me — was coming into the world. Sure, this is my second rotation, but the first, though fascinating, was the decidedly nonstrenuous 9-to-5 Psychiatry rotation. The first couple weeks of OB/GYN has you working from 4 in the morning till 7 in the evening. The unit in which I'm stationed delivers around a hundred babies a week. Here, what's miraculous is the transformation of the act of birth from the breathtaking to the manageable. "This is not normal," one new mother said, smiling through tears, trying to describe her feelings as she watched her baby being cleaned and monitored by the pediatricians. "Every delivery is different," the doctor responded, friendly but underwhelmed, as he sewed up an incision.

A miracle becomes everyday through systematization. The people were stunned by their first exposure to the divine voice, and refused to listen to God after his first words, but Moses had done it a thousand times; for him, it was already routine. When I see a pregnant woman, as ripe as a watermelon, warily approaching the secretary to say that she's here to give birth, I realize that this might be the first time she's ever said those words, while it's maybe the millionth time they've been uttered on this floor. Miraculous acts are not available to the medical student, but a short interview and physical exam, performed in the service of routine medical evaluation, can make sure that the abnormal and the wonderful give rise only to results that can be treated and managed. At least in the medical realm. As for raising the children themselves, that's an even more slippery fish to catch.

Zackary Sholem Berger received his doctorate in epidemiology in January from New York University. Now he's becoming that mythical figure, the Jewish Doctor. His OB/GYN rotation lasts until Purim, when he will not deliver any babies while drunk — or sober, for that matter. Questions and comments can be sent to doctor@forward.com; no medical advice given.

Taking off

This coming Friday will be the third where I leave the hospital early to observe Shabbos. I don't do this without mixed feelings. Observing Shabbos is one thing when one is a tradesman and puts down the tools of one's trade (or picks them up) on one's own recognizance. But the modern workplace, where one is part of a team (or a cog in a machine, depending on how you look at it) is something else again. One's actions affect others. In fact, entire chapters of Jewish socioeconomic history have been written on the turmoil which ensued when Jewish factory owners (never mind the non-Jews) collided with the Sabbath observance of their Jewish workers.

The fact that I have been able, more or less, to pursue my Sabbath observance without undue harm to my career or earning power says not so much about my religious asceticism or Will to Frumkeit, and more about the benefits accruing to me by virtue of my class (by birth) and the expenditure in my education invested by my parents. The fact that hyper-rigorous Sabbath observance has become the norm of the American Orthodox community, by the same token, says a lot about the economic success of that community.

But that's by the way. What I wanted to point out is that the issues in my case (that of a medical student) are slightly more complicated. Most folks in my vast readership (no longer the Daily Dozen, but certainly not yet the Daily Century, either) know that saving a life, in Jewish law, takes precedence over the Sabbath. (This statement is rough; there are many exceptions; but the general idea is valid.) I'm just a student, and not involved (yet) in saving any lives, so one might think that I could leave early with a light heart. But an inner doubter asks: isn't it possible that the extra clinical exposure, available to me if I worked Shabbos, is necessary to train me to be the best life-saver I can be?

Possible, but not actually the case, I think, in the current system of medical education, or at least the one I'm part of. The inner doubter raises an important point, though. After some stage of one's medical education, the activity of medical care must be construed as some sort of gross life-saving even if one is not actually saving lives at every moment. Otherwise medical practice for the Shabbos observer would be impracticable and a shayle would have to be asked every minute of every Saturday. That is to say, once I become a resident, I will have to act like a doctor -- cause I'll be one. And doctors can't get out of working Saturdays if they are the primary caregivers for their patients.

There are, I know, residency programs which do not require the students to work on Shabbos. How this functions I don't know; perhaps the patients are helpful enough to get sick Sunday through Friday?

Qualifications, hems and haws, and corrections to this are sure to follow.

Why I Can Daven At All Those Cool Ortho Shuls on East Broadway
. . . only until my daughter is old enough to daven

Naomi Chana explains it all.

The Boy Knows the Truth
Isaac Bashevis Singer (1904-1991)

First printed in the Yiddish journal Di Tsukunft, October, 1972. Reprinted in Di Tsukunft, October, 2004, on the 100th anniversary of Singer's birth. The Tsukunft editors point out that the story has not been included in any anthology in Yiddish, and has never been translated. I'll try to translate a paragraph at a time, whenever I have the time. Expect the translation to be finished, oh, never. Still, it can't hurt to start.

When Reb Gavriel-Takhne became the Klintover rebbe on the death of his father, he told his attendants that he would not receive women. It was true that his own father and grandfather, and many other rebbes, like Reb Sholem of Belz and Reb Khayim of Sanz, did receive women, but he couldn't compare himself to those righteous men. They were angels; he, Gavriel-Takhne, was a man of bodily needs. His blood boiled in him. In the middle of prayer inappropriate thoughts would attack him like locusts. Fasts and cold mikvahs didn't help. The evil inclination spoke to him without any scruples: anything goes, get some while you still can. From anguish the rebbe bit his nails to the quick. He pounded his head with his fists, tore his sidelocks, called himself an evil man, disgusting, a sinner. He looked for advice in religious works, but it turned out, strangely enough, that an evil spirit had attached himself to him. How ridiculous! Young men visited him to learn how to be God-fearing; scholars copied his words of Torah; he taught Talmud daily to yeshivah students; was ashamed before other people more than before God . . .

"This is a world of falsehood, anyway," said the rebbe to himself. Here, in the world of demons, everything was backwards. Countless times Reb Gavriel-Takhne had wanted to call together those close to him and tell them the truth: he couldn't be a leader of Jews. But the rebbe knew that as soon as he took off the spodik and the felt coat, he would immediately come under the Devil's control. The way things were, at least, he hadn't progressed to any actual sin.

He kept having the same thought. A man like him, Gavriel-Takhne, is ashamed before other people more than before God.

The rebbe would look into "The Beginning of Wisdom" and think about Rahab the prostitute; he would study the Zohar and lust after Avishag the Shunamite and Queen Esther. It said in works of Kabbalah that new personalities would spring up between Adam and Eve, Jacob and Rachel, David and Batsheba. In this case, they meant souls, not bodies. But as soon as the rebbe fell asleep, the bodies of those righteous women would reveal themselves to him naked. He would cavort with them like a he-goat. They'd sing different songs and uncover their shame. The rebbe got up trembling.

"Help, please help! I can't take it any more!"

The rebbe had a wife, a descendant of the Roptshitser rebbe, Menukhe-Alte. But as much as he was a man of lust, she was someone of whom it's said "even her pregnancy and giving birth are in holiness." He, Gavriel-Takhne, is tall, broad, with the voice of a strongman and the appetite of an animal. At fifty-seven his beard was still as red as fire, without a thread of gray. He had all his teeth. He could crack walnuts with them. One time, during a fire in his courtyard, Gavriel-Takhne tore locks open with his bare hands, carried out whole cases of holy books. He grabbed Avigdor the sexton, who had passed out from the smoke, and carried him down two flights of stairs. Then the rebbe went out to the well and for two hours straight drew buckets of water which the firefighters used to put out the fire.

Imperfect Understanding

Gregg Easterbrook, in his Daily Express column at The New Republic [I think this is the link, but it seems to be broken right now], says there should be fewer languages. In presenting his claim, he manages to conflate a number of issues while misunderstanding them. There are too many inaccuracies and howlers to go over individually, but we'll start with the main ones:

"The fewer the tongues, the more easily societies communicate." This is an argument by assertion. Easterbrook does not understand that we have both a global English-language culture and, at the same time, many minority languages which may or may not correspond to political entities. For example, all countries involved in the recent war in Iraq communicated in English among themselves, while their citizens speak languages other than English. Surely Easterbrook does not maintain that these countries would have "communicated more easily" if only all of their citizens spoke English. (Presumably our colonial mother, the United Kingdom, spoke something other than English in the late eighteenth century; otherwise we would not have had so basic a miscommunication as a war.)

Furthermore, not every minority language is an "indigenous language." Easterbrook is laboring under the misconception that there are two kinds of languages: global powerhouses, like English, and minority languages spoken only by the primitive inhabitants of an isolated territory. But there are many sorts of non-global languages, ranging from national vernaculars (Ukrainian, Belgian) to state-supported languages(Irish, Frisian) to stateless languages (Yiddish, Romani).

"For citizens of the developing world, speaking a top ten language opens doors to a better life." No one denies that English, or any other language of global commerce, is a route to economic success. This is trivial. There are two questions here: (a) how one is to define economic success. One can always make more money. Is it really true that all other languages besides English (or Mandarin) should be jettisoned as long as speaking them reduces one's income by some non-zero amount? Secondly, (b) how is one to define "a better life"? This is the non-trivial question which cannot be answered in daily-express fashion.

"Multiple languages arose because throughout history, many groups of people lived in isolation, interacting only with others like themselves." I've read this sentence a dozen times and I'm still not sure what it means. Does it mean that, ideally, there would only be one language, but that due to "many groups of people liv[ing] in isolation," multiple languages sprung up? (In that case, Easterbrook's knowledge of sociolinguistics stopped at the Tower of Babel.) But we know that many languages, if not all, arose precisely out of a process of contact and exchange between different groups. This certainly describes the genesis of English, Spanish, and Yiddish, and I bet lots of other languages too. Even the Romance languages (which Easterbrook might be thinking of) arose out of contact between Latin and coterritorial vernaculars, not out of inbreeding. I'm not sure what languages Easterbrook was thinking of when he wrote this sentence (if "wrote" is the word). He probably thinks that the indigenous languages he blesses with his disapproval somehow blossomed ready-made from the earth, without contact with any other language. This isn't true either.

"[. . .] when a rare language dies out, the culture it served can continue, just in some other tongue[.]" I admire Easterbrook's confidence, but I disagree. Cultures change when they are translated. Such translation is not a sin, and is not to be avoided -- it's necessary, after all, to help Jews understand what is said in the Yiddish most of them no longer speak. But this does not mean that all of Yiddish culture is readily translatable into English. Translation does not mean continuation.

"And of course if members of a small-language culture want to work to keep their tongue in use, that's great, so long as they know a major language as well." Now he tells us this, in the third-to-last paragraph? O editor, where is thy saving pencil?

Why there aren't (m)any blogs by third- and fourth-year medical students
Or: What's the recommended treatment for a blogger hiatus?

In case you haven't guessed, I am spending a lot of time doing other things than blogging, mostly experiencing various varieties of humiliation and quasi-pedagogic force-feeding. Some interesting learning and patient contact in there, too. Stay tuned for coming articles and for blog posts at irregular intervals.

The riv-haleshonot made local
More Tales from Down Under on the LES.

[Scene: A kosher bakery. Two Jewish men are leaning on the counter and talking to each other in Yiddish in confident, ownerly fashion.]

One of the women behind the counter, to another woman: They can talk to each other in Yiddish, but we're not allowed to speak Spanish!

ZShB [in Spanish]: They don't let you speak Spanish?

[He is ignored.]

*Riv-haleshonot (Hebrew): Language war (literally, "quarrel"). A phrase usually referring to the often-strained relations between Hebraists and Yiddishists in the Diaspora and the Land of Israel.

Sowing nostalgia
Loisaida stories, 1.

[Scene: Interior of a small store on a street near ZShB's new apartment. The very apotheosis of disorder. Shelves covered with dust, bits of recognizable leathery Judaica -- mezuzot, tefillin, etc. -- and other various merchandise. There's another store, somewhat less dusty and more ordered, down the block, but your narrator is not in a hurry and has chosen to wander on in here as well. At the counter in the front sits an old Jew in his seventies or eighties, with a white beard and a slanted, black "Litvish" yarmulke. His name is Rabbi E.* An open Talmud lies a few feet away. The conversation, of course, is in Yiddish.]

ZShB: Two havdalah candles, please.

[There's a pleasant conversation about ZShB's employment, marital status, and number of children. He is welcomed to the neighborhood.]

ZShB: Didn't there use to be a seforim ["Hebrew" book] store around here?

Rabbi E: Yes, but it closed last year.

ZShB: [Momentarily forgetting that he just went into another Judaica store a few blocks back] Is yours the only store around like this?

Rabbi E: Yes! [bangs fist on table] I'm the only one who sells good, kosher mezuzot and tefillin!

*He has more than an initial, obviously.

Shampoo, soap, and psychiatry

Feigning Sanity at Bellevue, my second article in the Medicine Mensch series.

And here it is in full:

MEDICINE MENSCH: Feigning Sanity at Bellevue
By Zackary Sholem Berger
February 4, 2005

My first rotation as a medical student is psychiatry, that branch of medicine that patrols the border between sane and insane. But as is well known to any observer of human behavior, the sane are sane up until the point when you start looking at them with an analytic eye. Then everyone seems to need treatment, doctors and students included.

At 9:15 every morning, our psychiatry ward has a "community meeting," a chance for everyone — patients, doctors and staff (the "community") — to thrash out problems that are relevant to life on our unit. A sociologist would have a wonderful time here. Everyone sits in large, colorful, uncomfortable plastic chairs, like booster seats for grownups. We're reminded daily that at the meeting, personal issues are out of bounds. But without fail, one of the patients always starts with the question, "When do I get out of here?" Or, "Quiero irme ya." ("I want to leave right now.") (The meetings are translated into Spanish.) "That's a personal issue," a staff member always answers, "but we can try to discuss it generally. We're only talking about community issues now."

(On the other hand, our staff meeting is a freewheeling chance to bitch and moan in the most personal of terms. Without coming to blows and, miraculously, without psychotropic medication, the issues are somehow solved, helped by the powerful motivation of getting enough work done by lunchtime.)

But let's get back to the first meeting. What does the "community" complain about? Someone gets tea instead of coffee at lunch, or vice versa. The meeting room (normally the patient lounge) hasn't had its floor washed in days. One of the patients won't take showers. "Hey, where's the shampoo?" Men are using women's bathrooms. And so on. If this list of problems sounds familiar, it's because they show up at all stages of life whenever people stay in close proximity: in the suburban home, summer camp, resort, homeless shelter or Elderhostel. We all have the same problems when staying three to a room.

Even in an emergency, the sickest mental patients have more in common with us than we might like to admit. A couple of weeks ago, I spent midnight to7 a.m. at Bellevue Hospital's Comprehensive Psychiatry Emergency Program — the psychiatric emergency room. The orientation packet emphasizes a number of safety precautions: Never be alone in a room with a patient; always have an exit route in mind; don't promise a patient, even in the name of politeness, anything that you can't deliver. From these caveats, I imagined a cross between a cellblock at Alcatraz and a chaotic thrill ride of the insane. (Never mind the prime rule of medical-student safety, on any ward, psychiatric or not: Get out of the way as fast as you can; someone larger than you knows exactly what to do in this situation.)

I saw five or six patients, and of those, only one needed urgent psychiatric care. Why did the others come to CPEP that night? It was rough outside, rainy and cold, with a brisk wind off the East River — not a good time to be kicked out by your mother because you've had a fight with her new husband. It also wasn't the best night (from another patient's point of view) to have taken a bus to New York from Michigan to "hang out with some friends" who turned out not to be so hospitable.

The attending physician on call that night decided that none of these other cases could be admitted. There were those who didn't have psychiatric problems at all, and just wanted a warm bed for the night. Others were indeed mentally ill, but not sick enough to stay in the hospital. Some fell into both categories. It's not trivializing the plight of the mentally ill to say that the daily lives of the sane are also ruled by institutions that cannot admit just anyone; the problem of limited resources is a general one. (Have you ever tried to find an apartment in the city, or get your kid into school, or find a job?) Even so, I kept asking myself the question: Shouldn't there be an institution that is ready to help these people, no matter what the cost? And here's the answer: Yes, and you're working in it. But you still can't do everything.

The next morning at 9:15 I did my little bit, filling in as a Spanish translator because a couple of people were out sick. Among other things, I helped make sure everyone understood an important fact: how packets of sweetener are distributed at lunch and why. Life on the wards, like life outside, is measured in shampoo and sugar.

Moving

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
on
Anna Margolin: Yiddish Poet of the Lower East Side
Tuesday
January 18, 2005
7PM

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.