Medicine Mensch goes (Poly)Glatt
Number seven in a series.
Visiting Patients, With Dictionary In Hand
By Zackary Sholem Berger
July 1, 2005
Before I became a medical student, I thought I spoke Spanish pretty well. I spent six months after college researching minority languages in Spain and, after moving to New York, I've had many a friendly conversation with miscellaneous Spanish speakers I've accosted: random passersby from Puerto Rico, law students from Colombia, grocery packers from the Dominican Republic.
Having a conversation on the street or a chat in a café about politics or literature is one thing. If you don't understand a word, you can smile or nod and pick up from context what's going on. But say you've been called down to the E.R. to take a history and do a physical, and you find a drunk, toothless man in handcuffs gesturing frantically at something underneath his bed. If you could understand drunken, toothless Spanish a little bit better, it might not take you 15 minutes of sympathetic listening to understand that the man wants his cell phone (which the cops sitting nearby are not about to let him have).
The difficulty isn't simply a matter of decoding the speaker's register (someone from a different socioeconomic class can be hard to understand, even in one's native tongue), nor is it the fact that various dialects of the language are represented at any urban hospital. It's often the words themselves that make things hard. Like every other medical student, I have a command of several different kinds of medical terminology: the mind-numbing jargon of the scientific literature, the half-macho talk of rounds and last but certainly not least important, the normal words people use to talk in English about whatever's the matter with them.
It's this last kind of vocabulary that I lack in Spanish. I can talk a blue streak about genetic predispositions and infectious agents, about endoscopies and anesthesia — these are international terms, much the same in Spanish, English and many other languages. But lay language is different. I've already experienced a certain kind of linguistic blockage more than once. I've started a conversation with a Spanish-speaking patient, we've built up something of a rapport, she's complimented my Spanish, I've figured out why she's come to the hospital. Then, all of a sudden, I need to ask a specific question to narrow down the field of possible diagnoses. I use what I think is the right word, and one of two expressions appears on the patient's face: either outright incomprehension, or a polite glazed-over look that means, "I'm going to keep my mouth shut until I can figure out what the heck this nice doctor is saying." It's then that I have to search my dusty old neurons for a Spanish word I learned once, many years ago, or for a synonym that's used in the home country of this particular patient. During one memorable conversation, a patient and I sat through a long, awkward pause before she figured out that I was asking about her period.
Those familiar with the overscheduled life of the medical professional might wonder what's the point of trying to achieve "medical fluency" in Spanish or another foreign language. For most doctors it might be enough to master a minimal vocabulary, and the extra minutes spent figuring out the Colombian word for "tampon" or "leg splint" can more profitably be devoted to a more extensive history or exam of the other dozen patients that have to be seen today. It's also true that a translator is (usually) available. That's if one wants to take the legal route. Many doctors use the Spanish-speaking janitor, or the patient's sister who's waiting in the lobby; neither alternative would be applauded by medical ethicists.
It all depends on how the doctor sees her practice. If her task is to see clients who are visiting for necessary medical services, they probably can be more efficiently served (not to say "processed") with minimal communication. Many common complaints can be divined from the patient's presentation and demographic with only the bare outlines of a conversation. If this approach isn't warm and personal, it's certainly necessary when there are hundreds of patients to see in a week.
But since I'm still a medical student, I can still afford to let my personal tendencies influence the way I see medicine. I'm a person who doesn't mind sacrificing a little efficiency (or even a lot) to get a good conversation going with the person sitting in front of me. Will that make me a better doctor? Beats me, but I know I'll have more fun this way.
"You can't learn every language," a medical student friend of mine pointed out when she heard about my linguistic ambitions, i.e., trying to learn some Chinese. Many people at Bellevue know some stock Chinese phrases, but if I can avoid it I'd rather not storm into the hospital room of an 80-year old man and blurt out the Chinese version of "Did you piss today?" Most medical students wouldn't be caught dead asking an older person that question in English; clearly there must be another way to do it in Chinese. And I'm still trying to find the Yiddish speaker who doesn't assume that accented English will impress me more than mameloshn.
If you happen to speak English, I will make every effort to accommodate you once I'm a physician. Please realize, though, that since I'll be a doctor, my handwriting will be illegible — in any language.
Still a medical student, Zackary Sholem Berger has a bunch of dictionaries at home, but he never can seem to remember the word he needs. When he's a physician himself, he can have a medical student look everything up for him. Send him questions in the language of your choice at doctor@forward.com.
6/30/05
6/27/05
A new translation of Pessoa: a review
In the way of bloggers everywhere, I'm posting here a review of mine which was rejected by a journal.
Fernando Pessoa: Selected Poems
Translated by David Butler
Every translation of poetry should come with an introduction explaining the approach of the translator. David Butler does this with admirable forthrightness in his recent volume of selected translations of Fernando Pessoa: "I have resisted the temptation to tidy up the English syntax for the sake of readability. . . . The awkward syntax . . . of Pessoa's poetry is intended as a semantic corollary to his overwhelming sense of existential 'thrownness', and is ill-served by imposing definitive structures or meaning on the English." "A great advantage of a bilingual edition," continues Butler, "is that it is far easier for the translator to resist the urge to rewrite," since the original is available to the reader for easy comparison.
Thus on the one hand we can praise Butler for an important service: presenting the nearest English equivalents of Pessoa's existentially knotty Portuguese. But the translator of poetry has another responsibility (which does not necessarily exclude Butler's approach): creating poems in the target language. Translating a poem into Portuguese into a non-poem in English which respects the unclarity and strangeness of the original is a good deed of philology but not yet a poetic accomplishment.
First, though, to Pessoa. Anyone but the blasé Pessologist will warmly welcome a new selection of his poems, since some of it will be new to the average reader. The effect of his controlled and variegated confusion is that of someone thinking out loud, unsure about everything but his own unsureness: "I write in the midst/Of that which isn't to hand." Is this the modern predicament, or merely a modern version of that pain which we dismiss with the classification "the human condition"? Pessoa (this time under his own name and not one of his famed multiple-personality eponyms) has something to say about this ( p.39):
Autopsychography
The poet's a man who feigns.
He feigns so completely
That he comes to pretend pain
For pain that he actually feels.
And those who read what he writes
Feel also, in the pain they read,
Neither of the two that he had,
But only that which they don't have.
Thus, to entertain our reason,
Round and round in wheel-ruts
Revolves that clockwork engine
That is termed the heart.
The combination of cold mechanics and raw pain is invigorating, Larkin without the censoriousness. Pessoa implicates us in his poetry, a sort of imposter's game or dressing-up of feelings as other feelings – but the poet also points out time and again that only through such playacting do we see what might be true.
A short review of Pessoa would be as inappropriate as a one-page review of the work of Emily Dickinson. Here I'll just something about the translation. Though in agreement with Butler's theoretical possibilities, the reader might find it difficult to find anything poetical in his translations. From Butler's introduction, it seems that this might be what he wants, and the translations themselves seem to bear out this suspicion. The last lines of the poem above, for example, run this way in the original: "E assim nas calhas de roda/Gira, a entreter a razao,/Esse comboio de corda/Que se chama o coracao." The verb gira precedes the noun comboio; in Portuguese, as in other Romance languages, there is nothing particularly awkward or significant about this syntax. Preserving in English this Portuguese syntax ("revolves that clockwork engine") throws the reader off guard and does not allow her to finish reading the poem without thoughts of translation intruding into her attention. This is presumably not the sort of "thrownness" Butler has in mind.
One could go through these translations and quibble with a number of word and phrasing choices (for example, Butler tends to translate Portuguese basta as suffice, a word which in English is confined mainly to upper-register speech), but this is unfair. Translating Pessoa requires concentration and sensitivity, and by and large these are present in this edition. Indeed, these same qualities should be brought by the reader to every poem of Pessoa's represented here, a record of a personality nervously approaching and then withdrawing from the world:
That which pains me is not
What is in the heart
But rather those beautiful things
Which will never exist.
They are the forms without form
Which pass by, without pain
Being able to know them
Or love dream them.
They are as though sadness
Were a tree and, one by one,
Its leaves were to fall
Between the trace and the mist.
In the way of bloggers everywhere, I'm posting here a review of mine which was rejected by a journal.
Fernando Pessoa: Selected Poems
Translated by David Butler
Every translation of poetry should come with an introduction explaining the approach of the translator. David Butler does this with admirable forthrightness in his recent volume of selected translations of Fernando Pessoa: "I have resisted the temptation to tidy up the English syntax for the sake of readability. . . . The awkward syntax . . . of Pessoa's poetry is intended as a semantic corollary to his overwhelming sense of existential 'thrownness', and is ill-served by imposing definitive structures or meaning on the English." "A great advantage of a bilingual edition," continues Butler, "is that it is far easier for the translator to resist the urge to rewrite," since the original is available to the reader for easy comparison.
Thus on the one hand we can praise Butler for an important service: presenting the nearest English equivalents of Pessoa's existentially knotty Portuguese. But the translator of poetry has another responsibility (which does not necessarily exclude Butler's approach): creating poems in the target language. Translating a poem into Portuguese into a non-poem in English which respects the unclarity and strangeness of the original is a good deed of philology but not yet a poetic accomplishment.
First, though, to Pessoa. Anyone but the blasé Pessologist will warmly welcome a new selection of his poems, since some of it will be new to the average reader. The effect of his controlled and variegated confusion is that of someone thinking out loud, unsure about everything but his own unsureness: "I write in the midst/Of that which isn't to hand." Is this the modern predicament, or merely a modern version of that pain which we dismiss with the classification "the human condition"? Pessoa (this time under his own name and not one of his famed multiple-personality eponyms) has something to say about this ( p.39):
Autopsychography
The poet's a man who feigns.
He feigns so completely
That he comes to pretend pain
For pain that he actually feels.
And those who read what he writes
Feel also, in the pain they read,
Neither of the two that he had,
But only that which they don't have.
Thus, to entertain our reason,
Round and round in wheel-ruts
Revolves that clockwork engine
That is termed the heart.
The combination of cold mechanics and raw pain is invigorating, Larkin without the censoriousness. Pessoa implicates us in his poetry, a sort of imposter's game or dressing-up of feelings as other feelings – but the poet also points out time and again that only through such playacting do we see what might be true.
A short review of Pessoa would be as inappropriate as a one-page review of the work of Emily Dickinson. Here I'll just something about the translation. Though in agreement with Butler's theoretical possibilities, the reader might find it difficult to find anything poetical in his translations. From Butler's introduction, it seems that this might be what he wants, and the translations themselves seem to bear out this suspicion. The last lines of the poem above, for example, run this way in the original: "E assim nas calhas de roda/Gira, a entreter a razao,/Esse comboio de corda/Que se chama o coracao." The verb gira precedes the noun comboio; in Portuguese, as in other Romance languages, there is nothing particularly awkward or significant about this syntax. Preserving in English this Portuguese syntax ("revolves that clockwork engine") throws the reader off guard and does not allow her to finish reading the poem without thoughts of translation intruding into her attention. This is presumably not the sort of "thrownness" Butler has in mind.
One could go through these translations and quibble with a number of word and phrasing choices (for example, Butler tends to translate Portuguese basta as suffice, a word which in English is confined mainly to upper-register speech), but this is unfair. Translating Pessoa requires concentration and sensitivity, and by and large these are present in this edition. Indeed, these same qualities should be brought by the reader to every poem of Pessoa's represented here, a record of a personality nervously approaching and then withdrawing from the world:
That which pains me is not
What is in the heart
But rather those beautiful things
Which will never exist.
They are the forms without form
Which pass by, without pain
Being able to know them
Or love dream them.
They are as though sadness
Were a tree and, one by one,
Its leaves were to fall
Between the trace and the mist.
6/24/05
Mazl-tov, Beyle!
Beyle Schaechter-Gottesman, Yiddish singer, songwriter, and poet, has been awarded one of twelve National Heritage Awards from the NEA. The Awards are the nation's highest honor in the folk and traditional arts.
I haven't written nearly enough about her in this space. Below is my translation of one of her poems. You can also hear some of her singing (you wouldn't be amiss in buying one of her CDs, either).
Let me repeat, with joy: מזל־טובֿ, ביילע! איר האָט עס כּשר פֿאַרדינט. (Mazl-tov, Beyle! It couldn't have been given to a more deserving person.)
Nobody
Beyle Schaechter-Gottesman
Nobody loves the weak one,
quietly modest,
watching and waiting,
the small one.
Nobody loves the one who’s alone,
hid in himself,
lost
in the inner I,
the one alone with himself.
No one loves
the one who loses,
in constant collapse,
one and lonely,
the nobody –
nobody.
Beyle Schaechter-Gottesman, Yiddish singer, songwriter, and poet, has been awarded one of twelve National Heritage Awards from the NEA. The Awards are the nation's highest honor in the folk and traditional arts.
I haven't written nearly enough about her in this space. Below is my translation of one of her poems. You can also hear some of her singing (you wouldn't be amiss in buying one of her CDs, either).
Let me repeat, with joy: מזל־טובֿ, ביילע! איר האָט עס כּשר פֿאַרדינט. (Mazl-tov, Beyle! It couldn't have been given to a more deserving person.)
Nobody
Beyle Schaechter-Gottesman
Nobody loves the weak one,
quietly modest,
watching and waiting,
the small one.
Nobody loves the one who’s alone,
hid in himself,
lost
in the inner I,
the one alone with himself.
No one loves
the one who loses,
in constant collapse,
one and lonely,
the nobody –
nobody.
6/16/05
Son of Intermarriage
Or: What do we call those pesky non-Jews who insist on hanging around?
Eons ago, when most of midtown Manhattan was covered by a vast inland sea -- I refer to July, 2003 -- I started this blog with a post about intermarriage. My unoriginal claim was that intermarriage is by no means an unmitigated evil for the Jewish community, and that our institutions need to find positions which go beyond preachy boilerplate.
A related conversation (what do we call non-Jews who choose to ally themselves with our community?) is going strong in the J-sphere. Here is some miscellany you might find of interest, most shamelessly filched from friend and commenter Becca.
Perhaps the only newsworthy bit I have to offer is that the Federation of Jewish Men's Clubs has prepared a twenty-two page pamphlet on supporting the non-Jewish spouse (I can't seem to find the exact title right now), supposedly meant for circulation to the members of the Rabbinical Assembly for a meeting in July. Since I can't find any information on line about an RA meeting in that month, I wonder if something else might be meant. In any case, the Forward is supposedly going to print something about the pamphlet and reactions to it.
Rabbi Steven Greenberg, in an essay on intermarriage, talks about reinventing the ger toshav for modernity. On the other hand, the authors of the new book A Place in the Tent: Intermarriage and Conservative Judaism (also reviewed here) suggest the term karov* (קרוב, lit. "relative") for any non-Jew who allies herself to the Jewish people without seeking membership.
In a private e-mail correspondence I'm involved with, one of the participants suggested that using the term ger toshav might encourage tradition-minded Jews to give due respect to the roles played by non-Jews in a Jewish community. To this, I replied:
The aforementioned Becca also shared some general comments on the rhetorical tasks faced by liberal Jews in taking account of the importance of their non-Jewish friends and relatives. (Rhetoric shapes our actions, hence the attention I'm devoting to it here.) I'm going to add her e-mail as a comment in my name.
I look forward to all of your views on the issue. Please note that the comments link at the end of each post seems to be broken; if you click on "link" you should be able to use the Blogger commenting feature.
*Which I will, to no one's surprise, pronounce korev. Kadimah Ashkenazistim!
Or: What do we call those pesky non-Jews who insist on hanging around?
Eons ago, when most of midtown Manhattan was covered by a vast inland sea -- I refer to July, 2003 -- I started this blog with a post about intermarriage. My unoriginal claim was that intermarriage is by no means an unmitigated evil for the Jewish community, and that our institutions need to find positions which go beyond preachy boilerplate.
A related conversation (what do we call non-Jews who choose to ally themselves with our community?) is going strong in the J-sphere. Here is some miscellany you might find of interest, most shamelessly filched from friend and commenter Becca.
Perhaps the only newsworthy bit I have to offer is that the Federation of Jewish Men's Clubs has prepared a twenty-two page pamphlet on supporting the non-Jewish spouse (I can't seem to find the exact title right now), supposedly meant for circulation to the members of the Rabbinical Assembly for a meeting in July. Since I can't find any information on line about an RA meeting in that month, I wonder if something else might be meant. In any case, the Forward is supposedly going to print something about the pamphlet and reactions to it.
Rabbi Steven Greenberg, in an essay on intermarriage, talks about reinventing the ger toshav for modernity. On the other hand, the authors of the new book A Place in the Tent: Intermarriage and Conservative Judaism (also reviewed here) suggest the term karov* (קרוב, lit. "relative") for any non-Jew who allies herself to the Jewish people without seeking membership.
In a private e-mail correspondence I'm involved with, one of the participants suggested that using the term ger toshav might encourage tradition-minded Jews to give due respect to the roles played by non-Jews in a Jewish community. To this, I replied:
The benefits of the term "ger toshav" are also its dangers -- well, maybe "dangers" is an exaggeration. Call them "downsides." Most tradition-minded Jews who are knowledgable enough about the term "ger toshav" in order for it to mean something to them (and, even more, with enough familiarity to create a less-negative reaction to intermarriage) will also realize that there is a long halachic history behind the term. None of you have to be told that Rambam holds forth at great length on the privileges and responsibilities of the ger toshav. While it might be comforting to some to know that the GT is not a new category, they might be less comforted to know just how different our allied non-Jews are from the (frankly) subject population envisioned by medieval halachists.
It's Elliot Dorff, I think, who points out in one of his biomedical essays that sometimes halachic categories do not correspond to present realities - sometimes they're so out of joint that no amount of shoving will make things fit. He mentioned this in the context of goses and terefah, but I think for the liberal Jew it applies as well for the status of women, and, in our case, for non-Jews within the (liberal) Jewish community. That's why "karov" seems like a good try. Pretty vague, true, but then perhaps what's needed is not a formal naturalization for allied non-Jews, just (as was pointed out previously) a rhetorical acknowledgement of their positive existence.
The aforementioned Becca also shared some general comments on the rhetorical tasks faced by liberal Jews in taking account of the importance of their non-Jewish friends and relatives. (Rhetoric shapes our actions, hence the attention I'm devoting to it here.) I'm going to add her e-mail as a comment in my name.
I look forward to all of your views on the issue. Please note that the comments link at the end of each post seems to be broken; if you click on "link" you should be able to use the Blogger commenting feature.
*Which I will, to no one's surprise, pronounce korev. Kadimah Ashkenazistim!
6/9/05
MEDICINE MENSCH
Making Rounds: A Hospital Drama
By Zackary Sholem Berger
There is a drama performed in hospitals that is as essential and unchanging as davening, or eating breakfast. It's the doctors' twice-daily bedside perambulation, known to everyone as "rounds."
Whenever a medical student walks into a patient's room, it's an act for both concerned. Perhaps the metaphor is inexact. Each actually wants to tell the other something that is necessary to know; real life is going on here, not just a staged meeting. But performance anxiety is also a crucial element of the interaction. The student wants to demonstrate confidence in front of the patient, in the hope of hitting on a juicy finding to feed the intern; then the intern, thus fortified, might look good in front of the resident, who would be nice to the intern — who would then, in turn, the student devoutly hopes, be nicer to her.
The patient has his role, too. There are as many different sorts of patients as there are people in general, but many would like to be the "good patient," the one whom resident and attending alike mention with a smile or, at least, without an eye roll and a barely suppressed groan.
Patient and doctor meet on this sort of medical date thousands of times a day in hospitals everywhere, each hoping that, for the other's sake, the two of them will hit it off.
But what is it like to go on rounds? It's a performance with its own special set of characters, among them the Patient (lying in bed, trying to sleep), the Medical Student (short white coat, bleary eyes, clipboard), the Intern (long white coat, even blearier eyes, folded sheaf of paper, look of a hunted woodland creature) and the Attending (long white coat, very little paraphernalia, confident and well rested). Morning rounds are executed in two acts. The first, featuring the Medical Student and the Patient, is transcribed below. (The Patient's responses are omitted — because, among other reasons, he's tired, talking through a sheet pulled over his head and wishing the Student would go away.)
ACT I
The place: A raucous urban hospital.
The time: 6:45 a.m.
Enter Medical Student.
Medical Student (to Patient): Good morning! Did you make a bowel movement last night? ...
I realize it's a quarter to seven in the morning. I need to ask you a number of questions about how you're feeling. Someone else asked you a bunch of questions this morning when she took your temperature? That was the nurse. And another person asked you questions earlier this morning? That was the intern. Sometimes he likes to get here early to get a jump on things without me. I'm a medical student, and I have my own questions to ask you. ...
Why can't we all coordinate the questions we ask? That's a good question. I wish I knew the answer to that. I'll get back to you on that one. ...
I'm glad you're answering my questions, sir, but please don't say that I can "practice" on you. My resident tells me I'm a vital part of the team. ...
So, about those bowel movements. Made any? Great! That's good to hear. What about gas? Urinating? How's your pain? Where would you rank your pain on a scale of zero to 10? Any other complaints? Okay — I'll speak to someone about the food here. And, what's that? Too many people asking questions? Your sense of humor is very healthy, sir. ...
Now I'm going to examine you briefly. First your abdomen. Where does it hurt? All right. Let me just look. I'm sorry! I know it hurts. I know, but I wanted to see for myself. After I'm done examining you, I'll just check your incision. Let me listen to your heart and lungs now. Breathe deep, please. ...
Okay, thanks a lot! Any other questions for me? ...
Normal food? I think you'll be eating normal food by tomorrow, but I'm not 100% sure. I have to ask the doctors, who are coming by a little bit later. Have a good day.
END OF ACT I
* * *
The second and final act of Morning Rounds happens a little bit later, with the Attending presiding. The curtain rises:
ACT II
The place: The same.
The time: 7:30 a.m.
Enter Attending, Intern and Medical Student. The Intern and Medical Student are silent, attentive, almost worshipful.
Attending (to Patient, while moving very fast): Good morning! How's the belly?
(Attending performs a thorough examination of the patient's abdomen in 25 seconds, during which time the Medical Student drops his pen cap, which rolls under the bed; makes a split-second decision to go after the cap, without success, and finally resolves to use only ballpoints like everyone else has, which click in and out. During this same period the Intern makes notes on 10 patients, tries to guess what time he's going home tonight and wonders what the hell his student is doing under the bed.)
Attending: Great! Okay, I'll see you later. Keep on feeling better. (Directs a stream of instructions to intern.)
(Attending, Intern and Medical Student leave the room and head down the corridor.)
Patient (shouting after them): Can I eat tomorrow?
(Medical Student does not answer. He will ask Intern later in the day, after rounds. The answer will be furnished by the time they all round again in the evening.)
Patient: Hello?
(Tries to go back to sleep.)
END OF ACT II
CURTAIN
If you missed the first performance, don't worry. The cast will be waiting by the elevators at 5 p.m. for a return engagement. Bring your clipboard.
Zackary Sholem Berger plays the part of the Medical Student. He's lost many pen caps on morning rounds while much of the city is still sleeping.
Making Rounds: A Hospital Drama
By Zackary Sholem Berger
There is a drama performed in hospitals that is as essential and unchanging as davening, or eating breakfast. It's the doctors' twice-daily bedside perambulation, known to everyone as "rounds."
Whenever a medical student walks into a patient's room, it's an act for both concerned. Perhaps the metaphor is inexact. Each actually wants to tell the other something that is necessary to know; real life is going on here, not just a staged meeting. But performance anxiety is also a crucial element of the interaction. The student wants to demonstrate confidence in front of the patient, in the hope of hitting on a juicy finding to feed the intern; then the intern, thus fortified, might look good in front of the resident, who would be nice to the intern — who would then, in turn, the student devoutly hopes, be nicer to her.
The patient has his role, too. There are as many different sorts of patients as there are people in general, but many would like to be the "good patient," the one whom resident and attending alike mention with a smile or, at least, without an eye roll and a barely suppressed groan.
Patient and doctor meet on this sort of medical date thousands of times a day in hospitals everywhere, each hoping that, for the other's sake, the two of them will hit it off.
But what is it like to go on rounds? It's a performance with its own special set of characters, among them the Patient (lying in bed, trying to sleep), the Medical Student (short white coat, bleary eyes, clipboard), the Intern (long white coat, even blearier eyes, folded sheaf of paper, look of a hunted woodland creature) and the Attending (long white coat, very little paraphernalia, confident and well rested). Morning rounds are executed in two acts. The first, featuring the Medical Student and the Patient, is transcribed below. (The Patient's responses are omitted — because, among other reasons, he's tired, talking through a sheet pulled over his head and wishing the Student would go away.)
ACT I
The place: A raucous urban hospital.
The time: 6:45 a.m.
Enter Medical Student.
Medical Student (to Patient): Good morning! Did you make a bowel movement last night? ...
I realize it's a quarter to seven in the morning. I need to ask you a number of questions about how you're feeling. Someone else asked you a bunch of questions this morning when she took your temperature? That was the nurse. And another person asked you questions earlier this morning? That was the intern. Sometimes he likes to get here early to get a jump on things without me. I'm a medical student, and I have my own questions to ask you. ...
Why can't we all coordinate the questions we ask? That's a good question. I wish I knew the answer to that. I'll get back to you on that one. ...
I'm glad you're answering my questions, sir, but please don't say that I can "practice" on you. My resident tells me I'm a vital part of the team. ...
So, about those bowel movements. Made any? Great! That's good to hear. What about gas? Urinating? How's your pain? Where would you rank your pain on a scale of zero to 10? Any other complaints? Okay — I'll speak to someone about the food here. And, what's that? Too many people asking questions? Your sense of humor is very healthy, sir. ...
Now I'm going to examine you briefly. First your abdomen. Where does it hurt? All right. Let me just look. I'm sorry! I know it hurts. I know, but I wanted to see for myself. After I'm done examining you, I'll just check your incision. Let me listen to your heart and lungs now. Breathe deep, please. ...
Okay, thanks a lot! Any other questions for me? ...
Normal food? I think you'll be eating normal food by tomorrow, but I'm not 100% sure. I have to ask the doctors, who are coming by a little bit later. Have a good day.
END OF ACT I
* * *
The second and final act of Morning Rounds happens a little bit later, with the Attending presiding. The curtain rises:
ACT II
The place: The same.
The time: 7:30 a.m.
Enter Attending, Intern and Medical Student. The Intern and Medical Student are silent, attentive, almost worshipful.
Attending (to Patient, while moving very fast): Good morning! How's the belly?
(Attending performs a thorough examination of the patient's abdomen in 25 seconds, during which time the Medical Student drops his pen cap, which rolls under the bed; makes a split-second decision to go after the cap, without success, and finally resolves to use only ballpoints like everyone else has, which click in and out. During this same period the Intern makes notes on 10 patients, tries to guess what time he's going home tonight and wonders what the hell his student is doing under the bed.)
Attending: Great! Okay, I'll see you later. Keep on feeling better. (Directs a stream of instructions to intern.)
(Attending, Intern and Medical Student leave the room and head down the corridor.)
Patient (shouting after them): Can I eat tomorrow?
(Medical Student does not answer. He will ask Intern later in the day, after rounds. The answer will be furnished by the time they all round again in the evening.)
Patient: Hello?
(Tries to go back to sleep.)
END OF ACT II
CURTAIN
If you missed the first performance, don't worry. The cast will be waiting by the elevators at 5 p.m. for a return engagement. Bring your clipboard.
Zackary Sholem Berger plays the part of the Medical Student. He's lost many pen caps on morning rounds while much of the city is still sleeping.
6/1/05
Election Day!
In Kiryas Joel.
It's the Aharonites vs. the Zalman Leib-ists, round twenty-seven, as KJers go to the polls to elect a mayor and two members of the village council. The Times Herald-Record's crack KJ reporter, Chris McKenna, has a good roundup of who the candidates are and why they hate each other. McKenna writes:
I don't know what these figures are supposed to show, but I gather the claim is that the Alliance is getting stronger in KJ. I doubt it. I bet they'll get clobbered today too.
Update: This is why I don't make my living as a political pundit. The Alliance made a very strong showing (though they still lost).
In Kiryas Joel.
It's the Aharonites vs. the Zalman Leib-ists, round twenty-seven, as KJers go to the polls to elect a mayor and two members of the village council. The Times Herald-Record's crack KJ reporter, Chris McKenna, has a good roundup of who the candidates are and why they hate each other. McKenna writes:
[The KJ Alliance -- that is, the Zalman Leib faction in KJ] has established
itself as a significant voting bloc of its own but one that still occupies a
distinctly minority position.
In 2001, its candidates lost by 600-vote margins of more than 4,100 cast.
In 2004, when approximately 4,500 voted, the margins were closer to 800.
I don't know what these figures are supposed to show, but I gather the claim is that the Alliance is getting stronger in KJ. I doubt it. I bet they'll get clobbered today too.
Update: This is why I don't make my living as a political pundit. The Alliance made a very strong showing (though they still lost).
5/31/05
5/30/05
The Bridge
Anna Margolin
(from Yiddish: Z.Sh.B.)
The Williamsburg Bridge naps
in the heavy gold of the day.
The city's wild heart
is breathing quick and weary.
In the day's heavy gold
the ferry's a blue cord.
Feverish and sharp
the accompaniment of the cars.
The heavy gold of the day
is brilliant, between iron ropes
nets cast out
to capture happiness.
But I don't want happiness.
I want my pain and secret.
I am a golden bridge
over the steel city.
Anna Margolin
(from Yiddish: Z.Sh.B.)
The Williamsburg Bridge naps
in the heavy gold of the day.
The city's wild heart
is breathing quick and weary.
In the day's heavy gold
the ferry's a blue cord.
Feverish and sharp
the accompaniment of the cars.
The heavy gold of the day
is brilliant, between iron ropes
nets cast out
to capture happiness.
But I don't want happiness.
I want my pain and secret.
I am a golden bridge
over the steel city.
5/12/05
Public and Private
And sick and well.
Medicine Mensch 5 is below. Enjoy!
MEDICINE MENSCH: A Tale of Two Hospitals
By Zackary Sholem Berger
May 13, 2005
Fancy Private Hospital is conveniently located in Upper Manhattan, a few blocks away from a subway stop. If you like, though, you can stroll to the main building along Madison Avenue, perhaps stopping at some of the boutiques you'll find along the way. A few other students and I took such a relaxed trip to FPH for a recent rotation. On our first day we went to a well-appointed office in an embassylike building of white stone, with an interior decorated in brass and wood. We settled into plush chairs and waited for the administrator. When she arrived, she gave us all a big smile as she handed out our orientation packets. "Welcome to Fancy!" she said. She gave us each a sheaf of meal tickets ("Hold on to these. They're just like money!") and told us where the swimming pool was.
Needless to say, we all had had somewhat different formative experiences in Raucous Urban Hospital, another one of the health care facilities operated by my university. There you're not so much welcomed as acknowledged. The elevators don't work, efficiency is not rampant and budgets are tight — but all this has come to be expected by the people who work there. Otherwise, it wouldn't be raucous and probably wouldn't serve as much of the public.
Both Fancy and Raucous are teaching hospitals where medical students (not yet doctors) and residents (doctors at the beginning of their training) learn to perform procedures and make diagnoses on real patients — you and me and our relatives. Everyone would love to be treated by the expert in whatever malady she's currently suffering from, but there aren't enough experts to go around. So people are treated by teams, the long chains of white-coated big-and-little-fish the patient sees snaking into and out of the room. Although a couple of people in that big group are more responsible for what happens to the sick person, no single person carries out all of a given patient's care over the course of a month.
That is, once in a hospital, every sick person realizes that he or she is one of dozens treated by a team of interlocking personalities. The patients at Fancy Private and Raucous Urban deal with this realization in ways that are superficially different. Some at Fancy Private, used to the best in everything in other areas of their lives (or merely the upper-middle-class certainty that they will be properly accommodated — be it at the hairdresser's, their favorite boutique or their local restaurant), will insist that they be treated only by their personal physician or at least an attending physician — no residents for them. Little does the patient know that when the attending physician gets word of this request, she'll probably roll her eyes, pick up the phone and have a good laugh about it with one of the residents, the ones she relies on to carry out the day-to-day work of patient care in a hospital with hundreds upon hundreds of patients. The Raucous Urbanites, on the other hand, tend to address everyone on the team — from lowly medical student to seasoned attending physician — as "Doctor," and impute to each of them the same level of training and responsibility. According to strict accuracy and ethical practice, the medical student should remind his patient that he is not, after all, a doctor. But how many times can you remind someone of this, especially when it's eminently possible that the person doesn't want to be reminded?
Public and private patients have something very basic in common: the wish to know who's treating them and the illusion that they have detailed control over their daily care. Of course they have control over the general decisions relating to their medical treatment: Informed consent is one of the pillars of current medical practice. (How "informed" this consent really is, however, is another matter entirely.) But once the patient makes a decision about medical care, then the team takes over, general decisions are transmuted into professional jargon like liters of lactated Ringer's solution, and a view of the forest is lost as trees are thickly planted at the patient's bedside.
That's why I try to introduce myself to every patient and have something approaching a conversation so that the patients at least have some personal contact with someone on their team, even if it's only the most insignificant and least important member. The Raucous Urban patients get my best doctor imitation, while the Fancy Private patients, if necessary, get my solemn oath that I won't go near their bed. Both of these behaviors are not quite in good faith, but they make everyone involved feel better. Perhaps one day I'll have all the public patients up to Fancy Private for lunch so that I can use up my leftover meal tickets.
Zackary Sholem Berger is a medical student at both public and private hospitals, depending on his rotation. He is doing surgery now, but don't worry — he won't be operating on anyone anytime soon.
And sick and well.
Medicine Mensch 5 is below. Enjoy!
MEDICINE MENSCH: A Tale of Two Hospitals
By Zackary Sholem Berger
May 13, 2005
Fancy Private Hospital is conveniently located in Upper Manhattan, a few blocks away from a subway stop. If you like, though, you can stroll to the main building along Madison Avenue, perhaps stopping at some of the boutiques you'll find along the way. A few other students and I took such a relaxed trip to FPH for a recent rotation. On our first day we went to a well-appointed office in an embassylike building of white stone, with an interior decorated in brass and wood. We settled into plush chairs and waited for the administrator. When she arrived, she gave us all a big smile as she handed out our orientation packets. "Welcome to Fancy!" she said. She gave us each a sheaf of meal tickets ("Hold on to these. They're just like money!") and told us where the swimming pool was.
Needless to say, we all had had somewhat different formative experiences in Raucous Urban Hospital, another one of the health care facilities operated by my university. There you're not so much welcomed as acknowledged. The elevators don't work, efficiency is not rampant and budgets are tight — but all this has come to be expected by the people who work there. Otherwise, it wouldn't be raucous and probably wouldn't serve as much of the public.
Both Fancy and Raucous are teaching hospitals where medical students (not yet doctors) and residents (doctors at the beginning of their training) learn to perform procedures and make diagnoses on real patients — you and me and our relatives. Everyone would love to be treated by the expert in whatever malady she's currently suffering from, but there aren't enough experts to go around. So people are treated by teams, the long chains of white-coated big-and-little-fish the patient sees snaking into and out of the room. Although a couple of people in that big group are more responsible for what happens to the sick person, no single person carries out all of a given patient's care over the course of a month.
That is, once in a hospital, every sick person realizes that he or she is one of dozens treated by a team of interlocking personalities. The patients at Fancy Private and Raucous Urban deal with this realization in ways that are superficially different. Some at Fancy Private, used to the best in everything in other areas of their lives (or merely the upper-middle-class certainty that they will be properly accommodated — be it at the hairdresser's, their favorite boutique or their local restaurant), will insist that they be treated only by their personal physician or at least an attending physician — no residents for them. Little does the patient know that when the attending physician gets word of this request, she'll probably roll her eyes, pick up the phone and have a good laugh about it with one of the residents, the ones she relies on to carry out the day-to-day work of patient care in a hospital with hundreds upon hundreds of patients. The Raucous Urbanites, on the other hand, tend to address everyone on the team — from lowly medical student to seasoned attending physician — as "Doctor," and impute to each of them the same level of training and responsibility. According to strict accuracy and ethical practice, the medical student should remind his patient that he is not, after all, a doctor. But how many times can you remind someone of this, especially when it's eminently possible that the person doesn't want to be reminded?
Public and private patients have something very basic in common: the wish to know who's treating them and the illusion that they have detailed control over their daily care. Of course they have control over the general decisions relating to their medical treatment: Informed consent is one of the pillars of current medical practice. (How "informed" this consent really is, however, is another matter entirely.) But once the patient makes a decision about medical care, then the team takes over, general decisions are transmuted into professional jargon like liters of lactated Ringer's solution, and a view of the forest is lost as trees are thickly planted at the patient's bedside.
That's why I try to introduce myself to every patient and have something approaching a conversation so that the patients at least have some personal contact with someone on their team, even if it's only the most insignificant and least important member. The Raucous Urban patients get my best doctor imitation, while the Fancy Private patients, if necessary, get my solemn oath that I won't go near their bed. Both of these behaviors are not quite in good faith, but they make everyone involved feel better. Perhaps one day I'll have all the public patients up to Fancy Private for lunch so that I can use up my leftover meal tickets.
Zackary Sholem Berger is a medical student at both public and private hospitals, depending on his rotation. He is doing surgery now, but don't worry — he won't be operating on anyone anytime soon.
5/11/05
Helping a Chadian defender of human rights
A friend writes:
Many have been active in various efforts to call attention to atrocities in Sudan and Darfur. I'm writing to introduce you to a human rights defender from that region, and to ask for your assistance in helping with his medical needs.
I work at Human Rights Watch, where I currently have the great fortune of sitting in the office next to one of the most extraordinary people I've ever met, Souleymane Guengueng, a Chadian human rights activist who worksclosely with several colleagues. He's an amazing, kind, warm and brave man, who is in the U.S. now for medical treatment for injuries suffere dafter being unjustly imprisoned and tortured in the 1980s. My office has raised most of the money for his treatment, but needs to raise some more.I'm writing to share this appeal for funds -- please share it with others, as appropriate.
Reed Brody, the attorney who has been working with Souleymane, sent me the appeal below. If you're interested in learning more about Souleymane, see these articles.
Please contact Reed Brody, brodyr@hrw.org, for further information.
From Reed Brody: Request
We are seeking to raise the last $10,000 needed for medical treatment forSouleymane Guengueng, one of our 2002 Human Rights Watch Monitors (total $40,000).
Souleymane Guengueng
Souleymane is the founder and Vice-President of the Chadian Association ofVictims of Political Repression and Crime (AVCRP), and is the main force behind the landmark effort to prosecute Chad’s former dictator Hissène Habré. As the New York Times said in its moving portrait of Souleymane, "on acontinent where ordinary men are tortured, killed and forgotten without asecond thought, Mr. Guengueng has done something extraordinary: fought back. After being unjustly imprisoned and tortured for two years in the late 1980's, he spent the next decade gathering testimony from fellow victims and their families. The evidence provided critical material forChadian and international human rights organizations to pursue a case against the country's former dictator, Hissene Habre."
France’s Liberation remarked that “a surprising tug of war pits this modest civil servant against the ex-dictator who bathed his country in blood.” Souleymane, falsely accused of supporting Habré’s opposition, lost much of his eyesight and almost died of dengue fever during two years of mistreatment in Habré's prisons, and watched hundreds of others succumb tomalaria, exhaustion, malnutrition and torture. When Habré fell, Souleymane and other former prisoners founded the AVCRP and gathered testimony from 792 victims, widows and orphans, hoping to use them to bring Habré to justice. When the new government recycled many of Habré's accomplices, however, Souleymane hid the files underneath the mud-brick home where he lives with the 24 members of his family, including nine children. That is where the files stayed for eight years until Souleymane handed them to a Human Rights Watch researcher in 1999. Since then, Souleymane has been the driving force behind this case. He has devoted all of his free time to the case – indeed his life is devoted to the case. He was recently fired from his civil service job because of this work.
Suleymane’s medical condition
When we brought Suleymane to the United States in late 2002 for the Human Rights Watch dinners, we were also able to get him two very successful eye operations and Souleymane can now see like a normal person. Thanks to our friends at the Bellevue/NYU Program for Survivors of Torture, we were able to have the operations done extremely cheaply.The bad news is that he was diagnosed with Hepatitis C, probably the result of a transfusion years back. The good news is that he has the strain that has an 80% chance of responding to a 6 month course of interferon treatment, which is what the doctors have strongly urged him to do to prevent potentially serious liver damage.
Souleymane Guengueng has become beloved to the staff of Human Rights Watch,and we have brought him back to carry out the difficult and debilitating interferon treatment. He has responded well to the first months of medication, though he had developed anemia, for which the doctors have prescribed additional medication.The total estimated budget is $39,860, or which we have already secured $29,000.
Checks should be made out to Human Rights Watch -- memo line "Souleymane Guengueng" -- and sent to Reed Brody, Human Rights Watch, 350 Fifth Avenue 34th Floor, NY, NY 10118.
A friend writes:
Many have been active in various efforts to call attention to atrocities in Sudan and Darfur. I'm writing to introduce you to a human rights defender from that region, and to ask for your assistance in helping with his medical needs.
I work at Human Rights Watch, where I currently have the great fortune of sitting in the office next to one of the most extraordinary people I've ever met, Souleymane Guengueng, a Chadian human rights activist who worksclosely with several colleagues. He's an amazing, kind, warm and brave man, who is in the U.S. now for medical treatment for injuries suffere dafter being unjustly imprisoned and tortured in the 1980s. My office has raised most of the money for his treatment, but needs to raise some more.I'm writing to share this appeal for funds -- please share it with others, as appropriate.
Reed Brody, the attorney who has been working with Souleymane, sent me the appeal below. If you're interested in learning more about Souleymane, see these articles.
Please contact Reed Brody, brodyr@hrw.org, for further information.
From Reed Brody: Request
We are seeking to raise the last $10,000 needed for medical treatment forSouleymane Guengueng, one of our 2002 Human Rights Watch Monitors (total $40,000).
Souleymane Guengueng
Souleymane is the founder and Vice-President of the Chadian Association ofVictims of Political Repression and Crime (AVCRP), and is the main force behind the landmark effort to prosecute Chad’s former dictator Hissène Habré. As the New York Times said in its moving portrait of Souleymane, "on acontinent where ordinary men are tortured, killed and forgotten without asecond thought, Mr. Guengueng has done something extraordinary: fought back. After being unjustly imprisoned and tortured for two years in the late 1980's, he spent the next decade gathering testimony from fellow victims and their families. The evidence provided critical material forChadian and international human rights organizations to pursue a case against the country's former dictator, Hissene Habre."
France’s Liberation remarked that “a surprising tug of war pits this modest civil servant against the ex-dictator who bathed his country in blood.” Souleymane, falsely accused of supporting Habré’s opposition, lost much of his eyesight and almost died of dengue fever during two years of mistreatment in Habré's prisons, and watched hundreds of others succumb tomalaria, exhaustion, malnutrition and torture. When Habré fell, Souleymane and other former prisoners founded the AVCRP and gathered testimony from 792 victims, widows and orphans, hoping to use them to bring Habré to justice. When the new government recycled many of Habré's accomplices, however, Souleymane hid the files underneath the mud-brick home where he lives with the 24 members of his family, including nine children. That is where the files stayed for eight years until Souleymane handed them to a Human Rights Watch researcher in 1999. Since then, Souleymane has been the driving force behind this case. He has devoted all of his free time to the case – indeed his life is devoted to the case. He was recently fired from his civil service job because of this work.
Suleymane’s medical condition
When we brought Suleymane to the United States in late 2002 for the Human Rights Watch dinners, we were also able to get him two very successful eye operations and Souleymane can now see like a normal person. Thanks to our friends at the Bellevue/NYU Program for Survivors of Torture, we were able to have the operations done extremely cheaply.The bad news is that he was diagnosed with Hepatitis C, probably the result of a transfusion years back. The good news is that he has the strain that has an 80% chance of responding to a 6 month course of interferon treatment, which is what the doctors have strongly urged him to do to prevent potentially serious liver damage.
Souleymane Guengueng has become beloved to the staff of Human Rights Watch,and we have brought him back to carry out the difficult and debilitating interferon treatment. He has responded well to the first months of medication, though he had developed anemia, for which the doctors have prescribed additional medication.The total estimated budget is $39,860, or which we have already secured $29,000.
Checks should be made out to Human Rights Watch -- memo line "Souleymane Guengueng" -- and sent to Reed Brody, Human Rights Watch, 350 Fifth Avenue 34th Floor, NY, NY 10118.
5/9/05
4/20/05
4/14/05
Why I kiss my child in shul
When I'm not davening, that is.
Gil "Musin' Man" Student, aka the "Bal-Hirhurim," has an informative and learned post about not holding one's child while davening (but see Josh Waxman's demurral). The comments on that post mention the prohibition in the Shulchan Aruch of kissing one's child in shul, or to quote: "Kissing one's small children in thesynagogue is forbidden, in order to fix in the heart that there is no love like the love of the Omnipresent." (Shulchan Aruch, OH 98.1, Remo).
Understanding this halachah and its sources might be a useful way to approach the different ways that (some) Orthodox and (some) Conservative Jews (and maybe Reform Jews as well, but I don't know so much about Reform Judaism) see halachah in general. For Orthodox Jews, speaking in general, the reason for the halachah is subordinate to the halachah itself. Yes, there are those situations in which "the reason is nullified and [thus] the decree is nullified," but from what I understand of contemporary Orthodox responsa there are very few situations in which a halachah in the SA is nullified based on a rationale that no longer applies. (If anyone can point me to such examples, I'd be grateful.) On the other hand,, when a Conservative rabbi makes an effort to understand a halacha in the SA, her first approach might involve an understanding of the motivations behind the halachah -- not necessarily through historical research or speculation, but through indications given in the sefer itself. Call it an active reading of the halachah.
So let's take a look at what this one says. To break it down into propositions, we first need to realize that there are several possible understandings. One is the following (call it formulation A):
1. There is no love like the love of the Omnipresent.
2. If you kiss children in shul, you show that you think 1. is false.
3. Thus you should not kiss children in shul.
Another (formulation B) is this:
1. There is no love like the love of the Omnipresent.
2. We should try to inculcate this understanding in our children and ourselves.
3. If you kiss your children in shul, you weaken this understanding, or make it more difficult
To rephrase: formulation A assumes that kissing your children in shul is, in essence, a challenge to the ontological authority of God's love. "See me kiss my children!" you are saying. "Even here, my love for them requires that I kiss them, even where I should be feeling the love of God." But this of course assumes that these two kinds of love are contradictory, that love of other people and love of God are mutually exclusive. Since this seems not to be true, at least to me, one begins to suspect that something else should be adduced to explain this halachah: namely, the prominent ascetic strand in our religious literature. For example, in siman 240 of the Shulchan Aruch, covering the laws of sexual relations, one recommended approach to sex (but by no means the only one) is something akin to terror. This is an exaggerated example of a general trend, that physical demonstrations of affection should be held in check as part of the religious life. (Compare also siman 255 of Sefer Hasidim, written before the Shulchan Aruch, which expands the prohibition to kissing one's child in the presence of one's rabbi [religious teacher, not community leader]).
If there is something besides this asceticism lying behind this halachah, I would like to figure it out so that I can better understand it. Unfortunately, I don't know when I'll have a chance to study the two works the Remo cites (or one of Remo's commentators cite?) as the sources: Binyomin Zeev (first printing: Venice, 1539) and Agudo (which I think is the same as Ha-Agudo, first printing Cracow, 1571). It would be interesting, and relevant, to find out the approach which these seforim take to the matter; i.e., with what philosophy they are deriving this halacha.
Formulation B is weaker, but still, I think, hard to defend. Just imagine this perfectly plausible explanation to a child about the relationship between God's love and parental love (what child would sit still for this without laughing in your face is another matter altogether): "I'm kissing you now because I love you. But Divine love is even greater!" That's just as defensible an account as "I'm not kissing you now, even though I love you, because Divine love is even greater." That is, kissing or not kissing a child in shul is not a particularly sensitive criterion for understanding, or agreeing with, the incomparability of Divine love, but is more strongly related to how one thinks of physical demonstrations of affection in general.
(Whether one should kiss one's child in shul in general, apart from this halachah, is a separate issue. I do it when I'm not davening.)
4/12/05
Beaver vs. Beaver
Sophomoricomical sci-jinks.
I'm not one to wax overly nostalgic over bright college days, but this is too good to pass up. (You can guess which school I went to by the fact I'm linking to it.)
Of course, the pranks I engaged in at Tech were more on the order of obscure religious/literary wordplay, but I can feel technically proficient by association.
Sophomoricomical sci-jinks.
I'm not one to wax overly nostalgic over bright college days, but this is too good to pass up. (You can guess which school I went to by the fact I'm linking to it.)
Of course, the pranks I engaged in at Tech were more on the order of obscure religious/literary wordplay, but I can feel technically proficient by association.
4/10/05
4/3/05
More of Bashevis's lustful rebbe
Still crawling along with my translation; if you're still reading the story, check out the new addition here.
Still crawling along with my translation; if you're still reading the story, check out the new addition here.
Yiddish Poets!
Among other events I wish I could go to in the coming weeks is this one on Sunday, April 10th, featuring a lineup of Yiddish women poets reading in both original and translation. Let me tell you about them, so that you'll go and hear them (and I can get the merit of adding a few to the crowd, even though, since I'm on call then, I can't be there myself). What follows are not wholly objective appraisals; Yiddish poets all know each other. (Dovid Katz says -- and he's right -- that today's Yiddish literature will be worth anything only if present and future critics from outside the Yiddish world recognize whatever quality it possesses. So if you go to this event on the 10th, and go you should, let me know honestly afterward what you thought of them.)
Gitl Schaechter-Viswanath manages to combine psychological sensitivity with homey (but deceptive) simplicity of speech in her careful though relatively unadorned and untricksterly work. She manages to be both acccessible and innovative, achieving literary quality without the obscurity which often accompanies it. I helped translate some of her poems for her first (and so far only) book, and I count myself a friend of hers, so I'm not exactly unbiased. In the spirit of beser hot ken shier nisht (you can always do better), I will say that sometimes I wish she pushed herself to risk new forms or venture some lengthier work.
Beyle Schaechter-Gottesman is one of the most important poets writing today in Yiddish. Her latest collection, Perpl shlenglt zikh der veg [The Winding Purple Road], includes a wide range of work, ranging from dark memoir to cutting parodies of past Yiddish giants (one of my favorite poems of hers is a dead-on, if unfair, takedown of Moyshe-Leyb Halpern) to lyric meditations on the South Bronx [sic!]. She is verbally inventive, if traditional in style, and manages to infuse each poem with the song and picture she has also created in other parallel parts of her life. (She is an accomplished painter and a very well-known Yiddish songwriter; I assume that she will sing a song-poem or two at the event.)
Miriam-Khaye Seigel [scroll down for a picture] is (shocker) another friend of mine! She's mostly a songwriter, with a singing voice that should be poured into the porch of every musically deprived ear. I've only heard a few songs she's written (because she's a perfectionist when she comes to writing and performing), but my impression is that she is a traditionalist when it comes to genre but a iconoclast in content. She is someone to watch.
Among other events I wish I could go to in the coming weeks is this one on Sunday, April 10th, featuring a lineup of Yiddish women poets reading in both original and translation. Let me tell you about them, so that you'll go and hear them (and I can get the merit of adding a few to the crowd, even though, since I'm on call then, I can't be there myself). What follows are not wholly objective appraisals; Yiddish poets all know each other. (Dovid Katz says -- and he's right -- that today's Yiddish literature will be worth anything only if present and future critics from outside the Yiddish world recognize whatever quality it possesses. So if you go to this event on the 10th, and go you should, let me know honestly afterward what you thought of them.)
Gitl Schaechter-Viswanath manages to combine psychological sensitivity with homey (but deceptive) simplicity of speech in her careful though relatively unadorned and untricksterly work. She manages to be both acccessible and innovative, achieving literary quality without the obscurity which often accompanies it. I helped translate some of her poems for her first (and so far only) book, and I count myself a friend of hers, so I'm not exactly unbiased. In the spirit of beser hot ken shier nisht (you can always do better), I will say that sometimes I wish she pushed herself to risk new forms or venture some lengthier work.
Beyle Schaechter-Gottesman is one of the most important poets writing today in Yiddish. Her latest collection, Perpl shlenglt zikh der veg [The Winding Purple Road], includes a wide range of work, ranging from dark memoir to cutting parodies of past Yiddish giants (one of my favorite poems of hers is a dead-on, if unfair, takedown of Moyshe-Leyb Halpern) to lyric meditations on the South Bronx [sic!]. She is verbally inventive, if traditional in style, and manages to infuse each poem with the song and picture she has also created in other parallel parts of her life. (She is an accomplished painter and a very well-known Yiddish songwriter; I assume that she will sing a song-poem or two at the event.)
Miriam-Khaye Seigel [scroll down for a picture] is (shocker) another friend of mine! She's mostly a songwriter, with a singing voice that should be poured into the porch of every musically deprived ear. I've only heard a few songs she's written (because she's a perfectionist when she comes to writing and performing), but my impression is that she is a traditionalist when it comes to genre but a iconoclast in content. She is someone to watch.
3/31/05
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.
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.
3/20/05
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!
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!
3/12/05
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.
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.
3/10/05
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?
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?
3/4/05
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.
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.
2/27/05
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.
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.
. . . only until my daughter is old enough to daven
Naomi Chana explains it all.
2/25/05
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.
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.
2/21/05
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?
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?
2/15/05
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.
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.
2/9/05
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.
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.
2/7/05
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.
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.
2/3/05
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.
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.
1/30/05
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.
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.
1/25/05
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:
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.
1/20/05
1/14/05
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.
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!"
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.
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.
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.
1/12/05
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.
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.
1/7/05
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!
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!
1/5/05
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.
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.
1/4/05
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.
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.
1/2/05
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.
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.
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