7/20/06

Shabbat and the residency: a rabbi advises

One posek I asked (I'm not going to say who it is, but you can probably narrow down the alternatives) said this:

If it were possible for all observant Jews to work in a shomer shabbos medical facility, it would surely be nice. I, however, do not believe that it is forbidden to work in a non-shomer shabbos facility. Do your best to avoid hillul shabbat, but when it must be done, do it be-shinui unless it is a case of pikuah nefesh or safek pikuah nefesh.

7/13/06

Irregulars of the Lost Ark

Newish: my review of Cecil Helman's book of prose poetry. (And if you don't like my review, here's another.)
The earth will be devoured by the sun

Ten billion years from now. That’s what they say.
Come on! Let’s think about what can be done.

It’s true, we’ve had an enviable run
Although it might not always seem that way.
Have you read how the ancients saw the sun

As a capricious god? You wanted none
Of that in school – now bend your knees and pray.
Surely there’s something more that can be done!

I guess that you could take a loaded gun,
Abduct professors of astronomy,
Demand solutions to the giant sun

That’s engulfing all our neighbors, first one
Then anoth – Look, the moon’s been swept away
By fire’s tides. Before destruction’s done

Let’s clutch our sides and laugh: It sure was fun
To be alive in those few heady days
Between the core of earth and molten sun,
Between our wishes and what can be done.
Do Not Reconsider

I signed my first DNR order today. I did not refuse, but I can't say I'm proud of it. The philosophical conumdrums that come into play are weighty enough not to talk about at length.
(And what follows, it should go without saying, is not a religious or halachic treatment.)

What confused me in this instance was that I, as one of the treating physicians, was asked to confirm that resuscitation of the patient in this case would be "medically futile."

I don't know what the phrase means. Of course, I could look it up, but it seems to me on first glance -- and what is a blog after all but a displaycase for first glances and uninformed impressions? -- that most possible understandings would be either truisms or impossibilities. Does medically futile mean that resuscitation would not return a patient to his baseline functioning (i.e. before the illness)? Or that it would not cure the diseases which originally caused the cardiopulmonary problems in this patient?

Perhaps the most likely meaning is that it would condemn the participants - patient, family, and doctor alike - to a process which renders medical decision making futile, since all end points are the same.

7/8/06

More Agriprocessors

For what it's worth to those not in my kehilah, the rabbi of our synagogue said today that Agriprocessors meat should not be eaten, though it is still kosher -- i.e. one can eat at another's house, or in a kosher restaurant, without inquiring into the provenance of their steak. He made the point that the slaughterhouse's current techniques, while receiving the qualified approval of Temple Grandin, still do not make the cut according to the Conservative movement's Committee on Jewish Law and Standards.

6/28/06

Good Shabbos. Now I'm really off to work.

I start work on July 1st, this Saturday. Wish me luck!

I don't know how many of you faithful readers have been following the discussion over at House Of Gil about "shomer-shabbos residency programs." I commented a few times there, but let me air my objections in my own daled ames (personal space), where I'm not afraid of injecting non-Orthodox heresies into a cozy Orthoblog. I assume I'll have my own Ortho commenters here, at any rate. (Hi, Dov.) And feel free to remember that I am very much not an unbiased party in this discussion (see the first sentence in this post).

I think it's yet another instance of confusing leshem shomayim (for the sake of Heaven, i.e. honest spiritual striving) with a race to Chumraville. Consider the following facts: nearly everyone in, for example, an internal-medicine residency will be taking care of dangerously ill patients the great majority of the time. ("Dangerously ill" is the relevant halachic category, allowing for translation losses. One can act in certain ways to treat such patients on the Sabbath.) Secondly the great problem with regards to shmiras Shabbos (keeping the Sabbath) in a hospital is electricity, the bane of the observant Jew's existence on Saturday. Yet there is room, on the left end of the spectrum, for leniency with regard to use of electricity. Lastly, it appears that at least some of the Orthodox poskim, well-respected and, naturally, massively erudite Torah scholars, who have weighed in on this issue are not fully informed about the metsies (the facts on the ground) that obtains in modern-day residency programs.

All of these would seem to militate for a reconsideration of what it means for a resident, or a residency program, to be shomer shabbos, Sabbath-observant. It would be wonderful for the Conservative movement to have a crack at it. Or, at the very least (from my way of thinking), it would be greatly preferable to aimless speculation if the two eminent Conservative poskim I have written about my personal situation would answer my e-mails.
Getting used (again) to medicalese

A man is (God help us) a "male". Patients "deny" some condition or other. A person with vascular disease is called a vasculopath. All such usages are defensible logically and, of course, save precious seconds here or there that can be used to get more coffee (or save lives -- whatever). But they grate. And I hope not to use them, unless, of course, my resident makes fun of me for talkin different. Then I will submit. Quickly and cravenly.
One yoke of servitude, check.
We who are about to be beeped salute you.

6/26/06

Secular conversion to JudaismOr Israelism?

The Head Heeb discusses the matter.

6/20/06

Devil take the translator
"Not really a translation, but a conversion, Judaization, or transference."

I didn't know that Baudelaire wrote something called Les Litanies de Satan ("le plus savant et le plus beau des Anges"). It's remarkable and off-putting to read a translation of that poem into Hebrew -- for those of us whose Hebrew is religious and literary, not vernacular, it causes a visceral reaction when literary tropes associated with the Divine are used to describe the "samekh-mem."

6/17/06

Green Squall
Is awesome.

Here, read this.

MEDITATION ON RUIN

It's not the lost lover that brings us to ruin, or the barroom brawl, or the con game gone bad, or the beating
Taken in the alleyway. But the lost car keys,
The broken shoelace,
The overcharge at the gas pump
Which we broach without comment -- these are the things that eat away at life, these constant vibrations
In the web of the unremarkable.

The death of a father -- the death of the mother --
The sudden loss shocks the living flesh alive! But the broken pair of glasses,
The tear in the trousers,
These begin an ache behind the eyes.
And it's this ache to which we will ourselves
Oblivious. We are oblivious. Then, one morning -- there's a crack in the water glass -- we wake to find ourselves undone.

* * *

You see from the above, too, that Hopler could be this century's redeemer of the poetic long dash.
Parsha question too late for Shabbos
As usual.

If Eldad means "beloved of God," what does Medad mean -- "beloved of water"?

6/14/06

Hiatus prep

It's not like I post that much anyway, but soon I'll be blogging even less, what with the start of my residency on July 1st and other writing projects. As General MacArthur did not say when leaving the Philippines in 1942, I really hope to be back here at some point soon -- with further hospital tales, poetry, Jewish curiosities, and the like.

6/8/06

A Valediction: Forbidding Rap Music

Schorsch's speech was strange, to be sure. Rap is not a devil whispering in the ear of Conservative Jews. It is, rather, a genre of popular music. (Perhaps Schorsch missed the essay in the back of Etz Hayim, written by R. Tupac Shakur, which makes this important distinction. Tupac is nothing if not inert.) Students writing random words in the snow is symptomatic of nothing but rabbinical students looking to have a little fun. Has the chancellor really forgotten his own yeshivah days?

But there is something very important that the rabbi said:
The history of Jewish spirituality is the never–ending effort to keep halakhah and meta–halakhah in creative tandem. Halakhah is the deed; meta–halakhah, the disposition. Halakhah is fixed, meta–halakhah fluid. Halakhah is legal, public and objective, whereas meta–halakhah is theological, private, and subjective. The intent of meta–halakhah is to inform, enrich and spiritualize our fulfillment of the mitzvot. Or to revert to my image of the aquifer, what is concealed is no less vital than what is visible.

The malaise of Conservative Judaism today . . . is that its adherence to halakhah is devoid of a spiritualizing meta–halakhah.

Perhaps he was too high-falutin in his language and snobby in his approach, but the problem is there and cannot be denied. There are many people working on pushing the cart of Conservative Judaism out of the theological-spiritual mud its stuck in, but the effort must be made. Criticising Schorsch for his criticism won't help us.
To the Rabbinical Assembly

I just had a chance to daven (as shliekh tsiber) from the newish Sim Shalom siddur for weekdays, known as "Slim Shalom."

One request, though. Can I ask you esteemed rabbis -- when you next publish a book, and it includes a Yiddish selection, can you please, please proofread it? Pick a spelling system. Any spelling system; you have several to choose from! (I have a soft spot for YIVO, but it is a sefer, after all, so you might go with Standard Charedi.) Even Soviet spelling. Anything's better than what-the-hell-it's-only-Yiddish-let's-spell-it-however-we-want. Ditto for the transliteration.

Pretty please? Look, I'll do it for free.

6/6/06

Readings

The 11th Street Bar was as packed as a herring barrel. The reading started on time, every reader stuck to the time limits, and no fakery was evident. Miraculously, everyone read work that was worth hearing. Hopler was vigorously lyrical, not as bawdy as he represents. Siken was knotty, associational. Strekfus was mythopoetic. Glück prophesied.

Afterwards, tipsy from a beer on an empty stomach, I walked and talked with a friend. At dinner, I read a poem to him. With generosity, good will, and enlightenment, this friend then ripped the guts out of the poem, splayed them out in front of me, and explained their pathology. Such criticism beats any praise.

On the bus home afterwards, I started some new poems. I didn't say they're good, but they're different.

6/4/06

Stately, plump Boaz Mirsky

Has Joyce's Ulysses been translated into Hebrew? My desultory searches are turning up nothing. (Same question goes for Yiddish, though it's easier to guess what the answer is.)

6/1/06

Tales of a Twenty-Sixth Grade Nothing
Not a student anymore. Can I handle it?

MEDICINE MENSCH: Bidding the Classroom Adieu

For some people, 12 years of school is enough. Add four years of college and 10 years of a long M.D.-Ph.D. program. Finally, at the end of all that, I can say that I'm no longer a student. I'm ready to enjoy the benefits of my new station in life: sleeping late, meals at my leisure, freedom from subordination to institutional requirements.

Just now, though, medical residency stands in the way. I will be working the hours I am told; my schedule of rotations includes more than a few lectures. During my three-year program, I'll have to pass several challenging exams, including the feared American Board of Internal Medicine certification. I'll have to make presentations, turn in written reports, be deferential to my instructors, and remember everything I'm told in case I have to repeat it at a moment's notice. I'll have a locker and eat in the cafeteria. The cool kids will wear better clothes. Sundays will be for laundry and homework.

Suddenly residency seems a lot like the past 26 years of schooling.

I could leap to the cliché that we are all life-long learners, and that my transition from student to residency is merely an example of the transitions we all undergo. More accurately, we are all both teachers and students, with the two roles assuming various proportions during different stages of our lives.

Becoming a resident doesn't mean that I quit being a student; it just means that the teachers, modes of evaluation and goals are different. It also means that I have become a teacher myself, counseling and tolerating medical students who are just like I was two weeks ago. Someone will throw themselves to the floor in a patient's room, trying to find the cover of a ballpoint pen, and I'll have to strike the teacher's balance between friendly sympathy and calibrated advice. ("Maybe you should get one of those clicker pens?" I'll suggest, and the student will nod dutifully.)

I'll have to teach each patient as I give treatment, not knowing if my words are making a dent — or if the patient is just smiling and agreeing with me in order to get the heck out of my examining room (or so that I can leave him at peace in his hospital bed). In return, every patient teaches the doctor, though it's often not immediately obvious what is to be learned from the umpteenth sick person you've just met.

Something else came to mind during my graduation from medical school, a carefully arranged, flowers-and-champagne event with more popping flashes than pomp and circumstance. The commencement address was the customary sort, reminding us that now is an extraordinary time in medicine: Unimagined advances in science and technology can be brought to bear in the struggle against disease, but, on the other hand, premiums for malpractice insurance are high, and the wolves of overregulation are at the door. (Because the acoustics weren't so great, I might have missed a metaphor or two.)

But there are many times when nothing is being taught or learned and no death-defying struggles are being waged, long stretches of workaday medicine where no high-tech progress is made. It's just doctor and patient waiting for the most recently agreed on medical strategy to take effect, saying hello to each other yet again — like co-workers who keep passing each other by the water cooler in the hall, wondering whether they have to say "Good morning" every single time.

There will be times over the next three years when I'll be neither teacher nor student, just an average guy doing a job day in and day out. But if I'm to keep a proper balance, this ordinariness carries with it its own sort of responsibility: to remember that my job is not, in the final analysis, an average one. This means, among other things — and with every bit of my well-earned humility, sense of insignificance in the larger scheme of things and healthy respect for my own fallibility — that what I do is important. Thus, even as I trip over myself countless times during the first year of residency, I still have value, and my patients need me. I want to remember this during the first night on call, when my first bonehead move makes a nurse slap herself in the forehead once I've turned my back. And since this is my final column, I hope I'll still have the opportunity to write about my mistakes — and have readers to point them out to me.

If you'd like to follow the Medicine Mensch through his residency, you can read his blog, http://zackarysholemberger.blogspot.com. Bye for now!

5/30/06

Taste and see: Shavuos foods from many lands
Plus, parve buffalo wings with blue-cheese sauce: a whimsical Torah derivation.

A tasty post, Becca!

5/25/06

Shabbos Dinner

On cleaning out some files, I found this account of a memorable Shabbos dinner with some disaffected Jews, originally published in the now-defunct journal Response in 1999 or 2000. Given the recent publication of Unchosen, I thought it might of interest for some. I know you're not supposed to publish long blogposts, but I couldn't figure out what else to do with it. This is exceptionally long, though; my apologies.

I should also say that I wrote this a number of years ago; I'm posting it unedited, because it's beyond editing. I wouldn't write the same thing now, and I probably wouldn't even have the same opinions.

Let's meet some disaffected Orthodox youth.

I've been invited to a Shabbat dinner in Brooklyn Heights by my visiting friend Yosl, an ex-Hasid, nigunim instructor, and occasional pizza boy living until recently in Omaha, Nebraska.

Although language is more often context than cause, you can say that I got to know Yosl through Yiddish. I was introduced to the language in high school, when my senior English teacher – a brilliant diabetic with thick glasses, little tolerance for fools, and a limited interest in pedagogy – suggested I study Yiddish, which she knew from home, as a filler for one of my free periods. She didn’t instruct me per se, but her suggestion was enough to get me started. Some of my most productive hours of high school were spent in the back of Ms. Donsky’s German class (she knew a half-dozen languages, I think), reading the Yiddish Forward while my recalcitrant contemporaries broke their teeth on German verbs. I’m not sure what everyone else thought I was doing. (I don’t know what Ms. Donsky is doing now, either. The last I heard she was living in Ohio with her sister. I don’t think of her enough, considering the importance of what she introduced me to.)

Thus I started up the slope, wanting to learn a little bit more, then learning that extra little bit and finding that the unknown extended even farther than I had thought. I read Yiddish books voraciously through high school and college (although my academic studies were not in Yiddish). I started writing Yiddish poetry, which has been published in most of the depressingly small-circulation journals that still exist in the secular (non-Charedi) world. I am active in Yugntruf, a Yiddish-speaking young people’s organization. In short, Yiddish-language promotion and creativity is a large part of what I spend my time on.

I am not one of those who became attracted to Yiddish as a means of escape from the religious community. I grew up in Louisville, Kentucky, and there – in comfortable suburbia, away from the infighting and unreflective extremism that characterizes New York Jewry – I was exposed to a self-confident if unpunctilious brand of Conservative Judaism. My parents, themselves quite proficient in Hebrew and very knowledgeable Jews, gave me the grounding I needed pursue my Jewish education on my own.

Since high school I have become considerably more observant than my parents; in the inaccurate and obsolete taxonomy favored by mass-market Jewish publications, I am “Conservadox” – that is, on the right edge of the Conservative movement. Some might call me a “baal teshuvah” (a “returnee” to the faith), but I avoid the term due to its unpleasant connotations of blind religiosity. If I might be allowed a more flattering self-description, I try to remain within halachah – the system of Jewish law – while recognizing its inconsistencies and remaining open to necessary, modifying challenges from personal intellect and modern morality.
And that’s why I’m so involved with Yiddish. Not because the language itself embodies any exceptional qualities: Yiddish is no funnier than, say, Portugese, with all due respect to the popularity of Leo Rosten and his ilk; and it’s no guarantor of peace and love, either, having been used as a means to intolerance on both the left (Stalinist) and right (ultra-Orthodox) ends of the spectrum. But Yiddish and Yiddish-language creativity have in modern times been inextricably associated with those wrenching historical transformations which have most indelibly affected the soul and the society of the Jew: from all-encompassing religion to all-challenging urbanization; from certainty to radical doubt; from “God, Israel, and the Torah are one” to a smorgasbord of competing ideologies.

As I make my way as a Jew, I find in the history of Yiddish and Eastern European Jewry a mirror – the old kind, with a decorative frame and mottled glass – of my own doubts and internal conflicts. Knowing Yiddish also affords me an appreciation of those Jews who are modern, but in a different mode – those dissatisfied Charedim who must pass from one sort of self-denying modernity, heavily accessorized to pass for what some imagine to have been 19th-century Eastern European Orthodoxy, into another modernity, broader and more confident, stripped almost bare of myth and religion.

So I follow with eager attention the goings on of Charedi society, and the often labyrinthine tales of those who pass from it into the wider world. (Charedi is a less pejorative and foreign-sounding term for “ultra-Orthodox,” the word often favored in the press. “Chasidic” is inaccurate, since many Charedim are not adherents of Chasidic philosophy and teaching.) That’s the passage my friend Yosl is traversing. He was born in Williamsburg, studied in a number of yeshivas in Brooklyn and Israel, got married – and decided, as the culmination of many years of theological doubt, that he did not want to have kids, because he did not want to raise any children as Orthodox Jews. He left the marriage and Charedi society, moving to Omaha.

I met Yosl at a Yiddish conference in New Jersey which was held (need you ask?) on the grounds of a Catholic college. I was fascinated by his personal history and drawn even more by his flouting of the rules of polite society. At this conference there was a book fair, and a certain newly-published volume on women and Yiddish was being offered for sale and autographs by the authors. Although I ended up buying the book, I expressed to Yosl some (I thought) subtle and quiet reservations about one of the essays. Yosl turned to one of the women and said in a loud voice, “Sholem says this book is bullshit.” There are more examples.

For a time I accepted Yosl’s unsubtleties with an ignorant tolerance: he’s an ex-Charedi, and must have “trouble adjusting.” He must not “be accustomed” to the rules that we follow on this side of the Williamsburg Bridge. In short, I made allowances for him (to myself) much as I would for an autistic child.

But not too long ago a friend pointed out the obvious to me: that’s just the way he is. “He gives the rest of us ex-Os a bad name,” said my friend. “He’s only drifting because he wants to drift.” Indeed, another ex-Charedi acquaintance of mine (who left that society at 16) is a rising young film-maker, well connected to just about anyone in the world of the Jewish culturally hip. Dislocation does not mean what I thought it would mean: sometimes it’s the perfect route to creative transformation; sometimes it amplifies the banalities already present; and sometimes it makes bottomless canyons out of little cracks in the psyche.

Why did I come to this dinner? I find the ex-Charedi crowd entertaining, and I think I might learn something about today’s Jews, a group close to my heart. In the circles I travel in, I know precious few people on the fringe of Jewish society – and observing the fringe gives a sense of what makes up the whole cloth. There’s a personal reason, too. I became more observant than my parents – what is Shabbat (or Shabes) like for someone who has gone in the other direction? The back-and-forth flux from O(rthodoxy) to C(onservatism) to R(eform) is what occupies the thoughts of many American Jews. What are the facts on the well-traveled ground between them?

(Yosl’s one of those who has made the cleanest break with his past, although he does maintain contact with his parents. I’ve changed the names of everyone else I’ve mentioned here, because for some of them being mentioned in an essay like this would have serious consequences.)

I arrive before sunset (so I don’t break the Sabbath by traveling) and bring a bottle of wine. Rachel, who's a non-Jew, a German student in the YIVO Summer Program, says by way of greeting, "I'm sorry, but I'm stoned." She learned Yiddish by listening to Kol Yisrael on her shortwave radio in Berlin, and now waits tables at Tavern on the Green to earn money.

I wait for the other guests to arrive. They all have a lot in common: ex-O (for Orthodox), Yiddish-speaking, versed in the texts of traditional Jewish study (and some in worldly learning as well), jobless, and disaffected. In Yiddish you'd call them apikorsim, that is, apostates. In English you'd call them slackers.

As the guests filter in, a few of us sit in the living room. The ketoyres (pot) goes around. Yudl, who is permanently high, talks with fervent enthusiasm about last night's Bob Dylan-Paul Simon concert. "'The Boxer' is a real Chasidic song," he avers. Through the segue music-entertainment-frum entertainment the topic turns to"Handl erlekh [Deal Honestly]," a Hasidic version of "Monopoly": "You're wearing a loud red dress. Pay fifteen dollars." "You're watching television. Go to hell. Do not pass Go."

The dining room fills up. Someone starts to sing "Shalom Aleichem"; a few join in, but there are some suppressed groans, and many eyes roll. Mendl, from a Vizhnitzer family and a former student at NYU, starts opening the wine for kiddush, while Yisroel Meyer, who works in the Brooklyn public library, says, "Oh, God, I can't take this" -- meaning kiddush, which he can't handle, along with all other appurtenances of tradition.

Why is Mendl able to appropriate the ritual for his own use, while Yisroel Meyer is not? I don’t know. But I do notice that Mendl – after he executes an imperfect opening of the bottle– takes hold of a strainer and begins to extract the bits of cork that have ended up in the wine. Suddenly I speak up: “That’s borer [sorting, one of the types of labor forbidden on the Sabbath].” And Mendl in response, respectfully, even chastened: “You’re right. I forgot. Maybe you should be doing this,” he says, gesturing with the bottle towards the kiddush cup. Why did I say anything? I am not that careful with that category of forbidden labor in my own kitchen, on my own turf. Why do I feel the need to emphasize my observance, when I bear no ill will towards these Jews for leaving observance altogether?

Caleb makes hamotzi, the blessing over bread. If you hang around with Yiddishists, you know Caleb. He dresses sharp, tonight in an outfit out of a 40s' movie (white shoes, white suit, thick, black-rimmed glasses), speaks and writes a fluent Yiddish, and is a goy gomer
-- a complete non-Jew -- on both sides. Nine and a half out of ten American Jews could not make hamotzi with his poise. He teaches Yiddish and earns some money (not an independent living by any means) as a Yiddish actor and public reader of poetry and short stories.

Berl arrives, tall, thin-boned, and with the remnant of a beard, and begins to spin a tale about his supposed profession: armchair terrorism, supporting despots, counter-revolutionaries, and all those who maintain the status quo. He is clever and cynical in the nihilst mold: "The Dalai Lama is worse than the Chinese, otherwise how could he stand by and let millions of people think he's a god?" He does not expect or receive any response to this claim, nor are there any cries of outrage at his choice of “profession.” It’s like a comedy routine without the audience, or any attempt to elicit laughter. The black humor is accepted as a matter of course as the currency of the evening.

Binyomin -- a long-haired, shambling, gesticulating eccentric -- is fascinated by the work of Elias Canetti, the Nobel laureate in literature born into a Ladino-speaking family in Bulgaria, and in particular his book "Crowds and Power." In a high-pitched, excited voice, much like Yudl in ecstasy over Dylan, he starts making fun of the yeshiva students who have just returned from protest gatherings in Brooklyn or Jerusalem: "There were thousands of Jews there! Thousands of Jews!"

Says Berl about Canetti, "That's what all religion is -- a fear of dead crowds: the rebbeim, the gedolim. Men take that fear and call it tradition." This is a quintessentially Berl-like statement: cutting yet overgeneralized, dismissive, dismissable, but fascinating. What can be said against this by one whose relationship to tradition is more positive? “No, I disagree! Religion is not a transformed fear of dead crowds!”? If I were to say something like that, I would be laughed at: not out of scorn, but out of the irrelevance of an argument on the pros and cons of religion. Religion, to these Jews, is not a selection on the menu or a component of one’s ever-shifting moral autonomy, but a determinant of one’s entire surroundings. By accepting this dichotomy between “religious” and “not religious”, they are employing the worldview of the very Orthodoxy they have in greater or lesser measure escaped.

As if to underline the point, someone proposes a debate on the value of religion between the late Bertrand Russell and the late Lubavitcher Rebbe; this leads to a suggestion for an advertising campaign for Smirnoff Vodka, which the Rebbe did not live to endorse.

The conversation, whose coherence is already sorely taxed, breaks into fragments. Binyomin brings up the Kotsker Rebbe, the eighteenth-century Hasidic leader whose philosophy is considered a forerunner of existentialism. What happened on that night, the night before the Kotsker's twenty-year seclusion? Is it true that the Kotsker deliberately extinguished the Shabbat candles by throwing his hat at them from the other end of the table, crying “There is no law and no judge!”? In a long, uninterrupted monologue, Binyomin analyses the treatment of this story in the writings of Abraham Joshua Heschel. Heschel – a Yiddish poet, historian of Chassidism, theologian, and ideologue of the mid-20th-century Conservative movement – considers the story to be generally true, a reflection of the Kotsker’s growing internal unrest. Binyomin finds little support for Heschel’s belief.

I can’t help but see Binyomin as a gilgul of Abraham Joshua Heschel. Binyomin’s knowledge is clearly encyclopedic, and I have been told he is a marvelous writer, although I have not seen anything of his myself. He still lives with his father, in a separate room piled high with books. What sort of writer must he be? If I were to guess, I would not put him with the self-consciously rebellious, sex-obsessed “children of immigrants” (Roth et al.), nor with the modern generation (Goodman, Bukiet), surer in its Judaism but conflicted. He has the speech patterns and casts the brilliant sparks of a European master, of a Thomas Mann or a Canetti. If there were a Left Bank, a Vilna, or a Warsaw to support him, what monuments would he compose?

Or perhaps he is like Yosl, and does not wish to compose anything.

Berl says that if sleep is a sixtieth of death, and sleep is so great, then death must be a real blast. "All I need in life," he says, "is a place to sleep and some nicotine. All the stuff in the Talmud is nonsense."

Berl’s throwaway phrase (“all the stuff in the Talmud is nonsense”) means not at all what you might think it to mean out of context. “All the stuff in the Talmud” is not a dismissive wave of the hand from a college student who has taken a few “X in the Talmud” courses from the Jewish Studies professors, but a deeply felt if casually expressed declaration of rootlessness. “The stuff in the Talmud,” for much of Berl’s life, had been presented to him as “all” – and not long ago he realized that much of what he had learned did not make sense to him. It is this doubt that Berl expressed – a doubt that has been part of the Jewish makeup since Moses Mendelssohn.

I head towards the Brooklyn Bridge for the walk home to Manhattan, but somehow I get lost and fumble around in the dark byways near the bridge for the better part of an hour. By the time I get home and mount the nine flights of stairs to my dimly lit apartment (I don’t take the elevator tonight), I have lost all Sabbath rest.

I thought that Shabbat meal would be an entrée into a fascinating world of tortured, European-style struggle between the man on the street and the Jew at home. In my more self-centered moments, I even thought that we more secular-minded Yiddishists could light the flame of a Haskalah redux which would burn through the divisions between the Charedi and secular worlds. We’d produce Yiddish creativity on a par with the best of the past, lighting the way to a future both more modern and more Jewish.

It’s now been many months. Yosl lives in Moscow learning Russian and teaching some Yiddish. Mendl is back at NYU, and Caleb and I were among the teachers at a Yiddish program this past summer. I don’t know what Binyomin and Berl are doing, but I have an idea it’s about the same – working at regular jobs, finding no purchase for the traction of their intellects. I still write in Yiddish and promote the language, and I still try to follow what’s going on with the Charedim – not to enter into their world but to get a better handle on my own.
Yet another reason not to buy Rubashkin's/Aaron's Best/Agriprocessors meat
It's kosher . . . but it's treyf.

See this remarkable article by Nathaniel Popper in the Forward. I hope not to buy any of their meat in the future, unless conditions improve, and I hope my congregation doesn't either. (For my previous post on the matter, see here.)
Batter batter batter
Swiiiiing philologist!

Favorite Yiddish neologism of the week (seen on a Charedi message board):
heymloyfekhts

The equivalent neologism in the circles I travel in:
kaylekhklap

Which will win? My money's on neologism number 1.

(If you don't know Yiddish, can you guess which English baseball word is being glossed here? And how do you say it in Hebrew? I dunno. If you don't feel like playing this game, here's another hint: English synonyms include big-fly, blast, clout, jack, shot, moonshot, and tape-measure shot.)

5/23/06

A Note to Mr. Spinoza

If God is the All
And All is in God
What then does one call
Every dingy day’s plod?

Divine attribute?
Or devilish sign?
The All makes all moot.
Whatever is fine.

5/21/06

The "radical intellectual freedom" of halachah
The positive attitude to controversy so frequently encountered in the halakhic sources, is an acknowledgment, whether intended or not, of the value of free expression and intellectual creativity. It affirms that no substantive constraints should be imposed upon participants in discussions of the law, as long as they are willing to abide by the formal rules of etiquette and procedure. This is by no means a trivial point: respect and reverence, though critical, are not meant to impact the substance of new ideas being put forward, but only the mode of their presentation. The often-heard allegation that Jewish law, in upholding traditional modes of exegesis, and in constantly consulting preeminent texts and authorities, precludes substantive halakhic innovation, is altogether erroneous. Indeed, only by appreciating the role of form in the halakhic dialogue, can participants appreciate, and, it is hoped, take full advantage of, the radical intellectual freedom it embraces.

So say the authors of this book, on which more later.

5/18/06

"The last Yiddish poet in America"?
Or: someone wrote a novel about my (greatX12)-granddaughter?

[From Publishers Marketplace. Thanks, Shana!]
FICTION: DEBUT
Peter Manseau's SONGS FOR THE BUTCHER'S DAUGHTER, the story of the last Yiddish poet in America and the young Christian translator who brings the poet's notebooks to light for the first time and wins the love of his Jewish co-worker at the Yiddish book warehouse, who is passionately re-discovering her roots, to Amber Qureshi at Free Press, by Kathleen Anderson at Anderson Grinberg Literary Management (NA).

5/17/06

Conservative Jews, and Yiddish speakers
More than a minyan.

Stephen Cohen's article in the USCJ's United Synagogue Review does a nice job of introducing readers to a little-known subculture.

5/14/06

"Kalechn"
Mystery solved!

Philologos is "tickled" at the Satmar succession dispute. There's no accounting for taste, though I find this a strange source of humor. At any rate, his latest column talks about a word which the late rebbe is said to have used with his son:
"You think I'm already kaleching?" Rabbi Moses was also quoted by New York magazine as having said to Aaron on the same occasion. (In Yiddish, presumably, this was "Du maynst az ikh kalekh shoyn?") "Kaleching," we are told by the article, means "mentally declining," although I suppose that "senile" would be a bit more colloquial.

Philologos further speculates:

With Slavic, we do a bit better. There is a Slavic verb — kaleczyc in Polish, kalitset in Ukrainian — that means to cripple or disable. This verb gives us the Ukrainian noun kalika, "a cripple," which has the same meaning in Yiddish. "Disabled" and "mentally declining" don't seem too far apart. Can this be the source of kalekhn?


It's not very likely. Apart from the fact that the Slavic verb is transitive and kalekhn is not, there is no phonetic reason that the Slavic "k" should have turned into a Yiddish "kh." I can't think of other Slavic words with which this happens.


The columnist goes farther and farther afield until he hits upon an implausible Talmudic derivation. Much more likely, I think, is that the transliteration "ch" in New York magazine is meant to represent the Yiddish sound "tsh" (טש), and that the Yiddish word meant is, in fact, kalyetshen (קאַליעטשען), a well-known verb meaning "cripple, disable." No need for etymological creativity here.

Update: I'm wrong again! I've learned a new word: (far)kal(e)kht, פֿאַרקאַלעכט, meaning senile, from the Yiddish kal(e)kh, קאַלעך, lime or plaster. See the comments for more. Yet another example of the differences between "my" Yiddish and "theirs."

5/12/06

Now officially calibrated

I graduated from medical school yesterday.

On Wednesday, in honor of the occasion, I shaved. Yet another sign that my current neighborhood is more religious than any I've ever lived in: the barber says, "I just wanted to remind you that it's sefirah." "Oh, that's okay!" I said with cheerful irreverence. "My graduation's tomorrow." "All right," -- politely -- "it's just that some people forget." And you're an apikoyres, he was nice enough not to mention.

I guess if the neighborhood were even more frum, he wouldn't have shaved me at all?

5/7/06

Hello Fuzhou!
My second-to-last column. My last column, about my transition to residency, will appear in June; prepare your elegies now.

Stomach Cancer: Venturing Into the Belly of the Beast
By Zackary Sholem Berger

I've come to Fuzhou, a city of 5 or 6 million people in southern China, to help along some research into gastric cancer. Fujian Province, of which Fuzhou is the capital, records more cases of the cancer than anywhere else in the world.

Fuzhou isn't a bad city to call home for six weeks — the length of our stay — but it's not for tourists. The city rates just three pages in Lonely Planet China. And for an observant Jew coming to China around Passover, Fuzhou is even less hospitable, with the nearest Seder hundreds of miles away.

But any city, anywhere in the world, harbors innumerable, unexpected sights and sounds; any place, touristed or not, can become an interesting destination. I haven't fallen in love with Fuzhou, but for me it's certainly brought about a fascination with China, one that I hope will lead to understanding.

What's my work here like? An intelligent, energetic, talkative bunch of medical students, all women ("girls," they suggested I call them in Chinese), are abstracting the medical information from patients recently diagnosed with gastric cancer at Fujian Provincial Hospital. Sitting in the hospital's dusty, badly lit document room with its shelves full of manila patient folders, I'm making a database of this patient information. All the while, I'm being entertained by the side conversations of the medical students and bemused by the passing tableau of Chinese street life outside the window: a brass band on a flatbed truck, on the way to a funeral procession; the daily full-volume medley of patriotic marches from the loudspeaker of the high school next door.
Most worthwhile are the accidental discoveries. I have learned that Chinese university students aren't allowed to get married, and that Chinese doctors in various specialties learn on the job, rather than taking another post-doc after graduation (as is done with fellowships in the United States). To my new colleagues I provide, in return, strange facts of American life. I try to explain (in my halting Chinese) that my search for vegetarian restaurants does not mean I'm vegetarian, merely that I eat animals slaughtered according to rules stipulated by the Bible.

Whenever I take a detour on my way to work through the various hospital buildings, I am reminded that the difference between China and the United States is in large part just more people. While a hospital in the United States aims to be like hotel, a hospital in China can only look like a train station — masses of people waiting for their names to be called and tripping over each other's packages.

The bald data of the gastric cancer patients tell the same story over and over again: A man in his late 50s or early 60s, from Fuzhou or Changle (another city of Fujian Province, unluckily known as the world capital of gastric cancer), is diagnosed with advanced disease. This is awful, because gastric cancer caught early is much more treatable. Even worse is the repetition of this pattern. It means that no matter what statistical regularities pop up in these case series, Changle will remain the world's gastric-cancer capital for the foreseeable future.

This might lead to frustration. What's the point of small-scale clinical research when faced with an insurmountable problem? China's public health picture doesn't make matters much easier. For one thing, there's little to no health insurance here, so the health care you get depends on how much money you have in your pocket. If a sick person shows up at the door of a hospital where the costs are too much for her to pay, she will be treated there only until she's well enough to be transferred somewhere less expensive. Fujian Provincial Hospital is a top-of-the-line facility, and the poor go somewhere else. If the gastric cancer cases I'm reviewing here are disheartening, I can only imagine what it's like for poorer patients.

Any casual look around the Chinese streets leads to other sobering public health realizations. Cigarettes are everywhere. (At a banquet in my honor, a hospital vice president and I drank a toast to the defeat of Big Tobacco. In the name of all Americans, I apologized for our exporting the problem.) Bicycle riders go helmetless. As China undergoes a transition from an economy of scarcity, with lack of hygiene and widespread infectious disease the main public health problems, to an economy of abundance, new causes of death vault to the top of the list: heart disease, stroke and diabetes.

In short, it's a huge country with huge problems. From a health care perspective, you can't accomplish much of anything in six weeks. Sometimes, though, tangible accomplishment is not the goal. The aim of my visit is to make a brief first acquaintance with a country of a billion people, and, in particular, with Fujian Province, which has sent 300,000 immigrants to New York City over the past 25 years. When I walk the streets and see the people — fixing their bicycles in the open air; squatting on sidewalks, cleaning piles of scallions; polishing shoes, placing hot bowls of soup with noodles into huge ceramic jugs to keep them warm — I count myself lucky to have made the trip. I hope to do my best for Fujianese patients, whether they're in New York or in China.

Zackary Sholem Berger has now eaten in the best vegetarian restaurant in the world. Write doctor@forward.com, and he will tell you how to get there.

5/6/06

In a Beijing restaurant
Returning soon to New York.

Waiter: What would you like?

Customer: Fish.

[Waiter walks over to aquarium and lifts fish by tail.]

W: How about this one?

C: Um . . . okay.

W: [Gives a flick of the wrist and sends the fish jackknifing onto the floor of the kitchen, some fifteen feet away. Calls out loudly.] One fish!

4/30/06

If I forget thee, Fuzhou
Things I want to remember about this trip to China. A to-be-modified list.

Standing with a section of dissected stomach in the pathology laboratories of the Fujian Tumour Hospital, while smiling for the Fuzhou television news cameras. Later in that same photo op, looking wise and pathologist-y while looking through a microscope at what was, to be completely factual, slides of perfectly normal thyroid. Being asked six times what my opinion of Fujian is. (Uninformed? Naive? "Please get some traffic laws enforced, and quickly too"?)

Strolling round the eerily empty grounds of one of Fuzhou's several gated communities, to which we were invited by a gastroenterologist at the Fujian Provincial Hospital. His house was huge by Chinese standards, and beautiful. A park in the center of the compound is surrounded by statues of Mozart, Schubert, et al. "What do the farmers do whose farms used to be here?" "They work in the development."

Industry Enterprise of Nanputuo Temple Xiamen, Vegetarian Dept. A/k/a the best vegetarian restaurant I have ever eaten at.

The abovementioned Nanputuo Temple, the first Buddhist temple I have ever set foot in. "Zey davenen! [They're davening!]" said Blanca as she watched worshipers with their candles. "Nisht genoy davenen, zey tuen tefile. [Not exactly davening, they're praying.]", I managed to come up with.

Blanca's kindergarten class at four forty-five, pickup time: thirty sets of hands grabbing at the wooden barrier separating them from their parents, while my daughter sits cool as a cucumber in the middle of the room, in her chair. "Oh, hi, Dad," she might as well be saying. "Here you are, then."

4/25/06

Vegetarian restaurants: a taxonomy.
Or: La la la la la! I can't understand you!

There are several kinds of vegetarian restaurants, and each have their place in the world: the restaurants based on the theory that vegetarian cuisine must imitate meat; the homestyle places; and those which manage to break free of the limitating modifier "vegetarian" to sublime deliciousness.

The first vegetarian restaurant we acquainted ourselves with here in Fujian province was of the first type (Fake Meat), and very tasty. We chose it as the site of the farewell banquet we threw last night for our Chinese friends and colleagues.

According to the textbooks, Chinese friendship is fueled by favors. In my brief time here, I've learned that this is true -- but it's not just cold quid-pro-quo'ing. Having to perform favors to keep the wheels of society going means that one is always on the lookout for favors to perform. Sort of like observing the mitzvot. Last night at the banquet we threw I experienced a marvelous balancing of emotions: satisfaction that we could treat our friends, and warmth at the hospitality and welcoming nature of the Chinese that had occasioned this treat of ours. Or maybe the warmth came from the not-bad Chinese beer, and the many times I said "ganbei." (Everyone pretended to understand my toasts -- courtesy of the Oxford concise Chinese-English dictionary and an American soupcon of linguistic chutzpah.)

We took a taxi back to our apartment complex, and the three of us walked around the circular driveway connecting the buildings. In a large, empty room in the middle building, whose windows looked out onto the driveway, we saw a solitary man playing the recorder. His music was beautiful, though I couldn't identify it as anything more specific than "Chinese."

The security guard and the doormen were chatting outside. I managed to ask them, in Chinese, "Does he play every night?", and they said no, just a couple of times a week.

"Is he a musician?" I asked.

They both laughed. "Sorry! We can't understand you! Ting bu dong!" No! I wanted to shout. Give me another chance, please! I can make this sentence work! I can change around the tones!

I have some experience with speaking languages other than English, my native tongue, and I can tell you that Mandarin Chinese has been the one which (in my brief time here) has demonstrated the most frustrating variation in how (or whether) I'm understood by the person I'm talking to. I performed an unintended experiment a few days ago on a street in Fuzhou, going into several establishments and asking, "Excuse me, please, where's the internet cafe?" Of five people I asked, three responded, one looked at me without saying anything at all, and one, a young woman working at a salon, shrieked, covered her face with her hands, and ran inside. Is it my Mandarin, or is it the fact that I'm six-foot-two and blonde?

I tried to ask the women my question again about the recordist, but the great wall of incomprehension was down for the night. I got to understand a bit; that's a tantalizing symbol of my entire trip.

The second type of vegetarian restaurant is typified in my mind by Veg City Diner, in New York (rest in peace!), now replaced by Curly's Vegetarian Diner. In other words, it's been a great trip to China, but it's going to be time to go home soon.

The third type of vegetarian restaurants include the best I've ever eaten in. Ladies and gentlemen, I have been to the mountaintop: the best establishment I've ever slurped a noodle at is right here in Fujian. More information to come.

4/21/06

Passover in Fuzhou: discoveries and reacquaintances

Fish breaded with matzah crumbs, fried in peanut oil. Yum!
Fish soup.
Fish.
And more fish.
The chocolate macaroons, carried across two continents and a great ocean, from The Sweet Life on Hester Street.
Salted peanuts.
kheroyses (charoset) made with dried fruit from said candy store, doused in red wine, and left to sit. More wine than fruit. Also yum.

Now the wine is used up, so this Shabbos it's pineapple beer and lychee-nut beer. Will report on consequences.

4/15/06

A code on the unit
The resuscitative dance.

MEDICINE MENSCH: Springing Into Action
By Zackary Sholem Berger
April 14, 2006

In the hospital where I spent my critical care rotation, the patients in the intensive care unit ("the unit," for short) weren't as sick as those in some other hospitals. They were all more or less aware and oriented to their surroundings. You could have a conversation with them.

On one not particularly busy day, a team of doctors was standing in a patient's room, chatting. The full-length windows (a common feature of ICU architecture) showed a sunny day. We were talking both to and about the patient, shifting easily between including him in the conversation and cutting him out of it. A nurse popped into the room occasionally, to take care of something or to confer with one of the interns. The other students and I hung out in the back of the room, talking about what residency programs we matched with and about our upcoming vacations. It was strangely peaceful.

Once again, a nurse again came into the room; she whispered to an intern. The intern's face assumed an expression of practiced frustration, and he left the room with a sigh. Purely out of curiosity, we three students followed him into an adjoining patient room. There the electronic monitor showed a grossly irregular heartbeat, and the elderly man in the bed said he felt uncomfortable and couldn't breathe. We couldn't breathe for a second, either — we knew that the heart irregularity we were looking at was deadly, more often than not.

Then everything started to happen at once. Someone called out, "Let's bag him!" and a mask was placed over the man's nose and mouth to help him breathe. He was still conscious and could state his name clearly through the mask, even though the beat on the monitor was still irregular. "He won't be conscious for long with that rhythm," someone said.

Someone else called a code, or a signal over the loudspeaker connoting a medical emergency. More generally, a "code" is the high drama of resuscitation made mundane by repetition. It's a combination of shared concentration, workplace banter and choreography that no one ever should have to witness as a bystander. This was the last code I saw as a medical student, which means it was the last code I could spend flattened against a wall, hoping no one would run into me, and occasionally running tubes to the laboratory or trying to page someone on the phone. I couldn't see the patient from the corner where I was standing, but the elderly man was now lying quietly on the bed as the team maneuvered around him. I hoped for his sake that he was already unconscious.

To the uninitiated, a code is chaos. I'm definitely not fully initiated yet, but I know enough to say that the chaos is only apparent. People participating in a well-run code, like any other piece of complicated teamwork, have their well-defined roles.

But even in this lifesaving drama, people can demonstrate their flaws. One doctor — whose specialty I won't reveal — wasn't able to do what he was supposed to do. And when the senior resident, who was running the code ( i.e., giving orders and directing the choreography), told him to take a minute and do what he should have done, he responded with an expletive.

To everyone's great credit, no one paid any attention. There were smirks and raised eyebrows, but people kept on doing what they were supposed to do. This was the first remarkable phenomenon of the code: Conflicts that ordinarily might have disrupted the choreography only served to emphasize how smooth it was.

One other thing happened, which is horrible to relate. Despite everyone's best efforts, the patient died. Half an hour after the 20 or more people in the not-so-large room had begun their unsuccessful struggle, only a few people remained with the deceased, and it was time for our team to resume rounds. We went back out into the hall and talked about the other patients. Then, finally, we retreated to the on-call room.

But even then, when we were safely out of view of everyone else on the unit, it was not a time to cry or to mourn. We kept talking. The attending physician who was rounding with us said that we should not beat ourselves up about the patient's dying, that everything had been done the right way. He made a few observations about the code, we shared our impressions, and that was that.

In the cold summary of hospital jargon, the patient had "coded." A hospital doesn't allow much deliberation during the aftermath. Perhaps the only lesson to be learned is that best expressed by Robert Frost in his poem "Out, Out," about a horrible accident:

They listened at his heart.
Little-less-nothing! and that ended it.
No more to build on there. And they, since they
Were not the one dead, turned to their affairs.


Except there is a saving grace. The affairs we turn to in the hospital are the saving of other lives. For good or ill, this is the only ritual observed in every hospital on the death of a patient: going back to work.

Zackary Sholem Berger is a frequent contributor to the Forward. He will start his primary care residency at New York University in July.

4/10/06

Two weeks in Fuzhou

My primary thought about being in China right now is: "What am I going to cook for Pesach?" (Answer: Fish soup. The fish are beautiful here, and the produce fresh and bright-tasting. Do I know how to fillet? Not yet. Can I ask for fillet at the store? Already tried that: after fifteen minutes of back-and-forth, I got a fish sans head but otherwise unaltered. So bring me the fish knife, squire!)

My secondary thought is this: I expected totaliarianism to be more . . . evident somehow. A Soviet grayness to everything, a hesitancy to speak about certain matters. It is true that the medical students I have the pleasure of spending time with did at first decline to criticize the government in public. But tonight we went out together, and they asked me what I thought of Chinese democracy. After a few minutes of pursuing the topic, I got the impresssion that they just don't care. It's all politics, one of them said. Would it matter if they believed the horror stories I'm telling them about their government's oppression? Or is economic life in China (for a certain class) just too much improved for the accusations of the disaffected to make much difference?

4/8/06

Tang meets WCW
Not quite Lolita in Teheran.

Somehow, exchanging poetry is even more interesting than typing information on cases of gastric cancer into a database.

As with every conversation with this group of Chinese students (all women), we talked this way.

1. I try to say something in Chinese, after looking up all the words I need in the dictionary. (Preparation time: 15 minutes per sentence.)

2. My interlocutors look blankly at me. Then one of two things happen:

a. "Oh!" The shock of realization, and they repeat the phrase with proper intonation. Or:

b. They grab the dictionary so they can figure out themselves what I'm trying to say.

3. Repeat.

This time we were talking about poetry. (The last time we were talking, I tried to use the phrase "vegetarian restaurant," and one of them asked politely why I needed access to a library. Tones matter, ladies and gentlemen. Don't try speaking Chinese without a high tolerance for non sequiturs.)

"What is the difference between 'poetry' and 'poems'?" they inquire.

Um -- poetry is "writing poems," the art of poem-writing, I responded lamely.

They had favored me with handwritten copies of two poems from the Tang Dynasty. (I'm now in love with Tang.) In return, I gave them a scrawled copy of William Carlos Williams' poem about the red wheelbarrow.

While trying to explain the poem, it became obvious how little I understand it. What is the meaning of "so much depends/upon"? Don't the white chickens (why white?) lend a comic air to the whole image? (A student asked if Williams meant to eat the chickens. Shades of the Koch parody.)

I asked them to bring me a modern Chinese poem. They agreed, but one said, "I don't like modern poetry. It's not beautiful. And it doesn't rhyme."

I suppose it's nice to know that some misconceptions are universal.

4/6/06

Preparing for a Chinese Seder

In thinking about our Fuzhou Passover, I've been trying to avoid the cliche of China-in-bondage. But the facts keep rearing their ugly dragon heads. Did you know, for instance, that Chinese university students are not allowed to marry? Or that the recent unrest in Guangdong province, in which police shot and killed protesters, hasn't even been heard of by the medical students I've talked to here in next-door Fujian?
Allegra Goodman's Science Fiction
A review for the Forward.

In her new novel, "Intuition," Allegra Goodman invokes the world of medical research with the convincing detail of an insider and an outsider's penetrating gaze. The book is a modern epic, a slimmed-down, suspenseful version of one of the 19th-century classics: a narrative about large social forces that is also a tale of unhappy lovers and broken-up research families.

The laboratory of Sandy Glass and Marion Mendelssohn is prestigious but frayed at the edges, in need of intriguing results to push forward a grant application. Cliff, a young post-doc whose previous experiments failed miserably, comes up with surprising new findings. But are they real? His newfound success is met with suspicion, and with accusations of fraud, by Robin, who is a fellow post-doc and his erstwhile girlfriend; the resulting scandal reshapes lives and careers with unforeseen consequences.

The real-life course of scientific scandal can be impossible to untangle — and often dull. Goodman's portrayal, on the other hand, is riveting, calibrating narrative revelation while preserving the ambiguities of scientific dispute. This is moral fiction without moralizing, in the tradition of Jane Austen — and, for that matter, Philip Roth.

Goodman's previous novel, "Paradise Park" (2001), followed a memorable Jewish woman in her search for spirituality. In her new book, thoughtful Jewish characters are found in a different milieu altogether: the maelstrom of scientific competition and its search for truth. Does this make "Intuition" any less a Jewish novel?

Sandy and Marion, the lead scientists of Cliff and Robin's lab, are both Jewish, but in different ways. Sandy (born Sam Glazeroff) is an assimilated Jew; it's his wife, raised Episcopalian, who remembers to light the menorah at the lab's annual Christmas party. He is the self-aggrandizing but charismatic clinician, a straight-ahead publicist for his laboratory's results and a purveyor of hope for his cancer patients. ("In the hospital," we're told, "Sandy could walk from room to room and pull out language tailored for every ethnic or socioeconomic background. Like the magician's endless chain of knotted handkerchiefs, he could evoke Italian meatballs, baseball statistics, sailing stories, even sentimental childhood memories of the High Holidays. No one could Jew a patient like Sandy Glass.")

Marion, on the other hand, is an exacting, idealistic scientist whose uncompromising skepticism in the lab matches her care in cleaning her home for Passover. "There was a stringency about the holiday that Marion enjoyed. She liked the idea of cleansing body, house, and soul. Passover preparation appealed to her as a kind of cleaning of instruments, the periodic check and renewal of materials in order to get better results."

Though Judaism is important to Marion and Sandy, it's their scientific practice that is more akin to faith. When the integrity of the scientific process is questioned, the doubts are as serious, and emotionally charged, as challenges to religious belief. In the final, climactic scenes of "Intuition," Sandy and his Jewish identity, Marion and her scientific fundamentalism, and the difficulties that beset scientific faith are brought together to dramatic and thoughtful effect.

It would be overreaching to say that science is to "Intuition" as religion was to "Paradise Park," and I am consciously emphasizing the Jewish element in this novel. Of course, Goodman is much too subtle and multifaceted a novelist to make explicit this connection between Judaism-as-religion and science-as-Jewish-pursuit. But in a novel of many strands — in which ethnicity, economics, science, love and passion are all part of the tableau — we can't ignore one of Goodman's unique strengths: Like the 19th-century masters, she carries with her a convincing particularism even as she expands her narrative territory to include ever-wider spheres of intellectual and emotional conflict. As Goodman's interests and novelistic accomplishments extend far beyond the Jewish world, she is still — or all the more so — a Jewish novelist, and one to be prized.

4/5/06

Kosher Chinese
More conversations with Chinese medical students.

[My wife, my daughter, and I had eaten at a vegetarian restaurant recommended by the students I'm working with. The students asked me about my dietary habits, and why I wanted to eat at such a restaurant. This conversation, like all others we've been having, is a linguistic smashup between my wretched beginner's Mandarin and their serviceable, though distinctively Chinese, variety of English. Also agreed upon in this conversation: Americans are friendly though their president is incompetent.]

Students' Q: How long have you been a vegetarian?

A: I'm not. I'm kosher.

[Here follows my basic explanation, with much pointing at dictionary entries. The Oxford English-Chinese dictionary's entry for "kosher" means nothing, apparently, to these educated, native speakers of the target language.]

Q: You don't eat shrimp? Or oysters?

A: No.

Q: What a pity! They are so tasty!

A: [shrugs]

Q: Wait! Fish are also living, but you eat them?

A: It's in the Bible.

Q: Oh, the Bible. [This with the same tone that one might say: "Oh, the Articles of Confederation."] We're Buddhist! We eat anything!

A: If you like, you can look up 'kosher" on the Internet. If you care.

Q: We don't care.
Fuzhou Sojourn

Another Western blogger in Fuzhou! Figure the odds.

4/3/06

On Sunday

On Saturday, we rested. On Sunday, we scaled a mountain called Gu San, or Drum Mountain. I carried my daughter uphill - at thirty-five pounds, she was some baggage. The hill rates a matter-of-fact three lines in Lonely Planet which does not capture the spectacle of hundreds of Fujianese, old and young, slackers and Army types, climbing the hill for pure recreation. This time they had the added attraction of giants walking among them -- me and my wife -- and their movie-star daughter. I am not kidding abou the reception she got. People crowded to touch her, women offered to carry her up the mountain, old men touched her face. But even this paled before the stir she has caused at her day care, where against my wife's vociferous protests she is given more than the oher kids, before they are.
My first day at work

My ever-helpful and indefatigable liaison picks me up at the door of my apartment building to take me to the hospital. Since we are late, he explains, we'll go on his motorcycle. I wear a helmet. I think I might die on the busy Fuzhou streets. We arrive safely.

I am welcomed by two distinguished professors and two gastrointestinal fellows. To put this in perspective, remember what sort of treatment the United States reserves for foreign-medical graduates. Then keep in mind that I haven't even graduated from medical school yet (I do so when I return, on May 11th). So you'll understand why I feel vaguely guilty about the friendliness, generosity, and eagerness to please that I have been received with by every Chinese person -- really! -- since our arrival. One of the professors comments that he knows I'm from Israel, since I'm wearing something on my head.

I get a tour of the hospital, which is large and well-equipped. The campus is attractively landscaped, with many patients, relatives, doctors, and nurses bustling about between buildings. The nurses wear peaked pink caps. I draw many stares, and I try to return them in a friendly way rather than by staring down at my shoes.

Later I have a chance to sit and talk with the fellows, who, like their medical counterparts in the United States, seem relaxed, hyper-trained, and underutilized. To repeat the theme: they are friendly and engaging, and really quite thrilled at my fumbling Mandarin. They're patient enough to wait while I keep looking up necessary words.

I am shown to the medical-records room, with sober shelves of manila patient records, and introduced to the medical students that I'll be working with. They will abstract medical records and I will enter the information into a computer. Medical school is five years long in China, but as in Europe and other countries (unlike the U.S. model) it's a course of study that starts at the beginning of university. They ask me questions about China. I ask them if they can criticize the government, and they say not in public. They would rather not talk about politics out in the open, but say they do so among themselves in their dorm.
At the end of a week in Fuzhou

On arriving at the airport I found someone holding a sign at the gate with my name on it -- a first indication of my undeserved status of "foreign expert" which can bring all sorts of special treatment that I am not complaiing about at all. We were driven through the hills of Fujian in the middle of the night; the first song we heard on the car stereo was "Hotel California." We arrived at our fabulous apartment in the middle of downtown Fuzhou. Our apartment has balconies onto which one can step out and view the quite unexceptional downtown of a midsized Chinese metropolis, topped most of the day by a grayish haze. The following typically Chinese characteristics (I think) of this apartment are worth mentioning. Nothing like the mound of paper goods (napkins, paper towels, and the like) which the typical American apartment is outfitted with; we have a small number of pink and green rags. No oven! On the other hand, no oven I will have to kasher for Passover.

The apartment building is part of a luxury complex, and there are security guards hanging out outside at all hours -- tall gentlemen loafing at their ease on the plastic chairs ouside. After the first time they see us, the don't need to ask anything about us. We're the foreigners: a six-foot-two-inch tall blond guy with a head covering, his almost-as-tall wife, and their daughter whose blond hair and white skin have already come close to causing innumerable traffic accidents, not to mention the definitely non-hypothetical spectacle of grown men and women gasping in awe and stooping to touch her cheeks. On my way to work, I meet the stares of many curious passersby.

Before I talk about my work, I should explain why I'm here. I'm participating in a collaboration between NYU and the Fujian Board of Health on the topic of gastric cancer, which is quite prevalent in southern China. Why the high prevalence? That's the research question. It certainly has something to do with diet and environment, but the NYU researchers I'm working with are particularly interested in the bacterium Helicobacter pylori, made famous this year by the Nobel Prize for Medcine -- and whether the interacting genetic polymorphisms (diversity) of people and H. pylori might explain the high prevalence of gastric cancer both in Fujian and in Fujianese immigrants, who make up most of the Chinese immigrant pool to New York.

My goal here is to help with the basic, epidemiological analysis of data collected by chart review. How many gastric cancer cases have there been in Fuzhou (or two particular hospitals in this city) over the past few years, of what types (i.e., found where in the stomach), and with what risk factors have they been associated? I have found out that medical care in China, at least in some sectors, is very much pay-for-service. The Fuzhou hospital I am working at now (about which more below) treats mostly middle-class and wealthy Fujianese. Poorer patients go elsewhere, and this bias in the distribution of gastric-cancer cases I'll be analyzing obviously means something to our results. From a broader perspective, this schizophrenia of the Chinese health-care system -- government funding of all hospitals combined with vast inequalities of treatment -- was examined in a recent article in the New England Journal of Medicine.

4/1/06

Greetings from Fuzhou!

Where I can't see blogs (or Blogger blogs). I hope I can post, though.

3/26/06

To China!

Leaving Monday. I'll write when we arrive.

3/20/06

Jewish geopolitics
Not paradoxical anymore.

I can't think of anything to blog. We're leaving for China next Monday, and I'm occupied with traveler's questions (will my bottles of Passover wine explode in my baggage? will my two-year-old daughter have to translate for us? will I learn to speak only a smattering of Mandarin, in a thick Fujianese accent?).

So I'll throw an article your way by someone who davens and teaches at my shul. I think it's very reminiscent of Michael Walzer's political philosophy.
Israel again [in the modern era] faces political decisions, such as to how to deal with other peoples and/or nations that critically affect their national security. Consider, for example, the following question: Is Israel obligated to construct the security fence, and/or otherwise to pursue policies, so as not to foreclose the possibility that a viable (and peaceful) Palestinian state can emerge in the West Bank? And, whether or not international law, or general moral principles applicable to Israel as a state, would so require, is there some, or any, particularly Jewish value that bears on this
question?

[. . .]

[. . .] Israel’s claim is not that it itself is a just, liberal state. Rather, Israel’s claim is that a state fostering Judaism (but still protecting the basic rights of all citizens) islegitimate within the context of a pluralistic international order that includes both other states dedicated to pure neutral-liberalism, and other states dedicated to “decent” particularist visions, e.g., to Islam, or to Christianity.

Such a pluralistic vision of the place and role of Israel vis-à-vis other nations has, I submit, very deep Biblical roots. Thus the vision of the end of days at the conclusion of Isaiah Chapter 19 is not a vision of an end to all nationalisms, nor a vision of Israel dominating other nations, but rather a picture of Israel co-existing with Egypt and Assyria:

In that day, Israel shall be a third partner with Egypt and Assyria as a blessing on earth. For the Lord of Hosts will bless them, saying, “Blessed be my people Egypt, my handiwork Assyria, and my very own Israel.”

3/16/06

Do blacks, Hispanics, and the poor get poorer medical care?

The intuitive answer is yes, and in fact previous literature (see this paper, for example) seems to support this assertion. But a new article in the New England Journal of Medicine claims to show the opposite. Say the authors of the new article: "Previous studies have focused on a narrow set of quality indicators and conditions in selected populations and have had a limited ability to adjust for the range of factors associated with poorer quality. Few studies have examined quality across the continuum of care for multiple conditions."

The paper by Asch et al., then, seeks to estimate whether the care actually received by the subjects in their study population correspond to a set of indicators of ideal care. The indicator set is available here as a PDF, in a working paper from RAND (the authors' institution).

Surprisingly, the authors estimate that the population overall received 55 percent of recommend care -- that is, we're all not getting the care we should be. Even more surprising was the finding that quality of care varied only slightly among racial and socioeconomic groups.

The authors conclude, "Quality-improvement programs that focus solely on reducing disparities among sociodemographic subgroups may miss larger opportunities to improve care. "

This is probably the case. But their results should not be accepted uncritically, for two important reasons.

1. Abysmal response rate. The authors included in the study "all persons for whom [they] had at least one record (37 percent of the eligible sample). " Of course, the authors performed sensitivity analyses (in lay terms: estimating what difference the response rate might have had on the calculated results) and constructed models which controlled for non-response. They say, for example, "For nonresponse by blacks [in this study] to have produced the magnitude of disparities commonly found in previous studies, nonrespondent blacks would need to have had implausibly low (near zero) quality scores." Whether this is implausible is open to question, I think.

The study also excluded people who don't have a telephone and who saw no health-care provider during the previous two years. Obviously, these are the poorest of the poor.

2. Quality by what measure? The quality indicators used in this study come from a variety of sources: randomized trials together with consensus statements by professional societies. Furthermore, we don't know whether these quality indicators correspond to decreases in morbidity or mortality.

Despite these weaknesses, this is a highly important result. And I can comment, based on my limited personal experience, that it rings true. Errors are widespread. I have seen the poor get the same care as the very rich, and I have seen both failed by the system.
Doc, I'm breathing funny!
Funny peculiar, or funny ha-ha?

In this week's New England Journal, Rachel Sobel, a medical writer and fourth-year medical student at UCSF, has a thought-provoking piece about humor in the medical workplace. When young doctors loosen up in private, patients are often the butt of their jokes. This helps to shore up doctors' sanity in a stressful environment, but corrodes the dignity of the sick and the doctor-patient relationship.
The medical teams convened for a ritual snack break at 10:45 on a recent call night. We ate our ice cream in the far corner of the Moffiteria — as we affectionately call the cafeteria at UCSF's Moffit–Long Hospital — fueling up before the onslaught of admissions. The evening's theme: funniest beeper pages in the middle of the night.

"I once got this page from a nurse," said an intern. "`Doctor, your patient is covered in ants.'" The table erupted in laughter. Apparently, the patient had come in off the streets and brought the ants with him. They crawled out from their hiding spots after the doctor had done the initial workup. Another hilarious page: "Doctor, your patient is on fire." The man in question was psychiatrically unstable and had ignited himself. We were howling in between spoonfuls of ice cream.

[. . .]

In retrospect, I realized that during that night in the Moffiteria, I had, strictly speaking, violated a central tenet of the professionalism contract, which states: "I will treat patients and their families with respect and dignity, both in their presence and in discussions with other members of the health care team." We had been laughing at the patients and their misfortune. They were the butt of the joke, their dignity violated. But they were also the ultimate reason why I had endured the rigors of training thus far — and why staying up late studying had been a labor of love. In hindsight, laughing seemed a bit like betrayal.

Why, then, in those few seconds of juvenile hilarity, did I not feel an ounce of guilt? Perhaps it was simply that being with a group of other medical "professionals" made it seem okay. Or maybe it was justified because laughing brought us together as a team in an important bonding moment, which would ultimately benefit our patients. Or perhaps laughing was less about making fun of patients and more about coping, finding humor in a day filled with suffering. We were witnessing more darkness in our 20s than many other people see in a lifetime.
Apprenticeship

I matched!

(Here's what I mean by "matching.")

3/12/06

If you can hear the sound of my voice, have a drink
And a snack.

Would that I could give shalekhmones to everyone I know. Until that day, this Purim poem, included in every bag of raisins and hamentaschen, will have to do. (Yiddish and Hebrew versions here.)

Pain brings redemption
Unless it doesn’t.
Reason to celebrate
Isn’t Their defeat.
My survival’s not the why of it.

Proper partying has a drive
Unbound to past suffering,
Reactive but not visceral.
I say we get drunk now –
Maybe just a little bit.

Prepare a list of our demands.
Upthrusting sugar-sticky fists,
Rage against the Maker.
Importune the Deity for
Moral strength, lawful rigor, smooth-burning whiskey, tasty cookies.

3/9/06

Of Three or Four People
Yehuda Amichai

Of three or four people at dinner
You're always sat next to the nudnik
Forced to hear about the neighbor's overgrown garden,
The uncollected trash on the hills
Lit by the soft golden stone
Paid for by the extortionate taxes
Of the municipality
Of Jerusalem.

And people who left for fifteen minutes
Come back in thirty, when dinner is cold.

Of three or four people at dinner
One always finishes his soup
But feels it's rude to ask for more.
He stares into the bowl.
Within him: hunger. For soup,
For peace, for Biblical passion
Tamely modernized. For language
Common, tasty and cozy
Like this soup
Which can no longer be ladled out

Since it has been eaten already
By you, and the main course
Still unserved.

3/6/06

Morality, homosexuality, and halachah
Fumblings toward a thought or two, in pseudo-axiomatic form.

1.1. The issue of homosexuality within (or without) halachah can be viewed in many ways. One can start with the relevant halachot and work from them "towards" the sociological reality of homosexuality -- that is to say, in a strictly constructionist vein, find those heterim [legal allowances] which might make it possible for the acknowledgment of homosexuality (not homosexual behavior itself) to exist within a halachic community. This assumes that the halachot are applicable, and that moral considerations are either (a) only intra-halachic, i.e. generated by the halachic system, or (b) never applicable to the halachic system even when generated from without.

1.1.1. Halachot are generally applicable. To be a halachically observant Jew means that there is a very strong presumption that the halachah applies in the case at hand. What the halachah is in a given case -- i.e. how that is to be determined -- is very complicated from a general point of view, and I won't go into that here.

1.1.2. There are cases in which the halachah is not applicable. Whether there is a general formulation of all such cases is beyond the scope of this blog. There is an argument among the poskim [halachic decisors] whether every state of affairs can be addressed by halachah, or whether there are some states of affairs which are halachically irrelevant.

1.1.3. Moral considerations are important for determining whether halachah applies in a given case. In opposition to R. David Halivni, for example, I believe that our halachic predecessors (Chazal) did operate with explicit moral criteria. Many of these criteria are explicit (tikkun ha-olam, for one), while others are obscured by literary style. Thus we would not be the first to use moral criteria for evaluating halachah. Whether such "firstness" is relevant is another question.

1.1.4. How moral considerations and halachah interact is not simple. There are some cases in which the moral reality has changed from what was held true according to the halachah as it stands.

1.1.5. Such changes in moral reality do not always require halachic attention.

1.1.6. When large classes of people, by virtue of their wholly moral actions, are regarded as "extra-halachic," or sinners, this requires halachic attention.

1.1.7. Note that 1.1.6. does not apply to egalitarianism, which should be defended on other grounds.

1.1.7. "Halachic attention" entails, among other things, a deliberation whether the halachah as it stands is consonant with the moral reality that we know to be the case.

1.2. Similarly, one could start with the premise that homosexuality is immoral, either because (as noted above) halachic prohibitions establish such immorality by their very existence, or the immorality of homosexuality is a fact of the matter independent of halachah. (Rabbi Joel Roth makes use of both these arguments in his teshuvah.) By this account, halachah would serve either as a guarantor of (heterosexual) morality, or a bar to homosexual behavior which is ipso facto immoral.

2.1. Adult, loving, consensual homosexual relationships are to be morally valued, i.e. are the opposite of immoral.

2.1.1. One can quarrel with 2.1., but this is not a place to rehash the arguments made elsewhere against such spurious claims as the following: homosexuals weaken heterosexual marriage; homosexuals weaken a society's moral fiber; homosexuals are sexually perverse.

2.2. A considerable minority of Jews are gays and lesbians. By 1.1.6., since the halachah as it stands considers them as sinners, liberal poskim (to whom this discussion is confined) should consider the matter closely.

2.3. The halachic ramifications of homosexuality are many, but at the root lies the de-oraita (Torah-level) prohibition of "lying with a man [as one does with a woman]," i.e. anal sexual relations.

2.3.1. Sexual relations are at the heart of a loving, consensual, adult relationship. There are sexual acts proper to heterosexuals and there are those proper to homosexuals. And, of course, there are those which overlap.

2.3.2. The moral dissonance caused by the halachic prohibition of homosexuality does not extend merely to later outgrowths of the Torah's prohibition, i.e. to "recognizing" gay-and-lesbian couples, or the like. Rather, it goes to the very root of the matter, to the prohibition of "lying with a man as one does with a woman."

2.4. A morally based halachic change must take into account the prohibition of anal sex.

3/2/06

Why Johnny still smokes
Unhealthy behaviors and why we can't stop.

MEDICINE MENSCH: Nobody's Perfect
March 3, 2006

When it comes to our health, we can all be careless. Why do some of us keep smoking when we have relatives who died young from lung cancer and heart disease? Why do we eat like it's going out of style when New York is chock-full of obese diabetics? Why are so many Sabbath tables heavily laden with cholent and challah with nary a fruit or vegetable?

All these behaviors are hard to change; some are even addictive. There's also ample scientific proof that some of them are partially society's fault. It is attractive to smoke when cigarettes are made to seem glamorous. It is hard to eat a healthy diet when the nearest store with fresh fruits and vegetables is 25 blocks away, in the rich people's neighborhood. To take a more familiar example, more and more of us are sedentary and overweight — with the rest of society forced to pick up the slack.

But every year there are many people who stop smoking, and there are others who manage to lose weight, even when all outside factors are stacked against them. Conversely, many of us who keep smoking, drink to excess or eat unwisely aren't doing so under duress. No one is holding a gun to our heads.

What's the cause of our errors in judgment? I don't know. But there are some potential answers.

We don't know any better. Why would someone knowingly behave in a way that has negative consequences? By nature, people strive for the good, one could say, and self-damage is only committed out of ignorance. But after years of intensive health education financed by everyone from the feds to Philip Morris, it's hard to find the untroubled soul who still believes that Marlboros are the doctor's best friend or that obesity is not damaging. Our response to being (re-)informed about the harms of this or that consumption is not a surprised "Oh, really?" but a guilty headshake and a sorrowful "I know, I know! I should stop!" There are those cases — such as in the early years of the AIDS epidemic — in which education makes, or would have made, all the difference, but not when an unhealthful behavior like smoking, poor diet or lack of exercise is already deeply ingrained.

We don't like to think about risks. Many people ride their bikes without a helmet — not because they don't know that helmets prevent injury, and not because they're foolhardy, but because they don't think about it. No one likes to think about car accidents, least of all on a beautiful spring day with the wind in your hair as you fly through Central Park.

That's an oversimplification. We do think about some risks quite a bit: The press has been preoccupied with recent disclosures about the ineffectiveness of the low-fat diet and with the pandemic of influenza among birds. But to use an unpoetic word, we misprioritize. It's not bird flu or fatty foods that are to blame for some of the world's worst and most frequent health problems — it's unwise, widespread behaviors, the consequences of which are easily predictable.

We can't be helped. Somewhere between the naiveté I started with as a medical student (just smile and be friendly, and people will cooperate to make themselves healthy) and the desperation of the cynics ("If there's a problem, it must be the patient's fault") is a disquieting truth. There are some of us who make decisions that doctors would call the wrong ones. Then, when we are involved in a conversation about our own health, given all the information and opportunities we need and provided with dedicated staff, experts in their fields who want nothing more than to help us over the rough patches — then, finally . . . we make exactly the same unwise health decision we made in the first place. Given all the necessary data, we make a different decision than public-health workers would make on our behalf.

Maybe that's because of the reasons I already mentioned: We don't know about the scientific evidence, or we can't appreciate technical discussions of statistical risk. But maybe, in the final analysis, we just don't want to. In other words:

It's out of our hands. We would change, but we can't. Quit bothering us. I don't like to exercise. I enjoy my cigarette. No one likes to be nagged. The more we're talked down to about what we should and shouldn't do, the more difficult it is for someone well meaning to broach the topic — and the more unpleasant it is for us to think about our unwise behaviors in the privacy of our own room. We avoid the issues.

Information is not the cure-all. Educating us to understand the complexities of health risks requires a shift in thinking that could take a couple of generations to take hold. Sometimes our frustrations and defensiveness seem insurmountable. So two choices are left: give up or keep trying.

Not coincidentally, these are the same choices every health-care worker has when trying to help a patient. Obviously there's only one right choice that helps both parties. To keep trying doesn't mean success; it means that patient and doctor show up at least semi-regularly — with ears open and with the hope that, equidistant from their frustrations, lies an understanding of why the other behaves the way he does. If we listen to each other in the doctor's office, maybe we'll all make fewer mistakes. Or at least we'll better understand the mistakes we keep making.

In the next few installments of Medicine Mensch, Zack will complete his last rotation as a medical student, travel to China, and get his M.D. Ask him about anything, or tell him how he's wrong, by writing to doctor@forward.com.