Thursday, July 29, 2010

Synagogue Committees

Over the years my professional and Jewish life has brought me to multiple committees.  Some had specific tasks like arranging a symposium for the local medical society.  More often the mission did not have an end point, and too often no point at all.  When I took my synagogue sabbatical in 2008, I set aside all my committee work except for our Education Committee which meets tonight.  We sponsor a variety of programs, most continuations of what we did last year.  Newton understood that inertia gives the world stability and predictability.  And then there is my program, known as the AKSE Academy, concepted by me (or actually a form of Genevah purloined from what another place does better) and designed by me as a hybrid of a medical style professional meeting and four ring circus.  My intent was to have two sessions of four classes on a variety of off-the-beaten path topics give by people who actually had proficiency in those areas.  The evening would start with Havdalah and have a brief social schmooze between classes.  Assembling classes to be taught by people with expertise?  Maybe a foreign concept in a world where mediocrity of the Hebrew School classroom has become the way Judaism is imparted to large numbers of people.  The initial project was well received, particularly in the quality of the classes so it is now time to set some rules and standards that can be perpetuated while the program morphs into a signature event to be used as a means of attracting more people to our synagogue.

With the committee meeting tonight, I have to assemble some thoughts.  What I want to establish this year might be called a predictable structure.  I'd rather exclude clergy and just have this as a congregant driven event to showcase the talent that our congregation has that none of the other places can duplicate.  This may not fly as derech eretz and clergy always attract people into the classrooms even if the subject were researched the night before and could be duplicated by a kid in the dalet class.  Last year I had a guest and would like to do the same each year.  I already know who I want and what I'd like him to talk about.  Ideally the guest should be an individual who used to attend our shul but moved on to make good for him or herself someplace else.  We have enough of those people to last about another six years.  If they tee me off enough and I leave, then perhaps seven, eight counting my wife.

I think I can create all six machshava sessions from actual events that took place under the synagogue that irritated me.  There might be a discussion of "Titles and Entitlement", the views of self as presented by Hillel and Miss Piggy, excessive piety, the broad spectrum of Genevah and Gezeilah, beauty or sacred space assigned to building committee VP's who will definitely have to look this up.  And then there are changing roles of women, both in the frum world and in Israel.  That is our Achilles Heel.  More will undoubtedly emerge.

Wednesday, July 28, 2010

Old friends

Attrition in Jewish life or in medicine rarely means ceasing to exist.  People move on to someplace else to worship or to practice or maybe retire from communal or professional activities, but they do not get vaporized, as happened to the deviants and malcontents in George Orwell's 1984.  Talent, energy, and dedication are all highly portable.

This morning I made arrangements to discuss my Jewish future with an old friend who looks at the Jewish world a little differently than me, has progressed within it and probably was treated a little kinder by it.  He is concerned about depletion of participation from the synagogues and Federations but legitimately challenges my view that the participants are now left to salvage the misdeeds of their predecessors.

While discussing this and sipping coffee, another old friend strolled into the Brew-Ha-Ha coffee shop.  This fellow, the man who I regard as the finest pulmonary physician to ever preside over the ICU and resident training at Christiana Hospital, departed a few years ago to join a practice in nearby Pennsylvania.  Everyone misses his knowledge, insight, dedication and good nature.  I do not know the circumstances of his exit  other than he needed to find professional fulfillment and contentment elsewhere.  We recognized each other immediately, each of us with an instant smile.  He asked me about Christiana, only to learn that I am also on the exit ramp.  I found it gratifying to learn professional life has been good to him since he left.

My neurology professor Dr. Simon Horenstein, used to describe strokes as bimodal.  There is usually something lost, but there is usually something that remains as well.  Jewish and medical organizations are indeed depleted by the people who depart.  But these individuals typically end up bringing to the next destination their presence in a way that went underappreciated by the last.

Tuesday, July 27, 2010

Synagogue Governance

Board Meeting coming up tonight.  I've been on the Board of two synagogues, a co-VP of one in the past, on Sabbatical for a year, then asked to return by the Nominating Committee which thought an infusion of laitzanos (scoffers, as in Mishle) might be helpful.  Like everyplace else, Adas Kodesch Shel Emeth (AKSE) has its challenges.  Our membership has declined substantially in the thirteen years I have been with them.  I do not think I personally scared anyone away but that probably has not  been the case for past and current clergy.  Income fails to meet expenditures and our membership does not include a sugar daddy of immense wealth who provided us with a permanent endowment.  I have been affiliated with two such congregations including the congregation where my Bar Mitzvah took place in the 1960's.  The endowment paid for the Rabbi, even in the absence of congregants.  On my last visit there in 2003, a year before they packed it in and donated the tangible assets to tzedakah, they had a Rabbi, a part time Hazzan, and a few Medicare Beneficiaries to assemble just enough men to read Torah.  Such congregations remind me of what a shul would be like after the neutron bomb decimates the population but does not harm the building or its sacred objects.  By and large the people who worship there should be the most sacred of the objects, though often not regarded that way by the leadership.  AKSE does not have that problem.  We are fully dependent on satisfied members kicking in a goodly number of American Shekels each year to meet our expenses.  It keeps the macher swoops from getting out of hand.

Over the years there have been a number of half-hearted attempts to reverse the trend including a pretty penny paid to a consultant whose advice, if followed, would at least have us governing ourselves more effectively, though still in organizational poverty.  Our synagogue, like many other organizations and individuals, has its comfort zone.  People understand the barriers to greater communal acceptability.  Our president assembled two committees this past year, one to look at financial options the other to look at membership and worship ideas that may make a membership to an outsider more attractive than it currently seems to be and provide better retention of the members that we currently possess.  The new President and Board entered this month, with the reports as the prime item for the first meeting.  I read the two proposals last night, finding the financial one rather thorough and thoughtful.

In many ways, though, the leadership past and present reminds me a lot of my obese diabetics, the bulk of the patient population of most endocrinologists.  These people come to the office knowing years before the initial consultation with me that it is in the interest of their health to slim down.  By the time somebody tips the scales at 300 pounds, there has been one or more attempts at damage control and for a lot of them some temporary success.  As I follow them along their weight rarely changes enough to move them from one health risk category to another.  So how do they control their poundage?  They will put skim milk in their coffee, maybe not eat donuts anymore, watch an exercise show on cable TV or any number of other measures that indicate sincerity of intent but little insight into what it takes to solve the problem.  Even if the insight is accurate, the committment to radically altering ingrained habits just doesn't seem to be there. 

So we continue with our delusion that allowing women to lead a small prayer from the bimah while allowing the more effective option of a Womens Tefillah Group to languish at the level of Junior Congregation will create the illusion of parity.  We grant titles to people with the rationalization of the Wizard of Oz that synagogue volunteers granted committee chairmanship or an office of governance will be able to impart the expertise expected of the position.  I do not think the clergy, Gabbaim or past presidents are above accepting a mediocre status quo rather than become disruptive people who expose naked emperors and offer them a towel.  Just like the fat diabetics who reject the diet and exercise recommendations but get by with some insulin and some metformin, the easy stuff.

My psychiatry professor taught me as a third year medical student that being crazy or delusional and being dumb are two different things.

Monday, July 26, 2010

Morning Minyan

On Sundays if not on call I try to attend minyan for Kaddish.  We generally get ten plus men, no women other than the wife of one of the regulars who makes the coffee, for which she gets little audible appreciation, though I try remember to thank her most of the time.  After minyan today, somebody engaged me in serious conversation, though this does not happen often.

A medical colleague shared my interest in a Medscape Physicians Connect thread on doctors who voluntarily give up their hospital privileges.  As part of the thread I had posted a symposium published by the Cleveland Clinic Journal of Medicine entitled "A Medical Center is not a Hospital" by Dr. Thomas Lansdale, which invited numerous spirited comments.  Shortly before publication, I had resigned from one of my hospitals, largely because I did not like their rabbi.  When comments were invited, I sent a rather lengthy and detailed response which made it to the online version of the CCJM, though not the print one.   As part of the Medscape thread I linked the CCJM comments, receiving much thanks for my rather brief contribution.  Eventually the issue of resigning from a hospital staff, or staying on grudgingly, garnered a couple hundred physician responses, far more than the usual Physicians Connect discussion.

The reasons cited are expected quite varied.  Dr. Lansdale cited primarily professional and ethical frictions between the goals of hospital management, of which he was part by his role as section chief, and his resposibilities to provide the patients for whom he and other members of the Department of Medicine are responsible with the finest in medical management for the illnesses that came their way.  Some of that reasoning continued on the Medscape Physicians Connect commentary.  However, much of it involves personal experience more than committment to patients.  Hospital generate ample income for some of us but for others it absorbs time without offsetting economic or professional benefit.  Many of my medical colleagues point to villains who have ruined it for them.  There are insurance companies that restrict decisions as basic as to when to hospitalize somebody.  There are managers who pounce on them for expressing themselves with visible or audible irritation when nurses fail to do what the physicians expect them to do.  There are foreign trained physicians and nurse practitioners who take their business away by agreeing to either work for less or join the hospital payroll.  There is the Democratic Party or the Republican Party whose policies or legacy provides a point of irritation.   There are colleagues who steal their patients. Stephen Covey in his monumental 7 Habits of Highly Effective People describes people who's fundamental goal in life is to stay a step ahead of their enemy.  These people really have very little proactive autonomy as their decisions are generally a byproduct of the people they need to protect themselves against.  Yet that theme seemed highly pervasive in the physician comments.  In that sense, resigning from a hospital staff enables a measure of desired escape.

Friday, July 23, 2010

My own seat

Shabbat arrives at sundown.  Where to attend shul should not be an intellectual question to be sorted out but for me there has been a menu created.  As an ovel, I try to be in place for Kaddish.  My home congregation sometimes gets a little shvok on assembling ten men for Kabbalat shabbat.  Guaranteeing ten men and assembling at a convenient time induced me to show up at the reform congregation several months ago.  Without belittling the importance of halacha, I find a level of kedusha there which does not exist in my home congregation.  I like the musical skills of their Hazzan and the insight, intellect and fundamental kindness which their Rabbi conveys each time he speaks from the bimah or wanders through the congregation with a portable microphone clipped to his robe.  After a few visits, I started sitting in the same place each time, or within four amot if my seat already had another tush in place.

Having  my own seat makes me part of the community.  The rabbi knows where to look for me even if he knows nothing about me, not even my name.  I have a perspective of the bimah and what goes on their within my line of sight.

At my home congregation I sit in the same seat when I attend with my wife.  When I attend alone, I sit someplace else and vary the location, even sometimes opting for the reserved men's section which my wife abhors but we both understand intellectually as necessary for acceptability of some of the worshippers.  There are different perspectives of the proceedings, some visual some auditory and tactile, as the people nearby who chat with you and shake your hand change from week to week.  I am also less a participant and more of an observer or transient when I lack my own fixed anticipated location in the sanctuary.

Thursday, July 22, 2010


For the most part, my level of observance seems to seems to trend in much the manner of our financial markets.  Over time, measured in decades, there has been an increasing level of approach toward frumkeit.  The setbacks, however, like those of the stock market, are both dramatic and rationalized.  The first occurred as a teenager when the Rabbi invited his wife to be guest speaker at a teen luncheon he was promoting.  At a public forum, he tried to take attendance in advance.  When I announced myself as intending to be absent, he asked why.  I told him the rules were attendance is voluntary.  He then took my private comments to him of dissatisfaction with the Hebrew school and made them public.  The people in the carpool could easily tell I was seething.  I do not know if anybody reminded him what confidentiality is about.  I figured that out long before I became a physician.  The next day I was a Hebrew school drop-out, and within a month the car pool pretty much disbanded with two other kids depleting the enrollment as well.  I did not go to shul again, except to attend an event for the next two years, but took an interesting and prolonged liking to his successor. 

The second downward blip was a more transient one.  There was a teen shabbat congregation, for which the congregation took great pride.  Like any teen group it had its cliques and I was external to it.  Unfortunately, the adult volunteer, an uncle of one of the participants and neighbor of another, had a way of playing favorites, one of whom accused falsely of some of some minor infraction like pulling the top off a cupcake before they said kiddush. Without giving me a chance to state my innocence he had a tizzy fit calling me unworthy of kiddush.  The next meeting, a couple of weeks later, they were trying to assemble a minyan so he went over to me at the main service to get me to come downstairs.  I politely called him a blight on Judaism and exercised my right as a post-Bar Mitzvah Jewish male to remain part of the main minyan.  Difficult to provoke but difficult to pacify = his loss offsets his gain (me), Easily provoked but easily pacified = his gain offsets his loss (him) as the sages of Pirke Avot accurately observed.  Of course there was a complaint to the Rabbi who concurred with me that freedom of worship exists within his congregation.  I never attended the teen service again.  By the time I completed high school I attended the main service regularly, became the most observant teen in his congregation, easily the most accomplished Jewish scholar and sufficiently skilled and committed to absorb easily into the Orthodox world of my university Hillel.

My next setback was a more innocent one.  I received only one medical school acceptance, that of my beloved St. Louis University, a Jesuit institution which afforded me more regard for my religious practice than any institution with which I have been affiliated before or since, including all of my synagogues.  Unfortunately there were no shul's in South St. Louis. It was easy for Kashrut to slide somewhat as my schedule often necessitated some grab n' go and Supermarkets were not open on Sundays.  My eating out standards have gotten reasonably tight in the ensuing decades.  I also opted to take my exams on Saturday morning with the rest of my class, rather than arrive at 6 AM on Friday mornings like the three kipah wearing classmates did.  But I made good on my pledge to myself that when I got a car in my third year, I will attend Hillel on Shabbos if not on call and shop at Schnuck's Supermarket in the middle of the Jewish area, which I did.

For each of these lapses, I always intended that they be temporary to adapt to current circumstances, and they always were until the current one.  Tune in.

Wednesday, July 21, 2010

Tisha B'Av Thoughts

Last night Eicha and Kinot marked the high point of a three week mourning period from the time the walls of Yerushalayim were breached  on Tammuz 17 to the destruction of the Temple on Av 9.  A theology of just deserts permeates Tanach, one that most contemporary rabbinical thought has rejected.  Contrary to the bombastic pastors of TV ministries, the jets did not take down the World Trade Center because we integrated American schools, allowed female sufferage or repealed prohibition.

Both Temples fell victim to outside armies for identifiable internal cause.  Tzuris to the inhabitants finds its justification in Avodah Zarah (worship of idols) in 586 BCE and Sinat Chinam (baseless animosity) in 70 CE.  Avodah Zarah and Sinat Chinam both remain highly prevalent within the Jewish community.

Depending on how you define Avodah Zarah, it is fairly easy to see why people have not abandoned it.  There has always been something alluring about defying some of the ascetism that rabbis of yore advocated.  Hellenism brought beauty and creative thought to the Jewish world.  Today, the relentless quest for money over piety gets a mixed message.  From the pulpit it is one of save some time for coming to shul.  From the synagogue presidents it is can we have some of that money.  From Reb Tevye comes the recognition that "If you're rich they think you really know."  There has always been a tension between how values are presented conceptually and how they are presented in reality.

Sinat Chinam may be more difficult to tease out, since the benefits to individuals and community are more subtle while the risks seem obvious.  Would the world really be better if Sinat Chinam disappeared?  As I ponder this question each year around this time, since it was proposed by a very fine Conservative Rabbi in his Tisha B'Av remarks, I remain convinced that a certain amount of Sinat Chinam has its place.  The original Talmud story involves reprisal by a man who was snubbed for a party invitation, which most of us would regard as trivial, but left him with anger and very limited recourse other than to let the Roman authorities take reprisal when he personally could not.  In the ensuing two thousand years we continue to have injustices inflicted upon us, usually by those in authority, for which we have limited ability for reversal.  There are the proverbial Macher Swoops of synagogues and Federations where the organizational policy is made in the back seat of a Mercedes-Benz while the Rabbi drives.  I've seen people in my synagogue blackballed from aliyot for beliefs that conflict with those of the gabbai who hands out the aliyot, while the rabbi acquiesces to the gabbai's positional authority to do this.  I've seen people with obvious neurologic disorders undermedicated with psychotropics prevented at Board meetings from expressing what they think.  On a more historical level, we have widespread departures from our communities, via immigration to America where men tossed their tfillin overboard on sighting the Statue of Liberty, to Jews responding to their mistreatment by embracing the Bolsheviks or the Hasidim.  If the greatest sage of his generation, Elijah the Gaon of Vilna, could really have his way, there would be no Hasidism which has enriched Judaism to our time.

In many ways, Sinat Chinam remains our Trump Card that we depend on as our recourse to amend mistreatment.  It is really part of Tikkun Olam, even its consequence is the absence of a Beit HaMikdash.

Monday, July 19, 2010

My heartiest Welcome

Tonight begins Tisha B'Av, the saddest day of the year.  For the first time in a while I will be staying home, fasting at least to the AM but not attending a public reading of Eicha or reading it on my own.  Both the shuls where I might perform this mitzvah d'rabbanan teed me off.  The pseudo frummies of my home congregation, who I mockingly refer to as the Taliban of the Ritual Committee probably deserve a day of sadness and certainly do not deserve something of the holiness of a Bet HaMikdash.  Having them weep together amongst themselves falls within my concept of Din.  Last year I read a chapter of Eicha at the conservative shul but this year I declined their Hazzan's invitation for an encore.  Interupting every chapter break with a Holocaust or related reading interupted the cadence of the Megillah.  I suppose adding to the misery of the evening has its justification.

Over several decades I have acquired two identities.  First I am a medical subspecialist who really has derived great personal satisfaction from the effort I put into maintaining myself as a skilled clinician and from the appreciation conveyed by many a patient whose life has proceeded in a better path than nature intended.  Yet within that sphere, there are many ways in which life as a physician could have been better and is threatened now.  Since I subscribe to a major physicians on-line program, with more than ample forum for my colleagues and I to express our experiences, I read a lot of notes of discontent.

My other identity is as of observant Jew.  In the spectrum, I'd probably fall in the box of Conservadox.  Discontent is less visible or audible here.  It is measured to a large extent by attrition.  Membership in my shul has plummeted, the Conservative movement which provided my core education implodes, while the finest Jewish minds in my community hold Federation and the Federation-types in sufficient contempt to sit on the sidelines, as I have done.  Rabbis milk their titles to acquire authority, with a real knowledge or skill base that would not take them to an internship in my medical world.  Dr. Moe, Dr. Larry, Rabbi Bob?  The net result has been talented people voting silently with their feet, yet having no serious recourse for reversing what drove them away.  These people of under-utilized talent have not really disappeared, yet they hide under the rocks for their own inner peace.
As I begin my public comments, I want to acknowledge that good and decent people are not always treated as they should be.  Both medicine and Judaism are diminshed when leadership driven attrition takes hold.  As I begin what I hope will be regular postings, I aspire to creating not only a forum to identify what has devastated a good portion of Judaism in my lifetime and jeopardizes the future of medicine as the baton passes from me to my medical student daughter, but find some means of reversal.