Tuesday, August 31, 2010

Synagogue Governance

Do I really care about how AKSE or any other synagogue is run?  Should I?  Having been to a place where I'd classify some of the activity of the baalebatim as bordering on evil, I think there is a reason to not only remain in the game, if possible, but to give up and depart under certain circumstances.  It seems that trends in membership data may support this view.  Fortunately there is nothing evil about AKSE.  Dumb, inept, insufficiently thoughtful for sure but not evil.

We have a Board Meeting tonight with the usual subjects up for discussion, mostly money either directly through a budget presentation or indirectly through a membership discussion or fundraising efforts that probably would do better if run by newcomers who did not carry the legacy of previously marginal efforts.  But directly or indirectly the agenda is money.  At least these things are measurable.

The real essence of how a congregation serves the people who attend, or who pay dues but don't attend, can be more elusive in its assessment.

Sunday, August 29, 2010


Quiet shabbos, intent to do chores on Sunday partly successful.  I made progress with making the bedroom tidy, washed the dishes, did grocery shopping, worked on my Torah portion, opened some unopened mail since last spring, listened to a shiur, took Alan to the bus stop and replaced my fleishig skillet that had served me well since my wedding but has acquired a significant part that fails to heat adequately.  Not bad. 

Friday, August 27, 2010

Shabbos Prep

Each Friday morning I arise at the appointed time, even when I wish to sleep longer and probably could sleep longer with no adverse work consequences.  My task: have a suitable shabbat dinner assembled before leaving for work.  Usually I make something simple, most typically chicken breasts seasoned, though sometimes cut-up chicken.  The best buy is actually whole frozen chicken but that has to be thawed earlier in the week and roasted the night before, as does turkey breast with bone in, as turkey cutlets are not freqently in the Shop-Rite case.  From time to time I will place beef cubes or chicken parts in the crock pot along with things to eat with it, a one pot meal that lasts several meals.  I usually make a starch serving, typically a box of couscous that cooks in minutes or rice variant that can cook while the chicken is in the oven.  Mini-challot are obtained that morning or defrosted the night before.  A vegetable or salad is made when Irene gets home, or in the winter a vegetable is made that morning and reheated on arrival home.  I rarely make dessert or buy dessert in advance.  Soda and beer are put in the refrigerator that morning. 

While I rarely spend money on shabbos other than a weekly cup of coffee early Saturday mornings at Sweeney's around the corner, more to support them than real need for outside coffee, I will also make sure that I have $50 available to me in cash and at least a half-tank of gas if I want to visit someplace that I might not be able to do on days when I have chores.  Half of each type of coin is placed in my Pushka when I get to the office, with the other half going to the Pushkas at AKSE during the repetition of the Amidah at Sunday morning minyan.  I read a commentary on the weekly parsha, usually one from the Rabbi I've chosen to follow each year.  This year it is Rabbi Wein.

Time has its own sanctity, as do the core concepts of Judaism including shabbat, synagogue and community.  None of them performs optimally.  All have their compromises.  All need tweaking, despite ongoing resistance to being tweaked.

Thursday, August 26, 2010

Filling in the Calendar

Last night I returned home from AKSE's Education Committee very disheartened.  My cohorts at the meeting had no interest in anything innovative, provocative, stimulating.  They had slots on the calendar to fill in and they did it.  Most AKSE activities strike me that way, from Shabbat services to Board Meetings.  I tried to make Minyanaires different with random discussions that people could not get anyplace else but for the most part the mentality is one of let's reconstruct last year's programs, get the same Torah readers to do what they did before, never risk negative feedback, and get a different result than the last time we did the same thing.  There are very few really stimulating analytical people there.  People don't like to move the furniture around and see if the next configuration comes out better than the last.  I suspect that the 125th Anniversary fundraiser will mimic the 120th with the same result, or perhaps a small profit though not one to impact materially on finances.  Board Members taking out $100 ads while the business that they work for that have $300 as chump change will be left to languish.  We populate our membership rolls with decent folk who go to work, do what they are told, have their periodic salary deposited but never have accountability for innovation, adaptation or risk.  We populate our committees, Board and pews the same way.  The slots on the calendar get filled in so that events happen at the appointed time.  Better events?  More inspiring events?Not yet.

Wednesday, August 25, 2010

Physicians of Despair

The Annals of Internal Medicine released a summary by Zeke Emanuel et. al. of how the upcoming health care law will impact individual physicians.  First, I had the privilege of attending an invited talk by Zeke at the Leonard Davis Institute last November and the added treat of having him answer my question.  All stereotypes that his public statements have created of him, he is a very astute, articulate thinker with real medical experience.  The bottom line seems to be that for service to patients to become maximally effective and efficient, medical care will need to achieve electronic computerized parity with the banks, hotels, airlines and pretty much any other industry.  I've had my billing system computerized via a service since the late 1990's, as have most of my colleagues.  I do not even know if traditional One-Write Billing stationery is still available for purchase.  Patient care, however, still depends on written charts, though the large hospitals seem to be making progress in transforming to electronic record keeping which enables access to specific information more readily, as long as the doctor knows what needs to be retrieved.  To do this requires a large capital infusion with little financial return, since payment currently depends on how many patients you see or procedures you do, which will remain the same.  To address this newly mandated overhead, economy of scale will predictably be required, with a fairly safe prediction that physicians who practice alone or with a partner or two will need to seek employment, as I have already done.

For many of us, we value our autonomy above all else and found medical careers one of the few remaining outlets for continuing that.  Self-employment as we think of it will soon disappear and with it the freedom to hire who we want, set our vacation schedule, keep a share of our profits for extra work, and maybe even give us a means of product differentiation of why patients should come to our office rather than a colleague's.  Sermo, a physicians web site, printed the article and invited members to comment, which they did.  People post with considerable frequency that they are fed up and often professionally threatened.  The folks in their 30's and 40's will have little choice but to adapt and maybe withhold tuition from their kids if they express an interest in studying medicine.  The people my age are more likely to have their financial advisers total up their assets and if financially feasible call it a career.  There is clearly a sense of loss, an early expression of mourning for loss of what we once had.

Tuesday, August 24, 2010

New Job Upcoming

We settled on a start date for Mercy Philadelphia Diabetes Program, the Monday after Rosh Hashana.  Not having patients for the last month has made me a little stir crazy but it is also an opportunity to do stuff that I've neglected due to work obligations and fatigue.  Unfortunately, I've been less than diligent about my writing and finances and housekeeping but much better than before about studying parts of endocrinology that I have neglected.  I've tried hard, though with less success than I had hoped, at creating a schedule for myself to keep while my time resembles a blank canvas.  It's easy to create time slots, harder to self-impose deadlines.

Monday, August 23, 2010

AKSE Academy

AKSE Academy began last year, recommended and inspired and partly purloined by me as a way for AKSE's Education Committee to avoid having a Shabbat Scholar in Residence.  I had found most of them disruptive to our usual non-mechitza style, an invitation for Rabbi Dresin to cast disparaging comments toward us for resisting accommodating our guest and generally not worth the $2K or so and the aggravation of arranging dinner and the like.  Thinking that nobody is better than our Shabbaton visitor, we opted for nobody, or in this case a series of nobodies to assemble about eight classes on a variety of subjects.  I modeled it partly on nights of learning that other places do and partly on a medical conference that typically has a menu of several simultaneous presentations that those in attendance can select.  It went well enough, with an attendance of about fifty and a small financial profit, that there is a consensus to develop this into a unique event in the community.

I've become very possessive of my creation, not wanting anybody to interfere with the content and almost impervious to feedback as I try to push the envelope that will be necessary to make it a signature event for the synagogue.  I'm also the most inquisitive person on the committee, which has its pluses and minuses.  It is very tempting to create 5 of 8 classes from negative transference reactions from AKSE's Bimah.  There's no shortage of them, and some pretty good topics such as the role of self, titles and entitlement, physicians destined for Gehennom, Genevah, misconduct in the name of frum, et. al.  I'm also probably the principal laytz in the congregation.  There need to be a couple of benign topics, things with little emotional content, like travel or Draft Dodging Tzahal or Sacred Space or money or Talmud study.  Maybe the emerging hi-tech industries of Israel.  Speakers come later.  Imprint comes now.

Sunday, August 22, 2010

Nurturing Talent

A Sunday off following Shabbat.  I attended my usual services, Beth Emeth for kabbalat shabbat and AKSE for shabbat morning but couldn't get it together for minyan this morning.  My daughter Rozzy came for a visit, so I really wanted to be home for her and I wanted to get some cleaning done this morning.  Minyan starts at 8AM on Sundays, so the real time away is about 7:45-9:15 if I keep the chats short over coffee.  They usually get a minyan on Sunday mornings so my presence has no material impact on the proceedings, among other rationalizations.  No getting around it, the only one that I inconvenience myself to get to is Beth Emeth's kabbalat shabbat.  I like that one hour's respite, scholarly rabbi, inspiring cantor, skilled organist and a hundred other worshippers who also made Friday night a personal destination.

Beth Emeth has a student from the Reconstructionist Rabbinical College assisting this year.  They gave her a relatively benign trial by fire, allowing her to conduct most of the service and present the sermon, which was a minor let down, as I had hoped to hear Rabbi Robinson's always learned message.  Rabbi Stern did OK for a start.  She seemed perky and enthusiastic, reasonably articulate, and with a beginning, a middle, and an end to the talk though the Jewish content and citations could have been more thorough.  I think she'll develop adequately with Rabbi Robinson and hopefully Rabbi Grumbacher showing her the ropes.

AKSE lags behind in developing people's skills.  Some of the Bar Mitzvah boys advance their proficiency, but for the most part they disappear within a year or two.  There is a tendency to find people who already know how to do whatever and put them on the schedule.  Some very negative long term outcomes eventually arrive this way.

Friday, August 20, 2010

Kiruv Unfulfilled

Most Friday mornings I arise at 5:30, a little earlier than I need to, to make dinner for shabbat.  This is more important during standard time than daylight savings time, and probably not urgent at all in the summer when my wife's seniority permits her to take each Friday as vacation, but it is something I've gotten used to doing.  Most of the dinners are simple, most often chicken breasts or parts seasoned, then seared in skillet and finished in the oven, with boxed couscous and salad or vegetable.  Sometimes like today, it's a crock pot stew that serves as cholent for dfina for later.

Shabbat dinner may be the best opportunity for kiruv, but we hardly ever invite anybody and do not get invited any more than we extend invitations.  As an Ovel, I need to get to shul for Kaddish after supper, though technically it should be before.  I happen to be fond of the reform service Friday night which enables my usual eating times and has a better conveyance of Kedusha than AKSE where the onset of shabbos is more akin to checking the boxes that the assigned prayers were completed with ten men in attendance.

When we interviewed clergy candidates, both for Hazzan and Rabbi, each was asked about how they do kiruv, which may be AKSE's path to viability.  The people offered the position mentioned guests and personal contacts.  To be fair, the Cantor did invite my wife and me to lunch and we went once though by kiddush I usually have the afternoon planned and regard a spontaneous invitation as a disruption.  I do not know who the Rabbi has over.  It has not been me.  There were plans to have small groups at people's houses with the Rabbi present.  I've never been invited to one of those parlor sessions.  I do not have a good answer for why kiruv goes unfulfilled.

Thursday, August 19, 2010

Annoying Colleagues

Al Tifrosh Min HaTzibur or "Don't separate yourself from the community," advised sage Hillel in Pirke Avot.  But sometimes a respite of uncertain duration may hit the spot.  This morning I opted out of Medscape Physician Connect discussions, where I tend to function as a sage, though perhaps politically more liberal and definitely more scholarly than most of the posters.  There's been too many diatribes, too much pooled ignorance, too much intolerance of other people's ideas.  When I started responding in kind, I knew it was time to neither read nor contribute for a while.

Wednesday, August 18, 2010

High Holy Day Prep

Yesterday I started learning the first three Aliyot of the Torah reading for the second day of Rosh Hashana.  I've done it before, though not in many years so I am rusty at it.  Then again, it is only half a column so I should be able to learn it my next week which gives me two additional weeks to polish it.  The three days plus YK mincha readings have been divided and for the most part the haftarot are recycled from year to year.  Nobody has to work especially hard and nobody has to challenge their capacity.  I've always been uneasy with that approach but it gets the slots of the schedule filled.  It does not create a setting where high level of skill is pursued or even valued, as it wouldn't get utilized even if available.  All the readers are my contemporaries or their teenage children, with a new slot opening up every couple of years when somebody goes off to college or a senior person decides to spend the Holy Days on a cruise ship.

People get their impression of the synagogue from those few days.  Beth Shalom, the United Synagogue affiliate, puts a lot of capital into showing patrons a good experience.  People come in their best suits, machers get aliyot and pat each other on the back on the Bimah, kids are showcased and clergy contract terms reviewed relative to congregational feedback.  At AKSE we are a little more laid back as a larger fraction of our membership shows up at other times during the year.  Still, we offered free entrance for our Rabbi's first year in the  hope that the experience would increase traffic, which it did, and paid membership, which it did not.

As a youngster attending the Community Synagogue of Monsey, Mr. Zeisel, my friend Howie's dad, took me aside and invited me to return for shabbos.  He predicted that I would find the Saturday morning experience of more spontaneity and less showmanship more to my liking and give me a better introduction to what living in a Jewish manner was really about.  He was right, of course, though the message has been difficult to convey.

Tuesday, August 17, 2010

Defunct Synagogues

Somebody forwarded a request for information on Bronx synagogues, of which I was familiar with one and had a vague memory of a Megillah reading at another.  My father's parents lived in a section known as Highbridge, which had its orthodox shul across the street from their apartment.  I do not know if my father's Bar Mitzvah, circa 1935 in the midst of the Great Depression, took place there or not.  His sister's children all had theirs in this building.  I was last there probably fifty or so years ago.  I remember it as being bigger and more imposing than the photograph suggests.  It had a balcony where the women either worshipped or chatted while the men engaged in shabbos sanctuary proceedings from the main floor.  My grandfather remained modern orthodox, his children went secular but even his grandchildren belonged to a synagogue and arranged for bnai mitzvah of his great grandchildren, so the place across from his apartment probably accomplished its long-term mission.

It is now a church, as are most of the other synagogues in the South Bronx, which I suppose beats being abandoned, the second most common fate.  Sanctity of space is probably transferable.  I lack a good sense of how that congregation depleted, whether similar to the depletion of AKSE slowly over a generation, or more precipitous.  Jews of the South Bronx scattered elsewhere in Metropolitan New York where other congregations grew.  Jews of AKSE migrated from the vicinity of the shul without really scattering but lacked any place else to go in their own neighborhood.  As we begin to observe AKSE's 125th year, predating the establishment of the Bronx shul by more than forty years, there is the looming prospect that its tenure is also finite though for much different reasons than what caused closure of the Bronx congregations.  Whether it fulfilled its mission of perpetuating Judaism elsewhere is also far less certain.

Monday, August 16, 2010

Blank Canvas of Time

A new week.  Sorta waiting for my new job to start so technically between jobs and not all that inclined to do stuff in the office that I ought to be doing.  In some ways the week is like a blank canvas with essentially no fixed appointments.  I could go to minyan though it's not one of my current motivations.  I could contact old friends, which might be closer to my motivation or could be partly accomplished via going to minyan.  I could spend the week on my soapbox.  I could pursue neglected projects, mainly the things I wanted to write this year but didn't.  We'll find out on Sunday's review how I did in my first hint of what retirement might be like.

Friday, August 13, 2010

Jewish Misconduct

Jewish misconduct.  The news yesterday included the arrest of an observant and generous fellow from Lakewood who may have made tzedakah a lavish beneficiary of criminal activity.  Not all misconduct rallies the civil authorities to interupt it.  My close friend stopped by my office yesterday.  We chat about synagogues and their denizens.  I've had my eye on one of the clergy for some time relating experience with sleight of hand and other activitiy that I think victimizes some of our congregants and maybe even jeopardizes our viability.  I heard more.  It's one thing for me to be on the receiving end, as I can and have walked away on occasion, even though I think I have one of the tougher hides to pierce.  It is quite another when the victims are elderly, frail, sensitive and loyal.

For the next AKSE Academy I want to include a shiur on Misconduct in the name of Judaism or perhaps one on the internal victims of the Jewish community.  I'll chat with the Rabbi about that soon.

Thursday, August 12, 2010

Mourning the End of Private Practice

This morning, not having a lot of professional stuff to do, I went to Medical Grand Rounds on current stroke recommendations.  Very well done and informative.  My friend Tony who gave the presentation really likes being the doctor.  He works for the hospital, having obtained a secure position there after his group practice which dominated neurology in the area overextended itself and had to disband.  I see him in the doctors lounge most mornings, planning out his day though the unexpected nature of acute strokes must make planning difficult.   He takes care of the patients, somebody else takes care of the business.  That is probably the way we are all heading if we can be absorbed somewhere.

Still, as I read the postings on Medscape's Physician Connect posting service, there are a lot of people who realize the end of their private practice independence is looming but are either in denial, rationalization or mourning.  Hard to tell which, or maybe a mixture.

Wednesday, August 11, 2010

Patient Anonymity

Between the closure of my medical practice, largely a reality, and my new job, still awaiting a start date, the days linger.  I read more, I chat with colleagues and friends about life as a physician, I read a little more endocrine science than I usually do.  Today's Endocrine Society Daily Briefing had a ditty from the LA Times citing a study from Waterbury Hospital, one of the Yale Medical School affiliates.  The study compared perceptions of physicians with how well they conveyed information to their patients with the reality of how much the patients retained.  Presumably these were hospitalist physicians who do not have ongoing relationships with patients that they care for in the hospital.  About 20% could name the doctor directing their care.  A relatively small fraction understood why certain decisions were made on their behalf.  Only about 10% received a heads up on potential side effects of their new medicines that might appear after discharge.  Needless to say, the physicians thought they conveyed the information much more effectively than they did.

This approximates my last couple years experience in the office.  Despite being the principal source of medical care for many, it is not unusual for patients to return for an office visit relating a hospital experience that occurred since their last visit that had been unknown to me.  They tend to have a vague grasp of their diagnosis, can name the medicines but not what they are for or why they were started.  Most cannot tell me a doctor's name, relating instead that "there were a lot of them."  This could reflect hospitalist shift work, resident care including changes in resident team based on the calendar of assignments or by changes in location within the hospital, consultorrhea, or weekend coverage.  Whatever the reason, nobody seems to be the focus of their care in the hospital, though it is usually well defined outside the hospital.

There have been physicians since the time of specialization that never connect to individuals.  We have radiologists, pathologists, anesthesiologists, researchers, public health officials and the like that never have to field a phone call from a patient or ever find out how a decision based on their work turned out later.  I think these medical colleagues miss one of the most gratifying aspects of being a physician, both from a personal and a professional view.  Moving this anonymity to the bedside cannot bode well for us.

rich the furrydoc

Tuesday, August 10, 2010

Prioritizing Synagogue Activities

My education committee chairman sent me a note asking if we could move the educational event that I run to the following week to avoid a conflict with a Game Night that another committee was putting together.  Logistically, it does not matter all that much which motzei shabbat the AKSE Academy takes place so it can be rescheduled.  The more important question in my mind is should it be rescheduled or should the components of the synagogue work in a more coherent way with priorities that are followed almost religiously?

Having been at AKSE for about thirteen years, I do not really think I could list ten priorities in order on a yellow legal pad.  Avoiding bankruptcy over the next few years would be first, I think.  At least pretty much all the officers say it is first but lukewarm willingness to do the things that avert the problem may provide a more realistic ranking to this particular imperative.  Having minyanim for each service ranks high until it comes time to actually fix the problem.  Making the congregation more attractive to a larger pool of women in the community ranks high but there is a phoniness about the decisions that impact upon this and how they are implemented.

No, there is Game Night and post-havdalah Machshava scheduled simultaneously and one must yield.  Which one?

rich the furrydoc

Monday, August 9, 2010

Maintaining Minyanim

This week's announcements at the conclusion of shabbat morning services included an invitation to play softball the next day and a reminder to the men in attendance that the minyan failed to materialize several times during the previous week.  On four occasions they got nine, which would make for a softball team which I think counts women, but not for a minyan which does not.  I could have gone yesterday morning but didn't, even though I am an Ovel.  I hardly ever miss Friday night at the Reform Beth Emeth and if not on call generally make it to shabbos morning for kaddish but I do not feel captured by the plea of the Rabbi and a few others for community.  On occasion, it is announced that a particular individual has yahrtzeit and a few men set their clocks to enable attendance.  But other than shabbat and Sunday mornings, the required quorum does not always materialize.

Ari Goldman's Living a Year of Kaddish   included several hundred pages on minyanim, largely struggling ones, despite his orthodox practice.  During my shiva last fall we got the ten at the two Chabad locations in Florida and at AKSE each morning but struggled with the evenings, requiring personal invitations.

In many ways the minyan has become a club with its regulars.  They see themselves as a predictable service to others who can take it or leave it, but never see a need to inconvenience the club members in any way to make it more attractive or secure.  There will be appeals for attendance as long as the required ten remains insecure.  Once there are ten regulars, as there were at AKSE not that many years ago before three of the daily attendees made Aliyah, the solicitation to have more people attend loses its urgency.  There is no longer a reason to expand the club or modify it so that it might be more attractive to more men.

Friday, August 6, 2010

Shabbos Prep

A lazy summer Friday with a few things to tidy up around the office as I take my final lap or two as a Delaware physician.  I am more inclined to think about shabbos today than to engage in useful work, though not ignore my closing tasks.  I read Rabbi Wein's weekly D'var Torah on the Project Genesis site earlier in the week.  Normally I make supper before I go to work but this week I delegated the task to my wife.  There are few bottles of craft beer worthy of shabbos in the fridge.  Of the local clergy, the one who gives the most consistently erudite and thoughtful weekly message presides over the Reform congregation.   He has not spoken this summer, delegating the task to congregants who have done quite well, though they do not have the core knowledge to link their message to a parallel message of Torah.  Some of the Rabbis in my community also lack that skill but the Rabbi Robinson of Beth Emeth stands out in that regard.   And they always get ten Jewish men there to enable me to say Kaddish.

Thursday, August 5, 2010

Retired Physicians at Grand Rounds

I went to Grand Rounds at the Wilmington Hospital this morning, a review of Cardiorenal disease that I felt badly about not understanding most of it until a nephrologist friend indicated that he didn't understand most of it either.  At the start of the talk there were about a half dozen people in the room, at the end about the same number but at the peak attendance I'd estimate three times that.  The majority of those in attendance were retired physicians who come regularly irrespective of the content of the talk in part to get free educational credit to maintain their state licenses and in part to get out of the house for some free coffee and muffin.  On the way back to the elevator I chatted with an old friend who I had heard was retiring.  I'd not seen his notice in the newspaper, as required by state law so I asked him when he would be shutting down.  He already had, which may explain why he felt it appropriate to let his beard grow in.  Office management did him in as a primary care physician, ironically on a day when the weekly issue of the NEJM had an essay on federal projects to keep the primary care workforce populated.  There is rent, staff salaries, billing fees, computer access, telephone, taxes and the like.  I think the retirements are going to peak with the next upward surge of the DOW or S&P 500.  These folks who ranged from primary MD's to orthopedists seemed to enjoy spending a morning with old friends and a cup of Java even if they had no inkling of what cardiorenal disease is about.

Wednesday, August 4, 2010


This morning I saw what I expect to be my final consultation at CCHS, a very nice gentleman with multiorgan problems who probably benefited from a number of the interventions done in his behalf over many years.  I had not seen a patient in about a week.  It was hard to get motivated to get to the hospital, as much as I wanted to see him and as lost as I felt not having a census for the first time since my fellowship.

USA Today recently published an article on Physician Burnout which describes a lot of people that I know, sometimes me as well.  I spent the last week resolving loose ends on charts, picking up dropped balls, staring at my box of charts with no enthusiasm at all.  I cannot wait to get back into an exam room where I can interview patients and put puzzles together.   For the last ten years I have quipped to whoever would listen that I am probably too innately intelligent to function as a physician in the 21st century.  Clinical guidelines have replaced judgment, the lab results and faxed glucoses need to be followed-up with uncompensated phone calls, my chart bench has endless notifications from insurers reminding me to have patients get lab work that was already done, or at least ordered, an eye exam that was also already done or reminded, medication warnings on people who had successfully taken those medicines for a decade, Medicaid representatives who do not return calls, formulary overrides inhibited by people who know less than me and have no understanding of how medicine is supposed to be used.  Medicine remains a challenge for me and the patient care gratifying but I understand why so many of my colleagues yearn for times past and opt out earlier than they had planned.

Tuesday, August 3, 2010


I made an agreement with myself that if insomnia wakes me early I would get up and do something useful rather than thrash around in bed until the appointed arising time.  My internal rhythm seems to have me up at about 3 or 4 AM each of the last two nights.  So what takes place at those hours?  Of the few hundred cable channels that we get, I can usually find one that teaches me some history or reviews how ski goggles are made. If not, there is likely something I've not seen yet on Shalom TV, though they are starting to accumulate their share of reruns.  There are a lot of infomercials that try to convince me that they can make me thinner but I do not watch them.  Sometimes I read, sometimes I check email.  Occasionally I go downstairs and lie down on the couch hoping to fall back asleep though I rarely do.  Once in a while I write.  I try not to eat before 5 AM.   When I am reading a good Jewish content book, which I haven't for a few months,  this becomes prime reading time.  It is also prime time to listen to whatever I downloaded from but it's been a few weeks since I've done that. 

It really should be prime time for machshava, for thinking and contemplating when all through the house not a creature is stirring except maybe my nocturnal predator cat.  There is much to recommend some comfortable solitude.

Monday, August 2, 2010


At my desk, tidying up the last of the charts.  Last patient went home from hospital on Friday and no more anticipated until my new position commences.  There is a proper amount of activity needed to stay motivated and today I am below threshold.

Sunday, August 1, 2010

Time Cards

Shabbos at my shul yesterday.  I was ba-al shacharit, clearly rusty for not having done it in a while, definitely an amateur, amid other participants who were exceptionally proficient.  I definitely like being there more when I have something tangible to do.

Fast forward to kiddush,  a hodgepodge of crudites, ice cream and cookies with the usual wine and schnapps selection.  When I do something, I treat myself to spirits, this time Seagram Crown Royal, a small sip that the police on Shipley Road would not be able to detect..

Conversation this week with another medical friend, this one a senior section chief of major accomplishment.  He came to services with a white polo shirt with the logo of a journal that he edits.  He described how much time he spends on the task, maybe about 10% of his week.  I commented that my new job requires me to track my time, something I've never done before.  To my astonishment, CCHS requires him to do the same, despite his very senior position and despite being among the most accomplished individuals who arrives at the parking lot each day.