Electronically Challenged

It took a geek to make my new iPod functional.  It's still not entirely functional.  Electronic Medical Records as I have used them the last three months impede my ability to think about patients.  My three computers, the main one, my laptop, and the one on my desk at work never seem to work at peak function.  And I get ripped off for most of the services I am compelled to purchase for these.

In a prior generation, when I was a potential geek on the sidelines, it was the cars that got enthusiasts enthused but irritated the rest of us by costly breakdowns for which we were dependent on people a little outside the main stream to get us mobile again.

My patients may have similar comments about me as their Patient Repairman.  I did not create the complexity of their physiology nor did I cause its malfunction, at least not initially.  Things are generally repairable and upgradable.  I do not perceive doctors as geeks the way I regard computer experts or auto mechanics, though the public may not concur.

This new calendar year, I will make a better effort to understand my electronic resources and bodily resources and use them in a more functional way.

Happy New Year.

Too Irritible

These past few weeks I've felt a little jumpy and perhaps hypercritical of what goes on around me.  It's hard to tell why, but small things irritate me.  My neighbor Reb Yaakov, the great sage of Monsey, used to get transported in a clunker that often failed to get to him to his desired destination at the desired time.  He used to shrug it off as HaShem's desire for him to be someplace different than where he wanted to be.  Things that don't work right or people who don't do what they are supposed to do might be part of a divine plan or plot.  Still, I greatly prefer to have what I need when I needed, to have nurses that give medicines at the appointed times and record on the record the things that need to be recorded, patients who keep their appointments, fellow denizens of the highway who share my interest in safety, Rabbi's who know enought Torah and have the intellect to discuss it, Board members who can go beyond nice as an end point.  It could be a lot worse, unlike the political wingnuts, Obama's decisions and Talk Radio do not get me emotionally involved at all.

I think my failing comes from not being able to separate things that I control and are amenable to correction, which should irritate me, from things I am not able to control but would still like to.  Finding what I need when I need it falls into the realm of possible, however prolonged the problem and unlikely the resolution.  As I learned this week, my iPOD may frustrate me but there is a geek at Best Buy who can make it work, or at least move me into the world of possibly having it function.  Blocking ladies with 425 SAT's from completing nursing school cannot be on my personal agenda.

Winter Storm

For my first nineteen years of practice, somebody else took weekend call when the big snowfall hit, then last year, my final one at Christiana, the lot fell to me.  I stayed overnight there for two nights, handled one emergency from ten miles away and scratched the fender of my car on a snow bank.  Now I am in Philadelphia where I take call half the weekends so having to cope with the Big One becomes inevitable.  So it is this afternoon.  I knew that the white downpour would arrive at about mid-day so I went to Mercy Philadelphia Hospital a little earlier than has been my Sunday custom, saw all the follow-ups and three new consults, then headed home with the expectation that I will be devoting tomorrow morning to shoveling rather than office patients.  I'd have closed my own office in these circumstances as few people can get around, though a few hardy folks always manage to show up.  Somebody is on site at the hospital so people receive the care they need though often from somebody who will need to catch up on sleep as soon as the relief crew arrives.

This time also offers an opportunity of a few hours without the usual intrusions.  It becomes a chance to do things that are important when most work days are devoted to shuffling the urgent.  Time has come to set the semiannual tasks, work on my two upcoming talks, tone down my ornery disposition by a vigorous session or two with a white driveway.  No need to arise as soon as the alarm buzzes tomorrow.

Taking Shabbos Off

Even when Christmas comes on shabbos, the Jewish doctors take weekend call, as I have done every year since starting practice in 1990 and all years but one since my internship.  This weekend, the legal holiday was Christmas Eve, a Friday, when I went to the relatively quiet hospital, saw a couple of new consults, rounded on a dozen more and drove home for a quiet shabbos dinner at services at Beth Emeth that failed to materialize.  Their intermarriage situation may be more profound than I realized.  Logistically it makes most sense for me to take Saturday call from home, which I did, then round and see new consults on Sunday, which is how I usually have been handling the weekends at Mercy.  Only one consult came through, no other calls.  It was my original intent to do nothing.  Instead, I caught up on decluttering, moving a few loads of papers to the recycling bin, putting away most of my clothing, creating a PsychoPath in the bedroom.  I did not go to services.  The Rabbi would wonder if one of the Jewish doctors showed up.

Synagogue's Core Business

The AKSE Board voted unanimously to renew the Rabbi's Contract.  That part was a no-brainer as he fulfilled one of the prime missions of AKSE with excellence.  There are severe financial limitations with expenditures exceeding revenue.  For years the Board of Governor's, of which I have been a reluctant part, has focused on increasing revenue, from a Capital Campaign which was intended to have nothing to do with operating expenses other than eliminating mortgage payments to enhancement of membership census.  That meant having an ambassador to the community with a pleasing personality that can attract members.  For the first time in years, the membership list has expanded.  No question that changing Rabbi's would interrupt the intent of the leadership.

However, stabilizing finances should be a means to an end, which is the operation of the services that the synagogue provides, particularly those things not attended elsewhere.  I am not sure that the Executive Committee which really has the responsibility for doing this really sees it that way.

There is probably some diversity of opinion as to what the mission of a synagogue ought to be.  I do not think AKSE ever developed a mission statement that could hang in a frame on several conspicuous walls for all to see or that can be printed on the letterhead or agenda of each Board of Governors meeting.  Having community outreach or a mascot is not the mission though it may enhance it or enable it.  The growth of transdenominational Jewish groups separate from denominational label suggests that there are no services that can only be provided by synagogues.  In most American communities, where early settlement records are available, the first project of each new community was to bury its deceased, which has some urgency to it.  Therefore the first communal effort was to purchase land for a cemetery and form a burial committee.  Even now, those unaffiliated with synagogues still have Jewish funerals with burial in Jewish cemeteries so a synagogue is not really a necessary institution even at the time of most immediate crisis.

At the last AKSE Board meeting a new grandmother described her son's community gathering on its own to attend the bris.  That particular community was generated by the synagogue, so one potential mission might be to gather subsets of Jews to better enable loyalty to each other.  Transdenominational groups which in some communities have siphoned both talent and membership dues from are synagogues, the Conservative ones in particular, have almost gone into competition with them by providing a better product at a lower cost. 

I think that the role of the local synagogues not fulfilled elsewhere would be to offer a measure of security for observing major life cycle events and offering a place to worship.  Assembling a community and advancing the Jewish capacity of its participants would fall into the next tier.  My report card on the Rabbi is very mixed, particularly when growth of membership for its own sake is not part of the core activity.  Life cycle events, other than assembling minyanim at the synagogue for those reciting Kaddish has been predictably available, no more and no less than previously.  Too often the worship experience has been numbing more than fulfilling.  I do my learning elsewhere, something that has become very easy in this world of electronic resources.  Groups have assembled more than before, though I am not currently part of one.  I've not sought one out and none has sought me out.  Very mixed assessment though I concur with the majority that it would be a mistake right now to direct attention on AKSE's core business.

Membership Mentoring

Our sages noted that no two people have the same voice, appearance, and views.  At AKSE I find myself generally critical, almost to the extent of the American politicians who seem almost programmed to oppose what is set before them by people of opposite views irrespective of its merits.  On the other hand they have enough cheerleaders but too few careful analysts.

The Rabbi and President decided that they needed a mentoring system for new members and went about recruiting veteran members to take newbies under their wing.  A list of new members, just shy of forty was sent out.  For all the effort of recruitment, there really weren't that many.  The majority were relatives of families signed themselves up as members.  One is 90 years old, another not that far her junior.  By my head count there were about three who were entering their prime with the talent and energy to allow the generational turnover to proceed in a way that improves upon the present.  To my assessment, that is not Membership Committee success but more accurately the illusion of success.

And they are attempting to socialize the folks to the AKSE way Federation style with a genuine Federation facilitator.  That process has led to the destruction of a generation of non-orthodox Jews.  Federation locally never got its young people of major talent to sign on and the Conservative movement similarly sacrificed its talent by setting a clear priority for loyalty over ability.  All appearances are welcome, but not all views.

I think it time to sit out a few weeks, perhaps the month of January, and decide whether $2000 could be better spent not only on my own Jewish advancement but on support of institutions that can distinguish between real success and its illusion.

Adopt a Family

Mercy's Endocrine section manager sent me an email that the group was providing Christmas presents for a local family, assigning me a 13 year old boy, who I know nothing about.  This being my first time, I asked the manager what the minghag b-makom, or local custom, happened to be.  I was mostly concerned about amount, eventually learning that my partner sent a check for $50.  While I like to give money as wedding gifts or even Bar Mitzvah presents where the funds can accumulate and the recipient starts out with savings or tuition, for events that will occur again, like birthdays or holidays, I prefer to take the opportunity to think about the recipient and how I might add a some form of more short term pleasure.

I know this fellow's age and that his family is needy.  No other information.  I do not even know if he is Christian and celebrates Christmas, as the West Philly area has a fair number of Muslims, either from an enclave of Bangladesh or African families, or African Americans who discovered Islam in the state or federal correctional facilities and who found the requirement for abstaining from drugs and alcohol useful for their future or maybe who found the doctrine of selective rationalization of violence attractive.  I know nothing about the recipient.

While it was my natural inclination to spend all $50 on a single gift, figuring that he'll never accumulate that sum to spend on himself, my wife, who has done this before, recommended that I divide the total into three gifts.  The office manager concurred with my wife, so I did. 

Several years ago the Jewish Theological Seminary's TOR-CH posting site contained a thread in which two orthodox missionary types electronically heckled the Conservative institutional structure and the mediocrity or less that has accrued from it.  The more capable of the two commented to me privately that he really wanted the Conservative participants to upgrade their Judaism properly which in his mind meant being more like him.  I politely responded that the goal should not be to have them more like him but better reflections of their own aspirations.  Gifts can get into a parallel trap.  I would like this early teen who I know nothing about to be inquisitive, creative, studious, responsible, all the things that I admire and then project upon him, though maybe not what he admires or even fulfills the intent of pleasure.

In the end, I divided the allotment relatively equally, settling for a Phillies sweatshirt where one can never go wrong, a telescope, and a soft-tipped dart board.  It does not fulfill any of the criteria I set ages ago for gifts for my secretary's son, who I do know, which must either make noise, get him suspended from school, or bring him to the ER.  None of these for the anonymous recipient.  Unless maybe if his evolving hormones and id prompt him to use the telescope to forgo looking  at the heavenly bodies in favor of a more earthly body belonging to cute chick in the apartment across the street.