Jewish American Heritage Month

Got a little testy with my professional organization, The Endocrine Society, which I continue to hold in utmost esteem, dedicated its latest issue of Endocrine News to Asian American and Pacific Islander Month.  No challenge to the worthiness of these professional colleagues or to the many contributions that people of that background have made to enhance American life.  Recognition is due, respect is ongoing.  A number of other organizations have posted parallel recognition in print and electronic media.

Concurrently, somebody also designated this Jewish American Heritage Month.  Recognitions are much fewer.  A Google search largely posts recognition to places where Jewish presence is already well established, as in towns or universities with substantial Jewish representation.  An exception might be Notre Dame.  But my medical alma mater gives a thumbs up to Asians but no recognition to Jews.  Same with the Endocrine Society.  

At present, we Jews happen to be the daily besieged.  Asians can walk across campus without threatening gestures from others walking in the opposite direction.  Not true for the Jews this past academic semester.  From time to time a report appears that the parent organization was receptive to recognition but subject to the veto of the DEI infrastructure.   I have no means of confirming these allegations, though they are at least plausible.  Asian achievements, which are many, are perceived to follow diligence.  Jewish achievements, which are many, are perceived to follow privilege.

Jewish history in America has its patchwork of alliances and rejections.  Every major city has a medical center, often an upper-tier destination in the annual Residents Match, with a Biblically derived name.  They exist because the premier academic centers excluded regional Jewish physicians from staff appointments.  We have law firms with Ashkenazi names because white shoe firms once spurned Jewish law grads.  We have experience in dealing with being overlooked.  Whether the snootiness of the first half of the 20th century or exclusion by DEI officers today, we succeed by tenacity and diligence, not privilege.

What disturbs me, though, has been the rejection of the opportunity by my professional organization and my Jesuit alma mater to use the designated ethnic month to affirm that their Jewish members, who are being publicly assailed right now, is simply not compatible with organizational standards.  A month was assigned for recognition of our contributions because there are substantial contributions.  Neither my alma mater nor professional organization is hostile.  But neither displayed boldness when they might have.

Mingling

Weekly planning usually occurs on Sunday mornings at my upstairs desk where I keep pens and highlighters of multiple colors.  Yontif postponed this session by until Monday, though I knew I had a special opportunity to assuage senior loneliness by immersing myself in different groups on consecutive days. 

1. Sunday: Simchat Torah Services at my synagogue
2. Monday: Platelet donation at Blood Bank
3. Tuesday:  OLLI Class
4. Wednesday: Philadelphia Endocrine Society
5. Thursday: Morning minyan at my synagogue
6. Friday: Two OLLI Classes
7. Saturday: Services at my synagogue

And toss in a flu shot at my pharmacy.

Mostly mixed result, colored perhaps by strains with people scripted differently than me about atrocities in Israel.  By I did my best to keep cordial and to interact, if not mingle.  Candid, not fully friendly comments are still forms of interaction, which is really the week's agenda.

Scorecard:

Simchat Torah experience somewhat above expectation.  Not a lot of me there, about 18 or so.  Hakafot shared with women, who were much less in number.  Songs selected by Cantor surpassed the Hebrew school ditties that I had come to expect.

Platelet donation proceeded smoothly.  Screening questions changed a bit.  My trip to France within the previous month did not disqualify me.  I watched Netflix home design show, actually four half-hour episodes.  No clogging of line, one minor reposition of needle.  Quick stop at canteen for my usual.  Afterward, stopped at Cabela's.  Saw nothing to buy.  Opted not to go out for lunch.

OLLI Class caused some friction.  I am not overly fond of the way the instructor presents the class.  Teaching us about "good people on both sides " amid asymmetric intentional atrocities while using the Muslim Brotherhood talking points did not reflect well on his intellect.  And his not well received analysis extended the class twenty minutes past closing time.  But I did make a YouTube Video of what I thought and he will not be happy with at least one of his student feedback reports.

Before driving to Philadelphia I had a very stimulating session at OLLI given by an expert.   I tried to extract more of his expertise at the end, creating some discord in the process.  But the Being with People initiative did not come until the end of the day.  I had not been to a Philadelphia Endocrine Society session live since Covid, and not at all in a couple of years.  I even did not pay my annual dues last year, but resumed this summer.  The live sessions had been reassigned to a less accessible location, but are now back to a place to which I am used to driving, as long as it is not very often.  My Waze App meant well, anticipating rush hour bottlenecks.  It tried to bypass one near my home by directing me north for two entrances to access the interstate.  Then manageable traffic.  Ordinarily it would take me to a main road that goes pretty much directly to my destination, though with a lot of traffic lights.  Instead, it exited me just past PHL Airport, directing me through some thoroughfares I do not remember ever driving on before.  I got to see the remotest of the PHL parking options and large swaths of the airport at its farthest reaches where private corporate and other non-airline jets take off and land.  Eventually return to the interstate, this time with a lot of other cars.  It took me to a highway divide where I had to change lanes on short notice, then through Philadelphia's Historical district, a place of very slim one-way streets, but at least in a recognizable grid. Got me to the parking garage where the gate failed.  After a few calls on the intercom, an employee let me in, providing me what would turn out to be a defective ticket trying to leave.

Not many people that I knew at the meeting.  A couple of old friends, friendly greetings to some new introductions.  Beverage server lives near me, taking the same roads and bottlenecks, so we had a short chat about that.  Outstanding lecture on hypoparathyroidism.

Route home by Waze also not what I expected.  Were I to commute by car to Center City, I'd probably get used to it, even in the dark for much of the year.  One time, I had to keep my attention focused on traffic, stopped delivery trucks, and some interstate access points that the civil engineers could have considered better, but once on the highway past a rather long and eerie on-ramp, getting home went smoothly.

Morning minyan takes place every Thursday at 9AM.  I was curious about who would go.  The usual suspects, those inner circle men and one other.  I was seven.  We got nine, but needed ten.  The new Rabbi really wanted to repeat the Amidah and read Torah that morning.  He summoned the lady in the kitchen, declaring it a fast day due to Israel atrocities and obviating her the task of making coffee or setting out donuts.  In its place she was placed in a sanctuary seat.  Then he repeated the Amidah, read Torah, did kaddish, all the parts that our tradition requires us to have ten men.  Nobody said anything.  At the end, the President asked me a few things about my trip to France, with another fellow joining in.  I had scheduled a flu vaccine that morning, so excused myself.

While I got to Walgreens in time for my appointment, the line at the pharmacy counter was long. The pharmacists and technicians seemed overwhelmed by volume, not only at the counter but also the drive-thru, and what was coming their way from online customers.  These folks were not trained by Disney MBAs who understand enough throughput to keep lines flowing.  My turn came, my deltoid got injected, and I roamed the aisles for the next fifteen minutes as the pharmacist had asked me to stay on site for safety.  Then home.  And a Zoom course on thermodynamics followed.

Friday morning I have two OLLI classes, the National Parks first, The Common Man to follow.  I made my own coffee, keeping it hot in a thermal mug given to me by a pharmaceutical company in the days when they gave doctors various reminders of which drug the companies wanted us to prescribe to the max. I got there just as the first presentation was to begin.  There is a half hour break between the two morning sessions.  I sat at a table for a while, sat on the patio for a while.  Did not mingle.

For shabbos morning the two casting directors assigned me two parts.  I would lead shacharit, which I do frequently.  And I would chant the Haftarah, an invitation that is rather infrequent.  I prepared the Prophetic portion to decent fluency.  The morning worship I do not prepare at all.  Instead, since I am already fluent, I select two tunes to insert that differ from what I had done the last time, usually the last two times.  And so I did.  Rabbi read Torah.  And when the Rabbi reads Torah, a congregant gives the sermon about the Torah portion.  Despite being a participant, I did not feel inspired.  A few handshakes along the way, mostly of a protocol variety.  Kiddush banter makes or breaks the morning experience.  I drove home broken.

When corporations and other employers try to boost morale and engagement of their staff, they take a number of approaches.  Look at the good our organization has done in its history would be one direction.  It seems to give a transient boost.  The strongest, though, comes from testimonials people receive as feedback for the benefits their personal efforts provided.  My congregation approaches zero.  There are influencers who matter and consumers who don't.  I'm a consumer.  I could say the same about the Endocrine Society.  As much as I enjoyed the session along with the minor adventure of driving each way, I wasn't a contributor.  But platelets, while often physically uncomfortable in the donation chair squeezing a rubber ball and watching Netflix, the people at the donor center are really appreciative of having donors who come on a regular basis.  I never see the platelet recipients, only sample pictures of kids on chemotherapy, but I know somebody somewhere is better off for the three hours between leaving my house and returning home.

While the intent was to be with people more than in most weeks, and I succeeded, those experiences mostly made me a taker.  The challenge is not only to be a person of genuine value, as platelet donors are, but to matter beyond the protocol handshakes.  I did in small ways.  Leading worship offered some thought and effort that made our synagogue a place where traditional services are executed by men of proficiency.  At the flu shot, I chatted with a lady behind me in line who may have been less lonely from the interaction.  I challenged the teachers at each of the OLLI sections. That might have advanced their perspectives on their subjects beyond what they would figure out for themselves.

So it is not so much inserting oneself into the herd as having that herd take a better form because they let me in it.  I think it did.

Disengagement

This year marks the Chai anniversary of a seminal, oft cited sociological treatise, Robert Putnam's Bowling Alone.  I've never read it but plan to when I complete the novel that I had earmarked for the second half of 2018.  Basically, he traces the decline of participation in organized social activities over about a generation prior to its publication.  As I retire, I find myself removed from my last pageant, the daily professional adventures of endocrinology.  I pay dues to a few things, the national and Philadelphia Endocrine Societies, Adas Kodesch Shel Emeth synagogue and its men's club.  I no longer pay dues to the American College of Physicians, the Medical Society of Delaware, the American Medical Association, nor have I been a financial participant with the Jewish Federation of Delaware for over 20 years.  I register Democrat, vote Democrat more often than not, but have never been a more than a nominal donor.  I am a proud alumnus of two fine universities.  Any donation to the larger one would not move their fortunes at all and would not be sufficient in amount to get my name engraved on a flush handle anywhere on campus.  My fondness for my medical school knows no bounds and they do get some money with no hesitation, but I do not really belong to any of its organizations.

Since Woody Allen accurately recognized that 80% of life is showing up, I do not show up all that much.  There is the annual Endocrine Society Meeting, too expensive now without the hospital subsidy.  The local Endocrine Society Meeting which occurs monthly will continue, though I have not really made a lot of new friends there.  I go to shul on shabbos but I never get the sense that my intellect and energy have much value to the leadership so activities of years past have atrophied.  As soon as I retired, I volunteered for a Democratic campaign.  One candidate took interest but not much became of it.  I signed up on their web site as a willing participant but I think their executive director would prefer Beautiful People with money or yes men who will not have the candor to tell them when they might be undermining their own potential electoral support.  In summary, I look like a prototypical Bowling Alone  individual model.

Despite not having been a meaningful Federation donor since 1994, though supportive of some of their constituent agencies generous with funding of Jewish projects elsewhere that would likely have gone to them were the experience better, for some reason I found myself back on the mailing list of Federation's monthly, used to be biweekly, publication.  It is kept on a display rack at shul, where I have browsed titles, clenching my teeth perhaps when I come across something that praises one of my travails of decades past, but never read any of the articles.  I recognize some authors, sometimes written by people of laudable presence, sometimes by people I found venal, but mostly not known to me, with expected turnover of participants expected over my twenty odd years of avoidance or maybe more active shunning, while I become a part of a larger trend of Jewish participatory entropy.

Two articles appeared in print recently, one from a globally distributed publication The Forward and the other a locally distributed Jewish Voice, the periodical of the Jewish Federation near my home.  They look at the Holy Days and at Judaism's trends in America very differently.

https://forward.com/opinion/407183/so-called-jews-of-no-religion-are-the-impetus-for-a-jewish-revolution/   "So Called Jews of No Religion are the Impetus for a Jewish Revolution"

Has the significance of the High Holy Days changed for you across the years?http://www.omagdigital.com/publication/?i=521893&p=&pn=#{%22issue_id%22:521893,%22page%22:36}

Has the significance of the Holy Days changed?  For the Rabbis responding to the question in The Jewish Voice, they are the anchors of tradition, at least in their homes, where families gather.  It's a form of keva, familiar people not seen in a while, familiar recipes on the table, familiar tunes that get brought out once yearly.  There are some elements of that for me, though very different from what it once was.  My attachment to the Yomim Noraim probably ended in college.  In high school teens were isolated by my synagogue to sit for a reduced fee in the mezzanine of a local movie theater that was rented for the occasion.  The people with me I knew from school, yet for those days we were separate from school.  While afforded unimportant status, we had the best seats and always air conditioned.  In college, the Holy Days were always a mixture of new people, the freshmen, and old friends not seen since the year before. There was community, even if limited to showing up there while the rest of the students threw frisbees in the quad.  We wore ties, something that would not happen again for a lot of us until next Rosh Hashana.  There were no longer familiar foods,  We separated from our families to be with other students.  I could sit anywhere in the auditorium I wanted, or at least on my side of the mechitza.  We had students conduct the service.  It was ours.  Graduations came and that was all gone, never to be recaptured.  Returning to a suburban synagogue, something just shy of a cathedral, with lots of people there who would never be seen again, not at work, in class, or in synagogue until next year prodded my cynical yetzer, neither tov nor ra but probably accurate.  I stopped focusing on the Holy Days as central, looked at those services as maybe a civilization reversal from the core of Judaism which is how you live on all the other days.  The respect for institution took a hit and it never recovered.

From the perspective of the Forward, in the article written by their editor in chief, I may have been a generation ahead of my time.  Attachment to the institutions and even to the practices did not sustain itself.  We can argue whether I helped bring it down as part of my generation or simply watched others do the things that made participation in the institutions unattractive, but there really are Jews, very valuable ones, who have departed not only the institutions but the beliefs that those institutions were designed to promote.  They have no compelling reason to recapture the recipes their grandparents made or to fly back to their hometowns, something their great-grandparents could not have done even if they wanted to.  While assembly of family for the Holy Days re-establishes this as sacred time for some, in the greater reality of Jewish history and American Jewish history in particular, there is a bit of myth to this.  People changed towns frequently, which is why the various desciples of the Ba-al Shem Tov are all known by their name and by the place they established their community.  In America, the reassembling of families only goes back about three generations though may be a central attribute for that middle generation, which is mine.

Rather, Bowling Alone, the hesitance to affiliate, affects Judaism as much as it affects political participation, attendance at PTA meetings, or enrollment in bowling leagues.  While the Holy Days offer a focus, a set time or keva to declare Jewishness if only for a few days, they do not really reverse what seem to be mega-trends, and alas, probably for cause.

ACP, Medicine's Conservative Jews

I'm down to my last medical organizational membership, the Endocrine Society, having let the clock run out on my membership in the American College of Physicians.  Of all the organisations that would regard me as a defector, I think the reasons for departure most parallel what has become widespread voting with one's feet on the organizational arms of Conservative Jewry, outlined in the Pew Research Report on Judaism in America.  In his book Getting Our Groove Back, Scott Shay devotes a chapter to Conservative Judaism's decline in formal affiliation, if not in practice or a reassembling of talent elsewhere.  Talent matters.  My own experience with the Conservative Jewish organizations suggested that at least the places I frequented were rather insensitive to the talent that people possessed when it failed to synch with Rabbi or macher agendas.  They failed to capture what the participants wanted to derive from their membership, resulting in attrition.  A revolving door of suburban families purchasing Bnai Mitzah for their children had become part of the culture, people never really connected.  Then there were the people like myself who either were connected or could have been but some clash of values never quite got smoothed out.

And so we have the ACP divergent path of what the seniormost leadership promotes and what dedicated internal medicine certified physicians might want of their professional organizations.  I want to be a really capable doctor, the best I can be, and receive a due measure of kavod for the work I put into it.  When I or any ACP Fellow requests expert advise, I want it from the specialist, not his or her understudy in the form of noctor.  The ACP should carry Flexner's banner a century after his report enabled the ACP to flourish.  They have not.  I work hard to maintain my skills.  They should never be jeopardized by the blight that Board Certification has become.  When I read a study, it should be somebody's research.  Meta-analysis has its place but not a dominant place.  And as people like me toil in front of the computer screen, watching our tasks trivialized to clicking boxes reminding people who have weighed 300+ pounds for decades to exercise while our contact time to do really useful stuff with these most difficult medical challenges gets tacitly eroded with ACP complicity when our own organization should provide advocacy does not bode well for their future credibility.

Scott Shay regarded the implosion of the Conservative Jewish organizations as one of the disasters for American Judaism.  And failure to advocate for the real interests of the core medical workforce, what should be ACP's unfulfilled mission, can be no less a disaster for American medical care.

No Response

Sent an inquiry last week to the three ritual officials of AKSE.  We had a week in which the Rabbi was away on shabbos morning.  The Torah reading proceeded in its entirety without those annoying Aliyah Sound Bites that interrupt the natural flow of the chanting and choreography of honors that I've come to expect.  So I asked them if there were any standards of interrupting a Torah reading.  None of them even had the courtesy to acknowledge the question.  I posed it to a reputable Webbe Rebbe who provided me the answer in a day.  There are two conflicting positions of recognized Poskim.  One says the Torah reading should not be interrupted, the other says it may be interrupted to honor somebody or to teach Torah.  So that interaliyah running commentary meets threshold, leaving me with the option of limiting my exposure to it, something I've already done.  Since sending my  inquiry, two of those three gentlemen asked something of me, one to conduct Shacharit, the other to chant a haftarah on relatively short notice.

And last week the head of medical technology stopped by my office late in the afternoon on no notice to promote his agenda on behalf of the hospital.  One inquiry to him in the past unresponded.  Detracts from his agenda.

And finally, there is a controversy over medical specialty recertification for which the Endocrine Society invited comment.  I'm sure a lot of people put in their two cents, as did I.  There was no acknowledgement, though to be fair the new Society President sent a note later that he and other medical society officials had met with them to express their constituents' displeasure.

In our era there seems no shortage of forums for expression, and the things we comment about get seen.  But without the response, which has become decreasingly obligatory as these venues expand, engagement suffers.  AKSE's logo:  Embracing/Engaging/Enriching.  This time I had to seek that interaction and knowledge externally.

Leadership Generated Attrition

Been thinking of writing an essay about how depletion of Jewish organizations and medical societies over my adulthood can trace its origins to the people who run these organizations.  I think it is true.  We saw it to some extent in the last Presidential election where the highly publicized donors in the Jewish realm could not capture the Jewish vote for their candidate.  That synagogues, JCC's and regional medical societies now struggle seems obvious.  The revered leaders have passed on, never quite grooming individuals of comparable character to take over.  Or perhaps they did groom them but at the expense of adaptability to the constituency.  Personally, I am down to my last medical organization, The Endocrine Society.  The JCC membership gave way, I have been repulsed by the experience with our local Federation and the Federation Types, my synagogue gets my dues but not the talent or creativity of thought that has far less value to the leadership than does the money.  I used to be a participant in all of these things and with the exception of Federation and maybe a previous synagogue, I did not really find any of the organizations outright objectionable, yet I am very much a part of their membership depletion.  To a large extent I am part of their talent depletion.  Ironically, the only medical organization left is the one where I would be regarded as too paltry a maven to be a serious intellectual contributor.

I find it difficult to detect a common thread that would not only capture me personally but a much larger population of former participants.  Rav Eliyahu Dessler divided people into Givers and Takers.  Maybe we are all Takers who found nothing worth taking.  Maybe we are fundamentally rebuffed Giver wannabes.  Each organization, Jewish or professional, exacts a serious financial commitment for which there is little return.  Certainly synagogue fees have escalated to where it really is not a good consumer purchase.  Medical organization fees usually run a few hundred dollars which is not really exorbitant relative to other professional expenses.  JCC is really  more of a consumer purchase of facilities and services while Federation expenses are to some extent voluntary.  No, I think the attrition has more to do with the value of connectedness than it does of expense, with the exception of the synagogue where some of the fees can be daunting and to some extent interpreted as a form of extortion to purchase a Bar Mitzvah.

Since it is easier to write about me personally than to generalize in the absence of assessed data, I'll go that direction, with a reasonable assumption that what I experience and act upon, others experience and act upon.  I used to attend Shabbat morning services every week unless I was on medical call or out of town.  Now I force myself to go about half the time to my own congregation, make a few entrances a year at other congregations, some more to my liking, some not, and for the last few years have dedicated one Saturday morning a month to my recreation, usually in the form of a day trip.  Guilt level = zero.  Number of people who have tapped into my mind to assess this transition also = zero.  And if they did, I'm not sure I could tell them.  But as an observer I feel little connection to the Rabbi or the relative triviality of the comments, I have found the operations of the governance sometimes offensive and have other outlets to enhance my engagement with Judaism.  Spending two hours enduring a series of Aliyah Sound Bytes does not measure up to what I could be doing instead, whether that be a schlep to Beth Tfiloh in Baltimore where I return with a shabbos that I could not otherwise duplicate or a day taking in the pleasantries of Hershey Park.  Shabbos, or really a form of half-shabbos, has not disappeared.  I do not write, service the car or use electronics as my form of reverence to the concept of avoiding melacha but I am not feeling any obligation to revisit some relatively negative encounters and impressions of synagogue leadership during limited time that I largely dedicate to myself.

For many years, as High Holy Day Torah reader, my very consistent observation was that the VIP olim had a generous generous handshake for embrace for each other but a perfunctory handshake for me from about half.  The work that went into this for their honor was their due.  Or they never quite captured Ben Zoma's concluding aphorism:  Who is Honored? One who honors all living things Avot 4:1.  And lets not omit USY which had its ongoing cliques that endure at a price.  But they also have a leadership that excludes holding office kids who opt for being on the high school athletic teams on shabbos.  They value obedience over talent.  Before long they find themselves with neither.

So yes, the organizations have depleted numerically.  But the people who depart for elsewhere or sometimes nowhere, as the much commented upon Pew Research report attests, take away talent and energy that could have been tapped but wasn't valuable enough or convenient enough to either seek out or accommodate once identified.  Cloning more of the last generation's leadership mindset only invites more attrition.  Reb Pogo's observation has been vindicated many times:  "We have met the enemy and he is us."

Annual Meetings

June brings two recurrent gatherings, one for the synagogue which I get to attend for free, or at least as a benefit of exorbitant dues while the other costs a bundle to attend though the very modest dues afford me a discount close to what I actually shell out to belong.  Both organizations have an upper class that technically I have a vote to approve and both organizations conduct organization business during the gatherings, though most people in attendance, myself included, are very much separated from that business.

What we hope to derive from membership, however, differs drastically.  The Endocrine Society provides a modicum of professional affiliation, which I value, and my principal source of professional advancement, which I regard as essential.  Well worth the membership dues even on the years I do not attend the meeting.  The meeting itself gets me to a place I might otherwise not visit, immerses me amid productive nominal colleagues who do things that make science and medicine better, engage me in conversation about their efforts, expertise and aspirations.  While much of the 3.5 days involves sitting amid a crowd of strangers in huge lecture halls watching the speakers' Power Point slides on a big screen, it is the interactive moments that stand out.  You have immediate access to experts and to peers.  And there is an exhibit hall where vendors show you real advancement, which is often commercially driven.

The synagogue functions on a very different plane.  Its purpose seems more elusive and the fees for affiliation cannot be regarded as a valid consumer purchase the way Endocrine Society membership or attendance at the Annual Meeting can.  It should be a more interactive place than the Endocrine Society meeting with its thousands in attendance, yet it is not.  Experts on anything are in short supply.  Much of the activity does not seem purposeful and the need to actually assemble more difficult to justify.  So attendance is in the dozens.  For good reasons, it last just a few hours instead of a few days.

So can the synagogue meeting, or its ongoing operations, extract the lessons of the Endocrine Society to make the experience more alluring?  I think the most striking difference has been the how the two organizations view what they present.  In order for the Endocrine Society to serve its purpose, there has to be ongoing productivity to present.  People spend the year expanding their expertise, not just the upper tier, but the people in training or obscure clinicians and scientists working very privately in their clinics and labs. Moreover, there are thousands of people who want to partake of what has been achieved.  The synagogue annual meeting does not really focus on achievement or innovation.  These are in short supply, as all but a few of the members lurk in the background, neither adding to what could have been achieved but wasn't nor particularly eager to take advantage of what others have done.  So the meeting becomes a perfunctory by-laws obligation to vote on an officer slate that nobody really elected and to see the budget that will fritter away the dues and fundraising revenues with little to show for it next year.

Solution, if there is any, would be to create a forum to showcase achievement and value it enough to personally invite people of talent to display what they have done Jewishly.  But changing the way people think, particularly those with leadership responsibilities, can prove a daunting undertaking, one that is not always welcome but pays off in a grand way when it succeeds.

Blank Canvas

Our new secular year has commenced.  Predictions and good intentions at the outset have a way of being faulty before long.  With good fortune having come my way, there seems to be relatively little that I need that I currently lack.  More energy and motivation, perhaps, but no material items.  A better future legacy than I've amassed thus far, perhaps.  Professionally I've gotten into the groove, given up my futile inclination to make Electronic Medial Record keeping compatible with optimal medical care, contenting myself to toss a few harpoons at the management that salutes this mandate and the non-participants in medical care who harbor a delusion that it will accomplish something other than what will really accomplish.  But there are things of personal gratification that can be accomplished.  After some pondering of what I value and what the realistic opportunities seem to be, I afforded myself twelve things to pursue.

1. Beer

While I lived in walking distance to America's largest brewery and took advantage of the proximity by walking there periodically for the Anheuser-Busch tour and tasting room, this was beer ordinaire.  As resident in Boston with a fondness for an occasional treat at Legal Seafood, a mug of suds would usually accompany supper, with the bar offerings for this expanding my culinary horizons.  Eventually a craft industry developed while importers made available choices that had been available elsewhere for centuries.  And it's not a particularly expensive adventure as creature pleasures go.  There is no reason why I cannot sample one that I've not had before twice monthly, once in a bottle at my own table and once at one of the growing number of places nearby that have extensive offerings that I could not possible sample in their entirety.

2. Professional

I work in an inner city taking care of primarily diabetes.  My folks do pretty well but there are a lot of statistics to suggest that their outcome under the best of circumstances lags behind where it might have been if their ethnicity and economic standing were different. I am in the perfect place to study this and my own professional Endocrine Society has an initiative to make resources available.  Unfortunately, the Endo Society is dominated by academics who are more interested in why they cannot get minority research subjects into clinical trials than they are in why they fail to derive maximum advantage from what exists for their care now.  It's worth a try to get some funds and absorb a resident into this type of project for which our patient population may be a prototype for a very large medical opportunity.

3.  Family

I do not neglect my family but they seem to work around the odd moments more than having pre-arranged time to do things together.  The priorities on my to-do list seem to need some revision.

4. My Blog

This past half-year, it was my intent to make my blog a forum for Jewish laytzanos with some medical cynicism thrown in.  In the process, I explored the world of Jewish blogging.  To my pleasant surprise, mine seems to have a niche with a largely untapped audience of potential participants.  The genres come in a number of forms.  The most consistently funny and appropriately cynical comes from www.frumsatire.com.  Heshy writes a lot more frequently than I do and his wit attracts comments.  His draw, though, is a limited Orthodox perspective that lobs its share of darts at misconduct and hypocrisy.  The other genres come from a mixture of Rabbis who want to teach something or Conservative cheerleaders of various types who cannot understand why they are experiencing an affiliation crisis.  What seems to be missing is my perspective of people who are loyal to ideology but look at the leadership as a mixture of operators and buffoons not up to the task of matching the Jewish excellence that people seek with the actual experience of participation.  The Pew Research study suggests that the people affected by this type of disillusion and desire for something more engaging might be huge and currently unfulfilled.  I have to figure out some better way to attract readers and engage in electronic sharing of ideas.

5.  Loyal Democrat

Among Will Rogers' many political quips, "I am not a member of any organized party — I am a Democrat."  For most of my voting life, I've looked at the political branch points much as I've functioned as a physician.  There is a problem to solve or decision to make, look at the options and pick the one that seems most likely to succeed within the bounds of Derech Eretz.  Umpire, Judge, Doctor, Scientist.  It is what it is.  Sure there are elements of competence and elements of morality that influence choices but until the past ten years, public positions that fall into the category of evil in America have been increasingly marginalized.  But wicked as a concept seems to be having enough of a resurgence to justify some effort at resisting it or at least pointing out what it is.  From the days of Amos and Isaiah, it has been unseemly to accept people of title who victimize vulnerable people in the name of expediency or social order.  That any support exists at all for denial of science to get votes or policies that deny people their due participation by placing stumbling blocks moves me to become more of a partisan in the other direction.  While my region has become solidly Democratic by affiliation, with even the elected Republicans for the most part staying a step ahead of venal, that is not true other places.  I have to offer my help in some way this half-year.

6. Writing

Among the things that intrigued me this past year was the Pew Research study on Jewish trends in America.  I might be the poster child for this and my declining shul might be the organizational prototype.  I am loyal to ideology, less respectful of the organization that brings these principles to public expression.  Since the release of the report, I've read a lot of hand-wringing from the depleted organizations but not a lot of accounts from the very people like myself who voted with their feet.  It is an experience that needs to be expressed in the right forum

I have also become something of a neo-Hellenist these past few years.  Denominationalism has declined.  There is an inherent beauty on Friday nights at the local Reform congregation.  A recent Orthodox wedding I attended reminded me that this can also be an enduring connection to Jewish life.  Exposure to quality knows very little ideological distinction as the Jewish Hellenists, the Jewish Iberians and those who rejected classical Orthodoxy in the 18th century in favor of Hasidism which advanced the value of each individual taught us from time to time.  Another idea not publicly expressed often enough.

And I've not contributed to the medical literature in a long time.  Need to remind everyone that life as a doctor has its glories and its frustrations.

7. Weight

A recent visit to Happy Harry's gave me access to a digital scale for only $9.99 so I bought one.  My weight recorded at 167 lb.  In the last two years I've had to move to the next size shirt and replace some pants.  My tailored clothing hardly gets worn but it still seems to get me by.  I'm more tired than I think I ought to be.  My feeding habits differ considerably from the advice I give to the chubby folks who visit my exam room.  I need to get serious with my health.  This takes a lot of forms, but for the most part, things that get measured get accomplished.  While I could keep score on medicine use, lab results, or clothing size, weight seems to be the most consistent measure.  It is also a byproduct of the efforts that promote other facets of health.  So for Day 1, I ate breakfast, went for a walk, shopped for a waffle maker that I did not find at a suitable price but at least it will help me shift some calories to earlier in the day.  Target weight by July 4th: 155 lb.

8. Shul

AKSE and its leadership have not endeared themselves to me this past year.  To keep my interest in Jewish things afloat and at a superior level, I accepted the logo of Engaging/Embracing/Enriching for the presidential delusion that it is and either took a sabbatical for six months or went on strike, depending on perspective.  But I read, commented on people's blogs, wrote to authors of things I read, resumed a weekly Parsha review.  Basically, replaced the things the shul should have been doing with other forums that advance me better.

We had a mandatory congregational special meeting a few weeks ago to vote on the Rabbi's contract extension and deal with the reality of nobody wanting to be left holding the Congregation's bag as President when the music stops not too far into the future.  While it had been my impression that I was the last critic still there, with the final remaining handful of loyalists who want to preserve the memory of better days until the lights go out for the  final time.  From the comments from the floor, largely by members of long standing, the dissatisfaction with a marginal experience that is not realistically marketable to the larger community seems broader than expected.  After the meeting I responded electronically to the three people who made the most substantial comments, responses of very little optimism.  While reversing damage may take some doing, it is possible but needs some fundamental revision of how people think, undoing the Peter Principle that dominates the Executive Committee, and having the congregants insist that the place function like a university instead of a Hebrew school even if it means making the Rabbi a figurehead or mascot.  I will try to identify and fulfill two needed projects that really are engaging.

9. Dad

My father died intestate in 2009.  He had a small amount of assets, too little to make a material impact on me or my brother, though probably would be welcome by my sinister.  I was the only child who remained connected to him for his final two decades, so I never felt much urge to pursue this.  I really should close the chapter, distributing the funds as the laws of Florida require.  I will get an attorney to take this over or it will never get done.

10. My Refuge

The mortgage has been paid off for decades.  If I wanted to get a Christmas Tree, which I obviously don't, I would have no realistic place to put it as there do not seem to be vacant corners anywhere.  I do have a few spaces that I could call my own.  There are two desks, a large one in what was supposed to be a study room but has become a repository for whatever.  And a smaller desk in a corner of the living room that really is mine.  And there is my bedroom, or at least my half of it.  At the moment I would call it half a queen size bed where I sleep, read, use my tablets, and groom in the adjacent bathroom.  There are other things that I would like to do there other than store stuff.  Making this half-room really mine occupies an important goal for the coming six months.

11. Guests

While I very much need private space, a lot of the decisions I made for my house in the thirty years I've lived here were predicated on creating a welcoming public space.  Our open houses have been two celebrations of childbirth and shiva for three parents and one gathering for my fellowship comrades, plus some birthday parties.  We have good living room furniture, good dining space, a fully equipped Kosher kitchen with my own culinary skills enhanced gradually over time.  But no guests to share this with us.  Since goals need to be specific to allow measurement, I set a quota of four guests in the ensuing six months.  That means I have to make the public areas more presentable first but I do not anticipate much difficulty with this.  Finding guests and occasions may pose more of a challenge, but four does not seem that many.


12. Day Trips

Several years back I allotted one day per month to visit a place I've not been previously.  My efforts took me to the Jersey shore on and off season, the Yuengling Brewery, Gettysburg and regional wineries, Maryland's eastern shore, the Poconos, and elsewhere.  I acquired a special liking for tours of odd mansions turned museums.  In addition to the interest that the sites create, this also becomes Me Time.  Getting to these places takes some planning, affording me a couple of private hours in transit in my car, with the ability to stop en route pretty much at whim.  I could count on this time set aside for myself.  Since I have no plans to expand my shabbos morning attendance at AKSE beyond the current twice monthly, I should be able to insert one of these day trips each month to boost my spirit as it has done in the past.

Twelve projects this time.  All with specific end points, none requiring significant hired assistance.  All creating a sense of accomplishment that can be a little elusive at times.

Opting Out

My third and final ACP renewal notice came in the mail yesterday, still unopened.  While the ACP remains the medical organization for which I hold the greatest fondness, I decided last spring to let the clock run out on the membership without renewal.  The reasons are multiple, reflecting on a mixture of the organization and of me.  I'm in the middle of reading a well considered book called Relational Judaism by Prof. Ron Wolfson who I've met a few times.  He describes the atrophy of once strong Jewish organizations which now struggle, partly through no fault of their own but partly through decisions of how the leadership and policy makers related to constituents.  It is very easy to look at synagogue membership or ACP membership as a consumer purchase.  In one sense, the rather high fee is of secondary importance since my hospital pays for one membership a year.  I could ask them to pay $600 to the ACP instead of half that to the Endocrine Society but my professional attachment has clearly evolved with the specialty.  But as a consumer purchase you have to assess what is received and set a value on it.  It's probably better for medical organizations or Jewish organizations to promote relationships, as Ron suggests in his book, than to sell a product that is often difficult to define.  I've not read an Annals article in a few years, attended a local or national meeting in a few years, bought insurance or studied from the MKSAP in some time, while the products have always been top notch and the people very gracious when I have attended.

No, it is not a purchase but an assessment of personal and organizational values that are always in evolution, sometimes for the better, sometimes not.  I think I became a continuous member circa 1982.  That leaves about 30 years of experience and transition.  There was a time when Masters got their designation by becoming the people who advanced medicine.  Some undoubtedly still do, though increasingly the designation reflects loyalty to the organization more than the gurus of clinical studies who transform out ability to function professionally.  That can only be a reflection of how the leadership of the organization assesses its purpose.

In 2011, I took what I hope will be my final recertification exam, especially if they decide to do drug screening on illicit Namenda which I will probably need to protect memory at age 70 ten years from now.  To be fair to the ABIM, the experience this time around seemed pretty decent, though cumbersome, unlike 1991 and 2001 when it was more of a fraternity hazing.  I think some of that credit goes to ACP alum, Dr. Cassells.  But the reality is that while my scores are comfortably above threshold, there is an endocrine failure rate of about 12% whose professional lives are disrupted while they remain worthy and competent colleagues.  More recently, the ABIM has made the MOC process more burdensome with little benefit to the public.  This seems like an obvious place where the ACP dropped the ball as the advocate of its members and no particular incentive to cap this type of regulatory excess.

Over that same 30 years the role of the internal medicine specialist has become more amorphous under the ACP's organizational watch.  There are places in our State of Delaware where a Board Certified, fully trained ACP Fellow can request expert consultation and have their patient assessed primarily by a nurse practitioner in lieu of the expert they were hoping to capture.  Not only has the ACP never challenged this but now they have taken a position of boosting membership by absorbing professionals of lesser training into the organization.  This, of course, never came up three decades back but sometimes the physician advocacy organization has a lot more credibility if they put expediency on the back burner and take a stand for consistency with the values that I think most physicians have.

And as Ron writes, it's about relationships.  Would I approach a large check as a contribution for noble cause rather than a purchase if the cause was really noble and if I had a fair amount of skin in the game?  Jewish organization and to a lesser extent medical ones design programs hoping that people will come.  I've designed my share for Adas Kodesch in recent years, some highly well attended.  But are they successful?  If attendance is the goal, then sure they are.  If developing an enduring attachment that withstands strained times and invites a measure of forgiveness for policies that do no go your way, then no, programming does not cement relationships.  In my decades as an ACP member and later a fellow, I was only invited to two meaningful projects the entire time.  Both involved my skill, by the way.  One was to create a wallet card with essential patient information that they could bring to office visits, the other was to attend a national meeting in Philadelphia to critique how the organization could be more responsive to its dwindling subspecialist members.   Total time spend on meaningful projects about eight days.  Never been invited to a standing committee all that time.  Never invited to share my expertise or experience at a meeting, never been invited to suggest an expert to share their special ability with the group.  These are the things that generate loyalty which transcends personal experience that will inevitably have its favorable and unfavorable times.  I do not know if ACP has as part of its mission to bring people on the sidelines into the group, hear their stories, fill in some of the voids that are inevitably part of professional life.  There have been a lot of Governors and a lot of projects in thirty years.  My guess is that the Pareto Principle where 80% of the activity is generated by 20% of the people prevails in the ACP as in anyplace else.  The question is whether the leadership ever thought seriously about how to change the proportion to 70/30 or whether they have the same complacency with A-lists that my synagogue does.

I eventually opened the final invoice letter. sending back the invoice unpaid with a note wishing the organization continued success.  The ACP has always had dedicated well meaning people at its helm.  But they may need to pause to reassess what their own constituents desire from affiliation and a fair amount of financial commitment, then provide it.

Some Time Away

I've been off about a week now, primarily to attend the Endocrine Society Annual Meeting in San Francisco followed by a respite in wine country and an intended viewing of Yosemite which did not happen for having underestimated the distance in my planning.  There were a lot of side projects to be attended from my estate planning to semi-annual project planning to computer upgrades for work to some writing that also did not happen, underestimating my stamina during the conference and my tolerance for wine afterward.  The synagogue annual meeting came and went in my absence, passing by my intent to transform from participant to observer.  But I'm rested and ready to return, though perhaps in a different form from when I left.

Travel probably reveals more about me to me than I learn about the place I visit.  I find myself generally more tolerant of glitches than I am at home.  Perhaps if I were a geek, San Francisco would be a permanent destination, easy to absorb into the technical world.  While there I passed by stores know for their exclusivity.  I am not a person who seeks exclusivity or indulgence, much the opposite.  New things intrigue me.  I never get tired of Chinatown and as I diverted my path toward the Golden Gate Bridge, I got to see if not experience some of the neighborhoods.  And across the bridge I encountered extraordinary scenery and eventually viticulture on a scale not imaginable in the East set amid the usual collection of fast food places and chain motels only a short car stop away.

At the convention I encountered research on how medicine is practiced and how things that I experience randomly can be quantitated.  My pet peeve of inadequate resident supervision has an outcome measurement that somebody did and discussed with me.  My interest in core science was a lot less than that, though a necessary component of understanding what I do professionally.  And it was reassuring to know that the grand professors had the same prescription plan impediments that I do.  Moreover I have the same skepticism of the role of leadership of the Endocrine Society that carries over to my Jewish world and my medical world.

So in a few days I return to usual activities and some catchup.  While will again have a $10 bottle price limit even though I can now tell the difference from the premium stuff I got to taste at the vineyards.  My interest in acquiring stuff has been blunted by the rejection of overabundant premium stuff which infused San Francisco.  I am a little more committed now to carving out some time each week to set the patients aside in order to focus on the more creative observations of medicine.

And there will be the next half years projects outlined.

Ooky Coffee

Up early.  Lots of little projects on my plate that I do not want to pursue right now.  Some bills coming due, a major bank deposit to be prepared, my Aerogarden needs to be set out and my article on Leadership Generated Attrition has been languishing for some time.  I have another week to learn how to use my new camera with 24X zoom in time for my daughter's graduation.  But sometimes I need idle time.  My mind seems to be in gear right after my morning stretch, supplemented by coffee.

The Keurig machine, or actually a K-cup compatible Mr. Coffee impostor that I got with a 20% off coupon a few years ago, has upgraded my every morning except Yom Kippur and Tisha B'Av.  While professional activities, child rearing and sometimes Jewish obligations hindered my development of more personal pleasures, I have taken a fondness to varietal coffee and varietal beer, both relatively economical indulgences compared to the alternatives of skiing and hedonistic electronics.  So the K-cups can be purchased in 48-cup variety packs while the 12-24 cup boxes can be acquired in innumerable varieties costing less that a visit to Brew Ha Ha, which I still do periodically, though more than brewing my own in a French press, which I also still do from time to time.  This morning I had Brooklyn Bean Roastery Vanilla Skyline and Tully's French Roast.  And then Betty the cafeteria lady can be relied upon to deliver a dispenser of pretty decent hospital cafeteria coffee to the Doctor's Lounge, there for the taking.

While the Vanilla Skyline blend was an extreme disappointment, too weak to justify another purchase of it at any discount, any large sampling is bound to distribute in the typical bell shape.  Most varieties fall within 95% of the gustatory mean, a few dreadful, a few superb.  Even though the Vanilla Skyline Blend left me unimpressed after two attempts, the remaining ten plastic containers will get consumed over time rather than wasted.

In a few weeks I allotted myself a few days \vacation tacked on to the Endocrine Society Annual Meeting in San Francisco.  I've always wanted to see Yosemite and visit the wineries, another source of immense variety.  A convenient base nearby to each might be Modesto, home to E & J Gallo, which I can get at any local store.  I will need to make a decision on witnessing wine made on an immense scale for a mass market like Gallo does, or more to my liking seeking out much more limited operations developed to allow expression of the winemakers' passion for their own individual craft.  It is the difference between a French press of commercial Martinson Coffee, which I still enjoy, or rolling the dice on a package of K-cups from a source that I have not heard of previously.  For the most part I will err on the more unique experience