Going Fishing

My recreation has gotten a little thin.  Even when I escape for a short time, whether to the Lancaster Outlets a few weeks ago or the Yuengling Brewery last weekend, there are always a few deadline projects on my plate, whether Torah reading, AKSE Academy, a resident lecture or mandatory training for an IT upgrade at work.  Recreation has become an escape when it perhaps should be its own destination.  My two harmonicas lay idle.  My fishing rod still has its sales label attached after a year.

This weekend's weather report promises a pleasant outdoors on Sunday so I think it time to get to White Clay Creek State Park to try my hand at angling.  I have a state fishing license with trout stamp, as the creek is stocked by the state.  My intent is catch and release, though my negligible skill makes even that unlikely.  I bought some basic hooks and floats and lures at Walmart.  I have a vest with a lot of pockets and a hat and sunglasses and shoes that would be no worse off with a coating of mud.  My cell phone is charged and my beeper remains within range.  I bought a portable chair which has been in my trunk unused for a couple of years.  I'm amply equipped.  Have to remember to take the beer I bought last weekend out of the trunk as it is technically not allowed in the park.  And my next project, a very difficult and long aliyah for parshat Naso has been photocopied so that needed recreation remains less than absolutely recreation.

Filling Schedules

There is creative work and there is implementation.  There are students and there are doers.  You can probably get by with doers alone but certainly people and organizations would flounder if creative intent never became reality.  Without the thinkers and creators, mediocrity would prevail.

As I researched my recent presentation for this year's AKSE Academy on Synagogue Life Cycles I found a tension between people who want vibrant programming that is always in some form of evolution and people who get lulled into securing what they have now, acquiring the rewards of advancement for keeping programming predictable if uninspiring.  There is the predictability that the McDonald's developers understood a generation ago that atmosphere can be both portable and standardized.  Go to any USCJ congregation and the books are the same and the worship is the same but skill with which worship is presented varies a lot.

From my own congregation's perspective, there are a few constants.  Torah must get read, Haftarah chanted and at least one Ba-al Tefillah is needed each shabbos.  It is certainly much less anxiety generating to look at last year's schedule and reassign the person who has the experience.  With the education program there is no reason why the Rabbi's classes need to change at all for the duration of his career if the goal is to present its existence on the Web Site for marketing purposes.  There may very well be a benefit to adding or deleting options based on attendance or feedback or the teacher's assessment of what those in attendance got out of their attendance relative to what the potential might have been.

It takes a different frame of reference to acquire stewardship of the programming, to schect some sacred cows and experiment with things that people might find novel and maybe even attractive.  It is much harder to do that, to badger talent to bring them from the sidelines to the mainstream, to require people exert a little more effort to learn a new Haftarah that was not recycling of their Bar Mitzvah lessons from the year gimmel,  to replace an accounting of members who have come and gone with a coherent plan to make membership more attractive, to infuse a measure of imagination that can be implemented into unique experiences while still filling the mandatory schedules.

Gift to Myself

My birthday came and went unobtrusively.  While my office manager knows when it is, the first time they posted it on the monthly office calendar, I asked that my privacy be respected and it never appeared again.  It does on appear of my FB profile though much else about me does.  A birthday is something that just happens, not something reflecting effort or interest on my part.  My wife and kids conveyed their good wishes.  We had a special dinner, waited the time to eat milchig, then had a slice of birthday cake.  Cards from my wife, the state senator and the state representative.  Nothing that needed to be unwrapped.

The only gift came from myself.  I selected a suitable retirement date, one that I will not work past unless some extenuating circumstance requires me to stay on a short time later.  A countdown timer has been set.

This date falls well beyond the departure date of our current President, far enough in the future to allow me to engage in a project or two that I would have liked to have done in my professional capacity but never did.  But it is also near enough to view with realistic anticipation.  Needless to say, the vagaries of my health and the fortunes or whims of my employer could hasten that date considerably but not extend it.

This seemed like the right time,  I like my work.  I like the people that I work with and am grateful to the organization for welcoming me into their whirl.  So it is hardly an escape.  Rather I view it as an opportunity to be selective about the things that I wish to pursue and to be with my wife enough to maximize companionship but not so much as to become a pest.  The deadline also prods me to think beyond my next patient, the next lecture, the next exam, the next license renewal.  Being the doctor can become too much of identity, too consuming.  While I value the skill and experience that has been mine to acquire and hopefully transmit a portion of it to the next generation of physicians, it comes at the neglect of other efforts that also bring their measure of satisfaction.  What will I do when I no longer have to show up at work?  Hard to say. I toured one of the big outlet centers yesterday, looking at the nice designer clothing and business cases that I had no reason to consider buying.  I paid $11 for a fishing license.  I still have two harmonicas that I need to learn how to play.  And the medical equivalent of Uncle Tom's Cabin, the tome that brings reform to a professional system that could use some revision still has not been written.

Definitely a good gift, one that brings me purpose.

Aseh L'Cha Rav

From my blog 5-25-11:  My hero Rabbi Jim Diamond took a steadfast position that all students at Wash U and Princeton had a stake in Jewish life around the campuses and he will provide the resources to fulfill it.  

Rabbi Diamond passed away unexpectedly and tragically this past week, killed while trying to get into the passenger side of a car,  returning home from a Talmud class. He more typically rode his bicycle from his home to the WashU Hillel building. One Sunday morning about ten years ago when as Executive Director of the Center for Jewish Life at Princeton University, he afforded me the great honor of speaking to my congregation at my invitation, he took the train from Princeton to Wilmington.  The half hour in my car gave me a little more private time with him than I deserved.  To his final day I never knew him as the driver.   I knew he was married and had kids.  I also knew that he was raised in Canada, though I always thought Montreal rather than the more accurate Winnipeg which had a very vibrant Jewish Community at the time.  I knew very little about him personally over the four years of direct contact and many more of indirect contact.

Yet I had the great privilege of getting to know him professionally, keeping in touch long after I departed St. Louis.  When I first arrived in St. Louis as a medical student in 1973 I needed Kosher meat.  I called Hillel and Rabbi Diamond provided me the address of where he shopped, a place called Diaments, which only closed very recently, the penultimate Kosher butcher remaining in St. Louis at the time.  He must have not realized that I lacked wheels, since the schlep there and back on a Sunday morning using the Bi-State Bus from South St. Louis took three hours.  Yet he got me there and back, noting some pleasure that the reach of Hillel might extend beyond the Washington University main campus to the Jesuit university four miles away.  Over the years there were classes, a weekly Kosher deli run from their kitchen that attracted the community and many conversations about Jewish life and where the future might be heading.  The Rabbi had started like most Conservative Rabbis as an assistant at a growing suburban United Synagogue affiliate in White Plains, NY.  He observed that the GI's who were growing their families at the time, probably mid 1960's, and acquiring a stable measure of prosperity as well, were not investing in their children's Jewish future.  The congregants were generous with maintaining buildings and paying clergy, they sent their kids to Hebrew school, but generally did not have let alone transmit a sense of what Jewish excellence is really about.  When it came time to decide if he really wanted to be a pulpit rabbi, he opted instead to pursue a college ministry instead, a place where he could direct impressionable young Jews of all types, choosing their own Jewish journeys for the first time.  He went to Indiana University first where he obtained his PhD in literature while running their Hillel.  Then he moved on to St. Louis, arriving about a year before I did, staying until 1995.  I received a notice that year, that they were naming the library in the Hillel building after him, the place where I divided my Sunday afternoons my final two years of medical school between my medical texts and whatever captured my Jewish interests on the shelves.  With the Rabbi's guidance, I had become Jewishly inquisitive, an imprint that follows me to this day.  I will teach a class of any size, from one person on elective to a Grand Rounds, another part of the Rabbi's legacy.  And while there is still considerable laytzanos in my mode of thinking, the Rabbi got me to temper it, or at least direct the cynicism for a beneficial purpose, which I hope is what I do here, though with varied success.  I sent off a donation, as was requested along with a note suggesting a retirement might be premature.  He responded promptly on Hillel stationery that we would soon be figurative neighbors, as he was taking a position with Princeton University.  I framed the letter where it hung in my office until my practice closed.

I got to visit the Center for Jewish Life one time, taking my son on a Saturday morning to visit Princeton University as a place that might be suitable for him to consider attending.  The campus seemed largely abandoned that morning.  We parked nearby the exquisite building, financed by dedicated and prosperous alumni, nearly all of recent vintage as Princeton was not a Jewish friendly university until the 1960's.  I wandered through the many rooms, finding a fully attended orthodox service in progress and a few doors away, a couple dozen people, most too old to be undergrads, including Rabbi Diamond, sitting living room style either holding a discussion or conducting an egalitarian service.  Except for my son's impatience, I'd have gone in to join them and offer a personal long overdue greeting to my teacher turned friend.  That would have to wait another year for his Wilmington visit.

Rabbi Diamond retired about ten years go, passing the baton to a young female Rabbi.  He kept active and engaged with young students of high school age as well as Jewish adult education.  Just like the airline tells you to put on your own mask before assisting others, the Rabbi kept his own mind engaged in Jewish learning right to his final day.

From a Hillel presentation, there could be no more fitting tribute than to the person I sought out as my Rabbi:

http://www.hillel.org/jewish/textstudies/pirkei_avot/pa_c1_m6.htm

Discussing Women

The Forward ran a feature on 36 American rabbis from around the USA recommended as outstanding clergymen by testimonials submitted by their congregants.  Among the lamed-vav was a gentleman I knew in college who worked the cash register at the Hillel Dining Room.  He was a year ahead of me in school and I never thought about him again until about ten years ago when Moment Magazine published a landmark article that he had written in response to a critique of Conservative Judaism.  My crystal ball from college days never would have presented him as a Rabbi, let alone a prominent one from the Chicago area.  He faded into the background again until appearing as one of The Forward's 36.  One can find out a little about most anybody in cyberspace these days so I did a quick search of his congregation's web site where the Rabbi usually has a short bio and a more substantial paper trail reflecting ideology.  His congregation, while Conservative, announced itself as Traditional, as does mine.  That has become shorthand for mixed seating at worship, open parking lot on shabbos but Y-chromosome for most ritual performance.  Shuffling though their web site, egalitarian did not appear but neither did non-egalitarian, which has less membership recruiting baggage than its euphemism Traditional.

Exploring further, it seems that my acquaintance of old appears again at the peak of his public prominence in 2001.  Another Conservative Rabbi in the region, this person the son of a man who I got to know well and admire when he lived near me, decided that his congregation really ought to make the transition to egalitarianism. Much to this Rabbi's credit, he did not impose the new policy as he could as mara d'atra.  Instead, he set aside a year of status quo to explore the options and ramifications.  Among the guests invited to discuss positions was my old college acquaintance who presented the case for restricting bimah participation to men, something which had become a minority view in the Conservative movement by then and remains even more of a fringe now.  The discussion by that congregation in Wisconsin centered around the religious propriety of the change and its implications for bringing new opportunities to women already in place who could expand their capabilities.

My congregation has also started to explore some measure of this change.  Propriety and religious opportunity for women has a much smaller place in the discussion than prospects for reversing membership attrition and acquiring a better market position for attracting new dues paying members.  What actually becomes of those women seems subordinate to what becomes of the congregation's checking account.  Advance the role of women not because it is consistent with communal values in 21st century America but because it is expedient.  Women are not really being served in that type of analysis as much as they are being made pawns for a goal that has little to do with the core mission of the synagogue.

In reality, women thrive Jewishly in many types of synagogues.  Conversely the United Synagogue of Conservative Judaism experienced its talent depletion in the very years they were advocating an expanded role for women as baalebatim and as rabbis.  Stable membership participation and communal growth are really byproducts of what is offered to any member of any gender or age to enhance their Jewish experience and reinforce their Jewish identity, irrespective of mode of worship.  At a forum of a Reform, Conservative, and Orthodox rabbi in San Francisco a couple of years back, podcast on www.yutorah.org an audience member asked the Orthodox representative whether the policies of his congregation diminished the importance of the women members.  He responded very insightfully that his women were more knowledgeable by far and more committed to transmitting Judaism to subsequent generations than the women of any place else in the city.  Worship takes about 1.5 hours each day, a little more on shabbos.  But the synagogue building and its resources are open from dawn until dark pretty much every day.  It is his women that take best advantage of what is available to them and have the most available to them.

My congregation's leadership likes to categorize things with labels.  Membership is who came and who went.  Education is what classes are on the schedule when it should be what benefit did people derive from the classes.  There is a Women's Tefilah Group that puts a priority on attendance when they should put the priority on parity with what the men perform.  That is how you distinguish our congregation from Brand X around the corner which lets women chant Aliyot but at a level of skill too paltry to even get an invitation at our congregation.  Discuss women, for sure, but discuss them in the manner of servicing them, not as a vehicle to strengthen a precarious financial situation.

AKSE's Peter Principle

AKSE's Nominating Committee issued its recommendations which become the coming year's reality.  Bylaws require the President to turn over every three years but now somehow it is no longer orthodox bylaws with the president returning as Executive VP and the president elect serving as head of the nominating committee. Maybe not even kosher bylaws, as my recollection is that the nominating committee members cannot themselves become officers. Each officer is a continuation from before, irrespective of achievements attained during their tenures.  A form of institutional incest which can be counted upon to beget recessive genes.  So for a number of years now the number of people advanced to the executive committee hovers at about zero.  Having been on the board during some of this time, I can attest to being very much underwhelmed by things like creativity and a marketplace for ideas upon which successful institutions like a synagogue depend.  The role of the religious VP seems to be to assign Torah readings when the Cantor is away.  I am hard pressed for anything that I might regard as a lasting achievement or innovation since the Rabbi's first year aboard.   Education has also become a recycling center with no innovations other than my AKSE Academy which is probably down to its final year.  We have no ways and means.  Membership reports are accountings of who has come and gone, truly devoid of anything innovative that might make the congregation attractive to anyone who is not already here.  The building people do not even have sensitivity for what the building is used for to have the right books in the pews in the right numbers before the worshippers arrive.  Our publicity has become more consistent. I cannot honestly conclude that it has been more purposeful.

Several decades back, a fellow named Lawrence Peter issued a best seller called The Peter Principle.  He observed that in many institutions people would get promoted through the ranks until they could no longer add to their own functions in a meaningful way and would then spend the rest of their time doing nothing particularly important, though becoming sufficiently entrenched in position to make it difficult to replace them with fresher minds.

As AKSE goes into what appears to be its twilight years, failure to refresh membership has its mirror in failure to refresh its leadership pool or to expand beyond comfort zones.  And Rabbi's, no matter how personable, do not alter the destiny of leadership generated attrition.

Reading Charts

Pet Peeve Time

My medical professors and senior residents trained me well.  I may not have liked it at the time, but they were insistent that I review old records when a patient was assigned to me.  Records were kept on paper with tabs for the various types of entries.  They would come up in a big basket, often with multiple volumes, and have the approximate appearance of a telephone directory from  a large city.  On the front of each admission would be a transcribed discharge summary which provided mostly useful information but occasionally became the source for propagated misinformation from one hospitalization to the next.  The specialists tended to go beyond discharge summaries,  needing to look at trends in lab data over time so I got very proficient at reviewing where the CBC's and creatinines had been the last few years.  Serial radiologic studies were more difficult to assess so a trip to the X-Ray File Room would be part of the chart review much of the time.

Computerization of records has made the review much easier.  Instead of having to go through each lab section of each admission, trends are now tabulated across admissions.  All the summaries are presented serially, all the X-Rays are presented in sequence, both images and reports.  This seems like a snap for those of us who once had to hunt for what we need but at least know what we need.  The amount of time spent doing these reviews probably has not changed much but the amount learned about the patient in that time has expanded enormously.  It helps, though, to know what you are looking for, a skill better developed by having to very selectively seeking out prior data from amid a multivolume record.

Many of my residents never acquired that skill.  They process through a new patient without ever looking at primary data from the past.  Summaries get propagated forward, misinformation with the correct diagnoses as a bundle.  But review of trends invariably comes from the consultants.  While this type of review is labor intensive, it is not that labor intensive.  And what might they be doing instead?  And why go through all the trouble of doing this if the patient will be handed off to somebody else in a day or two?  There is really no ownership of the patients, maybe not even stewardship.

So for now I have a useful but skill but one of diminishing interest.  I know how to use a stethoscope and slide rule too.