furrydoc

Me Time

2012-02-12T10:00:00.000-05:00

Yesterday I redefined shabbos as a break from what I usually do, whether that be the six days of labor or the seventh day of avoiding activities which occupy the other six days. I took a day off dedicated to myself and my inner spirit. This included a certain amount of Avot Melacha, and maybe stuff that I could have done today instead but yesterday was the better time for it. Kohl's opened for pre-Valentines Day at 7AM so they were about the only place open when I started. They were clearing out their winter duds so I picked up two winter hats, a new pair of leather gloves and a scarf made something that resembled wool but wasn't. I really do not need any of these, having always lived in a place that has four seasons which enabled these acquisitions over time. Moreover, I almost never have to go outside, my day beginning with a few meters walk from the front door to the driveway, followed by a parking space in the hospital's covered garage, then the reverse order home. Even on shabbos, it is not far from the AKSE parking lot to the front door. But this was a day of indulgence so for less than $16 for all the stuff I could not go wrong.

Next stop the new Panera Bread Company for a Mediterranean Breakfast Egg White sandwich which I ate there while wearing my new gray driving cap with the ear flaps tucked under and a large dark coffee which I nursed in the car's cup holder all the way to my next destination, Historic Cape May off season. My GPS has a bias for the Interstates but the official State of New Jersey Transit Map that I picked up a couple of years ago at a state highway rest stop had more inviting routes that I planned out the night before though I still got snookered off course by the GPS. Since I had no other destination and both routes took me places that I had never traveled before, it did not matter much which road I drove on, keeping the map open next to me in the passenger seat which allowed me to reconstruct my preferred route as I traversed the width of South Jersey. Like many of my previous day trips, the path there creates more interest than the final destination. I think of the New Jersey of my youth, populated by cousins who failed to follow the rest of the family east to Long Island, a connection between Rockland County where I lived and Manhattan where I wanted to go. Even now when I live literally minutes from the bridge that give me access, it is still a barrier to crossing the border at the other end to get where I want to go in New York. It is rarely a destination for its own merits. This time, though, as Route 49 took me through Salem, then Bridgeton, then Millville, finally making the rest of the ride along Route 47 which has its eastern terminus in the resort town of Wildwood with little else in-between, there was real farmland, a huge state prison without a lot of citizens nearby to object to its presence and as the shore loomed, some places that people might like to retire to.

Once nearby I again needed the GPS to find my way to the Emlen Physick House at 1048 Washington Street, the town's main attraction. Cape May runs a year-round tourism project with a guided tour by trolley around town, which has been designated an historic site due to its abundance of Victorian style houses, some in lurid colors. Over the years I've become familiar with old mansions, paying admission to acquire inspiration for what I would like to do with my house but haven't. One of the observations that has always intrigued me but seems fairly constant from place to place is that the country squires who own them never really keep pace with the technical advances that develop while they reside there. Despite the unquestionably prosperous Physick family staying until 1935, there was no telephone service, lighting was still done by gas, and there was no radio. To maintain the many houses in town would take a lot of artisans but no body quite knows where they or their shops are. There is a second mansion that I could have toured as well but opted to walk around town on my own. Most of the places were closed but they have a pedestrian mall where some of the shops stay open on weekends so I bought a bag of Kosher-certified salt water taffy and had it placed in a box that resembled one of the town's Victorian structures.

By early afternoon I was a little hungry. There was a sandwich shop near the lot where I placed my car, so I purchased by customary tuna hoagie, eating half there then half to be stored on the front seat for later. Next stop, the Hawk Haven Winery nearby. Finding it did not go easily as my GPS did not include any of the Cape May County wineries in its directory. The girl at the Wawa who I expected to know a major regional destination was underage but one of the customer was not, so he pointed me in the right direction but it was still not easy to find, the vines being on one side of the street with the tasting room discretely placed on the other. They hosted an advertised event of wine and chocolate pairing which made this the most crowded winery I've ever visited since the Bar Mitzvah class took their phony ID's to the Manischewitz plant. The owner just brought his first newborn home from the hospital the day before so Grandpa and an employee held the fort. Despite the crowd, it went well, though I think I liked the various types of chocolate squares better than the wine. Next stop, en route home, the Natali Vineyard which also had a special event, a local vendor selling baked goods and a local artisan displaying and selling valentines candles. The lady at the tasting room did not use a measuring pourer and had a generous hand. The final two liquid specimens, intended for dessert included 15.7% alcohol versions of banana wine and port. Upon departing, I took the second half of lunch from its wrapper and finished it before moving on the Route 47 for the non-stop return home.

Did I achieve my highest level of amusement? Probably not yet. I did learn a little more about me than I realized before. First, I like visiting old mansions. My house, built in 1967 and occupied by me since 1981 may have done a little better in some ways than the owners of the homes in Hyde Park, Winterthur, or the Emlen Physick house. My house gets advanced. A visitor to my place would find things in it that did not exist at construction time in 1967. We have modern central air conditioning. The antenna attached to the chimney came down with the last roof revision, to be replaced by cable transmission. We have appliances that did not exist when we first moved in. Somebody touring our house would find a flat screen TV of recent vintage, a small TV in the bedroom purchased around the time my daughter was born in 1983 and on my desk a 1960's black and white portable TV. There are electric typewriters now obsolete. There is a stereo with turntable and cassette deck. But my house is not a museum. As better devices come along, they find their way into how I actually live.

I also appreciate my time a little better. As one of my six semiannual projects, I designate one day a month for a day trip to a place I have not been before. Sometimes my time has to be truly mine, not a lot of it, but some. It does not belong entirely to the patients and housestaff of Mercy Philadelphia Hospital, not to my family, not to the synagogue, or since that time may be allocated on shabbos, not even to HaKodesh Barachu. Some measure of defined time has to belong to me alone, to be separated from other things that fall into have to do categories. Yesterday defined one of those necessary dedicated blocs of me time.

The Week Ahead

2012-01-24T07:00:00.000-05:00

As I begin the work week, there are no major appointments or projects or days off. No trips to the satellite clinic. No conferences to prepare, no evening meetings to attend or not as my hospital obligations dictate, no grandiose plans for the weekend, just activities settling back into their customary rhythms for the first time in a while. There are always chores and there are always my six projects to work toward.

They are:

Begin a research project.
Purge my downstairs of papers so I can bring in a cleaning crew.
Develop a real herb garden.
Write my estate plan.
Submit three papers for publication, two Jewish and one medical.
Go on a day trip once a month.

This should be the type of week that allows me to pursue them.

Proceeding in a Thoughtful Way

2012-01-22T06:54:00.000-05:00

Bingo will continue at AKSE for another six months or so votes the Board, with my vote in the majority, even though I personally regard Bingo as the wrong business for a synagogue to pursue. They do not generate enough revenue from this to defray financial shortfalls in a conclusive way. I concur with a negative voter who commented that the revenue does not justify the effort expended on this and the financial risk of an unsuccessful venture. Yet it is one of the few projects at AKSE that I can honestly say has been thought through in an objective analytical fashion by the people developing it. Its potential exceeds other fundraisers by a little yet is very labor intensive. Getting forty volunteers to help out, including many who have this as their main form of time donation to the synagogue, keeps the needed labor fairly secure to say nothing of the need to engage people in synagogue activities. Yet under best circumstances this is 8% of the congregation's budget. The bulk of revenue comes from dues paid by membership units and from voluntary donations beyond the dues structure. Still, the $8000 start-up investment required the organizers to analyze its potential and its risks, make corrections to inevitable missteps, then reassess outcome.

Very little at AKSE follows that outline, my own project of AKSE Academy included. If the honchos are serious about growth and financial stability, they will have to apply similar due diligence to membership.

Nominating Committee

2012-01-15T18:32:00.000-05:00

AKSE Board Meeting upcoming in a few days. This month's agenda contains one dominant item, whether to continue Bingo as an ongoing fundraiser. My position is currently neutral, but could be influenced by how the last year's experience is presented, or even by its results. Less obtrusively on the agenda will be the announcement of the creation of a Nominating Committee. While funds enable activities, people create the experience of engaging in those activities.

Being a nominal democracy, AKSE's members did themselves in for their own convenience a few years ago when they agree to a bylaws change that eliminated term limits for all officers other than the President. While holding a position for a long time can create expertise, that really has not happened with the possible exception of the Building VP where there has been some turnover. More characteristically, inbreeding stifles the ideas and innovations that are needed to make a place sparkle.

I do not know the composition of the Nominating Committee but can hazard a pretty safe guess that it will contain a small group of the President's A-List, a cadre devoid of anything that has a scintilla of entrepreneurial experience or intent. AKSE will always function as a top down organization as an unintended consequence, despite the very sincere belief of the participants that all members have a stake in what happens there.

Old Friends

2012-01-12T07:36:00.000-05:00

On my day off I ended up doing three useful tasks: assembling the snow blower, having my haircut and purchasing four post cards of my home state to send to people I've not connected with in a while.

When traveling to New York last month my path took me through the Bronx, more specifically through the neighborhood of a very likable friend whose career rose over decades and plummeted over months. I'd not known what became of my friend. He largely disappeared from Google searches, either professionally or in communal activities. Yet I thought of him as I drove through the neighborhood in slow traffic that allowed me to look around in the early winter darkness. I arrived at my motel where they had sample postcards on the counter. I took one, penned a brief note the next day but it sat in my living room for a month while I got around to purchasing 29 cent postal card stamps.

My son returned from St. Louis for the first time for winter break. I have lots of medical classmates who settled in the area, most of whom I've not seen or heard of since graduation. One psychiatry friend I kept up with in the early days of practice, marriage, kids and finally the early days of email but again a lapse of about 15 years. I do not know why she came to mind but as I purchased the four postcards of local interest, my first thought was which would be the one to best send her as a greeting.

Facebook has made renewing ties a lot easier. There was, and maybe still is, a dependence on weddings and funerals to bridge geography with perhaps a supplementation from class reunions. With the passage of time, the interests of closest personal friends diverge for a good reason while people who were mere acquaintances at a remote time have emerged as intriguing likable people in cyberspace. Some are caricatures of how I remember them, as undoubtedly I am to them. Forty years, though, provides a lot of opportunity to accomplish things, develop personality or personal ideology, nurture families, and watch ourselves become the dominant generation. All of these things got their start with a boost from the people we knew way back when. With a little luck and outreach we could still know many of them today.

Doing Nothing

2012-01-08T11:11:00.000-05:00

A rare day dedicated to laudable sloth. On my third cup of coffee. It's been a not too busy week with a day off for New Years Day and somewhat quiet in the office, dedicated to some catchup. The latter part of the week and lack of consecutive days off from work for a few weeks made me schedule some real me time or maybe more correctly leave me alone time. Yesterday morning I gave my periodic donation of platelets and plasma. It required me to get up early, eat at a time I normally would not have eaten, then get to the Blood Bank on time for a couple of hours of idle time watching Create TV, which is what I most like to do. It went very efficiently leaving me a chance to arrive at AKSE at my usual Saturday morning time. Mostly I skip services on platelet day but I am responsible for AKSE Academy so I thought I better mosey around and make sure the setup has gone as it should. After some rest in the afternoon, I returned to AKSE to host the event which went well. It always poses a strain on me, particularly towards the final week when I need to accommodate needs of speakers and assign rooms or deal with last minute cancellations. So the following day, today, I just want to do nada, though I really should assemble my snow blower that has been sitting in a box in the garage for three months. Maybe I'll dry-wall the bathroom ceiling, maybe not. No obligations today. No agenda for productivity. Maybe go to Shop-Rite, maybe not. Should soak fleishig dishes, probably will do that. Maybe send postcards to old friends. Things that I would otherwise not do.

A New Year

2012-01-01T08:27:00.000-05:00

I stayed up late to watch the gaudy ball come down over Times Square, had a small amount of low priced but good Spanish bubbly, then departed for a night's sleep to begin tackling the tasks of the coming calendar year. After pondering for a month, there is just not that much more personal upgrading that I would like to undertake. It would be nice to live with less clutter but do I really want to do the things that bring it about? Maximize longevity? Yes, up to a point. Exercise daily, probably not. Write a book for posterity? Maybe. Create fixed time devoted to nothing else, unlikely.

For the first time in a while, I could say that life has been going reasonably well, with the usual stresses but 2011 had fewer crises than most. The relative predictability of job, kids in school a while longer, stable home all create a lull to not want to seek very much beyond that.

Winter Holidays

2011-12-29T06:39:00.000-05:00

Hanukkah has come and gone, Christmas has come and gone, New Years as a denouement. My son and wife got extended breaks from their usual activities, I got a brief but welcome reduction in my activities as well. The office slowed down, leaving me with some catch-up opportunity, perhaps even a little get-ahead opportunity. I did some cleaning and organizing at home. My commitments to the synagogue still linger but most of that has been winding down.

I feel better than I did in the fall. Better rested, less frazzled, perhaps a little impatient with people as I gave myself a two week prescription holiday. My mind seems a little sharper, my posts on www.sermo.com a little more thoughtfully constructed, particularly the non-medical comments.

With just a few days until the conclusion of the current calendar year, I've not fully outlined my intentions for the next six months but they seem to be taking shape. There is a tension between thinking big and thinking realistically doable. I do not know which is better. Creation of Me Time each month with a day trip somewhere within 100 miles is doable. Disseminating my blog to thousands is probably not, at least as a personal project. Having a joint research project with U of Penn might fall somewhere in between.

My Highest Level of Amusement

2011-12-19T22:23:00.000-05:00

This weekend, or at least this shabbos, I took off. Recreation on Saturday, mostly chores on Sunday though only the ones that evoke a measure of personal accomplishment. The raw tally: got my cell phone replaced and the new one accepts a charge, headed toward Lancaster at the suggestion of the Pennsylvania Wine Trail, starting with Twin Brook and ending with Kreutz Creek, which tasted mostly like medicine. In between I had lunch in Strasburg and made the rounds at the Bird-in-Hand Farmer's Market. Picked my son up at the Airport. By then it was past sundown. I tried to get a few office gifts at The Christmas Tree Shop and TJ Maxx but came home empty handed. Concluded the day by gathering my laundry scattered around multiple rooms and transporting everything to one place so I could do the wash in its entirety on Sunday, which I ended up not doing. For Sunday I bought and wrapped the office gifts and made some real headway with the kitchen, even washing one third of the floor and the entire Formica counter. Seeing that the surfaces need replacement, I went to Lowe's where I looked at what it would take to cosmetically transform my kitchen. I want to upgrade my office, so I looked at area rugs, eventually driving to Air Base Carpet Mart where I bought one. Made progress on upcoming Torah and Haftarah readings.

How much of this is really the Highest Level of Amusement that I had intended? I definitely like visiting wineries, rejecting out of hand the Rabbinic concept that American winemakers are idolaters who will draw me to evil other than skipping services on Saturday morning. A number of my personal pleasures center around tasting: coffee, microbrews, making dinner. I've never taken great delight in eating out, though. I do not particularly like people serving me, much preferring to take what I want from among what I am willing to eat at a buffet. It has been ages since I've been to a good Sunday Brunch, something that I used to attend commonly when Rozzy was an infant.

I like shopping, or really looking at things more than buying things. There is cookware that I do not need, clever implementation of ideas in the Seen in TV section, regional specialties when I travel, tchotchkes of any type from cheap pens with imprinted with names that I'd never saddle a kid with for his whole life, coffee mugs of endless design, funny greeting cards. I do not find myself attracted to pretense. Fifth Avenue and the like holds no allure for me at all. I see places like that as repositories for unfortunate individuals whose self-esteem equates with what they are able to purchase that somebody else cannot.

There are few bodily pleasures that stand out. Warm water, whether from a shower or Jacuzzi. I like to exfoliate my forehead with facial scrub, then add a tingle from some type of atomic balm. Irene once got me a massage certificate as part of a United Way silent auction. Over the years, I've found myself waiting in line for mini chair massages that the Endocrine Society or similar medical organizations provide for those who attend the convention. These are definitely relaxing at the end of a second or third day of conference. But the real massage, which took a half hour and was of hand to skin format was not something I would seek out again. I found it something of an invasion of my space.

My real quest best reaches fulfillment when I travel to a place I've not been before. I love puttering around, not necessarily to the advertised attraction, but to some of the out of the way places that make the place I am visiting different from my home turf. Museums are fine but I much prefer to drive through neighborhoods, walk on the sidewalks, maybe visit the local synagogue and chat with the people who live there.

I'm always a little uneasy getting pampered. Because of my position people often seem more deferential to me than I think I merit, which may be part of the reason I like to escape to places where nobody knows me. When they ask what I do professionally I tell them that I sign things. Like many doctors, a sense of personal achievement comes mostly through what you do for yourself, for the effort that is put in starting with the every third night on call that has gone the way of the history book. That is not to say do not delegate things but the need to pull one's weight and to reject offers of others to do what you should be doing yourself eventually becomes an ingrained part of personality. A waitress does not have to bring me food that I can go to the buffet and get for myself.. A masseuse does not have to apply the soothing hands when my shower head has a setting that pulses hot water that I can direct where I want. Having a waiter who spends more on his tie than I do, which is probably most waiters and for sure most medical residents, leaves me a little uneasy.

A predictable break from labor has been mandated for thousands of years. Having somebody else convey to me a sense of self-importance that I really have not earned in the form of creature comfort or pampering is really not part of the divine directive.

Shabbos Services

2011-12-16T07:13:00.000-05:00

Uncertain what I want to do tomorrow morning. I am haftarah reader for Chanukah next week and one of the Torah readers for New Years weekend. Some of AKSE's talent has departed, not an extraordinary or disabling amount but enough to notice, making my participation more essential than it had been. Yet if you think of Shabbat as Rabbi Heshcel's Island of Time, some weeks it is better not to have an AKSE Ferry.

The services on Saturday morning, my Jewish centerpiece since grade school, have morphed from an Orthodox experience with full content and fluency to the United Synagogue of Conservative Judaism model, with its rabbinic or lay leader contrivances that so many of us, including AKSE's core talent, escaped from. The concluding time the last several months on Shabbat morning had extended a half hour. Kids from the Hebrew School now do Ashrei , replacing a quick silent reading with brief Chatima with a small parade and old Hebrew school flashback. I support learning and acquisition of experience as much as anyone else but this is tircha. Instead of a central message from the Rabbi, which has improved immensely in content over the past year, we now have an interruption between each Aliyah in addition to an introduction to both Torah and Haftarah portions. The Rabbinical Assembly has long taken the erroneous and destructive position that their congregants are Jewish ignoramuses who depend on them exclusively for every snippet of knowledge that they can impart. That is unfortunately in the process of being transplanted to the AKSE shabbat morning experience as well. Moreover, this is occurring at a time when the local Bulshitzer Rebbe has been siphoning off a measure of previous attendance. His product differentiation started with a more pure form of gender separation. He may be more successful with our help as we move to something more akin to a Beth Shalom experience while he starts later, moves through with minimal interruption and ends earlier.

It is possible to maintain a shabbat morning experience that has parity with what one might expect with a visit to any observant sanctuary around the world amid several formats. Penn Hillel has both a conservative and an orthodox minyan conducting shabbat services simultaneously. I have been to both and the content of worship is almost identical, the only difference being gender equality at one and a brief drash on Jewish Law at the end of the orthodox service. At Beth Hillel-Beth El where my wedding took place, the Havurah minyan conducts the AKSE service with very minor variation based on the Siddur they use. The only difference seems to be multiple Torah readers rather than a single hired reader and very capable female participation. There is no schtick from singing of Hatikvah to showcasing Hebrew school kids, to moving lecterns. The experience that their service conveys is judged my the fluency of the participants, a volunteer sermon that recognizes the audience as college graduates rather than Hebrew school graduates, and a concluding time that does not infringe on other elements of Shabbat's break from the other six days of work.

There was an interesting podcast http://www.yutorah.org/lectures/lecture.cfm/760703/Rabbi_Josh_Strulowitz/A_Panel_Discussion_with_an_Orthodox,_Conservative_and_Reform_Rabbi which presented a forum sponsored by either a JCC or Federation in San Francisco where three rabbis from Orthodox, Conservative and Reform congregations in the area discussed their ideologies and how they adapt it to their congregational realities. The moderator tried to bait the Orthodox Rabbi in a friendly way by asking about the divergence between public values of gender equality and practices at his synagogue. He did not bite with the expected defense as their practice being divine will. Instead, he made a couple of insightful observations of life at his congregation. First, the women at his shul were the best educated, most Jewishly involved women in the San Francisco Jewish community. More importantly, for people really committed to Judaism, the formality of worship and legal restrictions needed to fulfill the requirements are really a very small part of what happens in his shul. Almost no service other than shabbat morning takes more than an hour yet activities that make his congregation interactive to their members occur continuously. There are no restrictions for women outside of formal worship. They rise to the opportunity by making the educational and social programming attractive. There is a quest for excellence on all things.

It is that quest for excellence that challenges AKSE. The relative exile of its Talibans to the shteible of the Bulshitzer Rebbe should be an extraordinary opportunity for the mainstream that remain. The Ritual Committee, having divested itself of its Taliban impediments and securing a top-notch chairman, should be discussing ways to elevate the people to excellence in worship, not diminishing the experience of worship to adapt to the limited capacity of its people. I think it has been a shonda for my entire tenure there that the Women's Tefillah Group has been permitted by two Rabbis to continue to function as a form of Junior Congregation under AKSE's roof when their service should strive to be one that approaches parity with the main service with minor halachic adaptations in content. One Rabbi who probably couldn't care less about what happens to female worship has been replaced by one who sincerely does, yet finds it expedient to diminish all worship in some way. Making the AKSE sanctuary experience more like the Beth Shalom sanctuary experiences from contrivance to blue pencil editing of the sages' recommended content to enable more Rabbi commentary jeopardizes the very substance that has made AKSE unique in the community and attractive to its loyal participants.

Semi-Annual Projects

2011-12-15T06:17:00.000-05:00

Two weeks to go into the calendar year and I've not really done much in the way of thinking about the next six months and what I would like to accomplish and why. Traditionally I have six projects, all doable, but only the ones with firm deadlines generally reach fruition. Same this time. I finished my ABIM requirements largely because I did not have the option of not completing them. For the other five projects: my weight is the same, I did no estate planning, my bedroom sanctuary made some headway but it is a long way from a man cave, my skill with my iPod is the same and I blog less with no interaction.

This time I need to reassess projects in view of better stability where I am now and for some post-career time arising in the foreseeable future. I do not want to put any projects at work on the list other than to enhance my office environment as well as make some revisions to my work space at home. I would like to deal with clutter at home. Usually there is a home project among the six. Usually this involves a regional approach to the house, selecting one room for upgrade. This time I would prefer a mixed regional/ systemic approach, decluttering the entire first floor which includes the living room, dining room, kitchen, family room and laundry as well as an entrance hall. The barrier has always been dealing with paper and with an insatiable need for storage. The secondary barrier is that the paper is not entirely mine so I cannot make decisions on tossing things into the recycling bin or shredder unilaterally.

What I can do unilaterally is allocate some recreation time on the weekend which I think I am going to do one weekend per month, setting it aside for a day trip or perhaps an overnight respite. Retirement and beyond needs some attention. Making more money comes at the expense of my discretionary time so I have neglected financial reviews, estate planning, Long Term Care insurance, settling my father's estate, living wills to say nothing of how I will devote large blocks of time when there are no appointments to keep or assigned tasks to perform. Right now I have to designate Me Time. Not that far into the future there is likely to be an overabundance of Me Time with no current provisions for taking advantage of this.

So for the next couple of weeks, the yellow pad will need a few notations, then the final six projects get put into writing to be worked on if not exactly brought to fruition.

Pennsylvania Welcome Center

2011-12-13T06:40:00.000-05:00

Not long ago, the Commonwealth of Pennsylvania renovated its I-95 Welcome Center which appears as one departs Delaware. I drive this route most days but had never stopped in. I am usually with destination, as I was this time, but looking for excuses to delay getting to Mercy Philadelphia Hospital on a Sunday morning, I diverted my path off the highway for a few minutes. It was impressive. A spacious open area, immaculately clean, friendly lady at the desk, well lit and with walls of brochures regarding every imaginable place within the commonwealth that a visitor might want to spend money at. The centerpiece was a vintage car, a convertible, filled with assorted vacation memorabilia. Outside there was a picnic area, several tables painted red with mesh tops and seats as well as an overhang so those who divert from I-95 can eat while it rains.

Since the brochures were arranged regionally, I took several that announced attractions which I could reasonably get to and back in a day's drive.

December marks a semi-annual branch point for me. It is the month where I set projects for the next half-year. I find my personal situation more stable, more predictable, than at any time within the last few years. My kids are no longer in limbo on their professional paths. Dad's illness reached its unfortunate but expected conclusion. My economically precarious office has been replaced by a job where they seem to be happy to have me there. The ABIM requirements have been completed. Other than some oppressive tuition and the purchase of Long Term Care Insurance, I have no big ticket items like cars or condos in Florida to seek out.

One of the projects, inspired by the Welcome Center, will need to be some better protection of my time and recreation. For a number of years, I have successfully pursued a project of going to a new place every months, usually some place local like a new store but sometimes more afield like Bedford NY this month, San Juan last month and Cleveland in September. After looking at the brochures, including one for steeply discounted motels throughout Pennsylvania, I think one of the projects will need to be a monthly day trip to a destination intended purely for recreation, which the visits to Cleveland and Bedford were not. A 2.5 hour drive each way is very doable and places to visit abound, I just have to know what they are. Maryland has a state brochure and a Welcome Center that I've not been to despite driving past it many times. Atlantic City, Princeton and places in between are also well within my day trip capacity heading east. Even Delaware has its places I've passed through but never stopped. The important thing is that there be some dedicated recreation time, a planned and welcome respite from the clutter of my house and the unending not yet completed tasks at work.

Vacation and Back

2011-11-18T06:34:00.000-05:00

Completing my first week back at work after a long overdue week off. It took about three days to transition to vacation mindset, about another two to wonder if I could sustain the relative lack of deadlines and nightly happy hour through retirement or if I am really destined to identify myself so closely with my professional activities that nothing else could ever replace it. It was a good chance to sample what I would really do if I did not have to show up for work each day.

I did not really sleep late, in fact I had the same sleep pattern as at home, hitting the sack at about 10, waking up in the middle of the night, then actually arising at about 6 or 7 AM. I ate breakfast every day, probably the single biggest personal change in my activities on my days away from home where I more typically have coffee and little else until supper. Some laudable sloth in the morning. Our hotel was a beachfront one. Though the beach was small, there were few people there and the water always seemed warm. They had a more elegant pool area. I took a liking to the Jacuzzi but thought the setting too hot. I suppose I could have one installed at home. There was an abundance of deck chairs and to some extent I rested but really could not do that for very long, preferring to get up, wander around the very elegant pool area, maybe go into the three pools for short times, surf something on my iPod as the hotel provided WiFi.

Weather in Puerto Rico becomes rainy on November afternoons so it becomes time for tourism. Ordinarily I like to putter around new places but this time getting where I wanted to go took some doing. The road system, highway and local, leaves a lot to be desired and my rental car was sufficiently different from my usual Honda and Toyota to create a challenge. I had not exercised in ages so long walks, particularly uphill challenged my legs though heart and lungs seemed to tolerate the tasks uneventfully. This being a tropical area, I expected insects and was prepared to get some repellent at the local drug store but that was not needed.

I also consumed more alcohol than I ordinarily would. Typically on vacation I would have a glass of wine or a beer with dinner each evening, which in itself exceeds my usual consumption several fold. However, the resort prides itself on the manager's happy hour and we would not want to disappoint. While there is a two serving limit, the servings are generous and come with some munchies rather than substantial meal. One afternoon we toured the Bacardi Rum Factory, a local tourist destination well worth the time. Like most factory tours, the people take pride in what they produce and offer visitors their best stuff which I tried and rather liked. Even though several hours had passed and I reduced my Happy Hour allotment by half, it was still too much.

I came home reasonably rested, satisfied with the change of pace, not enthusiastic about returning to my usual weekly activities but not ready to retire either, though closer to it than I was a year ago. Having really liked the Bacardi 8 year old stuff that I sampled, I went to Liquor World and purchased a bottle for roughly the same price they were charging in Puerto Rico. It still sits in the unopened bottle. I have been able to tackle work without getting frazzled by excessive activity, which has not yet happened but eventually will.

Weekend Off

2011-10-24T06:54:00.000-04:00

While it was my intent to seek my highest level of amusement for shabbat, I had also intended to see patients in the hospital on Sunday. It was my good fortune, though to have nobody new to see other than a gentleman that I called in about on Friday night and who seemed to have something that can wait the weekend to sort out so I spared myself the round trip on Sunday. Three more came my way on Sunday afternoon so I will be playing catch-up but the extra day to myself felt at least welcome if not deserved.

For shabbos I convinced Irene to attend services with me at Beth Tfiloh in Baltimore. I try to go twice a year, usually only make it there once. It never disappoints. Bar Mitvah boy read the entire Parsha Bereshit, all 146 p'sukim largely error-free and with a nice early teenage voice. Rabbi Wohlberg crafted a sermon that drew on multiple sources to expand his theme. Even the Hazzan, who had been largely perfunctory on my previous visits, demonstrated why he holds a position in a large Orthodox congregation when most mechitza congregations no longer support them. A fair amount of what they do there can be incorporated into the ordinary function of AKSE but the sense of pursuing excellence does not seem to be there nor does the Rabbi seem to have a vision for what that might be.

I always wanted to visit the Boordy Winery on my way home. Once I stopped by but they were having a Festival of some type that I did not want to spend the money to attend. This time it was an ordinary tour day. For $5 they gave you a glass and enough samples to want to have the Maryland Police perform breathalyzers on the visitors as they returned to the public roads. For the first time, I declined to proceed with the full tasting after about six pours but Irene enjoyed the full spectrum.

Home in time to watch Mizzou lose. A rebuilding year. Shabbos concluded so after three days sans computer due to Yom Tovim and shabbos, I caught up with Facebook and e-mail, then off to sleep while the Cardinals were having a slugfest in Game 3 of the World Series.

Sunday had its own agenda. Irene wants to make the downstairs presentable. I want to make my bedroom a sanctuary, in not exactly a man-cave. My finances need some major attention. The sukkah has not yet become a temporary structure. I need to learn the haftarah and shacharit for next shabbos at AKSE. Some loose ends need to be tied up prior to vacation in only two weeks.

I ended up doing all the fleishig dishes, most of the essential laundry, made by living room desk nook functional, removed clothing intended for donation from the living room, deposited funds to my office account to pay the remaining bills, bought and installed a lamp for the bedroom, set aside some of the clothing I plan to take on the trip aside so I can put the rest of the summer clothing in a storage bag, and worked on the upcoming haftarah. While enough other stuff still need completion, this remains one of my more accomplished Sundays.

Chores

2011-10-19T06:00:00.000-04:00

It's only midweek. Despite a few decent night's sleep I am finding it hard to get going in the morning but once at work my energy manages to return at least until quitting time for everyone else but usually with a few patients still to be seen for me. I'm deprived of R&R which will arrive in a few weeks. Before that the undone chores accumulate, most to remain undone until my return to action in mid-November. This past weekend I got a table for the dining room assembled and the plumber fixed a major leak at the washing machine. Hospital billing got caught up. My unopened mail got opened and largely transferred to the recycling bin. More to do but limited motivation to act.

Sukkot

2011-10-16T18:30:00.000-04:00

Sukkot. This year finds me less motivated than in the past. I feel worn out, disappointed with the experience of my shul, maybe down a few rungs on the ladder of observance from a year or two ago. I bentsched lulav on Day 4 of 7. Our sukkah came out well, definitely worth the purchase of a pre-fab. Bringing a harvest to Jerusalem in Temple times may have been the precursor of what we think of as vacation. Getting away for a few days, maybe a little travel, getting deprived of some of your money in exchange for some satisfaction. Not having to go to work but only a half day in shul without all the shabbos restrictions of the other days off. Here it takes on something similar with anticipation and preparation to build the sukkah and acquire Four Species. Between Bond Appeal and synagogue appeal the week before some of one's funds have already been reduced. No tfillin the entire week. I must say, though, waving the lulav never really inspired me in a serious way and the final day of Hoshana Rabba I've always regarded as cult-like. It rarely comes out late enough in October to usher in the changing weather and changing clocks of autumn.

For the students it introduces exam season. They've attended classes for 4-6 weeks most years and therefore it's time to assess what has been retained. For Federal workers Columbus Day provides a real day off. For many of us we encounter Open Season when we can adjust our employee benefits. Those things often pre-occupy us, making the festival of Sukkot almost an afterthought were it not for the necessary preparation beforehand and the more gala Simchat Torah night to follow.

For me, the season also marks the approximate mid-point of my six semiannual projects. I took Board exams, made slow but serious progress on making the bedroom my sanctuary, have not yet made the blog interactive, not done any estate planning, my skill with the iPod has not advanced in three months and my weight is up a few pounds from July. My disposition has gotten a little better though.

Erev Yom Kippur

2011-10-07T06:44:00.000-04:00

Yom Kippur comes out on Shabbos this year. No exotic preparatory efforts, up early to make simple dinner, put my depleted supply of socks into the washer and dryer, enjoy some coffee, read about the Parsha which diverges from the weekly Torah cycle. I will be carrying the beeper and cell phone for this, the first time since my fellowship that I am subject to communication on Yom Kippur, but there is very little that cannot be managed that way.

While this has been a traditional transition point, reflecting back, making corrections, preparing to move onward without actually moving onward, I've been too preoccupied with other things to regard this as a meaningful break for me personally. That usually comes at mid-year and late-year when I do my semiannual goal setting. Still there is a benefit to having a communal break point, one stacked with good intentions, interruption of animosities justified and not, a remembrance for people close to us who are no longer at hand. One day out of a lot of days to escape meal preparation, to trade the pageantry of work for a more traditional formality, to not have chores that cannot be postponed until the sun sets the next day. While this is not vacation, it is a diversion that separates yesterday from tomorrow.

ABIM Recertification

2011-10-05T06:40:00.000-04:00

It's the following morning. Six hours in front of a computer answering questions. Don't know whether the score will meet threshold or not. Whatever the outcome, this time the questions seemed more in keeping with what I actually do in the office. I probably did well on the questions asking for a response to lab data, not as well on things involving karyotypes and genetic disorders that I rarely see. There were a lot of questions asking about lab features in a specific situation. I could usually exclude three of the five choices so if I get half of those correct I stand a fighting chance of not having to do this again.

For a profession that largely runs on the honor system, the security seemed excessive. Nothing in pockets except drivers license and locker key, no watch. My wedding ring has gotten too tight to take off easily but they let me keep that. They took a photo and a print of each palm that had to be verified each time you went into the computer room. They replaced my handkerchief with three tissues taken from a box at the doorway.

I have a pledge not to divulge questions, not that I remember all that many, mainly the ones I wished I had studied for but didn't. I spent a fair sum on preparation, attending a review course and purchasing a question-answer book from the Endocrine Society. Surprisingly little from the review course made its way to the actual questions. Many of the points in the sample questions appeared in other forms.

At this point, sitting in front of a computer for six hours has taken its toll. By the third two hour session I just wanted to get done. My analytical skills and ability to extract details from the questions had waned and response time was slower.

It's done now, at least until the scores arrive. Life was put on hold for a while. But right after signing out I headed off to the Motor Vehicle station a few miles down the road to get my car inspected and renew my registration, then a trip to the gas station that sells my favorite iced coffee at a bargain price, then some light shopping, then to Stanley's Happy Hour for a pint of Yardley brew made in Philadelphia while watching the playoffs and creating my October to-do list which does not differ all that much from what was never accomplished on my July to-do list. No debauchery, just an attempt to unwind and restart what had been set aside.

New Year 5772

2011-09-28T05:20:00.000-04:00

Rosh Hashana begins tonight. I do not feel connected to it this year. One year ago it marked the dividing line between closure of my practice and the first day on the new job. This year Board Exams follow Yontiff. I feel a little beaten down by the job, keeping long hours, looking for my next respite however brief.

I will not be attending AKSE services until Yom Kippur. Irene took a particular liking to an independent egalitarian offering run by people who desire a better experience than what their congregation offers, or more accurately needs to cater to in order to keep a broad dues paying membership content. I could use a couple of really good sermons. My heart is just not into the themes of turnover and renewal. Don't really need a new me, but some upgrades to the current me might be in order.

Shabbos Dinner

2011-09-16T07:13:00.000-04:00

As the sunset times get earlier and before long Eastern Standard Time arrives, there becomes less of a window for my wife to prepare a Friday night dinner worthy of Shabbos. That brings the task to me, generally done from 5:30-6:30 on Friday mornings but some preparation earlier in the week. Meat, usually chicken but sometimes beef or even fish if I plan to go to Beth Emeth reform oneg shabbat where the good stuff is milchig, has to be defrosted on Wednesday or purchased from Shop-Rite Thursday night. Mini-challot get defrosted on Thursday or purchased during the day on Friday. Depending on the main course I will marinate the meat the night before.

For the most part the preparation is simple. Usually chicken breasts or a dismembered chicken gets browned in a big pan, then seasoned and put in the oven while I prepare boxed couscous or rice. Occasionally beef is on sale, so I will put stew meat into the crock-pot along with vegetables, rice or beans, spices and plug it in. Once in a while flanken or short ribs goes on sale so that is prepared like the chicken. Occasionally I will feel more energetic and obtain a pot roast, whole chicken or turkey breast which I prepare Thursday night. A frozen vegetables get nuked in the microwave and Luigi's Pareve Water Ice makes for a suitable dessert.

Usually the dinner is simple, an end to an often arduous work week, a demarcation point, something worth a little extra preparation to do. We avoid appointments that night other than maybe watching or recording Washington Week and in a prior era seeing what JR was scheming on Dallas. Since I completed Kaddish, even attendance at Beth Emeth where I really like to hear what their Rabbi has to impart, is decided by what time I arrive home and what time they start that week. No appointment to finish at a certain time.

I've also not been to AKSE's monthly shabbos dinner in a very long time. While I admire the effort and intent of the people who assemble this, going there really amounts to keeping one more appointment, a place that I need to be at a fixed time. My work week keeps me in contact with people who come to the exam room at a specified time. I cannot escape from patients in the hospital, residents and colleagues tapping into my knowledge, irritation about some process gone wrong. Shabbos is really an escape from that. While my Rabbi's have tried to instill into my mindset the need to assemble with community that day, my fondest shabbat experiences really took place during my final two medical school years when I no longer had exams on Saturday morning and I could escape by myself for a peaceful evening. I would plan dinner alone or occasionally splurge oh so very gently to walk to a vegetarian restaurant not far from my apartment for a special supper that I would be unable to prepare on my own. Shabbos became an Island of Time with myself and later with my household, as it still is. While divine intent was for it to go from sundown to sundown, I came to appreciate and anticipate a somewhat shorter break from the usual, as shabbos morning services bring another set of appointments and a return to a a public sphere, though with different players to separate it from the work week. It is really about Me Time, Family Time, maybe a bottle of craft beer with a dinner that does not require scrambling for the final assembly and enjoyment. And then maybe some Rabbi and God Time the next day.

Learning a Haftarah

2011-09-07T06:40:00.000-04:00

AKSE had an interesting debate, or really discussion since in principle everyone was on the same page. Our Cantor opted to depart with more than ample notice and we really could use the savings in salary. Do we need a Cantor or do we need some or all the things the Cantor does? What is the minimum purchase and should we do the minimum? We do not have the capacity to get the Torah reading done by congregational volunteers. That has been long established and therefore a reader is hired for most of the Cantor's scheduled vacations. We already have a volunteer for shacharit most weeks and musaf when the Cantor wants to do shacharit instead. Can we get two a week instead of one a week and can we cover the speicial times as the New Moon approaches each month or the yom tovim or rosh chodesh impose significant variations to liturgy? And let's not even mention Shabbat Mincha where we have both a unique service and a Torah reading. The word from people who assign the parts, which gives them great credibility is that we cannot. This probably separates real Orthodox congregations where skill is abundant from the wannabes like us that promote the aura without really having the substance. And so the decision was made to bring a real Hazzan aboard for Shabbat and Yom Tovim. He began last weekend, a nice classically trained fellow from another era. While I appreciate his talent, my enduring fondness for Jewish worship really developed amid the Hillel foundations that I attended, the epitome of grass roots participation where a threshold of competence was expected, show-off flourishes discouraged, and the ba-al tefilah varied from one week to the next as did the tunes imported from the various home towns. As nice and adaptable as the new Cantor seems to be, I predict that those in attendance will tire of the experience in a relatively short time.

AKSE does have one remaining bastion of volunteers on its Bimah, the Haftarah readers. Most people acquire the rudiments of skill through Bar Mitzvah preparation and given enough time the portion can be recycled many years later. There are enough people, mostly alumni of the once grand Conservative congregations who can sight-read Hebrew sufficiently and have familiarity with trop to learn any Haftarah in a short time. The cadre of readers has expanded, though rather slowly.

My latest assignment on this takes place the Shabbat after next, Isaiah Chapter 60, one of the Haftarot of Consolation following Tisha B'av. The language seems rather difficult which challenges the fluency but it is these challenges that make the effort worthwhile.

Board Exams

2011-09-06T06:48:00.000-04:00

An every ten year ritual, starting about four years ago with open book self-tests and this horrid thing called a Practice Improvement Module that started out as a legitimate assessment of how well or poorly I communicate with referring physicians but morphed into a series of complex work flow diagrams when my two secretaries and I were the only ones there to do work. And now the exam. The patients in my practice modules and on the last two exams don't resemble what I actually see most days. I do not think I've ever seen a Fragile X Syndrome or a McCune-Albright "coast of Maine" cafe-au-lait spot. I've been studying from practice exams written by various professors whose biases can be detected from the questions but at least I can extract the principles that I am expected to know from the questions. Did well with the diabetic questions, stunningly poorly with the adrenal questions and somewhere in-between with the reproductive questions.

This is big business. I paid about $1000 to enroll in the program, $120 for the review book published by the Endocrine Society, and the outlay for the review course will set Mercy Hospital back most of my contracted Continuing Education allotment. The pass rate for Endocrinology is reported at 77%, the lowest of any specialty.

To be fair the American Board of Internal Medicine which sponsors this, it has moved ahead of the fraternity hazing of ten years ago. There is legitimate educational content to the practice sessions, the people I've dealt with by phone have been responsive and professional, the Old Boys have been retired and replaced by a CEO from the American College of Physicians who at least has a sense that an annoying process needs to have some off-setting benefit. Still the exam looms a month away as I continue to struggle with the review book and head off to the intensive review course in Cleveland in a few days.

Investing in Bingo

2011-09-05T06:35:00.000-04:00

Many synagogues, including mine, have their financial challenges. There is actually a literature on this, though my sense of the officers is that they really haven't explored this much, opting instead for a quest for fundraising which in a good year may add 5% to revenues though it usually comes with a significant financial risk to get that 5%. Memberships make the place financially solvent, either in the form of dues or contributions beyond dues. There is a limit, though, to how much of our own member funds we can wring out, so there is always an interest in getting income from other sources. Synagogues and churches have rented space in their buildings. Some have elegant catering facilities that generate a profit. Some have public events. Our officers opted for Bingo. Without getting into the propriety of this, which the Rabbi approved so it must be OK, its only direct purpose was to generate revenue with perhaps an unintended by important benefit of generating a rather strong group of volunteers dedicated to the project. It was expected to lose money the first six months, which it did, to the tune of $8 K which required re-examination.

As AKSE projects go, this one seemed to be handled reasonably well. People did their homework in advance, knew what to expect, analyzed trends, and expanded participation beyond the President's usual A-list people. Will it ever make money? What about serious money? What about the value of having a project that members are committed to for its own sake? Any indirect benefit to member retention? My interpretation on these questions is mixed. It can probably make some modest profit, about what a successful fundraiser would make.

When all is said and done, there is still a budgetary deficit forecast this year and no serious intervention to erase that, let alone repay what is owed other than Bingo. Until something else arises, break even with a measure of community development as a beneficial unintended offshoot needs to continue a while longer.

Vengeance and Grudges

2011-08-21T18:28:00.007-04:00

Evening of Learning

2011-08-15T07:19:00.000-04:00

Tisha B'Av 2011/5771. It was an ordeal to get home in time for the fast, having gotten some patients who needed the healing hands before I could head home. Rather than cut it tight, I stopped off at a buffet with a reasonable amount of vegetarian not far from Mercy Philadelphia Hospital which would assure me some nutrition in advance of the fast. I ate quickly, arriving home in time to get to either AKSE, Chabad or Beth Shalom, where my wife was chanting Eicha Chapter 2, barely in time to go to any of them. I decided to stay home and observe Tisha B'Av evening with the insights of the cyberspace Rabbis instead of rushing to hear Eicha. Since we are not permitted to greet people that evening, nobody would feel slighted by my staying home

Yeshiva University has an extraordinary program of recording lectures from all sorts of venues, then making them available for download at http://www.yutorah.org/. They had an entire Tisha B'Av program so I started with an presentation of about a half hour's length by Rabbi Kenneth Brander on Lessons of the Destruction of the Second Temple which was destroyed due to Sinat Chinam and never rebuilt. Then an intro to Eicha by Rabbi Einhorn who does the synagogue development program for the Orthodox Union. Then one more less memorable and I fell asleep. The following night the fast had not yet concluded so I listed to another iPod presentation.

None of these are interactive, which should be the prototype of rabbinical education, yet there was an elegance to each of the presentations that rarely comes my way live. We are fortunate to live in a time where the ideas of learned people are so readily accessible and if you want the learning and don't particularly desire the university degree or other credential, they are available at nominal cost.

Genevah

2011-08-04T06:58:00.000-04:00

New stationery for AKSE with the name of the newly hired cantor on the letterhead. The first mailing was to tell the truth about the now former cantor's departure. Rumors have a way of getting around. No, he was not fired but submitted his resignation with six month's notice and fulfilled his professional expectations to the final day. He will need a minyan and has to assemble it from somewhere or find one already functioning if he does not wish to attend the one at AKSE. Nobody will chase him away if he shows up. I hope nobody will expect him to provide his skills for free if he does come.

Apparently there are rumors that AKSE terminated the Cantor and rumors that he is in the process of siphoning AKSE's talented members. I must be on the B-list since I've not been invited to join him and heard nothing to the effect of an involuntary departure, though word of these things has reached me indirectly over a considerable distance. To squash this the President sent out a broad mailing to the congregation, copied to the presidents and Rabbis of all the area synagogues and the Federation. I think the content of the letter is accurate, whether worth the mailing costs to the congregation might be more questionable.

The On-Line Smicha program apparently goes in stages by topics. I surmise from all this that the module containing the principles of Genevah or stealing has not yet been tackled. Leaving a false impression like being terminated when reality is an unsolicited decision to quit would fall into the category of Genevat Da-at or literally stealing information. Depriving a congregation of its needed membership dues and its talent by soliciting the departure of others would also be a form of Genevah if specific individuals were targeted, though probably would be more akin to legitimate competition for desired services if not individually solicited. There is a synagogue etiquette not to lure members of another congregation to your congregation which has maintained collegiality in our region. This came up at a Board Meeting about three years ago when the new Rabbi arrived and the Membership Committee felt it appropriate to invite back members who had left with individual invitations to return, particularly those with Rabbi generated attrition. Most had latched onto other congregation, one even becoming its President, so the project was not undertaken to avoid the impression of Genevah.

Will AKSE have some of its dues, attendance and participation skimmed off by all this? I think there will be a small amount of one time attrition, though less than would ordinarily occur by other deterrents such as high dues, often boring sanctuary experience, and the actuarial outcomes of an aging membership base.

Six Projects

2011-07-26T06:40:00.000-04:00

Semiannual planning amid a time of overwork, where one transfers from one urgency to another without regard to importance. There are patients that need to be seen right now, others in the hospital that need to be seen today, expected to show up at AKSE on Saturday morning, there are deadlines related to my medical license and to closure of my office which still goes on one year after the last patient exited the exam room. Most of the important things do not have deadlines but are easily deferred to less important things that do. Each June and December I try to decide which things deserve my attention and creation of some appointment time with myself to do them. Usually I agonize over this, often spending more effort with the planning than the doing. It started out that way again but to my surprise, the projects fell readily into place over coffee at the Brew Ha-Ha about two weeks ago.

I will pass Endocrine Recertification Boards
I will create an estate plan with the attorney
My bedroom will be decluttered and redesigned as my personal sanctuary
The scale will read under 150 pounds
My blog will become an interactive one
I will finish the book I bought on how to derive maximum benefit from my iPod

All projects are doable and have identifiable end points where a box can be checked as done or not done. In the two weeks since its creation, the progress has been less than I hoped but this week I carved out specific time to do some of these things. Unfortunately I am still often tired when I return home at the end of the day. The bedroom and estate planning can be done on Sundays, the other stuff probably best to carve out 20 minute blocks during the week. The trick to accomplishing these will likely be to have finite intermediate points and somebody prodding me along the way.

Overdue Vacation

2011-07-15T05:58:00.000-04:00

It's been diificult to stay focused and motivated. The management has decided that there is too much idle time in the office due to no-shows and responded by overscheduling which leaves me scrambling to take care of the hospital and in a little ongoing conflict with them. I had some welcome down time yesterday, easy morning at the satellite clinic, no-shows at the office in the afternoon, enabling me to get to consults and hospital rounds earlier than usual. Last week at the satellite I divided the no-show time between semiannual planning and catching up on medical records. Yesterday I devoted a welcome hour to commenting on some postings by my electronic friends at AEI and reading about health economics and reviewing some Delaware medmal cases that were posted on line.

There was a fancy dinner at a hotel for employed physicians. On one of the rare occasions that I could have gotten there at 6PM, I sent my regrets, preferring instead to just get home, work on my upcoming Torah reading and maybe do a few chores.

My last recreational vacation took place in summer 2008. Since my partner left in February I have not had a beeper free day. The patients just keep coming at me. Any escape from that is welcome, even if only for an hour on company time. I've tried carving out ME days on Saturday and weekends where I just stay home, including the coming one. But I think the activity has gotten to me, I'm irritible, make decisions a little too impulsively, drop followup balls and really need to get away from this for maybe a whole week. Scheduled for November. Need to work on what my highest level of amusement is so that I might seek it.

Important Initiatives

2011-06-27T22:17:00.000-04:00

AKSE HEBREW SCHOOL

Easily provoked, hard to pacify is wicked, the sages of Pirke Avot noted, נוח לכעוס, וקשה לרצות--רשע yet find myself still irritated with the congregational president weeks after confrontation, still ready to take his money away and let him recoup $2625 from Bingo players who have no stake in the congregational experience or future.

This week I reviewed the things I actually did there that were of value to the congregation and of importance to me. Not committees, not positions or titles, but things that came from my perspective and intellect, actions that required insight and maybe some tenacity but reinforced the core principles that brought AKSE to prominence a quarter century back and in some respects sustained them in its decade of decline.

STUDY FOR RITUAL COMMITTEE ON TORAH AND HAFTARAH PARTICIPANTS

Very little about AKSE occurs thoughtfully with nary a modicum of learning from what went before. Leaders think they know where things stand, but there is precious little in the way of review and upgrade, irrespective of whether what occurred should be repeated. In medicine, data rules. There are symptoms that must be taken seriously but there is also objective information in the form of lab data and imaging. In law there is eyewitness testimony and documentary evidence. At AKSE hearing is believing. Sh'ma takes priority over Re'eh. It was my impression that from the time of the Cantor's arrival no new people had been added to the cadre of participants over the preceding five years and that those who remain were being scheduled more than they had been previously. With a little help from the office I retrieved two years worth of shabbat bulletins five years apart. The first year came from when we were interviewing Cantors, the second five years later. During the interview year, as expected, the people coming for auditions appeared on the schedule. Among congregants, however, only one new person was added. He was an important addition who has contributed greatly. For the First Congregation of the First State which prides itself on the talents of its members, the educational yield proved marginal It is one thing to obtain information, quite another to make use of it. To the best of my knowledge nobody since has repeated that review or tackled any other review. They are still trying to fix a morning minyan problem by perceptions when they could have real information and use it to move beyond the periodic appeals to men when there is already a literature on minyan development. Data can be obtained and spoon-fed to the people in a position to use it. But the curiosity to obtain it seems largely mine alone.

TOOK OVER MINYANAIRE TEACHING WHEN A GAP OCCURRED

For four years I conducted a class for the teens each Sunday morning. A parent whose own kids graduated from the program had been doing this but opted out when his last child graduated. That left another parent, perfectly qualified, indeed still there, to carry on. Conducting a class seemed like a suitable challenge, envisioned by me much like medical teaching rounds which I had not done in ages, the difference being that I would have to prepare the topic in advance. It also turned out that even though the minyanaires program had been ongoing for sixty years, I was apparently the first volunteer who had no children of his own in attendance.

The boys, and as much as I could the girls, were just not used to Judaism being a provocative enterprise. They were all alumni of AKSE Hebrew School, Einstein, and a few poor souls subjected to the combined Hebrew School. We started with Davening each week. I made no preparation whatever for this, simply interrupting the prayers at random when something of interest caught my eye. While they could recite familiar Hebrew and recall tunes, their education up until then afforded them zip in the way of vocabulary or the historical origin of the siddur, which is really a form of cut and paste from other sources. Ironically, the Rabbi has absorbed this into his Tefillah Tidbit presentation but my diversions for the kids were a good deal more sophisticated. We talked about time: et, sha-ah, zman. We talked about the senses: shma, besamim, maror, touching the mezuza, re-eh. They do not get this type of appreciation from either Hebrew School or public worship. Either they have to generate their own curiosity or somebody like me has to challenge them.

Similarly, the discussions after breakfast became a form of machshava. We discussed core values like Jewish Friends and Facebook Friends, Giants and Patriots on Super Bowl Sunday, the role of Jews in integrating Basketball, Jewish Litmus Tests, and any other imaginable implementation of core Jewish principles that find their way into their own experiences. Hebrew School is boring, always has been. Unless what is learned there gets repackaged later into something meaningful and timeless, it is only a matter of time, usually the freshman collegiate year when attendance is no longer taken, until attrition from synagogue, the primary institution of Jewish life becomes irreversible.

MADE A LIST OF ALL CONGREGATIONAL GROUPS

For all my irreverent quips directed at AKSE's professional and lay leadership, it has the potential to be the premier Jewish destination in the State of Delaware. Decisions may be dumb and they may think like Jewish Luddites but the people who comprise the membership are people of talent and for the most part decency occurs without the Rabbi having to insist on it. Yet in my time there, a fair amount of attrition has occurred, some passive as people moved to the nursing home, Florida or cemetery, some active, usually driven by the perception that AKSE deprives women of opportunities that would be available to them most anyplace else. We live in an America where one's merit counts more than one's chromosomes or pedigree, though nobody has been resentful of the Kohanim in any way. Yes, Judaism has its elements of Who You Are and What You Are. AKSE and anyplace else, offers a package. If there is something you might like to have but cannot, there is usually a way to find a suitable surrogate, unless the unavailable element is the absolute litmus test, which it rarely is. But why would somebody come preferentially to AKSE at considerable economic expense? If we entice a shopper with a free year, what might they do with that year to create an attachment?

To my surprise, as of a few years ago there was no organized list of what really happens at AKSE. My orthopod offered me a chance to find out and pass the results along to people who could act on them by invading my right knee with an arthroscope, traumatizing some irritating cartilage in a benevolent way, then confining me to bed for then next three days. I took a High Holiday bulletin, an Annual Meeting Report, the Bylaws, some Shofars and some weekly announcements and created a catalog of all groups that existed at AKSE at that time as well as some that should exist as required Bylaws mandates but did not, then submitted the list to the President, along with a separate designation of those that were exclusive to AKSE. At the next High Holiday Bulletin, the list was compiled and offered to those in attendance as an invitation to stick one's face into AKSE's trough. It still appears in a condensed or abridged form on the synagogue's web site, http://www.akse.org/. I do not think the project had nearly the impact that it could have as a passive list does not really acquire vitality until there is a Shadchan or at least a Cruise Directory to assess what people like to do and channel them into the appropriate group that already exists. That has not happened. In many ways the culture of AKSE over at least a generation has created an insularity that accepts newcomers but does not seek them out or do a particularly effective job absorbing them or taking an interest in what makes each individual a unique potential contributor. Therefore providing participatory opportunities for newcomers has to go in the other direction. For all the promise of the current Mentoring Program for new members, I doubt if anyone actually doing this has the saichel to take the rather comprehensive list compiled from my sick bed and match it to interest of the individual newbies nurtured through what we think of in the medicine world as a purposeful interview.

RESTORED A MAN FROM CHAREM TO THE BIMAH

We have Freedom of Religion in the United States. When Jefferson assessed this as a better late than never inclusion into the Constitution, his reasoning revolved around freedom of thought which can never be deprived and its free expression which can, or at least some very negative consequences implemented. We had a gentleman, a person who contributed materially and whose family are among the shul's most valuable individuals banned from the Bimah as an aphikoros based on his thoughts. I was never happy with Rabbi Dresin's decision or even the reasoning on this. Over the years I have flunked some litmus tests and have attended congregations as one day visitors with no return having been looked at derisively over driving there or my skepticism of Moshe taking divine dictation or that the men of Talmud simply discovered divine will that they did not themselves create. It was clearly within Rabbi Dresin's professional authority to make his decision and enforce it. If the victim did not leave on its account, neither should I though I was always uneasy with sending a person to Charem. There is certainly a tradition for this. A visitor to Amsterdam can see the actual membership roster of one of the synagogues with Baruch Spinoza's name crossed out. They probably did not even try to recoup those dues through fundraising or Bingo. Today people do not know who the machers of that synagogue were but centuries later people still study the thoughts for which Spinoza was rejected.

New Rabbi, new opportunity. I asked the Ritual Chairman to put the discussion of this individual to put a discussion of restoration of this individual to full participation on the agenda. It was clear that he had the same uneasiness with restricting a good and decent individual that I did so he agreed instantly to include this in the first Ritual Committee meeting with the new Mara D'Atra. The agenda item reached its appointed time with the new Rabbi commenting in a very cavalier way that Rabbi Dresin had given him a heads up on this and the old decision will continue. At the end of the meeting I literally stalked the new Rabbi to insist on a private appointment to discuss this and another issue that I think he mishandled, which also included the berating of child of a Committee member as the parent of that child listened defenseless. The purpose of having a new Rabbi was to turn a new page for the congregation. When I arrived in 1997, I think people were treated a lot more sensitively than in 2007, starting with the gentleman banned from the Bimah. People have their personalities which basically do not change short of brain injury or serious prescription writing. To wave off an injustice without even looking into the objections that people have pouncing on somebody who is only doing what his neural pathways direct speaks somewhat negatively of the Rabbi's judgment, maybe even the effectiveness of his collegiate education. In any case, fundamental injustice to an individual would not be waved off just like that with no challenge. I do not know if anyone else came to this fellow's defense. Not only did I approach the Rabbi but I called one of the congregation's psychologists who understands what obsessional people do and meet with Rabbi to teach his that, let alone not having a parent defenseless in the room while people attack his son's expected conduct. He understood exactly where I was coming from on this but I do not know if he followed through or if anybody other than me came to the defense of these two people.

I heard nothing else, but reinforced my impression of the new Rabbi from the public committee meeting and from the private session in his office. I heard nothing of the outcome but not long thereafter, this captive from Charem ascended the Bimah for an aliyah, overdue for several years, something that probably would not have happened without my insight and tenacity.

When Yochanan ben Zakai received a reward of three wishes, he chose two for the future and one for now, protection of the family currently representing the Davidic lineage and enabling the Academy at Yavneh to function undisturbed to assure preservation of Mesorah and one to find a physician for a worthy individual who needed one. We cannot really develop community without having sensitivity to the people who comprise the community. It is easy for the President to develop his A-list, which I think he has, and recycle what was done before, and easy for the new Rabbi to talk to the outgoing Rabbi to maintain what was done before, even if improper. The future really depends more on doing the difficult stuff, recognizing that outliers are part of the community too and that they have perspectives that make a community complete. How we treat the most difficult individuals really determines what the values and standards really are.

STARTED AKSE ACADEMY

Somebody asked not entirely rhetorically at a recent Board Meeting why do we have a synagogue? What is its product? Ultimately it is to make for more capable Jews, creating a commitment to Heritage, being able to explore what that heritage is with reasonable implementation. You can create community anywhere: Federation, Bowling League, work. You cannot make Judaism sparkle everywhere. That requires a certain amount of transmission of knowledge, an insistence that one's daily activities absorb Jewish values. Some type of teaching is needed for that. There also needs to be the right amount of selectivity over what gets taught. My first exposure to this came from the JCC Spring Valley when as a high school senior the congregation invited Professor Theodor Gaster of Barnard College to give six weekly presentations on Comparative Religion. As a university student there was ongoing interest in this type of Jewish learning. Over time the vibrant life on campus gave way to the local synagogues which have been in relentless pursuit of mediocrity for some decades. In tribute to Rabbi Kraft, his congregants endowed a fund to bring individuals of special accomplishment to present to the community and for a while the local Federation also sponsored a few giants of World Judaism to present at large public gatherings.

At AKSE, which should be the premier educational forum in the community, we never really caught on with this tradition which probably goes back to the days the Maggids who would travel from place to place imparting their wisdom to whoever might listen. We had visiting scholars, misnamed Shabbatons, who would impart three sessions of declining attendance starting with a well-attended but late dinner on Friday night, above average attendance with luncheon on Shabbat Morning and Mincha with at least a secure minyan. Reviews were mixed, it was expensive, there was a fair amount of discord on how to best accommodate different levels of observance that the guest required. By Sunday could anyone remember what the talks were about and did anyone become sufficiently engaged to live differently as a result?

The alternative, of course, would be to do the education internally. We pay two clergymen whose purpose is to advance us as Jews. The weekly sermon cannot go into a subject in depth. There has been an open interactive forum at the end of Kabbalat shabbat but since it is unprepared the responses to random questions often reflect a form of pooled ignorance. At the end of Minyan there is a brief remark on Halacha, again something read from a book but without analysis. Engagement of the congregation with their own Jewish advancement has not gone nearly as well as it could have.

To fill this void, if only for an evening, I recommended that we embark on a project done by many other synagogues, namely an internally generated evening of learning which became the AKSE Academy. It entails much less financial risk than outside speakers, requires no casts of thousands for dinners, no discord for mechitza and showcases individual talent, which plays to our strength. If AKSE is ever to exploit a form of product differentiation that enables it to overcome its community albatross of the Women's Thing, it will have to be the ability to attract the individuals who have a self-motivation to advance themselves Jewishly and impart their knowledge and education to others who are self-motivated in other ways. AKSE Academy may be one of the few things, however brief the annual experience, which enables that.

ARRANGED FOR PROFESSIONAL DEVELOPMENT OF AN INEXPERIENCED RABBI

Being in St. Louis the weekend the Rabbi came for his congregational visit I did not get to meet him or partake of any assessment. Vibes came my way, most of which proved accurate. In medicine we have the four ABLE's: AvailABLE, AffordABLE, AffABLE, and ABLE or some would say CapABLE. We scored three of four. Newcomers are generally greeting with enthusiasm and a measure of respect for the people who did the work to accomplish the mission. Yet first impressions count as well, and within a few shabbat services and a few conversations I really had no inclination to return from one shabbat to the next and endure some trivial part of my Hebrew School background recycled to me from the bimah for ten minutes each week. My college classmate now JTS Chancellor Arnie Eisen was quoted in the media as describing a Conservative Jewish sanctuary experience as one of "boring sermons, rote prayers, and people strutting around with great self-importance." AKSE had avoided much of that with a weekly sermon that often provoked Cards & Letters, a very capable Hazzan who made the weekly prayers something of the musical surprise that awaited and delighted me in my Hillel years that remain the model in my mind of what worship ought to be like, and the absence of macher swoops. Since I follow one sage each year for the weekly parsha, the year I followed Rabbi Frand there were a lot of AKSE sermons expanding on Frand's weekly theme, suggesting that Rabbi Dresin was reading the same book. I chatted with Rabbi Dresin about how he assembles his weekly message. He indicated that he has about thirty sources that he typically draws from, picks a theme and relates it to current experience. The sermons often did not really have a beginning, a middle and an end but never lacked for links to the wisdom of prior sages. Now the sermons did have a beginning, a middle and an end, composed at about the level of a Junior High writing composition.

In his memoir, Tending the Vineyard, Rabbi Berel Wein once of my beloved Monsey noted that as congregational Rav he only had about ten minutes each week to convey some type of insight to already learned people that they did not have when they arrived in shul that shabbat. Those sermons and later the history classes that he conducted for his congregants became the basis of the Jewish history books that made him internationally prominent. Our ten minutes recycled Hebrew School. There were no advanced concepts, no Machshava, no private follow-up discussions that captured the nuances of Judaism in his own themes. Now, they did have a beginning, a middle and an end. The presentations were grammatically at about a Junior High level to be delivered to PhD scientists which largely included Jews who abandoned the United Synagogue Congregations as too trivial Jewishly. While the public expression may have been favorable due to the absence of diatribe, the young Rabbi would not develop professionally if he kept doing this, though I suspect very few of the dedicated congregants would vote with their feet over this. After the first Rosh Hashana's mundane experience, I contacted the President who despite the generally good feedback over the sermons that he had heard clearly understood what I was pointing out and we arranged for a former congregant who now does homiletic coaching professionally to take the Rabbi under his wing and develop his presentation skills. A year passed with a clear improvement in style, some experimentation like presenting from the the pew level rather than the bimah, some interactive sessions. Yet come the High Holy Days, the themes and their development bordered on trivial. At the Board Meeting, there were comments about the Yomim Noraim experience which had most of the people admiring what had transpired until Irene rather than me took exception to the presentations that my daughter had commented were worthy of Rabbi Phil. They were, with the exception of Kol Nidre, largely devoid of any serious Jewish content. Irene had spent much of the Holy Days at an independent Conservative Minyan where volunteers made the days sparkle, then she came to AKSE where the message from the Bimah, something that should be the Rabbi's principle summer project, did not require either time in Rabbi School for content or even a high school diploma for level of presentation. Her comments were censored from the minutes by the Board of Governor secretaries until I raised the issue before the acceptance vote. If he underperformed, which he did, there is an obligation to recognize this and take steps to correct this. His future depends on this. I do not expect AKSE to survive until the Rabbi reaches the usual retirement age so there will come a time when he must market himself as CapABLE as well as AffABLE, AvailABLE and AffordABLE.

Shortly after the Holy Days, the homiletics coach came as guest speaker one Shabbat. He spoke about another Rabbi who had waited 23 Years to make an important point. I waited 23 days, then contacted him about the High Holiday experience, which he had also attended, then made some provisions to provide guidance and feedback so that professional presentations would be a better reflection of professional skill. Six months and then some have elapsed, and while I still perceive the homiletic repertoire to be a limited one, there is at least some consistent upper tier Jewish content to be imparted each week.

PROTECTED THE EDUCATION OF THE HEBREW SCHOOL KIDS

It makes no economic sense, and not that much educational sense for AKSE to operate its Hebrew School the way it does. There are enough kids for one or two teachers and loads of models for successful education in one or two room schoolhouses dating back to the Northwest Ordinance of 1787 which mandated this. There are benefits to larger enterprises. An attempt was made a few years ago to combine the AKSE and Beth Shalom Hebrew schools for mutual economic benefit and if done right mutual educational benefit. Our amigos across town really intended to continue what they had been doing for the last thirty years to undermine the Conservative Movement educationally, only have our kids subsidize their march to mediocrity or less. Along the way I had an interesting conversation with the VP Education for United Synagogue who understands the educational underpinnings that have brought about great attrition in his movement but an unwillingness to incur local unpopularity to correct them. AKSE and Beth Shalom educations were never equal. If one attends a bar mitzvah at each, the kids seem hard to distinguish. Both are destined to the same college applications, both read their haftarah and other parts of the service in a way that reflects nachas on parents and teachers. They separate at Gratz, approximately two years later when the AKSE kids become viable practicing Jews while the Beth Shalom kids remain ethnics, carrying for the identification with Judaism but not really having the literacy skills or the understanding of Mesorah that one needs to move beyond the bane of Hebrew School to the parts of Judaism that will enable their generation to make its contribution. To give AKSE kids a Beth Shalom education diminishes AKSE from its starting point and deprives Beth Shalom and the Conservative Movement of what they could have had instead.

Leaving my Beth Sodom quips at the doorstep, though with a repertoire greatly expanded from two years of committee meetings, I made a decision in my capacity of VP Education representing not only AKSE but Gail's interest and the educational outcome of the kids to take a very hard line. There were end runs. The Beth Shalom principal went so far as to propose a curriculum to the committee done unilaterally and without the derech eretz to even show it to Gail before presenting it, let alone composing it jointly for mutual interest. Worse, the Sodomites on that committee with the exception of one real educational professional saw nothing wrong with that, taking the view that the larger congregation should prevail. Years later I am largely convinced that wherever Conservative Judaism is heading, Beth Shalom will get there first by their own initiative. They do not have to take down the future of some really good kids or persecute a real pro like Gail in the process. I found it appalling how inconsistent our own representatives were, hand-picked by me for their expertise, in making sure that an AKSE education would continue to allow our own kids to advance as Jews.

There is a post-script. The schools separated. United Synagogue set standards for their schools which Beth Shalom agreed to pursue. I read the standards and they are a step beyond the principal-directed organizational anarchy that existed before. They in no way mandate what has become the expected AKSE education and its beneficial outcome. In some ways they make the Conservative educational system into a "Pig with Lipstick" and will continue to until they grapple with mandatory assessment of outcome but at least it is a formal recognition that what happens to the Hebrew school kids happens to the Conservative Movement a generation later. And what happens to AKSE kids drives what happens to vibrant observant and literate Judaism a generation later as well, irrespective of what the ultimate destiny of AKSE as an independent entity that stands for upper tier Judaism in our community happens to be.

COMMON THEMES

Seven projects, all significant. The Sages noted that no two individuals have the same voice, appearance, or mode of thinking. If I have a divine gift, it is my curiosity to explore why I have the experiences that I have and make the experiences new. All seven initiatives, and they really are all my own personal initiatives, reflect that. Moreover, all seven have passive beneficiaries other than myself. With the exception of the gentleman redeemed from Charem, the other six require some effort on the part of the ultimate beneficiary to derive what is possible from my effort, something that did not always come to fruition. But still each project advances capacity of somebody else in some meaningful way, and in a manner that nobody else either thought to do or took the initiative to do.

Day Off

2011-06-26T19:50:00.000-04:00

It was supposed to be. Unfortunately Mercy Hospital does not afford me real coverage so except for a brief time under anesthesia this morning my beeper has remained live even if I could not be physically present. My nurse practitioner got more than she bargained for trying to cover the hospital. I definitely need a real vacation and there can be no compromise on this. As is I do not really get time off, only postponement of the tasks. But those few minutes of propofol and what was probably forgetable extacy was most welcome.

Electronic Friends

2011-06-02T06:22:00.000-04:00

Cyberspace has served me well personally, medically and Jewishly. As I become irritated with the local synagogue and personal encounters there, I can look at the number of people of substance that I have exchanged e-mails on Jewish ideas from list I made a few years ago. It now numbers about three dozen. I can sit in my office by myself, post something on Sermo, usually in response to somebody else's comment or query, and expect some comment about mine. I've met langdon and endo1983, electronic caricatures of knowlegeable people. There are Tom and Rick of AEI. And there are enduring friendships from the 1960's Ramapo Central School District #2 recreated on Facebook.

I've never met most of these people, though I realize that they are people with unique appearances and perspectives. While there is no opportunity for a handshake, there is ongoing engagement just the same.

Dr. Moe, Dr. Larry, Dr. Alan

2011-05-30T11:32:00.000-04:00

Med school came through for Alan. Both kids went in my direction. I didn't realize I was a good influence, or maybe I wasn't. My kids inherited my diligence and tenacity, maybe a tendency to not take themselves or their talent too seriously. More importantly though, for all my hard work, for all my tendency to complain about people and circumstances, I never belittled my medical colleagues except in a humorous way. Same with patients. Some can be pretty irritating but my willingness to let these annoyances proceed in stride probably made them wonder sometimes why I did not always treat them with the same placid manner. Eventually they realized it is because I expected more of them than I do of patients. Both kids rose to the occasion.

While I might have like to have more for retirement set aside than I now can, I cannot think of a more valid personal legacy well worth the financial consequences.

Purchasing Judaism

2011-05-27T06:08:00.000-04:00

Went to the AKSE Board Meeting, the one where they discuss budget. It is actually a rather thoughtfully constructed, particularly on the income side where predictability is usually not a whole lot better than my trying to predict glucose outcomes from the insulin decisions that I make. They looked at what they actually took in and for the most part avoided the annual grandiose projections of what they might like to take in but probably won't. The expense side is much more predictable and the opportunity of a part-time salary has mitigated the reality of spending more than we receive.

Along with the budget came a dues increase of about 5%. That would bring my obligation to a whopping $2625 annually, which is enough to make me wonder not only what I get for what is by far my largest tax-deduction not counting my upcoming professional liability tail. I would also analyze the purpose of this expenditure and alternatives that give a similar or better return for a comparable sum.

One of the people at the Board Meeting asked rhetorically why the congregation exists and what its future might be. I incurred the irritation of the President, something starting to get a little beyond the energizing mini-conflict from my perspective, by pursing that thought not in a rhetorical way but in its implementation to decisions, whether to make the unpopular choices that eliminate debt or to charge young members a nominal fee to give them a measure of ownership in the synagogue and avoid a major deterrent of a $2625 bill just as they reach age 30 and have to start spending on their kids. Sometimes you give money away entirely for somebody else's benefit with no expectation of receiving any return, sometimes in gratitude for what you have already received, but most often to make a purchase for something you will get in return. Usually when I write a check the category is clear. My support of WashU Hillel is mostly one of gratitude, my monthly Jewish contributions are designed to be for somebody else's benefit with no strings attached and my credit card statement goes mostly to purchases for which I am the beneficiary. Things like taxes merge all three categories, supporting schools that benefited me greatly at one time, snow removal that benefits me now, and research grants on esoterica that probably benefit nobody but the person receiving the grant. But taxes define membership in America, Delaware, or municipalities and state sales or hotel taxes paid where I am not really a member perhaps gouge me unnecessarily or enable me to derive benefit in the places I visit which are reciprocated when others visit my places of citizenship. The synagogue dues fall into a similar realm, providing a forum of Jewish advancement for me, a payback for all the friendliness that has come my way, and a daily minyan for those who hold that experience in higher value than I do. The women of AKSE, who I think get much less from their membership than would be their just entitlement, get the same bill as me. The young members do not, yet they also have a mixture of personal benefit, gratitude, obligations to others whose needs differ from theirs, and expectation of citizenship that should accompany membership. I think the leadership is wrong to bypass some monetary contribution, however nominal, in exchange for what they receive, much as Medicaid and insurance companies have come to realize that co-pays of a minor nature reflect on ownership and responsibility for medical care that does not happen when people receive something without any requirement to contribute to outcome.

So is $2625 a justifiable purchase? I certainly get less for myself than I once did. My attendance on Shabbat morning has not only waned but there are times when my avoidance of being there is purposeful rather than a random consequence of the on-call schedule. While the messages from the Rabbi have clearly reflected his professional growth since his arrival, moving from recycling of Hebrew school dalet class to looking up something in book about Ramban that I do not have and imparting Ramban's insight to me, it is still not quite the same as having facility with 3000 years of our mesorah to explore a topic of Torah from its seventy faces. At least I am no longer bored but have learned not to engage him in conversation about his sermons. However, in medicine and in Judaism it has been the ability to engage my teachers and extract knowledge and insight that they have but I don't that has allowed me to advance professionally and Jewishly in a fairly consistent way most of my lifetime. If I purchase something for me with my dues, that is invariably the item of highest personal value but it has not been forthcoming. My personal creativity is tolerated but not valued. I see my inquisitiveness and my intellect as my most enduring Divine gift, the thing that drives me at work, in the exam rooms, teaching people and advancing myself Jewishly whether through Artscroll, yutorah.org, conversation with peers. It is that give and take, that floating of ideas into the marketplace of possibilities that drives medical progress and advances Jewish mesorah. I increasingly see that being consciously cut off at AKSE, to the point of no longer being a place where Judaism is advanced by exploring the wisdom and misadventures of what came before. To the extent that I am purchasing citizenship, the last couple of years have been a sufficient disappointment to make me think that a competing purchase of another type might be better. And then there are the other two elements, gratitude and need to support the benefit that others accrue though are of no particular value to me personally. These are hard to get away from, though perhaps easy to replace. My attachment to Wash U Hillel is permanent even though I was only there two years. Penn's is permanent. I owe the current group of students at least what the alumni afforded me. I don't have that devotion to AKSE. My sense is more that I paid dues for years, contributed skill for much of that time and received less than I put in, unlike Hillel where I put in bupkis and created an experience that carried forward forever. Hakaras HaTov is a core value, and AKSE is entitled to some of that irrespective of the irritations that have come my way. Same with services to others. The people there need Kiddush, benefit from the Rabbi's mind more than I do, need minyanim, need education. Even if I do not personally advance from these things others do. Then again, people need these things everywhere and the advantage of a monetary economy is its portability so I can take part of that $2625 and enable a different cadre of individuals to have these things that benefit them without benefiting me personally.

As I approach Shabbos, Memorial Day, the increasing Days of the Omer that I did not count this year for the first time in a while largely out of a sense of hypocrisy for towards the people who do yet fail to advance their character for their effort, and the end of AKSE's fiscal year, it is hard to dispel my impression that $2625 to AKSE is not a good investment in Judaism for me for sure and probably not for the Jewish public. The more I analyze this the more convinced I am both intellectually and emotionally that it would be better to simply disaffiliate from any synagogue as my father did at my age, also spurred by an assessment of financial value. He needed the money for other things. I am fortunate enough to still be earning a significant salary with the vigor at age 60 to do the things that justify it. Redirecting that sum in a more purposeful way needs to be considered and probably implemented. I would like to take 40% of this, about $1K and dedicate it to Jewish advancement for Irene and me, then take the other 60% as three $500 donations for the advancement of others. There are no shortage of destinations for this money to places that fulfill this mission far better that what I have seen come out of AKSE in recent years. It is a disappointment in some ways, as there are still friendships and gratitude there but it is not a prudent investment in optimal Judaism.

Board Meeting

2011-05-25T07:10:00.000-04:00

My attendance at AKSE Board Meetings has been largely a complete one, as has my attendance at its committee meetings and at Beth Shalom activities before that. I am hard pressed to think of any I skipped primarily because I didn't want to be there, finding them irritating or an undue depletion of time. At many of them I've been something of a space occupying lesion but I've always shown up, sometimes at some inconvenience to myself.

I find myself undecided on whether to attend tonight's session. It may be decided for me by a plethora of consults that keep me late at the hospital but looking at the agenda, mostly budgetary planning. I've been there before, or to some extent this comes up in a minor form with the financial report each month. Most of the big budgetary items are set. There are staff payroll costs which dominate the numbers, maintenance of the building comprises the second category of expense, and most other stuff is relatively diddle. There is not of discussion as to how well the big ticket items enable the mission of the synagogue as an institution but a lot of discussion on whether to save $500 on postage costs.

The income side may be more complex. It is harder to predict than the expense side, the retrospective review invariably being wrong and too optimistic. Yet the people who create the income side, primarily the members, are the very ones who need to be served on the expense side where the discussion never quite includes how well you serve them. It is hard to think of budgeting as a fundamentally abstract concept, much like basic science, which then gets translated to reality.

From my own perspective, there are spheres of concern and spheres of influence. On this I have little of either. The cynical me realizes that for the most part a herd mentality prevails, which may be good since you don't want to be doing radical things with the money of congregants who are change and risk averse but who are at least astute enough to realize that uninterupted progression of current trends will have its day of reckoning.

So what would I, as a sage lurking under the rocks, recommend. Just like I have a tendency to take patients at their word, I would take the task force at its word and proceed down the path of single clergy. Without getting into a discussion of the attributes that single Rabbi ought to have, the best way to economize is to do the work yourself and hire expertise that you do not have. Some of us can fix our own cars, some need an experienced person to change the oil. Some paint our own rooms or mop the floors, others hire painters and cleaning crews. Some of us who did not know how to paint or scrub even rise to the occasion and learn how. The opportunity to make that transition plopped into the congregation's lap without even having to contend with contentious contract renewal or denial discussion next year and the leadership failed to take advantage it. I think we need a certain amount of reliability on having a ba-al tfiilah and the expertise of a Torah reader. The price of a hired prayer leader, both an economic one and a lost opportunity one to engage the congregants and have them advance skill and rise to a need, seems inordinantly high for what we get in return. A school of AKSE's size should be a one or two room schoolhouse with a payroll to match. The progress of its alumni in parlaying what they learned there into more sustained adult Judaism should be tracked as part of the duties of the school staff for the purpose of upgrading the program over time and if the results are superior to anyplace else, which they are likely to be, then to using that as a source of product differentiation that allows us to recruit members. That would be a form of budgeting with a purpose.

Do we need a building that big? It is part opportunity, part albatross. On one hand, the proceeds from sale could provide enough interest to enable the congregation to live within its means. On the other there is a clear attachment of the membership to the physical structure and a willingness to support it so that element of expense seems purposeful. Rental of space with the building has gone nowhere. The options would be to either set aside the project or hire a seriously professional consultant who knows how to market space. And now we are out of big ticket items.

On the income side, the word on Bingo remains a work in progress. While I do not think this is the optimal business for a synagogue, the majority does and it could be a source of revenue. When all is said and done, the income side depends on membership, how well the current members are served and how well policies and experience attract or deter potential members. The task forces were too inbred to think beyond themselves and their own needs with a result that reflects this. They had an opportunity to capture other perspectives through the focus group but this had roughly the same impact as the paid consultant whose guidance never got implemented. There aren't too many ways to enhance membership. One would be to deal with the Women Thing. There are ways that can bring women closer to parity and there are folks like me who thrived on Hillel environments which must accommodate diversity, often by enabling parallel offerings. 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. AKSE had one minor foray into this with its monthly Mechitza minyan and a second foray with the Women's Tefilah Group. Neither fulfilled its potential and if I have any seriously negative clergy evaluation comments, it would be not prioritizing these two opportunities to advance the Jewish experience irrespective of whether the people are eager to be advanced. Not doing this for the Mechitza minyan enabled Ritual Talibans to undermine more mainstream progress on the Women Thing. Not doing this for the Women's Tefilah Group gave tacit or maybe even overt confirmation to the community that the Rabbi does not care about the engagement of women in his congregation to the extent that other opportunities are available for them elsewhere and that women who are really committed to their own advancement need to take their families to those places instead of AKSE. The other opportunity for advancing membership in places where mechitza or other forms of gender policy place women in a disadvantageous position involves providing a valued service ranked higher in importance than mode of worship. This can be community involvement open to women, but most congregations of all creeds offer this. Orthodox Judaism has a uniqueness of high level analysis of Judaism and opportunity for engaging in tradition. Most successful Orthodox congregations that have attracted substantial non-Orthodox membership have done this through the educational route. That means capturing college experiences which created a fondness with most people and not recycling Hebrew school which is usually the source of Jewish disdain and youngsters emerge from parents making their Jewish decisions to the college years where people make their own way. AKSE is still recycling Hebrew school as its standard.

Again, that is how budgeting becomes purposeful, looking at what is not yet provided that could be to make the offerings more attractive on the income side and investing on the big ticket items to accomplish this purpose on the expense side. Unfortunately there is not a lot of incentive to think of money as the means to the congregation's purpose.

Paper Everywhere

2011-05-18T06:21:00.000-04:00

We did some semblance of cleaning for Pesach as we do every year. Unfortunately this time it meant removing remnants of my now non-existant office transported to my living room to someplace else so that the carpet cleaners might purge Chametz. Some things went to the storage center I rented but most went to the family room or hall. As we get four weeks into the Omer ever more quantities of mail and magazines and newspapers have arrived, not to mention cardboard containers that still have some food in them. My kitchen table has no visible surface. My desk at work does not appear much better. I had to dig out the netbook from under a pile of stuff including forms that I was supposed to fill out but haven't yet.

Paper never quite ends but at least it can be sorted into categories of importance or perhaps even urgency. I'm not sure what happens to all the stuff that goes into the recycling bin which the trash collectors pick up every couple of weeks. Definitely better than keeping all that stuff here.

AKSE Comfort Zones

2011-05-08T08:24:00.000-04:00

THE OLD AKSE

At heart, I am probably a Jewish Hellenist time shifted to the contemporary era but thinking in a parallel manner to our ancestors who discovered that not all beauty had to be internally generated and not all rules remain functional forever. Moreover, I'm a sucker for talent and things done well. To some extent, I find a measure of friendly conflict energizing, something characteristic of my subclinical ADHD self. The Cantorial replacement committee brought a nice, talented young man for an audition this past shabbos. He is a fine musician, a pleasure to listen to though not necessarily a delight to worship with. I suspect his limitations as a reliable Torah reader will conclude his candidacy. Personally I found myself passively taking in the Musaf Symphony but more personally engaged in the concluding prayers conducted very competently by one of the rare teens in attendance.

AKSE has a legacy of taking the easy way out, staying within the comfort zone of what was done before and paying a rather large and inexorable price for doing this. There really is no reason to hire a ba-al tfiliah, though we do need a Torah reader of skill and reliability. The young man concluding the prayers demonstrated this quite well. His vocal skills more than met threshold, he certainly engaged me in the proceedings and his capacity to fulfill his Bimah assignment was more than ample. Moreover, he developed this skill as a component of his Jewish growth at AKSE, which is what I think the core mission of the synagogue really ought to be. We have capable members but very few of them enhanced their skills from the time they first arrived. It is more comfortable to let the women set up Kiddush and gather for Junior Congregation worship than to push for parity, acknowledging that true equality must be denied them. It is easier for Cafe Tamar to move outside its mission of showcasing AKSE people, opting instead to entertain them with semi-professionals, some probably not even Jewish, as its own talented people opt to take in that imported entertainment rather than endure rehearsal. Last year's dinner made some money but it struck me as the Ghost of AKSE Past, survivors of the 1980's glory days occupying the tables, celebrating what once was and not really grappling much then or beyond with what might be. On a more practical measure, most Torah aliyot I am invited to do are from the recycling bin of what I have done before. I assume that the same principle goes for the other readers. There is no incentive, indeed no expectation, that growth in skill needs to occur. And then there is the coup d'grace, a Bylaws amendment indicating that rotation of officers no longer needed to occur, and it hasn't. Committees from the Ritual Talibans to my Education Committee to a most inbred recessive-gene expressing Cantorial Transition Team, have the same people doing the maintenance of the core functions of the congregation but without the vitality that creates a vibrant future, which can only be had by moving past those comfort zones. All of this is comfortable but it comes at the price of progress that can only be attained by challenging people to do some things that they can do but have not done yet.

I certainly do not run my exam room or my teaching rounds that way. There is an expectation that patients will monitor their sugars, give themselves insulin and take responsibility for their care, even it they'd rather not. My residents are exposed to science behind what they encounter clinically, even if they've rejected any interest in basic science. And what I like most about Mercy has been the challenge to my intellect, ingenuity and energy needed to manage some very difficult medical problems that had previously languished. That his how people really move themselves and others ahead.

Passover 2011

2011-04-24T19:09:00.000-04:00

Less than an hour until the closing days of yontiff. I did not get to take the yom tovim off due to obligations of the new job but I got a long weekend for Good Friday, one of the fringe benefits of working for the Catholic Church. I recycled my Bar Mitzvah Haftarah for Shabbat HaGadol, had a relatively placid though late First Seder with the G's but without Bob and Stanley. Second Seder a sedate and minimal frills effort, just Irene and me. Good Friday a little stressful making dinner and trying to keep from having to drive to Mercy for an urgency that could have been easily handled by telephone. Shabbos morning at AKSE where my shacharit went OK though a little off-form perhaps, the Rabbi got miffed when the Cantor departed the Bimah for the mixed Shir Ha-Shirim, a quiet not too stressful afternoon at the hospital on Saturday afternoon and a restful Easter Sunday. There was a fair amount of stuff open but I did not stop anywhere except the Gulf Station. I needed the rest. Next long weekend not that far off, Memorial Day.

The Ritual Talibans

2011-04-07T06:13:00.000-04:00

It turned out differently than my crystal ball envisioned. Last year AKSE at springtime introduced some unexpected discord when the Rabbi ruled that women may read Shir HaShirim and Ruth from the bimah. The Talibans of the Ritual Committee objected, two walked out as the Cantor would have as well were the holders of his contract insistent that he stay. As it turned out the principal reader was ill and the Cantor would not fulfill his paid role, a position the Rabbi supported. Irene saved the morning, the Rabbi cashed in some of my respect points that morning and for some time thereafter. This year Irene was not invited so I just assumed the Talibans took it upon themselves to circumvent the Rabbi's ruling by only inviting men. Not so. They didn't make provisions to have it read at all. Our President has a very distorted view of what the broad representation of AKSE means. There is small cadre of participants that make the place go, except financially where large checks need to be solicited from people who consume very little synagogue activity in return for their consumer purchase. While I find the unrestrained intervention of three born-again BT's to be quite disruptive to future growth, their absence would collapse some very basic current activities like daily minyanim or having all the parts of shabbat and yom tovim conducted in a traditional way. The Rabbi falls short in his leadership role by not making provisions for the conduct of AKSE that have broader appeal and deter some of the baggage that these disproportionately active individuals bring aboard, irrespective of their current value to the immediate operations.

I received word indirectly that the Ritual Chairman/ Gabbai will be stepping down. He served his role with dedication and of the four was by far the most sensitive to the broader sentiments of the congregation.

Nominating Committee

2011-03-09T06:53:00.000-05:00

AKSE Board Meeting last night. I decided in advance to be a little provocative and annoy the President, which I accomplished by questioning whether they ought to be taking money from restrictive funds for operating expenses, then tossing the question off to the Rabbi for an assessment of propriety. Comments at the Board Meeting tend to float around finances, which really have not changed since my time there. They spend more than they take in and have no reasonable plan to spend less but only trial balloons to take in more. Membership is up but dues revenues are down. We really have no sage, but the closest to it indicated that no progress has been made in this dilemma in a long time.

Part of the problem, a large part I think, comes from the core participation. The Board destroyed itself a few years ago by eliminating term limits from the By-Laws for all officers except President. As a consequence the Nominating Committee contains four insiders who recycle officers then grapple with the reality that they are unable to think differently than they have before to transform the congregation in many potential ways to make it more attractive to other participants. Until they change that, forward motion is likely to be self-restrained. There just aren't that many creative people there who take a measure of delight in creating beneficial disruption that is needed for turning AKSE into the vibrant place to which outsiders will flock.

My Personal Museum

2011-03-02T06:37:00.002-05:00

Mice have taken up refuge in our basement. Each time we have the heater serviced, the technician finds about have a dozen carcasses behind one of the pipes, which we send to a mass grave at the public landfill. We do not know how they get there. The annual visit from the termite preventer includes some guidance at control as well. We place a few spring traps that never get activated, some warfarin that may or not provide lethal intervention when they return outside, but the population seems constant. A tour of the basement indicates that the rodents like to stay warm near the heater as their terminal event, but they have a more free range into the nooks and crannies where I have not been, and onto some of the benches and shelves where I have been. The exterminator's suggestion, which makes sense for a lot of reasons: rid the house of cardboard boxes where things are stored.

When I moved from St. Louis for the final time, I boxed all my possessions, shipped them by UPS which had limits on how much I could ship to one address so I used three, then gathered them all into my father's basement in Monsey. They eventually found their way into my basement, unopened since 1977. They have occupied a far wall in the basement, the best starting point for the decluttering project.

There is a grander purpose, of course. We tend to be hoarders, a notch or two below the pathological ones of reality TV but enough so that none of our living spaces have an open look. Many a semi-annual plan has called for decluttering but never materializes. This time it might but we need to start with by tossing stuff that has no justification for retaining. Rodent habitats seem like a good way to begin. And so I schlepped about eight boxes from the far wall of the basement to the two bins sitting in front of the garage door, one dedicated to recycling, the other for the landfill. Most of the boxes contained my school notes and term papers, largely from high school a few from medical school. There were favorable comments and critical comments, some in red ink, some in black ink with grades ranging from A- to C. The high school stuff had report covers so that went into the trash, the notes did not, so those went into recycling. As my prime productive years have come and gone without accumulating the fame that would give these auction value, none were saved for Christies. One exception, though. Part of a single box contained my Bar Mitzvah mementos, unfortunately including a few Thank You notes that never found their way to the mailbox. Postage was apparently 5 cents in those days. There was a check with my mother's signature to the synagogue that never went out and three kippot with my name stamped in gold. A few photos were retained, all in good condition except for one nibbled around the edges. There were thank you notes and photos from friends' Bnai Mitzvah and an invitation to an aunt's 50th anniversary celebration. Those do not need auction value. All fit into a very small box which I tucked away next to my desk in a living room nook. At my father's shiva, my stepmother handed me some photos, mostly from the World War II era. The contents of that Bar Mitzvah era box should get similarly distributed at my shiva.

Everyone has to deal with a past, present and future. High school certainly has some lasting fondness. Rediscovering some of those people on Facebook and seeing others at periodic reunions should suffice, or at least turn past into present. I do not need to keep the old term papers in my possession, particularly hidden possession. The present and hopefully near future will include less cluttered living space with some selectivity over what is left on display. Even the Smithsonian is selective.

AKSE Academy Review

2011-02-11T06:30:00.000-05:00

It went well, or at least was well received by those in attendance. I think the logistics went more smoothly than last year, the subjects maybe a little less engaging, and we were one class short. Those are the p'shat, the straightforward observations. Rabbi Einhorn, in his WINGS blog, the OU synagogue development feature, took a more expansive view of events. http://www.ou.org/index.php/blogs/rabbi_shlomo_einhorn/p-e-l_your_way_to_success/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+RabbiShlomoEinhornsBlog+%28Rabbi+Shlomo+Einhorn%27s+Blog%29

He divides events into three components: purpose, execution, and legacy or what I think would be better termed future opportunities that the event creates. The execution went reasonably well though with many rough spots along the way. As the person responsible for the core of the event, the classes themselves, I may have set too many restrictions on who may present. Timing and publicity could have been smoother and more expert. These components of process are also adaptable to the future.

As the originator of the event, I need to take a more critical look at its purpose and how well the purpose was fulfilled. Originally the Education Committee wanted to replace the shabbat guest which created a fair amount of discord, financial risk and less than enthusiastic feedback with something easier to do that did not require a lot of investment. If the speaker can give three talks in three sessions over a shabbat, I can arrange eight talks in two sessions over an evening. We may not have national renown but AKSE's own people at least have internal name recognition. A more subtle though elusive motivation lurks beneath this. The Ghost of AKSE past infuses itself into much of the mindset, making decisions almost habitual. From the 125th Anniversary preparations to the recycling of the same old predictable composition of the Nominating and Cantor evaluation committees, there is a tenacious effort to conserve what once went better to the neglect of new opportunities ahead and real adaptation to what exists now. I viewed AKSE Academy as the transition point. There would be discussions of contemporary challenges of Judaism given by people who had real expertise. Last year I tapped into the familiar, this year my invitations went to a tier of individuals who were not local fixtures. That talent which may not seem obvious comprises the uniqueness that AKSE brings to the local community. In a local Jewish world where excellence and effort beyond threshold often seems elusive and undervalued, AKSE Academy stands out for two hours a year plus prep time.

Where I think we fell farthest from Rabbi Einhorn's recommendations was in linkage of this event to other events for the synagogue which also should carry the theme of excellence amid a more pervasive pedestrian Jewish experience. This may be a very difficult thing to do anywhere and perhaps even expose AKSE's Achilles Heel where committees are more autonomous than they should be with little intersection of ways in which one group can enhance another or expertise in one area such as food or publicity becomes a transferable component that serves the larger operation. That is where leadership and perspective separate from management of tasks at hand. AKSE does pretty well at the execution end, not as well at generating creativity or moving its different components into different configurations by different people.

Sleepless Night

2011-02-09T06:23:00.000-05:00

Even though I have been up most of the night, making a futile attempt to fall back asleep after a 9PM to midnight snooze, aided by some benadryl, I do not currently feel tired. Hopefully I will not konk out before the usual work closing time. Some carryover from my old office took its toll last night and may not be resolved for a while so there may be more sleepless nights ahead. I could have tried to snooze for another 90 minutes or so beyond my usual alarm wake-up but it is more productive to just accept my wakefulness and start the day.

Me Time

2011-02-08T06:30:00.000-05:00

We were intended to work six days out of seven but even on that seventh there are appointments to keep. Most of us have a good measure of structure into nearly all our days, from when the clock radio buzzes, departure time for work whether we arrive on time or not, to the volunteer organization committee meeting we need to attend at the end of the day to a reasonably structured lights out so we can start over again the next day. Even our vacations structure our time to a great extent with airline schedules and cruise dining times.

Into each day on my Franklin Planner I include some Me Time, a respite with no agenda, no catch-up and even no particular time to partake of it. More recently, as Shabbat services became a diminishingly attractive destination, I've tried leaving that seventh day schedule free, admitting that I time it from Saturday wake-up to Saturday sleep rather than the more traditional lichtbentschen to havdalah. There are some constraints to the daylight hours, it being Shabbos, so no computer, cell phone, writing, shopping malls or similar stuff that would be part of a work week and can easily be postponed until after sunset. So what have I actually been doing with this unstructured time? I sleep later, often go to the library in the afternoon, play with the cats a little, read something Jewish, watch TV of the on-demand type, read a few days worth of News-Journals. After dark, I will go out to Trader Joes or Christmas Tree Shop or watch more TV. Productive? Rarely. Relaxing? Sometimes. Should it be allocated some day other than shabbos? Can make a case for it, though there are usually chores to do on Sunday.

Valentines Day Prep

2011-02-06T11:54:00.000-05:00

For a basically goyishe day, Irene and I have a fondness for Valentines Day. It marks the halfway point to our next anniversary, often the divide between our parents' yahrtzeits, the season of massive snow if we are to get any, not to mention a calendar reminder to appreciate each other. I am usually chief chef, taking care to make something that Irene especially likes though not the same from one year to the next. I've been pondering the menu but not yet selected anything. The day itself comes out on Monday this year, the time of her evening rehearsals. Tuesday is the night before my Grand Rounds so it looks like Sunday will mark the special dinner with gifts and cards postponed until the actual day. We cannot overlook the practical.

Going to the Doctor

2011-02-04T06:17:00.000-05:00

Dr. Tim tells me I've not been there in about two years. There are some symptoms to address, the discomforts of not quite six decades of wear and tear on the body parts. Probably some preventive maintenance is in order also. Nothing overwhelming, just annoying, but due to get checked out.

I've been tired of late, maybe a little down, enough to resume my citalopram supply that I was hoping to avoid as we approached the New Year. Sleep interupted pretty much every night for last month. Lab work from a couple of days ago should be available by appointment time. Then a full day in the office and the start of perpetual weekends on call.

Cantor Calls It Quits

2011-01-30T14:43:00.001-05:00

AKSE's Cantor, Rabbi Joel Kessler opted to depart with one year still remaining on his contract. While I did not expect him to seek renewal, I also did not expect him to decline riding it out. His professional competence in his Cantorial role goes without question. His fulfillment of the expected requirements and then some leaves the congregation in some jeopardy when he is not longer available to do the many things that need to be done. Others can do most of these things, though not nearly as well and certainly not with the reliability that we have come to expect. His future plans have not been announced, though I suspect he will seek a pulpit of a small Orthodox congregation that can only support one clergyman.

Like the Federal Government, AKSE has been spending more money than it takes in. We borrow against the value of our building which is paid off due to a Capital Campaign that concluded last year. Instead of making mortgage payments, we pay interest on our line of credit which is much smaller. There really are not a lot of ways to spend $34K less each year other than eliminating the Hebrew School, which will probably not do it since it would be offset by membership loss, or eliminating one clergy salary. At the Board meeting in December there was unanimous support to retain the current Rabbi and widespread support to make a three year committment to him. If the money runs out before that, the Cantorial position would have to go, though the things the Cantor does has a good deal more direct economic value than the things the Rabbi does if individual tasks would have to be replaced. Rabbi Joel could run AKSE as a single individual, the current Mara D'Atra could not.

I suspect it has not been a happy experience for the Cantor. There is a gradient between his professional skill and the Rabbi's, where discussions always seem to focus more on affable than on capable. The Cantor moves more Orthodox in practice, where the congregation does not. Very few congregants really value the expertise that he brings but hold a great regard for things much more trivial like Sunday school classes and lowest common denominator sermons that an Am Ha-aretz could find uplifting even if devoid of serious Jewish content. In many ways he must feel like the experienced sergeant who owe's a salute to a new ROTC lieutanant.

As one of the skilled people I will be expected to pitch in more than I do now, though I have mixed feelings about taking up the slack.

Deadlines

2011-01-23T16:56:00.000-05:00

For the most part, I do not like to work with firm deadlines but the externally imposed ones clearly make me more productive than the ones I impose on myself with utmost flexibility. I did manage to get my office closed despite my secretaries' preference to drag it on indefinitely.

These next few weeks, I have two major talks, one at AKSE Academy next weekend and another in mid-February for Mercy Hospital's Grand Rounds. I have been working on them but the looming presentation date has started to impose a greater measure of focus. AKSE sources are nearing completion with the upcoming week for editing. These next two weeks I need to devote attention to making my slides for Grand Rounds.

OU Convention

2011-01-21T06:26:00.000-05:00

A Day of Learning, just as advertised. Having made a weekend of it, I arrived refreshed from a night at a nearby Howard Johnson's, stopping at an Exxon station to fill my tank so I would not have to stop on the way home. At the registration desk I was a little surprised when they asked which Plotzker I was, but by chance I met the other two at lunch. I picked up my registration badge, checked my coat, went to another table to get my Convention tote bag with its mixture of advertising and schedule, then hurried to get to the first session, one on synagogue development before it started. By day's end I had also attended classes on Hazanut, another on synagogue development, one on autonomy, one on conversion laws and a plenary session on Mesorah. In between I grazed and looked at the OU exhibits as well as partaking of a brief but sumptuous lunch.

There were few knitted kippot but few overt Hasidim. People wore black suits even on Sunday, but they wore ties as well. Women attended but men far outnumbered them. Since everything was Kosher, I did not have to scrutinize menus but could just take from any edible display.

To my surprise, I could not identify a subliminal agenda. There was no sense of being under attack from external forces, no exhortations of the rabbis to rally the lay troops, no hand-wringing to decry adverse demographic or sociologic changes. The closest I came to that were the Hazanim pushing for the preservation of their declining art. There was no tone of discontent among the participants nor any sense of threat to what had already been achieved. Instead there seemed a muted celebration for what had already been achieved and an optimism that the trend would continue.

My two synagogue development sessions took different directions. The morning session had a professional consultant as its facilitator. She spoke of Board and Officer responsibilities, primarily governance with all its successful and failing variations. Congregations need to have a purpose with programming designed to fit that purpose. I think AKSE really does not, or at least has not articulated it clearly. The afternoon session dealt with making the experience of being in the synagogue more attractive. Why are people there? What happens when it is not shabbat? Do they come out of desire or out of obligation? AKSE keeps itself very vulnerable from this frame of reference. Interestingly the session was conducted by a congregational Rabbi who does consulting for OU congregations.

Definitely a very thoughtful day which achieved its purpose of pleasure mixed with insight to take back home.

Topping Out

2011-01-20T07:03:00.000-05:00

About thirty years ago there was a bestseller written by John C. Molloy entitled Dress for Success in which he explored the world of business attire. He argued for people at the lesser rungs of commerce to dress more like their senior executives. Of course, their spendable income was much less so they could not make frequent trips to Brooks Brothers, let alone Saville Row. In its place, he recommended going to the top stores to look at the finest business clothing, identify what made it different from the stuff most of us buy, then go back to our stores to look for the products that have those basic unique features.

So this weekend, I treated myself to forays into where the three main branches of Judaism excel, to see what I can bring back to my ordinary experience. After a wicked week at work, one in which I would have liked nothing better than to plop myself down after Shabbat dinner with a look at Washington Week followed by a visit to my mattress, I instead shlepped with Irene to Beth Emeth. I never regret the effort to get there. This Shabbat was special. It being Shabbat Shira, they traditionally have a special event with Kriyat HaYam by the Hazan. It happened also to be the week of the passing of Debbie Friedman, the most influential member of the Reform Movement whose music has added to spirituality of every synagogue I have attended since the 1970's when, as a rising star in the world of Jewish Music, she performed at the WashU Hillel. There were a couple hundred people in attendance, with all three synagogues represented, listening to a somewhat makeshift hybrid choir singing her melodies, trying to get the congregants to sing along much as Debbie would do at her performances, and incorporating the melodies into the kabbalat shabbat liturgy.

My destination for the weekend was the Orthodox Union Convention's Day of Learning, but since I needed some real recreation, I opted to make a weekend of it, seeking out the upper tier of Conservative Judaism. With some exploration on the web and some guidance from Rabbi Satlow, one of the real talents of Conservative Judaism, I opted for shabbat morning at Congregation Beth Sholom in Teaneck NJ, having heard that JTS Faculty and United Synagogue senior honcho's live in the community. They are having a Shabbat of learning that makes my AKSE Academy look minuscule. By Kiddush, my concept of the viability of Conservative Judaism had been completely transformed. It was like a Ramah experience made multigenerational and transplanted from a rural retreat to mainstream sanctuary. About 200 people attended. They must have a fair number of transients since only a few recognized me as a visitor, including the Gabbai who offered me Shishi, though I preferred to remain an observer rather than participant. Nearly all the men had knitted kippot like mine. None had a satin Bar Mitzvah souvenir and almost none took a black general synagogue issue one from the box. Most of the people who brought their own talesim, men and women, wore full orthodox style woolen garments, few had their own silk tallis though a lot of people like me wore the ones from the synagogue. The sanctuary had been prepared for shabbat, one of my pet peeves with AKSE. Each place had an Etz Chaim Chumash on the left and a Sim Shalom Siddur on the right. The congregation does not have a Hazan. Their web site hinted that they do not need one, as capable congregants were committed to not only showing up to make the minyanim but to make the services happen. This shabbat the Rabbi did the Pseuke D'Zimra. A young guy chanted shacharit, incorporating a few of the late Debbie Friedman's melodies into the Kedusha as a memorial, Torah reading was divided three ways, all done very well particularly the last two done by a young woman with lovely voice and impeccable skill. The very long haftarah was chanted by a rabbi who was not the congregational rabbi. He did it capably but struggled with some of the less familiar words in the song. Musaf was done by a middle age man, approximately one of my contemporaries, with a pleasant tenor voice who also incorporated a few Debbie Friedman melodies. Their liturgy was a complete one with a few variations from AKSE. Birchat Cholim came after the sixth aliyah. Their rabbi received a list in advance, read it and invited people to come up. Few did. I think it was a mistake for AKSE to change its policy from this. About three women were honored with aliyot as well as peticha, suggesting true egalitarianism rather than squaw work often seen in other Conservative settings and certainly at AKSE. A prayer for Tzahal and captives was then done in Hebrew by the rabbi. The prayer for Israel was done in Hebrew at its usual place followed by a prayer for the United States read in English by the Rabbi with an insert for the Armed Forces. The sermon was delivered after the scrolls returned to the Ark, given by the Gabbai who apparently was also a prominent attorney. He spoke about different ways to assess census to understand the Exodus and victory over the Canaanites. At the end, two girls concluded the service. They did not do Anim Zemirot but instead did the passage that separates Ein Kelokainu from Aleinu followed by Kaddish D'Rabbanan. They also did the Sabbath Psalm earlier in the service as their Siddur places it.

Then a visit to a friend recovering in a nursing home in Spring Valley, then some relaxation at the Howard Johnson's in Ramsey, then completion of the weekend at the final day of the OU convention.

We have a board meeting at AKSE this coming week. The President included a semi-annual summary among the agenda items. What made Beth Emeth and Beth Sholom Teaneck attractive places to attend may have been the excellence with which they executed what they intended in a way that enhances the experience of being there. AKSE has more pretense, aspiring to what it is not, guaranteeing that the experience of being there will never measure of to its hype. There are people there who will demean Beth Sholom Teaneck as inferior based on its USCJ affiliation yet ignore the talent of its members that make the experience of shabbat morning in the sanctuary sparkle while shabbat morning at AKSE parades far less capable participants from the Rabbi to the congregational volunteers offering a couple of hours of mediocrity.

Sunday on Call

2011-01-14T06:15:00.000-05:00

This one was difficult. I inherited a long list from my partner and accumulated five more. It took seven hours to get everybody seen and properly assessed. At least there were no major glitches. Everybody could be found in their room. The glucose and medication documentation had no serious lapses. Most of the elevators worked. There was coffee in the Doctors Lounge so I could grab some, then go to my office to extract data from the computer before heading off to a new consult.

Still, my personal agenda for the afternoon, including a SLU reception and basketball game at Temple, took a back seat to my professional responsibilities. I got home as Irene was leaving for her weekly choral rehearsal so my personal intent of carving out some neglected family time also did not get done. I did not take time to become more proficient with my iPod despite purchasing a book which would enable me to do this. AKSE Academy preparation also did not materialize in the way I had hoped.

Patients got good, thoughtful care, as they should but it took its personal toll, one that I expect to carry forth the rest of the week until I sign out next Friday for what I hope will be some real recreation.

Opting Out

2011-01-05T06:22:00.000-05:00

A broadcast notice arrived in my email on the AKSE's new mentoring program with an invitation to attend an orientation led by a Federation person on how to do this. I RSVP'd my preference to sit this program out. I do not think this decision violates my goal of dealing with people in a gracious way.

Socializing people this way has had extremely poor results for the two large organizations that did this, Federation and United Synagogue. It tends to alienate the most creative elements, the visionaries that are needed most while reinforcing loyalty to the status quo as the ultimate value. Inbreeding brings forth a lot of recessive, dysfunctional genes, as I found out with the High Holiday Honorees of the Education Committee undermining my AKSE Academy plans and dismissing out of hand any creative comment I bring to the meeting. Eventually you end up with selective attrition. Organizations like AKSE and USCJ affiliates that really need to be transformed to serve its constituents cannot be transformed when everyone is taught to think alike. You get oddities like the Rabbi contract discussion where the aphorism of the "four ables" which should be the essence of discussion never gets to the table.

A much better way to accomplish this goal of integrating new members into the structure would be to designate a host or two as resource. Izzy served that role but has never been replaced. The host can then distribute individuals to others of special talent and interest. Of the new member list that the Board distributed for this mentoring project, very few of the people were really new. I'm not sure what benefit they want to derive from their return or from their newly independent membership. The few new members and real talents, maybe three from that list, can be developed but I think they would inevitably contribute in a less structured format.

Sometimes I prefer to be an observer more than a participant.

New Me

2011-01-02T18:57:00.000-05:00

There really cannot be a new me, just an upgraded one. Under New Management perhaps. More gracious, healthier, dedicated to less clutter, medically more knowledgeable, electronically upgraded, ready to live comfortably without having to earn additional income each day or at least ready to accept the reality of my post-earning years. Those are the goals for the first half of 2011, though the end points by which success is evaluated are less distinct than they should be. Gracious may be acquiring new friends, attending social events, having more contact with old friends or even upgrading my performance as husband and father. Healthier has a lot of parameters from weight, exercise performance, lab data, clothing size. Decluttering I think means getting out from under papers and moving what is not likely to be used someplace other than my house. Putting decluttering on my schedule defines process, not result. Medically more knowledgeable has a result remote from the next six months. There will be a board exam which will have a result, but that comes in the second half of 2011. My electronic upgrades include iPod and phone, but again more process than end point. Post earning financial planning is more straightforward. I need a Long Term Insurance policy and an estate plan. Very clear end points.

"Begin with the End in Mind, " Stephen Covey advised. This week I determine the end points and the intermediate steps.

Electronically Challenged

2010-12-31T06:53:00.000-05:00

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

2010-12-30T05:39:00.000-05:00

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

2010-12-26T18:06:00.000-05:00

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

2010-12-25T20:37:00.000-05:00

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

2010-12-24T02:58:00.000-05:00

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

2010-12-21T01:28:00.000-05:00

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

2010-12-16T06:28:00.000-05:00

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.

Artifical Contentment

2010-12-13T22:24:00.000-05:00

I ingested my last Celexa tablet a few weeks ago, part of a drug holiday I gave myself after muffing a scheduled platelet donation last month by mindlessly taking an 81mg enteric coated aspirin tablet that I neglected to omit from my weekly pill case. So until the next platelet donation last weekend, I treated myself to a drug holiday. No aspirin as the blood bank program requires but also no statin, PPI, multivit or SSRI. Other than some wicked heartburn tided over by antacids, while disabling initially but just slightly annoying at present, no medicines. Yesterday, I restored the pill case with all but the SSRI. Aspirin and statin have evidence of life prolongation and other than some achiness early on as the Crestor dose was increased, there have been no adverse effects, though I always wondered if I really would need the PPI if I deep sixed the aspirin. I accept the endoscopist's finding that there really is some reflux but no Barretts, so both the aspirin and omeprazole returned to the pill case. I have a whole jar of OTC house brand men's formula multivitamin, so that went back to the pill case too. My citalopram tablets, even though of ample supply, stayed in the amber tube that I got from the Super G pharmacy a couple of months ago for $10.

Other than some annoying reflux, I clearly feel better without the medicine. It has been a tenuous course with the SSRI, starting many years ago with Prozac samples from the office, then Paxil samples which made me feel drugged and finally Celexa samples which became the generic citalopram. It is not my first withdrawal but unless a lot of people start complaining about me I do not plan to return to this medication.

Peter Kramer in his Listening to Prozac best seller of twenty years back described using the medicine for Obsessive-Compulsive Disorder, which at the time was an experimental use, and for which I worked out with my doctor my first trial of it in the 1990's. Dr. Kramer described Tess who became charming and sociable. I did not become charming, or at least nobody gave me feedback. What I became instead was dulled, almost emotionally neutral, without placing a value judgment on it. Irritants no longer irritated me. My patience improved and I could read or watch TV for longer periods of time with greater safety than if I had tried to achieve the same result with ADHD agents. In exchange for some form of artificial inner peace and perhaps a slightly better attention span, my mind wasn't as sharp. I had no particular inclination to look up medical information I did not already know. My abiltiy to write in an incisive way and to follow thoughts in sequence declined dramatically. Moreover, I felt tired, this being the symptom that prompted each of the previous withdrawals and return of irritibility guiding each restart.

So now I again find myself able to think clearly with very little inhibition to my natural candor. I am less tolerant of myself for not accomplishing at the end of the day and less tolerant of others who now irritate me.

Another book on the subject, Artificial Happiness, comes from Ronald Dworkin a few years ago. While the writing and analysis seem almost primitive next to Dr. Kramer's more elegant prose, he makes an important point that sometimes life's goals are best persued while irritated. If AKSE leaves me unsatisfied and treats me like a picador with multiple little sharp provocations, then using a pill as a surrogate to disaffiliating when I should diminishes my Jewish future. While patients may also irritate me more, I owe them the full measure of my skill which should not be set aside for my own inner peace. As I compile my intentions for the next six months I really want to work on conducting myself in a more gracious, less abrasive fashion than has been my history. But I need to give myself a genuine chance to do this without the phony pharmaceutical restraint.

Danny's Four Questions

2010-12-10T05:49:00.000-05:00

"He (Chanina ben Dosa) would also say: One whose deeds exceed his wisdom, his wisdom endures. But one whose wisdom exceeds his deeds, his wisdom does not endure" Avot 3:10

As I do the semiannual planning it essential to keep in mind that when the six month review occurs, we are the things that we do, not the things that we intended to do.

So far my intentions for the first half of 2011 include decluttering the house, using an iPod to advance my path to sagehood, preparing for my Board Exam, meeting a variety of health end points, completing and implementing my post-retirement financial program, and nurturing a more gracious presence. That is the wisdom that will not even arrive, let alone endure without some very specific means of doing them.

A passing acquaintance, Danny Siegel, an awesome sage who has devoted his energy to getting Jews to incorporate tzedakah into their usual activities, once sent me a note in response to a donation I had made to his Ziv Tzedakah Fund. It being the Pesach season, he included a brief article he had written about Danny's Four Questions. Years later, at each planning session and at each life's branch point, they still guide me.

What do you like to do?
What are you good at?
Who can help?

Why not?

Semi-Annual Planning

2010-12-09T06:23:00.000-05:00

Each June and each December I allocate a fair amount of effort into defining six finite, measurable projects that would advance me if I actually did them over the following half year. Usually only one has a real deadline with an inevitable end point. That one always gets done, whether it be celebrating a milestone anniversary or arranging a child's Bar Mitzvah. Most other things don't exactly end up getting procrastinated but never arrive at the pre-determined end point either. I always fall a couple of publications short of my usual goal of four, my finances get turned over to an expert but I never actually complete the estate planning that I had intended, some physical ailment crops ups that gives me an excuse for not meeting my exercise targets. Still, it is good to have a tangible measurable goal with a deadline to better enable some form of direction and prod to get there.

Usually it is not hard to get to six, some like repackaging intentions for better health or less random financial management in some form. For the past six month block, I started my new job, got my name in print only once but got three medical opinion pieces onto the electronic journal. My future financial needs of estate planning and long term care insurance will remain undone by New Year's Day. My weight is a few pounds above where it was in July and as in past years, my treadmill has become one more flat surface to put stuff on. There is usually a home upgrade on the list, this time to create a sanctuary for myself in my bedroom. The semiannual home upgrade project almost never gets done, whether dependent on me or a contractor. I tend to waver back and forth in its process, much like approaching anatomy, which can be taught either regionally or by systems that span several regions. I can either make my bedroom sparkle or I can rid the house of clutter wherever in the house unneeded stuff happens to be. I've tried both, neither effective. And by the end of the half-year, the sixth project has escape my immediate consciousness but is easily recalled by a glance at the 3x5 index card that I keep with the page marker of my Franklin Planner. Oh yes, it was to have a blog that other people might want to read. The postings are regularly implemented, the readership spotty.

So what do I hope my life will be upgraded to by Independence Day 2011? I will weigh less by intent, though the process for getting there still needs to be worked out. Upgrading rooms has been a sufficient failure that I will need to do something regionally this time. Now that I am earning a very substantial wage without the intrusion of running my practice, it is time to set a higher priority to this than I have been doing. There is always some form of mental advancement project that I really work on. The time has probably arrived to get some modern electronics such as iPod or iPad or Smart Phone to better enable this, though I've encountered a fair number of people who I think are not smart even though their phone is. What has not been on the intermediate goals in a while is some form of Jewish advancement. Slouching in level of observance would make for a good topic for one of the three essays I intended to write but didn't.

Bimah Me Up

2010-12-03T06:34:00.000-05:00

Many years ago a number of teachers guided me through some skills that would enable me to contribute to worship services, though the activities lay dormant and unrefined for many decades. As a senior resident I accepted a haftarah invitation, then some invitations came along for Torah reading. Functioning as shliach tzibbur never garnered an invitation, other than maybe maariv at a house of shiva or a Kabbalat shabbat when the hazzan was away. A couple of years ago, the gabbai got desperate enough to recruit me for Shabbat morning, which takes a little more preparation than the others. It went OK, though with far less proficiency than I had acquired with Torah and Haftarah reading. Time lapsed, then another invitation a few months ago, then they needed to scrape a little farther into the cadre of skilled men who get up that early on a shabbos morning so another invitation came. Unfortunately, the gabbai also botched the schedule, putting his son in the slot that had been set aside for me. I accepted a rain check for two weeks hence, which is tomorrow. I forgot at the time that this shabbat coincides with Hanukkah, so there are two additions that I had never done before: Hallel and Al Hanisim, which I had to learn. Most of Hallel I already knew as the tuneful parts are publicly recited. I just needed to learn a basic nusach for the brachot and chatimot, which was readily available from a number of audio sites online. Al Hanisim I was on my own. Last evening I went through the dry run for the first time. Not elegant, but not tircha d'tzibburah either.

For a congregation that either prides itself or deludes itself into thinking it has a monopoly on serious Jewish talent in our community, the evidence is that AKSE has not done an Ace job in expanding the proficiency that its members bring to the sanctuary. There are a handful of Bar Mitzvah boys who perform capably, though in a limited way, recycling what they learned for their bar mitzvah when convenient, though for all practical purposes never learning a new Haftarah or Torah portion. When the hazzan goes on vacation, he has to hire a Torah reader, one from the Conservative shul, setting aside all his semi-public contempt for inferior conservatives, whose alumni like myself allow AKSE to function from one week to the next. And the unwillingness of the women to advance their skill beyond a Junior Congregation level and the complicity of the Rabbi with this classifies as an institutional shonda from my perspective.

So while those who come early enough to hear what occurs prior to Torah reading will not exactly experience an audio treat, they will have a relatively rare opportunity to listen to an effort to advance skill, one performance that did not derive from the Davening Recycling Center.

Hanukkah

2010-12-02T06:22:00.001-05:00

We lit the first candle last night. This year, in our silver oil menorah, we used shabbos candles instead, as the oil can be quite messy and the shul's gift shop did not have any this year.

Hanukkah has multiple themes: victory by underdogs, living on one's own terms, recognizing the value of small amounts of good oil when usable but defiled oil exists in abundance, adding a new candle each night as there is more to celebrate as the days proceed.

In the late afternoon, not long before the sun set, one of my favorite pharmaceutical rep pairs who used to call on me to Wilmington stopped by the suite at Mercy to deliver some Novo insulins and Victoza samples. I was having a wicked day, ultimately seeing a personal record of eight consults before I departed for home long after most people had kindled their first Hanukkah light and munched their first latke. I interupted my tasks in the hospital to visit them for a few minutes. Drug reps make good spies, since their rounds take them to many places and they hear a lot of candid comments from doctors and office staff. So I caught up on some poop at Christiana and the welfare of my former colleagues. While I am rather content with my surroundings, despite not having the day to day control of my activities that I had in my own office, I've been treated rather well thus far and really like the people I've met along the way. All eight of the patients I saw as new consults probably benefited from what my skill provided them. I suspected that my colleagues at CCHS struggle more with their employer than I do with mine. That turned out to be the case. I think at least half of them are virtual serfs, tilling the exam rooms and wards under difficult circumstances, seeing large volumes of patients who get processed through more than they receive the individual attention than my partner and I are able to give and who need the medical care a lot less than most of the people that I have been seeing. While my path of least resistance as my office became less viable last year would have been to have them annex me, that shidduch was not to be. Those left on the outside but with a mission in mind sometimes really do triumph over the dominant players.

Getting Up Early

2010-11-30T05:52:00.000-05:00

My internal clock may be malfunctioning. Early to bed, early to rise has altered my schedule without contributing a whole lot to health, wealth or wisdom the past few weeks. As the clock moves toward 5:30, I've been up an hour, did some milchig dishes, made the crust for a Bookbinders Apple Walnut Pie that I've been meaning to make a gentleman who helped Irene out when her car malfunctioned last month but have not yet embarked on the planning for the upcoming week and month that was supposed to have been done two days ago.

Everything seems quiet with the sun not yet risen and no audios turned on. A day of opportunities to do things, both to set goals and pursue them, has hardly started. Coffee goes well this time of day, its attraction today being its pleasant but slightly bitter taste more than the need to perk up more than I am right now. For a brief time, at least, I do not perceive myself as overwhelmed.

Thanksgiving

2010-11-24T06:40:00.001-05:00

While my tendency is to be a kvetch, as tochacha is always the first step to improving most things or most people as the Sages suggest, there are times to break from this pattern. My American and Jewish cultures set some time on the calendar to enable this. The American one, Thanksgiving, arrives tomorrow and one of the Jewish ones, Chanukah, comes next week. Tal Ben-Shahar, in his PBS Special, suggested keeping a daily log of Hakaras HaTov, five good things that took place each day. I keep my log in a grade school composition book obtained in the back to school sale. It is very sporadic in entry dates, though I am fortunate that I am never at a loss to come up with all five. These entries are always a look back, though, never anticipation of the good that might come my way tomorrow. As the wise character Alfred Doolittle noted, "the Lord is throwing goodness at you but with a little bit of luck a man can duck."

Since I cover Xmas each year, I can always expect Thanksgiving as a day off, though this year only the one day. The menu has been planned, the kids arriving from NY at some point, and a marathon of enjoyable meal prep and eating awaits.

Dad's First Yahrtzeit

2010-11-23T06:01:00.001-05:00

Dad's first yahrtzeit came and went, uneventfully. I said Kaddish last shabbat, though the actual observance with candle began the Wednesday night before. AKSE never put it on their calendar, so no notice went out.

For my mother's observance, which will reach forty years this winter, I have received a notice from the JCC of Spring Valley or its current incarnation every year, at least since residency and maybe as far back as medical school. I send them a check each year, a small one, but enough to maintain me on the notification list, even though I've not been a member in decades. Then again, she has a memorial plaque there. At Beth Shalom, I received a reminder each year of my membership there and same for AKSE.

But AKSE has no organized mechanism for entering new data. Presence of mind would probably suffice as Dad's passing was announced from the Bimah on the day of death and they held two shiva minyanim at my home. But nobody had the presence of mind to enter it on their computer data base which meant nobody had the awareness to request a donation or ask me if I needed assistance in assembling a minyan. In the absence of thought, automated procedures become a reasonable surrogate. This apparently does not exist. My kids never have their birthdays announced in the Shofar, nor do anyone else's kids, even though a number of namings and bris ceremonies have taken place there, to say nothing of Bnai Mitzvot that where dates are assigned years in advance.

The consultant a few years back commented in his official report that many of the procedural aspects of AKSE's operation seem random when they should be consistently predictable. Entering dates may be one of them.

AKSE's 125th Anniversary Celebration

2010-11-15T06:12:00.000-05:00

The preparation and event have come and gone. I think people enjoyed the evening. I've not had prime rib in ages but I can see why its popularity has declined relative to Kosher chicken breast. But food and wine and a dance floor do not create history nor they portend a future. For all the attention on bringing young people into our sanctuary and Hebrew School, attendance and ad book advertising came from the old Adas Kodesch. It was an expensive evening, perhaps a couple hundred smackeroos for two dinners, an ad, some new clothing perhaps, a trip to the hairdresser, a baby sitter. This may have detered a lot of the younger ones. I saw the ghost of AKSE's past but not much of its future. It that sense, it may have been an error to revel in the past alone.

Physician Posting Sites

2010-11-12T06:18:00.000-05:00

My colleagues have opinions, as do I. We tend to be semipublic figures whose verdict means something, whether or not it is welcome. Most of us are also dependent upon the good will of our patrons. The need to enable candor while minimizing unfavorable retaliation for the opinions that we carry has led to a number of web sites that only allow physicians access, to express opinions to each other or ask for medical guidance that can be moved to patient care without formal consultation. I subscribe to two, Medscape's Physicians Connect and Sermo. Both are subsidized by some form of advertising, which is good since they would probably collapse if a fee were imposed on the users. I post on both, but have greatly curtailed my use of Physicians Connect which I think needs to eliminate anonymous posting and obtain a moderator. For an educated crowd, the physicians can be rather hateful, particularly those raised on revenge in the Middle East. I do not think a lot of them would want that level of candor identified with them and conveyed to their patients.

Politically, the most dedicated come across as libertarian: "Mine is mine and yours is yours, Average, though some say this is Sodom" as the sages of Pirke Avot observed. Sermo people have pseudonyms of their own choosing but not outright anonymity. Politeness is valued a good deal more on Sermo than at Physician Connect and remarks belittling another poster are rare, even on the political discussions, at the former though common enough at the latter that I took my intellect elsewhere.

People can also run medical dilemmas and opinions by specialists. While both contain a few medical loonies promoting their fringe agendas, the regular medical posters on each seem a reasoned bunch. Still, I get the sense that people who fundamentally like being doctors opt for Sermo, the kvetchers congregate at Physicians Connect.

Veterans Day

2010-11-12T05:58:00.000-05:00

South Florida Veterans Cemetery

Dad's Final Resting Place

Beth Tfiloh

2010-11-08T06:19:00.000-05:00

There are some destination synagogues for me. While saying kaddish, I took a liking to the experience and clergy at Beth Emeth, our local Reform congregation. While initially attracted by the security of a minyan and the convenient time for Kabbalat Shabbat services, it did not take long for me to admire the Hazzan's musical skills and the Rabbi's intellect. My own religious preferences aside, I always return to my car after a cup of soda at the oneg, about the only thing there I can consume after a fleishig shabbat dinner, thinking I have been to a place of kedusha. My own congregation does not seem to put holiness among its aspirations.

About once or twice a year, my destination congregation is Beth Tfiloh, a nominally Orthodox gathering in the northern suburbs of Baltimore. If I leave Wilmington at 8AM I can generally arrive at the end of Shacharit, and have never been disappointed. Each visit has a Bar Mitzvah, which I utterly loathe at all of the Wilmington congregations, where the boy effectively pre-empts shabbos. I make a point not to go those weekends, substituting some Pikuach Nefesh activity like being on call or donating platelets, which is what I was supposed to due yesterday until I botched the prep by taking aspirin from my pill case within 72 hours of the scheduled donation. So I went to Beth Tfiloh instead.

Beth Tfiloh has a mechitza, which my wife loathes. It is only about four feet high, made of plexiglass with an unobtrusive design. From my seat yesterday, not far from where I usually sit, I did not notice the physical barrier right away, just a lot of women on one side of the sanctuary and a lot of men on my side.

Each time I've been there, they have a Bar Mitzvah. I'd expect that from a congregation of over a thousand members. Yet the Bar Mitzvah never seems to intrude on the service. Twice they had invited guest speakers, Ruth Messinger of the American Jewish World Service last spring and Martin Fletcher the Middle East correspondent for NBC News yesterday. It would be unthinkable at AKSE or Beth Shalom to ask a Bar Mitzvah family to share their assigned day. Rabbi Wohlberg always has a presence, even if it is only to introduce the guest. Who is honored? One who honors others. Avot 4:1. The rabbi has had a word of tribute for all he mentions, from the Bar Mitzvah to the woman observing her 100th birthday in absentia. For an orthodox congregation, he finds a suitable role for women. I would not be surprised that if in private he is apologetic for not being able to offer more. This being machar chodesh, the women have a role of gathering for t'hillim or Psalms. He mentioned a women's tfilah group in passing. Attendance of 45% women by my estimate speaks for itself.

And there was no amateur hour. All participants came across as suitably skilled, even the Bar Mitzvah bachur who did a more limited amount of worship than some of the others. A morning's delight. Worth the shlep each time I go there.

shabbat prep

2010-11-05T05:56:00.000-04:00

Every Friday morning I arise early, or at least on time, to begin shabbat preparation that usually starts Wednesday by defrosting the meat I plan to cook, defrosting two minichallot on Thursday and preparing the dinner Friday morning. Chicken breasts work well since they cook easily but beef cubes can be put in a crock pot with vegetables and are ready by sundown. I usually make a starch, occasionally a vegetable, almost never a dessert.

Gas gets put in the car on Thursday night or Friday morning if there is less than half a tank. I stop at the cash machine if I have less than $50, though I rarely spend money on shabbos, other than my weekly cup of coffee to help support Sweeney's Bakery around the corner. When I get to the office, I put half my coins of each value into the pushka on the window sill.

This year I find myself less observant than last year, something that has cycled over decades. Sometimes the lapse involves circumstances or choices largely imposed upon me like call schedules or moving to St. Louis to attend medical school. Sometimes, including now, the reversal makes a statement of my disdain for people promoting their own observance agendas.

I attend synagogue less than I used to on shabbos morning, more on Friday night. On shabbos afternoon, when I used to rest or read, if not on call, I now schedule an appointment with myself to go out. I've been to a few arboreta, a nature preserve, some state parks, the beach, and maybe this weekend a college football game. I think these are the down times from the work week, just as much as steering clear of the cell phone and computer and stores, which I still do.

Election Day

2010-11-02T05:24:00.000-04:00

When I started, I had intended a forum for irritated physicians and synagogue members, of which there is no shortage. I have been ambivalent about whether the intent was to act or to vent. Polling suggests that dissatisfaction with our social environment extends to many parts of our grand experience. The voters today, and increasingly by absentee the last few weeks, intend to act.

Sanctuary Ennui

2010-10-29T06:01:00.000-04:00

My retired friend spends much of his unscheduled time in the library, sitting at publicly funded screen while searching cyberspace for items of interest to send along to friends who are not retired. Sidestepping the issue of electronic clutter that this sometimes creates, he hit a home run this week with an op-ed piece from The Forward, America's principal Jewish weekly, regarding the experience of attending services in different locales. In some ways I may be a modern day Hellenist willing to sacrifice some elements of tradition and letter of the law to enhance beauty or justice, and like most Americans have been acculturated to pluralism by the tenets of our basically irreligious Founding Fathers. I think Judaism would be better if the law promoted gender equality. I am less convinced that it is better by adapting the law to reflect that, as most Conservative synagogues have done, though they seem to have paid a very high price for the practice. Perhaps parity would have been a better goal. Yes, I am for gender equality and my activities outside AKSE reflect that. I am also for having Kohanim and Levi'im precede me in Torah honors even if there is a measure of lunacy to having some shoeless Am-Ha-aretz mumbling a bracha that had to be transliterated for him so that he might function as a divine conduit to bless a congregation of lesser yichus but greater accomplishment.

To make the proceedings of the sanctuary less intimidating to the novice we introduce contrivances like responsive readings of inanely translated liturgy. I think the sermons at AKSE rarely contain content that require anybody to be particularly literate to understand. Whether the Rabbi intentionally dumbs it down or actually functions at that level of erudition himself can be debated in both directions, I suppose. Berel Wein in his Tending the Vineyard, his memoirs on life as a congregational Rabbi, noted that each week he only has one real chance of about ten minutes to convey a real message of Judaism to the listeners that will have to sustain then to the next Shabbat morning. It our effort to be inclusive and not leave people behind, we sometimes forget that the mission of Judaism is to elevate people to a higher standard than from the starting point. Instead, we have changed the destination without really changing the people. In the USCJ world, egalitarianism, for all its social merits, ran in parallel with congregational decisions to popularize attendance via expanding comfort zones when they should have been upgrading educational standards. We elevate people to the mitzvah. We do not diminish the mitzvah to facilitate compliance.

Quest for Mediocrity

2010-10-21T06:18:00.002-04:00

Sometimes the quest is a relentless one. In both my medical world and my Jewish one this pursuit emreges in a variety of ways.

Having divested myself of all AKSE Committees except Education, last night I undertook my remaining contribution, which includes setting up a night of learning and arranging a visiting scholar, both works in progress. The committee decided we wanted a woman, as we had never had one, and I decided that we would capitalize on that talent to advance our women who have already reached Mediocrity's Promised Land and share it with the Lotus Eaters who now aspire to nothing else. I wanted our rising star in the learned observant Jewish world to worship with our women, if only to get them to elevate themselves for the purpose of having the guest think well of them. The response of the chair was just the opposite, to shield our women from having to move themselves along for any reason. It does not matter if I was able to bring cutting edge Orthodox Judaism to the Orthodox Pretenders, it disturbs the mission of stable mediocrity. So does requiring that all programs, without exception, undergo scheduled periodic assessment to determine future upgrades.

Having the seat on the Board of Governors reserved for laytzanos, I was equally disheartened by the Executive Committee report. Not only do they think they can make membership grow by dumbing us down and finding the niche gimmicks that portend the destruction of United Synagogue Jewry within the next generation, but they take the erroneous view that advancement should not be forced upon people. Friday night services are sparsely attended for a variety of reasons. I find them strikingly unattractive and go elsewhere as a destination at the start of each shabbat. But I they get ten men and can check the boxes that all prayers were recited, then there is no reason to make the service attractive to anyone else. If they get nine, there is still no reason to make the service attractive to anyone else, just recruit a tenth and leave things be.

Sometimes the quest for mediocrity is indeed relentless.

Diverting My Contribution

2010-10-17T11:30:00.000-04:00

Each year on Yom Kippur, the congregational president of AKSE makes an appeal for extra funds, which adds about 20K to the synagogue's treasury. This is the largest fundraiser of each year. It takes no committees and costs nothing other than the bookeeping and banking costs. It has been my tradition to write a check for $100, no strings attatched, nothing conditional to the check. Despite the long precedent, this year the contribution does not go to AKSE but to an organization called Women of the Wall, which our local reform congregation, Beth Emeth, has adopted as their recommended cause. While I have the good fortune to enjoy sufficient prosperity to write two checks of $100 each, I feel very strongly that this contribution really needs to go from AKSE with me as the conduit.

One of the challenges of observant Judaism has been the ambivalence to what the optimal role for women ought to be. When our Rabbi came aboard, my wife and I were optimistic that the role for women in the congregation would expand in a meaningful way. Had the Rabbi opted to take the progress in stages, conduct some experiments and modify what needs to be modified, I would have jumped aboard. Instead, he made some very trivial decisions that I think reflect a fundamentally limited intellect and marginal gift of Binah from HaShem, the closed the door on further modification citing the authority he has as mara d'atra. That is not like me at all, where I round on patients every day and correct yesterday's errors as I go. Judaism as I understand it takes a dim view of victimizing people without recourse. Our women are doomed to mediocrity without prospect of reversal. The Women of the Wall still have an upside. That is where my money goes. It cannot also go to support impropriety on my own home front.

While I think Derech Eretz would have me simply toss my AKSE pledge card into the recycling bin and write a check to Women of the Wall, my wife put a condition on the diversion. I would also have to write to the congregational President and explain to him in Jewish terms why the Women of the Wall are of superior worthiness.

Physician Posting Sites

2010-10-10T09:24:00.000-04:00

This summer I decided that I would no longer post comments on Medscape's Physician Connect, where I had been a regular for a couple of years, except at the Endocrinology division. I tried replacing it with Sermo, where I found the physicians more congenial but for the most part these places do not really attract a lot of people whose goal is to be congenial. Instead of finding it a place to exchange ideas, I found it a place to promote agendas, a place to express the desire for the gimmes whether that be removing the Israelis and any other Jews from Israel or removing the democrats from public positions or removing formularies from insurance so I can have my own way with no interference. When somebody who a different view somebody will invariably respond that they are inferior in some way. After maybe a year of this, doing my very best to be both erudite and polite, I found myself adapting to this environment more than I would like and offered myself a hiatus.

At first, I missed having a chance to express myself but that craving ran its course in a week or two. A few days ago, I gave it another look, reviewing the political discussions on Medscape and the medical ones on Sermo. I responded to Endocrinology on both but the political and practice of medicine subjects no longer held sufficient interest to open up the discussions to see what the medical discontents had to say about their never ending lists of real and perceived enemies.

Weekend on Call

2010-10-07T06:22:00.000-04:00

My first weekend on call at Mercy. It was definitely a quieter place than Christiana, with four new consults and about eight others who needed some kind of personal attention. There were not a lot of consultants or even ICU people or surgeons milling around by early afternoon, with the assigned hospitalists and a few residents assuming most of the patient care. On Saturday afternoon, the hospital hosted a community health fair so I agreed to occupy the ASK A DOCTOR table for about 90 minutes. A few folks came by including a couple of diabetics who needed some professional attention, but mostly folks with minor events that would not ordinarily incur a medical visit but as long as somebody is there to look at the rash or sore shoulder for free, why not. A physician who charges nothing is worth nothing (Bava Kama 85a), though that comment comes in the context of just compensation for an injury which includes payment for medical care, which by Talmudic requirement has to be mainstream care. I must say, I enjoyed being at the table, watching the people go by as I sipped on a Diet Coke.

Then Sunday I did real on call type of work, a slower pace that enabled me to think about what I was doing, instead of the Christiana burden of just getting through the enormous census and unending cell phone interruptions. Definitely a more civilized experience, and I suspect a lot better for the patients to have a doctor who is thinking more about them than about the tasks that lie ahead.

Electronic Medical Record

2010-09-29T06:26:00.000-04:00

My first day in Mercy's outpatient Endocrine Office, saved by no-shows which enabled me to struggle with their electronic medical record, a system called Nextgen. Our financial institutions and travel systems have taken full advantage of computerization, though our medical systems have been laggards. While I think there is much to be gained, the systems that I have encountered do not seem to be able to template a complex present illness such as diabetes particularly well. One worthy project might be to compare dictated History of Present Illnesses with those templated.

Mens Club Discussion

2010-09-26T19:47:00.000-04:00

AKSE has both a Mens Club and a Sisterhood, each productive in its own way. The Sisterhood raises money and makes sure food is on the table for kiddush and other events. The Mens Club meets monthly with some type of program. I attended today's meeting, one that I had looked forward to, where a U of Delaware professor of Jewish Studies would present on how he transformed from a good ol' boy of non-Jewish ancestry to a Jewish scholar, who definitely did not attend Rabbinical Junior College. Despite my anticipation, and the obvious knowledge of the professor, the morning was a great disappointment, so much so that I looked at my watch and bentsched early as the Rabbi watched.

The talk just wasn't focused. To make it more arduous, the organizers invited the Jewish War Veterans to present. And furthermore, the food fell short of its usual attractiveness. I probably won't go back to any more of these, no matter who is scheduled for the presentation.

High Holy Day Sermons

2010-09-22T06:44:00.000-04:00

Survived another Rosh Hashana and Yom Kippur, not quite knowing where I am sealed. Didn't do so great on "latznu" from the viduy, and not about to take the Rabbi's advice to work on where I personally fit in on my transgressions, at least that one.

I do not recall what the Rosh Hashana sermons were. Something about binding Yitzchak the first day, even though they didn't actually do it until the second day. For the second day, my daughter commented something about Dr. Phil on the pulpit. I do not recall anything of the sermon only the paucity of Jewish content, decent theme probably but without the substance that would enable me to recall the content a week later. Yom Kippur went better, with the Kol Nidre message including a decent review of several passages of Al Chait and a poignant message introducing Yizkor based on his feelings following his experience with a stillborn child.

Last night at AKSE's Board Meeting we had a High Holiday review. To my great surprise the sermons were well received by most of the Board Members. None of them required attendance at Rabbi School, the Jewish content was paltry in all, though compensated by other things in the YK messages.

Patient Repairman

2010-09-19T13:35:00.000-04:00

My new job has commenced. While I learn the lay of the land, I started seeing consults and visiting the primary care settings from which my patient originate. Thus far, the consults have challenged me, which energizes me more than I have been in some time. Not that I want anyone to be unnecessarily ill or ignore prevention but working as a repairman brings a type of thrill that had been dormant. Most of the people that I've seen had little medical thought given to them by those who had been treating them. A few easily correctable insulin revisions make all the difference the first 24 hours, though I ask each of these folks to bear with me for about six months to reconstruct their diabetes from insulin to end organs. Some of the people seem a little surprised to learn that with some alterations of treatment, they could be doing better. People had been experiencing marginal diabetic care for more than a decade, yet I was the first endocrinologist they had seen.

Can Obamacare really improve the medical outcome of these individuals? Unlikely, as absence of insurance does not seem at first glance to be the barrier to lower glucoses or protection of body parts in the diabetics that have come my way the first week. I think there needs to be somebody accountable for optimal medical decisions. As I visit the primary offices in a three mile radius, I do not perceive a lot of attentive goal focused medical care, with a few exceptions that bring me a measure of optimism.

For now, I like getting up early to go to work.

New Year 5771

2010-09-15T06:16:00.000-04:00

Rosh Hashana eases in and eases out. The day clearly demarcates one calendar year from another but it really occurs at about the midpoint of a season. At the start of Elul the parochet and Torah mantles switch over to white, Avinu Malkeinu, LDavid Hashem Ori and Shofar begin and continue through Yom Kippur, with an extension for Psalm 27 through Shmini Atzeret. Unlike the American New Year which tends to function as the anticlimax to the more widely celebrated Christmas, the Rosh Hashana goes in the other direction beginning an upward swing to Yom Kippur with sukkot as the anticlimax, though preserved by the comeraderie of socializing in different people's sukkahs.

At AKSE the first day appeared well attended, the second day less so. I located the No Chatter Section for the first time, staying in the designated Men's Section the first day. Unimpressed with sermons which had vallid topics but paltry Jewish related development. Went to in-laws afternoon of first day, followed by tashlich at nearby stream that still supports minnows who enjoyed the bread fragments. After yontiff, shabbos, appropriately restful, then some light chores Sunday, then new job Monday.

Definitely a transition of one time to another.

Erev Rosh Hashana 5771

2010-09-08T14:47:00.000-04:00

My greetings have been pretty much sent. This morning I arose at 5:30, my last full day in my medical office, to prepare dinner for yontiff. Irene made her annual rice kugel last night. I made the chicken today. I was going to make honey cake and had all the ingredients out but took advantage of my New Year's intent of cutting down on procrastination by postponing this until tomorrow, to take to my in-laws. I made Kojel for dessert instead. It goes much faster but never gels as well as trafe Jell-o, though I am told that there is now a reasonably competitive Kosher product.

Rozzy plans to be with us for the holiday so we purchased a worship ticket for her. I picked out a Round Challah, initially getting an Ace product from Safeway but returning it to the shelf when the self-register rang up $9.59. Procrastinate next year, try not to. Cheap next year, you betcha. Got a smaller and less inviting one at Shop-Rite for less than half that. Tablecloth looks grungy and I could not find the other fleishig one, so probably stop off at Boscov's on the way home for a new one. Then make a vegetable, make the soup and heat up the pre-made stuff for a good start to the New Year.

Son's birthday tomorrow. Same birthday as the world, at least this year.

AKSE Ad Book

2010-09-07T10:29:00.001-04:00

Some background: Adas Kodesch Shel Emeth, my congregation since 1997, needs to raise money or to spend less. About every five years they sponsor an event to celebrate something, this time the congregation's 125th anniversary. While it may be a social bonding success, though a very transient one, it rarely makes a lot of money as up-front costs of dinner and publicity are high. The Board and organizers always seem very ambivalent as to whether the purpose of the effort is social or financial. The dinner breaks even, though if they replaced the live band with a DJ they might come out ahead. I'd expect people old enough to have hosted some family simchas to possess the saichel to realize this. In any case, the real fundraising comes from an ad book, for which Irene and I wrote a check for $118 for a half page to announce a message. I could not help be a laytz, extracting the four types of students from Pirke Avot [5:15].

There are four types among those who sit before the sages: the sponge, the funnel, the strainer and the sieve.

The sponge absorbs all

The funnel takes in at one end and lets it out the other

The strainer rejects the wine and retains the sediment.

The sieve rejects the coarse flour and retains the fine flour

Labor Day

2010-09-06T02:30:00.000-04:00

HAPPY LABOR DAY

UAW

Push

Labor Party

Hard Labor

Rosh Hashana Week

2010-09-05T19:04:00.000-04:00

Some transitions. Kids start the new school year, some heading off to college for the first time. I tie up loose ends in the office in anticipation of my new job about a week hence. And then we have the transfer of the calendar from 5710 to 5711. I've been writing my summary of the past year: loss of father, closure of medical office, new car of necessity, new blog induced by some friction at synagogue, reunion with friends not seen in a while and likely never to be seen again. Much to bore other lost friends if I neglect to edit the grand message for each individual recipient.

Selichot at AKSE last night. Rather mundane discussion of the expected topics, the successess and failures of the year gone by and how we will ask Lucy to hold the football so we may all kick it one more time to allow ourselves the score next time that eluded us last time. As a college kid, I used to took with anticipation to selichot, particularly if Rosh Hashana occured shortly after arrival on campus. It was my first chance to socialize with friends who had made themselves scarce the previous two months, and without the threat of exams or frat parties competing for attention in Sunday morning's wee hours or an alarm clock jolting us at sunrise.

Rosh Hashana week has some acquired predictability nowadays. My son's birthday preparation, some Torah reading to be done, a Haftarah on Shabbat Shuva, special menus and meals to be arranged, office coverage to be confirmed and an afternoon and evening with my in-laws. Then a one day breather, then a new professional venue to make the transition an ongoing one.

Shabbat Prep

2010-09-03T06:49:00.001-04:00

End of the work week, end of the summer. Very early on Friday morning with a few tasks separating me from a shabbat respite, or if not a respite, then a change of pace. I made the foundation of dinner: flanken and Israeli couscous with sauteed onions and mushrooms. Then some cauliflower to parboil before lichtbentschen. When I get to the office, I will put my coins in the Pushka, then bring the pushka to my car, as this is the final Friday that I expect to be in my office. Maybe I will empty the Pushka, put the coins in the TD Bank coin counter and write a check for the proceeds to the Hebrew school like I usually do at the start of their school year. It will probably be the final tzedakah check from my office account.

On Fridays I do a double portion with my Franklin Planner, outlining both Friday and Saturday anticipated tasks. I also think about where I will attend services, usually Beth Emeth for Kabbalat Shabbat and AKSE on Shabbat Morning. This week I also need to pick up some mini-challot, either from Trader Joe's or Safeway. Come the end of the workday, the tasks will close, the majority typically not done, to be half-heartedly restarted when the sun goes down Saturday and more vigorously shortly after sunrise on Sunday.

While shabbos is different, is it really better, as people tell me it should be? Definitely a difficult question to analyze, but for now I'm content just leaving it different.

Electronic Outpatient Records

2010-09-02T11:39:00.001-04:00

This week I completed my formal training on how to enter data on Endocrine outpatients at Mercy Catholic Medical Center where they are implementing an electronic record, to begin on my second day on the job. Over the years I have become something of a medical craftsman, not quite an artist who takes creative liberty, but somebody very proficient who can discern one person's situation from the next. It came as a shock to encounter a computer program that can be clicked in minutes and generate a relatively nonspecific narrative about diabetes. It reminded me a lot of my residency time of despair when assigned to the coronary unit. I quipped in the 1970's about templating everyone's history with substernal chest pain of x hours duration that radiated somewhere, as where usually didn't matter much unless straight through to the back where thoracic aortic dissections go. You enter the age and the response to nitro if any and you could save yourself a good deal of writing. These histories didn't matter much since everybody got templated in their care with cardiac enzymes and an ekg. The differences in the ekg's mattered as did evidence of congestive failure but for the most part a jaded resident like myself could safely conclude that most angina follows a pattern that leads to uniform lab testing and a small variation in decisions with little nuances of history not all that essential to decisions.

That is not the case for diabetes where the difference between me taking care of it and the primary physicians or non-physicians taking care of it are the nuances of history. There are responses to individual medications, as virtually everybody who comes for consultation arrives already unsuccessfully treated. There are end organ symptoms that belong in the HPI, not the ROS. It is extremely hard to template that but people try.

Synagogue Governance

2010-08-31T07:16:00.000-04:00

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

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

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

Semi-productive

2010-08-29T19:22:00.000-04:00

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

Shabbos Prep

2010-08-27T08:54:00.000-04:00

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

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

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

Filling in the Calendar

2010-08-26T11:09:00.000-04:00

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

Physicians of Despair

2010-08-25T07:52:00.000-04:00

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

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

New Job Upcoming

2010-08-24T09:04:00.000-04:00

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

AKSE Academy

2010-08-23T16:17:00.000-04:00

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

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

Nurturing Talent

2010-08-22T16:55:00.000-04:00

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

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

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

Kiruv Unfulfilled

2010-08-20T08:23:00.000-04:00

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

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

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

Annoying Colleagues

2010-08-19T08:10:00.000-04:00

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

High Holy Day Prep

2010-08-18T09:41:00.000-04:00

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

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

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