modern-decor-lucite-giraffe-jonathan-adlerCada semana tutorizo (es decir, enseño y superviso) en la clínica de medicina interna a los residentes en las consultas externas del Hospital Johns Hopkins, en la calle Caroline en Baltimore. Los pacientes son en su mayoría de la ciudad Baltimore y afroamericanos, sin embargo recientemente empieza a acceder un número creciente de inmigrantes hispanohablantes.

He intentado algo nuevo estas dos últimas semanas. Cada vez que un residente me presenta un paciente (como nos exige la ley y la buena práctica), escucho la introducción, sonrío y luego me permito interrumpir con la siguiente petición:

-Por favor, dime algo no médico sobre el paciente.

En nuestra cultura médica, los residentes presentan al paciente de esta manera: “Sr. S. es un hombre de 69 años con enfermedad renal crónica, trastorno bipolar, enfermedad arterial coronaria, hipertensión e hiperlipidemia, acude para seguimiento.” Pero a mí me interesa cada vez más saber algo sobre el paciente como una persona con tres dimensiones, cuando no está en la clínica.

Las respuestas de los residentes a esta solicitud mía parecían pertenecera una de estas categorías.

Hay algunos que obviamente no habían pensado en tal enfoque. Uno dijo: “El paciente es muy agradable. ¿Eso cuenta?”. No, dije. Algunos residentes parecían reconocer que realmente podrían preguntar, por ejemplo, dónde vivía el paciente o qué hacía, pero les faltaba tiempo.

Otros habían preguntado sobre tales cosas, pero necesitaban permiso, por así decirlo, para mencionarlas desde el principio – para permitirse dar al amor por el paciente por los crucigramas, la devoción al coro de su iglesia y a la colección de figuras de jirafas, la misma importancia que la adherencia a la medicación y su nivel de creatina.

(Hubo incluso una residente que se rió, y siguió con su presentación – no estoy seguro si no lo entendió, o simplemente me ignoró).

Ninguno de los residentes dió dicha información personal sobre el paciente en la introducción de su presentación sin que yo lo hubiera pedido. Sólo se permiten ciertos tipos de conocimiento de los pacientes – sus datos biomédicos, sus disfunciones fisiológicas, y (algunos de) sus síntomas. Pero no su vida personal, no lo que hace que su vida – ellos mismos – les merezca la pena vivir. No ellos como personas.

Por supuesto, los criterios de conocimiento permisible se transmiten sólo implícitamente en la escuela de medicina y en la residencia. Pero son poderosos. Son una atmósfera que envuelve al médico en la clínica – tanto que incluso yo, varios peldaños por encima de los residentes en la jerarquía, me siento consciente pidiéndoles que me den una (¡sólo una!), “cosa no médica” como nombre justificativo, acerca de un paciente. E incluso entonces, debo justificarlo: “Se trata de ver al paciente como una persona completa”.

¿Qué cosas no médicas le han preguntado a su paciente o compartido con su médico?

No soy hispanohablante nativo y le doy gracias a un colega generoso de Madrid que me ha editado este blog. Por supuesto llevo la responsabilidad para todas infelicidades de estilo y errores gramáticos.

modern-decor-lucite-giraffe-jonathan-adlerEvery week I precept (teach and supervise) in the residents’ internal medicine clinic at the Outpatient Center of Johns Hopkins Hospital, on Caroline Street in Baltimore. The patients are mostly Baltimoreans, mostly African Americans, though an increasing number are Spanish-speaking immigrants.

I tried something new these past couple of weeks. Whenever a resident presented a patient to me (as is required), I listened to the introduction, smiled, and then let myself interrupt with the following request:

“Please tell me one non-medical thing about the patient.”

You see, most often, the patient is presented this way: “Mr. S. is a 69 year old man with CKD [chronic kidney disease], bipolar [disorder], CAD [coronary artery disease], hypertension and hyperlipidemia, here for followup.” But I was interested in knowing something about the patient as a person, when he’s not in clinic.

The residents’ responses to this request of mine seemed to fall into one of several categories.

There were those who had clearly never thought of such an approach; one said, “The patient is very pleasant. Does that count?” No, I said. A number of residents seemed to recognize that they might indeed ask about, for example, where the patient lives or what they do, but they hadn’t had time.

Still others had asked about such things, but needed to be given permission, so to speak, to talk about such things right up front – to give the patient’s love of crossword puzzles, devoted membership in her church choir, and collection of giraffe figurines the same pride of place as her creatinine and medication adherence.

(There was even one resident who gave a laugh and went right on with her presentation — I’m not sure if she didn’t understand, or was just ignoring me.)

None of the residents gave such personal information about the patient in the lead-in to their presentation before I asked for it. Only certain kinds of knowledge of patients are allowable – their biomedical data, their physiological malfunctions, and (some of) their symptoms. But not their personal lives, not what makes their lives — to them — worth living. Not them as people.

Of course, the criteria of allowable knowledge are transmitted only implicitly in medical school and residency. But they are powerful. They are an atmosphere all around a doctor in clinic – so much so that even I, several rungs above residents in the hierarchy, feel self-conscious asking them to give me one (just one!), apologetically named “non-medical thing,” about a patient. And even then, I must justify it — “It’s about seeing the patient as a whole person.”

What non-medical thing have you asked your patient about, or shared with your doctor?

Happy Purim 2017 from Zack, Celeste,

Progressive care is in danger. Candidates to protect health for the vulnerable, evidence-based medicine, and access for all need your help. Please give today.

Also, please check out the website for our new PAC, Clinicians for Progressive Care.

It comes to mind that this should be a field day for moral philosophers, or at least those in the Aristotlean mode who like to talk about categories of virtue and what not.

Look here! We have the idiotic evil incompetents (Trump and Bannon), the principled (but evil) organizational men, doers and organizers (Ryan and McConnell), the spineless collaborators (Rubio and Chaffetz), and the unscrupulous greedy connivers (Jared). We have the passive self-justifiers (Collins), the tragic-comic bumblers (Christie), and the self-aggrandizing demagogues (Stein). We have the earnest electoral failure (Clinton) and the distant hero (Obama). We have the safe champions (Gilibrand) and the fierce persisters (Warren).
Which is the worst evil? Which is the greatest good? Let the learned speculation start!

Our first podcast of the new year features a chat with the bilingual poet/critic/translator Alexander Dickow. Text of the poems he read are at the end of this post.

To a Politician
Your cellophane disguise for a tongue
Furiously unbefits the even knavest
Of these podium fisted Catilines I hate
Whose dim broadcasts encrust
With craven abjectives and slick nouns,
Whose paramount pronouncements’
Weighty grovel fresh veneers each victim eye,
Who gape and crave at limp wealth,
Puppets of their own slanted lip
And their thin speech as cheap
As its callous stakes are ruthless:
Our brittle faith, our breath, the truth.

Galaxy

Measureless and vacant husks
Veneer along the pale gaps
Kissing the smooth-lit kernels
Far across the hesitation
Contours

Where cycles dip
Ebbing forth aromas
Of nectar vicinities
All gleamed among
Their dim stretchings

Remote surroundments
Hint around lucid cusps
And milk-blinkings swerve
Over grooved vastnesses
Whose lofty gazes
Empty to the brim resound

Finespun legions
Of distant stone pivot
Within strange rings
And innocent strains
Swivel endless and lilt
Like hearts wept upon
The rings of far-fetched motes
Tingling their ancient aubades

Galaxie

D’incommensurables écorces
Enduisent selon les faîtes espacés,
Et frémissant le semis d’éclairages,
Floue les ourlets tout loin.

Arômes qu’émane
Un jusant cousus d’oublis,
Luisez vos affleurements sourds
Et vos proches nectars.

Des avant-preuves perlent
En glissant partout les orées lucides
Où des clins de lait dérapent
Pendant des éloignements vastes
Dont les grands regards
Vides à ras bord résonnent.

Des légions respirées
En pierre lointaine pivotent
Dans des cerclages
Et des airs d’innocence
Louvoient des vibrements
Comme des coeurs pleurés
Dessus les anneaux d’improbables noyaux
Frissonnant d’antiques aubades.

Advice for Jewish Adulthood

Regarding the shower knob in hotels, whichever way you turn it is wrong.
A half a bagel is like half a dream.
If you want a cookie, and eat it fast, you will see the glimmer of the heavenly vault out of the corner of your eye.
There is only one right way to write Hanukkah.
Stand up for what you believe in and get along with everyone. Isn’t that easy? Haha! Now you understand why there are no cookies in the house.
Princess Leia wore her hair that way so to have two Danish available for breakfast at all times.
Do whatever makes you happy, but let’s talk about the definition of “happy” through weekly phone calls and frequent texts, okay?
Nothing’s funny about Yiddish. Except your father.

משנה מסכת בידחות אבא

זאָגט די משנה. דער פֿאָטער מאַכט אַ שלעכטן וויץ. וואָס איז דער דין? זאָגט ר’ מיכל, גיב אַ קרעכץ. זאָגט ביילקע, פֿאַרקײַקל די אויגן און שאָקל מיטן קאָפּ אויף ניין. די חכמים זאָגן, אַז ביידע זײַנען גערעכט. וואָס איז אָבער דער דין אַז דער פֿאָטער זאָגט א קאָמישן וויץ? זאָגט אסתּרל, אַפֿילו איך ווייס אַז דאָס איז נישט מעגלעך. זאָגט ביילקע, כ’בין שוין גענוג אַלט צו מאַכן אַליין גוטע וויצן. היתּכן? זאָגט דער פאָטער. נישט מעגלעך. תּיקו.

את תהי לאלפי רבבה
או לבת 13
תהי מה שאת רוצה
בכל העולם לגמרי

בכל סיפור שלא כותבת
בכל שפה בעולם
ה’ דרכיך תשכיל. זאת אומרת:
תעלי לעילא בסולם.

***

When I think about her bat mitzvah, I think of it — as I do any major event — on many levels. In one sense the ceremony is mainly about her as an individual, her transformation (slowly and imperceptibly, in the moment, but retrospectively surprising and sudden) into a Jewish adult, navigating between choice and obligation. This is her gift now, to do with as she pleases, to open or abandon — what a horrifying and freeing thought all at once!

But we wouldn’t be doing this ceremony at all if it was just a thing-for-her. There are many Jewish worlds, histories, and dramas in parallel, and she can participate in many of them at once. There is the drama of relationship with God, spiritual creativity, and the perfection of compassion through the high art of halacha, liturgy, and Torah study. There is the meaning-making, innovation, and searching for the usable past which is modern Jewish culture — freeing oneself from past bonds while discovering for oneself what is to be a Jew. That search is made much more difficult without Hebrew and Yiddish, languages she knows and has a connection to. Finally, there is the life of a Jew in the world, supporting a democratic, Jewish Israel which does not oppress Palestinians, and being a citizen in these free, democratic United States. As I told her after Election Day, “It’s up to your generation to fix our mistakes.” And we said together: “No pressure!”

She is compassionate, sensitive, artistic, intelligent, and (sometimes!) focused. She has all the talents and skills she needs to ask the question, “What does it mean to make the world better for both Jews and non-Jews?”, and then do it. The manner of her doing so remains to be seen. I can hardly wait.

My post here.

I come to this book as an outsider. I am a white guy, a Jew, reviewing a volume of African American poetry for black people in Baltimore. I do this because I live in Baltimore, I feel a kinship with African Americans due to our shared history; and I want to know how poetry of different communities works.

This is all the more true because Tariq Touré’s poetry, in this black-and-white volume called “Black Seeds,” is aimed at his community. These are short poems about the state of black Baltimore, about life and death and striving, murder and failure and desperation. Each poem is accompanied on the facing page by an image, often a photo of an African American looking into the camera. The portraits are unadorned, beautiful.

This is 31rwu9z9dl-_sx322_bo1204203200_more than a community – it is an audience before whom the poet is performing. This is a multimedia presentation. It is based on the slam esthetic: each poem ends with a boldfaced title, the performer naming what he has just delivered with a flourish.

There are calls to nationalism:

“I see empires in your furrowed eyebrows” — Nubia

… and prayerful meditations on the self:

“Man is given seconds, yet begs for minutes”–The curious attention span

This is hip-hop on the page, and as such strikes a balance. On the one hand there is rhyme aplenty and anaphora, familiar in any oral tradition; on the other these are verses with plenty of space, cascading down the page, and capital letters to give emphasis. There is a poem Balance about this tension between the weight of history (and literacy) and the present-day of orality (and popular culture):

I have friends
Who sit and Pontificate
Musing over Plans
To leave
More than
A biological imprint
7 generations
Down the stream
Where
Apple headed children
Trip over
Their forefathers & foremothers
Legacies
On the way to school

And

I have friends
That have only
Planned
For Saturday night

The entire slim volume is balanced on the razor’s edge of this conflict: duties to the self versus duties to one’s people; honoring past martyrs and building bridges to the future impervious to flame.

Indeed, this book is surrounded by flame, fire out of the gunbarrels of police and the torches of protest in the wake of Freddie Gray’s death. One would expect there to be more hate. I don’t read that here, though there is sorrow and rage:

Jim crow’s skeleton
fell out of
a police van
crashed onto the ashen pavement
paraded down Pennsylvania avenue
brutalized the metal cavalry
of pigs
subsequently
announcing a 100% off sale
the city glowed
as Watts glowed
as Harlem glowed
as Ferguson glowed
for Freddie

Baltimore Power Keg

“Glowing” as candles glow, not burning or flaming as an explosion. The skeleton, zombified, brings multiple sites of tragedy and brutality into redemptive communion.

In the wake of my move to Baltiimore seven years ago, and even more so in the wake of Freddie Gray’s death, I have read more and more (though still not enough) contemporary poetry by African Americans. These poets inhabit a diverse space. Toure’s is not the academic poetry of Terrence Hayes or the pop-culture fueled confessional wit of Saeed Jones. His gifts are in the shared world of oral and written, of street, school, protest, home, and quiet self. I look forward to reading more of him, as he sheds his glow.

I have been translating the prose poetry/symbolic fiction pieces of Avrom Sutzkever, and a new translation of mine, “The Cleaver’s Daughter,” appears today on the Yiddish Book Center’s website. Here’s a taste. Enjoy!

She was my first love, the pockmarked redhead with cute freckles on her pert nose, like a poppy seed topping. I even allowed myself to imagine that she had as many freckles as she was years old, a freckle every year for good luck.

When I made her acquaintance, I counted nine of those presents on her nose. The street where we both grew up panted its way uphill, starting from the Green Bridge over the clay banks of the Vilia, ascending as far as the Sheskin Mountains, where the street became a trail going all the way to Vilkomir. Most kids from my street and even a number of adults called the girl the Cleaver’s Daughter.

Why did she get that name? Why was an orphan labeled that way?