Post-call on the pediatrics ward, Hillel Yaffe Medical Center. The team for most of call was two doctors and a nurse, all Muslim Arabs, and a Jewish nurse and intern. The atmosphere was warm and good, despite the general despair evident on everyone’s face, even though the news was open on one of the computers in the background, despite Code Red warnings heard occasionally from the app that a Jewish nurse and an Arab doctor had running. We talked freely about baseless hatred toward both sides. Freedom of expression. The fucked-up situation.

All the while, the Arab team members treated Jewish infants with dedication and a big smile, as Jewish staff treated Arab babies with the same dedication. In the afternoon, when the Ramadan fast was getting harder for one doctor and he asked to rest an hour or two, the Jewish and Arab staff stayed to cover him. These past few days, when two interns got called up from the reserves, the entire Arab and Jewish staff worked extra to cover them. Then, when the doctor ordered food for breaking the fast, he asked the Jews on the team if he could order them something to eat too. As they broke their fast, the Jewish staff kept working. Through the night, the entire team worked in full cooperation with smiles and laughter and good humor.

I know everyone has resentments, anger, opinions. And a solution, if there is one, isn’t simple and will require concessions from each side.

But – and call me naive – a night like this encouraged me, let me dream that one day what matters will be the fact that we are above all human beings, and somehow, maybe we can even build something beautiful and positive here together.

– Tal Kessler, intern, Hebrew University of Jerusalem (translated from the Hebrew by ZShB)

Myths bloom among mistakes.
A voyage of secrets:
along the routes of truth
you hear real screams.

Put down your pencil. People are dying
on the artists’ street.
What’s the point of rhyme
when your body doesn’t know what’s worse:

instant fire, or aimlessness
in endless hallways.
The poetic license expires.

Put down your pencil. You manage
instant sympathy.
You feel in your entrails
the hand of annihilation.

A missile eliminates
A bomb shatters you.

You are now expert in possible demises
The end of a straw-packed trunk of dreams

What’s life like
in death’s developments?

Medicine is a relationship between two people. I have my expectations, needs, and wants, and the patient has theirs.

However, the patient’s needs, wants, and expectations are more important than my own. She is the center of her health.

I will always:

  • Ask the patient what she wants, hopes, fears, believes to be true about her health.
  • Ask the patient what she prefers.
  • Tell the patient what options are available.
  • If I am not able to do what the patient wants, explain why not.
  • Ask the patient what her priorities are – whether in the moment, or in general.

I will never:

  • Assume that the patient wants the same things I do.
  • Blame the patient for their illness.
  • Belittle the patient for powerlessness.
  • Treat a patient worse than I would treat a family member.
  • Check a box before I check with the patient.

 

My new book is everything you wanted in a polyglot thrillride through better and verse. ONE NATION TAKEN OUT OF ANOTHER, a Yiddish and English book of poetry from Apprentice House, is now available on Amazon and BN.com – Kindle version coming. Screen Shot 2014-01-21 at 7.23.32 PM

Yes, One Nation Taken Out Of Another is a joyride through the Five Books of Moses on the back of a strange chimera – with an American head, a Yiddish heart, and all manner of multicultural, bassackward, and wandering limbs grafted on to the whole. The included poems are in English, Yiddish, and both. It’s midrash and whimsy, and an exploration of Bible, tradition, exile, redemption, and mystery. 

Here is some very kind advance praise.

“Zack Berger is at the forefront of a generation of poets attempting to resurrect Yiddish as a literary language. In this respect, his service to literature has already far exceeded any personal dimensions – his translations of perhaps the greatest Yiddish poet, Avrom Sutzkever, are absolutely exquisite. In One Nation, he attempts to translate himself. In the poet’s own words, “The world was flooded with death/ and to save it all a man built a poem.” If you’d like to find out the answer to his question “How do you English a Yiddish nation?” please come along for the ride.”

— Alexander Cigale, poet, translator, editor

“One Nation Taken Out of Another is Zackary Sholem Berger’s brilliant melting pot of a book, where English and Yiddish egg each other on like a “Hebrew word tied to the tail of a shampooed Manhattan poodle.” The Bible is an integral part of modern life in this poet’s world, and the poetry is accomplished: “Nathan’s Bar,” for one, is about as lovely and perfect a poem as you could ask for.

— Elinor Nauen, author of My Marriage A to Z and So Late into the Night

“Zackary Sholem Berger reminds us that the “vanished world” of Yiddish literature in fact endures. His poems offer insight into the nature of language, and the puzzle of identity, and the reasons why ancient stories matter so much to so many. Yet One Nation Taken Out of Another is no relic of the past; this is a vital, living book.

—Peter Manseau, author of Songs for the Butcher’s Daughter

דער טיטל איז “איין פאָלק ארויסגענומען פון אַ צווייטן”, אַן איבערטייטש פון “לקחת לו גוי מקרב גוי”, און פאַרדעם באַקומט איר אַ ייִד אַריינגעלייגט אין אַ ייִד און אַזוי צעטרייסלט אַז איר ווערט ‘פאַרקראָכן אין דער פאַלטשע סדרה’. דאָ קענט איר זיין ‘עולים ויורדים\ יורדים ועולים’, עפּישע הבטחות פון אַ גרויס פאָלק און אומצאָליק ווי שטויב און שטערן ווען מען פיטערט די קינדער ביים עס טיש, שפּירט דאָ דעם צופּ פון ‘האָרסראַדישקייט” מיט אַ שמייס פון דער ‘קאַנטשיקס צוגלופט’, נישט פון עבודת פרך נאָר פון זיין ‘צו פריי’.

בערגער האָט ווידער אַהערגעשטעלט אַ זאַמלונג פון קאַפּריזיש און לעבעדיקע פּאָעמעס צאַמגענייט מיט אַ וואַקיקייט (tiek-ykcaw) וווּ משה רבינו שטויסט זיך אָן אין איימי וויינהויז און ‘קיינער איז ניט דער בעל הבית’. אָבער אין דער ייִד פון געלכטער הערט זיך אויך דער ‘פּיין פון אַ נביא’ און די קשיא פון נדב ואביהו, וואָס מען האָט פון זיי נעבעך געוואָלט?

“אַ װאָלקן װערטער מיט אַזאַ מײן פֿאַרבאָרגן\אָדער אַ גאָט אָדער אַ פאָלק אָדער אַ מעשה\איז שוין מיט מזל דאָ”

קטלא קניא Katle Kanye, www.katlekanye.blogspot.com

“Zackary Sholem Berger’s Yiddish/English mirror writing gives us a new way of looking at language and tradition, Jewishkayt and Yiddishness, Abraham of Ur and Abraham Sutzkever. Berger’s work can’t help but be bilingual; a single language can’t contain all that he’s trying to say.”

— Michael Wex, columnist and author of Born to Kvetch

 

A patient writes (and I share with her permission):

On the night of April 20 after dinner I felt a great pain in my left shoulder and up along my neck. Chills and the pain prevented my sleeping. This pattern continued, severely, along with utter exhaustion by 3-4 PM every day and no appetite, through the 28th, while the pain began to extend into my left rib area, under my left breast. The 3rd night I remembered I had the 800-mg ibuprofen pills that Dr. B had given me, which I began taking every night thereafter, and it helped me sleep somewhat better. While all these symptoms persisted, after 4-5 days the overall pain began to slowly decrease a bit. On April 25, with my brother’s insistence, I went to the doctor. I was assigned to a Dr. A, who is working under Dr. D. She was worried that I might have had a heart attack, though we have no heart problems in my family. The nurse administered an electrocardiogram test, which turned out normal. Dr. D (whom I haven’t seen in 15 years or so!) also examined me. They had me get a chest x-ray and a blood test (for kidneys?) Dr. A phoned me today saying that these uncovered no problems, though a couple of little irregularities which she said are too minor to bother about. It was these that prompted me to have her send you the results, and this note of mine will give you their context.

All that being fine, now I have to return, on my own, to my original theory of what caused all this pain, sleeplessness and weakness. From early on I suspected that in working assiduously on the computer all day of April 19 and 20, I was unconsciously leaning strongly on my lower left arm and elbow – not having the perfect ergonomic set up for working on the computer. Nothing like this has ever happened to me before, though periodically I have tried to deal with the seemingly incorrigible constraints limiting my desk and desk-chair arrangement for using the computer. Though when I saw the doctors on April 25 I told them this admittedly-lay diagnosis, it didn’t interest them in the least, but now I”m pretty sure it explains what I experienced – though still not the complexity and severity of it.

Since you’re interested in the patient-doctor relationship, I thought I’d share with you my reflections on this happy-ending experience. (Though your book does help us a lot to understand the physician’s point of view). What I observed is that these highly trained physicians – both in “general internal medicine” – either weren’t interested in the “muscles and nerves” dimensions I had first proposed as a diagnosis, or else they didn’t have the basic knowledge or expertise to deal with what I related. I realize that they went for the potentially-fatal possibilities like heart, lung, kidney. Good. That’s reassuring. But even when I asked, before they dismissed me, what they would suggest about the severe pain and other symptoms, in the event that the tests showed nothing serious — even when I wanted to bring them back to the original problem, which still persisted – they offered no ideas about what might have caused all that I was going through, much less offered any details about how it might have happened, or guidance about what to do. And today when Dr. A phoned with the results, if I had not asked her specifically, she would not have addressed the problem itself. (She was not aware the pain had declined) When I did ask, she advised me to talk to a physical therapist, which I will.

Despite your excellent clarifications in your book, and re-orienting the patient’s perspective, we laypeople aren’t as compartmentalized in trying to think through our medical problems as you doctors are, though of course most of us are aware that the medical profession has various specializations. In my little episode, I thought that in the end the doctors I consulted would remember that I had come to them with a severe pain, and that they would eventually come back to addressing that. They seem very relieved that the worst hadn’t happened; but… hello? what about “me”? okay, if my heart, lungs and kidneys are okay, but what do you have to say about my pain and what might have caused it? and what should I do about it? I guess my original expectations in going to them were unrealistic.

Today, really for the first time, I feel fine. No pains. I hope I haven’t wasted your time with this little narrative, which I have not written out of frustration, but as part of our common interest in the “patient-doctor” interface.

I just got back from the annual meeting of the Society of General Internal Medicine. You should check out all the tweets.


Below is a poster that I presented there on how doctors and patients communicate in the hospital. Though the findings are limited and preliminary, I would welcome your comments!

How do patients and doctors communicate in the hospital? Assessing shared decision making and interpersonal…

It doesn’t shine or burn, but synthesizes
Daisy chains of fusing protons,
Reverse alphabetizes
Hydrogen to helium. Atoms to photons.

Energy is willed to us from mass.
Elements resolving into gammas.

Certain books have played outsized roles in my life. Most of these are the work not of a committee but of a unique personality. This is true of Jewish religious texts too. I have never really had a warm feeling for the Maxwell House haggadah – I didn’t grow up with it. The Artscroll haggadah is not my cup of chrein, and A Different Night, though valuable, has a little bit of short attention span about it. Here’s a picture! Here’s a poem!

On the other hand, Jacob Milgrom’s Leviticus series (for Anchor Bible), felt like a meeting with a learned, opinionated, and irascible uncle who had very clear opinions about the Holy of Holies (sorry, the adytum) and what it all meant. I was convinced, before I realized that critics are just as disputative as scientists and Milgrom’s truth was not the whole or only truth.

Similarly, Rachel Adler’s Engendering Judaism is the work of a single intelligence, though I might disagree with its ideological take. Judy Hauptman, David Weiss-Halivni, and Daniel Sperber are others who are able to convey a sense of themselves as people, not just footnotes strung on chapter headings.

This is the sort of haggadah I like. Menachem Kasher’s Haggadah Sheleimah, an encyclopedic work (like his Torah Sheleimah), is as much a reference work as a useful haggadah to have at the seder table. You want variants of the Kadesh Urchatz mnemonic? Here they are, about a dozen of them. A synoptic version of the Arami Oved Avi? Yes. What about essays on various halachic and ideologic problems in the haggadah? Sure. Catalogs of different charosets in the rabbinic foundational texts? Enjoy! Through it all, Kasher is present. He does not refer to himself in the first person, but he has his biases, preferences, and pet peeves.

So I was particularly pleased to receive Gabriel Wasserman’s haggadah, called Ashira va’Ashanenna Ba’Chashikot, a work he has assiduously updated over the past few years. I bought the sefer fair and square, and you should get it too (available from the author by email, gavrielwasserman@gmail.com). I am relatively knowledgeable in Jewish matters, but I learned a passel of new facts from nearly every page. If I am in the right crowd, I will be hard-pressed not to lift my eyes from the haggadah and say, “Hey! Did you know…” every few pages. Did you know that some communities *do* make a bracha at Urchatz? Or that pears are a common ingredient in many charosets? Did you know that there is no stage of the seder called “Nirtzah”?

Thus this sefer is packed full of chochma (wisdom). What makes it entertaining, though, is Wasserman’s idiosyncratic authorship. What else would you expect from a haggadah with the author’s picture on the front and back? (Though, to be charitable, the front picture is of the back of his head…) Wasserman’s asides refer to friends he has learned from, niggunim he grew up with, recipes he traditionally prepares for the holiday (oh, yes, there are recipes too). There is a running commentary, parallel columns in English and Hebrew (except for the spots where one language seems to leave off for a page). Here too are his own bravura piyyutim. My favorite parts, besides those mentioned, were the mentions of Yemenite practices (all new to me), and the musical notations in the back.

I would love to see this haggadah get broader distribution, so I will allow myself some suggestions. A higher production value, such as might be provided by a mainstream house, might enable illustrations, consistency in layout, and a larger font size for the Hebrew. (Perhaps younger folk than this legally-blind forty-year-old might not have a problem.) The haggadah is not for everyone: the author, it is clear, does not see teaching the children as the primary or even (apparently) the most interesting commandment of the day, though he certainly does not ignore it either. The English translations are occasionally not as eloquent as the author’s Hebrew.

These are minor quibbles in a fascinating, unique, and enlightening work. May Gabriel Wasserman merit many more years of disseminating his piyyutim, Torah, and haggadic spirit to all and sundry!

 

Key Medical Reversals, 2001-2010
from Prasad et al., Mayo Clinic Proceedings, August 2013 (http://www.mayoclinicproceedings.org/article/PIIS0025619613004059/fulltext)
Englishified by your host

Number 1 (because all 10 can’t fit in one status)

Treating bacteria in the urine in diabetic women without symptoms of urinary infection: DOES NOT HELP

Harding et al., 2002 (http://www.nejm.org/doi/full/10.1056/NEJMoa021042):
In contrast to European groups, many American societies recommended using antibiotics to treat such women. This randomized trial found increased antibiotic use associated with such a practice but without any improvement in complications or reduction in the time of symptomatic infection.

Take-home: Antibiotics don’t help in women without urinary infection symptoms, even if their urine test shows bacteria.

I am looking forward to participating in a TEDMED Google+ Hangout, March 25th at noon, on the topic of Health Myths. You should come participate! To quote a blogpost from the TEDMED folks:

You can get the flu – or worse — from a vaccine. Only old folks get strokes and heart attacks. Calories in, calories out. X-rays cause cancer. Sleep eight hours a night and drink eight glasses of water a day. Skip the sunscreen on a cloudy day. Take a multivitamin every day, just to be on the safe side. An apple a day keeps the doctor away. Exercise more to lose weight.

What are the most popular health myths, and how do they spread?  Does social media spread scams faster that it helps dispel them?  How can doctors help patients practice proven steps for prevention – and still keep up on current research themselves?

Great questions all. Leaving aside a quibble about X-rays and cancer (about which the jury seems to be out still, or at least conflicted), the list above points to something important about so-called health myths: they come in many different flavors. Flu is not caused by a vaccine; that’s just wrong. But older people are generally speaking indeed at higher risk of strokes and heart attacks (though of course it’s not only them). “Exercise more to lose weight” isn’t exactly true, but exercising is one way to keep off weight lost through reduced caloric intake (and – can lead to weight loss by itself, actually).

All this is just to say that one myth may be quite unlike another. They are as diverse in their way as any kind of belief. Thinking more about it, I would like to jettison the whole term “myth” altogether. We all have beliefs. Some of them hew fairly closely to the science – others don’t.

What the summary above artfully avoids is potentially the most interesting question: who believes most in scientifically unfounded assertions? Is it patients, or doctors (and nurses) themselves? I would wager that we are all in the same boat. Much as doctors don’t know statistics, much of us don’t practice according to the medical evidence either.

If you push a little bit on many medical assertions once held to be widely agreed-upon truths, you will find yourself coming away with a handful of dust — and more, if you push harder. Does everyone need screening for prostate cancer? No. What about breast cancer? Unclear. Does vitamin D help much, say, for heart disease (except in older populations at risk of fracture)? Maybe, though the evidence is thin. If we treat mild hypertension, can we expect mortality benefits? Doesn’t seem that way. Yet practices based on these suppositions persist.

In other words, doctors are as much myth-makers, and myth-peddlers, as patients. Which means we all need to reevaluate our relationship to science. If doctors can be as uncertain as patients, shouldn’t we be skeptical of the hierarchy that still obtains in certain quarters? Shouldn’t we come together to discuss our fears, preconceptions, worries, and expectations?