I saw a woman yesterday making a decision that might lead to her death, and I feel powerless to stop her. I cannot talk about her in detail. Her gastrointestinal tract is not working – it is putting out too much. Her body thus is deprived of functional fluid in the blood vessels, which makes it difficult to supply the kidneys, and their filtration is failing. She is wobbling, has fallen several times.

Medicines might decrease her output, or supplement her diet with the nutrients her body cannot retain. But she thinks they harm her.

Surgery might help repair her gastrointestinal tract to absorb the nutrients she is losing, which might help her kidney function. But she is afraid surgery will kill her.

Neither of these beliefs is completely out of the realm of normal. Medications are routinely prescribed for slim benefit and without due discussion of harms. Surgeons can underestimate risk, and surgery can lead to terrible consequences.

I think and write a fair bit about letting patients make decisions that are right for them, but every once in a while — and maybe more often than that — I face someone who is digging themselves a very deep hole. My nightmarish vision is that they are watching it fill with their own blood.

I laid out the options: she cTVA_Douglas_Dam_jack_hammerould take medications; seek the advice of the surgeon or other specialists. I urged her to keep the appointment with the kidney doctor. One option, I said, would be to admit her to the hospital to get her treatment with more dispatch; the other would be to find a facility where she could live more safely while still maintaining a modicum of independence.

None of their satisfied her. I imagined that she was encircled, entrapped by an impenetrable wall, and all the rhetoric, empathy, and understanding were thin reeds that broke into shards against the rough bricks. I felt like I was sitting and staring at her, willing her to change her mind, and I had no power. Rather, I do have power, and exercising it might be helpful, coercive, or both. Would that be the action of my best professional or humane self?

We parted with a handshake and a thank you for each other’s time.

She thanked me for giving her my expertise as a doctor, though it did not change her mind or course of action.

And I thank her for teaching me what I can be thanked for.

bioethicsinstitute.org/partnering

It’s time to register (free) for our Partnering with Patients conference, June 1, 2016, at Johns Hopkins. It’s open to all.

Please submit an abstract in any field related to shared decision making. Deadline May 1.

Questions? Seebioethicsinstitute.org/partnering.

Happy Purim 2016 from Zack, Celeste, Blanca, Micah, and Eleanor!
אַ פֿריילעכן פּורים פֿון שלום, סעלעסט, ביילקע, מיכל און אסתּרל!
איחולי פורים שמח משלום, סלסט, ביילע, מיכל ואסתרל

[NB: dairy hamentashen!]

If you predict your people is about to be destroyed,
And your instincts are impeccable, you’re bound to be annoyed.
Nothing seems to work. Your side’s down several thousand.
Don’t despair. Just don your dress, or grab your Shabbos hosen:
Be a hero bold, or heroine hearty.
Foil the bad guys’ plans, and plan a party.

“Kick out the refugees,” they said, “They pray weird and look funny.
I heard that guy will kick them out. Spend only his own money.”
No fatalism, honey-bunch. Now is not the time.
Redemption might be stuck in traffic, but wouldn’t it be fine
If you dressed up all nice as Savior Smarty?
Get the bad guys drunk and let them party.

You’ve read the story every year, you thought it allegory.
Depredation, war, and rape — all things blood-and-gory
Only happen in the books. At least to those unlike us.
But we were once the depredated. They still do try to fk us.
Fast is fasted. Scroll is written. Fate’s captain is still charting.
Get the bad guys stuffed. But first let’s party.

זאָלסט נישט שווײַגן אין דער שוואַרצער שעה
כאָטש רווח און הצלה זײַנען אַלץ נישט דאָ
(און וועלן נישט קומען, ביז מע ווערט גרײַז-גראָ)
נײַערט זינגען פֿון זעלבסטשוץ און הנאָה.

פֿאַרבעט דײַנע שׂונאים און זײַ די מלכּה
וואָס שמייכלט אויף דער משתּה און פּלאַנירט אינעם אַלקער
און לאָזט זיך נישט טשעפּען, כאָטש דער וויזיר לאָקערט
טאַנצט מיט דעם סקעפּטער בעת נשמה פֿלאַקערט.

זה שיר הזמן הזה
מלא ספק ואי-סיפוק
זה שיר בלי התחלה
וסוף לו — אין. שום קיץ.

אכן אשיר בזמן הזה
שיר הפסקה ואיפוק
זה ניצחון של אספקה
בלי התלה על עץ.

Multifaceted philosopher Hilary Putnam has died. In 2008, I interviewed him for the Jewish Forward on his approach for religious thought. 12821510_1194112173934389_7934087212595550885_n

At thirty
Avrom Sutzkever

At thirty my father’s heart gave out
While playing Reb Levi Yitskhok’s melody
On a small fiddle at nightfall –
The fiddle trembled childlike on his shoulder.
And its language, a bright magnet,
Drew the distant world
Into the shadowy hut
Where I, a seven-year-old dreamer,
Wrapped myself around
Fatherly knees.

It was – was – in bright Siberia.
A spot of sun, or the hot tongue
Of the freezing wolf,
Licked the snows on the pane
And couldn’t melt through.
The only light came
From the fragmented sounds
Of the fiddle, sparking in stripes
Against my humid eye.
Suddenly my pale father
Grabbed his heart, jerked, wobbled
With his arm stretched out,
And into my arms his body fell
Together with the fiddle,
As a heavy branch falls
Onto a green wave
And is carried away. . . .

Overhead floated a melody.
Down below, on the floor,
My father’s last breath was failing.
And whether I’m convincing myself it’s true
Or what I say is true:
Lying now eternally joined to a cold silence,
His lips confided in me:
“Thus, my child,
Test the weight of life in your arms
So you become accustomed
To carry it completely, to the end . . .”

Then the poet was born in me.
A kernel slumbered within me
Carrying in its core a certain mission.
I imagined I became the lord
Of forests, people, things.
Whatever I saw
Was my embodied desire.
My father’s last will
Followed me from then on:
“Thus, my child,
Test the weight of life on your arms
So you become accustomed
To carry it completely, to the end . . .”
Now, when I have run up against my father’s age,
Hurried up upon it,
And there’s no way back or forward,
When I notice my face in a mirror,
My distant father
Wells out to me from its waves.
Perhaps I’m him, and my years
Are only a link to his departed life?
The same face as his,
Recollecting snow on windowpanes . . .
The same heart
Which is getting ready to give out,
And just like my father
I also own a little red fiddle:
See, I tear open my veins
And play on them my melody!

But there’s no one here
Whose knees to wrap around,
Weighing out my life,
Dragging on, as with a wind,
My cloud of yearning to a clear destination,
Where all words come to rest,
Where days come together
But never meet.

I clasp in my fist, like a stone,
These thirty years
And hurl them into the cold
Mirror’s chasm.

From Yiddish: Zackary Sholem Berger
[originally published in the journal Passport at the University of Arkansas, which seems to be defunct]

I published a short poem at the site Asses of Parnassus. Go assess.

Partnering with Patients in Decision-Making: Continuing the Conversation at Johns Hopkins will take place on June 1st, 2016, from 8am to 5pm, in the Owens Auditorium in the Cancer Research Building. Open to all, this meeting will feature discussions of clinical, educational, and research approaches to decision making in the Johns Hopkins Medicine context, emphasizing diversity, interdisciplinarity, and the particular needs of Baltimore. Two keynote speakers with national reputations, as well as a poster session, will help make this a day to assess where we stand and move forward to enable change. The meeting is free of charge.

Our generous sponsors are the School of Nursing, the Patient Experience Office at Johns Hopkins Hospital, and the journal The Patient — Patient-Centered Outcomes Research, as well as the Primary Care Consortium. Institutional sponsors include the School of Medicine, the School of Public Health, and the Berman Institute of Bioethics.

Please respond to this poll to let us know whether you might attend and how you might like to be involved further.
https://www.surveymonkey.com/r/VV25NMS

Best wishes,
Zackary Berger, MD, PhD
For the organizing committee

The Other Side

The New York Times recently covered the Yiddishophilia — in recitation and in his own poetic creations — of the contemporary master pianist Evgeny Kissin. The poems he recited, and their translations (by me, among others), are available here. Here is one of them.

A teatr iz di velt (The World’s a Theater)
Translated by Zackary Sholem Berger

The world’s a theater.
God’s director.
A fine play. A pity, though:
The prompter is the Devil.

The booth is the black heart.
The Devil forges the play!
And if you recite the wrong thing
You can’t take it back!

Of course, you can’t be careful enough.
And can’t make a fuss.
The play is fantastic.
The mistakes – genius!

The actor stumbles too.
When he’s supposed
to hurl the cup away,
he brings it to his mouth!

The wine drops glow like flames.
He empties the glass.
There’s no hurrying the thunder.
God’s patience is great.

“The way we always do it”: Why some Jews see value in metzitzah b’peh (oral suction at circumcision…