Chief surgical resident Aaron Kendrick, who wanted to be a surgeon since middle school, has spent almost six years in a grueling general surgery training program at Erlanger hospital.
But this summer he’s switching gears to begin a three-year residency in anesthesiology, a field with better pay and a more relaxed schedule that will allow Dr. Kendrick to spend time with his wife and new baby, due in December.
“Mainly for me it’s the predictability of schedule,” he said. “General anesthesiologists work shift work, and when your shift is done, you go home.”
The number of general surgery residents here who practice as general surgeons is falling, said Dr. Phillip Burns, chairman of the department of surgery at the University of Tennessee College of Medicine’s campus in Chattanooga.
“Whereas 15 years ago 75 percent of our (general surgery residency) graduates here would be going into general surgery practice, it’s now down to about 25 percent,” Dr. Burns said.
...
“We have a shortage of surgeons, and physicians in general, that is coming on like a freight train in this country,” Dr. Burns said. “If we don’t do something to increase the numbers of surgeons that are graduating and available to go into spots, we’re going to have huge problems. In 10 years we’re going to have catastrophic problems.”
...
It’s a field in which pay is declining, with falling reimbursements from private insurers and government programs such as Medicare. Doctors also point to increasing medical liability insurance costs as a deterrent to entering the field.
For many young doctors entering practice with sometimes $150,000 in debt, general surgery may not make sense as a career choice, said Dr. Charles Portera, a surgical oncologist, a subspecialty that still incorporates general surgery.
“It’s kind of a sad state of affairs,” he said. “You’ve got to work harder to make the same amount of money that you did a few years ago. ... Why should these young kids go into it when there’s easier ways to make a living out there and still have a family and quality free time?”
[Full Article]
As a guy who's been interested in surgery since early childhood, it was quite the smack in the face to find that I have yet to encounter even one person involved in the medical field who would recommend going into general surgery. And I've spoken to plenty. The training is long, you work like a dog, and the compensation is small (and shrinking - thanks Medicare!) compared to the time put in and opportunity costs - and especially compared to the careers of other specialties.
General Surgery is a dying field in America through the shrinking compensations of government programs, endless hassles of hospital administrative red tape, which make for an unpleasant working environment and which exist only secondary to the perverse litigiousness of American society. This artificially intense liability of a surgeon simply working his trade also manages to add insult to injury by requiring ever larger chunks of one's salary be handed directly to malpractice insurance. As surgeons need to take on larger and larger loads just to stay afloat it saps them of leisure time, basic family interaction and those periodic iconic personal events that make up a person's private life.
Why would anyone want to be a general surgeon?
Heck, in twenty years where are you even going to find a general surgeon when your kid has emergent appendicitis at 3am? Is America ever going to wake up?
Wednesday, January 21, 2009
Tuesday, January 20, 2009
Little Details
Right in the third sentence of his inaugural address Pres. Obama says:
"Forty-four Americans have now taken the presidential oath."
Eh, not so much. Grover Cleveland swore himself in twice in nonconsecutive terms as number 22 and 24 Presidents of the United States.
Oh well.
In any case Obama made a decent speech, but I still think the best presidential speech I ever heard was this one:
Still brings tears to my eyes...
"Forty-four Americans have now taken the presidential oath."
Eh, not so much. Grover Cleveland swore himself in twice in nonconsecutive terms as number 22 and 24 Presidents of the United States.
Oh well.
In any case Obama made a decent speech, but I still think the best presidential speech I ever heard was this one:
Still brings tears to my eyes...
Monday, January 19, 2009
How I'm feelin'...
Greatly Relieved - that a cease fire has finally been established in Gaza. Though...
Endlessly Frustrated - that a true peace seems further away than ever.
Growingly Anxious - about big career decisions that I'll need to make this year as I realize med school is nearing its final few stretches and most of my information comes in second hand form.
Downright Concerned - about the fate of medical practice in America where managed care, government regulations and CYA practice secondary to litigiousness is progressively grinding enthusiasm out of the field.
Abashedly Hopeful - as I see the strength of American democracy in the upcoming inauguration of Obama, through whom I also feel a...
Frank Solidarity - with the Black people of America who are seeing what was unthinkable just a few decades earlier.
Awed Delight - for Sully Sullenberger who with aplomb saved 150+ lives with an amazing landing in the Hudson.
Defeatedly Blase - about studying all this week for the coming exam that caps off my latest hospital rotation. Though I've also got..
High Hopes - for my irregular week off after that exam when maybe I'll go skiing and have a superbowl party or something.
There you go. The latest review of what's on OP's mind lately.
Endlessly Frustrated - that a true peace seems further away than ever.
Growingly Anxious - about big career decisions that I'll need to make this year as I realize med school is nearing its final few stretches and most of my information comes in second hand form.
Downright Concerned - about the fate of medical practice in America where managed care, government regulations and CYA practice secondary to litigiousness is progressively grinding enthusiasm out of the field.
Abashedly Hopeful - as I see the strength of American democracy in the upcoming inauguration of Obama, through whom I also feel a...
Frank Solidarity - with the Black people of America who are seeing what was unthinkable just a few decades earlier.
Awed Delight - for Sully Sullenberger who with aplomb saved 150+ lives with an amazing landing in the Hudson.
Defeatedly Blase - about studying all this week for the coming exam that caps off my latest hospital rotation. Though I've also got..
High Hopes - for my irregular week off after that exam when maybe I'll go skiing and have a superbowl party or something.
There you go. The latest review of what's on OP's mind lately.
Thursday, January 01, 2009
Conubium aka Kiddushin
"According to [early] Roman law, a child is the legal heir of his father and is in his father's custody (potestas) only if his father and mother were joined in a legal marriage (justum matrimonium). The capacity to contract a legal marriage was called conubium (or ius conubii), and was possessed almost exclusively by Roman citizens. Marriage between a person with conubium and a person without conubium was valid, but it was not a justum matrimonium; and without a justum matrimonium, the status of the child follows that of the mother." - Shaye J. D. Cohen, "The Beginnings of Jewishness," page 294.
Compare with:
According to Jewish law, a child follows the tribal status of his father if both his father and mother possessed the capacity to join in a legal marriage. This capacity is called kiddushin and is possessed exclusively by Jews. Relations between a person capable of kiddushin and a person incapable of kiddushin, say a Jew and a Gentile, results in the status of the child following that of the mother.
An echo of Roman law in Halachic matrilineal descent?
Compare with:
According to Jewish law, a child follows the tribal status of his father if both his father and mother possessed the capacity to join in a legal marriage. This capacity is called kiddushin and is possessed exclusively by Jews. Relations between a person capable of kiddushin and a person incapable of kiddushin, say a Jew and a Gentile, results in the status of the child following that of the mother.
An echo of Roman law in Halachic matrilineal descent?
Tuesday, December 16, 2008
A Story From Work
I met a girl today. She's about three weeks old now, weighs about two pounds and has been in the NICU [Neonatal Intensive Care Unit] since birth. Let's call her Elizabeth - and this is her story which I feel compelled to write.
Elizabeth's mother is a crack addict with a $300 dollar per week habit. She's also an active prostitute working in the Bronx and she's got the likely slew of active infections that inevitably go along with that. Elizabeth's mother is 38 years old but looks like she's a senior citizen. Her mother realized for the first time that she was pregnant three weeks ago and came to the public hospital where I work to seek an elective termination of the pregnancy. And with a mother as unfit as she clearly is and a pregnancy as clearly unwanted as it was, nobody on staff seems to even think to object.
As you likely know, elective abortion is only legal in America up until the end of the second trimester or 24 weeks. What you may not know it that estimation of the fetal age can be done by ultrasound by taking measurements of different fetal anatomical features. It is well known by any competent obstretrics staff that by the second trimester these estimates can easily be as much as two weeks off. It can also be somewhat subjective since it depends on the ultrasound's operater to determine where to measure from. This technique's main purpose is just to show that the fetus is growing appropriately over time, not to age the fetus with a great degree of accuracy. Obviously the mother did not have even a single visit of prenatal care and so nobody knew how old the fetus was. The chief resident instructed the intern, "Go find out if the fetus is less than 24 weeks old." Then with the pressure to find a young fetus, the intern returned with a reported estimate of 23 weeks and 5 days.
With that factoid in the place, the team started to induce an abortion. The goal was to deliver the 23+ week old fetus intact and alive and then, since it being woefully premature and unprepared for the outside world, refrain from providing neonatal care with the expectation that nature would take its course and it would soon die. This is all permitted by current US law. And so this is what they did. They delivered the fetus and laid it on the crib in the delivery room under the warming light which was not turned on. She laid there for a full 7 minutes - losing body heat and not breathing while they dealt with care for the mother. At seven minutes, the attending physician walks in and sees that that fetus is still alive! She immediately calls in the neonatal pediatricians who manage to resuscitate the baby and Elizabeth is whisked away to the NICU, where she still lives today. After examination, it turns out that the baby weighed nearly 900 grams - a weight more consistent for a fetus of 27 weeks than of one of 23.
Think about what this means folks. What happened here was that these doctors were so jaded about bringing another unwanted crack-baby with hepatitis into the world that they fooled themselves (I'm being generous) into believing it was less than 24 weeks old, delivered it prematurely and then were willing to sit back and do nothing while it died right in front of them. When I saw poor Elizabeth in the NICU with tubes and probes going every which way and I heard this story I was absolutely floored. What the FUCK! I had previously worked with these people and I cannot believe that their judgement could be so absurdly screwed up on all moral, legal and medical levels.
Granted, a baby born - even at term - with a sustained cocaine exposure in utero and a number of serious infections is unlikely to have a great outcome, but delivering her prematurely and then allowing her to lie there freezing and anoxic for seven minutes surely didn't help her situation one bit! The neonatalogist treating her told me that she has good expectation to survive but zero expectation to do so without severe neurological consequences. I find it difficult to even find words to describe my enraged reaction to how the selfishness of the mother and the collaboration of her doctors lead to this horrible outcome for an innocent baby girl. It sounds like a sick joke, but she's an abortion survivor.
Of course her mom who tried to abort her did not give a damn and within one day of delivery she slipped out of the hospital and has not been heard from since. What tops the icing on this shit pie is the likelihood that if the mother had the inclination to, she probably has standing to sue for malpractice even though they were doing exactly what she asked of them and she's as, if not more so, culpable morally as any of them.
Update: 12/20/08
So I did some more sleuthing on Friday and I think I need to give those doctors an apology. Not entirely, but I think they were definitely more within their scope of practice than I had initially been told. What had actually occurred was not that the mother came in seeking an abortion, but came in with a story of abdominal pain, preterm premature rupture of membranes and likely chorioamnionitis. She hadn't wanted the pregnancy and had intended on a termination (she had had ten (TEN!) previous terminations on record) but that wasn't the reason she came in. The sono showed anhydramnios AND with their estimation of a previable fetus they decided to follow the course they did. If they hadn't induced labor then the fetus was likely to die anyway given the anhydramnios and the likely chorioamnionitis, and thereby also offer a serious risk to the mother.
What they still did wrongly though (imo), was in performing a poor estimation of the fetus' age - she was still significantly more than 24 weeks old and was indeed (obviously) viable - and then not having pediatrics in the room to perform a proper and timely resuscitation. So here it's less of a moral/legal issue and much more to do with simply poor management. All the same though, a terribly sad story all around.
Elizabeth's mother is a crack addict with a $300 dollar per week habit. She's also an active prostitute working in the Bronx and she's got the likely slew of active infections that inevitably go along with that. Elizabeth's mother is 38 years old but looks like she's a senior citizen. Her mother realized for the first time that she was pregnant three weeks ago and came to the public hospital where I work to seek an elective termination of the pregnancy. And with a mother as unfit as she clearly is and a pregnancy as clearly unwanted as it was, nobody on staff seems to even think to object.
As you likely know, elective abortion is only legal in America up until the end of the second trimester or 24 weeks. What you may not know it that estimation of the fetal age can be done by ultrasound by taking measurements of different fetal anatomical features. It is well known by any competent obstretrics staff that by the second trimester these estimates can easily be as much as two weeks off. It can also be somewhat subjective since it depends on the ultrasound's operater to determine where to measure from. This technique's main purpose is just to show that the fetus is growing appropriately over time, not to age the fetus with a great degree of accuracy. Obviously the mother did not have even a single visit of prenatal care and so nobody knew how old the fetus was. The chief resident instructed the intern, "Go find out if the fetus is less than 24 weeks old." Then with the pressure to find a young fetus, the intern returned with a reported estimate of 23 weeks and 5 days.
With that factoid in the place, the team started to induce an abortion. The goal was to deliver the 23+ week old fetus intact and alive and then, since it being woefully premature and unprepared for the outside world, refrain from providing neonatal care with the expectation that nature would take its course and it would soon die. This is all permitted by current US law. And so this is what they did. They delivered the fetus and laid it on the crib in the delivery room under the warming light which was not turned on. She laid there for a full 7 minutes - losing body heat and not breathing while they dealt with care for the mother. At seven minutes, the attending physician walks in and sees that that fetus is still alive! She immediately calls in the neonatal pediatricians who manage to resuscitate the baby and Elizabeth is whisked away to the NICU, where she still lives today. After examination, it turns out that the baby weighed nearly 900 grams - a weight more consistent for a fetus of 27 weeks than of one of 23.
Think about what this means folks. What happened here was that these doctors were so jaded about bringing another unwanted crack-baby with hepatitis into the world that they fooled themselves (I'm being generous) into believing it was less than 24 weeks old, delivered it prematurely and then were willing to sit back and do nothing while it died right in front of them. When I saw poor Elizabeth in the NICU with tubes and probes going every which way and I heard this story I was absolutely floored. What the FUCK! I had previously worked with these people and I cannot believe that their judgement could be so absurdly screwed up on all moral, legal and medical levels.
Granted, a baby born - even at term - with a sustained cocaine exposure in utero and a number of serious infections is unlikely to have a great outcome, but delivering her prematurely and then allowing her to lie there freezing and anoxic for seven minutes surely didn't help her situation one bit! The neonatalogist treating her told me that she has good expectation to survive but zero expectation to do so without severe neurological consequences. I find it difficult to even find words to describe my enraged reaction to how the selfishness of the mother and the collaboration of her doctors lead to this horrible outcome for an innocent baby girl. It sounds like a sick joke, but she's an abortion survivor.
Of course her mom who tried to abort her did not give a damn and within one day of delivery she slipped out of the hospital and has not been heard from since. What tops the icing on this shit pie is the likelihood that if the mother had the inclination to, she probably has standing to sue for malpractice even though they were doing exactly what she asked of them and she's as, if not more so, culpable morally as any of them.
Update: 12/20/08
So I did some more sleuthing on Friday and I think I need to give those doctors an apology. Not entirely, but I think they were definitely more within their scope of practice than I had initially been told. What had actually occurred was not that the mother came in seeking an abortion, but came in with a story of abdominal pain, preterm premature rupture of membranes and likely chorioamnionitis. She hadn't wanted the pregnancy and had intended on a termination (she had had ten (TEN!) previous terminations on record) but that wasn't the reason she came in. The sono showed anhydramnios AND with their estimation of a previable fetus they decided to follow the course they did. If they hadn't induced labor then the fetus was likely to die anyway given the anhydramnios and the likely chorioamnionitis, and thereby also offer a serious risk to the mother.
What they still did wrongly though (imo), was in performing a poor estimation of the fetus' age - she was still significantly more than 24 weeks old and was indeed (obviously) viable - and then not having pediatrics in the room to perform a proper and timely resuscitation. So here it's less of a moral/legal issue and much more to do with simply poor management. All the same though, a terribly sad story all around.
Monday, December 15, 2008
Connections
LNM writes: "I think a big part of this was that philosophically I had tied "doing mitzvos" directly to "serving god". For decades my attitude about Torah and Mitzvos was that everything we do is in the service of god. Light menorah? Because god wants us to. Shake the lulav? See god. Tie your shoes in the opposite order you put them on? god again."
My perspective:
Doing something in the mindset of "avodat Hashem" doesn't necessarily imply that "God wants us" to do anything. Think of all the times you do an act in honor or in respect or in memory for something or just to show your allegience to an ideal without a conception that the 'something' wanted it to be done.
The simple understanding of mitzvot is indeed 'commandment,' but there's also a strand in Chassidic thought (see Likkutei Torah, Parshas Bechukosai 45c) that it's related to the word 'tzaveh' - which means 'connection.' Jewish observance can therefrom be understood in part as a human-based effort to 'connect' with the transcendent.
So yeah, it depends completely on your approach and mindset, but shaking lulav for example can indeed be an attempt to connect with the divine by using it as a vehicle to raise your consciousness towards those ideals. This isn't to say that Jewish observance doesn't have it's great value as social activities and a cultural heritage, but I think this is a nice vort to put a little kavanah back into your actions.
My perspective:
Doing something in the mindset of "avodat Hashem" doesn't necessarily imply that "God wants us" to do anything. Think of all the times you do an act in honor or in respect or in memory for something or just to show your allegience to an ideal without a conception that the 'something' wanted it to be done.
The simple understanding of mitzvot is indeed 'commandment,' but there's also a strand in Chassidic thought (see Likkutei Torah, Parshas Bechukosai 45c) that it's related to the word 'tzaveh' - which means 'connection.' Jewish observance can therefrom be understood in part as a human-based effort to 'connect' with the transcendent.
So yeah, it depends completely on your approach and mindset, but shaking lulav for example can indeed be an attempt to connect with the divine by using it as a vehicle to raise your consciousness towards those ideals. This isn't to say that Jewish observance doesn't have it's great value as social activities and a cultural heritage, but I think this is a nice vort to put a little kavanah back into your actions.
Sunday, October 05, 2008
Yom HaDin
If there's one thing that troubles me about basic monotheistic theology is the idea of divine justice. Not that the idea is a bad one per se, but it just seems to fly so contrary to what I know about life and what goes on in the world that it makes it very hard for me to believe that justice reigns and that everyone gets it square in the end. When innocent children die painfully from genetic defects, murderous tyrants on the other side of the world live in luxury and at any time any regular shmo can die suddenly from a previously undiagnosed medical condition or a car accident or a stray bullet or a hurricane it certainly seems like what rules the roost in this world is mere chance rather than justice. At birth you're dealt a random hand and most of your life is played out with one roll of the dice after another. Sure, maybe you make some decisions on your own that set the course of your life, but there are larger forces in play that can wipe out all your plans in a moment.
Anyway, sure, this is an old old issue and there are always some stock answers that people pull out to reassure themselves. Maybe there's a Master Plan, maybe everything gets sorted out in the next life, maybe maybe maybe. Maybe not.
These were the thoughts that I had running through my mind all through davening on the first day of Rosh Hashana. See, my conception of God (in the abstract, non-anthropomorphic panentheist kinda way) certainly makes good sense of God as the almighty, as the creator, as the sustainer, as ruler, as awesome and fully worthy of reverence and praise. It also can make good sense of God being the source of an objective morality with schar and onesh following suit not as divine interventions, but as natural consequences of community behavior. I'll refrain from going into too much detail, but I see it in how moral action raises the net well being in a society and simultaneously betters the noble sense of self, whereas immoral behavior does the opposite. But still, how can I make account with the traditional conception of the Dayan Ha-emet given what I see of the world and my conception of a non-personal deity? In what sense does a panentheist God judge? And for that matter, in what sense can a panentheist God forgive?
So, as I was saying, I just could not get this out of my mind. What is the meaning of Rosh Hashana and Yom Kippur if not for the whole Yom HaDin thing?
To work my way through this dilemma I oriented myself to the idea that God doesn't judge per se, but that God is that moral standard against which we must judge ourselves. I think I went through this in a post last year about Yom Kippur, but whereas we might go easy on ourselves when considering our past actions, if we would imagine a perfectly reliable and righteous Judge considering our deeds we'd realize that we wouldn't get away with a fraction of what we'd permit ourselves. We then must judge ourselves to whether we are truly *worthy* of all the gifts given to us in our lives - and, yes, whether we deserve some comeuppance. Different people have different strengths - in this past year have you done all you could do to make this world a better place? I'm sorry to say it, but I know I haven't. Not that I'm a bad guy - or so I like to think of myself - but I've surely fallen short of what I could have done or what I could have been.
So with that conception in mind, an extended metaphor, I was able to finish davening with a clearer head - and I can look forward to a meaningful experience on Yom Kippur.
Anyway, sure, this is an old old issue and there are always some stock answers that people pull out to reassure themselves. Maybe there's a Master Plan, maybe everything gets sorted out in the next life, maybe maybe maybe. Maybe not.
These were the thoughts that I had running through my mind all through davening on the first day of Rosh Hashana. See, my conception of God (in the abstract, non-anthropomorphic panentheist kinda way) certainly makes good sense of God as the almighty, as the creator, as the sustainer, as ruler, as awesome and fully worthy of reverence and praise. It also can make good sense of God being the source of an objective morality with schar and onesh following suit not as divine interventions, but as natural consequences of community behavior. I'll refrain from going into too much detail, but I see it in how moral action raises the net well being in a society and simultaneously betters the noble sense of self, whereas immoral behavior does the opposite. But still, how can I make account with the traditional conception of the Dayan Ha-emet given what I see of the world and my conception of a non-personal deity? In what sense does a panentheist God judge? And for that matter, in what sense can a panentheist God forgive?
So, as I was saying, I just could not get this out of my mind. What is the meaning of Rosh Hashana and Yom Kippur if not for the whole Yom HaDin thing?
To work my way through this dilemma I oriented myself to the idea that God doesn't judge per se, but that God is that moral standard against which we must judge ourselves. I think I went through this in a post last year about Yom Kippur, but whereas we might go easy on ourselves when considering our past actions, if we would imagine a perfectly reliable and righteous Judge considering our deeds we'd realize that we wouldn't get away with a fraction of what we'd permit ourselves. We then must judge ourselves to whether we are truly *worthy* of all the gifts given to us in our lives - and, yes, whether we deserve some comeuppance. Different people have different strengths - in this past year have you done all you could do to make this world a better place? I'm sorry to say it, but I know I haven't. Not that I'm a bad guy - or so I like to think of myself - but I've surely fallen short of what I could have done or what I could have been.
See, I believe in justice. I believe it is a characteristic set in the moral fabric of interpersonal relations. It is something we need to strive for, to struggle to achieve, rather than a fact of reality bestowed upon the universe. A common theme in Judaism is that humanity is co-creator with God. We have the potential to make justice have more impact on our existence than even chance. It is in our power and it is our duty.
So we're given a set time of some ten days at the start of the year to orient ourselves back to this basic task. And even if we were to judge ourselves unworthy we are given tools like teshuvah, tefilla and tzedaka to help change our mentality and to alter our behavior so that we can start the new year afresh with full potential. The purpose of these days is not to endlessly harp on our wrongdoings, but to do so only until we right what is wrong and become better people from that point on.So with that conception in mind, an extended metaphor, I was able to finish davening with a clearer head - and I can look forward to a meaningful experience on Yom Kippur.
Sunday, September 14, 2008
Kannoim Strong-arm Twerski Off Molestation Panel
Top Doc Scared Off Panel On Rabbinic Sex Molesters
by Hella Winston
A prominent Orthodox rabbi and psychologist has been intimidated into quitting as head of a just-formed task force dealing with rabbinic sex abuse of minors, organized by Assemblyman Dov Hikind this week.
Dr. Benzion Twerski told The Jewish Week Wednesday that he was quitting the task force because “I was prosecuted in the street for daring to join such a venture.”
“To protect myself, my family, and reputation, I decided to withdraw from this project,” he wrote in an e-mail as the paper was going to press with a story announcing Hikind’s formation of the task force. “From this point, I am avoiding participation in any forms of public service. Public life is not for me.”
Hikind, a Brooklyn Democrat who represents Borough Park and Flatbush, deplored Twerski’s abrupt departure from his new panel.
“He was basically forced to resign,” said Hikind. “He was literally put against the wall, and he felt he had no choice. We’ll get somebody else who’s very respected. But that’s not the point. The point is they got to him, they threatened him.”
Twerski’s dramatic departure came just as Hikind was rolling out the new panel, planned as the next step in a personal crusade against child sex abuse in the Orthodox community that he has come to view as an epidemic.
Hikind said he had amassed a dossier with the cases of “hundreds” of individuals who say they have been sexually molested by rabbis and other Orthodox community members during their childhood. And he threatened to broadcast the names of their abusers if community leaders do not respond to his call for action against them.
“Let me tell you,” he said in an interview last week, “when there’s a person who we have confirmed through a variety of people has been doing terrible things” and those who know refuse to go to the authorities, “I am prepared to name names. I am prepared to be sued by those pedophiles. If they’re innocent, let them sue me.”
...
Neither man would specify the nature of the threats made against Twerski to force his departure. But Hikind called them “pathetic and sad.”
“My heart goes out to him,” he said. “I don’t know if I should laugh or cry. Things are opening up, people are coming forward, but we are still so far away.”
This story is absolutely pathetic. I really hate what those self-important holier-than-thou protectors of child molesters are doing. Friggin' Taliban Kannoim. Somehow in their screwed up little minds, they think making a serious attempt to put a stop to rabbinical child abuse is somehow a potential damage to their community. Their priorities are totally screwed up and each person who pressured Dr. Twerski - or frankly aided or abetted this apparent policy of secrecy and cover-up generally - is morally responsible for each and every child molested since their obstruction of justice. Make no mistake, that is what they are doing and by right they ought to have their own seats right next to the actual molesters when they have their day in court. Utterly disgusting.
On the bright side though, I'm very glad to see Dov Hikind stepping up to the plate on this one. I'm surprised to see it, since I've generally not been impressed with his public service to date, but I give credit where credit is due. Frankly, I'm glad to see people of some note making motions to control this festering disease deep in the underbelly of the Orthodox community.
by Hella Winston
A prominent Orthodox rabbi and psychologist has been intimidated into quitting as head of a just-formed task force dealing with rabbinic sex abuse of minors, organized by Assemblyman Dov Hikind this week.
Dr. Benzion Twerski told The Jewish Week Wednesday that he was quitting the task force because “I was prosecuted in the street for daring to join such a venture.”
“To protect myself, my family, and reputation, I decided to withdraw from this project,” he wrote in an e-mail as the paper was going to press with a story announcing Hikind’s formation of the task force. “From this point, I am avoiding participation in any forms of public service. Public life is not for me.”
Hikind, a Brooklyn Democrat who represents Borough Park and Flatbush, deplored Twerski’s abrupt departure from his new panel.
“He was basically forced to resign,” said Hikind. “He was literally put against the wall, and he felt he had no choice. We’ll get somebody else who’s very respected. But that’s not the point. The point is they got to him, they threatened him.”
Twerski’s dramatic departure came just as Hikind was rolling out the new panel, planned as the next step in a personal crusade against child sex abuse in the Orthodox community that he has come to view as an epidemic.
Hikind said he had amassed a dossier with the cases of “hundreds” of individuals who say they have been sexually molested by rabbis and other Orthodox community members during their childhood. And he threatened to broadcast the names of their abusers if community leaders do not respond to his call for action against them.
“Let me tell you,” he said in an interview last week, “when there’s a person who we have confirmed through a variety of people has been doing terrible things” and those who know refuse to go to the authorities, “I am prepared to name names. I am prepared to be sued by those pedophiles. If they’re innocent, let them sue me.”
...
Neither man would specify the nature of the threats made against Twerski to force his departure. But Hikind called them “pathetic and sad.”
“My heart goes out to him,” he said. “I don’t know if I should laugh or cry. Things are opening up, people are coming forward, but we are still so far away.”
This story is absolutely pathetic. I really hate what those self-important holier-than-thou protectors of child molesters are doing. Friggin' Taliban Kannoim. Somehow in their screwed up little minds, they think making a serious attempt to put a stop to rabbinical child abuse is somehow a potential damage to their community. Their priorities are totally screwed up and each person who pressured Dr. Twerski - or frankly aided or abetted this apparent policy of secrecy and cover-up generally - is morally responsible for each and every child molested since their obstruction of justice. Make no mistake, that is what they are doing and by right they ought to have their own seats right next to the actual molesters when they have their day in court. Utterly disgusting.
On the bright side though, I'm very glad to see Dov Hikind stepping up to the plate on this one. I'm surprised to see it, since I've generally not been impressed with his public service to date, but I give credit where credit is due. Frankly, I'm glad to see people of some note making motions to control this festering disease deep in the underbelly of the Orthodox community.
Sunday, August 10, 2008
קָצַפְתָּ עָלֵינוּ עַד-מְאֹד
As I often do following the night's reading of Eicha, since my shul only has these ancient kinot booklets instead of real books, I looked it up in the English in order to get a better understanding of what was read. I have a passing understanding of Biblical Hebrew, but to really get at the little phrases and deeper meanings some further examination with a translation is helpful. Anyway, I found something interesting that I hadn't noticed before.
The final couple of pasukim from the megillah are as so:
כא: הֲשִׁיבֵנוּ יְהוָה אֵלֶיךָ ונשוב (וְנָשׁוּבָה) חַדֵּשׁ יָמֵינוּ כְּקֶדֶם. כב: כִּי אִם-מָאֹס מְאַסְתָּנוּ קָצַפְתָּ עָלֵינוּ עַד-מְאֹד
Which mean, according to my understanding, '21: Bring us back to you, God, and we shall return, renew our days as of old. 22: For even if you totally rejected us, you have exceedingly raged against us.' The point being - we've been punished enough and it's cold outside, let us back in and we'll be good.' The Artscroll translation basically agrees with this assessment - 'For even if You had utterly rejected us, You have already raged sufficiently against us.'
But what I had been reading initally was, I confess, not the Artscroll but rather the NIV, which goes:
21 Restore us to yourself, O LORD, that we may return; renew our days as of old 22 unless you have utterly rejected us and are angry with us beyond measure.
Now that certainly gives the whole thing a different flavor, doesn't it? UNLESS? Clearly, in the Christian mindset there's a distinct possibility that God may have rejected the Jewish people and thereby explaining the whole reason for their religion. God needs to outsource his message since his chosen company isn't being reliable.
This is even more clearly seen in the older King James Version which I subsequently reviewed out of curiousity:
21Turn thou us unto thee, O LORD, and we shall be turned; renew our days as of old. 22But thou hast utterly rejected us; thou art very wroth against us.
BUT? Here the Christian assessment is that hope is lost for the Jews. God has rejected them utterly.
Ok, so that's an interesting little tidbit about the basic historical Christian understanding of Jewish persecution, but let's hear a nice dvar about this whole fasting deal in the face of theological skepticism.
Sure. See, a great thing about these terrible days is that few skeptics doubt that what they describe actually happened - at least not in any foundational detail. The Temples were destroyed, many Israelites were killed, the people were exiled or enslaved and basically the Jews were on the losing side of overwhelming ancient conquests. All of this before the adoption of the Geneva conventions. But what about the theological implications traditionally employed? Did God really [literally] send Babylon and Rome as means of punishing the sinning Jews?
Well, here's my take on it. While I wouldn't say that God plotted out the rise of those nations to pour out his wrath in such and such a way, but that to a certain extent a society's welfare is bound directly to the moral standards of its people and its leaders. When corruption abounds, when the rich abuse the poor, when brother cannot trust brother and the whole edifice of civilized society is on the brink then that decadent society has become weak at its heart and can be easily overcome by outside pressures - especially by foreign invasion. Isaiah, as related in this past haftorah, particularly remarks on the failings of the corrupt leadership and we are all familiar with the classic sinat chinam before the fall of the Second Temple. These things are cancers of society.
So with that, we have the traditional Jewish approach of following a tragedy with mussar. We look into ourselves to see what we can improve to perhaps prevent anything like it from happening again. I think this is a great approach. Producing something morally constructive out of something terrible. But we shouldn't be thinking of it in terms of satisfying a metaphysical Umpire (though perhaps metaphorically), rather it should be seen as a proactive effort to strengthen our moral ties to each other and to society at large. We can prevent the threat of moral decadence and the dangers it poses to society in general.
The final couple of pasukim from the megillah are as so:
כא: הֲשִׁיבֵנוּ יְהוָה אֵלֶיךָ ונשוב (וְנָשׁוּבָה) חַדֵּשׁ יָמֵינוּ כְּקֶדֶם. כב: כִּי אִם-מָאֹס מְאַסְתָּנוּ קָצַפְתָּ עָלֵינוּ עַד-מְאֹד
Which mean, according to my understanding, '21: Bring us back to you, God, and we shall return, renew our days as of old. 22: For even if you totally rejected us, you have exceedingly raged against us.' The point being - we've been punished enough and it's cold outside, let us back in and we'll be good.' The Artscroll translation basically agrees with this assessment - 'For even if You had utterly rejected us, You have already raged sufficiently against us.'
But what I had been reading initally was, I confess, not the Artscroll but rather the NIV, which goes:
21 Restore us to yourself, O LORD, that we may return; renew our days as of old 22 unless you have utterly rejected us and are angry with us beyond measure.
Now that certainly gives the whole thing a different flavor, doesn't it? UNLESS? Clearly, in the Christian mindset there's a distinct possibility that God may have rejected the Jewish people and thereby explaining the whole reason for their religion. God needs to outsource his message since his chosen company isn't being reliable.
This is even more clearly seen in the older King James Version which I subsequently reviewed out of curiousity:
21Turn thou us unto thee, O LORD, and we shall be turned; renew our days as of old. 22But thou hast utterly rejected us; thou art very wroth against us.
BUT? Here the Christian assessment is that hope is lost for the Jews. God has rejected them utterly.
Ok, so that's an interesting little tidbit about the basic historical Christian understanding of Jewish persecution, but let's hear a nice dvar about this whole fasting deal in the face of theological skepticism.
Sure. See, a great thing about these terrible days is that few skeptics doubt that what they describe actually happened - at least not in any foundational detail. The Temples were destroyed, many Israelites were killed, the people were exiled or enslaved and basically the Jews were on the losing side of overwhelming ancient conquests. All of this before the adoption of the Geneva conventions. But what about the theological implications traditionally employed? Did God really [literally] send Babylon and Rome as means of punishing the sinning Jews?
Well, here's my take on it. While I wouldn't say that God plotted out the rise of those nations to pour out his wrath in such and such a way, but that to a certain extent a society's welfare is bound directly to the moral standards of its people and its leaders. When corruption abounds, when the rich abuse the poor, when brother cannot trust brother and the whole edifice of civilized society is on the brink then that decadent society has become weak at its heart and can be easily overcome by outside pressures - especially by foreign invasion. Isaiah, as related in this past haftorah, particularly remarks on the failings of the corrupt leadership and we are all familiar with the classic sinat chinam before the fall of the Second Temple. These things are cancers of society.
So with that, we have the traditional Jewish approach of following a tragedy with mussar. We look into ourselves to see what we can improve to perhaps prevent anything like it from happening again. I think this is a great approach. Producing something morally constructive out of something terrible. But we shouldn't be thinking of it in terms of satisfying a metaphysical Umpire (though perhaps metaphorically), rather it should be seen as a proactive effort to strengthen our moral ties to each other and to society at large. We can prevent the threat of moral decadence and the dangers it poses to society in general.
Wednesday, July 30, 2008
Informed Consent for HIV Testing
This is a topic that's bothered me for some time. In most US states it is state law that HIV testing first requires the patient's (often written) informed consent - this is STUPID. See, even while you would think most people suspected for HIV would eagerly want to know if they were infected and then change their behavior to help their own health and protect the people around them there remains a significant population who frankly prefer to remain ignorant - or at least maintain their denial. The fact is that the population of people who tend to get HIV are those who are not very health conscious and engage in risky behavior like having unprotected sex with multiple casual partners, especially men who have sex with men, and share needles for their drug habits. These are people who prefer living life as if there are no consequences and I don't think medical ethics demands that we kowtow to their preferences and permit them to remain nominally ignorant as they remain a public health threat.
As far as I know, for every other infectious disease it is standard policy in America to assume presumed consent by the patient and test at will unless the patient proactively refuses. You don't need informed consent to test for hepatitis or Lyme disease or syphilis, so why HIV? Now I know why HIV has been put in this special legal bubble. It was once upon a time an incredibly scary disease, poorly understood with severe social stigma and no real treatment, so it made sense to protect a population which had little interest in finding out they had a death sentence. Few of them would seek medical care generally if they knew they'd be forced to face the horrible truth.
Fair enough, but that was decades ago and now with proper treatement HIV is more of a chronic disease. Infected individuals can lead a fairly normal life. What was once sensible medical policy is now obstructive to getting this life saving treatment to people and is a real threat to the public. People should be routinely tested if they are suspected of HIV, need to be told sooner rather than later and face their fears so they can get the treatment they need. (Whether they ought to be penalized if they don't subsequently change their behavior vis-a-vis public health concerns is another question. After all, STDs are essentially behavioral disorders more than anything else.)
As some have noted, I haven't been doing much blogging this past little while and the reason for this is that I just started doing my clinical rotations at med school and as you may imagine that tends to take up some time. For the past six weeks or so, I've been working at a hospital in the Bronx where HIV is more prevalent than the common cold in the inpatient population. Zero exaggeration. There were times when easily more than half the patients on our service were known to be HIV positive. And if not HIV then you can be sure as the ever hopeful Obamanicks that the patient has got hepatitis. Maybe I'm getting a poor cross section, but it seems like you can hardly throw a rock in the Bronx without hitting a person with a severe, chronic infectious disease.
Anyway, while I had been thinking that way about HIV for a good while, what really hit the point home was a patient I've been following. Guy came in for some difficulty breathing over the course of several weeks and was found to have an AIDS defining pneumonia that only the immunocompromised can get and a CD4 count in the single digits. Patient refused HIV testing. His wife communicates with the doctors by telephone about his condition and she's casually complaining about how she used to be such a healthy person but lately she's been feeling sick. Hum...
So normally, with a positive HIV test, you can break with normative patient/doctor confidentiality and inform the spouse that their sexual partner has HIV if you have reason to believe the spouse won't do the informing on their own. But because this guy is refusing testing, the doctors can't legally label the patient as HIV+ even while he's being treated with a clinically AIDS-defining pneumonia and therefore cannot tell the wife. Welcome to the world of medico-legal meshugas. Anyway, what we ended up doing was telling the wife to tell her family doctor that her husband is being treated for a pneumonia with this and that drug regimen, which any astute physician would immediately understand to be HIV related and have her follow up with him. Hopefully that'll work out as best it can.
Of interest, it seems like the CDC recently came closer to my way of thinking and as of 2006 their recommendations are:
-HIV screening (another term for broad-based testing) for patients ages 13 to 64 in all healthcare settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
-HIV testing of people at high risk for HIV infection at least once a year.
-Screening should be incorporated into the general consent for medical care; separate written consent is not recommended.
Now, I'm for the total normalization of HIV testing to be like other infectious diseases. If the patient is in the hospital then you can just test their blood for whatever without special notification. We don't tell patients that we're testing for hepatitis - which we do test for regularly. HIV should not be treated like a legally special condition and it's time for the state legislatures to get on the ball with this one.
As far as I know, for every other infectious disease it is standard policy in America to assume presumed consent by the patient and test at will unless the patient proactively refuses. You don't need informed consent to test for hepatitis or Lyme disease or syphilis, so why HIV? Now I know why HIV has been put in this special legal bubble. It was once upon a time an incredibly scary disease, poorly understood with severe social stigma and no real treatment, so it made sense to protect a population which had little interest in finding out they had a death sentence. Few of them would seek medical care generally if they knew they'd be forced to face the horrible truth.
Fair enough, but that was decades ago and now with proper treatement HIV is more of a chronic disease. Infected individuals can lead a fairly normal life. What was once sensible medical policy is now obstructive to getting this life saving treatment to people and is a real threat to the public. People should be routinely tested if they are suspected of HIV, need to be told sooner rather than later and face their fears so they can get the treatment they need. (Whether they ought to be penalized if they don't subsequently change their behavior vis-a-vis public health concerns is another question. After all, STDs are essentially behavioral disorders more than anything else.)
As some have noted, I haven't been doing much blogging this past little while and the reason for this is that I just started doing my clinical rotations at med school and as you may imagine that tends to take up some time. For the past six weeks or so, I've been working at a hospital in the Bronx where HIV is more prevalent than the common cold in the inpatient population. Zero exaggeration. There were times when easily more than half the patients on our service were known to be HIV positive. And if not HIV then you can be sure as the ever hopeful Obamanicks that the patient has got hepatitis. Maybe I'm getting a poor cross section, but it seems like you can hardly throw a rock in the Bronx without hitting a person with a severe, chronic infectious disease.
Anyway, while I had been thinking that way about HIV for a good while, what really hit the point home was a patient I've been following. Guy came in for some difficulty breathing over the course of several weeks and was found to have an AIDS defining pneumonia that only the immunocompromised can get and a CD4 count in the single digits. Patient refused HIV testing. His wife communicates with the doctors by telephone about his condition and she's casually complaining about how she used to be such a healthy person but lately she's been feeling sick. Hum...
So normally, with a positive HIV test, you can break with normative patient/doctor confidentiality and inform the spouse that their sexual partner has HIV if you have reason to believe the spouse won't do the informing on their own. But because this guy is refusing testing, the doctors can't legally label the patient as HIV+ even while he's being treated with a clinically AIDS-defining pneumonia and therefore cannot tell the wife. Welcome to the world of medico-legal meshugas. Anyway, what we ended up doing was telling the wife to tell her family doctor that her husband is being treated for a pneumonia with this and that drug regimen, which any astute physician would immediately understand to be HIV related and have her follow up with him. Hopefully that'll work out as best it can.
Of interest, it seems like the CDC recently came closer to my way of thinking and as of 2006 their recommendations are:
-HIV screening (another term for broad-based testing) for patients ages 13 to 64 in all healthcare settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
-HIV testing of people at high risk for HIV infection at least once a year.
-Screening should be incorporated into the general consent for medical care; separate written consent is not recommended.
Now, I'm for the total normalization of HIV testing to be like other infectious diseases. If the patient is in the hospital then you can just test their blood for whatever without special notification. We don't tell patients that we're testing for hepatitis - which we do test for regularly. HIV should not be treated like a legally special condition and it's time for the state legislatures to get on the ball with this one.
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