All Body Parts All the Time

The content of this blog post may not be suitable for all readers.  Reader discretion is advised.

A friend recently suggested that my life is “all body parts all the time.”  In some ways, she’s not wrong.

With my reconstruction now complete, I’m able to turn my full attention to researching and writing my master’s thesis which also focuses on a particular (but different!) body part.  
 
In case you haven’t been following the story, I’m writing about the Haredi practice of metzitzah b’peh (oral suction as part of Jewish ritual circumcision) that, in the last eight years, has resulted in 11 cases of neonatal herpes in New York City, including the death of two babies. Recently the New York City Board of Health voted to require Haredi mohelim to obtain written consent from parents before performing metzitzah b'peh as part of the baby's bris.  The Haredim have filed a lawsuit against the city, and a judge ordered a stay on the requirement until the next hearing, which is scheduled for November 14.

But, rather than get into further details here, I’ll let you read the section on Jewish ritual circumcision that I’ve just completed...which also partially explains why I haven't been able to blog here in recent weeks. 

Jewish Ritual Circumcision

According to Klein (1992), “[t]he operation of ritual circumcision consists of three steps:

1.      Milah, the cutting off of the foreskin.

2.      Peri’ah, the tearing of and folding back of the mucous membrane to expose the glans.

3.      Metsitsah, the suction of the blood from the wound.” (p. 422)

Initially, these steps were described in the Talmud—a compilation of rabbinic writings completed by the 5^th century—in the context of what can and cannot be performed on the Sabbath.  According to the Talmud, “We may perform all the necessities of circumcision on the Sabbath.  We may circumcise, uncover the corona, draw the blood, and place a bandage and cumin upon it.”

Later, these same steps were described again by Moses Maimonides, the 12^th century Torah scholar and physician in his Mishneh Torah (Repetition of the Torah).  This 14-volume work describes all the laws of Jewish observance as detailed in Jewish texts (Torah and Talmud).  In his Mishneh Torah, Maimonides writes:

How is the circumcision performed?  The foreskin that covers the crown of the penis is cut off until the entire crown is revealed.

Afterwards, the soft membrane that is beneath the skin should be split along the mid-line with one’s nails and peeled back to either side until the flesh of the crown is revealed.

Afterwards, one should suck the place of the circumcision until all the blood in the further reaches is extracted, lest a dangerous situation arise.  Any [mohel] who does not perform metzitzah should be removed from his position.  After one has performed metzizah, one should apply a bandage, a compress, or the like. (Touger, 1991)

It is important to note that the Hebrew Maimonides used to describe the third step in the process is metzitzah [suction], not metzitzah b’peh [suction by mouth].   Although the text does not explicitly specify the suction method to be used, it is plausible to presume that during Maimonides’ time, suction by mouth was the only feasible way to draw blood away from the circumcision wound.  Touger (1991) offers this commentary on the text, providing an explanation of why metzitzah b’peh has largely been abandoned by all but the most ultra-Orthodox Jews:

Traditionally, the mohel sucks out the blood with his mouth.  Nevertheless, in previous generations, the Rabbis did grant license to use a pipette because of the possibility that germs in the mohel’s mouth might infect the child.  Today, there are authorities who suggest the use of a pipette because of the danger that the mohel could contract AIDS. (pp. 220-221)

And yet, like their brethren in 19^th century Hungary and Germany who believed the commandment to perform metzitzah b’peh was handed down from God to Moses, Haredim in New York City continue this custom, believing that their practice imbues it with the weight of Jewish law.  According to Dvoretzky and Roth (2012), counsel to the International Bris Association (IBA), one of the three organizations that has filed suit against New York City for its efforts to obtain parental consent prior to ritual circumcisions in the Haredi community:

Traditionally, metzitzah was performed using direct oral suction—metzitzah b’peh (“MBP”)—and this method remains in widespread use in Hasidic, Orthodox, and ultra-Orthodox Jewish communities.  Indeed many prominent rabbinic authorities maintain that MBP is the only legitimate way to properly complete the circumcision in accordance with Jewish law. (p. 26)

It seems extremely unlikely, therefore, that the Haredim will forsake metzitzah b’peh under any circumstances, despite the possible health risks to both the infant and the mohel that have been identified by generations of scientific experts—and heeded by rabbinic authorities—beginning in the 19^th century.

Yes, at the moment it is all body parts all the time!  Stay tuned....

10-11-12

Although I have little affinity for numbers, for much of my adult life I’ve been fascinated with dates—such as today—that have some order or progression to them.  I recall signing in at my summer job (where, in 1977 at 14, I think I was still a volunteer) at the Franklin Township Public Library when the date was 7-7-77.

Many years later on July 8, 1990, I watched Charles Kuralt quip on CBS Sunday Morning about what had happened at 34 minutes and 56 seconds after midnight (and would happen again at a bit more than half past noon) on that date.  Yes, the time and date readout was a perfect sequence of numbers:  12:34:56 on 7/8/90.

In the early 90s while living in northern New England, I’d randomly point out to anyone who’d listen, let’s say on August 8, 1992, that “Sixteen years from today, it will be 08-08-08.”  In the same vein, I’d note, on April 3, 1995, let’s say, that “Seventy-four years ago today, it was 4-3-21.”  This quirky habit continued through the turn of the century and, once I’d relocated to Los Angeles, with my new friends and colleagues out there.

It should come as no surprise, then, that in the wee hours of today a Los Angeles friend (who now lives in West Virginia) sent me this Facebook message:  

Let me be the first (and probably only!) to wish you a happy 10/11/12!!! :-)

She may have been the first, but she definitely was not the only.  At 8:34 a.m., my former boss from New Hampshire (who now lives in western Pennsylvania) forwarded to me this email he’d received earlier in the morning from his daughter:

From: Scott’s Daughter [mailto:scottsdaughter@gmail.com]

Sent: Thursday, October 11, 2012 8:11 AM

To: Scott

Subject: In place of Jane

Since Jane Herman isn't here to remind you......

Today is 10/11/12

:)

Enjoy it, everyone.  It won’t be 10-11-12 again until 100 years from today!

Letter to The Mums: Always on our Minds

Dear The Mums,

The most recent edition of RJ magazine includes this little blurb that I wrote last year just before the High Holy Days.  I wouldn’t normally point something like this out to you, but this past Saturday was Brian’s bar mitzvah and I chose my jewelry for the occasion very carefully.  Included in my ensemble were a necklace and two bracelets that belonged to you.  When we got to temple, Aunt Claire was wearing earrings--which you know she doesn’t do very often.  They were very pretty and I complimented her on them.  She told me that you had given them to her.  It seems that you were on everyone’s mind that morning.

The bar mitzvah was lovely and Brian did a great job.  The service was a bit long, though, given that it was a double and there were the extra Hallel readings for Sukkot (as well as a second hakafah before the scroll was returned to the ark.  I’ve never seen that done…have you?)  You’ll be interested to know, too, that in Conservative congregations, God’s still reviving the dead, unlike “by us” where the Eternal is giving life to all. :-)  Meitim vs. hakol aside, the Conservative siddur lists the matriarchs in the order that you prefer them:  Sarah, Rebecca, Leah and Rachel, and Ted told me that every time that passage was read, he thought of you.  You really were ahead of your time.  Amy and I opened the ark before the Torah service, Daddy carried one of the scrolls, and Aunt Claire had an aliyah. She did a wonderful job; you would have been proud.

At the reception, I chatted with Sherry and Marvin Freedman and all of Aunt Claire's neighbors and friends -- the Marks', the Ronans, and the Kossins.  We talked about you, and Mrs. Ronan told a story about Uncle Irv.  Before long, we were all laughing about his cigarettes and how he'd stick them in his pocket whenever anyone came out into the garden to check on him. Those memories never seem to fade...they've just gotten sweeter with time.

Here are some pictures so you can see how we’re all looking these days.  We missed you, but in so many ways you were right there with us…as you are always.  

Ian:  Getting so tall, but still sweet as ever

Ian and Amy

Pretty Jill (she's 15!)

Daddy with Amy and me

 Chag sameach, The Mums and xoxo,

~ Boo!

P.S.  Melinda Panken used your ethical will as part of her remarks during Yizkor on Yom Kippur and Peter Weidhorn told me that there wasn’t a dry eye in the sanctuary.  I think that your values are living on in ways that you probably couldn’t have imagined when you first penned those words.  xoxo.

The Big Umbrella of Torah...in a Small Jewish World

I love that the umbrella of Torah is so big and wide that this past Friday's edition of the URJ's Ten Minutes of Torah was about BRCA mutations and Hereditary Breast and Ovarian Cancer (HBOC).  I'm honored to have been able to use such a widely read forum to raise awareness about this topic, and I appreciate all the wonderful feedback I've received about it.

First prize, though, goes to Marvin Freedman, who printed out a copy and, when he saw me at yesterday's family bar mitzvah, asked me for my autograph!  Marvin, who served on the URJ board of trustees with my mom, and I are not related, but might best be considered "kissing cousins."  His wife, Sherry, is a cousin of the bar mitzvah boy's paternal grandfather, z'l, and I'm a niece of the bar mitzvah boy's paternal grandmother. Small Jewish world, indeed!

Hadassah Arms? No, Michelle Lives in the White House

Travis Long/The News & Observer, via Associated Press

This article about Michelle Obama in today’s paper reminded me about Allison Olmsted, a colleague from my days in New Hampshire, who once wisely quipped that “No one over 30 should ever wave on the beach.”  Indeed, Michelle Obama is the exception that makes Allison’s rule true.

For years, my sister and I always jokingly referred to those jiggly flaps of skin—often found on older and (mostly) Jewish women we knew—as “Hadassah Arms.”  Meaning no disrespect to either the women or the organization, it was a reference that reflected our world, and quickly became part of our family’s vocabulary. 

The clincher came, though, when one of us said something to our Aunt Claire about “Hadassah Arms.” Not understanding the reference, she thought we were talking about an apartment building!

Our Yom Kippur Browse

Yes, my dad and I maintained our minhag yesterday and after a bit of schmoozing following the morning service at temple, we drove down the road to Barnes and Noble for our annual Yom Kippur browse.

Increasingly (and as I wrote last year), it seems, the store is filled with more “stuff”—stationery, school supplies, writing journals, calendars, photo albums, e-readers and the like—and fewer books, and this year was no exception.  Nonetheless, ignoring our hunger, the thick, earthy smell of coffee from the café, and several rowdy teens, we each managed to find a few books, a chair and enough energy to thumb through our selections until it was time to return to temple for the afternoon service.

While my dad perused The Beauty and the Sorrow: An Intimate History of the First World War, Explorers of the Nile:  The Triumph and Tragedy of a Great Victorian Adventure and To End All Wars: A Story of Loyalty and Rebellion, 1914-1918, I went back and forth between two hefty selections:  Les Miserables and The Fountainhead.  Of course, the hefty selection I should be reading right now is Bureaucracy:  What Government Agencies Do And Why They Do It, all of whose 464 pages are supposed to be read by the time I get to class on Monday night.  Better get to it... 

In the meantime, stay tuned to find out what my dad and I actually end up reading in 5773—especially once my thesis is finished in December, when I’ll be able to choose my own books instead of having someone else choose them for me.

A Tattoo Tutorial

Because I’ve been so very forthcoming about my ongoing BRCA journey, I need to fill you in on today’s adventure—not only because it’s a milestone on the journey (the last official step in the reconstruction process that started 14 months ago), but also because it happened to coincide with the beginning of Hereditary Breast and Ovarian Cancer (HBOC) week.

So, here we go…

A few minutes before 10 a.m. this morning, I checked in on Foursquare at Memorial Sloan-Kettering's Rockefeller Outpatient Pavilion on 53rd Street.  Up on the 10th floor, I checked in again—this time with the receptionist in the Plastic Surgery suite.  About 10 minutes later, I was in one of the exam rooms (at this point, I think I’ve been in all of them), where I met Casey, Dr. Mehrara’s physician’s assistant (PA), who, if she was so inclined, could moonlight as a tattoo artist in the Village.

Initially, had the setting been a bit different, I might have mistakenly believed I was at the Clinique counter in Macy’s, trying to find just the right shade of lipstick.  As she applied each option to my skin, Casey would comment:  "This one is too orange…  I think this one’s too pink.  Let’s see what happens if we add a little brown to this pink one…"

Once she and I agreed on the color, we moved on to pick the size of the areola, using what looked like one of those kitchen gadgets that lets you measure how much spaghetti to cook based on the number of servings you need.  With the tentative measurements and pigments marked on my body, Casey called in “the boss” who OK’d our handiwork.

With that approval in place, she got down to work.  Because there are few if any nerve endings in the abdominal tissue that now masquerades (quite well, I think) as breasts, the actual tattooing didn’t hurt, although I could feel the pressure of the needle.  In one spot, there does appear to be some nerve regeneration going on (this is a good thing), so she applied some topical Lidocaine before taking up the needle again.  Once she was finished, I got a quick look at my newly tattooed (but also very red and bleeding) body parts before she applied antibiotic ointment and covered them with non-stick gauze anchored in place with medical adhesive tape. 

Armed with written instructions and all the supplies—non-stick gauze pads, antibiotic ointment, petroleum jelly, adhesive tape—I’ll need to care for my new tattoos for the next week, I was back in the waiting room by noon, ready to make my next appointment, which is now scheduled for January.  Thirteen blocks later, my new tattoos and I were at 633 and I was at my desk, catching up on emails from earlier in the day.

No, definitely not just another day in the office, but rather a personal milestone worth marking in some indelible way.