Monday, November 9, 2015

Intergenerational Simchas

I have been a mohel for about 16 years. Several years ago I stopped counting the number of brisses I've presided over as it doesn't really matter any more. People often jokingly ask "Have you done this before?" but it's usually because they assume a mohel is more middle-aged or older (I'll get there eventually, IY"H), or they're being generously kind in guessing my age particularly after hearing I've been on the job that long.

But, as is plainly clear, the oldest child who has been circumcised by me is 16, and is certainly not yet a father. And considering how many times I've heard of a mohel circumcising the son of someone he circumcised so many years ago, I look forward to the days when I'm called to play that role.

And yet, I've had some interesting stories which are nonetheless related to playing such a role. Here are three of them.

Story #1. A father who was raised in a Reform Jewish household told me he realized he had been circumcised when he was two days old and his bris was not "kosher." He asked me to perform Hatafat Dam on him (see second half of this post). His wife was pregnant at the time, and he thought - just in case it's a boy - it would be a good idea to have his own bris "kosherized" before he'd be bringing his son into the mark of the Covenant. Sure enough, we took care of him, and 4 months later he actually circumcised his own son (with my assistance) in a moment I will never forget. Especially considering his sharing with me his backstory, which was briefly mentioned here. So I guess maybe I have presided over the brisses for a father and a son!

Story #2. I did a bris for a couple that are contemporaries of mine (I actually went to pre school with the wife/mother!). Some time later I got a call from his father, who was in his fifties, who was in a second marriage and had a new son! In this way I did the bris of a (half)brother of someone for whom I had done his son's bris.

Story #3. This isn't a bris story as much as it is an interesting story. I recently got a phone call from the father of a baby whose bris was over a year ago, asking "Do you do weddings as well?" Yes... who is getting married? "We are!" I had no idea they weren't married when I did the bris. Somehow it didn't come up. Anyway, I recently performed the wedding for this couple, certainly making for the most unique intergenerational simcha I have ever presided over.

Tuesday, October 13, 2015

Most Inspiring Line of the Year

I did a bris this week for the first child of a couple with a fascinating family background and incredible personal story. I wrote up a "Dvar Torah" based on my experience at this bris. But I am repeating the story here, because it is a remarkable tribute to how love of family could cross the most surprising walls of time and space.

 I learned a very important lesson this week, from a Tzanzer chossid I probably never would have met were I not invited to be the mohel for a very unique family. The baby’s father grew up Chassidic, but lives a vastly different lifestyle now – absolutely Jewish, but not particularly observant. And yet he told me over and over how much he wants his parents and brother, who were to be flying in from Israel, to feel comfortable at the bris. “I don’t live as a chossid. But I love them, and I respect them so much.”

 After my post-bris visit, I told his parents how much I admire their ability to embrace their son’s choices, and to maintain the connection with him – despite the physical distance and the worldy-distance. His father told me they email each other several times a week, and of course speak on the phone. I complimented them – the parents – for keeping their son close to them.

 And then his brother said to me, “He is also mekarev us.” (He brings us close to him). “He has really opened our eyes. And we need that more than anything.” This insightful comment really struck home.

 How often do we see families torn apart over religious differences? How often are children rejected, or parents ignored, or grandparents deprived of a relationship with their grandchildren (which hurts both directions) on account of a fight or disagreement that should not be irreconcilable? Egos are hard to drop. Taking a stand in the name of religion or God is hard to give-in on. But we must recognize what the greater lesson, what the greater value is, when we encounter what we see as conflicts that cut to our core.

 A Tzanzer chossid loves a secular Jew because he literally is his brother. And his eyes have been opened to the idea that life is much bigger than one way – that people can be Jewish in many ways, and they can still have a “Yiddishe neshoma,” a Jewish soul.

Amazing story. Still inspired.

Thursday, September 10, 2015

How Mickey Mouse Saved the Bris

Walt Disney might be spinning in his grave.

This morning I had the opportunity to do Hatafat Dam on a two-year-old who had been circumcised in the hospital when he was two days old. Because he is more aware than a baby is – I've more often done this on babies whose parents realized after the fact that this was a necessity for their child's bris - we needed to find a way to distract him from what was taking place.

Before we began, his mother asked me if this will take 4 1/2 minutes. Since Hatafat Dam takes less than a minute from start to finish (most of the time is making sure there is no residual bleeding) I told her 4.5 minutes would be fine. She proceeded to put on a Mickey Mouse video which he watched on her phone during the quick procedure.

 The video did the trick. He didn't notice what was being done, and when it was all over, he was still involved with Mickey Mouse. Of course, I reminded everyone present (just a few very close family members) that what we were doing was for the sake of Covenant, though perhaps a little louder than normal to counter Mickey's voice.

 Walt Disney was known to be something of an anti-Semite (see here, confirmed by a great niece - though of course, there are folks who are trying to whitewash Disney's stellar image). I wonder what he'd think if he knew he'd positively played a role in distracting a two year old when his circumcision was turned into a bris.

Thursday, July 30, 2015

Getting the Percentages Right

After a bris, I try to explain to parents what things will look like over the next few days, weeks, and months as the circumcision goes through its different stages of healing.

There is swelling, a reminder of what things look like before vs after, there are stages of healing, a couple of long-term reminders:  the Chubby Baby Syndrome and the Fusion Challenge.

I often comment about the importance of using a marker to indicate where the edge of the foreskin is before circumcising. When this is done in advance of the bris, and when the mark is actually followed during the circumcision, the incision can be very even and beautiful (to quote a colleague who loves to use the word 'beautiful' to describe his work).

But what are we marking? Why can't a rough estimate be sufficient?

There is a very definite point where the foreskin ends, and that spot is where the skin of the shaft lies naturally beneath the outer edge of the glans/corona. A "beautiful" circumcision has all of the foreskin plus the membrane beneath it removed at exactly that spot.

However, owing to the reality that most circumcisions are not accompanied by a complete removal of the membrane beneath the foreskin, there is a benefit to removing a little more than just the foreskin, because leaving MORE skin plays a significant role in the Fusion Challenge, and especially in the Chubby Baby Syndrome (I get many questions from mothers who ask about the need to pull down the skin over the longer term. Depending on how the circumcision goes, this is an issue for some people, or may never be an issue at all.)

So let's say there is 100% shaft skin to leave behind. A good mohel will actually leave between 88-95% of the original shaft skin, since the remains of the membrane will make a proper fusion with the shaft skin and fill in the remaining 5-12 percent of the shaft as needed.

Without using the marker, the chances of removing 50% or more of original shaft skin are not unheard of. And the incision has a decent chance of being significantly unbalanced - one side having more skin removed than the other (a little uneven is not bad - these things have a tendency to heal nicely nonetheless). This form of operating is a tremendous disservice to any baby.

Being educated about circumcision takes a lot of guesswork out of the process. Best of luck to everyone!

Sunday, July 19, 2015

The Good Ole Perks

A few years ago, there was a to-do in some Israeli newspaper or in the world of a sector of Jewish blogosphere over a Facebook post posted by a rabbi who announced he had shaved during  Sefiras Ha'Omer. He also mentioned that he is a mohel.

Why people made such a to-do is beyond me. The custom not to shave during Sefirah is just that - a custom. And the fact that he is a mohel gives him every excuse to shave on the day of a bris.

And, the same holds true for the mohel (and the father and the sandak) during the Three Weeks, and even the Nine Days. 

So if you want to have every excuse to shave during the three weeks, look into becoming a mohel. Get busy! And every bris should come your way so you should grow in your experiences and feel confident (and people should feel comfortable with you) so you can shave without hesitation during the Nine Days.

Or, you can be Sefardic. :/

Sunday, June 28, 2015

One of Our Favorite Topics - In the News Again!

A wonderful perspective about metzitzah is presented below.
Sadly it will be ignored by the right wing community that has turned this issue into dogma, that has equated this ancient and halakhically unnecessary practice with those that originate from Sinai.

In the end of the day, the practice is a Chillul Hashem.

It turns Jews away from Bris Milah, either completely, or opting for hospital circumcisions which are often before the eighth day of life.
It turns non-Jews into people who degrade Judaism and its practitioners.
And it is near impossible to justify in the realm of modern sensibilities (and there are halakhic alternatives!).

It's not as if there isn't history to metzitzah being problematic. And even right-wing rabbis coming up with an equitable solution which maintains metzitzah (for those that require it) while doing it in a way that is hygienic and antiseptic AND halakhically acceptable. (Even though if pushed most would probably admit that metzitzah is not a necessary component of bris milah, certainly not on the level of the circumcision itself).

I don't pay attention to those who says "It's time for the Jewish people to get with the times and stop circumcising their sons." These people are ignorant of the Covenant and our attachment to it. They often "think" they have a solution, which they call a Brit Shalom, but they have made up a ritual that ignores everything that is written in Bereshit 17 about Avraham's descendants and God.

Anyway, enough about this. Here's a link + the full text of the article.

NYC Metzitzah Policy Is ‘Insufficient’
Tue, 06/23/2015
Special To The Jewish Week

As Jewish physicians we feel a special responsibility to speak out on health matters that uniquely affect the Jewish community. The policy recently adopted by the City of New York to respond to herpes simplex virus (HSV) infection risk as a result of a certain form of ritual circumcision is inadequate. For Jewish medical professionals to remain silent during this discussion would be, in our judgment, inappropriate.
HSV, which commonly causes “cold sores” and genital herpes, can result in death or permanent disability in newborns.
There have been multiple cases of newborn males with laboratory-confirmed HSV infection following out-of-hospital Jewish ritual circumcision. There is strong evidence that in the majority of these cases the infection was associated with metzitzah b’peh, in which the mohel places his mouth directly on the newly circumcised penis and sucks blood away from the wound (direct orogenital suction, abbreviated as DOS). This represents an ancient practice, but since the formulation of germ theory in the 1800s the overwhelming majority of traditional ritual Jewish circumcisions no longer employ this practice, instead using alternative methods of suction. Some members of the charedi community continue the practice of DOS.
Keeping a campaign promise, Mayor de Blasio has rescinded the requirement that parents give written consent prior to the performance of DOS on their newborns. Instead, when a baby contracts HSV following DOS, if the mohel is proven to have the same HSV strain as the infected baby by DNA testing, then the mohel will be banned for life from the practice. It can sometimes require multiple DNA tests to establish a match.
We think the policy is insufficient.
Circumcision is surgery and can transmit infection if not performed under antiseptic conditions. Oral contact with an incision by a person who is an HSV carrier, even if he is unaware of an open sore, risks transmission of HSV and other pathogens. Alternative means exist by which blood may be drawn from a circumcision wound such as a sterile glass tube or sterile gauze.
Several arguments have been voiced either in defense of DOS or to mitigate concern. The ones we, as physicians, are least qualified to respond to are theological. Genesis [17:10-11] instructs “every male child among you shall be circumcised. ...” The Babylonian Talmud states that “if a mohel does not perform suction, that is deemed dangerous and he is to be dismissed.” While defenders of DOS will invoke an interpretation of the Talmud passage to support it, the overwhelming majority of Orthodox rabbinic rulings — as well as those of the other religious streams — either deem DOS as being inconsistent with Jewish law and contemporary knowledge of hygiene or, at the least, acknowledge that removing blood by other means, such as with sterile gauze or a sterile glass tube, is preferable.
Additional arguments have been voiced in defense of DOS. The first is that, according to some New York infectious disease specialists, the link between HSV and DOS and newborn death or severe brain injury has “not been proven.” Those holding such view seem unpersuaded by the detailed analyses published by the U.S. Centers for Disease Control (CDC), which establish the link and the ratio of newborn infections of HSV type 1 v. type 2. Scientific evidence supporting the causal link between DOS and HSV was recently reviewed by six members of the Albert Einstein College of Medicine faculty in the Journal of the Pediatrics Infectious Disease Society. If individuals, however, are not persuaded by sound virology and epidemiology research, we would bet that no adult who understands the transmission of disease by microbes would consent to a human being’s putting their mouths upon a fresh surgical incision.
The second argument is the assertion that, if a mohel rinses his mouth with wine or an antiseptic mouthwash, the risk of HSV infection by DOS is eliminated. While prolonged exposure to alcohol in a laboratory Petri dish can indeed inactivate HSV, any claim that a dilute alcohol swish in the mouth, with its multiple nooks and crevices, will prevent HSV infection is fanciful.
The third argument is that the new NYC policy represents a reasonable compromise, protecting an individual’s right to practice his/her religion while employing the tools of public health to limit the spread of disease. But allowing some babies to suffer the consequences of HSV infection before taking any action against the offending mohel, who must be proven to be the culprit by DNA testing, is not a preventive public health measure. It is too little, too late. DOS violates a baby’s right to be protected from an obvious impending harm. The government has an overriding interest in protecting infants who cannot speak for themselves.
DOS ignores the teachings of modern medicine and the overwhelming consensus of modern rabbinic rulings. Behavior by mohelim and local politicians that ignores fundamental principles of hygiene, and abrogates their responsibility to protect innocent children, is shameful and simply wrong, despite their express desire to maintain ancient religious traditions.
The Jewish medical community should strongly affirm its respect for religious pluralism and sectarian particularism. It should dedicate itself to working with rabbinic leaders to make them aware of the unequivocal scientific and medical facts about the dangers of DOS and the urgency of using existing safe and acceptable alternatives. Moreover, we urge our political leaders to go on record supporting this approach.
This statement is from Dr. Edward R. Burns, executive dean, Albert Einstein College of Medicine, Bronx; Dr. Robert Goldberg, executive dean, Touro College of Osteopathic Medicine, Manhattan; Dr. Laura Gutman, associate clinical professor emeritus, Duke University School of Medicine, Durham, N.C.; Dr. Robert Gutman, consulting professor, Duke University School of Medicine; Dr. Edward C. Halperin, chancellor and CEO New York Medical College, Valhalla, N.Y.; and Dr. Allen M. Spiegel, dean, Albert Einstein College of Medicine.

Tuesday, June 16, 2015

The Shabbos Bris

I had a bris on Shabbos this past weekend. Shabbos brisses are not as common as other days of the week (though statistically, babies should be born more or less equally on every day of the week). Of course, a baby born on Saturday via c-section will not be having his bris on Shabbos anyway. 

What is Allowed for a Shabbos Bris?

The Mishnah on Shabbat 133a says the following:
משנה. עושין כל צרכי מילה [בשבת]; מוהלין ופורעין ומוצצין, ונותנין עליה איספלנית וכמון. אם לא שחק מערב שבת - לועס בשיניו ונותן, אם לא טרף יין ושמן מערב שבת - ינתן זה בעצמו וזה בעצמו. ואין עושין לה חלוק לכתחילה, אבל כורך עליה סמרטוט. אם לא התקין מערב שבת - כורך על אצבעו ומביא, ואפילו מחצר אחרת.
We perform all the needs of circumcision on Shabbos. We circumcise, uncover the corona, and draw out the blood; then place a compress and cumin on it. If he did not crush the cumin before Shabbos, he chews it with his teeth then applies it. If he did not mix together the wine and oil on Friday, he applies each one separately. We may not prepare a new bandage, but a rag can be wrapped around it. If it wasn't brought to the place of the Bris in advance of Shabbos, he can wind it around his finger and bring it [to the bris] - even from a different courtyard.
The key phrase is the first one: we do everything that is necessary for the bris itself, meaning the moment of the actual circumcision. Many things that are done during a circumcision are otherwise a violation of Shabbos: the instruments are muktzeh, causing a wound, marking where the foreskin is, etc/

What is Different At a Shabbos Bris?

The main difference is in the immediate aftermath of the circumcision. If the mohel notices that there are tzitzin she'einan m'akvin - portions of the skin or membrane that might be a little asthetically unpleasing but are not on the glans - they may not be removed/cleaned up on shabbos. If, however, these leftovers would render the bris unkosher, then they could be removed on Shabbos, in the immediate aftermath of the bris. 

Anything Else?

Once the circumcision instruments are used and no longer needed, they become muktzeh. If the mohel can leave his things in a safe place where they won't get misplaced or accidentally taken, he should do that, rather than take them home with him. 

Finally - an older mohel told me this one long ago - if the mohel is inconvenienced in any significant way, on account of his having to leave his family for shabbos for example, it is certainly appropriate for the bris family to make arrangements for where he'll stay (if he can't on his own), and compensate him for his travel, bris services, and time away.