Monday, January 15, 2018

Oy Oy Oy. Let's Understand Priorities

In addition to being a mohel, I am the rabbi of a synagogue. On a daily basis, after morning services (on days when I don't have an early morning bris), we learn some Jewish law. It's amazing how much can be covered over the course of a year learning just 2-3 minutes a day.

We are currently learning the laws of Shabbos, and have arrived at the segment related to what is done differently when there is a Bris on Shabbos!

The Talmud says clearly (it's actually a Mishnah).
תלמוד בבלי מסכת שבת דף קלג עמוד א
עושין כל צרכי מילה בשבת 
All needs of the circumcision can be performed on Shabbos.

The reason this is important is because circumcision, mitzvah (commandment) that it may be, is elective surgery. And while the elective surgery is required, we do not violate or desecrate the Sabbath through having elective surgery on the Holy Day. Therefore, such a procedure should take place on any other day of the week.

Why is there an exception for Shabbos? Because the verse says that when a woman gives birth to a boy, on the 8th day he is to be circumcised. (Vayikra 12:3)  [This means only if she gives birth through birth canal and the 8th day is absolutely Shabbos, meaning the child had to have been born after the stars came out Friday night, and before the sun set on Saturday.] This 8th day business is so serious, that when it is clear that the baby's 8th day is Shabbos, his required 'elective' surgery takes precedence over the Holy Day.

In the context of addressing what are "צרכי מילה" I mentioned two things that I heard from my rebbe, Rabbi Moshe Tendler.

1. Metzitzah, which is a tradition Rav Tendler supports for it to be done in a sterile way, using a tube, as a vestige to a requirement of the Talmud, but which clearly has no necessity today as the Talmud clearly mentioned it as an act which had medicinal purposes, whose merit is clearly not supported by today's medical understanding - in his view, performing Metzitzah on Shabbos is a violation of Shabbos! [See here where Rabbi Moshe Feinstein noted that, in general, if Metzitzah were not done (accidentally, for example) there would be no need to revisit the wound, and the bris is kosher]

2. Using a marker - I have noted here - Magic of a Marker and here - Getting the Percentages Right (and much more critically here) of the IMPORTANCE of using a marker when circumcising, for the baby's sake, to get the circumcision as precise and even as possible. There is no question, in my mind, that marking the foreskin is the most important thing I do in preparation for a bris, because once the foreskin is pulled forward to apply the shield, it is impossible to know exactly where the edge of the foreskin is without that mark. Particularly since we don't want to remove more skin from the ventral side, I maintain that any mohel who scoffs at marking the baby is being foolish and is doing a disservice to the baby.  Rabbi Tendler is of the opinion that marking the baby is a necessity of milah, and that just as the circumcision (a Shabbos violation of cutting, causing a wound, etc.) pushes aside Shabbos, marking the baby (a Shabbos violation of writing) pushes aside Shabbos.

Two days later, someone in the synagogue told me that his son is a mohel in Israel, and that his son completely disagrees with these two points. Mostly, he believes that marking the baby is unnecessary EVER, because mohels in Israel don't do it! To which I said, most mohels in Israel don't wear gloves when they operate - does this make their method correct? (It happens to be that his son was trained wearing gloves, so he wears gloves.) By and large, I think I've addressed most of his son's and my differences in this post.

As for metzitzah on Shabbos, it boils down to how we understand necessity, how the Talmud viewed metzitzah (is it a requirement or medical recommendation based on medical knowledge of the time), as well as how we punctuate the Mishnah - most notably the continuation of the Mishnah, the part which I did not provide above.

Bottom line: As Jews we prioritize Shabbos. Absolutely. But Shabbos comes every week, and every week we have an opportunity to experience it better than last week. A bris is a ONE TIME opportunity, and you really only have one shot at getting it right. This is why the rules of Shabbos (for things that could not have been prepared in advance) are suspended for the mohel/caregiver when it comes to the conflict with Shabbos that a bris presents. No one questions that the rules of Shabbos are set aside when it comes to saving a life. Certain rules of Shabbos should also be pushed aside in order not to ruin a life through an imperfect circumcision.

So let us understand priorities, and not have our Hashakafic differences determine what is best for the baby. Let reality determine what is best for baby.

Sunday, January 14, 2018

The Scare Tactic - Long Term Reminder

Provocative title, I know.

Some of my favorite blog posts concern explaining how things will look after the bris, and long term care reminders. Why? Because I don't post pictures of actual circumcisions, so I need to be quite descriptive, and rely on other images to get the point across.

See for example the following urls.
http://www.mohelinsouthflorida.com/2010/01/what-will-it-look-like-before-and.html
http://www.mohelinsouthflorida.com/2011/01/knowing-what-to-expect-afterwards.html
http://www.mohelinsouthflorida.com/2012/09/chubby-baby-syndrome.html
http://www.mohelinsouthflorida.com/2011/08/fusion-challenge.html

Certainly my most favorite blog post about explaining the anatomy - with pictures! - and what happens during a bris, is here. The only challenge was that I had injured myself at the time. Can you tell?

So what is the scare tactic? How do I get people to understand the concern of Chubby Baby Syndrome, and the reality of the Fusion Challenge, the need to be resilient (in some cases) in pushing back the remains of the membrane (or ha'priah) and making sure it does not fuse to the glans?

Here's the story.

A few years ago I had an incredible bris experience, which actually led to this amazing story. (I wrote up a dvar Torah using the story, which is on my other blog). When I visited the baby at the end of the day, to remove the bandage and see that all was well with the bris, I met one of the father's friends.

Permit a brief pause, but this is actually quite relevant. At many brisses, while most people are respectful, respectable, and honorable, there are some men who make unnecessary (and unfunny) jokes about bris and circumcision. I promise I've heard them all. The most common one is "rabbi, do you do touchups?" As if the person is suggesting he is 'unhappy' with his circumcision or that I have any interest in doing a surgical correction. My thoughts on this kind of humor can be found here. 

The friend of the father had a question about his "bris," and after ignoring him/pushing his 'question' aside a couple of times, I realized he was actually serious. This was very rare. (Like urologists, I examine adults on occasion, to see if their circumcision is kosher, particularly before a conversion, or if someone not circumcised by a mohel wants to make sure his circumcision is adequate and correctable through hatafat dam bris) We went into a room for a consultation, and with a quick look I knew exactly what was wrong.

When circumcised as a baby, this man's caregivers did not separate the membrane, and it had fused to the top edge of the glans (38 years earlier). During erections, instead of the glans going straight, it was being pulled back by the 12-o'clock skin of the shaft. I told the fellow he needed to consult with a urologist and have it surgically corrected. And his friend, the baby's daddy, confirmed for me several months later (when we randomly met in a store) that his friend had things taken care of and was grateful.

Bottom line: Parents, this need not ever be your child's experience if you take heed to what I (or your son's mohel) tell you about aftercare and how things are supposed to look (see all links above for descriptions).

That is my "scare tactic." I hope the message comes across loud and clear.

Wednesday, January 10, 2018

Table of Contents - Symbolism

Symbolism
Beauty of the Bris
Inspiration of Bris
Covenants in the Torah
Why We Name the Baby at the Bris
Elijah the Prophet
Rabbi Samson Raphael Hirsch on Bris Symbolism
What's in a Name?
Saying וכרות עמו הברית Together at the bris
Significance of Bris [audio class]
The Shalom Zachar - sources of the Friday night celebration
Why We Circumcise - the Footnote
What is the Covenant of Circumcision?
Achieving Perfection

Table of Contents - Stories

Stories that are Inspiring or just Nice
Bris Where the 3 Boys Were Killed
A Promise Fulfilled
Best Line - Great Story
AMAZING STORY ABOUT A NAME
First Bris of 2016 - WOWZA
The Infertility Miracle Twins

For FUNNY stories, click here and look for "Stories"

For RANDOM stories, click here and look for "Stories"

Table of Contents - Sterility

Sterility
Cleanliness and Efficiency
Sterilize and Reuse vs. Disposable
Sterility and Cleanliness - Can't Overemphasize
Gloves   and Gloves Part II
On Creating Standards for Sterility
In the Florida News

Table of Contents - Mohels

Mohels
Putting Your Mind At Ease
The Color White
Hollywood mohel will travel
Different Types (Levels) of Mohels
Mohel's Role in the Ceremony
How to Find a Mohel
Doctor Vs Mohel
Special Role of Being a Mohel
Sensitivity Factor

When 2 mohels are involved

Table of Contents - Questions to Consider and Ask

Questions to Ask
Good Questions to Ask ANY Mohel
Prioritizing Our Questions
Wrong Attitude is NOT to Ask
FAQ - Summary (links to answers to the questions) - Shorter Answers Appear in a Link at the top of the page
Inquiries Welcome
CONCERNS - SUMMARY OF IMPORTANT LINKS

Table of Contents - Miscellaneous

Miscellaneous

Delaying and Figuring Out When the Bris Will Take Place
When Baby is REALLY Small 
Timing the Bris - Figuring out when the bris will take place
DELAYING a Bris - when and under what circumstances?
JAUNDICE
C-Section differences
What happens when 8th day is Shabbos or Yom Tov and the bris has been delayed?

Stories
AMAZING bris experience
Amazing story attached to baby's name
MohelinSouthFlorida Goes Intergenerational
Historical - portrayal of adult circumcision for conversion
Historical - a list of circumcisions from the 1700s
Scare Tactics - An Experience I had which highlights why parents MUST listen to aftercare instructions

Before and After
When to call the mohel
Calling the mohel does not equal booking the mohel
What to Prepare for the Bris
BEFORE AND AFTER - What it Looks Like

General Qs
Lighting
Foreskin - how is it disposed of?

Twins
The joy of TWINS - with a photo!    
Another TWINS photo

Proper Attitude of Mohel = Confident Parents
The Importance of Trust
It's All About the Baby

Fun Stuff
How do you spell MOIL, MOHEL
Bris Humor
Source for the Bris Party
Are there BOOKS about Bris? [Not too many in English - you'll find much more information in this website!]

Table of Contents - Preparations

Preparations
Family and Friends Focused
When to Call the Mohel
What Kind of Party
Supplies List page    (earlier blog post = What to Prepare for the Bris)
Private Room
Kippah for baby?
Bris at Night?

Table of Contents - Problems

Problems

Anatomical
When There is NO BRIS due to a baby's anatomical reality
What problems with the baby would cause the bris to not take place on time - ie to be delayed?

Corrections needed?
Most Common Issues After the Bris
What Will it Look Like Before and After
news out of Israel
What Happens in Circumcision
What I Learned in the Operating Room

Dealing With A Delayed Bris
When DOES the DELAYED BRIS take place?

Expectations
What Can Go Wrong at the Bris
The Part No One Talks About (relates to previous)
The One-Two Stage Process (a positive twist on previous)
MYTHBUSTER: The Bleeding Vein

Long Term Care
Knowing What to Expect Afterwards
The Fusion Challenge (related to previous)

SAFETY = TOP PRIORITY
This should NEVER happen - a tale told to me by a baby nurse
Denuding the Shaft
Safety Precautions EVERY MOHEL AND PARENT SHOULD BE DOING

My Worst Story
Vindicated!- a story of a not as great bris experience, with a satisfying (for me) conclusion