Tuesday, April 24, 2018

The Vigilant Parent

Vigilant. Not vigilante.

Last week I received from a phone call from a somewhat reluctant father, who was calling more because his wife was concerned about how their son's circumcision looks.

The following is my recollection of what he said, though it is not an exact quote.

"We had a friend of mine fly in from New York to do the bris 5 months ago. It was a little weird because he did something afterwards, and he followed up with us a lot, but eventually - he lives in NY and we are in Florida - I can't bother him to come down to look at it. But I found what you wrote on your website and so I'm calling you."

Not having been at the bris, not having seen the baby before or afterwards, not having witnessed the actual circumcision, I told the father that I could not comment on the job without seeing it. And so we made arrangements for me to visit, and sure enough, the mommy's instinct was correct and there was a(n easily) correctable problem, which I have called the Fusion Challenge. Basically the remains of the Periah skin (membrane) had gotten stuck to the back of the glans.

I separated the skin with a little pressure, the baby did not bleed, and I showed the parents very simply how they could avoid this concern in the future.

And then I told them this story. Which, as usual, had its desired effect.

The point is, if you, the parents, are vigilant about how to care for your baby's circumcision after the bris, you'll never have these problems or concerns. So be sure to know what you need to do, and follow through with it for your baby's sake!

Tuesday, April 10, 2018

Periah

The second stage of Brit Milah, which is sometimes accomplished along with the first, is the one that is often used by anti-circumcision people as being "anti-traditional." 

They'll often claim that it wasn't originally instructed to Abraham, and therefore doing it is "not what God intended."

I love how they have a hold on "what God intended."

The truth is, they have no blessed idea of what they're talking about, and no business chiming in on Jewish practice, when they are anti-Jewish practice. 

The same Talmud that debates and discusses whether Abraham did Periah dictates that there are three stages to a bris procedure: Milah (excising the foreskin), Periah (revealing the glans - either through removal or folding back of the mucosal membrane), and Metzitzah (drawing out blood from the wound).

I bring this up here because in advance of a class I'm giving next week, I came across this comment from the Haktav V'hakabbalah (a commentary on the Torah) on the verse in Vayikra 12:3 which states that when a woman gives birth to a son, on the 8th day of his life he is to be circumcised. 

הכתב והקבלה ויקרא פרק יב
(ג) בשר ערלתו. יש לפרשו באחד משני פנים, הא' בשר הוא כנוי לאותו אבר, כמו זב בשרו, החתים בשרו, וערלה הוא שם לעור המכסה את העטרה, והיה ראוי להסמיך ערלה לבשר ולומר ערלת בשר, כמו ונמלתם ערלת לבבכם, והב' בשר הוא עור החופה את הגיד, כי העור נקרא בשר, כמו דבקה עצמי לבשרי שטעמו לרד"ק דבקה עצמי לעורי, ויהיה טעם בשר ערלתו, בשרו הערל. וההבדל שבין הפירושים האלה הוא, אם ניתנה פריעת מילה לא"א אם לא. והענין מבואר יותר ס"פ לך לך.

Rabbi Mecklenburg's comment here discusses how the reading of the verse in question would determine whether Periah was given as an instruction to Abraham.

However, as I've noted before, we don't circumcise because Abraham circumcised. He may have started a family tradition! But we circumcise because we were commanded to at Sinai, in a different covenant which has kept the Jewish people a distinct unit for thousands of years.

Therefore, while the historical debate of Abraham's periah makes for interesting dinner-talk it is completely irrelevant to our practice.

On top of that, I can certainly add that if asthetics are the least bit of a concern to anyone who is either circumcising a child or having oneself circumcised (as an adult, etc), the status of periah's having been done will actually have a significant impact in whether one "looks" circumcised. 

I'll leave the pro-con benefit vs no-benefit argument to others to tackle. We circumcise because of our mitzvah and our Covenant. But once we're doing it right (i.e. with periah) it should also look right.

AMEN.

Tuesday, March 13, 2018

When the Mohel is also a Synagogue Rabbi

In old Jewish towns there was often one person who was a Jewish know-it-all. He was the sofer (Scribe), Shochet (ritual slaughterer), and Mohel. 

Despite the fact that this person held several positions, there is actually indication in Jewish law that the shochet shouldn't also be a mohel. Why? Not because anyone is afraid he'd do anything wrong to the child! It's actually something which is a serious concern to devout Jews, but not because of whatever you might be thinking.

The assumption is that any shochet will be busier than any mohel. Every family needs to eat daily, while even if a family might have had a baby once a year, it's not always a boy. And of course some have babies far less frequently than that.

So here's the reason: When a shochet finds himself in a situation where he has a knife in his hand (even though it's a much smaller knife than usual, and he is looking at a baby and not a bird or animal slated for slaughter), he might accidentally say the wrong blessing before commencing the job.

You read right. The wrong blessing. Now the blessing a shochet makes (Blessed are You God... Who has commanded us to slaughter animals) might not sound good before circumcising a baby. But no one thinks he'd go and slaughter the baby. Everyone is moi confident that the bris will go just fine.

I finally understood this on a very deep level this week. As I am also a rabbi of a synagogue, this time of year is somewhat dedicated to people appointing me to be their agent to sell their chametz in advance of Pesach. When we meet, I always tell them, "Please appoint me to be your shaliach/agent to sell your chametz."

As I do brisses a lot more often than I sell chametz, you can probably guess what happened. 

One night this week, I was a little distracted as a person came to make the transaction with me, and I told him, "Please appoint me to be the shaliach to do your son's bris!"

Like in the example above, I did not circumcise anyone at that time, and the error was quickly corrected and our transaction went without a hitch. But it just goes to show how we can train ourselves to say things. After all, every time the father is not doing the circumcision himself - which is his mitzvah - I remind him "You have to appoint me to be your shaliach to fulfill this mitzvah on your behalf."

AND THAT is an honor that I cherish anew every time I receive the call!

Thank you, as always, for your trusting your baby's bris needs to my hands. 

Friday, March 2, 2018

The Best and the Worst of Times

This blog post has two anecdotes from this week, each followed by the method of procedure I utilize in these circumstances. Like any religious milestone and lifecycle event, the only thing that gives it that flavor is when the rules are being followed. I didn't make the rules, so please (if your circumstance is described below) don't cast aspersions against things which have defined the Jewish people for millennia.

Shabbos Bris and Bilirubin/Jaundice
I got a call last night (Thursday night after Purim) from a couple whose son was born last Saturday morning. A baby born on Shabbos is supposed to have his bris on Shabbos.

Owing to a very mild case of jaundice (bilirubin count 15.3), their mohel told them that they could not have the bris on Shabbos, and it will be Sunday. Wanting to do things right, they found my blog post on the subject online and called me to see if I'm available. I'm not, which is fine. But there are two things going on here which, to me are a cause for concern.

1. As noted in the article recounted in that blog post, the craze over jaundice, and the fact that some mohels will delay brisses on account of it, is mostly based on a misunderstanding of halakha. Also, the medical concern is unfounded as most doctors will tell you that normal physiological jaundice (which is the most common type) need not delay a bris. Mohels need to drop the arbitrary bilirubin number of 12 and have brisses take place on time when the number is higher. I have never had a problem with babies who had a bilirubin count of 16 (or even lower than 18 when the numbers were descending).

2. To do a bris at the right time is a mitzvah. A Shabbos bris provides added stress to parents if the mohel they want to hire does not live in their neighborhood, as he needs to be housed for Shabbos, with all the arrangements that entails. Of course it's inconvenient for the mohel as well. But it is important to the family to do the bris on the 8th day. This is why I find the mohel jumping at excuses to delay the bris - for his own convenience - to be wrong.

Instead of saying "bilirubin is too high, so I'll do the bris on Sunday," the mohel should be honest and say this: "Your baby should have his bris on time. I am not available to come for Shabbos. If you find someone to do the bris that day, wonderful! Mazal tov! If not, I am happy to be available at the next opportunity, Sunday morning."

I have given that speech to many people. Some have found someone else. Others could not find someone for Shabbos. Others chose on their own to delay to Sunday because they wanted me to be their son's mohel, based on all the research they had done. Let us understand bilirubin and jaundice better, getting out of old-school methods of delaying brisses. And let us (mohels) be honest about what we can and can't do, and not delay a bris due to our (mohels') inconvenience. 

Non-Jewish Mother
I do feel badly every time this happens. But this is one place where the kind of Judaism I live draws a clear line. By birth, only a child born of a Jewish mother is Jewish. If his mother is not Jewish at the time of birth, he is not Jewish and needs at the very least to undergo some form of conversion. 

As I like to say, I'm not judging anyone. Heaven forfend I would ever suggest anyone is not a good person. All I'm saying is that a non-Jewish woman is not a Jewish personWhich, of course, has ramifications for her child.

While there might be a financial incentive, I made a decision a long time ago not to do "brisses" on babies born from non-Jewish women, even if the father is Jewish (because they usually want a Bris, and the baby doesn't even need to get circumcised! and is certainly exempt from a Bris!). I am not supervising a conversion in these cases. And I certainly don't want to mislead anyone into thinking all is good and kosher when it is not. The child would still need a conversion as the circ would not turn him into a Jew.

I don't know the rabbi who called me on their behalf earlier this week. But he certainly thinks differently. When I told him "The baby is not Jewish and doesn't need a bris," he said, "Now I know where we stand." [For what I sometimes offer people in these circumstances - which very few people have taken me up on - see the second half of this post. under "The Cases I Will Take."]

The continuation of the Jewish people is most possible through Jewish marriage, Jewish education, and a commitment from both parents to raise their children as Jews. While to the modern eye matrilineal descent might seem to be anachronistic, and the concept of "Jewish DNA" only passing through the mother might seem to be bigoted, the fact remains that that is the core definition of Jewish peoplehood (outside of proper conversion) which has defined us almost forever. 

I look forward to continuing to service Jewish babies in this holy mitzvah. 

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