Wednesday, January 26, 2011

Knowing What To Expect Afterwards

[For much more detail on this subject, click here. The short version follows.]

When your child is circumcised, it is a good idea to get a good feel for how long the healing process takes.

In most cases, I need to see the baby only once after the bris, often enough to remove a bandage, but even when the bandage comes off on its own, just to see that everything is healing nicely. This has changed the time frame of my care for the baby - I used to see the baby, in some cases, two whole days after the bris. Now I see him within a few hours.

I FIND SEEING THE BABY A FEW HOURS AFTER THE BRIS TO BE MUCH BETTER: FOR THE BABY, FOR HIS PARENTS, AND YES, EVEN FOR THE MOHEL

There are mohels who like to see the baby a few days later, or even to see how things are looking a few weeks later. This is admirable.

At the same time, in the event that something is not OK at that two week period, there is really nothing that a mohel could/should do at that point. Any "correction" should be taken care of right away, which would perhaps necessitate an additional follow-up visit.

In simple terms:
* The glans (tip of penis) should be a dark red, and the extent of its outline - like a helmet on a head - should be visible all around
* There will or will not be remains of a membrane below the glans (also a dark red, though a slightly different hue). It is often swollen, though to what degree depends on how much membrane is present.
* The skin where the incision took place should be identifiable below the glans or membrance, and should be as close to even in its circumference around the shaft. Depending on the baby's anatomy, in some cases, the mohel might cut at more of an angle, to compensate for a differently angled glans.

If this is what things look like after the bandage comes off (with the caveat of the possibility of some swelling below the glans), all your baby needs is "time." Some colors may emerge (white, yellow, green) that are just the way the area scabs. But even all this goes away within a couple of days, and certainly very quickly once antibacterial ointments (bacitracin, polysporin, etc) are no longer applied to the area.

For instructions on how to care for baby, see here

Tuesday, January 25, 2011

Finding a Mohel in South Florida

A web search for a "mohel in south florida" or "mohel in florida" may have brought you to this particular page.

Ought you just go with the top search engine listing?

RESEARCH RESEARCH RESEARCH

Everyone who has any media sense or savvy will have nice pictures and guarantees of a beautiful ceremony. Of course that's what you'll find. After all, don't we all do the same thing?

Yes, and no.

Yes - we all do a ceremony, we all do a circumcision, and we all take care of your son.

No - it's not all the same.

Tuesday, January 18, 2011

Circumcisions versus Brisses - Circumcising Jews, Half-Jews, Non-Jews

As far as I can tell, citizens of the world who circumcise their sons either do so as a medical procedure or as part of a religious ritual that is a right of passage.

I have met doctors who perform circumcisions all the time, and some who do them every now and then. Each one has a method which works for them to achieve the desired result. (Doctors are wonderful people, and they usually specialize in a particular field. As such, I would be wary of doctors who do not do them regularly, simply from word of mouth from other doctors who've told me their colleagues ought to stick to what they know - but that is for a different discussion.)

Mohels find themselves in a unique circumstance. Most mohels (certainly Orthodox mohels) are not physicians, and yet they have what many would consider a medical expertise in a very limited field. Does this make them obligated, under a sort of Hippocratic Oath, to perform circumcisions whenever called upon to do so?

Firstly, mohels are also specialists and should never extend beyond their training. There is circumcision, which is more or less routine, and there are surgeries which require a reconstruction of the penis. A mohel who is untrained should not undertake such a procedure, particularly if the best setting for it is an operating room with general anasthesia.

Secondly, circumcision, particularly on a newborn, is not, objectively, a "necessary" procedure, and in most cases is not life-saving. As to-circumcise or not-to-circumcise is a choice made by parents, mohels are under no obligation to accept the job if they do not want to. (Religious law might require them to in the event there is no one else available, particularly for a bris which must take place on the eighth day -- though obviously if it does not work out on the eighth day, it can be done at the next opportunity, ideally as soon as possible.)

So we come to our question: May a mohel circumcise non-Jewish babies, or is he only allowed to do brisses (as opposed to routine circumcisions)?

Sunday, January 16, 2011

The Honor of Being Called Again

I've been in Florida for a little over 2 years, and I've already had a few repeat customers. (I have many in New York, but 2 years is about the average between most kids in a family.)

In general, I appreciate the trust you, the parents of newborns, put in me. If you knew me before your baby was born, it is obviously easier for you to make the call. And while I always view doing a bris as a privilege, it is a different experience when you already know one another. To misquote Barney, "I know you, you know me."

If you never met me before you needed to arrange a bris, the trust is even more appreciated. You are calling me "cold" - perhaps after having done your research. And you give me the job of bringing your son into the "mark of the covenant." This is the greatest honor.

Before I became a "Mohelinsouthflorida" I was a mohel in New York. It became a competition with some grandparents, how many of their grandsons had I circumcised.

I believe the record is 6 for two sets of grandparents. (Full disclosure - one of those sets are my parents, who have six grandsons). I have a few sets of grandparents with 5 or 4 grandsons I've circumcised, and whole host of triple and double-dippers - either one each from two (or three) of their married children, or two from one set of parents (which obviously makes the parents repeat customers), etc.

I cherish the trust, the friendship, and the opportunity to serve you and your family at this very special time for your family.

Saturday, January 15, 2011

FAQ - Frequently Asked Questions SUMMARY

Short answers to the following questions can be found here

The links will send you to longer answers to the questions categorized below...

MOST PRACTICAL 
* I'm a practical person and don't have time for all this. What do I need to know and do to prepare for a bris? You can start by utilizing all the "page" links at the top of the page, or you can go to this blog post which covers each essential thing you need to find, from the preparations for the bris to the longer term care instructions and things to note.

ABOUT THE MOHEL
* Anythoughts on how to find the right mohel? (Aside from calling the number on the right of the page? :) Seriously though -- Important to know what you're looking for and to ask the right questions, basically - do your research!! My own comparison of Billet vs the other guys
* What is your training? (read my mini bio on this homepage)
* Why did you become a mohel? What do you enjoy about being a mohel?
* Are you a doctor? No.  Does a mohel need to be a doctor? Read the second half of this post
* (or read this article from the jweekly of California)

PREPARING FOR THE BRIS - DETAILS AND MINDSET
* What do I need for a bris? Supplies
* What is the setup for a bris? Setting up the room
* What goes into preparing a bris party? What is an appropriate venue for a bris?

THE CEREMONY AND THE PROCEDURE
* How does the ceremony work? (General overview of the Ceremony)
* How is a circumcision done? Methods,
* What exactly happens in a circumcision? Before and After (note the link to the circumcised banana)
* Explain the honors of the ceremony: HONORS LIST (more detailed list of the honorsKvatter, Kisei (Chair of) Eliyahu (Elijah the Prophet), Sandak
* What is metzitzah? As straight as I can give it to you, An Additional Thought, Is it a "Mitzvah"?
* How do you balance inclusion of family, friends and guests in the ceremony? Having Family and Friends Involved (includes honors list)
* What surgical instruments and supplies are used in a circumcision?  SHIELD              TUBE               KNIFE              PROBE             HEMOSTATS           MARKER              GLOVES             NUMBING

AFTER THE BRIS
* How do I care for my son after the bris? Instructions  Thoughts on Tylenol
* What will it look like? Before and After
* What can go wrong? Common issues  Correctable and Really Bad, Long term Care Reminder

MISCELLANEOUS
* How does it work if one of us (baby's parents) is not Jewish? A: If his mother is Jewish...  What Makes a Jew, Mohel's role in circumcising half-Jews (one Jewish parent) and non-Jews
* What will the bris itself (circumcision - mohel's role) cost? Initial Thoughts   and    More straightforward
* How important is sterility really? OneTwo,  Three
* Is there a difference between a bris and a circumcision? This topic,  Related conversation

Thursday, January 13, 2011

He's YOUR Son, Really

I've blogged about this before - but it deserves a repeat every now and then (though I am presenting things differently)

I was invited to do a bris on shabbos recently, outside of my home town, so my family enjoyed the good company of our relatives who hosted us and the lovely community where the new baby's bris would take place.

Being a visitor for shabbos, as the mohel for the bris in town, I was comfortable introducing myself as a mohel to people (especially pregnant people), even though normally I hesitate to do so (it's my bad business sense that prevents me from this sort of 'ambulance chasing.') In this context it was normal. I met a lot of people, and the conversation always went like this.

"Nice to meet you. Welcome to our community. I am ____, what's your name?"
"Avi Billet. Nice to meet you too."

"What brings you here for shabbos?"
"I am doing the bris tomorrow/ I am doing the bris this morning/ I was the mohel this morning for the bris."

"O - Mazal tov!"

"Thank you. Mazal tov. Good shabbos!"

I had a conversation along these lines with a couple who is expecting a baby soon, at which point they said, "Well, our family only uses Mohel X."

Were you happy with the procedure, with the ceremony, are you aware that the way he does a bris might not follow your standards of halakha (Jewish law)?

"If you know anything about my parents" (says one member of the couple) "you won't argue and you won't ask any questions either."

To which I said, "But it's YOUR baby! YOU have the right to choose what YOU want."

Please don't misunderstand. Had they given any indication that they LOVED (or even liked) the mohel in question, I would have dropped the conversation. An A+ experience with a mohel is a beautiful thing, and they should return to it.

But, they were hesitant, they seemed unsure, and frankly, a little too adherent to old-school mentalities as dictated to them by their parents/ in-laws.

Everyone wants a mohel who does a good job where it counts - meaning surgically, asthetically, and healing wise. Everyone wants there to be minimal bleeding, and for the baby to heal quickly, and without incident. There are never guarantees with anything in life, which is why you do your research, and you pray and hope for the best.

But some people would also like a mohel who relates to them in a way others don't. They want personality "b" instead of personality "a."

All I am saying is this: You NEVER need to settle for an option that is disagreeable to you. Look around, know what questions you want answered, and what you want the answers to be. Make a few phone calls. Read websites, blogs, discussion groups, interview a few mohels, and make a decision.  You owe it to yourself to have the best experience YOU want to have. And you owe it to your baby to give him the best care in every department.

  • A mohel who does a bris according to the halakhic dictates of the lifestyle you have chosen for yourself (or the level in Jewish law that you at least want for your son's bris)
  • a ceremony that agrees with your personalities and the style you want for yourselves and your guests
  • a standard of sterility that is top-notch for a public ceremony such as a bris
  • a bris that has a time limit - that does not drag on
  • that starts on time and finishes in a timely manner that is respectable to all present - most notably the baby, but which is also sensitive to the needs and schedules of those honoring you with their presence
Best of luck in your research, and in making the choice that is right for YOU.

Tuesday, January 11, 2011

Emotions Vs Intellect Vs God's Law (part II)

[Part I is here]

Rabbinic literature is loaded with discussions about the importance and greatness of Bris Milah. In many postings, I have alluded to the connection between Bris and Pesach (I will write about this some day). One of the most noticable connections is that Elijah the prophet makes an "appearance" at both.

Here is another connection, as quoted in the Chapters of Rabbi Eliezer (the same one I've quoted a few times recently - just a different section of his comments):
 פרקי דרבי אליעזר (היגר) - "חורב" פרק כח

בני יעקב מלו את בניהם ואת בני בניהם והנחילם לחק עולם עד שעמד פרעה הרשע וגזר גזירות קשות ומנע להם ברית מילה, וביום שיצאו ישראל ממצרים נמולו כל העם מקטון ועד גדול, שנ' כי מולים היו, והיו ישראל לוקחין דם ברית מילה ונותנין על משקוף בתיהם דם ברית מילה ודם פסח ונתמלא רחמים על ישראל, שנ' ואעבור עליך ואראך מתבוססת בדמיך, בדמך לא כתיב אלא בדמיך, בשני דמים דם ברית מילה ודם פסח, ואומר לך בדמיך חיי, ר' אליעזר אומ' וכי מה ראה הכתוב שני פעמים בדמיך חיי, אלא אמ' הב"ה בזכות דם ברית מילה ובזכות דם פסח נגאלו ממצרים ובזכות דם ברית מילה ובזכות דם פסח אתם עתידים להגאל בסוף מלכות רביעי

The children of Jacob circumcised their children and grandchildren and left them with this practice forever until the wicked Pharaoh rose and made harsh decrees, preventing them from doing Bris Milah (performing the covenantal circumcision). On the day they left Egypt the entire nation was circumcised, from young to old, as it says "Because they were circumcised when they left Egypt" (Joshua 5:5).

The Israelites took the blood of the circumcision and they put that blood and the blood of the Paschal lamb and put them both on the doorposts to become recipients of God's mercy on that fateful night, as it says " And I passed by you and saw you downtrodden with your bloods, and I said to you, 'With your bloods, live,' and I said to you, 'With your bloods, live.' (Ezekiel 16:6). It doesn't say "blood" in the singular, because it refers to two bloods which caused God to skip over the houses that night.

Rabbi Eliezer says, "Why does the verse say 'With your bloods, live' twice? Because the Holy One Blessed be He declared that in the merit of the blood of the covenant and in the merit of the blood of the lamb the Israelites were redeemed from Egypt, and in those same merits they will be redeemed again, at the end of the fourth exile."
3. A Covenant of Blood (count continues from previous posting)

In essence, then, we have a covenant created over blood.

Monday, January 10, 2011

Emotions Vs Intellect Vs God's Law (Part I)

[At the risk of sounding repetitive - I've addressed some of these issues in this posting, using a different tone, albeit a similar point of view]

I came across an interesting article - the woman's personal story is intriguing, and the conflict she faces for herself is fascinating. You can read it here. As I was reading the article, it occured to me that if the "comments" section were open to the world, it would likely generate much feedback. And surely, as of this writing, there are over 300 comments.

While I only looked at the first page of comments (who has time for all that?) it became clear to me that not only does the author not understand why we do this, but all the negative commenters are also equally misguided.

The debate over whether circumcision is "mutilation" will probably go on forever. I've addressed it peripherally in this blog in the past. And, as this is a "pro-bris website" (as opposed to a pro-circumcision website), I would like to suggest reasons for why we do this, why we go through the ritual, the ceremony, and why our attitude need not echo or mirror the cynical ways of those who write negatively of "bris milah," who arrogantly believe that their own logic and emotions are wiser than thousands of years of Jewish tradition, which is grounded in a faith that brought monotheism (God) to the world.

Friday, January 7, 2011

A Source for the Bris Party

In the grand scheme of things, Bris Milah is a mitzvah just like other commandments. Since when do we make a party just because we've fulfilled a mitzvah?

Our assumptions are incorrect because Bris Milah is a big deal. Talmudic sources talk of why Bris Milah is such a big deal (Nedarim 31b-32a). (Look it up for the many details)

The Midrash tells us in Pirkei D'Rabi Eliezer 28

ר' אומ' לא עכב אברהם מכל אשר צוהו, שנ' ובן שמנת ימים, וכשנולד יצחק בן שמנת ימים הגיש למילה שנ' וימל אברהם את יצחק בנו בן שמנת ימים, מכאן את למד שכל איש שמגיש בנו למילה, כאילו כהן גדול מקריב מנחתו ונסכו על גבי המזבח, מכאן אמרו חכמים חייב אדם לעשות שמחה ומשתה באותו היום שזכה להמול את בנו כאברהם שמל את בנו, שנ' וימל אברהם את יצחק בנו וכו'

Translation: Avraham did not neglect anything God commanded him to do, as it says "And when he is eight days old [you will circumcise him]..." When Yitzchak was born, he was brought to his bris at eight days of age, as it says "And Avraham circumcised his son when [his son] was eight days old."
We learn from here than anyone who brings his son to his bris is compared to the High Priest bringing a Mincha offering on the altar.
From this comparison the wise men taught that a person must rejoice and make a celebratory meal on the day he merits to have his son circumcised, as it says with regard to Avraham "That Avraham circumcised his son" [and the implication is that he made it into a big deal.]
There are other reasons, of course, for celebrating, but this will suffice for now (it was inspired by the teaching I found last week (presented two posts ago)).

Sunday, January 2, 2011

Elijah the Prophet

At many brisses, two chairs are set up at the spot where the bris itself will take place. Ask the mohel, he'll tell you "One is for the sandak (who holds the baby during the bris), and the other is for Eliyahu Hanavi (Elijah the prophet)."

You're kidding, right?

No. The tradition to have a place set aside for Elijah at a bris is pretty old.

Let's Talk About Honorariums

From thefreedictionary.com:

hon·o·rar·i·um (n-râr-m)
       n. pl. hon·o·rar·i·ums or hon·o·rar·i·a (--)
A payment given to a professional person for services for which fees are not legally or traditionally required.
********************************************************************************
In traditional sources, Jewish professionals - rabbis, teachers, mohels, shochets (ritual slaughterers), sofers (scribes who write Torahs, Tefillin and Mezuzahs) are not really supposed to take payment for their services rendered.
 
Practically speaking, if these people are not independently wealthy from other endeavors, you'd be hard pressed to find anyone who would continue to work in these fields. In other words, if this is their full-time line of work, or something they do from which they rely on "supplemental income," then it is important to see that they are paid appropriately for services rendered.
 

Saturday, January 1, 2011

What Can Go Wrong At A Bris?

Aside from the cream cheese being moldy, and the family rabbi not being prepared to speak...

REPAIRABLE

If a mohel has, minimally, a decent reputation, he will not likely do anything during the bris that will cause permanent damage. Obviously the foreskin will be removed, but depending on what else comes off with the foreskin, even a foreskin has a possibility of regenerating.

Here are a few samples of things that can "go wrong," that are entirely fixable/correctable within a few minutes of the bris:
1. Not enough foreskin removed (talk about undercutting the competition!)
2. Excessive membrane (or ha'priah) remains, either on account of not having been touched, having been partially removed (but not completely), or on account of it looking aesthetically unpleasing
3. the glans is slightly twisted in how it sits back in the shaft, misalligned from post-bris bandaging (or natural state).

Just like after a bad haircut one can always take off more hair, if not enough skin is removed (which can happen), or not enough of the or ha'priah is removed, it is always possible to fix. And if a mohel notices or realizes it either during the bris or upon checking the baby right after the bris, the best time to take care of it is that moment.