Tuesday, February 28, 2012

Mohelinsouthflorida.com discovers VENMO

This is not a regular blog about bris. But it does relate because people ask me all the time "How would you like to be paid?"

It's a "taboo" subject to be sure, because an honorarium for a mitzvah is not really a "payment," right? And because with the exception of when I travel a long distance, when it's more my time that is being compensated, I don't put a price on the mitzvah. People usually give what they can afford or what they feel is appropriate.

Whatever works for you works for me. Which up until now has been cash or check. With the "venmo" app (free), or online at venmo.com, you can process a credit card payment directly to me if you have my cell phone number. This way you can get the points (or whatever rewards your card offers) for the bris as well.

The app has other uses - such as ease of splitting bills at restaurants between friends, or utilities in a living situation where these things are split. But you can look it up and use it however you like.

Monday, February 27, 2012

Twins - Double the Joy!

 A while back, I blogged about having multiple brisses or twins or triplet brisses.

Most brisses are, as you can imagine, single-serving affairs.

But I had the privilege to preside over a "twins" bris once again recently, and when I saw the babies with their mother after they had eaten post-bris, I couldn't resist taking this picture.


Makes you want to have twins. Doesn't it?

These guys are extra special, because as twins, they shared the same sac and placenta. You can't get any closer than that. Their parents named them David and Yonatan - like the two Biblical characters who cared so deeply for one another, whose love for one another is described by the Rabbis as "A love that is not dependent on anything."

Wednesday, February 8, 2012

Mohel's Role in the Ceremony

Different factors play into parents asking for the ceremony to be tailored to their unique crowd and guests.

Of course this is obvious, but the main messages I try to convey in the bris ceremonies over which I preside include:
1. We are celebrating the continuation of the Abrahamic covenant of Genesis 17, which coincides thankfully with the birth of a baby boy.
2. The families of baby's mother and father are celebrating here today.
3. There is much significance attached to the ceremony - much of which has literally been introduced in the last few hundred years, as the ceremony has to a large degree been influenced by a fair dosage of symbolism.
4. The ceremony is an education opportunity.
5. There are some circumstances when light humor is beneficial to ease the nervous tension in the room, which is typically brought on by the fact that a circumcision is about to take place.
6. The ceremony is NOT about the mohel.

All these being the case, sometimes one, sometimes a number of these being true, the ceremony will have the same main ingredients but will never look the same twice.

0. Mohel Circumcises, Someone Else MCs, or runs the show
This does not happen often, but there is sometimes a rabbi, or a close relative or friend who runs the ceremony, and the mohel is literally hired to circumcise, and that's it.


1. Most basic
I will introduce the honorees and go through the ceremony step by step without fanfare. No explanations necessary - this is usually a knowledgable crowd.

2. Minimal Explanations
I will add a brief explanation of each step of the bris as each honoree is introduced.

3. Educational Ceremony
The different honors are explained in greater detail. A light comment, some good-natured humor, and an overall respectful message for the crowd. The ceremony concludes with the baby being given his Hebrew name and the final blessings embedded in the liturgy are briefly explained.

We can discuss what you want, or you can decide for yourself.
But know this: I make the ceremony about the "Bris (the Covenant)" about the family, and about the baby. No part of the circumcision or ceremony stands to serve any purpose to shine light on the mohel, to make it about him, so he becomes the object of attention. It is about the experience, the family, and whatever people can take away from their participation in this special occasion.

I firmly believe that a good mohel's mannerisms, sensitivity and awareness of the needs of people will serve him better than being a showman. Some people like a good show, but most just people prefer honesty, dignity, and a healthy dose of good natured cheer.

Which I hope I provide satisfactorally.

Sunday, February 5, 2012

A Beautiful Sentiment

At today's bris a self-described "grandmother-age" woman said to me, "It was so nice to meet you. It's good to see a young person who enjoys being Jewish and contributes to Judaism in this manner."

Her husband also commented how years ago the thought was that Mohels will die out. It is therefore nice (if not surprising) to see a young mohel.

I know I won't be young forever. But while I am still blessed with relative youth, I am grateful for the opportunity to play this role at this stage of life.

I look forward to the day when I'll look back and see another generation of Mohels being trained to undertake this task that helps families fulfill this sacred and ancient mitzvah and tradition.

Friday, February 3, 2012

Numbing

I once addressed the "numbing" question in a posting that covered a few topics.

Since it comes up every now and then, here are a few thoughts to consider.

Concerned parents have different attitudes about numbing the foreskin before the circumcision. Here are a few examples of things that have been shared either with me or between parents who discuss this in my presence:
  • Babies have been circumcised for thousands of years without numbing. He'll be fine without it.
  • If you can do anything which will ease his discomfort, we'd appreciate it.
  • Babies nerve endings aren't developed as much. He doesn't feel it so much anyway.
  • He feels something, but he cries every time we open his diaper.
The feelings run the gamut, but they are also tainted by a little bit of misinformation.

#1. BABIES FEEL PAIN. The "nerve endings aren't developed" argument is a load of hooey. To suggest that a baby doesn't feel pain is to assume that a baby only cries when hungry or when needing a diaper change. Give a baby a blood test and you'll hear cries of "bloody murder."

#2. ALL STUDIES OF THE PAIN BABIES FEEL DURING CIRCUMCISION ARE IN HOSPITAL PROCEDURES (with either 0 or local anesthesia) WHICH CAN TAKE BETWEEN 10 AND 45 MINUTES. A BRIS, ON THE OTHER HAND, TAKES A FEW SECONDS. In other words, while there is pain at a bris, the amount of pain is directly correlated to the amount of time the procedure takes place. Since the bris is done using a different method than the hospital procedure, the painful part is minimal, in comparison to the rest of the time which I define as "discomfort" (ie. let go of me, stop putting pressure on my circumcision wound, close my diaper, let me eat, etc.)

#3. INJECTIONS ARE MORE PAINFUL THAN THE BRIS. We know injections are sometimes important. But that doesn't mean that they are painless. Even if we can withstand the needle, there are some shots that hurt hours after adminstered. Typically injections for a circumcision are done in three places, around the circumference of the dorsal (belly) side of the penis, to create what is called a "penile block." It makes the baby relatively calm during the circumcision, but at the cost of three painful injections.

#4. TOPICAL ANALGESICS WORK FOR THE MOMENT OF THE BRIS, BUT DO NOTHING ONCE THE FORESKIN IS GONE. Essentially, the shaft of the penis will not have sensation, and the baby can be quiet in the moment the foreskin is excised. But when pressure is applied to the now-open wound, all bets are off. The baby will likely cry even if the area was numbed beforehand, simply because he is uncomfortable (see the end of #2 above).

MY PERSONAL FEELINGS

I think injections are good for the doctor in a hospital setting (assuming he is working with a newborn and is not using general anesthesia), because a hospital procedure - or any procedure that includes a clamp utilized for more than a few seconds - is long, arduous, and painful to the baby if the area is not numbed. But I don't believe injections are beneficial to anyone in the event a mohel is circumcising using a more traditional circumcision method/procedure.

I have no personal problem or objection to the use of a topical analgesic/numbing agent, as long as I know what it is and it has a decent track record. There are debates about EMLA cream, for example. A doctor I know recommended I introduce people to "ELAMAX," which can be obtained OTC at a drugstore (just ask for it). I used to carry a 30% lidocaine cream that I had made by a compounder, as per a prescription given to me by a doctor (email me if you'd like to see the article that introduced me to this idea - I can send you the pdf). But it became complicated to get to people or if I only saw the baby a few minutes before the bris it was not enough time to put it on, so it wasn't worth the hassle.

There are other issues to consider as well (if you really care, see Phil Sherman's discussion of this in Q14 on his FAQ page), so I don't raise the issue unless people ask.

Simply put, I have found that the "pain concern" is more of an issue for parents than it is for the baby. When the bris is over - more accurately, when I close the diaper and get the baby dressed - he is usually fine. When I am done, the discomfort is over. The "pain" is over as soon as the foreskin is removed. Some babies still need to eat, but some go right to sleep. A little bit of Manischevitz does wonders.

To quote one of my teachers, there are two mitzvahs for which God said "You will feel pain." One of them is Bris Milah (the other is fasting on Yom Kippur). But, he argues, we do not need to maximize the baby's pain. He is therefore an advocate for using the numbing cream. Which is why I won't object to the proper cream being used. I will add, however, that the speed in which we operate is its own form of anesthetic. The method we use is far less painful than a "clamp method." All told, the traditional Jewish method minimizes the baby's pain as much as possible by its quick and simple design.

I mentioned above that the pain concern is more of a parental one. One of my colleagues is fond of saying that the person who feels the most pain at the bris is the... baby's mother. Sometimes the father too. The best anesthetic, therefore, is to pour two shots of whisky. Give one to Mommy, one to Daddy, and the baby will be fine.