Month: December 2019

A Meditation on Christmas

Note: The following post is written by Leah Bakst, my daughter. Thank you, Leah, for your thoughtful, interesting contribution.

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I’m no expert on schizophrenia, but as I understand it there are two important categories of symptoms. Positive symptoms are things that are extra or added to the average experience. This could be something like hallucinations or delusions. Then there are negative symptoms – things that most people experience that can be absent in someone with schizophrenia. Like experiencing pleasure. Thankfully, most people have rich experiences of pleasure, but these feelings can be missing in people with schizophrenia.

In the same way that there are positive and negative symptoms associated with particular disorders, I think we also understand our identities through both things we Do and things we Don’t Do compared to the average experience. I’ve been thinking a lot about this in the context of being Jewish at Christmastime.

In my experience of Judaism, there are definitely things we do:

  • Eat bagels (with cream cheese and lox!)
  • Fast on Yom Kippur
  • Hold Seders on Passover
  • Light candles on Chanukah
  • Ask lots of questions
  • Gesticulate

And many things we don’t do:

  • Eat milk and meat together
  • Eat shellfish or pig products
  • Eat leavened foods on Passover
  • Work on the Sabbath
  • Believe in Hell

There’s a lot of food-related stuff.

In my immediate family, there was one critical addition to the “Don’t Do” list: celebrate Christmas.

We did not have a tree. We did not have lights. We didn’t sing Christmas carols. Obviously, we didn’t go to church. We didn’t watch Christmas movies (with the critical exception of Die Hard, which, yes, is a Christmas movie, fight me). We didn’t have stockings or ornaments. No eggnog, or Christmas cookies. (I did taste eggnog for the first time last year, and I finally get it. It’s delicious. And mixes oh-so-well with bourbon.)

There were absolutely things we did do on Christmas. As the stereotype goes, we went to the movies where we saw many people we knew from our local synagogue. We also ate Chinese food. These were our own Christmas traditions and absolutely left me feeling like a part of my own special community.

There were challenges though. In high school, I sang in a select choir that went caroling. It was by no means mandatory, but most of my friends would bundle up and go to the local shopping plaza to sing and make merry in the few days prior to Christmas. I couldn’t imagine purposefully missing an opportunity to make music and have fun with my friends, so I went. But there was a discomfort that tugged at me. This was something that We Didn’t Do. And if I define myself by not doing that thing – not being part of the community that carols – then what does it mean if I go right ahead and sing along?

That wasn’t the first time I was presented with a challenging choice around Christmas music. In my public elementary school, we sang songs about Jesus in music class around the holidays. As a born participator, I decided that I would sing the songs only up until the lines that seemed religious. During those moments I stood silently, feeling out of place while my classmates sang with gusto around me, not knowing if the line I was walking was the right one.

Later on, the studio where I took dance classes took part in a Christmas parade. As before, I couldn’t imagine missing out and I happily danced the parade route to Mariah belting “All I Want for Christmas is You.” That one didn’t bother me so much. And I appreciate my parents letting me find my way – they certainly didn’t tell me I couldn’t dance in a Christmas parade. I guess this wasn’t something We Didn’t Do, but it wasn’t exactly something We Did Do either.

Now I’m older, and engaged to a non-Jew. My blond-haired, hazel-eyed sweetheart of Swedish descent, who formerly self-identified as a “Jesus freak.” Though he’s no longer particularly religious, he grew up very connected to the Protestant Christian faith and his family has many lovely Christmas traditions that they continue to keep.

As we work to weave together our two lives and traditions, he has lovingly embraced my areligious Judaism. He lights Chanukah candles with me, has fasted on Yom Kippur, and enthusiastically supports my quest to host Passover Seders in our small apartment. He loves the questioning nature of the Jewish faith, and the outward emotionality and warmth of many Jewish people. He has managed to embrace a set of traditions, an ethnicity, an identity that isn’t his without feeling like he has lost or diluted himself. It is a shining example of being a partner.

For some reason, it feels harder on my end. This is the second Christmas I have celebrated with his family. They are such wonderful people and have welcomed me so warmly. I feel unendingly lucky to be marrying into this loving, generous, and kind family.

But.

(There’s always a but, isn’t there.)

Christmas feels uncomfortable.

We gather in a house with a beautiful wreath on the door and single candles alight in each window. Late on Christmas Eve, we pile the presents under the tree, and set up the nativity scene on the mantle. Christmas morning we grab a cup of coffee and unwrap fabulous gifts. And only after the whole room seems fully blanketed in an array of colorful paper and ribbons, do we clean ourselves up for Christmas dinner with family friends.

None of this is particularly religious. I’d even go so far as to say it’s quite fun! But a small voice within me continues incessantly: this Isn’t Something We Do.

What do I do with that voice? That itchy feeling?

And why is it so easy for my fiancé to bring new traditions into his ken, and so much harder for me.

I know there’s an easy and obvious answer, but it isn’t really an answer at all. When he celebrates Chanukah or Yom Kippur or Passover with me, he is not at risk of being unwittingly assimilated into a dominant Jewish culture. There is literally no chance that if he’s not careful, there won’t be anyone who continues to celebrate Christmas or carry on the Christian tradition. After all, the American tradition is, by and large, a Christian one.

It’s not the same for me. My family made it through the Holocaust by the skin of their teeth. In my particular branch of the family, there are four grandchildren. That’s it. Two boys, and two girls. If things go traditionally, that means only the boys are carrying on the family name, and it is all on their shoulders to keep that alive. What a terrible and strange burden. We survived all of that only to… just kind of get swallowed up by American life?

And if part of how we define ourselves as Jews is by the things We Don’t Do, then will my children really be Jewish if they do those things? Is that the first step on a gradual slide into losing our Jewish identity?

And whether or not that’s true, do these questions fundamentally insult the many people out there (family members of mine and otherwise) who consider themselves meaningfully half-Jewish? As if their connection to the religion and tradition does not pass some purity test because they also observe some Christian traditions?

I’m really not sure where this leaves me. At the moment, I’ve been treating it all like a mosquito bite: the best remedy is not to scratch it and let it be, and trust that my body will eventually take care of itself. If I just let myself participate in these traditions, then maybe over time I’ll learn that I have not lost any of myself at all. In fact, I’ve gained a beautiful connection to my new family’s traditions. That would be a holiday movie-worthy ending.

But for right now, I don’t have that certainty. I’m just doing my best not to scratch and trusting in the knowledge that my fiancé and I can figure it all out together.

Adventures in Puberty

Mom felt woefully unprepared for her own puberty. When she found blood in her underwear, she thought she was dying. Her mother, my Nana, had said nothing to her about the changes she could expect as she matured into womanhood. Determined not to make the same mistake, Mom was on a mission to provide me with the necessary information. She may have overcompensated.

Mom sat my brothers and me down to tell us the facts of life…at the same time. I assume this explanation was prompted by questions from my oldest brother. The problem was that I was four and a half years younger than him. I think I was five at the time. I wasn’t ready for the birds and the bees yet, at least not at the level that my almost ten-year-old brother needed. I was confused by the information and what I did understand sounded disgusting. Mom meant well, but it was a perplexing start to my girlhood.

Over those early years, I was all too aware of my mother’s menstrual problems. Mom and Dad referred to it as being ‘unwell.’ Dad would say to me, “Mom is unwell, you need to let her rest and…..” fill in the blank with a household chore or errand. As a result, I learned to prepare roast chicken and other meals as a youngster. Mom could be debilitated by heavy bleeding. She had several medical procedures to address it, culminating in a total hysterectomy when she was 42 (I was 16 at the time). She refers to that surgery as the happiest day of her life, exaggerating only a little. I now understand she had fibroids and endometriosis. As a young girl observing this, and for lots of other reasons, I wished I was a boy. But that was not to be – the inexorable maturation process did its thing. And, not only that, it did it on a much earlier timetable than my peers.

I asked Mom about getting a bra at the end of third grade. She seemed taken aback. I don’t think she noticed what seemed obvious to me and was making me very self-conscious. She took me to a store in our local shopping center and I was fitted for a bra. At the beginning of fourth grade, at the age of nine, I was beyond a training bra!

Since I was already afflicted with self-consciousness, being fully developed by fifth grade didn’t help. Even in seventh grade many of my classmates still looked like young girls. I would have given anything to have a flat chest! And, like my mother, I had menstrual problems. My period was very irregular and when I got it, after missing it for several months, it was terrible. It would last for two weeks, with cramps, and I bled profusely. I didn’t feel like I could talk to Mom about it, immersed as she was in her grief since Nana had only recently died.

It was 1972 and they didn’t have the feminine products available today – sanitary napkins were bulky and didn’t come with a wrapper in which to dispose of it (you had to wrap it in toilet paper). The girls’ bathrooms in school didn’t have waste receptacles in the stalls either, just a garbage pail by the sinks. All of which meant that it was nearly impossible to be discreet about having my period. I needed to carry a purse (something I didn’t ordinarily do), and I would have to take that purse with me to the bathroom. Even on an ordinary day, the idea of using the bathroom was an anathema to me, I tried to avoid it. I didn’t want anyone to know about my bodily functions. I don’t know why I felt ashamed, but I did. I thought other girls, if they even got their period, didn’t have these issues, and I didn’t have the nerve to broach the subject with anyone. So, I muddled my way through, hoping not to embarrass myself by staining my clothes (which sadly did happen on more than one occasion).

Eventually, I had an episode of cramps that were so bad, I had to tell my mom. She made an appointment for me to see her gynecologist. Dr. Holland asked a series of questions before examining me. Mom was not in the room. He asked if I had had intercourse. Surprised by the question, I answered no; thinking to myself I’m 13! It made me wonder if girls my age were having sex.  Apparently, some did, or he wouldn’t have asked the question! Then he asked if I was sexually active. I didn’t understand the difference between the first and second question. I almost asked him to explain but was too embarrassed. I just said no, again.  A nurse stayed in the room for the physical exam, which was weird and uncomfortable but not traumatic. Fortunately, he found nothing wrong. He made some suggestions to treat the cramps if they were painful in the future and that was that.

Not everything was bleak during my junior high school years.  In 9th grade I connected with a few girls. We made a plan to leave school for lunch, a daring idea. Gerri and Lisa came up with the notion of sneaking out – everyone was supposed to eat in the cafeteria (maybe they were afraid we wouldn’t come back!). We decided we would go to Lisa’s house, where no one was home, since it was only a couple of blocks away. We would make sure to get back in time for our next class.

The big day arrived, and we successfully escaped. We were feeling triumphant as we hurried to Lisa’s house. We were walking down Avenue K when we heard a car horn and some hooting and hollering. We all turned to look. At first, I didn’t know what I was seeing. Then I realized it was flesh pressed up against the rear window. They were butt cheeks! We shrieked and ran. We were afraid the car would follow us. We got to Lisa’s house –  laughing and terrified at the same time. One of the girls knew that it was called being ‘mooned.’ I had never heard of that. Some kids may have been exhilarated by the adventure, but I took it as a sign that we shouldn’t have snuck out. I didn’t leave school for lunch for the remainder of the year.

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Nana and me. At the beginning of my journey to womanhood, maybe a year before Nana died.

Another Day, Another Controversy

Last week the New York Times headline read: Trump Targets Anti-Semitism and Israeli Boycotts on College Campuses. It caused quite a stir in the Jewish community.

The first paragraph reported that the President planned to sign an Executive Order that would permit the federal government to withhold funding to colleges that fail to combat discrimination. That didn’t sound like a bad thing, but then I read the second paragraph (I added the bold):

“The order will effectively interpret Judaism as a race or nationality, not just a religion, to prompt a federal law penalizing colleges and universities deemed to be shirking their responsibility to foster an open climate for minority students. In recent years, the Boycott, Divestment and Sanctions — or B.D.S. — movement against Israel has roiled some campuses, leaving some Jewish students feeling unwelcome or attacked.”

Reading that the Executive Order would define Judaism as a nation and/or race made the hair on my neck stand up. As I surfed the Internet looking at reaction to this, I found a number of comments picking up on Judaism as nationality as problematic. I was more disturbed by the use of the term race.  That idea, of Jews as a separate race, struck terror in my heart. After all, that was one of the essential pieces of Hitler’s plan to exterminate us. Identifying us as a race, as ‘the other,’ as subhuman, made the Holocaust possible. I came to understand this when I took a class in college called The Making of Modern Germany. That class was the single most important one I have ever taken.

Professor George Stein taught every Tuesday and Thursday for ninety minutes during the fall semester of my sophomore year at SUNY-Binghamton. He stood at the podium, wearing a dark suit and tie, his black hair meticulously combed, and lectured to us. It might sound boring, but it was anything but. It was a history class, but he drew from music, art, folklore, science and philosophy to tell the story of a nation. In the telling he gave context and insight into bigger themes – What is a nation? What is modernity? It was fascinating. It wasn’t interactive. Professor Stein may have left a bit of time for questions, but essentially it was entirely lecture and I wouldn’t have had it any other way. You could hear a pin drop in the hall. I took notes furiously; I wanted to commit to memory all he was offering because it was so compelling and comprehensive. I never considered skipping class. I wish I could take it again. I held on to some of my notebooks from college and graduate school. Unfortunately, I have not been able to find that one. Over the years I have wanted to refresh my memory any number of times.

My mind went to that class when I read about the Executive Order. I remember clearly Professor Stein explaining the importance of Hitler’s manipulation of antisemitism. It was already entrenched in Eastern Europe based on the belief that the Jews killed Christ and the widely circulated lie that Jews used the blood of Christian children as part of the Passover ritual. Professor Stein traced how those seeds were exploited to take hatred to the next level. Judaism became more than a religion – Jews became a race with unique characteristics (a whole science was devoted to elucidating the differences). This was a critical step in building the case for genocide.

This is why reading that Trump was urging the United States government to begin defining Judaism as a race was alarming and terrifying, even as it was being offered to ostensibly combat harassment of Jews on college campuses. I could easily imagine it being turned on its head, as so many things are these days, for nefarious purposes.

When I saw that the Anti-Defamation League supported the Executive Order, I thought there’s no way they would if it was as explained in the New York Times article. I read as much as I could on the Internet. That first day I found a lot written about the Executive Order, but not the order itself – which was frustrating.

As I was reading, I was thinking, wasn’t antisemitism already covered by our nation’s laws? Why was this necessary? I went back to look at the Civil Rights Act and found that Title VI, which covers any entity that receives federal funds, prohibits discrimination based on race, color or national origin. Title VII of the same act prohibits employment discrimination on the basis of sex, race, national origin or religion. Obviously the two lists are not the same.

Why aren’t they the same? I didn’t do deep research into this, but since educational institutions are permitted to be connected to a religion (e.g., Jesuit colleges, parochial schools) or same sex and still receive federal funds, I think they couldn’t include those categories in Title VI. Whether we should provide public funds to institutions affiliated with a religious denomination is a discussion for another day.

In my work with NYSSBA, though, I knew that this issue of schools addressing antisemitism has been litigated many times. So, the question remained, under what authority, could schools (colleges or public schools) act against antisemitism? The Civil Rights Act is enforced largely through the Department of Justice and the Department of Education. Those agencies are responsible for interpreting the law and have offices within them that receive complaints of discrimination and/or harassment (harassment can be a form of discrimination). Over the years, dating back to the Bush II administration, they issued guidance documents (the DOE calls them ‘Dear Colleague’ letters) which interpreted Title VI as covering religion. In the aftermath of September 11th, when Muslim students were especially vulnerable, the government explained that when students were targeted for being perceived as a different race the school district had an obligation to protect those being harassed. So, using the same logic, Jewish students and Sikh students (or any student whose religious practice or nation of origin may make them appear to be of a different race) are covered by Title VI.

Then the question becomes, what does this Executive Order offer that is different? After looking into this, I have no answer.  I came to the conclusion that it remains to be seen whether this is a positive thing, or a dangerous step, or not really a change at all (and just political pandering) – as with many things, it depends on how it is interpreted and implemented.

[By the way, it is worth noting that states also have laws that offer protections, too. New York State’s anti-discrimination laws are much more expansive than federal law and includes LGBT and disabled citizens, among others.]

The Executive Order was finally posted by the White House the next day – needless to say, I read it. I will point out that the Executive Order, and the source document it is based upon (a definition of antisemitism adopted by the International Holocaust Recognition Alliance) does not say that Judaism is a race or a nation. It also does not say that being anti-Israel is equivalent to being anti-Semitic, despite what Jared Kushner opines; though that is where the waters get muddy. The IHRA document specifically says “….criticism of Israel similar to that leveled against any other country cannot be regarded as anti-Semitic.”

As we know, on college campuses Israel gets a lot of criticism. Where it crosses over into antisemitism is complicated and often in the eye of the beholder. Can a person be anti-Zionist and not be anti-Semitic? If anti-Zionism means you oppose the existence of the State of Israel, it is hard not to get a whiff or more of antisemitism (other than Jews who believe that God – the messiah – is the only one that can create a Jewish homeland).

The founding of the State of Israel was, in my opinion, as legitimate as any nation. After the Holocaust, it was clear that Jews needed a homeland. As a result, the U.N. defined and authorized its creation. Every country I can think of has disputed boundaries and conquests in its history that contributed to their current configuration. The United States, Russia, China, Great Britain all come to mind. I’m not aware of any country that wasn’t built on the blood of a people in some way or another. Israel is no different.

I have lots of criticisms of Israel and how it conducts itself, especially under Netanyahu. But to suggest that it deserves to be isolated in the same way as North Korea or Iran, or to question its right to exist, is a bridge way too far. Students should be able to study in Israel. Academic exchanges should be welcomed. Individuals can choose not to buy its products if they don’t like their policies, as I don’t shop Walmart. But, I am not seeking to have Walmart driven into the sea, or cutting it off from civilized society. I would like Walmart to change – to treat its employees fairly and to operate as a good corporate citizen. Maybe it isn’t a perfect analogy, but I think it makes the point.

If this Executive Order is used to stifle protest of Israel’s actions, then it will be a misuse of governmental authority. If it bolsters the federal government’s authority to investigate harassment of Jews, that would be a positive outcome given the frightening increase in anti-Semitic hate crimes. If it gives authorities more cover, and suggests more political will to confront it, then maybe it can be helpful.

In sum, my two takeaways from this are: (1) the New York Times did a poor job of reporting on this and contributed mightily to the controversy by mischaracterizing the Executive Order. Some might not be surprised at that, I am disappointed.

And, (2) as with all things with the Trump administration, we will have to be vigilant to make sure power isn’t abused or turned on its head.

Funny Jokes and Serious Matters

Note: This is a guest post by my husband, Gary Bakst, M.D. While I may question whether the jokes are funny (Gary didn’t write them!), I don’t question the seriousness of the subject he addresses. Thank you, Gary.

Jewish Humor – here are some jokes that have been around longer than I have:

  1. Why don’t Jews drink? It interferes with their suffering.
  2. My wife will buy anything that’s marked down. Yesterday she brought home two dresses and an escalator.
  3. A man can’t find a lawyer. He picks up the Yellow Pages and picks out a law firm-Schwartz, Schwartz, Schwartz and Schwartz. He calls up and says, “Is Mr. Schwartz there?  A guy says, “No, he’s out playing golf.” The man says, “All right, then let me speak to Mr. Schwartz.”  “He’s not with the firm anymore.”“Then let me talk to Mr. Schwartz.”  “He’s away in Detroit.  He won’t be back for a month.”“Ok, then let me talk to Mr. Schwartz.”  “Speaking.”
  4. I’d like to help you out. Which way did you come in?
  5. In New York’s Garment District, a little, old man is hit by a car. While he is waiting for an ambulance, a police officer tucks a blanket under his chin and asks him, “Are you comfortable?”  The man responds, “I make a living.”

It is that final joke that I am thinking about as I write this essay.  I grew up in a middle-class family and in a middle-class neighborhood. I remember when Linda and I struggled to make ends meet.  I realize that we are more comfortable today, but I still like to think that I am connected to the struggle of the average person/average family.  The reality is, every so often a patient says something that reminds me that I am not as connected as I’d like to believe.

They will tell me about the cost of an item – perhaps $10 – that is a big deal in their lives.  They are living on fixed incomes or small paychecks.  They have worked their whole lives but cannot afford things that I would take for granted.  While every expense is important, the one that we are most often speaking about is the cost of their medication.

This is a problem that has been mentioned often in the media.  But I don’t think that the real impact on so many people has been adequately discussed.  The stories I see in the news are about the most extraordinary examples.  They don’t convey the reality that I see people face numerous times every day.  The reality is, especially in the world of diabetes care, that we are in a time when there are great medications that can change people’s lives.  They can safely lower their glucose levels, protect their hearts and their kidneys, prolong their lives.

On the other hand, I have never seen a time in which so many people just couldn’t afford their medications.  It was not that long ago that medications were prescribed by doctors and filled at pharmacies and patients picked them up for no copay or small ($5-10) copays.  Now, the doctor writes the prescription and it goes to maybe a pharmacy, maybe a gigantic mail order facility.  The insurance company rejects the charge but doesn’t tell either the doctor or the patient why the med was rejected or what alternative would be covered.

Our staff spends enormous, frustrating hours, expensive hours, working on getting medications approved.  When a medication is approved – not necessarily the medication we had ordered but some theoretically similar drug – the patient is still left with frequently gigantic out of pocket expenses.

Some of this is related to the fact that medications are so much more expensive than they used to be.  The pharmaceutical industry is entitled to make their profits and needs substantial income in order to invest in the next generation of medications.  But too much of that profit comes from the US (as compared to overseas markets) and it seems like the average American is carrying a financial burden that is breaking their back.

On top of this, the insurance companies routinely reject claims, use intentionally opaque methods to keep us and our patients in the dark about what they need in order to approve those claims and even when they cover the medications, they leave too much of the charge on the shoulders of the patient.

Insurance companies typically use ever increasing premiums to herd patients into high deductible plans.  This means that you pay your premiums, but the insurance company may never spend anything on your care.  The situation is similar for those who receive their insurance through the Affordable Care Act (Obamacare).  While it is great that there is insurance that people can access, the insurance is often expensive and comes with high deductibles.  And, for those who get their insurance through Medicare, the development of prescription drug coverage (during the George W. Bush administration) is a great step forward but the coverage comes with that so called “donut hole” which means that you have to pay thousands of dollars out of pocket and then you can get back to where the coverage helps you out.

In the end, we are at a time of crisis in health care affordability and especially medication affordability.  Recognizing that I have no expertise in this topic beyond what I see every day in my office, I would make several suggestions that I do not hear from our politicians of either party.

  1. I would end the policy of not allowing Medicare to negotiate with pharmaceutical companies regarding the price of medications. Medicare needs that tool.
  2. Congress needs to pass a law limiting how much more any medication can cost in the US as opposed to the rest of the developed world. Perhaps up to 20% more but not the 300% more that we often see.
  3. I would outlaw deductibles over $1000
  4. I would limit how terrible any insurance policy can be and still be legal to sell in the US. If you are marketing your policy as insurance, it has to be helpful to people when they get sick or injured.
  5. I would require insurance policies to offer adequate reimbursements to hospitals such that they can hire enough nurses to truly take care of patients. Patient to nurse ratios are becoming dangerous and patients will be harmed.
  6. I would increase reimbursement to doctors and other health care providers for primary care services. This would continue the trend of reduced reimbursement for procedures and presumably make more doctors consider careers in primary care – not enough doctors are going into primary care.
  7. I would require insurance companies to make public how much money they spend on items other than patient care and to make public their procedures for approval of tests such as PET scans and for medications and expensive treatments. It is time to remove the curtain and give doctors and patients a fighting chance to get patients the care they deserve.
  8. Medicare is more efficient in translating money into care and I would require private insurance companies to make strides towards that benchmark in order to operate in the US.

There it is. That is my little manifesto.  The rantings of a comfortable doctor on behalf of his uncomfortable patients.  Now one last Jewish joke:  A Jewish grandfather takes his grandson to the beach when, suddenly, a gigantic wave sweeps the boy away.  Panicked, the grandfather looks up and prays to God, “Oh God, please bring him back.  Let him live.”  Just then, an even larger wave deposits the boy back on the beach unharmed.  The grandfather looks up and says, “He had a hat.”