Category: Guest Post

A Reckoning

NOTE: Today’s blog post is written by Gary, my husband. He was reflecting on the fact that we have, depending on the data source, reached or exceeded 200,000 American deaths from Covid-19. Gary and I feel that we have become numb to the loss; maybe complacent is a better term. He wrote this as part of a letter to our children. I asked if he would allow me to share it on the blog. Obviously, he said yes.

            One other thing you need to know. In our family since Trump was elected, we have referred to him as the CF. CF stands for character flaw. We were naming his flaws, dishonest, misogynist, selfish, ignorant, when our daughter Leah noted that there were too many to count and that in fact, he was just a giant Character Flaw, hence he is the CF which is how Gary refers to him the letter that follows.

            Today is the final day of summer with fall well entrenched in the air and the days rapidly shortening.  Fall officially begins tomorrow morning.  It is a time for introspection for us as Jews with the high holidays underway and the annual fast less than a week away.  It is a time of bounty with harvests, apple picking and pumpkin picking and a time when leaves begin to change color leading to what will be the prettiest time of the year.  

            At the same time, it is a time when summer plants wither and die, flowers fade, and soon, frost covers the morning landscape.  You can smell the change in the air.  That warm, soft smell of summer is giving way to the smell of leaves and the mornings start to become foggy with the sun slower to burn off the haze.  So, while it is a time of beauty and bounty, it is also a time of loss and withering. 

            This year, of course, it is a time to mourn in very specific ways.  For so many people, it is a time to mourn the loss of certainty with jobs lost, incomes lost; with lives upended, people suddenly stuck at home.  People are working from home more than ever before; people are stuck home without daycare available to them and schools are still struggling, even with the school year already underway, to find ways to deal with COVID and still provide for the needs of their students, their teachers and other staff and the families that depend on them. 

            Everything is upended.  Things we have taken for granted are no longer true.  Going out to eat, going to a movie, going to a ballgame, a museum, a concert are all either no longer possible or are so very fraught.  

            There are different counts of how many Americans have died of COVID but it appears to me that we have, in fact, reached another tragic milestone:  200,000 dead Americans.  As brutal and horrible as this reality is, as many people have died, have lost loved ones, often dying alone in ICUs with family unable to be with them, the fact that it did not have to be this way makes it so much more tragic. 

            The CF has been accused of mismanaging the pandemic, but that accusation wildly understates what he has done and how serious the crimes he has committed are.  People make mistakes but they are not all created equal.  If a doctor makes a mistake, someone could be harmed, someone could die.  If an air traffic controller makes a mistake, many people may die. 

If a president makes a mistake – let’s say President Obama failing to block a resolution unfairly condemning Israel, there can be repercussions on an international level.  The Palestinians, in that case, became yet more emboldened in their rejectionist policies.  But that was, relatively speaking, a minor mistake.  A much larger mistake was President George W Bush invading Iraq.  It broke that country apart, opened a Pandora’s Box of Sunni and Shiite militant groups, bolstered the Iranian regime and paved the way for the creation of ISIS.  It cost many, many lives in the region, cost thousands of American soldiers’ lives and cost us enormous sums of money.  It also harmed Israel by permitting Iran to send advanced weapons to Hezbollah (and more recently also to other militant Shiite groups) over land through Iraq and Syria. 

That was a gigantic mistake.  It has repercussions that have continued to harm us and will continue to harm us for some time.  But it was still a mistake.  (Not a mistake by Cheney – intentional on his part and on the part of others.  But, I believe, a mistake on W’s part). 

            The CF, however, did not make a mistake.  He thought that his intentional sabotage of our efforts to confront the coronavirus pandemic would bolster him politically.  It has not worked out that way – that was a mistake.  But he absolutely, positively intentionally lied to us about the pandemic and he has blood on his hands.  I cannot tell you how many people have died because of the CF’s lies, but I am absolutely certain that he lied and that deaths resulted.  We know that from innumerable reports over these months.  We know that from the audio tapes recorded by Bob Woodward. 

            And we know it from the words of the CF himself.  He admitted that he lied.  He lied while admitting it – when he tried to sell us on the excuse that he did it to avoid fear among the American people.  Nonetheless, he lied to us.  And, because he lied to us, and because he also presided over an administration that left its job, the job of organizing our response to the virus, of generating strategies for confronting it, to the states, lots more Americans died.  Lots of Americans became sick, many suffering a devastating illness, many suffering a very long term illness, many never regaining all of what they lost.  Many lost loved ones.  Many will never be whole again. 

            Think about it for a minute.  Someone in that position, someone who has chosen to take a position that has enormous responsibilities, that places the health, safety, even the lives of the American people in his hands.  He has actively campaigned for the position, been in that position and had years to familiarize himself with the responsibilities inherent in it.  He has been given a huge challenge to save Americans’ lives.  That challenge is his duty – his sacred duty – as the person given all of the titles and powers and resources that come with the job he chose to take.  

            And he intentionally chose to let Americans die instead.  He said things – it’s a hoax, the media and the Democrats are hyping it, it’s no worse than the flu, it will soon disappear, it will magically disappear, the best thing you can do if you have a mild case is to go to work with it.  He’s said things – open up the economy, open up the schools, open up sporting events, open up anything and everything, open them up quickly and regardless of the consequences.  

Think about this for a moment, during the entire time that we have been confronting this horrific, deadly plague, he never once – never – took the position of waiting.  He never said that those people in that meat packing plant should not be there until they figure out how to safely operate it.  He never said that eating in a restaurant in a state with incredibly high virus prevalence might be dangerous.  Not even once. 

            The intent is as horrific as the crime itself; it is unforgivable.  It is something people should be learning about for generations to come, forever.  When we learn about American history and we think of people who have been traitors to our country, we should not first think about Benedict Arnold whose name itself has come to be synonymous with such treachery.  In the future, that distinction should belong to the CF.  (“He took money to provide classified information to the Russians.  He’s a CF.”  “She hacked into the computers of our electrical grid and demanded ransom payments in order to not plunge millions of Americans into darkness during a heat wave.  She’s a CF.”)

            200,000 Americans and counting.  It is sad, tragic, horrific.  It is worse than that because it is also treachery.  And it is a disaster that is far from over. 

            Another tragedy, of course, is the passing of the magnificent and beloved Ruth Bader Ginsburg whose life is exactly the opposite of his.  She did not come from wealth.  She faced obstacles that she ought not have had to face because of her gender, because she was a mother.  Nobody took her entrance exams for her.  Nobody used their money and influence to help her get into the places she got into.  And, once there, she was consistent, moral, ethical and used her passion, abilities and energies to help others.  She was a good and loyal friend to many and demanded more of herself than of others. 

            And she should also be remembered forever.  She should be remembered as a hero, a role model and an inspiration to us all.  Women, in particular, will find inspiration from her good works and, as Jewish people, we can allow ourselves just a bit of nachas that it was one of our own who did all of this. 

            Her story is one that we can all think of when we wonder what it is that we can do to make the world a better place.  For crying out loud, she was 5’ 1”  and probably never even weighed 100 pounds.  So much greatness in such a little package.  She could fit in aunt Rochelle’s clothing. (Editor’s note: Gary’s sister is also a petite person as anyone who knows her can attest – also, not a person to be underestimated.)

            While the political part of what is going on now is very concerning, and while it may take a while to know what the outcome of it will be, the greatness that she embodied is something we will hold onto and let us allow some of that light to shine on us.  

NOTE: I wanted to share this because I think we need to look at the totality of what Trump has done through this pandemic. It can’t be emphasized enough. We need to look for the light in the midst of the darkness, and RBG’s legacy can offer that, but we need to reckon with his actions and that many have been complicit in it. We can disagree about what would have been the best strategy to fight the virus, but his lies cannot be forgiven.

A Seminal Event

Note: My mother has continued to write stories of her youth. This one was shared previously on my brother’s Facebook page. I wanted to share it, too, since it is such an important part of our family story.  In fact, I had written about it before here. After my Mom’s essay, there is a postscript with some facts and figures about the storm and then a portion of my previous post. My Mom’s description adds details to my understanding of how that momentous, traumatic experience, the New England Hurricane of 1938, felt to her and the lesson she took from it. 

Change by Feige Brody

There is always change, whether it is the change of seasons, change of jobs or change of homes. The first momentous change in my life, which I can recall, was in September 1938 when I was not yet 5 years old. We lived on the second floor of a two- story building in New London, CT. I was playing outside when a black cloud covered the sun and changed my day to night.

When the winds and rain began no one knew that it would be unlike any other storm, but would be the most powerful and destructive hurricane in New England’s recorded history. As my mother called me up the stairs, I recall her attempting to remove things from the clothesline when it snapped, and all the white sheets went flapping into the black sky.
Mother and I hurried inside where my two -year old baby sister, Simma, was crying in her crib. Mother closed all the windows and I played with Simma singing “Rain Rain go away.” Suddenly a burst of wind shattered our windows. Glass and rain poured into our apartment. Mother plopped us onto the center of my parents’ bed. She had to keep us off the floor while she attempted to clean the debris.
To our immense relief our soaking father soon arrived and the first thing he said was “Christopher Columbus saved my life.”
Dad then proceeded to tell us that he had been delivering breads and cakes when the storm intensified. His car was stuck in a flooded street and the car started to fill with water so he scrambled out. Holding onto the walls of the buildings he started making his way home. A gust of wind however sent him air borne and blew him into the statute of Christopher Columbus which was right in the middle of the road. Dad held on for dear life; eventually, he and Christopher Columbus parted, and Dad resumed his precarious journey back to us.
Our apartment was illuminated only by the outside flames of a burning New London. We could hear fire engines and sirens. The water in our apartment began to rise; Mother knew we were going to have to abandon our home and she started packing diapers and a few other items.
Fortunately, a coast guard boat soon arrived, in what used to be our back yard, and we climbed through the broken window in the kitchen and into the boat. I remember putting my hand in the swirling water and splashing. It was fun and exciting for an almost five- year old girl. But the fun subsided soon. When we were deposited on relatively dry land there was utter darkness. Electric wires were whipping in the wind and we were drenched and walking on wet ground. I had to jump to avoid the live wires which were sparkling and sizzling all around us. I was frightened for the first time. No one was able to hold my hand because Mom was carrying Simma and Dad was carrying our few belongings.
I learned that life could turn around in a second. We lost everything in that hurricane. Our life was changed in every way.
My father, a voracious reader, quoted Voltaire, and told me “All is for the best in the best of all possible worlds.” 80 plus years later, I do not believe “all is for the best,” but, I do believe that this is the best and only world we have, so we should make the best of it. And this has been my philosophy of life through changes in jobs, changes in homes, and changes in the seasons of our lives.

Post Script: Some facts pertaining to the hurricane on the 21st of September 1938:
1. There was no warning system- in 1938 forecasting in US lagged behind Europe
2. No insurance
3. This was prior to the naming of hurricanes
4. 682 people died
5. In 1938 dollars: 306 million in losses (which is 4.7 billion dollars in 2017)
6. It was a Category 5 Hurricane with wind 160 mph
7. 2 billion trees destroyed
8. 20,000 electrical poles toppled
9. 26,000 automobiles destroyed
10. Damaged or destroyed 570 homes including mine

Here is a link to footage from the National Weather Service that shows the fury and aftermath of that epic storm: link

——————————————————————————————————————————

This is an excerpt from the blog post I wrote, which is a profile of mom’s Dad, who I called Zada. He was the essence of resilience.

An essential part of family lore involved the hurricane of 1938. Nana and Zada, as well as my mother and her sister (almost five and two years old respectively), were living in New London, Connecticut. Zada was working at his father’s bakery when a fierce hurricane of historic proportion came ashore without warning. Nana and the two girls had to be rescued by a Coast Guard boat that plucked them from their second floor apartment, saving them from the floodwaters that had already engulfed the first floor.

Zada, 34 years old at the time, left work and tried to make his way home during the storm. The wind was whipping at over 100 miles per hour and the rain was relentless. The Thames River had overflowed with a record tidal surge (a record that stands to this day) and was streaming through the streets. Zada clung to a statue of Christopher Columbus to avoid being swept away. Zada maintained that the statue saved his life.

Eventually he was reunited with his family, but they had lost everything to the storm. The bakery was destroyed, as was their home.

newlondonct_nydailynews
A view of the destruction in New London (NY Daily News)

There were a number of family legacies of that historic storm. Zada started celebrating his birthday along with Christopher Columbus on October 12th . As a child I thought it was his actual birthday. Since Zada came to this country from Russia as a baby, his birth records were in dispute. While Christopher Columbus may be in disgrace today, we are still grateful for the monument to him in New London. In fact over the years I have gone to visit it several times.

IMG_3151
Me paying homage in 2011

On the Avenue

Note: My mom has been trying her hand at writing, too. During this shut down, where she has been almost entirely confined to her one-bedroom apartment, she has been reflecting on her life. She wrote this piece and I thought I would share it. I think it gives some insight into her and some lessons she taught me. Plus, I think it is great that she is putting pen to paper (and in her case it is with pen and paper) and I want to encourage her to continue.

I’ve often heard women complain that their husbands were busy playing cards while they were left alone. I didn’t mind.

This is what I did.  I walked the Avenue, Fifth Avenue.

On Thursdays my husband, Barry, and his friends would get together after work, have dinner and then play cards.  They always played at our house because it was a central meeting spot.

In the meanwhile, I would finish my workday at school in Brooklyn and take the subway to the city.  There is only one city, Manhattan.

I would walk up the avenue, but not like Fred Astaire and Judy Garland (Easter Parade, 1948), more like Bill Cunningham (NY Times Photographer).  I‘d go to the corner of 5th Avenue and 57th Street to watch the world go by.   The languages I heard, the clothing I observed and the ages of those walking the Avenue were as varied as the cultures they represented.

Since the hour and day was not conducive to seeing a Broadway matinee, I varied my excursions.  Sometimes I would go to St. Patrick’s Cathedral. The outside was surrounded by the ever-present sounds of construction and general din of the City, but inside was quiet with magnificent stained glass windows.

Most fun would be visiting the luxurious bathrooms of the very expensive department stores such as Saks 5th Avenue.  The restrooms were decorated with silk or satin wall coverings and gold-plated faucets. I got a kick out of my brief moment of feeling rich and pampered.

Other excursions would be to the jewelry stores, Cartiers and of course the crown jewel, Tiffany’s.  Tiffany’s had a special room where they displayed replicas of the trophies made for championship teams and marvelous tiaras and necklaces commissioned by famous people.  The real jewelry would be in locked cases.   Obviously, I never bought anything; but it didn’t hurt to look.

Other times I would go browse in Barnes & Noble – no coffee bar then—and also the Hallmark store which had all kinds of knick-knacks in addition to the wide array of cards and wrapping paper.  I strolled past the other famous shops as well.

Getting into the City always excited me, with its energy and hustle bustle.

I would head home, plug in the coffee pot and bring out either the brownies or pie that I had made the night before for Barry and his fellow poker players.  After the refreshments the guys would head home. We all had work the next day.

 

My take: Mom loved the City and she passed that on to me. While I have not ventured into the fancy stores on Fifth Avenue, or tried their restrooms, I have people-watched along that iconic avenue and I have spent hours in its bookstores and that same Hallmark shop.

I also learned that husbands and wives don’t need to be joined at the hip. Mom and Dad had unique interests and that was a good thing – they gave each other space to pursue them. This was a valuable thing to understand and was an important building block for my own marriage.

I well-remember poker nights because the smell of the cigars wafted up from the basement. I was sometimes asked to help clean up the next day and the air was still hazy from the lingering smoke. My dad didn’t partake, but his friends sure did. I always hoped there was leftover brownie as a reward for my efforts.

Also, Mom loved coffee – I believe she must have built an extraordinary tolerance to caffeine because she consumed potfuls (of regular!) in the course of the day when I was growing up. At some point it did catch up with her so that now she has to limit her intake, but she still loves her two cups in the morning, black (no sugar, no milk).

C97379F4-9930-4C8F-8A6D-450AD136416D_1_201_a
Mom – not with coffee since it was the afternoon. Diet ginger ale will have to do 🙂

Thanks, Mom, for sharing.

A Meditation on Christmas

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

613B8133-5789-4BD1-B8D4-0F076EAE42D3

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.

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.”

Laura Bakst: A Granddaughter’s Journey

Note: One of the greatest sources of pride and joy for Paula and David are their four grandchildren, each accomplished in their own right. Laura, third oldest and the daughter of Gary’s brother, was kind enough to contribute this piece. 

Nearly five years ago, I made my way across rural Germany to visit my great-grandfather’s grave. While the trip itself took only a few days the process started months earlier in New York, when my Poppy (grandfather) presented me with a disintegrating photograph of his father’s tombstone and the knowledge that it was located in a Jewish cemetery near Kassel, Germany.  I could tell that at the age of ninety Poppy was still haunted by not knowing what came of the grave that he last saw over sixty years ago. I also knew that given my upcoming travels to Israel and Europe it was likely the only opportunity I’d have to locate the grave in the near future, and possibly in his lifetime.

Over the next few months I sifted through archives, including multiple visits to Yad Vashem (Israel’s holocaust museum), attempting to find records on my great-grandfather.  Eventually I stumbled upon a German database of abandoned Jewish cemeteries. With the aid of Google Translate, I managed to obtain location information for a gravestone that appeared identical to the one in my grandfather’s photograph. It was in a cemetery in Hofgeismar, a small town in Northern Germany.

Fortunately, it was relatively easy to tack on a detour to Hofgeismar between trips with friends to Berlin and Amsterdam. Nevertheless, I was still nervous to be traveling across Germany on my own; I was the first in my family to return to the country since WWII, did not speak the language, and was traveling in areas not frequented by tourists. Fortunately, the kindness of others made the process a bit easier: I had made a few German friends while I was studying in Dublin who helped me book trains. Julia, a woman who volunteered at the Jewish Museum in Hofgeismar, was generous enough to not only respond to my cold-email inquiring about the cemetery, but also coordinate my entire itinerary for the day in Hofgeismar (unfortunately I was not able to meet her in person as she was traveling for a conference in Israel at the time).

Around 6:45am on a brisk October morning, I left my friends in Berlin and anxiously entered a metro station. True to Germany’s reputation, the four separate trains I took were impressively prompt. After making it to Hofgeismar, I met Mr. Burmeister, the Jewish Museum’s director, who drove me to the cemetery.

fullsizeoutput_794

I didn’t really know what to expect, but I recall being surprised by the beauty of the place. Though obviously aged by the elements, the gravestone was completely intact, with the inscription still easily readable.

fullsizeoutput_795

The small cemetery was in a lovely location, overlooking gorgeous valleys and blanketed by colorful leaves.

fullsizeoutput_798

Following the Jewish tradition, I left several stones on behalf of my family on the gravestone. Across from my great-grandfather’s grave there was a small hill, below which a number of stones from the 1800s once stood. Unfortunately, they were destroyed during WWII (the cemetery houses Jews from after the war and pre-1936), so Mr. Burmeister showed me the memorial stone erected in their memory the prior year (2012).

Mr. Burmeister gave me a tour of the small but substantial Jewish museum, in which we had an interesting conversation about the Jewish history in Hofgeismar and his interest in the subject as a non-Jew. While there are no longer any Jews in Hofgeismar, before the War it was home to one of the highest percentages of Jews in Germany (10%).

iq8%AtghSM+mXOlhooBd2w

Julia’s friend, Gabriele also showed me around Hofgeismar. We walked down to where the community temple once stood, now destroyed. We also drove through where the displaced persons camp used to be, the same camp that my grandfather stayed in after my great-grandfather died from surgical complications. The grounds are now being used for a school and police station.  The town center was exactly as I’d have pictured it, with lovely sculptures and traditional German buildings.

fullsizeoutput_799.jpeg

Gabrielle pointed out some of the homes where Jews once lived, in front of which small metal squares note their names, dates of birth and death, and what occurred to them during the war. I remembered seeing similar stones in Berlin, and Julia explained that they are becoming more common as people are more open to uncovering that their homes may have been taken from Jews.

fullsizeoutput_79a

While the entire trip was extremely meaningful, what struck me the most was how seriously modern-Germany takes addressing its history. Unlike in America, it’s illegal to deny the Holocaust, display Nazi symbols, or otherwise incite hatred based on religion or ethnicity. All schools deeply educate students about the Holocaust, leaving my German peers more knowledgeable about it than me. People like Mr. Burmeister and Julia chose to dedicate their time to preserving the Jewish history in a small, now Jew-less town. Mr. Burmeister’s parents had no familial connection to Judaism, but rather his interest in the subject was peaked as a schoolboy studying German history. A teacher from a neighboring town told me how she believed it was important to expose her students to Jewish culture early on, bringing her class of 8-10 year olds to the Hofgeismar Jewish cemetery and Museum for a three-day workshop. Through tears she explained that she educates others about Nazism because her daughter has a disability and likely would have been killed had she been living during WWII.

Note: Laura is quite correct in saying that David was haunted by never having gone back to see his father’s grave. In going through the effort of locating and visiting the site, Laura did a mitzvah (good deed) that brought her grandfather comfort. Thank you, Laura, for doing that and for sharing this story on my blog.