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Tuesday, September 28, 2010

Journey Back-Poland 5 (Rzeszow and Tyczyn)

Town Square Rzeszow
We arrived in Rzeszow (don't even try and pronounce it) following an extremely long and emotional day (we dropped our guide at his family home.)  Navigating the old city center to find our hotel-even with a GPS and detailed Google maps-proved a major challenge.  In the end, we succeeded through the kind help of a police escort-our first sign that we were in a special place.  And special it was!
New Synagogue Rzeszow
Old Synagogue Rzeszow
Our hotel looked out over the spectacular, colorful square seen above and was crowded with enthusiastic locals enjoying a sun-drenched drink while watching World Cup soccer on strategically placed huge screens.  the local tourist center had already closed but there was plenty of light so we followed our interpretation of the Polish map to find the two rebuilt synagogues.  I always find it amusing to see the "old" synagogue and the "new" nearly side-by-side.  These two were huge and spoke to the large population of Jews in the region for centuries as well as their relative prosperity and freedom.  Again I was directly confronted with the sweeping destruction Hitler promulgated in just a few short years.  A small plaque on the new synagogue gave a poignant tribute.
We slept and ate well, rising early for what we knew would be another long day.  Our guide rejoined us and we headed due south to Tyczyn, the family home of my grandfather.  The town dates back to 1398 and underwent the usual sequential sacking and pillaging through the ages ultimately becoming a part of Galicia (of the Austro-Hungarian empire).  The town square sat on a small hill, commanding control over the surrounding rural villages.  The Stryj River was nearby and served multiple purposes including swimming for the local boys!  We had spent some of our many driving hours reading a memoir of one of his brothers and had already learned about the remarkable mobility of this community-both during times of distress (pogroms) and for business (trading and commerce).  Unlike the villages we had visited the day before, the Jewish population of Tyczyn was relatively small (under 1000) and in the minority (though there were still two competitive synagogues).  As elsewhere in this region, the Jews were primarily shopkeepers.
Rynek Tyczyn
The town square was small and shaded, anchored by the Rynek (town hall).  Within the town hall we found the library where an extremely helpful woman showed us her impressive section of local history books.  While many were in Polish, just looking at the photos was worth the time though there was great focus on the many churches and Christian life.  Then suddenly she seemed to remember something and pulled out what looked like a college term paper-our guide grinned and translated: The Jews of Tyczyn! Here was gold-an entire treatise, even if it was in Polish.  After a set of negotiations, she agreed to let us take the manuscript to the one nearby copier so we could have it properly translated back home (I did leave my passport in exchange).  Just as we were about to leave with our precious document, she called us back, with the even more startling news that the author was still alive and living in Tyczyn!  More chaos ensued as our guide acquired the telephone number, called the author, was declined a visit.  Clutching our precious sheets, we emerged back onto the square, found the copier (hidden in the back of a tiny variety store) and began to circle the square to identify the crumbling remains of the synagogue when the next miracle struck-for some inexplicable reason, the author now called back and agreed to a visit!
For the next hour we were thoroughly entertained by a remarkably healthy 90 year old who managed through a combination of English, German and Polish to relate many memories about his life in the village.  During WWII he had been forced to serve in the German army (having been a Polish army officer before the occupation) but after being wounded, returned to witness some of the final carnage extracted upon the Jews.  His property bordered two important landmarks-one was a dilapidated, abandoned, crumbling home that he identified as belonging to the Tuchmans who were cousins of my mother!  Apparently no one wanted to disturb the building as it was known the last inhabitant were the mother and children who had been shot by the Nazis right near the village.  The second was the Jewish cemetery.  While the cemeteries we had seen in Smigrod and Dukla were chilling, the one in Tyczyn was overwhelmingly somber and distressingly sad.  The large plot is fenced and locked, access is almost impossible, and it is clear there is little care given to the place.  Through the fence, we could just glimpse one remaining tombstone-standing in silent witness and memorial.
Cemetery Tyczyn
We thanked our gracious guest, understanding just how special it was to have met and talked  with someone who walked the streets with my grandfather, who visited my great-grandfather's store and who had taken the time to write down what could have become the lost history of the Jews of this small town. As we left, Mom took a few mournful photographs of the Tuchman house, we claimed the copies of the manuscript, retrieved my passport and headed out of town.  A long drive was ahead of us-it would give us both time to ponder another rewarding, revealing but emotional day in eastern Poland.

Monday, September 27, 2010

A Thoughtful Man

I recently read a commentary by Dr. Manoj Jain in the Washington Post about the impact of malpractice on the way we practice.  Dr. Jain has become a physician leader in the arena of quality improvement and he writes honestly about the spiritual jolt every physician feels when they receive news of a malpractice lawsuit or even a potential lawsuit.

"I stood, stunned. My white coat, which held the daily tools of my profession -- my list of patients, the Sanford antibiotic manual, a black stethoscope -- felt extraordinarily heavy."

He relates the statistics all physicians know so well-that most suits (>80%) involve NO malpractice and also that injury that results from medical negligence (98%) never result in a malpractice case.  Before concluding he reminds us about the cost of this errant system.

"A lawsuit threatens my livelihood. It alters my judgment; it's like the difference between the "right thing to do" and the "politically right thing to do." Surveys of physicians conducted by the Massachusetts Medical Society found that 80 percent practice "defensive medicine," ordering extra tests that some say add billions annually to our health-care expenditure."

I wish more conversations about liability reform could maintain this civil, thoughtful analysis rather than the usual hyperbolic rhetoric.
Dr. Manoj Jain

Friday, September 24, 2010

Robert Glick-Neurosurgeon

The following is reproduced from Heart of a Lion, Hands of Woman: What Women Neurosurgeons Do .  With the holidays approaching, I thought you might enjoy!
Thanksgiving from hell…Almost! (1996)

Roberta Glick, M.D.
Roberta Glick

I am eight months pregnant. I am 43 years old. My husband invited 20 guests, “his family” for the “second night” of Thanksgiving. Need I say more.
Let me give you some background. Several Jewish Holidays have traditional second nights, including Passover, Rosh Hashanah and Hanukkah (which has 7). In this era of “post-modernism”, we’ve created a new tradition of “second night” of Thanksgiving at our house. Friday night following the usual Thanksgiving celebration, we invite my husband’s brothers and their families who have come into town for the grand Thanksgiving party held at my step-mother-in-law’s house. We also invite several of his relatives from the side of the family we don’t see on Thursday, and other friends.
Our party was originally for 10 to 12 people and I was told, by my husband, “Don’t worry, you won’t have to do anything”. By Tuesday before Thanksgiving, the count was up to 16 people. By Thursday, Thanksgiving Day, it was 17. And by 3 p.m. Friday, it was 20. Our “traditional “second night” meal is spaghetti. The recipe is one my husband’s mother used to make for the kids some 25 to 30 years ago. She was an artist who died of breast cancer, and her legacy includes her 3 sons, her paintings, and her spaghetti sauce recipe. We still have the original one written on disintegrating paper.
My 5 year old son and I spent much of Wednesday and Thursday evenings decorating the house for Thanksgiving and Hanukkah (which was one week after Thanksgiving) and setting the table. Because it was Friday night, the Jewish Sabbath, we light candles and say blessings over wine and bread, challah. The table must be set so that all of the woman have a set of candlesticks to bless, all the men have prayer caps (yamalkes) and everyone has a special Kiddush wine glass and prayer book. This is in addition to all the usual silverware, dishes, drinking glasses, and wine glasses.
I am going to reveal one of the very guarded secrets of marriage that no one ever talks about. That is, before a party, there are tremendous tensions and “discussions” between spouses. Something like this. I, of course, am the one with great expectations who wants to make a “perfect party” with matching cloth napkins, lovely polished silverware, glistening crystal, fresh cut flowers, and candles. But I’m no Martha Stewart, nor do I know who Martha Stewart really is. I’m a working pregnant mother, with grand illusions and with morning sickness for 8 months.
My husband on the other hand, believes that good food and good friends are all you need for a great party, and don’t worry about the rest. “We can use paper plates and paper napkins,” he says, as I cringe, appalled. So after two days of “setting up”, as my son calls it, I thought everything was under control, especially since my husband (Don’t worry, you won’t have to do anything but rest and relax) had ordered flowers, chickens, all kinds of salads, fruits, cakes, pies, and other desserts from a wonderful local caterer.
So feeling confident, we went to the circus. On the Friday morning of the dinner party, we decided to take 12 brothers, sisters, nephews, and nieces to the 3-ring Barnum and Bailey Greatest Show on Earth. It was a great time.
After the circus, at 2 in the afternoon, we went to pick up the food at the caterer’s shop. But the caterer was closed. No one answered the phone or the pager number that we had been given. Because we had used their services often in the past, we totally trusted the chef (a 450+ pound guy who was always sitting down when we saw him). He was obviously a great cook. We had even faxed our order 2 weeks in advance and received a return fax message earlier in the week. So why worry. I kept telling my husband, “Let’s give them another hour, they’ll show up”. Always the eternal optimist, I am.
At 3 p.m. we had to reset the table from 17 to 20. Actually, we had to add a third table for the kids and rearrange all the furniture in the living room to accommodate it. At 4 p.m., still no word from the caterer. Dinner was called for 6 p.m., and all we had so far was spaghetti and spaghetti sauce. My husband said, “I better go shopping””.
“What about the flowers?” I asked.
“I’ll pick some up,” he said.
“Find a bakery and use the health food store for fruit and chicken,” I said.
“I will,” he answered.
“Stop and Chop” became our mantra because at 5 p.m. we started making green salads and fruit salads and chicken for 20 people. In the meantime, maybe it was hormonal (which translates as the unknown “woman” factor), maybe it was my way of dealing with reality and insanity all at once, maybe it was because I was 8 months pregnant, but as I was getting out more silverware to reset the table, I sat down on the kitchen floor and started shedding tears and having bouts of laughter in succession.
A race to the finish. The first guests begin to arrive. I handed them knives, cutting boards, bowls, and plates to help prepare the food. Finally dinner was ready and we all sat down. Just as I was sitting down and finally relaxing, the phone rang.
It was a friend whose father, a university professor with some recent visual and mental changes, had just been diagnosed with a malignant brain tumor. He called to tell me that he had been doing some reading and found out that this tumor, called “Glioblastoma Multiforme”, was the worst tumor one could have and that his father may have only a few months to live. He was shocked, and severely upset and angry all at once. Portable phone in hand, I left the table and wobbled back to the kitchen to talk to him.
When I returned to the table 15 minutes later, I realized that a Thanksgiving party that nearly went off track, one that I knew I would laugh about later, in the years to come, was not the life drama or tragedy I saw it as just minutes ago. My perspective on life at that moment was like looking through a telescope as I refocused the lens. As I looked around the table, I was thankful for all the good friends and family, joy and good health, and good times we were able to share that night.
And I thought of my friend.

Note: About one hour into the dinner, we received another phone call. It was one of the partners of the catering service apologizing and letting us know that they went out of business that very day. Something about taxes. They didn’t even offer a cake.

Monday, September 20, 2010

Sad, So Sad

She was 78 with bones to thin I could see through them on xray
And a spine so crooked, she could challenge a pretzel
She had seen three world class surgeons who had said "No"
But here she was,hope in her eyes, asking for my help

She was 78 and in pain and her predicament so sad
Her problem was nature and the bad hand it had dealt
And no medicine nor surgery could outwit Mother Nature
So no one wanted to help, it just wasn't their job

She was 78 and her husband even older
No one wanted them to suffer but there was no easy answer
And together they refused to accept and so on they wandered
Wasting resources and time and getting less help than they should

She was 78 and in pain and the system conspired
So that she kept up her futility, remained in great pain
And once again, I shook my head and knew in my heart
She had failed the system and the system failed her.

Friday, September 17, 2010

Waking Up America

In Sunday's NY Times, Thomas Friedman confronts the issue of what ails America with such directness, it struck me like a bolt of lightning.  In talking about why many of our systems have failed to thrive (e.g. education), Friedman places the balme squarely on individuals and the resultant collective mentality.  He writes:
We had a values breakdown — a national epidemic of get-rich-quickism and something-for-nothingism. Wall Street may have been dealing the dope, but our lawmakers encouraged it. And far too many of us were happy to buy the dot-com and subprime crack for quick prosperity highs.
In contrast, he talks about the "Greatest Generation" and why they succeeded:
First, the problems they faced were huge, merciless and inescapable: the Depression, Nazism and Soviet Communism. Second, the Greatest Generation’s leaders were never afraid to ask Americans to sacrifice. Third, that generation was ready to sacrifice, and pull together, for the good of the country. And fourth, because they were ready to do hard things, they earned global leadership the only way you can, by saying: “Follow me.”
He adeptly depicts our status quo:
For a decade we sent our best minds not to make computer chips in Silicon Valley but to make poker chips on Wall Street, while telling ourselves we could have the American dream — a home — without saving and investing, for nothing down and nothing to pay for two years.
And to tackle our current malaise our national debate must begin between:
Democrats and Republicans who start by acknowledging that we can’t cut deficits without both tax increases and spending cuts — and then debate which ones and when who acknowledge that we can’t compete unless we demand more of our students — and then debate longer school days versus school years — who acknowledge that bad parents who don’t read to their kids and do indulge them with video games are as responsible for poor test scores as bad teachers — and debate what to do about that.

Thomas Friedman is probably one of the better known opinion writers for the NY Times because of his many best-selling books including The Flat Earth (how the internet is changing the world ), Longitudes and Attitudes (the world after 9-11) and The Lexus and the Olive Tree (globalization).  I was fortunate to hear him speak and to meet him in a small forum afterwards.  I have generally found his writing thought provoking but perhaps mildly simplistic and sometime redundant.  However, this Sunday he wrote this column that is clear, direct and thoroughly appropriate not just for education and politics, but for medicine as well-we need far greater honesty from all sides of the debate and then greater cooperation in finding creative solutions to move forward.

Monday, September 13, 2010

Journey Back-Poland 4 (Smigrod and Dukla)

Zmigrod Seal
Now the time came for us to delve into the very personal portion of our journey.  Up to this point, we had gotten a taste for Jewish life in Poland but now we would visit the very cities and towns where our fore-bearers had been born, lived and worked.  To do this, we had hired a local guide who knew the area, had some experience with genealogical searches, and perhaps most importantly-spoke Polish.  We left Krakow and headed East into the foothills of the Carpathian mountains.  Our first challenge was traffic-usually bad in this rapidly developing part of the country but made impossible by recent floods that had rendered nearly all the local bridges impassable.  After driving for what seemed like hours, a kind trucker finally escorted us through a most convoluted route and delivered us very close to Nowy Zmigrod.  In preparation for this trip, I had found incredible information about Zmigrod and the surrounding region on shtetlinks.  The town had a long Jewish history dating back to the 15th century.  From then until WWII, the population of the town was about half Jewish.  Along with several surrounding towns, Zmigrod was an important component of the Ukrainian-Hungarian trade routes-critical in the wine/salmon/horse and timber trade.It was an important center of Jewish learning and boasted two elaborate synagogues!
Old Synagogue-Zmigrod
Unfortunately, there are few remnants of Jewish life in Zmigrod today.   After a stroll around the town square, we made a futile attempt to establish which buildings might have been the synagogues.  From our research, we had a map of the town at the turn of the 20th century but nothing connected-our forays into several local shops were rebuffed, the purveyors seemed concerned by our enquiries.  Next we tried the municipal center and after several false starts, we were directed to the cultural center, home of the local historian-an individual working hard to establish a Galician museum.  What luck! He was a treasure of information.  He had many old photographs of the town, showing the splendor of the square and of its Jewish heritage.  Later he proudly took us on a tour of the Jewish cemetery, just outside of town.
Cemetery Zmigrod
Covering more than four acres and four centuries,  the partially restored plots reflect the history of Zmigrod's Jews-up to their final slaughter (the 1250 men, women and children shot and buried in a mass grave in Halbow on July 7, 1942 have their own memorial).  While I could not read the Hebrew inscriptions, it was very special knowing there were people buried here who knew my grandmother when she was born, who worked beside my great grandparents, and perhaps even generations before them!  I was also struck by how different my grandmother's family life was from my mental images.
While I have little doubt that their lives were very difficult-like most of the rest of the world there was no electricity/refrigeration/automobiles- but they were considerably more mobile than I would have imagined.  Trade routes brought goods and people from Budapest, Prague, Warsaw and beyond.  I have since learned that the "Fiddler on the Roof" image was promulgated in part as propaganda to serve political  exigencies.  While my grandmother (Frieda) only lived in Zmigrod for a few years (more on her later history to come), this was her first home and the documented home of her father and as such, represented for me a generational connection of great importance and I was commensurately moved.

Rabbi's grave Zmigrod

From Zmigrod, we traveled 8 short miles to Dukla-home of Frieda's mother.  This town is strategically situated at the lowest and easiest pass through the Carpathian mountains-a critical link between Hungary, Slovakia, and Poland (the Austro-Hungarian Empire).  It was a prosperous trading town that was more than 80% Jewish.   An old baroque palace (of Mecinski) remains the only real evidence of Dukla's former glory.  The original town square is quite large and an ornate, but now decrepit, Town Hall commands the central place.  Several of the building around the square had clear evidence of former mezzuzah (a religious ornament placed on the door frame) but no Jewish life remains.  We took pictures of every house here in hopes that one day we may determine where my great-grandmother lived.  Dukla did have a small tourist center where we got directions to both the synagogue and the cemetery.  I also bought a spectacular little book of late19th and early 20th century post-card photographs of the town (it is written in Polish but the pictures tell enough fo a story).
Synagogue remains, Dukla
The synagogue was built in 1758 (nearly 20 years BEFORE the Declaration of Independence) but like most of Polish-Jewish life was destroyed during WWII.  Today, the external brick structure remains as an eerie monument that I found more poignant than many "official" memorials.  I closed my eyes and tried to imagine my great-grandmother, standing in the women's galleries, praying within these walls.  And I thought also about how this woman took her family out of Poland to Germany-the beginning of the journey that had now come full circle with our visit here.
The Jewish cemetery would be our next stop in Dukla and I was glad we saved it for last.  By now, we expected the graves to be desecrated but devoted locals have worked to restore what they could to a state of honor with a respect for the departed.  I watched my mother wander through the few rows of tombstones and I felt a deep ache in my heart for all the sad history of repression, pogroms, and death that have despoiled the lovely Galician hills and the nearby mountains that we splendidly visible from the hillside position of the cemetery.  I had seen Auschwitz-Birkenau, Schindler's Factory, the Krakow ghetto, and more but for the first time, tears sprang to my eyes.  Why this spot in Dukla helped serve as my catharsis I will never know but I sensed my mother felt similarly and we returned to the car and began the long drive onto to Rzeszow in silence.

Cemetery, Dukla

Friday, September 10, 2010

Days of Awe

Jews around the world are celebrating Rosh Hashanah, the new year and next Friday, we will celebrate Yom Kippur (Day of Remembrance).  The time between is a deep time of reflection, sometimes referred to as "The Days of Awe".  As this time occurs in the fall, I often find myself walking trails with the leaves exhibiting their finest wardrobe and with the air redolent of harvest, apples, and drying leaves.  Taking a small amount of time for introspection-whether driven by traditional holidays or another motivation-can be a good thing.  Too often I find in our "modern world" we are swept along, so busy doing work, caring for family, paying bills, exercising and the like that we don't STOP, listen to ourselves and take the pulse of our loved ones.  Every year, I promise myself to make sure I do STOP from time to time, not just during the Days of Awe but on a more frequent basis.  And then another holiday season rolls around and I realize, I have reflected less than I hoped in the past year.  Certainly looking inward can be painful but I also know that it helps bring me peace and serenity.
For those who celebrate, I wish you Shana Tova.  For all the rest, I wish you your own path to a small share of peace and serenity.

Friday, September 3, 2010

Happy Birthday Randy!

This weekend I had the distinct pleasure of celebrating my sister's 50th birthday.  When Randy was born, just 9 1/2 months after I arrived, my parents were told many sad things about Down's Syndrome children.  To their credit, my parents decided to raise her (not place her in an institution) and to fully integrate her into our family.  Though they were told she was "uneducatable and only partially trainable" she now reads on a 4th grade level, can do simple math, cooks a spectrum of foods, and can challenge most people on tv trivia!  When I was young, I had to cope with the notion that her probable life expectancy was only 20 years (at that point, most Down's Syndrome children were institutionalized and died of institutional diseases, not their Down's).  During college, she would come to visit me at Brown and while I went to classes, she would befriend everyone in the dorm, even some I barely knew.  Her charm and congeniality was infectious.
For nearly 25 years, Randy has lived semi-independently in a group home and worked steadily.
There is no doubt, having Randy as part of my family has influenced much of who I am.  My career in medicine is probably related as well.  If so, that's one more reason I have to thank her, as it has been a wonderful and rewarding career.
What lies in Randy's future is unknown.  Statistically, she has a high chance of early Alzheimer's but otherwise, her longevity and well being is probably very similar to others her age.  I look forward to celebrating many more landmark birthday's with my very special, "baby" sister!