peculiar,Something for everyone:A drama tonight!Something appealing,Something appalling,Something for everyone:A drama tonight!Plenty of kings, plenty
of crowns;Bring on the lovers, liars and clowns!Old situations,New complications,Everything portentous, nothing
polite;Tragedy tomorrow, drama tonight!Something convulsive,Something repulsive,Something for everyone:A drama tonight!Something aesthetic,Something frenetic,Something for everyone:A comedy tonight!Plenty of gods, lots of
evil fate;Weighty affairs that just won't wait!Nothing that's formal,Nothing that's normal,Lots of recitations to recite;Open up the curtain:A drama Tonight!Something erratic,Something dramatic,Something for everyone:A drama tonight!Frenzy and frolic,Strictly symbolic,Something for everyone:A drama tonight!
|Your Brain is Green|
Saturday, October 06, 2007
Monday, September 24, 2007
Report: Air pollution 100 times lower during Yom Kippur
By Zafrir Rinat, Haaretz Correspondent
Air pollution in
Jerusalem and the Dan region was 100 times less on Yom Kippur than on ordinary
days, when cars are on the roads, air pollution monitors from the Environmental
Protection Ministry found.
According to the figures released by the
ministry Sunday, levels of nitrogen oxide in the Dan region over Yom Kippur were
two to 12 parts per billion - but when the holiday was over, the figure rose to
205 parts per billion. In Jerusalem, the numbers declined from 250 parts per
billion in the afternoon before Yom Kippur to between two and 12 parts per
billion during the holiday.
Nitrogen oxide is the compound emitted by
vehicle exhaust pipes and is one of the prime urban pollution indicators. One
component of this kind of pollution, nitrogen monoxide, is considered
particularly dangerous to health, causing chronic and even fatal respiratory
Last week, the Environmental Protection Ministry
released figures for 2006, which indicated that some areas of the country
exceeded World Health Organization pollution standards for ozone in the lower
atmosphere. One of the causes of ozone pollution is the release of nitrogen
oxide into the atmosphere.
OK, folks, the solution to one of the world's major problems is clear: everyone become an Orthodox Jew, and one day a week, DON'T DRIVE ANYWHERE! That should reduce carbon emissions by almost 15%, even if everyone exhaled at the same time...
Sunday, September 23, 2007
Yom Kippur is, in Jerusalem, at least, a day eagerly awaited by children under bar mitzvah age. It's the one day of the year they can ride their bicycles or use their scooters or roller blades on the streets themselves without fear of being run down. (Actually, there are a few--very few--cars on the street, mainly ambulances or police vehicles, and these are often stoned if they inadvertently stray into any religious area, even when clearly marked as emergency vehicles)The yearly celebration of Non-Motorized Vehicular Traffic Day
is about to begin.
Yom Kippur is a phenomenon outside the normal time of the world. The Orthodox have a bit of this every Shabbat, but on Shabbat one does have clocks one can consult. Technically, we have them on the Day of Atonement, too, but they seem irrelevant. There's nowhere to go, nothing to do, but pray. You don't visit with friends, you don't sit down to eat. You go to shul. Or, for the irreligious, you sleep. You're in God's time, not human time.There's no radio or TV. For some, this is a worse deprivation
than food and drink. By 8:30 in the evening, when the services for Yom Kippur
Eve are over, people are eyeing one another anxiously, wondering how the heck
they will manage to last out the 25-hour period with no other diversion beyond
praying or talking to one another. I bet there are husbands and wives who
actually see each other for the first time in a year on the
The Middle Ages has been called the "Age of Belief". Science requires exactitude, and therefore one has to know exactly where one is in time and space. God's time, however, is more elastic. Its markers are not hours or minutes but events.It occurred to me, reading some of the extremely beautiful,
mystic, and complex piyyutim (liturgical poems), that were written mostly in the
Middle Ages, that this is what it must have been like for everyone, all the
time, back then. Of course, there were various methods, since antiquity, for
telling time and artificial ways of dividing the day into parts. But the average
man did not. He got up with the sun, and went to bed at dark. What wasn't
finished today would be finished tomorrow. Journeys took unknown amounts of
time; one could guess, based on previous trips about approximate arrivals, but
no one could keep to a schedule, or a deadline. It was all "in God's Hands" and
everything happened when it happened.
On the New Year will be inscribed and on Yom Kippur will
be sealed how many will pass from the hear and how many will be created; who
will live and who will die; who will die at his predestined time and who before
his time; who by water and who by fire, who by sword, who by beast, who by
famine, who by thirst, who by storm, who by plague, who by strangulation, and
who by stoning. Who will rest and who will wander, who will live in
haromony and who will be harried, who will enjoy tranquillity and who will
suffer, who will be impoverished, and who will be enriched, who will be degraded
and who will be exalted.
Paul Johnson, in "History of the Jews" has written about the peculiar relationship of Jews to history. The best book about the Holocaust, Andre Schwarz-Bart's "The Last of the Just" makes just this point. He uses a hassidic legend about the "36 just (righteous; the word is the same in Hebrew) men" in each generation whose hidden suffering hastens the Coming of the Messiah, to create a story about a Jewish family, beginning in the massacre of the Jewish community in York in the 1100s, that is granted the "privilege" of having one of these hidden saints in each generation. The 36th generation member, Ernie Levy, ends up in Auschwitz:The interesting thing about this beautiful prayer, called the
"Utaneh Tokef", is that it was written, as so much else of the High
Holy Day liturgy, during the Middle Ages, specifically during the period of
intense and bloody persecution of the European communities during the Crusades.
The author of this prayer was himself martyred. The melody of "Kol
Nidre" dates from a little later, the period of the Spanish Inquisition;
when Spanish Jews, having been forcibly converted to Catholicism in 1391, could
only practice Judaism in secret. But life for Jews around 1100-1200 had also
been extremely perilous, since many Crusaders decided to deal with the local
"infidels" before going to the Holy Land to deal with the Moslem infidels.Jewish liturgy has very little input from the Holocaust,
possibly because it is so fresh. There is a paragraph in the Yizkor service--the
memorial prayers for the dead--but not much else. The death of ten celebrated
Sages at the hands of the Romans is related, but not those who died in the
concentration camps. But the rabbis of the Middle Ages were composing mystic
poetry contemporaneously with events because they could see in them the
historical perspective, not being limited by clocks delineating human
His eyes still closed, he felt the press of the last
parcels of flesh that the SS men were clubbing into the gas chamber now, and his
eyes still closed he knew that the lights had been extinguished on the living,
on the hundreds of Jewish women suddenly shrieking in terror, on the old men
whose prayers rose immediately and grew stronger, on the martyred children, who
were rediscovering in their last agonies the fresh innocence of yesteryear's
agonies in a chorus of identical exclamations: "Mama! But I was a good boy! It's
dark! It's dark!" And when the first waves of Cyclon B gas billowed among the
sweating bodies, Ernie...leaned out into the darkness toward the children
invisible even at his knees, and he shouted with all the gentleness and all the
strength of his soul, "Breathe deeply, my lambs, and quickly!"When the layers of gas had covered everything, there was
silence in the dark sky of the room for perhaps a minute, broken only by shrill,
racking coughs and the gasps of those too far gone in their agonies to offer a
devotion. And first a stream, then a cascade, an irrepressible, majestic
torrent, the poem that through the smoke of fires and above the funeral pyres of
history the Jews...had traced in letters of blood on the earth's hard
crust--that old love poem unfurled in the gas chamber, enveloped it, vanquished
its somber, abysmal snickering: "SHEMA YISRAEL ADONOI ELOHENU ADONOI
ECHAD...Hear O Israel, the Lord is our God, the Lord is One. O Lord, by your
grace you nourish the living, and by your great pity you ressurect the dead, and
you uphold the weak, cure the sick, break the chains of slaves. And faithfully
keep your promises to those who sleep in the dust. Who is like unto you, O
merciful Father, and who could be like unto you....?"And then Ernie knew he could do nothing more for anyone
in the world, and in the flash that preceded his own annihilation he remembered,
happily, the legend of Rabbi Chanina ben Teradyion [recited on Yom Kippur]: "When the gentle rabbi,
wrapped in the scrolls of the Torah, was flung upon the pyre by the Romans for
having taught the Law, and when they lit the faggots, the branches still green
to make his torture last, his pupils said, 'Master, what do you see?' And Rabbi
Chaninia answered, 'I see the parchment burning, but the letters are taking
wing'"...."Ah yes, surely, the letters are taking wing" Ernie repeated as the
flame blazing in his chest rose suddenly to his head....And so it was for
millions, who turned from Luftmenschen into Luft. I shall not
translate. So this story will not finish with some tomb to be visited in
memoriam. For the smoke that rises from the crematoria obeys physical laws like
any other...the only pilgrimage, estimable reader, would be to look with sadness
at a stormy sky now and then.
And praised. Auschwitz. Be. Maidanek. The Lord. Treblinka. And praised. Buchenwald. Be.
Mauthausen. The Lord. Belzec. And praised. Sobibor. Be. Chelmno. The Lord. Ponary. And praised.
Theresienstadt. Be. Warsaw. The Lord. Vilna. Yitgadal. Skarzysko. v'yitkadash. Bergen-Belsen. shemay
rabbah. Janow. Yitgadal. Lodz. v'yitkadash. Neuengamme. shemay rabbah. Pustkow....v'imru "ameyn"....
Thursday, September 20, 2007
Sharks gotta swim, and bats gotta fly,
I gotta love one woman till I
To Ed or Dick or Bob,
She may be just a slob,
But to me,
She's my girl.
In winter, the bedroom is one large ice cube,
she squeezes the toothpaste from the middle of the tube!
Her hairs in the
Have driven me to drink,
But she's my girl, she's my girl, she's my
And I love her.
The girl that I lament for,
The girl my money's
The girl my back is bent for,
The girl I owe the rent
The girl I gave up Lent for
Is the girl that heaven meant for
So though for breakfast she makes coffee that tastes like
I come home for dinner and get peanut butter stew,
Or, if I'm
It's broiled hockey puck,
But, oh well, what the hell,
And I love her.
I don't think there is a single Israeli that doesn't have a love-hate relationship with the country. But it's particularly strong among those who have chosen to come live here, and aren't here from necessity. The "olim by choice" often have very exaggerated notions of the hypothetical utopia they have come to. In other words, they expect the "Heavenly Jerusalem" and get the "earthly" one instead. And a very earthy one it is.
As a result, they generally go to one of two extremes. Either they deny that there's anything wrong with the country, and all criticism of it is a libel verging on the criminal, or they can't stand anything at all about Israel. This leads to two further divisions: those who return to the home country they never really left (mentally and emotionally), or those who are determined to change Israel for "the better" (i.e. American way of doing things). Sometimes the latter even succeed: while our oven-ready chickens still have lots of feathers on them, we do have an anti-smoking law and we are supposed to use seat belts.
So, remember: Israel is a work in progress. For every downside, there is an upside, or nearly so. As the words of the Naomi Shemer song, "For All These Things" (Al kol eleh) goes (more a paraphrase than a translation, btw):
Every bee that brings the honey
Needs a sting to be complete
And we all must learn to taste the bitter with the sweet.
Keep, oh Lord, the fire burning
Through the night and through the day
For the man who is returning from so far away.
Don't uproot what has been planted
So our bounty may increase
Let our dearest wish be granted:
Bring us peace, oh bring us peace.
For the sake of all these things,
Lord,Let your mercy be complete
Bless the sting and bless the honey
Bless the bitter and the sweet.
(Please don't uproot that which is planted, Don't forget the hope [play on words of Israel's national anthem]
[God] cause me to return* and I will return to the Good Land.**)***
Save the houses that we live in
The small fences and the wall
From the sudden war-like thunder
May you save them all.
Guard what little I’ve been given
Guard the hill my child might climb
Let the fruit that’s yet to ripen
Not be plucked before its time.
As the wind makes rustling night sounds
And a star falls in its arc
All my dreams and my desires
Form crystal shapes out of the dark.
Guard for me, oh Lord, these treasures
All my friends keep safe and strong,
Guard the stillness, guard the weeping,
And above all, guard this song.
For the sake of all these things,
Lord,Let your mercy be complete
Bless the sting and bless the honey
Bless the bitter and the sweet.
Bless the sting and bless the
Bless the bitter and the sweet.
*The Hebrew word " hashiveni"is used in the morning prayers "cause us to be ingathered from the four corners of the earth" --an allusion all Jews know.
**" (The)Land" is a synonym for Israel
***The parentheses were not translated. This version is meant to be sung to the original tune, and has kept the meaning of the original.
Tuesday, September 18, 2007
Absorption Ministry survey finds immigrants suffer severe
By Anshel Pfeffer, Haaretz Jewish World Correspondent
A survey carried out by the Absorption Ministry shows
that the income of new immigrants is substantially lower than that of veteran
Israelis. The survey, prepared for the Immigration and Absorption conference
scheduled to take place in Ashdod next month, showed that 41 percent of new
immigrants earn no more than NIS 5,000 per month. The survey includes immigrants
who have been in Israel for as long as 17 years. Only 13 percent of veteran
Israelis have such low wages. According to the survey, 20 percent of new
immigrant families earn more than NIS 10,000 per month, compared to 45 percent
of the veterans.Other economic indicators surveyed in the study have shown
gaps that do not favor the new immigrants. As such, when it comes to housing, in
spite of government grants, only 62 percent of new immigrants live in a home
they own, compared to 77 percent of Israeli society in general. Also, among new
immigrants, unemployment stands at 13 percent compared to nine percent among the
general population. Notwithstanding the economic difficulties, 75 percent of the
immigrants participating in the survey, conducted by Dr. Sonia Michaeli, the
ministry's chief scientist, said that if they had to do it all over again, they
would still choose to immigrate to Israel. Only 10 percent of respondents said
they were unsure about whether they would choose to immigrate to Israel in view
of their experiences since coming here. However, dissatisfaction is much higher
among those aged 18-34: as many as 30 percent say they are not certain they
would like to stay here. [ http://www.haaretz.com/hasen/spages/904786.html ]Not exactly the Goldeneh Medina...but then, I never expected it to be. But I do wish this article would be posted, in large print, on the wall of every Aliyah Center in the US.
Wednesday, September 12, 2007
Monday, September 03, 2007
From The Times
September 1, 2007
The rise of a combination of extreme scepticism towards established sources of
authority in science and medicine and anxiety about environmental threats to our
wellbeing has led many to put their faith in self-proclaimed mavericks and
alternative healers and charlatans. The recent outbreaks of measles, which
resulted last year in the first childhood death for 15 years, shows how
dangerous this credulity can be.
As doctors, we are grappling in our
surgeries with fear and confusion, exacerbated by an apparently endless series
of health scares and panics. A campaigner came to me convinced that a local
mobile phone mast was causing her breathing difficulties; later she admitted
that she smoked 30 cigarettes a day. A young man, committed to the “near-death”
experiences offered by inhaling the veterinary tranquilliser ketamine in the
course of weekend clubbing binges, inquired whether I would check his serum
cholesterol level to assess his long-term risk of coronary heart disease.
Patients who consume vitamins, antioxidants and herbs by the bucketful commonly
refuse to take medication recommended for high blood pressure or some other
condition because they “don’t want to get hooked on tablets”. Some patients even
refuse chemotherapy for cancer in favour of homoeopathy, acupuncture or
Once upon a time, the writers of science fiction liked to postulate a future in which science was discredited. Human beings, the usual tale went, could not ever travel to outer space, or something like that. Sometimes a worldwide nuclear catastrophe had occurred. In any case, civilization returned to a pre-Industrial Revolution standard, including a total rejection of science and a "rediscovery" of magic and superstition.
There are moments when I think it's happening now. Or at least, to a subculture. But why just now? The strides obstetric and gynecologic medicine has made--just one scientific discipline--since I finished nursing school have been immense. The minimum limit for viability, when I was a new graduate, for a premature baby was somewhere between 28 and 30 weeks; now it is about 23 (although outcomes at this stage are not very good) Forceps deliveries were routine. There was no fetal monitoring or ultrasound. Fertility treatment was crude and not very successful. The first IVF baby had yet to be conceived.
But medicine has also had some notable failures. Nearly all my life I've heard that the "cure for cancer" is right around the corner; AIDS, unknown when I was at the beginning of my career, looms large over us all and has changed sexual behavior. The prospect of Alzeheimer's frightens every person who is approaching an age his grandparents never dreamed of achieving. And medicine has increasingly become complex to the point of unintelligibility to the average person, and no one doctor can encompass ALL the medical knowledge there is. "Disseminated intravascular coagulopathy", said fast enough, sounds a lot like "abracadabra", and "Exubera!" reminds one of a spell in Harry Potter rather than the name of a inhalable form of insulin.
And thereby lies the point. The average guy has lots of jargon thrown at him which he doesn't understand, and is ashamed to admit he doesn't understand. So when someone says something which isn't scientific at all but is really just rubbish, he doesn't see any difference. Add to this that any esoteric or exotic "knowledge" which is supposed to come from a mythic past, some Golden Age (so much better than our own degenerate cultures) or some Far Eastern source (Shangri La, remember, was in the Himalayas) is ipso facto held to be "better" than some modern laboratory concoction, and, as P.T. Barnum said, "there's a sucker born every minute".
A form of massage which claims to massage an organ which cannot be palpated, and is based on the "insights" of a South American "shaman" is one of these totally imaginary "treatments". Like many other panaceas, this "Mayan Massage" can cure numerous different ailments with a single type of manipulation (and is painless and non-invasive--good news for the needlephobic): infertility, prostate trouble, digestive upsets, emotional problems (interestingly, the website refers to the "redirection of blood" to make the chi flow better. Chi is a totally unprovable kind of energy invoked in certain Chinese philosophies. Didn't know the Mayans and the Chinese knew each other) The "shaman" who claimed to be the master of this knowledge died at an extremely advanced age, we are told. I bet he didn't really know how old he really was, just as this folk medicine is completely without any scientific background. But it does sound so nice. And it will cure just about everything, by "readjusting" an organ which cannot be felt externally.
Daniel Ben-Ami, in Spiked, writes:
Imagine an egalitarian world in which all food is organic and local, the air is free of industrial pollution, and vigorous physical exertion is guaranteed. Sound idyllic?
But hold on… Life expectancy is 30 at most; many children die at or soon after birth; life is constantly lived on the edge of starvation; there are no doctors or dentists or modern toilets. If it is egalitarian it is because everyone is dirt poor, and there is no industrial pollution because there are no factories. Food is organic because there are no pesticides or high technology farming methods. As a result, producing food means long hours of back-breaking physical work which may end up yielding little.
There is – or at least was – such a place. It is called the past. And few of us, it seems, recognise the enormous benefits to humanity of escaping from it. On the contrary, there is a pervasive culture of complaint about the perils of affluence and a common tendency to romanticise the simple life.
From the 1790s onwards, in the aftermath of the French Revolution, the prospect of a world without scarcity seemed like a realistic possibility. Humans strove for a day when they could have a guaranteed food supply at all times. It should be remembered that the famous clause in Christianity’s Lord’s Prayer – ‘give us this day our daily bread’ – was meant literally. Our ancestors struggled for a world where we could take abundant food, clean water and adequate shelter for granted. Not only have we achieved these goals, at least in the developed world, but modern technology and economic organisation have improved our lives hugely.
What a shame all these rejectionists of modern technology and science couldn't be transported back just one or two hundred years and see just how awful life really was, when it was all "organic" and pre-sanitation (a bath at birth and a bath at death were quite enough for most, and there was no such thing as clean water or fresh vegetables in cities; indeed the inability of a city to provide services limited their very growth) and pre-antibiotic, when Rh sensitization (oh yes, it happened back then) meant the death of every child a sensitized woman bore (and no way to avoid repeated pregnancies), and diabetes was a death sentence. Or maybe we don't have to build a time machine; just go to the Third World where the maternal and fetal death rates are still astronomical and life expectancy is short, especially for a woman. Where women literally walk for days for the privilege of delivering in a hospital instead of in their own homes, where the Caesarean rate is "admirably" low because it is simply unavailable. Where there are entire hospitals of women with recto-vaginal fistulas constantly leaking urine and feces because of botched births. (In forty years of midwifery, I have never seen a woman so injured)
I get so ticked off at this foolishness. At least be consistent--if you want to espouse primitive knowledge, then espouse the primitive lifestyle. Get rid of electricity and running water, squat over a latrine which is a hole in the ground, don't use refrigeration, no analgesia and antibiotics, and when your labor goes sour, hitch up the horse and buggy, but don't go to a hospital--that's a modern invention--find a "wise woman" somewhere, and pray to some deity that you and the baby survive--and if you do, expect to repeat the experience every couple of years until it does kill you.
I'll stay in the 21st century, thanks very much.
Thursday, August 30, 2007
There is another definition that requires some explanation but is important to understand in this story. A "bastard" in Jewish law (mamzer) is the child of an adulterous relationship, not born out of wedlock. There are very significant penalties for being a mamzer, one of which is not being allowed to marry anyone but another mamzer for 10 generations.
Back to the story.
Jewish rabbinical courts consist of three rabbis. Women, children and idiots are not allowed to be witnesses. When we applied for an Israeli marriage certificate, we of course submitted the marriage license signed by Rabbi Lipman in Washington DC. However, the Israeli rabbinate keeps lists of American rabbis they deem sufficiently Orthodox, and Rabbi Lipman wasn't an Orthodox rabbi. That in itself wasn't an insurmountable obstacle. Cohabitation can be one of the three ways a woman is "purchased in marriage" (the language is Mishnaic, not mine). But a Jewish marriage has to be between two Jews. Was I a Jew?
Bring your mother to Israel to testify to her Jewishness, the rabbis told me. No way, said I. My mother was undergoing chemotherapy and could not travel. OK, have her make a deposition before a rabbi we accept. I refused this too, because I knew my mother had a very bad conscience about marrying "out" and the last thing I wanted at this time was to increase her emotional problems. Finally, after much consultation, the rabbis decided my two aunts could make depositions, stating that they definitely knew my grandmother to be Jewish, and my mother was indeed their sister. (Trying to explain this to my aunts was a job in itself, since neither was observant. WTF? Of course Bubbie was Jewish! Nevertheless, it was done.)
Then the rabbis dropped the bombshell: how do we know that your first husband was indeed NOT Jewish? Perhaps he was secretly Jewish, and in that case, since you don't have proof of death, you are still married to him, not having received a Bill of Divorcement according to Jewish law! Bring HIS parents--if you can't find him--to Israel to testify that they are goyim!
This was patently impossible. Bernard had never told his parents, from whom he was estranged, that he'd even married me. The rabbis had cause for concern because in Europe there were children who had been saved from the Holocaust with faked baptismal papers, and his mother might have been one. But it was very important because I was now pregnant with my first child, and unless I could prove, to the court's satisfaction, that my first husband had not been Jewish (and therefore my first marriage was not Jewishly valid), I was pregnant with a mamzer, because the second marriage was invalid.
DH didn't understand the implications; he may be a "kosher" Jew, but he's Israeli, and not a Torah scholar. I collapsed in hysterical tears outside the courtroom. Another rabbi hurried over, thinking perhaps we were having a marital dispute, and when I managed to blurt out a bit of the story, he immediately told us to follow him to the offices of the Jerusalem Chief Rabbi. This rabbi was his secretary. I spent over two hours with Rav Zolti (z"l), and the upshot was he gave me a letter to take back to the court which said, in essence, "solve this now".
The rabbis did, in the following manner:
As stated above, a Jewish marriage is the union of two Jews (a man and a woman, incidentally) and must be dissolved according to Jewish law with a "get" or Bill of Divorcement. However, a marriage between a Jew and a non-Jew is not a valid marriage, and no Jewish divorce is required. So, (Talmudic sing-song with waving finger for emphasis is appropriate here) if we cannot prove that Bernard definitely wasn't Jewish, then, the rabbis reasoned, using the "no women, children, or idiots are legal witnesses" cop-out, we can definitely say that Antigonos isn't Jewish because her aunts' testimony is worthless!
So they sent me to be "converted".
It was less of a problem for me than for DH who, if he didn't rabidly hate the rabbinate before, he does now. I recognize the legal fiction, and the need for it, that the rabbis used. They were forced to work within Jewish law, and in its best tradition managed to find a way around what appeared a nearly-insoluble problem. DH just thought the whole thing was a farce. At the end of the day I merely was dunked in a ritual bath and given a piece of paper which I think I've lost over the years (along with my Israeli marriage certificate, which I haven't lost). The rabbis are happy. Now my daughter's getting married, and because I went through this soap opera she isn't having any problems with the rabbis at all. Her Jewishness isn't in doubt.
But every time the stranglehold of the religious authorities in the areas of conversion, marriage and divorce makes the headlines, I feel sympathetic. On the one hand, it is Halacha--literally, "the way in which one walks"--that has kept the Jewish people a coherent unit throughout more than two millennia, in spite of the most ferocious persecutions. On the other, it takes rabbis of real moral stature to be able to have the guts to adapt the Halacha to current conditions. It's just too easy to fall back on the generations of scholars who went before and not allow any innovations out of fear. Right now there are significant numbers of Russians who would formally convert if it wasn't made so difficult; they have Jewish partners and have chosen to leave the FSU and make their lives here, and there are many Ethiopians who consider themselves completely Jewish but whom the rabbis doubt and it is deeply insulting to them. Once again, a bill is in the Knesset for civil marriage, but that will only divide the religious and the secular even more. It is a very difficult problem.
Tuesday, August 28, 2007
The test is more for women who run a high risk for having GD. I don't fall intoBut gestational diabetes is not real diabetes at all, and it isn't an inherited trait. Gestational diabetes is a condition of pregnancy where the mother's blood sugar during pregnancy behaves in the same way that it does in true diabetics. However, almost always, it returns to normal within hours of birth. The risks of gestational diabetes are twofold: either the baby is unusually big, with the consequent problems of possibly being too big to go through the mother's pelvis, and also, after birth, having trouble maintaining his blood sugar levels, or the baby is unusually small because the placenta isn't working properly and the baby is being starved of oxygen and food. A baby whose blood sugar levels unexpectedly plummet can convulse, and there can be permanent brain damage as a result since during a convulsion, the supply of oxygen to the brain is interrupted.
this category, however the concern lies in my being adopted and not knowing my
biological health history. For all I know, my biological parents could now have
diabetes. Nonetheless, even if I am tested there is not any real evidence that
shows treating GD can improve the outcome for mom & baby. So, I am going to
think about it over the weeknd....and make a decision early next week. Of course
the risk of not having the test is growing a larger baby, and in the end not
being able to have a vaginal delivery....that is not an option for me.
our homebirth....is going to be peaceful and quiet (soft
meditative music)....relaxed, candlelit and romantic.
Criteria in the UK have changed in the thirty years since I studied to be a midwife at Cambridge. Back then a woman having a first baby could not have a home birth, because it was not possible to know whether she could put a baby through her pelvis or not. Ultrasound has made that less of a risk, since both the size of the baby's head and the weight can be reasonably estimated and the diameters of the pelvic inlets and outlets can be measured. As Birdie's Mama came closer and closer to her due date, it is impossible to know from her blog whether she had ultrasounds to estimate fetal size at all. She passed her due date, and obviously was oblivious, as were her health care providers, of the risks of postmaturity (placental insufficiency which causes the baby to have no reserves for the stresses of labor)
In the event, engagement happened in the 38th week. Apart from that, there is little information in the blog about her status until a brief mention, in her 41st week, that she has lost her mucus plug and thinks she is beginning to go into labor. Even though she added details to her blog after the birth, all that is certain is that she had contractions for 24 hours. Whether these were real contractions, whether she had any cervical dilatation at all, what station the baby's head was at (whether it was actually descending through the pelvis), we don't know.
She writes that her midwives listened to the fetal heart every half hour or so. It's better than nothing. But a heartbeat can be within the normal 120-160 bpm range and the baby can still be very stressed. That is why intermittent fetal monitoring is done in the hospital; to see whether the baby's heartbeat is showing normal beat to beat variability. If it is absent, if the FH is always the same rate, this is not a good sign. By the time there are decelerations, the baby is now actively distressed. Moreover, it is often very hard to hear the baby's heart beat without electronic equipment (did the midwives have a doppler?) during contractions. If the baby's heartbeat is 80 between contractions, that is a very serious matter indeed.
Was it normal that I did not feel my baby m0ving at all during lab0r? The
morning that my lab0r had begun and then stalled I mentioned that I had not
really been feeling her move to one of our hom3b1rth m1dw1ves, as I did feel
little concerned about this, but she told me that this was normal. She
when my body is c0ntr@cting that the baby "bears down" and does
What incredible balderdash! Of course babies move during labor. Sometimes less than before, but they do move. Birdie's Mama was right to question. She also began to wonder whether the "excruciating pain" she felt was right. Any woman who has had a baby can tell her that it is no picnic. So much for the romantic side of labor. Labor is not only hard work, it hurts.
The "midwives" put her on her side. There is no mention of oxygen in the blog. They then called the backup midwife (by implication a CNM) rather than alert the hospital that they were bringing Birdie's Mama in with probable severe fetal distress and to prepare for all emergencies. The hospital, in any case, was a small community one without an obstetrician in the house all the time, and possibly no neonatal intensive care facilities. The "three minute" trip, because of weather conditions, took longer (it always does; and getting dressed, etc. eats up the time as well. This is one of the reasons that countries with organized backup facilities for home births work on a concept of bringing the "hospital to the home" rather than the other way round). The nurses at this hospital were obviously unprepared for this type of occurence.
What Birdie's Mama describes as chaos, and as a situation where no one knew what to do is not entirely fair. (I can't think why she was told to go into knee-chest position). Writing after the event, there is an element of wanting to assign blame as a way of relieving guilt (she becomes much more critical of the hospital later on) Not being a medical person, she didn't fully understand what was going on. But there were delays that would not have happened had she been laboring in a well-equipped and staffed hospital. Further, she seems to have had some kind of seizure on the operating table, but I suspect it was a panic attack--certainly not surprising.
In short, her baby was born dead. There was some question whether the baby's heartbeat was actually heard in the hospital, or whether what the nurses heard was the maternal pulse. How long the baby had been in distress is unknown. One has to wonder whether the "midwives" actually heard the fetal heart before deciding that Birdie's Mama should go to the hospital. It's quite possible that what they heard was the maternal pulse. The placenta looked "normal" (no reason why it shouldn't actually) and nowhere is it noted that an autopsy was performed before the baby was cremated when dead three days.
I think Birdie's Mama's antenatal care was not adequate. She was obsessed with the effects of "toxic" substances on her fetus and eating only "organic" vegetarian foods, but certainly the choice of birth attendants was not sensible; these were not medical professionals. The question of whether a home birth should have been attempted is controversial. I'm not convinced that she was a low-risk patient who should have had even a trial of labor at home.
For the past few months she has been wallowing in grief. It is always tragic to lose a baby. It's my opinion that she needs professional counseling (and her husband probably does too). As grief gives way to anger, the next stage of grieving, her anger is increasingly directed outward at the hospital. Understandable, but not really correct, given the circumstances. Her most recent posts discuss the possibility of trying for a VBAC in her next pregnancy. She thinks this is possible because of the type of Caesarean Section she had. Wrong. It depends on a number of factors. VBACs, when the reason for the C/S was fetal distress are possible; if the reason was failure to progress in labor/cephalopelvic disproportion (baby too big to pass through the pelvis) it is not, whether fetal distress was a factor or not. Since babies tend to be some ounces bigger in each subsequent pregnancy, this may be a major consideration.
Right now she has become enamoured of something called "Mayan Massage". I haven't got a clue what this is, but since her uterus long ago reentered the pelvic cavity and cannot be massaged at all abdominally, I can't think what organs other than the intestines are being massaged and what effect this has on adhesions (present, if at all, within several weeks of the operation) or on the position of the uterus or its ability to house a pregnancy. It is a total waste of time, and money, although a massage is an enjoyable way of spending time, I'll grant you that.
In short, next time round Birdie's Mama should get competent, professional medical care during her pregnancy, and accept it. She should choose a hospital not because it's homelike or comfy, but because it contains all the facilities needed for all events connected with birth, uncomplicated or complicated. The idea that hospitals just want to make people suffer as much as possible is absurd. Unlike minimally-trained homebirth "midwives" who bleat on and on about having beautiful and "spiritual" experiences, hospital staff have only one top priority: the safe delivery of mother and baby. That is, after all, the whole point of giving birth.
I wish Birdie's Mama consolation for her loss, and the wisdom to make better choices next time--and I'm sure there will be a "next time".
Sunday, July 22, 2007
Shades of an old Jewish joke. But this isn't funny: see "Glad tidings for the lepers" in today's Haaretz.
And I think it's time to tell my own story.
First, some background. My mother was born to a Jewish family that left Russia in 1905 for the Lower East Side. She alone of her three siblings was born in the US. In her 20s, which was during the "Roaring Twenties", like many other young Jewish women, tried hard to obliterate all traces of her heritage. She was a "flapper"; she anglicised her name, did not date Jewish boys. When the Depression hit, she kept her job with the Veterans' Administration by moving to Washington, where she met my father.
Dad came from the Black Hills of Dakota--Sioux Indian country. Two of his grandfathers had fought against one another at Gettysburg, and the family, on his father's side, could trace its American roots to before the War of Independence. He was something of an oddball for his time and place, however: he voted Democratic, considered himself an agnostic, hated everything to do with horses and cowboys, affected an Edwardian look about 2 decades too late. His plans to become an engineer were sidetracked by the Depression, and in the mid-1930s found himself also forced to move from the Chicago branch office of the Weather Bureau to Washington, DC.
My mother, who thought Zelda Fitzgerald was simply the bee's knees, the height of exoticism, thought my Dad looked a lot like F.Scott Fitzgerald, and they fell in love. They were married in a civil ceremony, although it became obvious pretty quickly that Dad knew quite a bit more than Mom did about Judaism, he had no desire to convert. In fact, my mother's family accepted him much more warmly, in that day and age when intermarriage was a major crime, than was usual.
In due course, I arrived, but I was not told I was Jewish until I was 7. I then had 4, very disorienting, years of cheder. Shortly after refusing to go to Hebrew school (the afterschool variety) any more, Leon Uris published "Exodus" and, Halleluyah! I could be Jewish without being religious.
Fast forward to my 20s. Now a registered nurse, I met a young Frenchman on holiday, and we decided to get married. He was as irreligious as my father, but nominally was Catholic. The marriage (civil) lasted 4 months before being annulled (civilly). He had married mainly to convince himself that he wasn't homosexual, and had discovered that indeed he was. I later heard, via a third party, that he had committed suicide. I don't know if that was true or not, and never bothered to investigate.
When I opened a file at the aliyah center prior to making aliyah, I told all the above story to the shaliach. He thought he was doing me a favor by noting my marital status as "widow" because it gave me a double aliyah grant. At the time, I didn't know that. I don't remember supplying any evidence of my Jewishness, by the way. The shaliach took my word for it.
Fast forward again, to 1979. My mother was terminally ill; I had met the sabra who would become DH, and we went to the US for the wedding. The ketubah, an artistic one, was actually written here, to be signed and filled in as necessary in the States. I went to the only Orthodox mikvah in the DC area, but the wedding itself was going to be performed by a Reform rabbi, who was not only a very close friend of mine, but my parents' main support (Dad had never converted, but Mom dragged him to services every Friday night) during her illness. Rabbi Lipman had a lot of experience with Israeli bureaucracy and the Israeli rabbanut, and made sure the ceremony was halachically correct.
When we got back to Israel, DH said he wanted to get an isshur nisuin--a certificate from the Israeli rabbanut--that acknowledged our marriage. And that's when the fun began. The rabbis wanted me to prove (1) my Jewishness, and (2) the Jewishness, or lack of it, of my former spouse.
(to be continued)
Friday, July 20, 2007
Thirty years ago, when I made aliyah, it was quite true that Israel lacked many American luxuries. Electrical appliances--those which were available, in pre-microwave and pre-VCR eras--were so highly taxed as to be almost beyond the reach of Israelis, with the exception of small refrigerators (not self-defrosting) and rather basic, and also small cooking stoves. Lots of women still did laundry by hand, although the washing machine (also small by American standards) was somewhere between "luxury" and "necessity". My sister-in-law, who lived on a moshav built to house Jews from Middle Eastern countries in the 1950s still only had one tap, for cold water, in her kitchen. Dryers and dishwashers were still regarded as luxuries. TV was black and white and there were only three channels anyway: Israel, Jordan in English, and Jordan in Arabic. All the channels closed down early enough in the evening to ensure you got a good night's sleep. To have one's own car--a "private"--was definitely a luxury.
So immigrants, clutching their precious "rights", prepared to abandon America for Israel as if they were going on a kind of Mayflower in reverse, bringing everything they could possibly want for the next 50 years with them. Lifts were packed, for example, with disposable diapers (unknown in Israel) and jars of instant coffee (expensive and although locally available, not very coffee-like to the American palate). Soft toilet paper was also a favorite. In the 1980s it seemed water filters were an indispensable item (tap water is safe to drink in Israel).
Appliances were bought en masse from export shops on the Lower East Side. The "rights" allowed you to import one of each kind of item from your country of origin without Customs duty or purchase tax (usually 110% for electrical items). The only way you could NOT pay tax on a German-made washing machine was to import it from a 220 volt electrical appliance shop in the US. Having "rights" for tax exemption had another consequence: it made you buy locally more than you needed, since you only got "one". I am lumbered today with a 2 X 3 meter carpet I can't begin to shift because it's so heavy, but had I bought two smaller carpets back then, I'd have had to pay tax on one.
And the Americans came with everything, from stashes of vitamin tablets to a five-year supply of sponge mop refills. Not just what they had owned in the Old Country, but everything they could possibly imagine needing in future. Questions on the Tachlis email list, which I joined in 1997, often were about items veteran Israelis had never even heard of, nor felt the lack of. Diaper Genie bags? GPS units? Pressure cookers?
In the past decade prices have plummeted on nearly all electrical appliances, and at the same time the shops all began to carry wider and wider varieties of brands, from excruciatingly expensive to el cheapo Far Eastern junk. My first PC cost me close to $2000; I replaced it a few months ago for a much better one for about $700. My first TV was also well over $1000 for a small, 14" B&W one; you can now get a 37" LCD one (HD ready; there's no HD in Israel yet) for about the same price and the average price for a 29" standard TV is around $500. DVD players can be bought for less than $100; my first (Betamax) VCR was about $2000.
It's ALL here, folks! You may not get the tax discount, but it hardly matters, when you add the shipping costs to the "cheaper" item you bought in the States, from a narrow range and without any certainty of local service.
Israel isn't the end of the world. It really annoys the heck out of me that olim are still being duped into shipping massive amounts of stuff in the belief that they are going to some benighted desert like sub-Saharan Africa and the "natives" sit around outside thatched huts, rubbing two sticks together to make fire. And it annoys me even more that, now that Nefesh b'Nefesh is giving money to olim, businesses are actually starting up to relieve them of it, by making claims that the services they provide will actually save the oleh money and/or distress. 90% of it is so unnecessary.
The latest cause for oleh panic was the reduction in the discount given to olim buying a new car. Life in the US (except maybe in central Manhattan) without a car is unimaginable. Here, it is a very mixed blessing. The cost of gasoline, insurance, and maintenance is extremely high. Local incomes, however, are relatively low, in most cases. A car is a convenience, no doubt of it, but once the grace period for income tax reductions, etc. ends, and the oleh is living on an Israeli income, a car can become a huge burden. Try telling this to an oleh; he won't believe it until it actually happens. So, to counter the payment of purchase tax on a car, olim now are increasingly attempting to actually ship their cars from America! Besides a huge amount of bureaucracy and regulations to cope with, it costs about $8000 to do so. But of course, those homesteaders in the Old West moved west with their wagons and livestock, so I suppose I shouldn't be surprised that today's olim want to bring their MPVs and vans with them...
Sunday, July 08, 2007
Most of us with parents who were first generation immigrants remembered how they worked long hours every day, and then went to night school, if at all possible, to "become Americans". My mother, the last child and the only one born in the US, after her family left Russia in 1905, was the "Amerikanska" and it was so important to leave the shtetl behind that no one ever spoke to her in any language but English, even though my grandmother's English was very poor. And she herself rebelled against her birth name of Luba and Anglicized it to "Lenore" when she was in her 20s. It was only with the rise in "Black Power" in the 1960s that ethnicity became "chic" in the US.
Something similar seemed to be happening in the UK. When I lived in Cambridge in 1975, the British comedian Dick Emory had a very popular sketch on his weekly program in which, dressed as a bucktoothed, elderly Indian gentleman in Nehru cap and jacket, he would give his grandson heavily-accented advice, every sentence beginning "We British..."
But the similarities with the two immigrant experiences end quickly. The US, at the beginning of the 20th century, took in vast numbers of immigrants from all over the world, and had lots of space for them. Even while trying to become "American", just about everyone had roots not many generations back somewhere else. Britain had a very homogenous culture and not a lot of room. In fact, one of the raisons d'etre for the Empire had been its solution for masses of young Britons looking for work they'd never find in the home island. Emory's Indian gentleman wasn't applauded for wanting to identify as British; he was laughed at. And color mattered, in the UK, too. (It did in the US, Asians and blacks, getting the worst of it, so that the "white races" like the Irish and Jews fared better). But whereas the average American had at least some sympathy for the "greenhorn", the British were patronizing, secure in their Britishness. At least until after the Second World War, when the wogs and darkies decided they'd rather be independent .
Friday, July 06, 2007
Monday, July 02, 2007
Besides, I intensely dislike the humidity of the coast, and if I were to go to the Tel Aviv-Gush Dan region, I'd go in December. But who am I to refuse a free meal? (Nurses, it should be noted, never refuse free meals.)
We drove through the chaos at the exit from Jerusalem that is the building site of a very modernistic Calatrava bridge that the city needs like a lok in kop, just as the sun was setting behind the Judean Hills, and everything seemed normal (the road's been improved a bit, I confess) until we got to the Shaar HaGai interchange, where the mountains suddenly change to flat land. What had been fields seemed mostly now to be road construction sites, with unfinished tunnels and flyovers and bridges and the landscape totally ruined in just about every direction. I had hardly taken this in, as we passed the exits to Ben Gurion, when one of the red double decker trains rushed by, and I had the feeling I had been transported suddenly to Queens, or the Jersey approaches to Manhattan. Tony Soprano would feel right at home. The entire approach to Tel Aviv now looks dreary and run down, with large billboards, often almost entirely in English, advertising Sony or Chevrolet. The roads are full of shiny, large cars, and in between hi-rise buildings like the round Azrieli Tower there are strip malls with Office Depots and McDonalds.
The restaurant itself is at the marina, just outside a shopping mall that could have been anywhere in the American Southwest, with its "Mexican Mediterranean" theme. For a fixed price you get an endless amount of 11 varieties of beef which has been grilled on rotating spits "in the Brazilian manner". Except that I ate too much meat and not enough roast potatoes, so that I awoke hypoglycemic and sweating at 4 a.m., it was a pleasant experience--I might think about going again in about 5 years or so.
But I felt so sad, seeing the Israel I made aliyah to disappear under the Trans-Israel Highway and skyscrapers and malls a la East Coast USA. Time was, as you drove from Jerusalem to the coast, Shaar HaGai was an intersection, where (after waiting for an age and with your pulse racing that you could get your car in gear and cross the dual carriageway before some other car came, like a bat out of hell, across your path) you turned left to go to Bet Shemesh. This "intercity highway" was actually two lanes in each direction at this point. As it went around the Taggart fort, dating from the British Mandate, now the headquarters of the Tank Brigade (with a tank up on a high platform, looking very odd indeed) and the Trappist monastery at Latrun, the road narrowed to one lane in each direction. It crossed a ravine by way of a single lane wooden bridge, causing traffic buildups in each direction, then rose out of the ditch by a series of hairpin curves, to enter an area of moshavim, mostly subsisting by selling produce and flowers at roadside stalls.
There was no such thing as an "express" Tel Aviv-Jerusalem bus when I arrived in the 70s. There were several varieties of "local" depending on whether the bus stopped at every stop or every second or third stop, or merely when flagged down or a passenger (who then would often trudge a kilometer or more to his yishuv) indicated he wanted to alight. There was no airconditioning--the buses resembled the yellow and black school buses one sees in rural American areas (except these looked a lot more banged up and dirty) and the back third was empty for baggage, goats, chickens, or Yemenites, who felt more comfortable squatting on the floor, apparently, than sitting on the fiberglass (hard to vandalize) seats.
The road was lined with eucalyptus trees, bark peeling, leaves always--even in the winter when it rained--looking dry and tired. Every so often there'd be a black and white sign, like an arrow, pointing to a clump of houses in the midst of fields that, depending on the season, were either plowed earth, green with growing grain or sunflowers, or yellow as harvest approached. "Gezer" was about halfway between Jerusalem and Tel Aviv, and it was always something of a shock to realize that the modern kibbutz was barely a stone's throw from Solomon's chariot city. A lot of the place names, such as Mikveh Israel, had distinct resonances to any student of Zionist history, not to mention ancient history.
The closer to Tel Aviv and the coast one got, the more the fields gave way to orchards. The Nesher cement factory intersection was where one really felt the approach of the city. And the old central bus station in Tel Aviv! A world in itself. I think I'm the only person around who actually misses the old Central Bus Station in Jerusalem. It was, so, well, Israeli. It was so grimy and uncomfortable, open to the elements, with convoluted railings and splintery benches designed to keep the passengers from mobbing the driver when the bus (finally) opened its doors. But prior to the everyone-has-his-own-car era, the Egged bus co-op was a real leveler of society and you met everyone (and not infrequently their pets and/or farm animals) on the bus. Thank heaven Tverya's bus station still hasn't been "modernised".
I don't mind good highways, and fancy restaurants and malls. But so much of the flavor of Israel is going, soon they'll have to build theme parks to remind us what the earlier decades of the country were like ("Experience life in a ma'abara! Work in the fields by day and dance around medurot at night like a chalutz at the Tzena-World! Group discounts for students and pensioners")
Sunday, June 10, 2007
Friday, June 08, 2007
Tuesday, January 16, 2007
"But you will not convince the nurse-specialists of this; they still
churn out their vacuous botty-wipe when they would be better occupied wiping
bottoms. "Thus writes "Dr. Crippen" of the NHSDoctor blog. He is a British GP who is deeply, deeply unhappy with the state of the NHS. His attitude seems to be that the NHS would be in fine form if doctors were paid the kind of salaries that US private physicians made, and if it were managed by the CEOs of major industry.
This does seem somewhat contradictory to the original aim of the NHS, which was to provide every British citizen with a high level of free health care, but I can see the allure of it. My own experience of the NHS, in, admittedly, a somewhat ideal situation and over 30 years ago, gave me a lot to think about.
ANY national health service, introduced at a time when the country was bankrupt [as the UK was after two ruinous World Wars, a Depression, and the loss of its Empire] is going to have hard going living up to its promises. Especially at a time when it still had food rationing, for heaven's sake. Moreover, there wasn't then--and there isn't now--any way to adequately budget such an all-encompassing health service for the simple reason that inevitably it will uncover vast amounts of hidden health problems. You don't go to a doctor when you're feeling a bit off-color if it's going to cost you an arm and a leg. But if it's free, you run to him with every ache and pain (real or imaginary) and some turn out to be serious, unsuspected illness. Further, there's no way of knowing what advances there will be in medical science. Heavens, when I was a child, there were hardly any antibiotics besides penicillin, and when I was a newly-graduated obstetric nurse, neither ultrasound nor fetal monitors had yet been invented.
And lastly, the NHS was brought into being by politicians. And every change of government--and sometimes even more often than that--added "reform" which is politician-speak for another layer of bureaucracy. And bureaucracy = inefficiency nearly 100% of the time.
But my year in Cambridge was vastly instructive. The level of care a pregnant woman/newly-delivered British mother and her baby got was immensely better than her American cousin who did everything privately and at great expense (let's not even compare our British patient to those millions of American women who have no antenatal care at all because they haven't got insurance or ready cash). Even in the mid-70s there was moaning and teeth-gnashing by the consultants about the "14 signatures" needed to order a new scalpel, but I couldn't help feeling that some of this was overreaction when I made home visits (home visits!!) to every woman after discharge from the postpartum ward to check her and her baby. American women have no such service at all.
But that's not what I really wanted to address when I began this. "Dr. Crippen" doesn't like nurses who don't stay in "their place". He doesn't like nurse practitioners, calling them "nurse quacktitioners". He obviously feels very threatened by them and wants to maintain his medical superiority at all costs. I noticed this back in the 70s in Cambridge. Doctors did not breathe the same air as us on a social level. Nurses were expected to associate with hospital auxiliary staff, such as ambulance drivers. Our lounge in the hospital had a black and white TV and several tabloids and the Daily Telegraph while the doctors' lounge had a color TV and The Times. (As a Yank who didn't know any better, and since the doctors' lounge was in the part of the nurses' residence in which I lived, I blithely used the doctors' lounge all the time and none of the doctors--the British are so polite--quite had the nerve to ask me to leave it) This was rather odd, because the relationship between the obstetricians and the midwives was actually quite good, on a professional level. The Central Midwives Board's code of practice made us the complement of the doctors, not subordinate to them. As long as our patients were within certain parameters, we were not even obliged to notify a doctor of their existence. But once those parameters were crossed, and we called a doctor, he knew that it was not a trivial call.
What "Dr. Crippen" is actually protesting is not that nurses are too stupid to work in conjunction with, instead of for doctors. What he is protesting is the level of their education, which, for all I know, may be inadequate nowadays. If this is true, then get the nurses' education upgraded! But don't be paranoid about nurses being used as "doctors on the cheap". Nurse practitioners can be an immense asset.
I currently work in the Israeli version of an HMO. Every day I get women who come into my room seeking amplifications and explanations that their doctors either didn't think necessary to give or which they didn't understand. It is part of my job to make sure these women do understand, as well as to screen those patients prior to seeing the doctor. Sometimes they don't need to. Sometimes they need to see the doctor immediately and must jump the queue. The doctors rely on me to be sufficiently able to discern this. That's what I mean by "complement".
I could do more. There really isn't any reason to make a woman wait an hour to get a prescription for prenatal vitamins, but in Israel nurses cannot write any prescriptions at all. As a midwife, in hospital I can do a vaginal exam to determine if a woman is in labor, but I can't do that in a sick fund clinic, although we tell women that they should come to us rather than go directly to the labor unit if they suspect they are in labor, in order to prevent unnecessary trips to the hospital (which charges the sick fund). So when a woman arrives, in obvious labor, I have to have her wait until a doctor is free (and to the great annoyance of the other women, who have to wait even longer to get into the doctor).
When I was a student nurse, I remember being told by a nurse nearly ready to retire of her excitement when, in 1938, a doctor had actually allowed her to take a blood pressure. Now of course, even nurses' aides do it. As doctors get new toys, they generally find that--amazing!--the nurse who was too stupid or uneducated to use the old ones has suddenly had a brain transplant and can cope with the technology. I think it took about 3 years before we were allowed to do anything more than wrestle the tank-sized first models of fetal monitors into patients' rooms. Placing the sensors on the woman's abdomen was obviously beyond our capabilities (although dragging the heavy machine around wasn't) until ultrasound arrived and then the doctors had something new to entrance them and fetal monitoring became a time-consuming burden best left to their "inferiors".
Because I spent some time in medical school, I understand the difference in the mental disciplines of doctors and nurses. Our goal is the same: to return the patient to health; our methods are different. It is truly sad when one group feels threatened by the other, and the other is made to feel inferior to the "superiority" of the medicos. I'm not a "diluted doctor" nor do I want a string of initials after my name for the snob appeal in order to feel less "exploited". I think doctors--some of them, at any rate--actually resent that it is good nursing care which can actually be the determining factor in a patient's recovery. (And let me state that the quality of British nursing care which I saw in Cambridge was truly excellent). So yes, "Dr. Crippen", wiping bottoms is important. But it's not the only thing. When my mother was dying, good nursing care was all that eased her suffering, once the doctors had thrown up their hands. But the kind of care she received could not have been done by stupid, uneducated, indifferent health care workers. It was done by highly intelligent, well-educated nurses, who saw aspects of her situation the doctors never noticed. Without the care and the observations of the nurses, doctors wouldn't have almost any data on which to base their plans of treatments. Lab results and tests only tell you so much.
As part of his blog, "Dr. Crippen" includes a weekly diary of some of the patients he sees. Nearly every week he describes at least one patient who could have been assisted by a nurse, at least partially, and would have helped him spend more time with the sicker ones. He finds this almost frightening, and I really can't understand it. I'm not there to replace him, heaven forbid.