Ben Avuyah

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Sunday, February 18, 2007

Halachah: Crunchy on the outside Chewy on the inside

"Well your transcript speaks for itself…."

The look on his face was serious…and tired; dour, in fact, as he flipped through the pages as if he was weighing some celestial dilemma of yore that drained the very vitality of life from his veins.

I scrutinized every line of his aged pale skin from across the table, that pasty mask spread thin over bone, every furrow and trough a potential tell of his inner thoughts.

Had the interview been too boring? Had too many minutes of bland conjecture and review of particulars left us flat?

Should I reverse the formality now, boldly charging into some delightful anecdote starring yon bastion of charisma…yours truly?

Should I corral the fluttering butterflies in my stomach into a stampeding force and break the silence with a witty and impassioned spark of personality?

Had the time arrived to cobble together my doppelganger; that spare personality, hastily assembled of raw ambition and coffee grinds, that I was accustomed to modeling for public consumption on such occasions of need?

Thought materialized into action as my tongue, as dehydrated as shoe leather from the unique fusion of coffee and nervous adrenaline, peeled off my soft palate, from whence it had nestled so cozily, with an audible, multi-punctate, staccato of well adhered Velcro, echoing in my inner ear with the full force of social faux pas it represented. Only to be deftly outdone by my dry lips, which having been pressed shut for some time, opened now, with a bold and melodic "pop", as if I were about to jump from my chair, wave my hands in agitation and assault my interviewer with a rich and hassled monologue of Swahili, replete with every guttural click and whir of the deep rain forest, capped off with the deliverance of a graceful blow dart to the jugular.

But just before my witty rejoinder could rumble out of my dry throat like so many dusty old nails…he spoke.

"You are one the best candidates we've seen this year", he looked happy now, almost relieved, and his pronouncement echoed through my head.

I felt wonderful.

Muscles unclenched, my shoulders loosened and finally fell to a relaxed position, enough saliva was actually liberated for me to lick my lips. That poisonous bile my stomach was churning melted to butter.

By God it had gone well…very well. Those poor suckers waiting for their turn to interview had best grab Danish from the food cart and head for the hills….this was a wrap.

God, I reveled in the moment.

There he sat, chairman of the department, ostensibly the top of his field, surrounded by his myriad of diplomas, symbols of abundant ego allowed to overflow until they occupied every nook and cranny of conceivable wall and shelf space….and he chose me!

Me, to pass along the torch of medical knowledge. Me, to become his heir, his adopted son, to glean from him the wisdom that takes a lifetime to gain.

It was heady, and a sense of warmth and euphoria spread from my innards like warm milk laced with opoid, soothing the frayed nerves with the dulling salve of success, ending in each appendage with a tingle that made me want to giggle like a little girl.

He was crossing the room now with a hand extended…

I gripped it firmly looking him in the eye, my pleasure undisguised, for this was no longer the meeting of one doctor evaluating a potential hire. This was a meeting of peers, of colleagues, who recognized each others accomplishments and worth.

“I had best get going, I have a busy day tomorrow”, he confided to me, his new resident, save for the ceremonial red tape of the paper work, “and I have a few charts to tweak for medical necessity before tomorrows rhinoplasties, gotta get that insurance to kick in.”

Of course he did…that Jag doesn’t buy itself.

Still standing in the middle of the room, I marveled at how quickly our relationship had gelled. How quickly I had moved from a seeker of admission to a trusted confidant.

Trusted with the inner workings of his practice….the slightly questionable inner workings of his practice.

Well, I conjured; he wouldn’t be the first physician to get cosmetic surgery covered for patients who couldn’t ante up, by attaching some element of medical necessity to it…

He was smiling at me from across the room as he packed his papers into his briefcase….or was he studying me?

How quickly that warm tingly feeling was replaced with ice in my veins.

Shit. Shit. Shit. Shit. Shit……

Had my interview really finished….or had it just begun?

“Tweaked for medical necessity”?

The words just crept out.

“Ben, your new at this”, he said as he lifted his briefcase from his desk, “with time you’ll learn how to bend and break rules as you need to…”

He walked across the room and patted me on the shoulder, “Don’t let the insurance company tell you how to practice medicine!”


Foul Damnation!

I had been safe on the shore line, well rescued, well resuscitated, and now….. back into the dark waters?

What was this? What kind of unholy trial was I now participating in?

Didn’t he understand? I knew anatomy, I knew physiology, I filled in multiple choice bubbles with a number two pencil with greater accuracy than the rest of my class. Those were my tests, those were my challenges...

Did he need to know that his new resident would not be a leak to the insurance companies about his questionable practices? Was he prodding me now to get a feel for how at risk he would be with me underfoot?

“Well I agree with you there, we should always put the patient’s health ahead of insurance rulings…”

Or had I misread him? Was he placing a moral conundrum in front of me to see what I was made of?

His eyes were shallow pools of pale blue looking into mine and offering not a clue.

“…but I don’t see how that is related to…uh what you said….before….”

Good will, comradery, fellowship, left the room and took their kindly warmth with them.

There was a clammy cold between us now…

“Excuse me?”

I avoided his gaze and stared at the down turned corners of his mouth; trying to parse it all out.

He could be on the level, honestly discussing the way he “bends” rules with a future resident. It was certainly possible, in which case I had just begun to throw away years of hard work to enter this program.

But did I want to work for someone who was that confident of his shady practices?

On the other hand it could all be a test…

Could I tell truth to power?

Could I challenge the chairman on my own heartfelt moral principles and not waver against the force of his personality?

Some programs wanted yes men, but some wanted strong individual thinkers…

There where no answers to these questions or at least none appeared to me in the uncomfortable silence as he waited for my reply.

“I don’t mean to be rude, or offensive, but just want to point out that adjusting the symptoms or fabricating….”

“You know something”, he said, his voice an octave higher, “I’ve been treating patients for thirty years…I’ve been chairman of this department for ten….where do you get off telling me…
“I’m sorry.”

“…telling me what the right way to take care of patients is.”

“I’m just trying to tell you how I feel about any program that would not be up front about…”

“You know what, Ben….Ben, thank you for interviewing at our institution”, he said his hand motioning me out the open door.

Christ, if it was a test, it was a damned good one; his face was as red as mine.

I walked quickly past his secretary and the assembled interviewees, the shame of failure hastening my pace to a brisk jaunt that took me out of the building into bitter New York cold, then down the steps to the warmth of the subway.

Even all these years later I can still remember the sense of confusion that filled my head as my body swayed to and fro in the unique ballet that the curving tracks of the southbound A compelled every passenger to dance.

Where had I gone wrong?

I ranked the program low on my list, associating it with a sense of personal embarrassment, and matched elsewhere, but over years of meeting with people in my field and rehashing painful memories of residency, I have run into a few who had done their time at that very program.

In fact, I found that it was a somewhat well kept secret among administration and resident alike, that the interview was a moral test, the chairman’s indignant face a well institutionalized act, and the passing answer was unwillingness to capitulate to his will. That was the type of personality he wanted surrounding him.


It makes one think, and when I think… I think of religion.

To those of us still clinging to the left flank of modern orthodoxy, at least outwardly, there exists a series of bizarre responses of the Rabbinate to modernity.

Yes it’s true; they will agree in private, that the modern mind functions via principles of intellectual honesty. That we believe things to degrees, and that degree is determined by the amount of evidence and data available. Yes, they will whisper, in hushed tones, that the level of probability and evidence supporting the particulars of our faith are low, and that one may indeed by more honest to believe very watered down versions of the actuality of our mesorah…


But, you must keep halachah, our system of law must be raised out of objectionable controversies, and quibbling inquiries of its validity. And as long as one believes in Halacha, they may pursue more comfortable beliefs regarding our biblical heritage.

Now, let me be sympathetic, I full well understand that without Halacha modern orthodoxy cannot survive. I grasp the fact that this is a flailing attempt to deflect that final blow to the wind pipe.

But is it honest?

Are the same problems that push us to realize the unlikely nature of our religious traditions also present at the base of our halachic structure?

I think that they are.

After all, Halacha is different from secular legal systems in that at its most base, it believes itself to be a representation of Godly will.

And that’s the problem.

Even the greatest amongst us recognized that although we may perceive God through his actions, we cannot hope to reach an understanding of his motivations, his plans, or the manipulations by which he tests us. (

The difficulty is that halachah is not a self contained legal system. It is an extension of God’s mind, and in that sense it is an outgrowth of theology itself: A murky tar pit with no bottom or sides upon which we insist we have built or rigorously argued a coherent code of law.

Yet the fact remains that upon such an unsteady foundation the only blueprint for construction is doubt.

I highlight but one example above…the idea that a creator being may deliver a code of law to test if its subject can follow it, to test if and when its subjects righteously rebel against it, or any number of reasons in between. Without knowing motivation or plan, there is not much more to say.

With the axiom in hand, the we are not privy to God’s thoughts, it appears equally likely that he would choose to test our ability to follow what he has clearly spelled out, as he would to test our ability to rebel, and “tell truth to power” when we “feel” our rules are not guided by moral dictates acceptable to our human sensibilities. Indeed, I weigh the second option over the first. What can God know about you character other than a willingness to follow rules, in the first scenario; it is the second case that is necessary to evaluate character.

I’m sure my devout brethren will argue, “God would never test us that way”. However, the more certain one is of that assertion, the more useful it is to a creator who really does desire to gauge our traits in terms of self assuredness, moral awareness, and ability to trust our own judgment. In fact, the only way such a creator can evaluate these traits is by artificially manufacturing a situation in which one is reasonably convinced that he challenges the will of the creator, and is strong enough to do so in any case.

I won’t harp on this for too long, as theology is just a merry-go-round of “what if’s” and “maybe’s”. We may all shout at each other until we are blue in the face yet no certainty will present itself.

You may proclaim that the best reshonim with ruach hakodesh said God wouldn’t test us that way, and I may proclaim that it was necessary for him to reliably convince us of this through the rabbinate, so that he could test us that way…let’s leave it there.

Of course, the above scenario is one aspect, one symptom, of a legal system based on unfathomable motivations.

How does one extrapolate, apply, and amend rulings, when we must honestly claim we cannot know what God wished to accomplish with them. In which direction do you make them more stringent? In what way to you provide leniency? Without intent it is just a game.

The point I return to is the integrity of Modern Orthodoxy.

One may admire their retreat from untenable positions of faith with regard to our traditions. We may salute them as they voluntarily back into a corner crying “myth” and “lore” to the tower of babble, and mabul, and avos.

But I believe that the central claim of Modern Orthodoxy: that Halachah can stand untouched by modernity, unsinged by rationality, unscathed by empiricism….is false. It is plauged by all of the external problems of believability that the rest of our religion is exposed to, as well as the inherent internal problems of a legal system derived from that which is, in it's own admission, unfathomable.

Thus, as long as Halachah claims theology as its foundation stone, let it build no higher than it can afford to pick up the pieces.