Haven't posted any comments all month. Maybe I got sidetracked by the yom tovim. Since last time I departed St. Francis Hospital which has greatly liberated my schedule and my personal life though I will need to reschedule the office to minimize the financial impact of this.

Yesterday I had a chat with somebody my age who got absorbed away from patients toward management. I couldn't tell whether he liked the new arrangement. I suspect he'd like to see a few patients but I didn't suggest he put himself back onto the call schedule. For my part I've become increasingly intrigued about the operations of medical care and would like to close my career by moving in that direction. There is now a great interest in outcomes and cost-effectiveness and coordination which are underserved by the payors. Come February I'll have more of an opportunity to pursue this and hopefully latch onto something professionally.

It's early morning, coffee ration nearly depleted until I get to the hospital and make some more. I've felt tired of late, not ill, just worn out and not motivated. It shows in the office where charts have begun to accumulate and partially completed projects don't seem to get fully completed. I've begun marking the completable tasks on my daily list and have focused a little more on checking them off so they don't keep getting carried over from one day to the next.

Some of the simplest tasks like exercising and eating judiciously have proven the most intractable. Some of my writing tasks remain in limbo, particularly the difficult ones. Next week I depart from the St. Francis hospital, ostensably to create time away from urgent toward important. I think that will happen.

It was an unusually pleasant shabbat experience last weekend. As part of my monthly visitation series I had intended to sample an orthodox shul not far from my in-laws. As a courtesy, when I visit a place where people walk, I park the car in a shopping center or similar place about a half mile away. There are occasions that warrant my enduring some precipitation but congregational exploration and voyeurism is not one of them. The forecast warned of showers at about the time services would conclude so I redirected my schedule to Har Zion, a megashul in a ritzy area whose wealth and prestige allows them first dibs at professional religious talent.

In many ways it was the finest Conservative Judaism that money can buy. The Rabbi seemed younger than I might have expected for an appointment to preside over such a monument to the USCJ. The Cantor chanted in a lyrical manner befitting ongoing vocal coaching. While I'm not a great enthusiast of cathedrals, particularly Jewish ones, I left with a better appreciation of why our ancestors insisted that the Mishkan and Temple be ornate, though I think sacrificing a bullock on the shulchan of Har Zion's bimah would detract from its visual, auditory and olfactory appeal. Art hung from the wall. Every room had a donor plaque. There was a spiritually appealing alcove where they kept their yahrtzeit plaques, gated and specially illuminated. For kiddush, they served Johnnie Walker Black in heavy-bottomed shot glasses and wine in stemware. Their kids wore clean clothing on shabbos. No artificial fiber ever touched the president's skin. Plush Judaism. It was also competent Conservative Judaism, something I do not experience often enough.

Hospital census zero for the first time in memory. That gives me a taste of the fall when I pull out of St. Francis Hospital and will have considerably more flexibility to my day, not to mention earlier returns home and more productive evenings at home. For now this is a novelty, a temptation to loaf but an opportunity to catch up or maybe even move ahead. My desk is a mess, the ABIM renewal has gotten behind and my car could use some new oil. It's all about priorities. It's also a chance to start moving into the things that allow me to become a sage.

Last evening I went to a Beth Shalom shiva minyan. There was some fear that a minyan would not materialize as the passing of a very wealthy member would siphon off some of the usual attendance. We got good attendance. The rabbi was not there, following Sutton's Law, I presume. A congregant conducted services while I worshipped in my usual way and observed in my usual way. Some differences were quite apparent. First, despite the early hour, they started with maariv instead of mincha. I do not know if the baala tfilah could repeat a weekday amidah. At maariv, the baala tfilah did stuff with a tune only. There were the usual English readings and while I read familiar Hebrew at a good clip, she moved on before I could finish which implied to me that nobody was really reading the silent parts with any proficiency. The service was designed to be familiar but not to enhance capacity over time, which I think to be the ultimate downfall of the conservative movement and the product differentiation opportunity for akse, though I'm not optimistic of our baalebatim appreciating that.

Recovering from a weekend on call. It was one of the lighter ones, usual frustrations of my communication system failing on me but not oppressive in terms of volume or urgencies. I'm a little overdue for vacation. I can tell by my general irritibility and lack of interest in doing what i ought to be doing. For the Glorious Fourth I have a four day break during which Irene and I will take in the sights of Mystic and environs. I went there as a camp outing in 1963 and remember the day fondly. Over the years I've had occasion to pass through New London but never stopped for anything more exciting than a snack at the local mall.

I have surprisingly little planned for the outing. Travelling by car allows me to bring a few extra things like books and my laptop or maybe even my drawing kit, things that would be too big a shlep on a plane for a four day trip. My plan at present: Thursday morning getting there, Thursday afternoon resting at hotel, maybe stop at Coast Guard Academy or art museum at Connecticut College, Friday and Saturday Mystic Seaport and Submarine attractions, Sunday home with perhaps a stop in NYC to see Alan's new digs. Nice dinners in the evenings.

I'm flexible and it's Irene's respite too.

rich the furrydoc

shavuot has come and gone. yizkor may have been the last rabbi dresin i will hear, at least officially as he will not be speaking at the belfer bat mitzvah this coming shabbos and i am on call the following week. that leaves the board meeting dvar torah and the last shabbat in june as the final opportunities.

my take on his pre-yizkor remarks goes something like this: he sees the leadership of the congregation as somewhat delusional if they think they can perpetuate the status quo indefinitely. i couldn't agree more. he sees little incentive to grow the capacity of the membership, it certainly doesn't appear self-driven. not only is it languishing at akse but throughout the community there has been an acceptance of mediocrity. his antidote to mediocrity differs from mine. he would put in a mikvah. why? to make it easier to convert people but he would be the first one to withold that right from his fellow RAD members if akse owned the mikvah and set the policy. i think the status quo is better, with the conservatives in wynnewood controlling the mikvah's access and the black hatters assuring its kashrut. he would like a stronger day school. ironically, me too, as it sets the jewish tone for the community. if it is run by slimebugs as i encountered, then it is probably a correct assumption that the leadership of the jewish community tolerates slimebugs. if it functions as a little snot factory, then that same patronizing approach by the leadership toward the constituents permeates other areas. the day school must be strong in its teaching and above reproach in how it treats people at the margins. the rest of the community will follow that same barometer.



i see akse's potential very differently than rabbi dresin did. my model focuses on a hybrid between hillel and ramah. the congregation needs to reflect its constituents to create a base of stability. you cannot successfully pretend to be what you are not under any circumstances. true, you can display what you aspire to but there is a certain amount of honesty required that you really aspire to what you claim and a certain accountability that you work toward what you claim. i see beth shalom doing that but not akse.

akse has a lot of strength. i don't think people realize how important it is to not have macher swoops and to have champions of pet projects. i do not see a lot a vision of what is possible and what is worth working toward.

on the agenda for today, post-practice planning, semi-annual planning and life after st. francis, all related in some way. at the penn commencement mark platt c'79, jd nyu and prominent hollywood producer spoke about the stories that need to be told. we all have some of those stories and are al part of some of those stories. can i describe a genius or a buffoon well. can i make mediocrity or something exception appear vivid. i'd sure like to try this coming six months.

life after st. francis

after several years of professional torture that i can honestly say a) diminished me as a physician and b) prioritized other peoples expectations over my own, i not only decided to pull the plug on st francis hospital but actually did. while the chief medical officer made a very negative impression on me not matched by anybody else over the years, in a sense i am grateful since i probably would have shown more loyalty to a physician that i hold in higher professional regard and not afforded myself the chance to harvest things more to my physician liking as my career reaches its conclusion.

now comes what to do instead. fortunately, june coincides with my semiannual planning that will be taken into account. my guess is that i will have about 15 extra hours weekly as a result of this change though only about half that will come within ordinary working hours. there are certainly new opportunities and i've already made a few early inquiries to explore them.

return to work after a three day weekend. it's not easy and perhaps makes a statement about the work. i've divided my projects into six segments, each done semiannually. this half year:

1. become a sage
2. make my bedroom a sanctuary
3. observe shabbat
4. lose weight
5. move ahead professionally
6. create my synagogue's future

how did i do?

1. i had an editorial in the delaware medical journal and a personal letter with the head of united synagogue of conservative judaism
2. i started organizing things but it's a daunting task and my wife has other priorities
3. i read rabbi frand's commentary every week and i had a shabbat guest.
4. i weigh more than in january. restricting intake has been a struggle and i've been very inconsistent with exercise
5. i decided to divest myself of the st. francis hospital. i'd like to become an expert on coordination of care and cchs may give me an opportunity to pursue this, if not i'll find the opportunity someplace else. i've written a few editorial pieces commenting to the aei think tank and gotten a few responses.
6. i've written a few editorials pieces, transmitted to people who can benefit from them. i've gotten the financial reports to be more understandable.

not bad, not great, but i worked at them with reasonable diligence. in a week it will be june, time to plan the next semiannual projects. i think i need to be more specific about what i want to do.

memorial day holiday, a day off to get caught up on household chores, some of which i did. my garden was disappointing except for sage which seems to outgrow the entire 4 x 4 ft block. we got the deck prepared for the finishers and i made some progress putting away my clothing which has been a daily incomplete project for nearly three months. for a half hour i decluttered the basement, something not really on the get myself ahead list but necessary. rmp

introduction

it is time for me to set up. first, a little about me. i graduated an american medical school of which i am quite fond in 1977. appointments with me are increasingly hard to come by through no fault of my own, though after thirty years i am starting to wind down the patient care aspect and harvest the proceeds of varied experiences and a creative, irascible mind.

while i thought i might be an empty nester by now, such is not yet the case. my daughter starts medical school in the fall, my son just graduated and probably will spend the coming year seeking his highest level of amusement on the video screen. my guess is that he will turn toward medicine as well, maybe going into critical care where the physicians now watch the icu activities on television from a remote site.

this past august my wife and i celebrated our thirtieth anniversary, which counts far above any professional achievements that may have intruded along the way.

we live in a typical suburban tract house, all paid for except for another year or so on a home improvement loan to install paint-free siding, then followed by another similar loan of similar sum for a new roof. we are hopelessly thorough savers, which has worked well for us economically but also resulted in 2400 or so square feet of clutter. the organizing shows on tv wouldn't know where to begin.

this memorial day weekend i'm toying with the summer schedule of obligations: graduation, the rabbi's retirement reception, shavuot, a medical center outing that i'll probably skip, our friend's daughter's bat mitzvah that i won't be able to skip, jury service, a respite away for the glorious fourth, my wife's friend's daughter's wedding, and finally my friend's wedding which we'll tie into vacation. there are two weekends on call thrown in as well. could use some downtime.

rich the furrydoc