Friday, January 31, 2014


Trumah: guarding the sacred


The core of the Mishkan is the aron.  The a aron contains the tablet s. But the tablets are inaccessible.  They are Surrounded by numerous barriers:the caporeth with its Cherubim, the Parocheth, the inner sanctum etc.  It makes the core unknowable and mysterious.   Yet, the core is in the public domain. The innermost secret is known by everyone.

The Parsha ends with the word nechosheth, copper.  I think  this is an allusion to the serpent (nacash) of Eden , and is a key to understanding the idea of the sacred.   The  temptation to violate the holy barrier is the essence of the sacred.  That battle between curiosity  and the proprietary is the home of sanctity.

The public knowledge of the structure and contents of the Mishkan  only adds to the temptation.  The. Cherubim reinforces the analogy. They fly over the core of the Mishkan, the tablets. They adorn the  Procheth, just as they guard the path to Eden. The tablets are the forbidden fruit. They give wisdom, they reveal too much about the nature of Gd. They must be entombed and guarded lest their secret be revealed.  Yet, there is no secret at all.
Violating the sanctity of the Mishkan is like adultery. The revelation is that there is no revelation. 

Friday, January 24, 2014

Mishpatim: Applied Torah

Much of Mishpatim deals with the problem of the practical application of the Law engraved in stone.  Real situations require subtle interpretations. 

I like to think that the eternal Truth of the Torah  is applicable in all situations, including my medical practice.

I saw a patient yesterday who had been treated for a life threatening blood clot to the lung.  Analysis showed that she had an immune problem, the Lupus Anticoagulant.  This diagnosis has a very bad reputation for causing all kinds of clotting problems, including strokes.  

I saw this patient  in the context of her desire to become pregnant.  The Lupus Anticoagulant that she had could become more dangerous because pregnancy alone increases the risk of blood clots.  In addition, the Lupus Anticoagulant increases the risk of miscarriage by generating blood clots in the placenta. 

Most clots do not have a clearly identifiable cause. The usual, basic treatment for people who have blood clots is to give them anticoagulants, medicines that make it somewhat harder to  generate a clot.  The anticoagulant medicine is given for some time,  often  6 months.  The duration of treatment represents a time in which the unknown cause, hopefully, goes away.  A few years ago, the New England Journal of Medicine published an article implying that the physician should check a blood test, d-dimer, a test for ongoing clotting, before stopping treatment .  That article makes sense to me, and I routinely do that. The d-dimer test is somewhat ( possibly) overly sensitive.  Sometimes it is positive, and no clot is found. 

We had treated the patient in the usual manner.  We then rechecked the Lupus Anticoagulant  test and d-dimer test and they were negative.  I then applied the parsha: 
  לֹא-תִהְיֶה אַחֲרֵי-רַבִּים, לְרָעֹת; וְלֹא-תַעֲנֶה עַל-רִב, לִנְטֹת אַחֲרֵי רַבִּים--לְהַטֹּת.2 Thou shalt not follow a multitude to do evil; neither shalt thou bear witness in a cause to turn aside after a multitude to pervert justice;





Rashi interprets this to mean

From here they [the Sages] expounded that we may not decide unfavorably [for the defendant] by a majority created by one judge. They interpreted the end of the verse: אַחִרֵי רַבִּים לְהַטֹת, “after the majority to decide,” [to mean] that if those [judges] voting [that the defendant is] guilty outnumber those voting [that the defendant is] innocent by two, the verdict is to be decided unfavorably according to their [the majority’s] opinion. The text speaks of capital cases [i.e., in regard to the death penalty] (Sanh. 2a).

I understand this to mean that one should not make a life or decision based upon a single determination. 
So, before stopping anticoagulant we repeated the tests.  This time the Lupus anticoagulant was again negative, but the d-dimer was positive. 

The patient told me that she had gone to and ER for leg swelling and asked that the d-dimer test be done. 
The ER doc told her that he would not do the test because if  this overly sensitive test  came back positive, he would have to treat her!

  מִדְּבַר-שֶׁקֶר, תִּרְחָק; וְנָקִי וְצַדִּיק אַל-תַּהֲרֹג, כִּי לֹא-אַצְדִּיק רָשָׁע.7 Keep thee far from a false matter; and the innocent and righteous slay thou not; for I will not justify the wicked.



Thursday, January 16, 2014

Yithro: Objectivity

Yithro: Objectivity

Yithro is an outsider.  He had not been among the slaves in Egypt and he had only heard about the miraculous, victorious crossing of the Suf Sea. He is not among the descendents of  Isaac and  Jacob. No promises about the future in a land of milk and honey await him. 

The Israelites had seen themselves chased out by the Pharao (13:17).  Yithro sees that  Gd  has redeemed  them (18;1), and  thus kept the promise.  The people see the crossing of the red sea as  an excellent military strategy.  Yithro sees it as just retribution (18;11) for casting the Israelite sons into the river, and is thus evidence for  Divine justice.
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Yithro also sees Moshe from a different perspective. He also sees Moshe as a human with faults; a  man who left his wife and children to accomplish the mission.Yithro is  able to see the burden  Moses cannot bear. Moshe cannot continue to deliver this ad hoc justice.  The situation needs a bureaucracy, perhaps similar to the one they just left in Egypt.  The revolution is over, now  the Israelites must create an establishment.

The founding principles, the ten commandments, come in a sound and light show, surrounded by warnings against physical trespass ( do ot approach the mountain under penalty of death) that translates, evetually,  into conceptual warnings against violating the law ( under penalty of, usually, the same death: stoning)


Part of Moshe's greatness was that he took advice, and translated it into effective action.


Friday, January 10, 2014

Beshalach: the struggle

Beshalach:  the struggle

One way to view life, one way to view history, is a as a series of battles. You are oppressed, you struggle with the oppressor, if you prevail you sing a song: the Battle Hymn of the Republic and mention Gd as the Man of War. Beshalach can be read in this way.

The parsha begins by attributing the Exodus  from Egypt to an eviction by Pharaoh. Whose point of view is this ? Gd's? Moshe's? the reader's? Israel's -  most likely.  The statement is set up as  a straw man to be knocked over by the drowning of the Egyptians in the Sea of Reeds. ( perhaps the sea of the end? Yam Sof). An example of the paradigm.


The people are led to avoid battle. Gd does not lead the people through the land of the Philistines, despite ( or because) it was close, lest they regret leaving Egypt when they see war. There are some wars that lead to nothing but regret. How do we apply this verse to the ongoing battle between Israel and  the Philistines (Palestinians)? How do we apply it to the last 50 years of American foreign policy?

The battle feelings spill over into the necessities of life. The people are ready to stone Moshe because of the lack of food and water. Moshe tells the people that their  struggle is misdirected.  Their gripe is with Gd. But Gd ( Man of War) is so inaccessible and inscrutable.  The aggression needs an outlet.

Then there is Amalek.  The inevitable war,  This battle is not for land  or booty. This battle is pure, and perhaps by virtue of that, it is a battle for survival

You will find everything in the struggle.  But is that the best or only model?




Friday, January 03, 2014

Bo: arbitrary 

The plague of the first born, the centerpiece of Bo, is a paradigm of the arbitrary rule. 

The plague of death is imposed upon the firstborn, regardless of his merits, regardless of her innocence. Babies and dirty old men are subject to the same  penalty for an accident of birth order. This is a kind of fairness: every being, human or animal, is treated the same. fristborn means death, not firstborn means life.   It seems more equitable than your money or your life or the concentration camp  selection. Salvation comes from joining the Hebrews in their matzo and lamb's blood smearing ritual.

The consequences of this plague include a transfer of authority away from Pharaoh to Moshe
 In Chapter 11, Moshe says to Pharaoh:
וְיָרְדוּ כָל-עֲבָדֶיךָ אֵלֶּה אֵלַי וְהִשְׁתַּחֲווּ-לִי לֵאמֹר, צֵא אַתָּה וְכָל-הָעָם אֲשֶׁר-בְּרַגְלֶיךָ, וְאַחֲרֵי-כֵן, אֵצֵא; וַיֵּצֵא מֵעִם-פַּרְעֹה, בָּחֳרִי-אָף.  {ס} 8 And all these thy servants shall come down unto me, and bow down unto me, saying: Get thee out, and all the people that follow thee; and after that I will go out.' And he went out from Pharaoh in hot anger. {S}

 The release of the Hebrews has become the popular idea of expulsion of the Jews.  Egypt must be Judenrein! The Hebrews bring a curse upon the land.  

Here is survivor guilt,  survivor glory and  survivor debt. Escape from the arbitrary, worn as a sign on the arm and head. 

Every person is special in her own arbitrary way.