Closer to the Heart

מִזְמוֹר לְתוֹדָה: הָרִיעוּ לַיהוָה, כָּל-הָאָרֶץ
עִבְדוּ אֶת-יְהוָה בְּשִׂמְחָה; בֹּאוּ לְפָנָיו, בִּרְנָנָה.
דְּעוּ– כִּי יְהוָה, הוּא אֱלֹהִים:
הוּא-עָשָׂנוּ, ולא אֲנַחְנוּ– עַמּוֹ, וְצֹאן מַרְעִיתוֹ.
בֹּאוּ שְׁעָרָיו, בְּתוֹדָה–חֲצֵרֹתָיו בִּתְהִלָּה; הוֹדוּ-לוֹ, בָּרְכוּ שְׁמוֹ.
כִּי-טוֹב יְהוָה, לְעוֹלָם חַסְדּוֹ; וְעַד-דֹּר וָדֹר, אֱמוּנָתוֹ.
–Psalm 100, “A psalm of thanksgiving,”

Yesterday, Sarah and I went to CFA for a 6-week sonogram. This is the point we hadn’t gotten to in the past – that is, in both of the prior pregnancies, it was a sonogram at about this point which determined that the foetus had died.

This time was different. Dr. Sacks was extremely blasé about it – “oh, here’s the baby, and there’s the heartbeat.” They didn’t give me a digital image, but it looks like this*:

I started crying right away – and only came back to the present when he said “let’s hear it,” and played a staticy audio – it was clear (at 112bpm).

I am grateful to have been brought to this place now, and like the psalm says, I will serve the LORD in joy.

I’ll try to stay in today, but daydreaming has a way of getting the better of me, and this sure sounds like the coolest thing ever.

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* Given the whole discussion about ultrasound and abortion in Virginia recently, the audibility of a heartbeat at 6 weeks throws the positions of the partisans into sharp relief.

Once, Twice, Three Times (for my lady)

Sarah and I learned earlier this week that we’re expecting. We’re following Sybil Sanchez’s approach, and being open about it, in large part because of the experience we had with our first and second pregnancies, both of which ended in miscarriage.

After the second loss, we saw Columbia Fertility Associates, and after some tests, our endocrinologist said that Sarah had an uncommon chromosomal issue which affected processing of folate – but this is (happily) treated with prescription-strength vitamins, rather than requiring more invasive means. We just got her initial sets of blood work back, and they’re quite encouraging. Yay!

Of course, it would not be human to lack fear – and the anticipation of fear and loss can be every bit as bad as the loss itself. So what to do?

Perhaps I could throw myself on the will of my Creator, nullifying my dreams in the desire for serene acceptance of providential decree? Or perhaps I should erupt in thanks and praise, recognizing that it is the breath of God which quickens life in the womb, and that this miracle has touched us once more is eminently and immanently Divine. Or perhaps I should attempt to persuade, in the vein of the Patriarchs and Matriarchs – all of them prayed for their progeny, and most of their children were hard won.

But why pick one?

So for now, the bubbly, almost giddy expression I’ve been wearing this week is now explainable, and I’ll try to stay in the moment as much as possible.

עת רצון

Yom Tov nusaḥ (words + melody of prayer) is one of my favorite synagogue things.  Leading shaḥarit (morning services) yesterday was more emotionally challenging for me than I had expected. The first paragraph of Hallel (psalm 113), concludes triumphantly with the following verse:

מושיבי עקרת הבית אם־הבנים שמחה הללו־יה

(He makes the childless housewife a happy mother of children).

This is, of course, the end of a psalm which is specifically talking about how God is great and glorious, but that he is immanent rather than distant.  This is the same vibe which permeates ps 147:3-4 as well -

הרפא לשבורי לב ומחבש לעצבותם׃

מונה מספר לכוכבים לכלם שמות יקרא׃

(He heals the broken-hearted, binding up their wounds:

He counts the number of the stars, calling them all by name)

The order of those is significant – we get a clue about God’s priorities, that caring for the grieving is more important than the entire physical universe.

But back to yesterday – I wasn’t ready for the emotional impact of that verse to really hit me in the moment, but it did.  All of a sudden, I had an overwhelming feeling of powerlessness and desperation – it hit me that only God’s decision will change the reality in which Sarah and I find ourselves.  And in that moment, I felt myself change from singing about God, to singing to God.

Intellectually, I know that requesting prayers aren’t supposed to be said on Shabbat or Yom Tov, but it’s a horse of a different color to actually step outside of that sort of moment.

Besides, if we were really that serious about not making requests, we wouldn’t include things like “And as for me, may my prayer come before you, Lord, in a favorable time – God, in Your great loving-kindness, answer me with Your saving truth.” (ps. 69:13).

The comfort of the second derivative

The trees at the Georgetown waterfront are the same age and species. They are all at different places in their seasonal leafing. I find this comforting.

I sit at my table, and wage war on myself

Sarah and I learned on last week that we were having our second miscarriage in seven months. In both cases, there was nascent life that simply stopped progressing – the sonogram view of the empty amniotic sac made my heart fall. The first time this happened, I held out tremendous hope for a miracle – that by some means the physicians had miscalculated the growth rate – that the foetal pole would blossom into the child we’ve wanted so much. That didn’t go well. This time, there was no pole at all – a yolk sac, but no indication of progressive sustained life.

And so turbulent emotions overtake me – in the non-deterministic manner of all turbulence, I find myself unpredictably swung from feeling to feeling, holding on to the relative stability of my workplace – a few know, most don’t, but it’s immersive enough that I can live in routers and switches for a few hours, seeking solace in the shared commiseration over frustrating policies or losing myself in problems there. You see, those problems can be solved.

When I was in college, I remember thinking that I did not want to have children. I believed the zero-population-growth people, and embraced the misanthropic view that the presence of humans was the problem with the world, rather than the purpose of it. I also remember thinking that I would be too much of a screwup to raise children, and that I should “not wade in the gene pool”, as was said by a person I know whose family has chosen to be childless (maybe they say “child-free” – I don’t know).

I do know that somewhere in the dating process with Sarah, I had the epiphany that I really, really wanted to have children with her. I was ready and eager before Sarah was, and when she became open to the idea, her severe health problems were in full bloom, rendering the idea moot.

For a long time, I believed that the likelihood this we would have children was low, and tried to get okay with that. I served as gabbai (sexton) for many years, and one of the things I really looked forward to was that the gabbai is the one who gets to publicly name all of the daughters born in the community. I grabbed onto that with both hands, and my eyes would get teary each time I said it. Seeing all of the britot (circumcisions) of the boys, likewise I would get teary. It was a solitary kind of hurt – no one asked about it, and I didn’t volunteer anything. I didn’t want to make any of my internal struggle public. I read the book of tehillim (psalms) several times asking that God either grant my prayer or remove the longing, and I eventually found a stable sort of peace about it. Part of that stability included thinking that this was a Divine decree – that the sins of my past life had been those which merited karet v’ariri (excision & childlessness). That self-flagellating approach was pretty seductive – conversations with RDBF, who indicated that there was not the slightest rationale for believing this, and describing my thoughts as theologically problematic did not shake the allure of seeing this denial as a form of intentional punishment from God.

A few years ago, the possibility started getting a little more real: Sarah’s health had been improving, and that dovetailed with her increasing desire. Since then, I’ve let myself get extremely eager and can really feel the pull. I’ve been much more in touch with the desire to be a child’s jungle gym, and to do all of the quotidian tasks of parenthood – pick up sick kid from kindergarden? Sure! Order diapers by the pallet? Absolutely! And so it came to be that 2011 was the year we expected to start trying in earnest.

And now this.

My mouth tastes like ashes. The Biblical image of seeing something wonderful and having it denied you is Moses looking out over the promised land, after he has been told that he will not live to enter it. I can imagine how he felt.

Some thoughts dominate me:

The essence of the tziduk ha-din (acceptance of Divine judgement, said at funerals) is Job 1:21: יהוה נתן ויהוה לקח יהי שם יהוה מברך… (…the LORD has given, and the LORD has taken away; Blessed is the name of the LORD.

Here, my prayers are for acceptance, for understanding of God’s will. After all, where was I when God put the world on its foundation? Though I don’t understand the Divine plan, that doesn’t mean that there isn’t a good reason for it, and maybe I was right before about what I deserve.

But then there’s the rest of me – less serene, and more angry. This is the part of me that wants to “rage against the dying of the light”, to call God down from His heaven and hold Him accountable for what He has done. Every day, we paraphrase Isaiah 45:7:

 יוצר אור ובורא חשך עשה שלום ובורא רע אני יהוה עשה כל־אלה – [God] forms light and “creates” darkness, makes wholeness and “creates” evil; I am the LORD who makes all of these.

The verb בורא boreh (“creates”) is exclusive to God: it refers to creation ex nihilo, and implies that neither darkness nor evil would exist in this world were it not for God’s conscious decision and creation. Shall not the Judge of all Earth do justly, indeed.

I’m left with some pointed questions for my Maker – while I’m not eager to meet Him, I do want some answers about why the world is set up this way.

I waited to publish this so that I could calm down a bit. It helped some. Most of the people I’ve spoken to have been sympathetic, and a bunch of friends took care of us – it’s a measure of comfort to have friends, and it’s greatly appreciated. But it still hurts, and I still want the answer to my prayers to be different.

Sew what?

I bought a new Atara for my tallit when we were in Israel. I did this because I’ve started wearing my tallit over my head during the Amidah, but I was finding that it kept slipping off – so I needed something with a bit more weight.

So when I went to sew it on, Sarah asked whether I shouldn’t just take this to a tailor to do a professional job – no, says I, I’d rather have the pride of personal workmanship! I started sewing it on by hand, as I don’t have a sewing machine.

Of course, two days before Rosh Hashana I took an accounting, and realized that I was only 1/4 of the way through – so I ended up going with the tailor after all. D’oh! But the silver lining of the story is that the tailor praised my sewing skill (!) and said that of course she’d use a machine because it would take way too long by hand (!!)

So all that is a prelude to a big “thank you” to my mom, who insisted that I learn to sew (although I’m not in her league – she makes her own clothing, while I can be pleased with how well a button is attached).

My heart is in the east, but I am at the ends of the west

Sarah and I returned from a wonderful trip abroad this week. We went first to Manchester, UK, to visit Sarah’s aunt, uncle, and a few extended family, and also to see the childhood home where her father grew up (her aunt lives there now). I had been a bit nervous about that portion of the trip – the rioting in the UK fortunately had calmed down before we went, and also this was a family visit to family I don’t know all that well. Fortunately, it was delightful – that part of the family isn’t religious, but they went way out of their way to accommodate both kashrut and shabbat. The synagogue, the Heaton Park Hebrew Congregation was lovely, and I got to have a long chat with the (very good) Hazzan about meticulousness in prayer. Also, the JS Restaurant was thoroughly fabulous: I had a meat pie which was phenomenal, and we got to spend time with some of Sarah’s more distant relatives whom we had never met before.

And then we went to Israel. Surprisingly, the duty free in Paris actually had some Royal Lochnagar scotch, which I remember as being my favorite scotch ever. We landed after midnight, so by the time we had gotten through passport control to the rental car and into Tel Aviv, it was almost 3AM. Note: the GPS that the rental car places will sell you is exactly like the ones in the US, and its map of Tel Aviv is hideously out of date (it couldn’t get us to the Marriott, which has been near the waterfront for decades…)

So the following day, we meandered around the craft fair downtown, and got a couple of neat things (e.g. a diorama of an Elvis (!) scene, a different and very nice Seder plate, etc), and we started looking for a place to eat. We found several which weren’t kosher, several that were but were unsuitable for glutards, and then had our choice between three (!) suitable places, all within the same walking area. We drove from there to Haifa, where we intended to visit the Bahá’í Gardens the following day. Unfortunately, when the website says that there are no tours on Wednesday, what it really means is that the gardens are closed on Wednesday. Bummer. So we headed out to Zikhron Ya’akov, where I had a yen to visit the Tishbi winery and restaurant, and there I was not only able to buy a bottle of their amazing brandy – we had what we both agree was the finest meal on our trip. Note: for any visitor to Israel, it’s worth going out of your way to eat there.

From there, we headed on to Jerusalem. We switched our reservation from Bakah to Ra’anana, based on some hunches and advice from friends, and fortunately the hotel was cool about it.

So then there was Israel: in addition to the happiness of our very long-time Efrat’s wedding, we got to see our friends from Zurich (who are trying aliyah for a year), Sarah’s childhood friend Yedida (whom I met on our last trip), and several other friends whom we’ve known from DC, most of whom now live in or around Jerusalem. More than that, Sarah got to go to Shira Hadasha, and I got to find a whole bunch of different shuls (and of course the Kotel), and we could wander through neighborhoods and say “it’s time for lunch; at which of the four kosher restaurants on this block would we like to eat?”

More than all that (not that that wasn’t a lot), the powerful experience for me was one of belonging – that the rhythm of life there really matches my own. Friday is a half-day, and shops start closing around one-ish, and the pace of the city gets even more frenetic than usual, until shabbat comes in, at which point it is suddenly calm. By “calm” I mean that streets which were carrying hundreds of cars per minute would now have three or four in the same span. Shops were closed – Emek Refaim had morphed from a monumentally busy shopping and restaurant street into a deserted strip – the only people on it were either going to or coming from services. The Mamilla mall and street were shut down, and that was a particularly visceral example of the difference in lifestyle. My mom tells me that this is how Bethesda, Md was in the 60′s (except on Sunday rather than Saturday), but I wasn’t there.

Last time Sarah and I went to Israel, we thought it was great, and told ourselves, “we should visit here more often;” on this trip, the question became “why precisely don’t we live here?”

There is a minyan on the train from Jerusalem to Tel Aviv. Of course there is. When we were walking through the neighborhoods, mostly on shabbat but also at other times, there were little neighborhood parks in which oodles of children were playing, and their parents appeared (stereotyping by dress) to be of substantially different ideologies. This is exactly the sort of urbanism I support: because nobody there can afford a lawn, everyone is in the parks – this is both more efficient and also community-building. Even more, the idea that the synagogue isn’t the center of the community is, to my American mind, wholly revolutionary. In fact, the non-centrality of the synagogue to daily life means that innovation in prayer services becomes optional and even welcome, instead of being an existential threat to the survival of the community, as it is in the diaspora.

For me, this has opened a floodgate of emotion about the idea of making Aliyah. I know that Nefesh b’Nefesh does all sorts of stuff to help make this possible, so it’s good to know that there is a professional organization which is trying to help. I had said many times that [they] would take me out of my Georgetown house in a box; now perhaps that box would be a container.

I don’t know if this is in our near or far future – it’s just amazing to me that it’s gone from something which was beyond the pale to a real possibility. We have a lot of research and thinking to do – I imagine that it’s hard to move away from family, and hard to leave a community of friends, but the call of a place where I am normal is strong. Until then, I’m left with Yehuda haLevi, who wrote the title to this post.

An Answer at Last!

I got my results today from Optimal Health, and now I have some results. I have confirmed cases of lyme, bartonella, strep (!), and a suspected case of babesia.

Apparently there’s a sign up in the microbial world: “come on in, the plasma’s great!”

Here’s the scary parts: first, both the really awesome rheumatologist and the excellent neurologist performed assorted Lyme tests, including of spinal fluid (!), and yet the infection did not show up on standard tests. This goes to show you that the standard tests completely suck. OHP uses Fry Labs, which has really, really thorough methodology of actually looking for organisms themselves. Here’s what Bartonella and the biofilms look like:

In addition, they use IGeneX labs which in their work provides a much more thorough Lyme analysis, looking at more bands and providing more detailed results, and this was how they confirmed my Lyme and got the inconclusive babesia.

Second, OHP’s working theory on this is that when I got the wicked-bad parvo infection in February, and swelled up, the steroid treatments I got (which were absolutely necessary, and reduced the swelling) dampened my immune system enough that latent infections were able to become active. They believe that tremendous numbers of people in the mid-Atlantic region have latent infections of this type, which cause subclinical symptom levels. Yikes.

Third, it turns out that both Lyme and Bartonella can be transmitted sexually, so it may be the case that I got this from Sarah, or perhaps she got it from me. This is an unpleasant line of reasoning, and I don’t think I’ll go very far down that path, but it needs to be more widely known, so that if one partner gets a confirmed Lyme, the other should get checked as well.

So then there’s treatment. There’s a whole bunch of dietary changes (argh – pizza is *so* far out…), a metric ton of supplements, along with two antibiotics and an antimicrobial solution. The OHP approach is “low and slow” – it’s designed to get rid of the parasites as fast as possible without killing the patient. Emotionally, I’d prefer the bazooka-size antibiotic dose, but that wouldn’t kill the infections any faster, and would just make me more miserable, so maybe that isn’t such a hot idea after all.

But in the words of a real American hero, “knowing is half the battle.”

We have met the enemy and he is us

Walt Kelly, who famously said the title of this post, did not live to see a specific case of this phenomenon. I just learned about the new FDA guidelines for doctors regarding opiate medications, and I’m not pleased with what I’m learning. As background, both my wife and my mother are disabled and suffer from chronic pain which can be pretty debilitating. I’m in the midst of a significant pain episode – possibly due to Herxheimer reactions caused be one of the 20 pills I took this morning (or maybe one of the 16 I took tonight – who knows?) – so as would be easy to imagine, making it more difficult for doctors to prescribe cheap, effective painkillers is not something which gives me a warm fuzzy.

I know about the abuses: about the so-called “doctors’ offices” which are the size of a closet, where “patients” are bused in from all over the country; I know about the straw purchasers and about how some of those meds can be crushed and snorted to significant effect; and I even have a family friend who is wrestling with the demon of addiction to opiate painkillers. All of these cases speak to a significant question: why are we doing this? Who, precisely, benefits? What is the harm we are trying to prevent?

When I’ve asked that question of multiple very smart people today, the answer I was given was “it’s a big problem if people take morphine and drive” – which of course has nothing whatsoever to do with whether they took it legally.

So I come back around to a more pointed phrasing of the question: given that many of the societal problems we are experiencing are the direct and indirect consequence of the prohibition regarding an individual’s use of these substances, is the cure worse than the disease? It sure looks that way to me.

It goes to 11

For those playing along at home, a spinal tap is pretty short: about 5-15 minutes of truly excruciating nausea-inducing pain. It is not a worse experience than the EMG, but it hurts more than any one part of it. Oh, and th effects linger: sitting up for more than a few minutes is quite unpleasant. The va’ad of greater Washington will be issuing a statement describing this as “not recommended.”

I’m particularly grateful for Sarah taking care of me: she’s the best blessing I’ve ever received.