September 17, 2010

With this Yom Kippur leering at me like a large impending ruling, it became evident that I needed a serious shift in how I was going to look at this Friday night and Saturday.  I’ve come to realize this can be a day that is filled with opportunity rather than an impossible conquest met by a surge of guilt I have received in past years from reading many sermons with familiar paraphrasing like “What we can learn from Aushwitz is…..”, “If the Pogroms taught us nothing else it’s….”, and my favorite: “Jews who sin don’t win, they get punished,” ouch! And what is it with Yom Kippur speeches needing a Holocaust tear jerker story anyway? Must every Yom Kippur service remind us that they hated us, they killed us, we sinned, and we might get punished again if we sin this year? Can’t we make it a little less impending? How bout a slide show of all our blessings? I’d like all the people in Synagogue who bought houses, new cars, got great jobs, found cute wives, met great husbands, had healthy babies, and had no one sue them to stand up and tell us about their awesome fortune coupled with a list of confessions of bad stuff they did. Wouldn’t that make for a more inspiring Yom Kippur sermon? I for one wouldn’t be hungry if I got that sort of joyous testimonial.

So it’s no wonder that Yom Kippur has always been a holiday that has filled with me and so many others, I imagine, with dread and fear. For so long it has felt like a day of reckoning for which I may surely lose. ‘Cause let’s face it, I surely sinned and clearly the punishment is waiting for me around the corner to attack me like a grim reaper (Heaven Forbid, pu, pu,pu, Chas V’shalom, knock on wood, and any other sayings that should take such bad ideas away from G-d- like he isn’t capable of thinking them up himself, and yet Gd willing, Imirtza Hashem, Bli-ayin horah I hope this Yom Kippur is the day with which I successfully make G-d realize I deserve a little reprieve for a better year than last. And YES I’M SORRY. I’m really really, truly, seriously SORRY.)

But it wasn’t until I shared this frightening nerve-racking- neurotic fear of Yom Kippur with my husband that I became enlightened to a new and better attitude. Rather than write his brilliant point of view for you all to observe, I thought I’d ask my dear husband to write his idea of what he thinks Yom Kippur is meant to be for us in his own words, a much better sermon than any Holocaust infested guilt plagued speech reminding us that yes, it can happen again, and threatening us that, yes we are sinners, and yes we will spend all day praying and fasting, and yes it may not be good enough- even if we break our fast on Lox and Bagels, we still might get what’s comin’ to us. Unless we sponsor the Lox and Bagels for the whole shul, then maybe we’ll be left off the hook.

So here is my sweet husband’s enlightening version of what tonight should bring us, and may we all have an easy fast with the knowledge that fasting the day can be an opportunity rather than a day of miserable fear with a lack of fortune at the end of the Yom Kippur rainbow.

OPPORTUNITY KNOCKS:  By, Rabbi Robbie Tombosky (My Favorite Rabbi)

As Yom Kippur approaches people from around the world take a somber moment to reflect upon the year past and take stock of their lives.  In fact, the very air we breathe seems to feel different today as we prepare for this most holy of days – the Day of Atonement.

Our sages have taught, the underlying principal of Yom Kippur is repentance and self-reflection – a day when G-d awakens his compassion for those who have sinned or gone astray; a day to make amends and turn over a new leaf.

Although the opportunity to achieve amnesty and forgiveness for our past iniquities is truly an ominous and precious gift – it also gives rise to a fundamental question.

If the raison d’être of our existence is to remain innocent and pure of sin then why do we put ourselves in harms way by actively engaging in the world around us?  How can we ever hope not to err or go astray when we are surrounded by temptation?  Simply put, if one wants to remain clean and pristine isn’t it counterintuitive to play in the mud?

If it is our goal to leave this world as pure and innocent as we were upon our arrival would it not make more sense to adopt a lifestyle of isolationism and insularism?  How can innocence and purity be preserved in the oftentimes brutal pursuit of building one’s career, providing for one’s family, and acquiring financial security and wealth?

Furthermore, isn’t it somewhat hypocritical to stand before G-d on this Day of Atonement to ask for forgiveness for going astray once again this year?  Didn’t we ask for forgiveness last year and the year before with a promise for better results?  How can we stand before G-d again this year without feeling disingenuous?

In order to fully appreciate and understand the true nature of Yom Kippur we must first understand our significance as G-d’s partners in this world.

The true raison d’être of human existence is to engage in the world around us and imbue every aspect of our physical existence and experience with the intrinsic purity and goodness that each of us has been brought with us into this world.

Unfortunately, as in every mission of great importance, there exists an element of great danger and peril.  As we engage in our daily activities we put ourselves at risk of losing our focus and of succumbing to temptation, jealousy, greed or fear.  We are in constant jeopardy of becoming distracted, confused or disillusioned by our environment and the real pressures and stress of everyday life.

This is the secret of Yom Kippur.

The abstinence, fasting and repentance of Yom Kippur is not a punishment.  The day of Yom Kippur is an opportunity for spiritual renewal and healing – a day that allows us to reconnect to the quintessential part of ourselves that is always pure and innocent, so we can continue our vital mission of sharing that part of ourselves with the world around us.

It is a day that G-d says to us, “I appreciate the sacrifices and the commitment you have made in being my partner and in doing my work in this world.  I appreciate your monumental accomplishments. And I also understand the unfortunate casualties and collateral damage that are part and parcel of accomplishing our vital mission.  Please don’t be dissuaded from continuing your mission!  As you commit to being my partner for another year, and do your best to accomplish our mission with as little collateral damage as possible, I am committing to giving you complete amnesty for your mistakes – a new beginning with a renewed sense of energy and purpose”.

The gift of Yom Kippur is upon us and the opportunity to reconnect with our better selves is at hand.  Let us pray that each and every one of us is blessed with good health and sustenance for the coming year – and the clarity of mind and purity of heart to be a good partner and become a part of something so much greater than ourselves.

Best wishes for a meaningful Yom Kippur.

 

 

… or, An Angioplasty Also Won’t Make You Taller

Over a million coronary angioplasties are performed in the US each year.  In this procedure a thin tube is threaded into a narrowed coronary artery.  Through this tube a balloon is inflated to open the narrowed artery, and then a stent (a metal mesh tube) is placed to keep the newly expanded artery open.

Some large well-designed studies in the last few years have taught us that angioplasty is a life-saving procedure in the setting of an acute heart attack but that in patients with chronic stable angina (chest pain due to coronary artery narrowing) angioplasty decreases the pain but doesn’t prevent heart attacks or save lives.  (I summarized these findings two years ago, so see the link below for more background on angioplasty.)

So have doctors and patients absorbed this new sober understanding of the limited benefits of angioplasty?  A fascinating study in the current issue of Annals of Internal Medicine answers this question.

The study interviewed over a hundred patients who were scheduled for possible angioplasty and 27 cardiologists who were involved in their care.  None of these angioplasties were for an acute heart attack.  Interestingly, only two thirds of the patients suffered from chest pain.  The patients and cardiologists were surveyed about what benefits they should expect from the angioplasty.  The difference between the cardiologists’ and the patients’ answers were startling.

The cardiologists reflected an understanding of the recent studies.  They mostly said that they expected the patients to have less chest pain after the procedure but that they didn’t expect it to lower their risk of future heart attack or death.

The patients’ opinions were very different, despite the fact that they each had spent a significant amount of time with a cardiologist who explained the procedure to them.  88% of them believed that angioplasty would reduce their risk of heart attack, and a similar number believed that angioplasty would reduce their risk of a fatal heart attack.

What’s going on here?  Are the patients being misinformed?  Are they signing up for an invasive procedure under false hopes?  It’s hard to be sure.  The investigators don’t know the content of the conversation between the cardiologists and the patients.  It’s possible that the cardiologist just detailed the risks, not the benefits.  Or it’s possible that the patients were told the benefits but mistakenly assumed that if the cardiologist is recommending the procedure, it must also prevent heart attacks and prolong life.

It’s also possible that the findings are biased by the fact that all the patients selected for the study had already been scheduled for a possible angioplasty.  That means that the most well-informed patients who had elected not to proceed with angioplasty would not have been included.  That’s like surveying customers in an organic food store and finding that most of them have falsely elevated beliefs about the benefits of organic food.  All the skeptics of organic food aren’t in that store and would be missed by the survey.

Regardless of the specific cause of the patients’ misunderstanding, the study is a good reminder that doctors perform risky invasive interventions on our patients every day.  We owe our patients education about why we’re recommending the procedure.  Patients owe it to themselves to ask specific questions about benefits, risks and alternatives.

Learn more:

Annals of Internal Medicine article:  ” target=”_blank”>Many Heart Patients Place False Hope in Angioplasty

My post in 2008 summarizing the benefits of angioplasty:  Is There a Patient Educator in the House? Read More »