Monday, January 24, 2011

We should never know from this

The Times has an article today about one of the saddest ceremonies in our tradition: The circumcision of a deceased infant. Reading it, I could only think of that strange ungrammatical sentence my grand-mother would utter whenever she heard some terrible news: We should never know from this.

See the article after the jump:

An Infant Dies, and a Jewish Ritual of Birth Begins -

My hands trembled as I grasped the tiny sleeve of skin with my forceps and separated it from his pale, still penis. He lay weirdly motionless on a utility table, which I had draped with a slate-blue operating-room towel.

A few feet away, his young parents sat quietly wrapped in each other’s arms. Several family members and friends stood silently around the periphery of the small hospital room, whose gray-green walls enveloped us dispassionately.

The pregnancy had been uneventful. A month before the due date I had received a familiar, reluctant, yet eager call about arranging a bris, the ritual Jewish circumcision performed on the eighth day of life. The expectant parents promised to call back after delivery to confirm the date and time so they could order the deli platters.

Like many parents nowadays, this couple preferred a medical circumcision — respectful of religious tradition but performed by a physician, with local anesthesia and sterile technique easing the anxiety associated with an old-fashioned bris on a kitchen counter. This is where I came in.

As a urologic oncologist, I ordinarily focus on those afflicted with cancer, often at life’s end. So 17 years ago, I became a certified mohel, hoping to marry my surgical skills and my knack for calming nerves with the hopeful optimism of growing families. A bris provides an intimate and reinvigorating view of life’s beginning.

The ninth month passed, but the happy call never came. A week after the mother’s due date, I learned, the fetus’s heart rate had slowed alarmingly and he was delivered by emergency Caesarean section. Born limp and gasping, he was resuscitated and whisked to the neonatal intensive care unit.

But three days of 21st-century medical heroism failed to provide even a glimmer of hope. A flat electroencephalogram confirmed the dire prognosis. His brief life was waning.

The mother’s best friend called me with the news.

“They’d still like you to perform a bris but don’t want to put him through any unnecessary pain,” she said. “Can you do it after he dies?”

I could, it seemed. My rabbi assured me that Jewish tradition allows for such circumstances. The ceremony is different, of course — there’s no talk of bar mitzvah or marriage, and the prayer for healing is redirected at the grieving family. A post-mortem circumcision allows a moment of normality before the immense loss must be confronted. The rabbi taught me what to say to make the ceremony kosher: the Hebrew phrase “Ani hu ha’Elohim” (loosely translated as “Above all else, there is God”), repeated seven times.

The hospital staff removed the baby from the ventilator, took out the intravenous lines, swaddled him and handed him to his parents. They were led to the hospital room, where they sat gently cradling their warm newborn son for just an hour as pink faded to gray.

Then, like a candle suddenly extinguished by a gust of wind, life left. A sad emptiness remained, as if the air were pierced by a pungent, thin plume of black smoke, rising and quickly dissipating. He was gone. No future, only a past.

Explaining to those now gathered the meaning of what we were to witness, I began the procedure I had done a thousand times. I took the baby from his father, unwrapped his soft blanket and gently laid him on the utility table. But today there were no squirming legs, no lidocaine injection, no smiling grandparents recalling their own son’s bris a generation ago. Just a drop of purple blood.

I must have fumbled with the instruments a little too long. “It doesn’t have to be perfect, Doc,” the young father called out, breaking the tension that had gripped the room. Cool relief wafted through in quiet chuckles.

Actually it does, I thought — this one has to be extra perfect. This was their only unsullied moment with him, all they might remember. With no life ahead to pin dreams on, he had paused for one intense and ephemeral instant before being wrapped in the ancient tradition of his ancestors.

“Ani hu ha’Elohim...Ani hu ha’Elohim... .” I barely recognized my own voice echoing the incantation, the words punctuated by muffled sobs in the room. As I faltered, I drew strength directly from the young parents. Lost as they must have felt, their faces remained strangely calm. I could feel their approval, their encouragement, their stamina. In turn, I reflected it to support them. I was the instrument, and they allowed no fumble. Amen.

Two years later they called again: “We’re having a boy, and we’d like you to do the bris.” The pregnancy had been uneventful. I melted into my chair, almost overcome with dual emotions. My heart throbbed with the memory of their pain, yet that pain was tempered with their resolution and new enthusiasm. It felt like water of such extreme temperature that it could be either hot or cold.

A month after that, we had a happily pedestrian conversation about date and time. Eight days later, the spring sun radiated through a brilliant blue sky into their home. The smells of brewed coffee, warm bagels and fresh lox overlay the chatter of arriving guests. Suffused with morning light, the living room slowly filled with each of the previous attendees. Wearing giddy smiles and energized with new hopes and dreams, the young parents again handed me their newborn son.

Dr. Mark S. Litwin is a professor of urology and public health at the University of California, Los Angeles.

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