Dead Center Read online

  ONE

  WHEN PEOPLE ASK what I do for a living, I have two answers. The first, that I work for the medical examiner’s (ME) office, usually generates interest on its own, especially in these crime-drama days. The second, that I’m the cantor of a large Manhattan synagogue, is likewise good for a certain amount of conversation, especially among those who remember the cantors of their childhood intoning the Kol Nidre during Yom Kippur.

  For some reason, though—perhaps because of that old saw about the whole being greater than the sum of its parts—when I tell people about my two jobs, they seem to find the combination a source of decided fascination. Many strangers find it odd, these simultaneous careers in forensics and religious music, and some days it is fairly odd to me. I wonder if there’s ever been another medicolegal investigator (MLI) who’s worked a double homicide in the morning and conducted synagogue services at dusk. How did a nice Jewish boy from the Orthodox community in Brooklyn end up this way, fussing around with dead people for a living?

  The reasons involve history—the Orthodox community’s and my own within it.

  The early years of the twentieth century saw an enormous influx of Jewish immigrants from Eastern Europe to New York City, a veritable Ashkenazi tidal wave. Many immigrants hit the shores of the “golden land” and quickly merged into the mainstream culture of the melting pot, throwing off the shackles of Old World traditions that now felt too old-fashioned. But quite a few held on to the ancient practices, and the more observant of the immigrants opened kosher food shops and yeshivot (Jewish parochial schools), built synagogues and ritual baths, and tried to keep alive—through dress, language, and custom—the culture they had once had in Europe. Doing so wasn’t easy, because the general drift of American culture in those years was toward the secular. But their efforts to retain their cultural identity were passionate and won them a place in the urban fabric of the times.

  Change in New York City’s Ashkenazi community continued at a slow pace during the Depression and World War II. But the two decades after the end of World War II were years of dramatic growth and equally dramatic consolidation of the community. Into the early 1960s, the Frum community, as observant Jews call themselves, saw many adherents become more secular and less observant as they were forced to seek jobs outside the community, experience some of the culture of that outside world, and become more interdependent with it. In America, they did not have the insulation from secular influences that they had been used to in Europe—that accorded by the shtetl, the insular villages where Jews had lived. In the United States, Jewish sons and daughters could go to universities, to medical and law schools, open businesses, or work in a wide variety of fields, and many did.

  My parents, both born in the United States before the end of World War II, were typical Orthodox Jews of their generation. Fully observant of all Jewish law, they raised me, my older sister, and my younger brother in a strictly kosher home in which the highlight of the week was the Sabbath. My father always wore a yarmulke or skull cap, and my mother, as a married woman, dutifully covered her head in public. But they had also been secularly educated, and they were fully integrated into modern society without sacrificing their beliefs or practices.

  My father George’s varied businesses—at one time or another he was the proprietor of a carpet store, a commercial bakery, a wholesale food distributor, and a check-cashing store—certainly brought him in touch with the outside world. My mother Helene, who has a PhD degree, had a thriving private practice in special education and had been a university professor; she, too, was clearly comfortable in the wider world.

  As the 1960s wore on, there was a perceptible shift within the Frum community in a different direction—away from the modern world. Partially in reaction to its members’ increasing secularism, and partially because the Frum community was now numerous and wealthy enough to afford the move back toward its roots, it began to do so. The Orthodox became more orthodox, more observant of the myriad laws governing daily existence and ritual, more conservative, and more insular. Another pressure pushing this return to fundamentalism was the psychological makeup of a community whose members considered themselves to be collective Holocaust survivors. By 1965, when I was born, the community had already launched a drive to re-create, in the New York Orthodox community, the Frum lifestyle of pre–World War II Eastern Europe.

  My childhood was filled with stories of the wonderful Yiddishe life of the old country, told on countless occasions during my early school years by the rabbis of our religious schools and neighborhood synagogues. It was our obligation, they told us, to cling ever more tightly to the ways of our ancestors now that Hitler had killed six million of our relatives but failed to eradicate Jews as a people. For us to survive and to be more religious as a community and as individuals would signify the ultimate defeat of the terrible hatred that the Third Reich had embodied.

  This drive to fundamentalism meant that people born into the Frum community in the 1960s and afterward were faced with a choice. They had to decide which side of the line they would be on: the side of the Hebrew/Yiddish/Frum culture, or the other, secular side that we called the Goyishe culture. If members wanted to be secular—or didn’t want to be quite as observant as others in the community—they left the culture behind, either drifting away slowly or making a decisive break. In either instance, the community often cemented such choices in place behind the former member: when you left, you left everyone you grew up with. Indeed, families sometimes even chose to sever close relations with kin who abandoned the Frum for the outside world.

  The twenty years between my parents’ generation and mine saw tremendous changes in how orthodoxy was practiced—right down to the way the Frum dressed or named their children. In the 1940s, my grandparents had wanted their children to fit in. They chose to adopt English-sounding names for my parents, which helped them not to stand out—a desirable thing to the Holocaust generation, for whom standing out was a terrifying prospect. Twenty years later, though, the Jewish community was beginning to feel safe and at home in America; that’s why my parents felt comfortable naming me Shiya, and giving my brother a name with one of those “ch” syllables that makes it difficult to pronounce. By the time we were born, my parents’ common English names were no longer considered appropriate for a Frum child; I would have been mercilessly teased in yeshiva (Jewish parochial school) with a moniker like George.

  Despite the fact that my parents had grown up in a relatively relaxed Orthodox community, by the time that I arrived, they had moved along with the swing to the right and were solidly in the Frum culture. This made sense for our family, whose roots were deep in the Orthodox Jewish community and culture. Growing up I heard as much Yiddish as English, and it was impressed on me that learned rabbinical scholars abounded in our family tree as far back as we could follow it. Such scholars are also well represented in the family’s current generations. Cantors also abound in the family; in fact, you can’t throw a prayer book at a family reunion without hitting one (or at least someone who thinks he is a cantor).

  For grade school, I attended a yeshiva in Brooklyn, one that I have to characterize in retrospect as a very conservative academy—conservative in both the religious and the political senses. It was a parochial school that relied heavily on the traditional and religious aspects of Jewish culture, with instruction in secular subjects being an afterthought at best. The school’s administration was aware of the state’s minimum guidelines and met them—barely. Most graduates of this yeshiva would not go on to secular education at any level; a few would continue their religious studies on through adulthood, and during the rest of their lives would do nothing else but study the Talmud, the compendium of Jewish law and tradition begun two thousand years ago.

  My high school years were spent at a similarly conservative boarding school in Montreal, Quebec. This institution also produced few college-bound graduates, and many students had no realistic hope of going on to a secular higher education because of the
poor foundation they had received in non-Jewish academic subjects. Graduates were relatively unprepared for taking SAT exams or for the rigors of higher education in subjects such as mathematics, history, literature, or science.

  There was precedent, though, in my home for seeking a college degree. I certainly wanted one, even though my teachers at the yeshiva and my classmates decried it as a waste of time and energy. To my parents’ credit, they actively supported my decision to leave the yeshiva world and, belatedly, seek a sound secular education. But then, they had known for a long time that I was uncomfortable within Orthodox Judaism.

  At the age of eleven, a momentous thing happened to me: I discovered science fiction. The very first science fiction novel I read was Robert Heinlein’s Stranger in a Strange Land, and in it I found a structure that enabled me to start fashioning my own questions about religion and my place in Orthodoxy. What a revelation—for the first time in my life I experienced a feeling of deep intellectual connection. It elated me: here was someone who thought the way I did. By the time I was thirteen, I had read everything of Heinlein’s and had gone on to Isaac Asimov, Arthur C. Clarke, and Carl Sagan. I also branched out into general literature and discovered John Steinbeck, starting with his novel The Pearl. Through these tutors, I studied secular philosophy, science, and literature. I thrilled to the science that Asimov, Clarke, and Sagan revealed to me, and even more to the philosophy of Heinlein, whose books seemed to me exquisite essays on the human condition. Steinbeck opened my mind and heart to the joys of shared experience. These authors gave me the courage to question and stand up for my inner beliefs, which were at odds with those of the community in which I was living. I became particularly devoted to so-called “hard” science fiction, which became for me a guilty pleasure, my refuge from the world, my home away from home.

  Flush with newly expanded horizons from these books, I was beginning to feel that the Orthodox view of the world was increasingly narrow—so Biblically oriented that it didn’t even take into account actual Jewish history, let alone world history after Biblical times. Most graduates of my yeshiva would have been hard pressed to tell you when in history Moses must have lived, or what daily life had been like for people in that era; we understood nothing of the life of nomads in the Mosaic era, for instance. Judaism and history were taught as a single interwoven entity, with little or no references to non-Jewish culture or to concurrent events in the world that did not interact with Jewish culture. For example, although I was taught the writings of Maimonides, I was never permitted to learn the fact that in addition to being a renowned Jewish scholar, Maimonides had been a physician to Egyptian royalty in the twelfth century, and that the reach of his writings extended far beyond Judaic studies and influenced thinking in the non-Jewish world. Nor did I learn in yeshiva that leading rabbis of his time considered Maimonides a radical, viewed his works as heresy, and denounced him to the Inquisition.

  Around this time, I began questioning my teachers and parents about basic tenets of Orthodox doctrine, though I quickly learned to do such probing in a careful manner, for while rigorous debate was supposedly a welcome mainstay of the Talmudic lifestyle, in practice acceptable debate topics were limited to those entirely within the belief system. It was fine, in this schematic, to spend all day arguing about the order of sacrifices in a temple that had been destroyed two thousand years ago—and, believe me, we spent many days doing just that—but raising the question as to whether animal sacrifice was divinely decreed or just a man-made form of worship was not fine at all; it was tantamount to heresy and not to be tolerated.

  In the strict Orthodox community, censorship abounded. Magazines, television, movies, most fiction, and many other forms of literature and art were completely banned from our reading and viewing. You were at risk of being expelled from school if you were caught peeking. Today this ban extends to the Internet.

  Increasingly sensitive to the constraints put on my general learning by my religious upbringing, I simultaneously became aware that my feelings about that upbringing were different from those of most of the people around me. They seemed to want to remain in the culture; I wanted out. The revelation that I must leave was complete and fundamental for me, and I never changed my decision about it, though it would take another decade and a half, until I was twenty-seven, before I had finished extricating myself fully from the Orthodox community.

  Many times during those years, I felt as though I were conducting a masquerade, displaying all the outward accoutrements of Orthodox Judaism but without the inward conviction. I was certainly not rejecting Judaism or God, but rather an Orthodox fundamentalism so rigid that in recent years I have referred to it (though only in jest) as Taliban Judaism.

  Despite my misgivings about this masquerade, I continued to be a dutiful student at the yeshiva and learned a great deal there that was of use to me at college and, still later, in my profession. Perhaps most important, among all the things I learned in those years, was a set of fundamental skills: how to ask questions; how to acquire and analyze information—to deconstruct things; and how to be logical and follow the truth wherever it might lead.

  At some level, my parents were aware of my struggles in the yeshiva learning environment. And so, with their blessing, I applied to and was accepted into college. I was fortunate to get in since I had virtually no background in the sciences or other secular studies. In fact, I had to spend two summers taking courses and passing five New York State Regents examinations in those courses, a prerequisite for obtaining a New York State Regents diploma. Without such a diploma, you did not have much hope of attending a four-year college in New York State.

  While at college, I decided to become a physician assistant (PA), and after four years of undergraduate work, I entered a PA program. That program would lead me to a professional degree, though not to a master’s. Today, many PA training programs are given only on the graduate level—you enter them after first acquiring a bachelor’s degree, and when you graduate the program, it is with a master’s degree or its equivalent. I think that’s a better way to do it. A PA needs to be a bit older, to have more schooling under his or her belt before starting to work, because the responsibilities he or she faces as a new PA are immediately so great—caring for patients in hospitals and clinics, with only minimal supervision—that they demand not only a solid foundation but also a certain maturity that comes only with age and experience.

  I enjoyed every minute of PA school. Raised on a steady Talmudic diet of such obscure subjects as learning what to do when your neighbor’s ox falls into a hole on your property, I finally had course material into which I could sink my intellectual teeth.

  PA school is like an abbreviated and accelerated version of medical school. Instead of attending, say, 120 hours of lectures in anatomy, we got 60. Instead of two years of didactic (theory) courses, as were offered in medical school, we took one; and instead of spending the ensuing two years in clinical rotation, we spent one year on hospital wards. The entire course of study for PAs usually amounts to a solid twenty-four to twenty-eight months of work and classes; the precise mix depends on the school, but all such training heavily emphasizes the clinical aspects of medicine. The training can be so relentlessly clinical because most people who become PAs do not go on to medical research. Another reason that our training spends less time on the underlying science is that a PA can practice only under the supervision—preceptorship—of an attending physician. However, when legally supervised, we can diagnose and treat, prescribe medications, first-assist in surgery, and so on, just as a medical doctor (MD) can. We can even sign prescriptions, hospital charts, and orders. The regulations delineating the scope of practice for PAs vary from state to state, sometimes considerably. Some states insist that charts signed by a PA must be countersigned by a physician within twenty-four hours, while others require such charts to be signed within a week or within a month.

  While newly minted MDs go on to residencies and other postgraduation training—high
ly structured clinical training programs that can last from three to seven years—there is no similar requirement for PAs to go through a residency; you graduate, pass the national board exam, and then you’re officially a licensed PA. Instead of a residency, PAs learn on the job, which allows them to put their classroom learning to immediate use. This also allows a PA to start earning money immediately, which was important for me because during PA school, I had married, and by graduation, our first child was on the way.

  In the late 1980s, a young PA was a great thing to be. We were in tremendous demand, each graduate having a choice of about seven jobs waiting on the outside. During the last few clinical rotations of my training, physicians I had never met before would approach me in hospital locker rooms or hallways and give me their cards. “Call me as soon as you get licensed,” they would urge, “I’m paying top dollar.”

  I chose as my first position a staff job with an inner city clinic located on Manhattan’s Lower East Side that had its patients’ fees paid mostly by Medicare or Medicaid. The clinic had never before hired a PA, but the director was a savvy businessman who realized he could pay a PA a third of what he would pay an MD but still get 90 percent of the work that a physician would do. His calculation made no difference to me; at the time, I was thrilled to have a $30,000 salary.

  The clinic, as I had hoped, was a golden learning opportunity, giving me the chance to work with patients of all ages, from newborns to octogenarians, and providing constant traffic through the waiting rooms. There were few places in the city where I could have obtained as much hands-on and widely varied experience. I bought a new lab coat—full-length—several pairs of slacks, and a new stethoscope, and I plunged right in. My orientation at the clinic was short, as its directors firmly believed in the old med-school adage, “See one, do one, teach one.” For three weeks, I was paired with and followed around one of the clinic’s staff physicians, learning the ropes. After that I was turned loose on the patients, with a doctor nearby for supervision. And then, one week later, the doctor who had been supervising me was fired. It turned out that he’d provided false documentation when he was hired; though he’d been a physician in Russia, he’d neglected to obtain the necessary license to practice medicine in the state of New York; instead he had submitted to the clinic the credentials of a licensed doctor who had died some time ago. The clinic had to scramble to find someone else to supervise me.