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Frontier Bris

I did my first circumcision in Pocatello, a town in the southeastern part of Idaho, where the majority of the population is Mormon and the nearest mohel, should you have such an exotic need, is probably 170 miles away in Salt Lake City. We did it the medical way—in the hospital nursery with the baby strapped onto the “Circumstraint,” a molded piece of plastic equipment, with Velcro fastenings to keep the baby’s arms and legs from flailing into the way.

A baby on a Circumstraint looks a bit like a turtle on its back, but with a little white T-shirt, a bare belly (with the amphibious umbilical stump) and more accessible genitals. As a medical student, I’d seen a few circumcisions before, but for the first time I wasn’t horrified. I was focusing every ray of attention on not cutting off too much of the baby’s penis.

The attending physician (we’ll call him Dr. Hammond) walked me through the preparations step by step, wandering off between instructions with his bifocals dangling from one hand. First I unfolded the brittle paper around my sterile gloves and wriggled my hands into them, avoiding contamination I swabbed the baby’s skin with iodine soap, let it dry, and injected the local anesthetic at ten and two o’clock at the base of his penis. There were two nurses going about their business behind me, and a student nurse with long, honey colored hair leaning on the counter to watch. A row of shiny metal instruments was laid out beside the baby on a sterile paper blanket, like utensils for a very precise picnic. The baby had tired, his cries winding down as I waited for the local anesthetic to take effect, and was now asleep. I was amazed at my beginner’s luck.

As I reached for some pincers, the student nurse asked, as if she had just considered it for the first time, “What are the medical reasons for circumcision?”

“None,” said Dr. Hammond.

“Cultural and aesthetic,” I muttered, gingerly separating the foreskin from the glans with the small, pointy instrument.

“Nobody in Europe is circumcised,” he stated.

“Unless they’re Jewish,” I said.

“Well, right,” he said. “I don’t know why they started doing it here a century or two ago.”

Then he started talking, standing among the carts of new babies, “You know, we like to say God has told us to do certain things but usually there is a more practical reason. For instance, circumcision started over a thousand years before Abraham—when was he? Three thousand years B.C.?”— I nodded— “because some kind of parasite in the Nile would get in under the foreskin and give people nasty infections.”

I was too wrapped up in my snipping and trying to keep up my end of this discussion. The baby was still sleeping, his belly softly moving with his breath.

“People ask me, ‘What would you do?'” Dr. Hammond, raised Catholic and married to an Episcopalian, went on, “and I say, ‘I have three girls.'”

He tucked his bifocals into his shirt pocket. “There’s no reason to do it except for showering with dad.”

As I finished up, I was pleased with myself I was exhilarated by carrying off the new procedure, buzzing partly from terror and partly from triumph. Of all the powers I had imagined my medical education bestowing me, this was not one I had anticipated. What a great skill. As I tagged after Dr. Hammond, I started daydreaming about how I could moonlight as a mohel-ette if my budget ran low.

Down the hall, we joined up with the family practice resident for rounds in the neonatal intensive care unit.

“How are you?” he greeted me.

“Great!” I said grinning. “I just did my first circ.”

He flashed me an appalled look.

“Yeah, I’m relieved it went okay,” I said, trying to turn down the gleam in my expression. It dawned on me that a female circumciser enjoying herself was a scary prospect for some. And regardless of gender, how crude to be too pleased about doing something bad to a baby.

My feelings were more mixed than simple satisfaction anyway. My small, feminist thrill continued through the morning, along with a sense of displacement and let-down.

Circumcision was not just another medical procedure for me; it was already part of my experience as a Jewish ritual. Sure, it was ironic to get a lecture about the pointlessness of circumcision from the person teaching me how to do one. But beyond that, for me it was a moment when my own identity as a Jew seemed strange, isolated, possibly contradictory, and stubborn.

How had my path brought me to such an odd view of myself? I grew up with my Mom and step Dad and a brother and sister in Berkeley, California and visited my Dad, step Mom and two more siblings in New York during vacations, flying back and forth on my own from an early age. My California parents had an on-and-off membership at the Reform synagogue where I had my bat mitzvah; my Dad and step Mom walked weekly to an Orthodox shul. In both families, and in both communities, our Judaism was something I enjoyed unselfconsciously: the weekly beauty of Shabbat, the family seders, the love of books, a sense that history should be taken personally.

As a medical student at the University of Washington, my appetite for sampling new places pushed me to request a rotation in Idaho, a two-day drive from my home in Seattle. Alone in the car with my quilt, my skis and my books on tape, I crossed mountain passes and snow-blown expanses of high desert, watching the wisps of snow swirl across the road in front of me. I arrived after dark on the second day at a barren med student apartment with matted dark brown carpeting and all but two light bulbs burned out.

It’s early January and a week goes by before I see the town during daylight. On the first evening, standing in line at the Albertson’s with my light bulbs, milk, bread, and tuna, I wonder if I can possibly be the only Jew in Pocatello. Will the cashier pinpoint something different in my dark features and urban speech pattern, or is my identity so foreign here as to be invisible to the people around me? When Dr. Hammond says circumcision is a matter of showering, says no one in Europe is circumcised, I feel that invisibility like a cloak. When I speak up, offering my mild disagreement, I feel a twinge of alarm, and pride, in revealing myself

I have taken myself to an unfamiliar part of my own country where my Jewishness and my medical training meet up unexpectedly, like two friends from a small town in the Midwest who run into each other on a boat on the Yangtze River and almost fail to recognize each other. I find myself in a small newborn nursery, carrying out a practice that has religious and cultural significance for me, in a place where it has none.

Dr. Hammond had the bald head fringed with hair and the prominent nose of a Franciscan. As the pediatrician covering hospital duties for the week, his style manifested itself in his brief, illegible notes, an irritable, distracted air, and a vehemently rationalist approach. He was well-read in the medical literature and a conscientious physician.

[“Why’d you do that?” he once snapped at me when I showed him some calculations I had made the previous night to increase the caloric intake of a growing preemie. It wasn’t clear to me where I had gone wrong. There was some crucial reason which made my formula unnecessary, but Dr. Hammond was in too much of a hurry to clarify it for me. My calculations were scratched out—as useless, apparently, as stringing garlic around a baby’s neck. And yet, though he and the rest of the medical world saw little or no reason for them, he took the time to teach me how to do circumcisions.]

The medical version of the procedure sacrifices the mohel’s speed for near-foolproof security against accidents. The required sterilized instruments include a needle for the local anesthetic, delicate pincers and clamps, a bell-shaped device to protect the head of the penis during the cutting, a safety pin to secure the foreskin around the bell, and a small pair of scissors. The medical circumcisions I’d watched had taken at least 20 minutes from the time the baby was placed on the Circumstraint to when he was released, hastily reswaddled and wailing, into the arms of one of the nurses. Strapping the babies down was the hardest part to bear— some took offense right away and never stopped their enraged, heart-rending cries through all the rest.

The second baby I ever saw born, named Christian by his young, unmarried parents, was the first baby I saw circumcised in a hospital. The doctor I was observing was re-learning the procedure, which she hadn’t done since early in her residency. With hesitations and coaching, it took her 40 minutes, made excruciating by the baby’s unremitting screams.

Long before medical school, when I was eight, I’d seen my Brother Aaron’s bris. We had it in our living room, crowded with friends and relatives. I remember weaving through their knees to get to the food—a fine spread of bagels and lox, crudités, and pastries. The only thing that horrified me then was the way Rabbi Weinberger fondly hefted my brother in one meaty hand like a loaf of uncooked bread dough. His handling was so careless that at one point he clonked my brother’s head on the dining room table. The circumcision itself took about 15 seconds—before you knew it, it was over and the baby was sucking a few sweet drops of wine from my father’s pinkie.

“That rabbi is kind of rough,” my grandfather, a man rarely provoked out of silence, said afterwards.

Though not a lasting trauma as far as I can tell, circumcision does seem like a mean trick to play on a kid without a good reason. The passage in Genesis, the one that led to my grandfather’s, and father’s, and brothers’ brises, goes like this:

And God said unto Abraham; ‘….ye shall be circumcised in the flesh of your foreskin; and it shall be a token of a covenant betwixt Me and you. And he that is eight days old shall be circumcised among you, every male throughout your generations.’

So for Jews, circumcision is an emblem of a larger religious commitment that binds the community (of males) and the generations together. It is a mnemonic of the flesh, passed down for five thousand years. If medical school had mnemonics like that, no one would ever forget the cranial nerves or any step in the pathways of biochemistry. Even my not-so-observant California parents considered circumcision an indispensable act of Jewish identity. I was three and a half when my brother Tal was born. Although my parents had explained everything about how he was conceived, they could not figure out a way to tell me about circumcision. Without saying anything, they took him to the hospital for a circumcision, where an Israeli friend read blessings. A few days later while I was watching my step Dad changing the baby, I piped up with the observation: “Now he looks just like you, JJ!”

My brother Aaron’s bris was informal, brief, unceremonious even. The symbolism of the tradition is so weighty that the execution can afford to be understated. How Rabbi Weinberger held my brother in one hand has become a family story. His bris is well-remembered, a part of the chain of family celebrations.

So it surprised me to realize that the ornate preparations of medical circumcision—the gadgetry and the rituals of sterile technique—add up to a procedure pretty empty of meaning. This is the difference between an emblematic and a literal act, whether you think of circumcision as a “token of a covenant” or, as in the title of one medical article, a “phalloplasty.”

Although at the time I was taken aback by Dr. Hammond’s dismissiveness of the health benefits of circumcision, I now think some of this indifference is just as well. Taking sides in the tussle between science and religion, it’s usually easier for me to make fun of the hocus-pocus of religion. But in this case, evidence-based medicine looks a bit loopy pushing the practical reasons for something that up until the twentieth century had been performed principally as a symbolic act.

Circumcision became widespread in this country during the late nineteenth century thanks to physicians who believed the procedure prevented a range of physical and moral taints, including masturbation and venereal ulcers. These men couldn’t tell the difference between symbolic and literal benefits of circumcision. In 1866, the vice president of the American Medical Association wrote;

the prepuce seems to exercise a malign influence….
beginning to affect [a man] with all kinds of physical
distortions and ailments, nocturnal pollutions,
and other conditions calculated to weaken him
physically, mentally and morally; to land him perchance
in Jail or even in a lunatic asylum.

But why do today’s Mormon and Protestant parents of Pocatello, Idaho, want their baby boys circumcised? I never worked up the gumption to ask them. A small study was more bold: it found that most parents make up their minds about circumcision before hearing any suggestions from their doctor. The most common reason parents choose circumcision is that they think it makes cleaning easier. In America, circumcision is noticeably more popular in families of higher socioeconomic level. So the perception of hygiene (real or imagined), along with a whiff of social respectability, continue to give circumcision its appeal.

It’s also the aesthetics. As a six-year-old friend once said, a baby boy gets circumcised “so he won’t wind up with a big, puffy dick like my cousin Andrew.”

I went on to do five or six circumcisions in Idaho, some on screamers, others on quiet babes. There was a day-old 11- pounder, amazing as science fiction, who had the unfinished features of a newborn blown up practically to the bulk of a preschooler. He saw right through my deceptive cooing, even if he was born yesterday. He didn’t care whether what I was doing had a meaning or not. As soon as he caught sight of my subversive feminism and my sharp little instruments he retaliated preemptively, getting me right in the chest with a high arc of pee.

Another day, the family practice resident had me circumcise a baby in front of his father, who had requested to watch. A miraculous high-wire steadiness, one that always eluded me during piano recitals, came over me. The child too was exceptionally calm during our performance and barely made a peep through the whole thing. Having an audience, and a father at that, made this circumcision more similar to a bris than any of the others I did.

I was pleased when the procedure came off flawlessly, proving me professionally competent. The father, a silent, pared-down man with his fingers crammed into his blue jeans pockets as if to keep them out of harm’s way, remained outside the spotlight of my concentration. Afterward, I wanted to say, “Mazal tov!” but kept my mouth closed. I had done my job coolly and well; he had shown more interest than most parents. But I wished I could have offered him more joy and flamboyance, lifted his son up over my head, poured wine, told a joke, provided a good story to tell later. It seems unlikely the family ever says, “Remember that brown-eyed girl medical student who removed your foreskin?” It did not, after all, have the staying power of a ritual.

Shala Erlich has an M.D. degree from the University of Washington, and an interest in the intersection of medicine and culture.