By Mark S. Litwin, M.D., M.P.H. Illustration by Cliff Alejandro
MY HANDS TREMBLED as I grasped the tiny sleeve of skin with my forceps and separated it from the baby’s pale, still penis. He lay motionless on a utility table, which I’d draped with a slate-blue operating-room towel. A few feet away, his young parents sat quietly wrapped in each other’s arms. Family 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’d 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, this couple preferred a medical circumcision — respectful of religious tradition but performed by a physician, with local anesthesia and sterile technique. This is where I came in. As a urologic oncologist, I ordinarily focus on those with cancer, often at life’s end. Seventeen years ago, I became a certified mohel, hoping to marry my surgical skills and 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 due date, the fetus’s heart rate had slowed alarmingly and he was delivered by emergency Caesarean. Born limp and gasping, he was whisked to the neonatal ICU. But three days of medical heroism failed to provide any glimmer of hope. A flat electroencephalogram confirmed the dire prognosis. 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 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 healing prayer 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 “Adonai 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 IV, swaddled him and handed him to his parents. They were led to the hospital room, gently cradled 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 smoke, rising and quickly dissipating. He was gone. No future, only a past.
Explaining to those now gathered the meaning of what they were to witness, I began the procedure I’d done a thousand times. I took the baby from his father, unwrapped his soft blanket and A Young Life Passes, and a Ritual of Birth Begins By Mark S. Litwin, M.D., M.P.H. Epilogue 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. “It doesn’t have to be perfect, Doc,” the young father called out, breaking the tension. 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 to, he had paused for one intense and ephemeral instant before being wrapped in the ancient tradition of his ancestors.
“Adonai hu ha’Elohim . . . Adonai hu ha’Elohim . . .” I barely recognized my own voice echoing the incantation, the words punctuated by muffled sobs. As I faltered, I drew strength from the young parents. Lost as they must have felt, their faces remained 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.” 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.
A month later, 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 in the David Geffen School of Medicine at UCLA and of health services in the UCLA School of Public Health.
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