I often get questions from people who are contemplating going into medicine, and I tell them all the same thing: My great-grandfather, Sam Levine, didn’t work on Shabbos.

You know his story, so familiar we forget how extraordinary it is: Arrived in Ellis Island in 1898 with just the clothes on his back, got fired every Friday because he wouldn’t work on Shabbos. Each week he had to find a new job, but of course some weeks he couldn’t, and his family literally starved. But my great-grandfather refused to work on Shabbos.

A hundred years later, I eat sushi, pulled brisket, and cholent on Thursday nights and can’t even imagine what it feels like to watch your kids waste away from malnutrition. Work on Shabbos? Of course I don’t work on Shabbos.

Then I finished med school and had to apply for a residency.

I grew up in New York, the New York that starts and ends with New York and everything outside of New York is some vague fabled land called “out of town” or “flyover country” on the way to the West Coast. I love New York, but there was no simple way for me to do a shomer Shabbos residency there.

I’m aware that there are certain heterim some rely on to perform their residencies over Shabbos. But the great-grandfather I am named for starved; I could leave New York.

I poked around, found a nice Midwestern city where they had never seen an Orthodox Jew before in the hospital and had one of the top-rated emergency medicine programs in the country. I went down there to talk to them. The entire hospital was looking at my yarmulke — this was right over the Mason-Dixon Line and they were sure my beanie was covering my horns. They had never heard of Shabbos before, but they agreed to take a gamble on me.

It was like a gift from Hashem: Not only are you going to get a shomer Shabbos residency, you are going to get a shomer Shabbos residency in one of the top programs in the country.

And that’s what I tell all the guys who are thinking about med school: It can be done. You will have to sacrifice some things, but Yiddishkeit is not one of them.

When I started my residency I made a commitment: I was the first shomer Shabbos Jew these guys had ever met, and I was going to make sure I was a fitting representative for all of us. I was going to work harder than anyone, I would cover every shift. I would be consistent in my Yiddishkeit. I would be consistent in my menschlichkeit. I would never give anyone any reason to accuse me of taking advantage of Shabbos.

It was complicated. First I had to explain what Shabbos was: “A day of rest that goes from sundown on Friday through sundown on Saturday.”

A couple weeks in, the residency director called me. “You told us your Sabbath starts at sundown of Fridays,” he said, “but I see you’re leaving an hour before sundown every week.”

As best as I could I explained that “sundown of Friday” actually meant “18 minutes before sundown” and I also needed to drive home and shower before then.

“Okay,” he said, “but why aren’t you back promptly at sundown on Saturday night?”

So I had to explain that “sundown on Saturday” actually meant “72 minutes after sundown.” (The concept of “sundown” is easy, the concept of “tzeis hakochavim” is a little more complicated.) “We have to wait until it’s for sure night,” I explained. “We don’t want to shortchange the Sabbath so we need to be stringent on both ends.”

In the winter, when Shabbos ended early, it was easy for me to get back on Motzaei Shabbos for the night shift. But in the summer, Shabbos ended really late. I’d come flying into my house on Friday afternoon with just enough time to shower, I’d go into the study and lay out my scrubs before Shabbos. The minute Shabbos was over I’d make Havdalah, eat a quick Melaveh Malkah, jump into my scrubs and fly out the door, like a fireman. I wasn’t going to give anyone any ammunition against me.

This whole system was pretty new when Dr. J came up to me one night in the ER. I hadn’t known he was Jewish (maybe he wasn’t) but that was what he wanted to talk about.

“You really don’t work on the Sabbath?” he demanded.

“That’s right,” I said.

“You eat kosher?”

“I do.”

“You keep all the rules?”

“Yes.”

“Where are your tzitzis?”

It was the night shift. Technically, I could have left them at home. But you don’t cut corners with Yiddishkeit.

I pulled out some strings. Dr. J looked at them for a long moment. Then he left and never bothered me again.

Consistency wins respect.

Since emergency medicine doctors see all kinds of medical scenarios, we residents rotated between departments, learning a little bit of everything. So I spent time in plastic surgery, in orthopedics, in trauma, in the ICU.

At one point in my first year of residency I was on the trauma team of the surgical ICU. Surgeons are notorious for their crazy hours. The hospital was very supportive of my not working on Shabbos, but the person doing the scheduling for the trauma team was giving me trouble. He insisted that I had to work a particular Saturday shift.

I tried explaining the arrangement to him, but when I couldn’t budge him, I sent out an e-mail to all the residents: Hi guys, I’m scheduled for the Saturday 7 a.m.–7 p.m. shift next week. I’m offering $1,000 for someone to take the shift for me.

The attending director of the ICU didn’t know what to make of it. “You’re a resident,” he said. “You don’t get paid much. You’re going to spend a thousand bucks to get out of one shift? Are you serious?”

“I am dead serious,” I said.

I didn’t have to pay a thousand bucks. He made it work for me. I worked that Sunday, Tuesday, and Thursday, and I didn’t have to cover the Shabbos shift. Those trauma attending doctors became good friends and mentors.

“I’ll tell you the truth,” CJ, a resident from Mississippi, told me. “We heard about you before you came, the guy with the Sabbath, and we thought, what’s up with this guy? What’s his problem? But then you came, we saw you work hard, and we respect that.” He was right that I worked hard — out of all 48 residents in my program, I logged the most hours my second and third years.

So when those guys thinking about med school come to me, I tell them that too. You can get a shomer Shabbos residency, but you can’t be greedy. You really have to be there — Sundays, holidays, any shift that’s not actually Shabbos or Yom Tov. You have to be willing to cover for everyone else. Even though you’re not getting paid extra. They’re taking a risk on you, they’re doing you a favor. Don’t give them any reason to regret it.

It’s tough being a shomer Shabbos resident. It’s tough being always “on” — always on shift, to the minute before Shabbos, and again the minute Shabbos is over, always covering for the other residents, every Sunday, every holiday, every family event. And always on alert: that you’re the representative for Jews and the Torah, that any mistake or flaw or inconsistency is going to reflect badly on you and on the entire Jewish People.

It’s tough. But nobody forced me to become a doctor. I could have been an accountant or an electrician or a speech therapist. In the US in the 21st century, I have my pick of professions. My children aren’t going to starve.

My great-grandfather didn’t work on Shabbos, and neither do I.

All names and identifying details have been changed. Patient profiles may be based on composite cases.

While there are ample kosher senior citizens programs in some parts of the U.S., in others there are clear signs that the menus are changing. Whether it is being done to save money, or to respect residents’ personal choices, is a matter of whom you ask.

In 2016, Sinai Residences in Boca Raton, Florida, asked several hundred seniors who had put down deposits, how important it was for them to be served kosher food.

Chris Newport, Sinai’s executive director, reported that the responders said that “having a kosher option was great, but being completely kosher would deter them from moving in.”

As a result, the Jewish Federation of South Palm Beach County, which developed the not-for-profit senior community called Sinai Residences, gave up their plans for a kosher kitchen.

From Philadelphia to Silicon Valley, a number of communities for Jewish senior citizens, have been giving up their exclusively kosher diet.

Finances definitely plays a role in the decrease of kosher-only senior facilities, the larger issue is the decreased commitment to kosher.

Back in the years after World War 2, when the baby boomers were first being born, the masses of American Jews kept kosher, whether because of their personal commitment to kosher law or their need to have their parents and other family members visit in their home. Literally, in those days, every home with a mezuzah used only kosher food.

Unfortunately, over the years, only the observant Orthodox have remained committed to kosher. Even the Conservative movement  does not claim more than 20% that keep kosher at home.

According to a 2013 Pew Research Center survey, only about 22% of American Jews keep a kosher home, almost exclusively the Orthodox.

Currently, many senior facilities have two dining rooms, one kosher and one not. Some of the residents vacillate between the two.

The Gurwin Jewish Nursing & Rehabilitation Center on Long Island reports that 20 out of their 460 residents eat only kosher. And, at Long Island’s Parker Jewish Institute, 20 out of 525 keep kosher only.

With 10,000 baby boomers turning 65 every day, Jewish communities will need to address this issue now in order that there be sufficient facilities providing kosher for their residents into the future.

Crippled by Hurricane Harvey, Three Brothers Bakery, a Houston landmark, chose to  remain open during Pesach and no longer be a kosher bakery [at all their three locations]. The Houston Kashruth Association immediately removed their kosher supervision to Three Brothers. Today, Three Brothers, make what they call “Jewish-style baked goods.”

The Juckers, who own Three Brothers, have been in baking industry for 5 generations. The Jucker brothers had mastered their baking skills in Poland before the war, at Morris Jucker’s Bakery in Chrzanow. Their kosher history goes back 200 years.