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The Yale Journal for Humanities in Medicine |
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Spirituality, Religious Wisdom, and the Care of the PatientVisiting the Sick: Jewish Wisdom and Practice Speak to the Loneliness of Illness Rabbi
Tsvi Blanchard, Ph.D. Illness, especially serious illness, has a way of focusing our attention on essential issues. It calls into questions many of the conventional, habitual attitudes and beliefs that we use to hide from our all too human vulnerability. Illness punctures our defenses. We are wide open to our deepest fears. We often feel weak, powerless and alone. Let me tell you a story. Once while walking down a hospital corridor, a resident stopped me and asked if I could take a few minutes and visit a patient. "Of course, "I answered, " what's the problem?" The patient was fifty years old, had an infected cardiac valve and was not responding to treatment. Yesterday, the staff had informed him that they were not sure that he would survive. This morning he had asked to speak to a rabbi. As you might expect, I went to see this man. Although, initially, all he seemed interested in taking about was "Can Jews be cremated?" In was able to use this as a way of gaining his trust. He then revealed that when he had learned that he might die, he "told off" both his wife and only son, sharing in no uncertain terms how much he felt that they had used and abused him. " But I am dying," he said, " and I don't have to take it anymore." He then ordered them out of his room and out of his life. He was now interested in cremation because he didn't think that they would see to it that he was buried. Diagnosis" Profound loneliness presenting as an infected heart valve. The story has a happy ending. After we had talked for several hours, he realized that he really wanted to work things out with his family; he lived and, with the help of a good family therapist, was able to repair his relationships with his wife and son. This story reminds us of an important truth: Most people seek meaningful connections with others. For Judaism, this reflects the reality is that we are never really alone. Although our experience, our personal biographies have a unique individual component, we nonetheless all live out that experience in webs of relationships. Our experience within families, workplaces, schools, communities, welfare and court systems shapes the possibilities that we experience, as well as our sense of the moral and spiritual quality of our world. But, as with the man in my story, we are not always emotionally in touch with these relationships or even aware of their importance to us. We can feel lonely even if we are not in fact alone. Our ability to cope with the loneliness that comes with illness depends in large measure on our capacity to connect and draw strength from the various webs of relationships in which we live, especially from the new and very important web of relationships we added when we became a patient: doctors, nurses, social workers, and chaplains-the whole health care team. How can professional health care teams approach the diverse forms of loneliness they encounter in their patients? What can the professional health care team learn from Jewish practices that speaks to the loneliness of patients? First, we should note that the classic Jewish response to the isolation and loneliness that often accompanies an illness is the mitzvah of bikkur cholim, the religious practice of visiting the sick. Friends, family, congregational members and ones rabbi will come to visit, often in this way engaging the healing power that derives from feeling a part of a personally significant web of human relationships. Another story: Many years ago, my father had emergency quadruple bypass surgery. When we first came to visit him the next day, mom spent the entire five minutes we were allotted telling him who had called and left a message inquiring about his welfare and wishing him well. This perplexed me until she explained: Dad feels more alone now than ever. He needs to remember that he is still connected to his friends and his community. That will bring him comfort. And that is the mitzvah of bikkur cholim. Concerning the practice of visiting the sick, perhaps, the most direct and accessible entry point to the Jewish tradition is Maimonides, the most outstanding Jewish mind of the Middle Ages. This legal and philosophic genius was himself a physician. Maimonides discusses the practice of visiting the sick in his encyclopedic presentation of Jewish law and practice, the Mishnah Torah. As the appended text shows, Maimonides groups visiting the sick together with many diverse acts-aiding travelers, comforting mourners, burying the dead with dignity and respect, helping people get married, even creating a joyful wedding. They are grouped together, Is suggest, because they are all acts of hesed, that is, acts that behaviorally implement dispositional character trait of loving-kindness, They give body to the abstract concept of social love for our neighbor. Why are the considered acts of hesed, acts of loving-kindness? What makes them acts of hesed, I propose, is that each one of them addresses a human vulnerability. I do not mean by this that each of us is vulnerable to all of them. I mean that we all share the condition of being exposed to some danger or significant insufficiency. We are all vulnerable. At the very least, even if we ourselves never travel, or even if we have enough money to marry comfortably, each of us is aware of our own vulnerability to illness and death. Whatever the illness, we all know that being ill can mean feeling painfully alone. We know that we all are, or one day will be, sick. That means that all of us will come to know-or perhaps we already know--the profound sense of loneliness comes with being ill. Maimonidies text reveals an underlying logic here. Since we are all vulnerable, we are all responsible for visiting the sick. Note that this is a mitzvah b'gufo, something we must actually do ourselves. Again I see an underlying rationale. We must physically do it ourselves, because just as wealth cannot buy health, we cannot send our money in place of our physical presence. For health care professionals this has an odd implication: when you are with a patient, you are not simply caring medically for that person-performing the mitzvah of healing the sick-but you are also visiting that person--performing the mitzvah of bikkur cholim. Let us think a bit about the nature of this mitzvah. What does it mean to visit the sick? To be sure, it means doing some of the things that heath care teams are already doing-taking the practical actions that support healing. But it means more than this. First, it also means that, when we visit the sick we must identify with the person. We must seek out our similarities; we must find how we are like him or her. A mere intellectual recognition of shared human vulnerability is not enough; we must move from such a perception of the universal to a more concrete apprehension of the particular. We must understand as concretely as possible how it feels to be lonely? Anyone who has had the experience can tell you that the loneliness that goes with illness is not just about wanting company. It is far more about feeling that you have to go through this terrible experience all by yourself. We can you feel this even when we are surrounded by people. There you are, a patient, lying in your hospital bed with a serious illness. People, even staff who are skillfully caring for you, may very well surround you but you can't help but wonder "Are they in this together with me? Or are they "just doing their job". Am I really going through this horrible experience alone? Given the very real constraints on the time professionals have to be with any individual patient, reassurance about this concern often comes from a patient having the feeling that " they are on my side and thus doing what they can." The concept of being on the side of the patient" has roots in the Jewish tradition. The following rabbinic text makes it clear that we are indeed to "be on the patient's side, however difficult and problematic the patient may be, ' Rav Huna said in the name of Rav Yosef: It is always the case that G'd seeks (i.e. is on the side of) the pursued.. Even when a righteous person pursues a wicked person, G'd seeks the pursued. "(Vayikra Rabba 27:5) Here is story that shows how "being on the patient's side" affects how a caregiver behaves. An old friend of mine taught at a major American medical school. He was junior to a surgeon who had perfected an operation for throat cancer that would allow people to speak afterwards. When the famous surgeon would round, he never said anything to the patients about their surgery. He simply dealt with the medical issues at hand. My friend made it his business to stay a few extra minutes and "visit", assuring the patients that their surgery was successful and they would indeed speak again. These few minutes of conversation greatly comforted the patients. It also sent them a message: You aren't alone; I am in it with you. We all know the difference between, on the one had, physicians, nurses, dieticians, aides, OTs and PTs, even social workers and chaplains who just do their jobs, professionally and respectfully to be sure, and, on the other hand, those who also "visit patients" while they do their jobs and in that way remind patients that they are not alone. The deep loneliness we are considering derives from this sense that "I am in this alone. I am going through this horrible thing alone, facing and enduring it alone and nobody really cares enough to be one my side." You don't cure this kind of loneliness simply by putting someone into the room. The visitor has to share the humanity of the patient. There needs to be a real connection to the patient. To use an old cliché' the visor must be truly present with all the personal vulnerability that entails. It is in this way that we actually become a significant part of the patient's supportive web of relationships and acknowledged as such. I appreciate fully how difficult this is to do in practice. Perhaps this accounts for the fact that being seriously ill in contemporary America is too often a profoundly lonely experience. Second, the fact that we are dealing with a mitzvah means that in Judaism there is a spiritual context for visiting the sick. We not only care about the health of the patient, but we want G'd to know that we care. In addition, we are taught that G'd is present with us at the sick bed. When we are in a room with a patient, we are none of us alone. Let me go out on a limb here. If the patient and the members of the health care team are overtly religious or spiritual, this presence can, and I think should be spoken of openly. What if, given the views of the patient or the team, it would be inappropriate to do so? I think that it is still possible to evoke what for many modern people is the equivalent of the idea that we are all created in the divine image, that is to create a sense of the fundamental dignity and worth of the individual human person. In short, whatever our theology, we need to at least to act as if the patient is created in the image of G'd and thus, we are indeed none of us-patients, physicians, nurses, family-- alone but in the presence of G'd. Think what it would mean to your patients to deeply experience that you, the people who are caring for them, feel that in being with them you are also in the presence of what is of ultimate worth and value. Such patients would, I think, be unlikely to suffer from loneliness. Helen Alvare, "Loneliness in the Context of Illness and Dying- A Catholic Perspective" Published: January 12, 2005 |
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