The Delicate Mitzvah
Levine, Joseph
THE DELICATE MITZVAH VISITING THE SICK JOSEPH LEVINE Every morning, when other rabbis go to their synagogues, I go to my hospitals. I am a hospital chaplain. I find the members of my congregation...
...Today the "actors" often wander about the hospital "stage," bumping into one another, or worse, not appearing on cue at all...
...There is no maximum limit to the fulfilling of this obligation...
...Every cookbook has simple instructions, but most people just don't bother...
...You fulfill the mitzvah with your self...
...Would you call her...
...B., sleep well...
...Almost all of us will spend some time in the hospital as patients in the course of our lifetime...
...remember beginning a conversation with a patient who, for some reason, gave me the impression of being awkwardly positioned in the bed in a manner that had nothing to do with his illness...
...If possible visits should be prearranged so that the whole clan does not descend on the patient at once...
...Is this what will happen to me someday...
...Even if one makes mistakes, I find the patient will generally overlook them...
...The nurse said, "I was just in her room...
...When I arrived the family was gone...
...to ask...
...After all, most of us were born in hospitals...
...You can't buy a hospital visitor for money...
...A word about admission procedures: be prepared to spend more time than you imagined would be necessary...
...He has lost control over so much of his life...
...One should visit the sick often, even many times on the same day—but should be careful not to impose or tire him...
...Translated from Otzar Dinimu-Minhagim...
...For it is the fear that strips away the pseudo-immortality that the healthy tend to wrap about themselves...
...You do not fulfill the mitzvah with your body...
...in this example, commercial bakeries...
...Remember that just below the surface of a seemingly innocuous conversation, a deep river of emotion is silently flowing, carrying memories, hopes and fears for both of you...
...She wanted people, not data...
...Would you please return to the hospital...
...Even if there are no signs posted forbidding smoking, it is common courtesy to refrain in the sickroom...
...She gave me the room telehone number...
...But there is a difference between information and comfort...
...When I met them I could see that they all loved Mrs...
...Society provides an alternative...
...I have found that patients soon devise little parting speeches that usually begin with the phrase, "It is very nice that you have taken the time to come to see me . . ." that translates as "Goodbye for today...
...The destination is a hard metal table, in a bare cubicle under a science-fiction machine that clicks and whirrs while lights flash on a control panel in an incomprehensible code that spells out impersonal data about your very personal life...
...Heart speaks to heart...
...And this list doesn't even touch on the actual illness, the prognosis, or the physical pain...
...B. was awake now...
...Even after her remarriage these feelings persisted...
...A hospital gown may be designed to give excellent access to the trunk of the body with a minimum of difficulty, but it certainly leaves a great deal to be desired in the dignity department...
...It is very tiring for someone who is sick to play host to a group...
...A shared history binds you to one another...
...Our bodies at this stage were vastly different...
...Since diet is often a component of treatment, inquiry in advance helps to avoid mutual disappointment: a call will clarify the situation...
...It is not the responsibility of the patient to furnish a detailed account of his illness to each visitor...
...It is far safer for the patient to vent at someone who does not have physical control of his body...
...We are really not expected to provide "answers...
...I told the nurse that I would go to my office and wait for the family's return...
...And there is a smell, not necessarily unpleasant, but strange, a signal that one is in an alien place...
...We'd like to believe that it is, but it's not...
...B. had died...
...Each individual has a unique role to play...
...If you can identify hostility early, you have a better chance for dealing with it before it erupts in anger or tears...
...I wondered if they had left for dinner...
...A dollop of benign gossip doesn't hurt either...
...I was wrong...
...How the pattern of your life changes...
...A matter that would be a minor irritation in the outside world is magnified in the hospital setting...
...But the big thing is the fear...
...Remember, we are no longer dealing with two psychologically equal individuals...
...People are not interchangeable...
...On the contrary, some of my patients find their stay in the hospital rather pleasant...
...Just as one would not think of dropping in on friends at mealtime without calling, I think it's important to check ahead to see if a visit is appropriate...
...One lies in a strange bed which is usually higher than beds at home...
...In spite of pre-arrangement, the visitor may arrive in the middle of, or shortly after, some incident that brings these pent-up emotions to the surface...
...The lady was very weak...
...Is it an atavistic fear that we will catch the dread disease if we acknowledge its existence...
...As we were returning from a Shabbos service I made a joke...
...After all, you have made the effort to come in spite of parking difficulties, in spite of a natural uneasiness in the presence of strange surroundings, in spite of having to face the fact that disease is part of life, you have come...
...In the sickroom the means are the ear and the eyes...
...I called: "Goodnight, Mrs...
...Indeed, according to Jewish tradition, a visitor carries away a portion of the patient's burden by virtue of his visit...
...The Talmud states, "The company and reassurance provided when visiting the sick usually helps a friend to get well again...
...One should also inquire as to whether the illness is creating financial or other difficulties—and, if so, should offer to assist...
...There is no orientation offered for meeting the less dramatic occurrence, such as hospitalization, which has a significant emotional impact on the patient and the extended family...
...in a short time in spite of the visitor's apprehension, the patient will know, perhaps not on the first visit but soon thereafter, that the visitor has come to "be with," rather than to "carry out an obligation...
...He crashed into the wall, where he sat chuckling, the wheels of his "chariot" spinning, which led to another round of giggles from both of us...
...No one I have ever talked with has argued that "store-bought" tastes better, but it is more convenient to pick up a loaf at the supermarket...
...The physical pain had subsided (for the present...
...B. died two days later...
...I find that a spouse admitted to the same hospital where a husband or wife passed away will often have a harder time adjusting to the routine of the institution...
...Just because you are visiting in a sickroom there is no need to adopt a demeanor appropriate to the apparent "solemnity of the occasion...
...He laughed so hard that his hand slipped on the control switch...
...This mutual experience had affected both of them with the result that while she was in the hospital they had had several telephone conversations sharing their feelings about their lives...
...Illness so often brings out the unexpected...
...B. would be reaching out to them...
...she continued, as though thinking aloud, "Yes, we have belonged to a congregation for years...
...But you won't find Bikur Cholim in the Yellow Pages...
...Visitor in a Strange Land For the visitor, the first sensation upon setting foot in the hospital is a certain uneasiness...
...They never expected that Mrs...
...One should speak words of comfort and consolation so that he will not be frightened and will listen to the doctor...
...She looked up at me and said, "The priest was just here, yesterday the minister stopped to ask me how I was feeling...
...The lobby might be mistaken for a hotel, except for the everpresent wheelchairs and an occasional patient on crutches...
...Rabbi Joseph Levine is Jewish Chaplain at the Clinical Center, National Institutes of Health, Bethesda, Maryland, and Director of Jewish Chaplain Activities at Saint Elizabeth Hospital, Wahsington, D. C...
...B. seemed to be sleeping...
...One of the things that often strikes me is what I call the "surprise factor...
...A fter a few uncomfortable moments he shyly informed me that he was perched on the bedpan...
...It depends on both parties...
...I felt her disappointment...
...Anger It is not unusual for the patient and the visitor to experience anger toward each other...
...Introspection is contagious...
...We are beginning to develop processes for helping people cope with the two ends of the lifecycle, each a normal part of a continuum...
...B. It just had never occurred to them to leave a telephone number where they could be reached that evening...
...The patient is very sensitive to alterations in visitors' attitudes...
...There are two kinds of patients: some seem to cope well with the hospital routine and staff no matter what their illness, while others seem imprisoned by anger and suspicion...
...The patient has been placed in a very dependent role for almost all his needs...
...Vulnerability Illness, whether at home or in the hospital, can provide a unique opportunity for a person to grow emotionally...
...A Magnificent Risk I acknowledge that there are emotional dangers in being so open, so vulnerable to another human being...
...In a place without clocks and calendars time is measured in events...
...remember a patient with a very serious illness, A.L.S., which left him almost totally paralyzed...
...Few words passed between us...
...Recently both she and her ex-husband had been ill...
...It had been less than an hour since I arrived home from the hospital for dinner...
...When one comes to visit the sick, it is improper to sit on an elevated seat or on the bed or by the head...
...People often feel that they have to "bring something...
...In fact, it is almost inevitable...
...Service industries have sprung into being...
...This is the place where she died...
...Today we obtain much of what we want through the labor of others...
...Is it any wonder that loneliness, boredom, fear, shock, anger and guilt inform the patient's emotional health...
...A visit to a patient in the hospital would not be a task that one sandwiches into a busy day...
...Under the best circumstances, resentment builds up on the part of the patient...
...One of my patients told me that she had felt great bitterness toward her first husband who had left her for another woman...
...There are experiences which are never described in any glossy "Welcome to Our Hospital" brochure...
...No wonder that people assume that there is a trained "someone," a professional whose services can be purchased for a fee...
...We cannot play each other's .parts, even with the best of intentions...
...The family had not returned...
...I find the members of my congregation not in pews, but in sick beds...
...And don't forget your social security number—it's more personal than your name...
...I worked / I was President / did the onegs for the Sisterhood...
...I was in bed...
...It's easy to visit the new baby nursery, but the cardiac unit or the cancer ward...
...A gift can be a valuable symbol of caring...
...How are you today...
...The possibilities of mutual enrichment are too precious to be jeopardized by fatigue or rush...
...Eyes communicate...
...The reasons given usually range from "It's cheaper to buy bread at the store," to "I don't have the time...
...So that by sharing my experiences and observations, patients and visitors alike will find guidance in dealing with the trauma of hospitalization...
...Some Problems The reasons there is difficulty jn fulfilling the mitzvah are as different as the individual involved: hospital visitation is like baking bread at home, a semi-lost art...
...I returned to the ward...
...He could move around in an electric wheelchair that he steered by using two fingers on a control stick...
...My first thought when I recognized the nurse's voice was that Mrs...
...The tubes for the intravenous solutions were neatly taped to her orm...
...Even under the best circumstances, going to the hospital is a source of trauma for the whole family network...
...On paper it looks easy, and perhaps at one time Bikur Cholim was...
...Another date can be arranged at a mutually convenient time...
...It's o.k...
...I tried to share some of my experience with this patient...
...Unfortunately, Bikur Cholim can't be similarly "subcontracted...
...But this very anxiety can be an asset in carrying out the delicate mitzvah...
...Incidentally, most hospital rooms contain neither clock nor calendar...
...Perhaps that is because we who work in the world of the ill are particularly sensitive to how thin the border is between health and sickness...
...Normally, we exercise great control of where and when we remove any of our clothes...
...Figures in white solemnly stand around while questions about your body functions are discussed, your chart is consulted, heads nod in knowing cadence...
...She was dying...
...It can be an opportunity to confront our own fragile humanity struggling to be heard...
...Therefore, neither party should be surprised at an outburst...
...How long should a visit last...
...Some old wounds of the spirit can be healed during the long hours that the body takes to mend...
...The Patient: Stranger in a Strange Land The first sensation is usually a chill on the buttocks...
...No family group, just some off-duty staff...
...A casual glance at the Yellow Pages of our telephone books will provide ample evidence...
...Shortly after eleven o'clock the phone rang...
...Or was it a coma...
...People often ask me the date and the time...
...gives the patient the option of sharing as much or as little as seems appropriate...
...When there are two people sick, one rich and one poor, and many people are visiting the rich, you should visit the poor...
...If the planned visit should conflict with a procedure, or if the patient is not feeling up to it, it is better to postpone the trip...
...The room may change from full to empty in a moment, followed by the barely discernible sounds of hallway consultation which can be partially heard but seldom understood by the patient, with a predictable rise in anxiety...
...It was obvious that my "information" held little comfort for her...
...This too is O.K., as long as both parties keep in mind who and where they are...
...is a question that people often ask...
...Still, we enter the procedure with naivete and with fear...
...Entries march before our eyes, firms all ready to supply us with everything from "abdominal supports" to "Zoysia grass...
...And the wisdom of silence can be very, very helpful...
...And we indulge...
...Where had her family gone that evening...
...Or the anxiety may revolve around failed attempts at communication between the patient and the family or the family and the hospital—except that this time the surviving spouse is the patient and fears that she may be the victim...
...The most important element is the person...
...I never found out...
...Very often the conversation turns to the outside world from which the patient is a temporary exile...
...Now, people have come to need help, for it is large and often intimidating institutions we are dealing with...
...salespersons, chaplains, nurses, culminating with your doctor (often accompanied by what appears to be a gaggle of geese...
...The family is waiting...
...Unfortunately, people fail to realize that the attempt to have someone else substitute for the friend, relative, fraternal organization or synagogue only compounds the pain and anger of the patient...
...A telephone call to a close relative or to the nursing station can also provide valuable information...
...Further, though hospital linens are functional and clean, by no means do they feel like the home-laundered sheets and pillowcases to which our skin is conditioned, another disorienting factor with which we must cope...
...The majority of us will die in a hospital or hospice...
...When the contemplated gift is food, we can run into problems...
...Is there something I have not been told...
...I told her that sometimes people don't know that someone is in the hospital in time to visit...
...A new patient had been admitted...
...When one enters the sickroom, one is entering a slightly different world...
...Two hours later, the nurse called...
...Take the hint...
...In the past, when the sick were cared for at home, a visitor might meet townsmen, see familiar faces in familiar surroundings...
...So many memories come flooding back: faces of people trying to do the right thing yet often getting lost in the confusion and anxiety of dealing with illness...
...I have actually met patients who like the food...
...If something looks strange, ask if something unusual is taking place...
...Expectant fathers attend natural childbirth classes with their wives, while the upsurge in the Hospice movement shows that the death process too, is beginning to receive appropriate attention...
...Nor does the hospital visitation provided by clergy and social workers serve as a surrogate for family and friends...
...The covered parts of our body are "special territory...
...This unfamiliar world is populated by people dressed in white...
...If possible, the visitor should give the patient the option of choosing the time for the visit...
...It's reassuring in an atmosphere of so much uncertainty to know that some of your patterns of relating remain the same...
...Further, Ivhave found that most hospital employees, from elevator operators to administrators, are caring people who do their best for the patients...
...A pause...
...A hospital room is not the place for a mini-convention...
...The patient who either consciously or unconsciously identifies himself as a victim suffers more before, during, and after hospitalization...
...I guess the surprise is mutual because I am surprised by their surprise...
...Could you come up and see her...
...They are authorized to touch you, to wake you in the middle of the night, to stick needles into your body, and take blood at what appears to be incredibly frequent intervals (with varying degrees of skill), to command urination, to grant or withhold food...
...Are they talking about me...
...The patient will appreciate your consideration...
...It is a question of one's body image: persons who fear that their bodies have betrayed them lose some confidence in their power to recover...
...We serve best when we look and listen...
...Then there is the matter of excursions down long unfamiliar corridors, passing people, fully dressed people, to the place where "they" do the "tests...
...A shared history can't be fabricated...
...Height is an important factor in our spatial orientation, particularly when it represents power and authority...
...I was recently asked for my social security number as part of a free blood pressure screening—as if someone else might desire to assume my blood pressure identity...
...There was a pause, then a hiss of rage: "not a card, not a call, nothing...
...It is a mistake for the visitor to regale the patient with case histories of friends and acquaintances who have "survived" or had horrible experiences with the same, or a similar, illness...
...Our value lies more in helping the patient to clarify thoughts and feelings about the significance of what is happening...
...Yet it would be an error to assume that what I have described is the normal hospital routine for every patient...
...In humor, we were equals...
...I will come by tomorrow...
...One should not visit either early in the morning or late at night...
...In removing our clothes we also part with many symbols of our position in life—an appointment book, an heirloom ring, a wristwatch, etc...
...That is what I would call a magnificant risk...
...The building is haunted by the ghosts of memory...
...Other times, the assumption is that the card has already been sent...
...They enjoy the attention, the good humor of the staff...
...For the first time in years, a person can be alone with his thoughts and feelings, free to examine a lifetime...
...The duty nurse on 10 E called...
...Mrs...
...We held hands...
...Their most prominent feature is their1 nostrils (as they tower over us while we lie on our backs...
...For example, if part of your relationship with the patient has revolved around swapping jokes, bring one along...
...There is a potential that dialogue may take place and the blessing of comfort and insight may emerge...
...And since the visitor has his or her own anxieties and possible unresolved antagonisms that existed prior to the hospitalization, the potential for a flare-up is always present...
...When stationary communities existed, which automatically went into action in times of illness, each person was an actor who knew his role as well as the part that every member of the cast was to play...
...But preparatory information is invaluable because it can insulate the patient emotionally before the actual whirlwind begins...
...She had seemed so weak...
...It is a mitzvah to visit the sick, to ask regarding his state of mind and condition of health...
...I have found that the visitor often leaves the hospital richer in mind and spirit, if he or she has successfully fulfilled the delicate mitzvah of Bikur Cholim with sensitivity, trust and love...
...The unspoken command of the whole staff is "cooperate...
...In spite of the color T.V., books, magazines, or recreational therapists that the hospital provides, the patient remains hungry for the company of people from home or the office, people who care enough not to send the very best, but to bring themselves in person...
...Listening to another may cause us to hear a still small voice of our own that we have managed to suppress for years...
...This is another reason why working at one's awareness of what is going on is important...
...the "nurse" might very well have been a family member...
...She wants to say 'good night' to someone...
...What is true is that almost all of us are afraid of illness...
...It is a trade-off...
...Nedarim 40A) Yet, in the course of my rounds as a hospital chaplain, I have come across many patients just like this one: / found her alone in the room...
...People either know each other or they don't...
...But listening to understand is a discipline, for in the daily world we are most often valued according to our ability to provide information, or answers...
...Often it is a period of deep introspection...
...I checked the cafeteria...
...We live in an age of specialization...
...So our skills wane...
...Many patients are amazed to find themselves in the hospital...
...One of our bonds was laughter...
...It js the middle period that seems to be neglected nowadays...
...Our tradition offers some guidance for appropriate behavior in relating to the sick person...
...People of all ages, races and nationalities, almost all of whom you have never met, freely enter the room...
...That is why I am writing this essay...
...A visit can be a very pleasant event to anticipate...
...Incidentally, while this last suggestion seems so contemporary, it is interesting to note that in Amsterdam, Holland the Jews were specifically warned against smoking in the presence of the sick in 1742...
...I went home...
...It alternates between periods of solitude broken by sudden onslaughts: volunteers, library book carts, dietitians with menus, housekeepers, T.V...
...Taste, texture, perhaps some nutrition are lost in exchange for a different time priority...
Vol. 4 • May 1979 • No. 5
