Learning from Loss

Rabbi Melanie Aron

Yizkor 5772 — Saturday, October 8, 2011

When my father was first diagnosed with a very unusual and highly malignant cancer, I sat and wept through the spring Yizkor services. I was sure that by that time the next year my father would be dead. I remember talking with the cantor about how she would have to lead the Yizkor services after his passing, as I could barely get through them with him still alive. I was too young and my father was too vital for me to accept what was happening.

My father did not die of his cancer. A statistical outlier he lived almost another decade and died of a totally unrelated disease.

That early mourning though wasn’t wasted. I think of it like the Braxton-Hicks practice contractions I went through with Jeremy and Shifrah’s pregnancies which made their deliveries easier. My father’s serious diagnosis back in 1998 forced me to come to terms with the reality that he could die, something that somehow I hadn’t believed before, despite his multiple heart attacks and bypass surgeries.

Birth and Death. They are both uncontrollable, raw experiences. We try to make them happen according to our schedules, but that rarely works. We medicalize them both, not necessarily to anyone’s benefit.

Modern medicine extended my father’s life by almost 25 years after his first heart attack. Without the advances of modern science, he would not have lived to see his 78th birthday, to know his 6 grandchildren, to work productively into his 70’s and enjoy an honorable retirement. His father, my grandfather, had enjoyed none of this, having died suddenly at 45, leaving behind a 15 year old son and 7 year old daughter. Those additional years were a great gift to my father and to our family, and we would not have wanted to have missed out on any of the many medical interventions that made them possible. But at the end, when the PSP, a Parkinson’s related disorder, had progressed to distort not only my father’s body but his personhood, the value of modern medicine was more ambiguous.

Judaism takes a very positive view of medicine. Already in the book of Deuteronomy we are commanded to take great care with our bodies. This was interpreted to mean, among other things, that a Jew should not live in a community where medical care is not available. The text in Exodus which requires that the guilty party cause the person they have hurt to heal, was understood to require paying for his medical treatment. The wisdom of the physician was considered a gift from God, and if the physician turned away a patient that he or she had the skill to heal they were violating the commandment: thou shalt not stand idly by the blood of thy brother. Unlike some other religious groups, Judaism does not teach dependence on miracles.

Maimonides, the great philosopher and physician, deals at length with very contemporary concerns about diet and exercise in preserving the body’s health. When our local Jewish Community Relations Council gets involved in combating the food deserts in our community, the neighborhoods with 4 times the number of fast food restaurants as grocery stores where healthy food can be purchased, they are acting in Jewish tradition. Our Haftarah this morning reminded us that it is a religious obligation to feed the hungry, but it is also an obligation to be sure that the food that the poor have to eat is healthy and sustaining. Recent studies of childhood obesity, which has reached epidemic proportions in our country, 1 in 5 children, find that it is caused not so much by overeating, as by eating the wrong foods.

At the individual and personal level, when we take on a discipline of diet or exercise designed to improve our physical wellbeing, we can see that not only as a health practice but also as an expression of our Jewish spirituality. Within the Jewish world view, taking care of our bodies is not optional, it is required.

But modern medicine has its limitations. First are the limitations in how medicine is practiced today. The lack of coordination of services is a particular problem for the elderly. Towards the end of my father’s life, he was living in Florida and was no longer being treated by the physicians he had personally trained, having taught in the local medical school for almost 40 years. In Florida he saw a different side of American medicine. There were easily over two dozen health care practitioners involved in his treatment in one way or another, but they knew almost nothing about what the others were doing. When he was hospitalized, the hospitalists did not know what the physicians who usually saw him were planning for him, and when he was discharged, the physicians who saw him in their offices knew little about what had happened in the hospital. Even when he was living in a skilled nursing facility, the third tier of his senior housing, what we used to call a nursing home, there was no real coordination between the doctors and nurses there and the specialists he would visit outside the facility.

From my visits to our members in the hospital and in rehab facilities, I think that this lack of coordination is unfortunately often the case here in California as well. I know that some medical groups and Kaiser in particular are trying to overcome that problem. There is hope that computerized medical records will help. But change will also require a transformation in attitude --from focusing on the particular service being provided-- to focusing on the health and wellbeing of the individual patient. We as patients and family members can ask for case conferences bringing together at least the many specialties located in a particular facility, but more needs to be done to insure that care is coordinated and patient centered.

The second limitation is not one that I expect to be overcome. It is the limitation of our physical beings, the nature of the material of which we are formed. Though we wish it were otherwise, we are finite beings. Our warrantee is not infinite, 100,000 miles, 200,000 miles, our life spans are extending like the mileage of our cars out here in California, but they are not infinite.

Judaism is all for life, and for struggling to live even under very difficult conditions. Pikuach nefesh, saving a life, is a great mitzvah which overrides almost all other concerns.

Life is the great gift which if we appreciate it properly, helps us not to sweat the small stuff. Rabbi Chayim Shmuelevitz taught that if we had a sufficiently great appreciation for life itself then even if we have many difficulties, we could still live a life of joy. He tells the story of a man who was drinking from a glass, which slipped from his fingers and broke. That man might indeed be irritated by the inconveniences involved in cleaning up the mess. But imagine the scene if at the exact moment that the glass fell and broke, someone ran in and told this person that he had just won a huge sum of money in the lottery. He would be so overwhelmed with his good fortune that he would be oblivious to the loss of a glass and the bother of having to sweep it up. Similarly someone who feels the joy inherent in life itself, will have an easier time when things do not work out the way he would wish. Whatever setbacks and losses we experience, the rabbis urge us to remember that if we still have life, we have something of enormous value. In most circumstances, life is the great gift, which puts everything else in perspective.

But that there is a time at which we become a goses, moribund, a being lacking the ability to sustain life for a lengthy period, and Judaism teaches that the choices we make at that time should reflect respect for the natural processes of our bodies.

Birth and Death. An attempt to exert too much control of either can be counterproductive. Studies are finding that elective inductions of labor, sometimes done for the convenience of patients or doctors, have an increased risk of leading to a c-section or other complications. Because of this, elective inductions are becoming less common now and are chosen only by a more selective process.

Attempts to postpone death beyond a certain point also may bring unnecessary pain and hardship to the dying and their families. That one third of those on hospice die within the first 7 days, is not a reflection of the morbidity of hospice, but of our reluctance to begin dealing with the dying process at the appropriate time. Hospice cannot turn loss into an easy experience, but I have witnessed hospice as a great gift to the patient and their family. It has been clear to the person who is ill and to all who loved them, that hospice improved their quality and sometimes even their quantity of life. Rather than spending their last weeks in the hospital, enduring multiple procedures, they can often be made comfortable, able to enjoy some of the things that brought them joy during their healthy lifetimes. These can be simple things, like having “the girls over for bridge,” watching the sunset on their back deck, or being in the house to hear the noise of kids coming home from school. These are important gifts, yet we are very hesitant to bring in hospice, even when we need it the most.

As we take the time this afternoon to remember those who are no longer with us, we deal with our love and sometimes our regrets.

Death, like birth can on occasion be sudden and unexpected, giving us no opportunity to plan or to help those we love so much. At those times, we can only to react to unfolding events. But often death, like birth, is something we can glimpse on the horizon, and doing so can work with the natural processes of the body.

May our love for those we have lost propel us to improve life for those who are still with us. May we find the inner strength to provide the appropriate medical advice and loving support for those who we care for in their last months and weeks of life. May we also commit as a community to learning from our collective experiences so that we might make things easier for those who will follow our loved ones down that path. There are so many ways that the memories of our loved ones live us with us as a blessing, may this be another.