Staying Away Is Not an Option – Bikur Cholim

Staying Away Is Not an Option
By Joanne Kenen

Stefanie Augustine

It may not be the easiest of 613 commandments to fulfill, but visiting the sick is nevertheless one of the most significant, meritorious and, ultimately, fulfilling of the interpersonal mitzvot.

It is hard to visit sick people. And the sicker they are, the harder the visit.

Visiting someone in the hospital can set off fears of illness and infection, stir up memories of past losses or remind us uncomfortably of our own mortality.

Then there is the “shlep factor,” as Rabbi Elliot Dorff, rector of the American Jewish University in California and a leading bioethicist, puts it. In our 24-7 multitasking lives, it is hard to find time for what can turn out to be an aggravating experience. We drive to the hospital, pay for parking, wander through unfamiliar corridors looking for the right room—and then discover that the patient is off undergoing tests or asleep.

But perhaps the biggest barrier lies somewhere between those existential fears and that mundane hassle. We do not know what to say, what to do or how to act around a sick person. We may not know when and how to simply sit in caring silence.

“If there was a script, we’d have printed it up and we’d be handing it out,” says Rabbi Mark Popovsky, a chaplain at New York-Presbyterian Hospital and the author of a manual on Judaism and serious illness available through the Duke Institute on Care at the End of Life, which last year sponsored a conference on the topic. Popovsky reassures visitors that saying something awkward to a sick person may not be wonderful but it is “100 percent better than abandoning them.”

Until the last century, people were generally more comfortable with death and illness. People were born at home and they died at home. Children were not shielded. Adults did not turn away. Now illness is an isolating experience. We endure much of it alone, or in a hospital room shared with a stranger.

Classic Jewish texts do talk about illness, how to visit, how to help, but the customs and traditions were not passed along as widely to contemporary Jews as were rituals surrounding death and shiva. We know we need a minyan to say Kaddish, but we may not be familiar with the comforting traditional image of the Shekhina, the presence of God, hovering above the head of a sick person. Details in the classic texts, like what times of day are best to visit or how to approach a sick person lying on a pallet on the floor, may not be literally applicable to 21st-century medicine. But the basic message is emphatic: We must visit, and that our visits themselves are part of healing, at least emotionally or metaphorically. In healing, we partner with God.

If some classic details about approaching the sickbed are archaic, others resonate across the centuries. For instance, our tradition tells us that visitors should sit down when they visit a sick person, not stand over them.

“I once visited a 95-year-old rabbi,” says Rabbi Dayle Friedman, director of the Hiddur Center on Aging at the Reconstructionist Rabbinic College near Philadelphia. “And when I sat down, he cried. He said, ‘I can’t tell you how many rabbis have been here, and no one has sat down.’”

“Sit so you are not higher than the person,” Friedman adds. “Sit so we don’t approach the sick person as though we are saying I am whole and you are broken. We are all living with mixed wholeness and brokenness.”

Standing can also send a message to the patient that the visitor is uncomfortable and can’t wait to leave. Your body language shouldn’t say, “I’m outta here.”

Another barrier to visiting people is our own emotional turmoil. Relationships are complex, and we often have ambivalence or unfinished business, what Friedman calls “paradoxical relationships of anger and love.” Hospices are often excellent at helping families reconcile, and social workers in some health care settings may also be able to help. They cannot wave a magic wand and undo a lifetime of damage or distrust, but they can help people find a path toward what is most important when time is limited.

For this, there is a script, says Dr. Ira Byock of Dartmouth, a leading expert on hospice and palliative care and the author of The Four Things That Matter Most: A Book About Living (Free Press). Byock’s script is a mere 11 words: “Please forgive me,” “I forgive you,” “Thank you” and “I love you.”(It may be a little shmaltzy, but then so is chicken soup.)

Jewish professionals have found ways of making their visits more comfortable and comforting. After years of working with the elderly, social worker Cheryl Tarash in Durham, North Carolina, still pauses and prepares herself before entering a nursing home. Recognizing that even high quality nursing homes are not necessarily cheerful places, Tarash has learned to focus “on the person, not the environment,” she said. Susan Rosenthal, coordinator of the Jewish Healing Network in New York and a cancer survivor, recalls that it took her years to discover that the reason a very close friend never visited during Rosenthal’s long and frightening cancer treatment was that the friend had lost a baby sister in childhood and could not cope with hospitals. Rosenthal reminds people that if they can’t come to the hospital, pick up the phone. Or visit when the patient gets home. With hospital stays now often lasting just a few days, people doing a lot of recuperating at home appreciate the company and may need practical assistance if family members must return to work.

How a visit proceeds, in a hospital or at home, depends in part on the prognosis. It is a lot easier to chat about the PTA, mutual friends, baseball, the kids, Desperate Housewives or what is going on at shul with someone who is going to recover fully.

With a seriously ill or dying person, it is more complicated. The person may still want to talk and engage with you about all the things you usually talk about, be it books, politics, real estate or the opera. Getting them to talk about intelligent things, even when their body is failing, can help them retain their humanity and dignity.

But seriously ill or dying people may also need to communicate other feelings. Give them openings to talk. Try to assess what they need from you.

If the prognosis is bad, talk about what they can reasonably hope for—freedom from pain, family reconciliation, expressions of love. Think about whether you would feel comfortable offering to help with an ethical will or a tape recording of family history, stories or memories.

“Acknowledge what’s going on here,” urges Friedman. “On a deep level, to truly meet another human being we have to acknowledge their reality.”

“Visiting isn’t all about lighting up the room,” says Rabbi Steve Sager of Congregation Beth El in Durham. “It’s okay to share the darkness.”

Sometimes sick people do not want to talk; socializing can be a burden and the sick person might feel obliged to put up with what Popovsky calls a “façade of strength.” Make your visit short, if you think that is what’s called for. But make clear to your friend or family member that you will be back soon.

Silence, too, can be healing. “Being present,” to use a term popular among those who work with the seriously ill, is a challenge to people accustomed to doing—and talking. Tarash recalled that when her aunt had cancer, “many people who cared about her found it hard to be with her.” Tarash discovered an ability to “sit with her, hold her hand, make a space to be with her, without necessarily saying anything.” The experience influenced Tarash to become a hospice volunteer, which, in turn, helped steer her career toward dealing with the aging and the infirm.

“It’s hard for people in general,” Tarash says, noting that you may have to go through a few awkward moments to become at ease with silence. “We feel compelled to try to fix, to help. The way we feel compelled is by doing something. But sitting, holding someone’s hand and not saying anything is actually doing a lot.”

Ann Kline, who became a hospice volunteer and then a lay chaplain in the Washington, D.C., area after her own parents’ death, had a similar learning curve.

“As Jews we don’t listen. We talk!” she says. “Think of our whole image of Jews around the table—all talking at the same time.

“But we have to become comfortable not doing. There really are a lot of times when there is nothing to do. Nothing that needs to be done. The person needs to be listened to. To be sat with, to be comforted—especially if someone is suffering there is nothing to do except to be with them, and that is the hardest thing [for] people to grasp.”

Even the Talmud describes how the great Rabbi Akiva swept a sickroom. But sometimes we don’t have to do. We just have to be. “Our tradition says the merciful one wants our hearts,” says Friedman. “We’re bringing ourselves. That’s what the person who is sick and suffering demands. Our hearts.”

Additional Resources
Jewish Ritual, Reality, and Response at the End of Life: A Guide to Caring for Jewish Patients and Families, by Rabbi Mark A. Popovsky, introduces Jewish beliefs and practices around illness, death and loss and provides practical suggestions for responding to the sometimes complicated situations where the clinical, religious and cultural are entwined (available at

My Grandfather’s Blessings: Stories of Strength, Refuge, and Belonging and Kitchen Table Wisdom 10th Anniversary (Riverhead), both by Rachel Naomi Remen.

Rabbi Isaac N. Trainin Bikur Cholim Coordinating Council (www. runs an annual conference in New York on visiting the sick. The councils’ Web site has tips for visitors, the halakhot, prayer guides and other resources.