Tikkun Olam

I had a "first" last week. I went to a Jewish funeral. I had academic knowledge of Jewish funereal customs, but there's always a disconnect between knowing about something and actually doing it. Just ask anyone who is about 6 months out of seminary on their first call. "Gee, they never talked about this in seminary!" is a common refrain.

I had a patient who was in hospice care for just shy of two months who was Jewish. Now he and his wife (who was Christian) admitted that he wasn't a "very observant Jew." He participated in yahrzeit (the annual commemoration of the the death of a loved one), but that was about it. His sister and her husband were very observant - all of them belonged to Beth Shalom, the oldest synagogue in Frederick, Maryland.

I hadn't yet met the new rabbi at Beth Shalom but my patient assured me that the rabbi had visited him from time to time at the nursing home. This patient was open enough to allow me to be his chaplain and assist his prayers in ways which honored his Jewish heritage. During our time together, I supported both he and his wife with quiet presence and assurance.

Last Monday, I heard this patient had taken a turn over the weekend - he wasn't eating or drinking anymore and his weight was only 85 pounds (down from about 140). I called Beth Shalom to leave a message for the rabbi. Rabbi Murray Singerman called me back and we ended up meeting that afternoon with the patient's wife to discuss Jewish burial customs. It was a wonderful learning opportunity. Murray shared with us that the highest form of altruism in Judaism is to prepare a body for burial and bury the body. The community does this as an unselfish act - the dead cannot express their gratitude. I helped Murray make contact with the funeral home and made sure that our staff and the nursing home would not accidentally violate spiritual boundaries by bathing the body (which they would normally have done).

Murray prayed with our patient - in Hebrew and English. He recited Psalm 121 and said the Shema. He told us as we were leaving that the next day was Tisha B'av - a day of fasting and mourning. I wasn't familiar with this observance ... but I would learn about it quickly.

Our patient died in the middle of Tisha B'av ... right at the stroke of midnight! Tisha B'av is the day in the Jewish liturgical calendar which commemorates the destruction of the Jerusalem temple in 586 BCE by the Babylonians and in 70 CE by the Romans. Murray called it "the darkest night of the Jewish year." How ironic that the Almighty would call his "not-very-observant" son home in the middle of this dark night!

The funeral was scheduled for Thursday morning and I went to represent our hospice staff. Murray gave a wonderful homily which integrated the desolation of grief with the desecration of the temple. He also said that the Sabbaths which follow Tisha B'av are the Sabbaths of Consolation which will lead up to Rosh Hashannah. The Sabbaths of Consolation feature readings from the halftorah (the prophets) who speak the words of comfort promising the restoration of the Jewish people. This is also our consolation and promise in a journey of grief.

I went to the cemetery along with the family and Murray explained the Jewish traditions which we would observe. We would be burying the body - which comes as quite a shock to most Christians who have (unfortunately) had their burial rituals sanitized of this tradition. We processed to the grave and watched as the casket was lowered into the ground ... and just the ground ... no vault liners (Jews having been doing "green burials" long before it was fashionable). Murray explained that the first three shovels of dirt are put into the grave by the family using the back of the shovel. This symbolizes our reluctance in performing this act. Our patient's wife placed the first shovel of earth onto the casket and his immediate family followed. The rest of the mourners present, including me, also shoveled earth into the grave.

Once everyone had shoveled earth into the grave, we all sat down and Murray, with his sleeves rolled up in 90+ degree weather, kept on shoveling. He explained that we needed to cover the coffin. I realized that Murray, the deceased's nephew, and I were the only ones young enough and physically fit enough to shovel all that dirt. So I got up and grabbed a shovel and began filling in the grave. What a sight ... a priest and a rabbi shoveling away on a hot summer day to bury a good man!

The Jewish people speak of their ethical responsibility to repair the world. This is summed up in the words tikkun olam. I came away from this burial in awe that our Lord had provided this moment of grace where I could participate in a very holy moment. I believe taking care of the dying and dead and their loved ones is part of repairing the world.

Best Pauline paraphrase ... evah!

I was very blessed to have a patient in the past month who made quite an impression in his one week in hospice care. This fellow had pancreatic cancer and there was no more the oncologist (who happens to be our hospice medical director) could do.

When "J" got the news from the doctor, his response was the best paraphrase of Paul that I've ever heard:

"Well, I got friends and family here - and I love them a lot. And I got friends and family in heaven - and I love them and miss them a lot. So I figure either way, I win!"

Romans 14:8:

"If we live, we live to the Lord, and if we die, we die to the Lord; so then, whether we live or whether we die, we are the Lord's."

Either way ... we win!

 

Start talking ... now!

"Give it to me straight: do I have much time left?"

This was the question posed to me by a new patient just recently. She had cancer and it was spreading ... quickly.

"No, your time is growing very short."

Last week, she was walking throughout the nursing home. This week, she is bed bound.

"Will I be healed?"

We live in a "fix it" society that believes medical technology can fix anything. We deny that we will grow old, get sick and die. We forget that healing isn't just about the body.

"Yes, you will be healed, but not in the way you might have expected. Your cancer will not go away and will likely take your life. But your spirit will be healed and God's perfect healing for all of us is on the other side of the grave."

Sometimes it is spiritually and emotionally healing to let go of a futile fight. There is peace when we can stop raging against a progressing illness and just be there.

"Will I make it to North Carolina?"

Her daughter lived there and this patient wanted to visit her there. Her daughter was here now to take care of her mother.

"No, I don't believe you are strong enough to get to North Carolina."

"Can I go home to my house? I don't want to be here."

Most of my patients want to go home. Sometimes they mean the house they lived in for many years ... sometimes they mean their heavenly home. In this case she meant the former as it was more peaceful than the nursing home where she was.

"Well, I can't promise you that, but I'll see what we can do. In the meantime, we're committed to keeping you comfortable in body, mind and spirit."

"Does my daughter know how bad it is?"

Too often, families have a sense the end is near but fear talking about it with each other. The dying family member doesn't want to upset anyone and the other family members don't want to upset the dying person either. It's often an unintended conspiracy of silence which doesn't help anyone.

"Well, she's in the hallway with your nurse and it is our practice to be compassionately honest with people about what is happening. With your permission, I'll tell her what I've told you." My patient nodded.

 

The patient's daughter was clear about her mother's poor prognosis and I told her it was ok to talk about it with her mom. This patient did get home to her house for her final days and her daughter was able to be with her to the end. She lasted just 11 days in hospice care.

 

If there's anything I'd like to shout from a mountaintop it is to start talking about your end of life plans with your loved ones ... now! If you have trouble getting started, check out the Five Wishes web site at http://www.agingwithdignity.org/five-wishes.php. The site has the Five Wishes form which includes both the advanced directive for medical care and a medical power of attorney form. In addition, there are sections about what kind of comfort care you want at the end of life and what you want your family to know. The form is legal in 42 states and can be used in the other eight states in combination with state issued forms. There are videos and helpful books to assist you in having these conversations with your loved ones.