Joy and Fear during the holidays

I recently published this piece in a couple of local newspapers.  I did already share this on Facebook but I thought pre-Yom Kippur, it would be good to reflect once again on this idea.

Joy and Fear during the holidays:

The Rosh Hashanah liturgy describes the Jewish New Year as a day consisting of two diametrically opposed images:  “Today is the birth of the world.  Today all creatures of the world stand in judgment – whether as children [of God] or as servants.  If as children, be merciful with us as the mercy of a father for children.  If as servants, our eyes [look toward and] depend upon You, until You be gracious to us and release our verdict as light, O Awesome and Holy One.”  How can a person simultaneously grasp these two images of a day of birth, a day filled with joy and expectations, and a Day of Judgment, a day filled with fear and trembling?   

As part of the preparation for the Jewish holidays of Rosh Hashanah, Yom Kippur and Sukkot, there is a tradition to recite Psalm 27 at the conclusion of the daily morning services  as well as either the daily afternoon or evening services.  The recitation of Psalm 27 commences at the start of the Jewish month of Elul, the month preceding the holidays, and continues through the end of Sukkot.  The words of Psalm 27 were King David’s prayer to G-d that he should merit dwelling in G-d’s midst, even when feeling abandoned and orphaned in the world.

In times of joy, it is fairly easy to find comfort and peace in life.  Most people feel a sense of elation and independence.  When in crisis, however, people often turn to those who have always provided strength and security for them in life.  For most, parents represent that security.  Yet, many of the crises faced occur when parents are no longer able to help.  I have heard many caregivers of a dying loved one express the wish that one or the other parent were still alive to be a rock during troubled times.  In the pre-holiday tradition of reciting Psalm 27, one of the verses recited reflects on the need for security during crisis.  King David said, “While my father and mother have forsaken me, G-d will gather me in (27:9).” 

The liturgy highlighted above focuses on the crisis moment of the holidays.  The image of standing in judgment is an acute reminder that every year, as time moves forward, we face the inevitable truth that for some, the past year was not meant to be completed.  As such, survivors are struck by a sense of loss during the liturgical points reminding them of the essence of Rosh Hashanah and Yom Kippur, namely the renewal for another year for some people while the conclusion for others.  And yet, hope remains, that when we feel forsaken, there is still something to protect us.     

Loss changes the fabric of one’s life.  It removes the sense of invincibility and security.  Yet, while reflecting on Judgment Day, one is also reminded that there will always be a security blanket.  The security blanket, G-d, can be cherished or can be discarded.  Either way, the blanket remains, accepting however one feels and reacts to happiness and sadness, joy and fear. 

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Spiritual Care in Israel

Ynet recently had a piece on the growing field of Jewish Spiritual Care in Israel.  Having been an outsider witnessing the growth of the field in Israel, it is wonderful that the topic is being presented in the papers.  As the article indicates, the Israeli needs in spiritual care during crisis are distinguished from American Jewish needs, and as such, there is a need to develop a unique system.  Much of that has to do with the Israeli “secular population, that is not enamored by a rabbinic establishment, yet is becoming more spiritual, as has been described by, among others, Yair Sheleg, in his work, The Jewish Renaissance in Israeli Society: The Emergence of a New Jew [Hebrew].

 

When Rabbi Mike Schultz met Sharona (alias), she was a young mother of two girls, suffering of terminal cancer, and angry – mostly at God that is not planning to let her see her girls grow up.

 

Schultz, a Jewish spiritual care provider in profession, helped her understand that she can use the illness to prepare her daughters for life, and leave this world without anger.

 

After the personal coaching courses and the empowerment trend – it is now the turn of Jewish spiritual care. A relatively new profession, imported from the United States, is becoming an acceptable professional field. It is a complementary profession to mental and health treatments, when the crisis is big.

 

“I was an occupational therapist, working with chronic and terminal patients,” said Dvora Corn. “I felt that despite everything I can give the patient, there is still something missing.”

 

Corn founded Tishkofet foundation, and she serves as Chair of the Network of Foundations for Spiritual Care in Israel.

 

“It is possible to heal some of the people, or help them live with the illness, but there is an entire part left untouched – and that is the patient’s spiritual world,” Corn notes.

 

“The spiritual world is the purpose a person sees in his life. The therapy world deals with finding solutions for the illness, but there is very little reference to what happens beyond that.

 

“When a person experiences a crisis, his world changes. Sometimes the illness prevents physical functions. Sometimes he is forced to leave work. His relationships and abilities in the family change, and then he has to reestablish what his purpose is at the current time.

 

“That is the place of the spiritual counselor. He does not talk about religion, but rather he finds out what is the person’s beliefs, and how can he lead him to a place that has meaning, to a purpose.”

 

Rabbi instead of priest

In the US, spiritual care is a well-established and old profession. Its origins are in the Christian world, in the work of priests that accompany terminal patients in their final days.

 

About a quarter of a century ago, American Jews decided to create a Jewish counterpart, and established a group of rabbis that specialized in spiritually uplifting patients, basing their work on Jewish holy and literary sources.

 

Some five years ago, UJA-Federation of New York, the largest of its kind in the world, decided to bring the spiritual care to Israel. They initiated a conference of ten foundations that deal with various types of mental assistance for patients, and together they began creating programs that would train Jewish spiritual care providers.

 

Since the group was established, some 25,000 Israelis received spiritual care in various fields such as: Addiction, old age, victims of terror, and illness. Thanks to the UJA-Federation, some 10,000 Israeli professionals have already been exposed to the new field, encouraging future collaborations between them and spiritual care providers.

 

“UJA-Federation believed there is room here to bring a knowledge field that does not exist in Israel,” notes Elisheva Flamm-Oren, planning executive for UJA-Federation of New York’s Caring Commission, who works at UJA-Federation’s Israel office.

 

“The Jewish spiritual care provider expands the boundaries of treatment. He does not deal with the patient’s hurting leg, but rather gives him an embrace that can help the patient heal. The provider is in a place of being, not only doing, bringing the ability of connecting to another human being.”

 

Flamm-Oren, who is involved in the spiritual care project, reveals, “Since Jews in Israel experience their Jewishness in a different manner, we needed to take the Jewish content world and adjust to Israel. In the US, for instance, chaplains are mostly people who come from the religious world.

 

“In Israel – because of the sensitivity regarding religious figures – it was important to create a Jewish language coming from a more accessible place, and therefore, most care providers come from the therapeutic field, though they are familiar with the Jewish world.”

 

“We decided unanimously that spiritual care in Israel cannot be solely based on rabbis,” adds Corn. “The Jewish community in Israel is complex, and we couldn’t have brought the American model to Israel. The belief and needs of a Jew from Brooklyn are different from those of the Israeli Jew. There are people here that have no connection to religion, but they too need to search for meaning.

 

“There are all sorts of religious sects, and we did not want to be under a certain Rabbinate, so we could convey the message to the broadest circle as possible. That is why we built a unique Israeli model that relies on our culture, nature, and historic origins.”

 

Search of meaning

Currently, there are three institutes in Jerusalem where Jewish spiritual care can be learned: Shechter Institute, Hebrew Union College, and Shaare Zedek Medical Center. Studies are based on standards and programs from the US, combining studies in a clinic and in the hospital, in order to provide the spiritual care with all the necessary tools.

 

In the first stage, the therapist gets to know his patient. In the second stage, he suggests tools to the patient that would suit him personally, and bring him to a place in which he finds meaning. These tools could be from the world of music and song, Jewish texts, nature, holidays or Jewish history.

 

“Many people in a crisis feel as though they have no other options, or ability to choose,” notes Corn. “They feel that their world is growing smaller. Our purpose is to find new things that will open them up. We use painting and sculpture to give them power of expression. Others find it more suitable to study a text through which they could raise questions about themselves and find answers.”

 

“We take Jewish motives that, for instance, Jews in New York are less familiar with – but here in Israel, any child in kindergarten knows,” explains Flamm-Oren. “From that we connect to the illness. Before Rosh Hashana, the care provider finds out with the patient, where can he replenish? How can he recharge himself for the New Year? What will be sweet for him this year?

 

“On Hanukkah, the care provider checks with the patient on what are his sources of light? How can he banish darkness? How can the patient use his weak power to overcome the big things happening to him? On Passover, we examine what is freedom and what is enslavement. On Tu B’Shvat, we plant hope.”

 

“On just an ordinary day, we can take motifs from the Weekly Torah Section and check how we can leverage the biblical story into our life. There could also be joint study of Modern Hebrew poetry, guided imagery, or connection to nature.

 

“The spiritual care provider brings with him an entire content world that a social worker or other therapist does not. He touches a basic place of the spiritual world, and when a person is going through a crisis, he has the ability to reach such places, because even when the body is ill, we sometimes discover the spirit is strong.”

 

Seeing the scenery outside

Rabbi Schultz, a Jewish spiritual care provider, tells us, “The first thing is listening to them with an open heart, accepting everything they say. Only after you make a connection with the patient, you start to try to understand what is happening inside, what is going on in their spiritual world. In training, you learn how to reach the major points, and it is done through a lot of listening.”

 

“The attentiveness of the spiritual care provider demands that he does not escape the difficult things he hears. People don’t always immediately express the difficulty, they rather imply it. Some 70% of my help, I believe, is that the person in front of you accepts your difficulty.

 

“If someone feels fear, then your job is to enter that place of fear and uncertainty so he is not alone with his fears and then help him connect with his strengths.”

 

The spiritual care provider meets with patients in unpleasant places, and their purpose – as tour guides in the paths of life is to show them the scenery on the way.

 

“I received a telephone call from a social worker that one of her patients was diagnosed as a cancer patient, and refused to receive treatment,” says Rabbi Schultz. “The team had a hard time accepting her decision because she had good chances of recovery. This is a woman that has already been sick in the past, and underwent very difficult treatments, and she told me she does not want to go through them again.

 

“She said she feels like a prisoner that cannot get herself out of the prison, asking me to get her out. Of course I wanted her to do the treatments, but you cannot force her. When we talked about her ability to choose, she felt that her entire body is releasing, and decided to do the treatments. Today, she is in a good state.”

 

Light shining through great darkness

Corn tells us about a 47-year-old woman, suffering of terminal cancer, who wanted to know how she could end her life without destroying her family.

 

“Except for cancerous cells, her body was packed with guilt that instead of being a mother to her children and take care of them, they are taking care of her. She felt that she is a burden on her family, the spiritual care process was to return her to maternal function.

 

“During the process we showed her that she has power because of what she went through. We cannot say she passed away happy, because she wanted to live. However, at the end of her life, she taught her children that you couldn’t do everything alone.

 

“To her eldest daughter, who got engaged during her illness, she wrote: ‘I will not be at your wedding, but when you enter the relationship you will understand that from now on you depend on someone else as well, and it is a good dependency. You will get everything from this dependency. Do not see it as a negative thing.’

 

“She could write that from the illness of all places. The spiritual care provider taught her and her entire family that dependency can be seen as a system of give and take, and at the end of her life, she taught her children what should be important in life.”

Jewish spiritual care: Creating sound spirit

Sometimes, when things seem hopeless, room should be made for spirituality. What began in US with priests becomes Jewish spiritual care in Israel

Tzofia Hirschfeld

Published: 09.27.11, 14:14 / Israel Jewish Scene
When Rabbi Mike Schultz met Sharona (alias), she was a young mother of two girls, suffering of terminal cancer, and angry – mostly at God that is not planning to let her see her girls grow up. Schultz, a Jewish spiritual care provider in profession, helped her understand that she can use the illness to prepare her daughters for life, and leave this world without anger.

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After the personal coaching courses and the empowerment trend – it is now the turn of Jewish spiritual care. A relatively new profession, imported from the United States, is becoming an acceptable professional field. It is a complementary profession to mental and health treatments, when the crisis is big. “I was an occupational therapist, working with chronic and terminal patients,” said Dvora Corn. “I felt that despite everything I can give the patient, there is still something missing.” Corn founded Tishkofet foundation, and she serves as Chair of the Network of Foundations for Spiritual Care in Israel. “It is possible to heal some of the people, or help them live with the illness, but there is an entire part left untouched – and that is the patient’s spiritual world,” Corn notes. “The spiritual world is the purpose a person sees in his life. The therapy world deals with finding solutions for the illness, but there is very little reference to what happens beyond that. “When a person experiences a crisis, his world changes. Sometimes the illness prevents physical functions. Sometimes he is forced to leave work. His relationships and abilities in the family change, and then he has to reestablish what his purpose is at the current time. “That is the place of the spiritual counselor. He does not talk about religion, but rather he finds out what is the person’s beliefs, and how can he lead him to a place that has meaning, to a purpose.”

Rabbi instead of priest

In the US, spiritual care is a well-established and old profession. Its origins are in the Christian world, in the work of priests that accompany terminal patients in their final days.

About a quarter of a century ago, American Jews decided to create a Jewish counterpart, and established a group of rabbis that specialized in spiritually uplifting patients, basing their work on Jewish holy and literary sources. Some five years ago, UJA-Federation of New York, the largest of its kind in the world, decided to bring the spiritual care to Israel. They initiated a conference of ten foundations that deal with various types of mental assistance for patients, and together they began creating programs that would train Jewish spiritual care providers. Since the group was established, some 25,000 Israelis received spiritual care in various fields such as: Addiction, old age, victims of terror, and illness. Thanks to the UJA-Federation, some 10,000 Israeli professionals have already been exposed to the new field, encouraging future collaborations between them and spiritual care providers. “UJA-Federation believed there is room here to bring a knowledge field that does not exist in Israel,” notes Elisheva Flamm-Oren, planning executive for UJA-Federation of New York’s Caring Commission, who works at UJA-Federation’s Israel office. “The Jewish spiritual care provider expands the boundaries of treatment. He does not deal with the patient’s hurting leg, but rather gives him an embrace that can help the patient heal. The provider is in a place of being, not only doing, bringing the ability of connecting to another human being.” Flamm-Oren, who is involved in the spiritual care project, reveals, “Since Jews in Israel experience their Jewishness in a different manner, we needed to take the Jewish content world and adjust to Israel. In the US, for instance, chaplains are mostly people who come from the religious world. “In Israel – because of the sensitivity regarding religious figures – it was important to create a Jewish language coming from a more accessible place, and therefore, most care providers come from the therapeutic field, though they are familiar with the Jewish world.” “We decided unanimously that spiritual care in Israel cannot be solely based on rabbis,” adds Corn. “The Jewish community in Israel is complex, and we couldn’t have brought the American model to Israel. The belief and needs of a Jew from Brooklyn are different from those of the Israeli Jew. There are people here that have no connection to religion, but they too need to search for meaning. “There are all sorts of religious sects, and we did not want to be under a certain Rabbinate, so we could convey the message to the broadest circle as possible. That is why we built a unique Israeli model that relies on our culture, nature, and historic origins.”

Search of meaning

Currently, there are three institutes in Jerusalem where Jewish spiritual care can be learned: Shechter Institute, Hebrew Union College, and Shaare Zedek Medical Center. Studies are based on standards and programs from the US, combining studies in a clinic and in the hospital, in order to provide the spiritual care with all the necessary tools.

In the first stage, the therapist gets to know his patient. In the second stage, he suggests tools to the patient that would suit him personally, and bring him to a place in which he finds meaning. These tools could be from the world of music and song, Jewish texts, nature, holidays or Jewish history. “Many people in a crisis feel as though they have no other options, or ability to choose,” notes Corn. “They feel that their world is growing smaller. Our purpose is to find new things that will open them up. We use painting and sculpture to give them power of expression. Others find it more suitable to study a text through which they could raise questions about themselves and find answers.” “We take Jewish motives that, for instance, Jews in New York are less familiar with – but here in Israel, any child in kindergarten knows,” explains Flamm-Oren. “From that we connect to the illness. Before Rosh Hashana, the care provider finds out with the patient, where can he replenish? How can he recharge himself for the New Year? What will be sweet for him this year? “On Hanukkah, the care provider checks with the patient on what are his sources of light? How can he banish darkness? How can the patient use his weak power to overcome the big things happening to him? On Passover, we examine what is freedom and what is enslavement. On Tu B’Shvat, we plant hope.” “On just an ordinary day, we can take motifs from the Weekly Torah Section and check how we can leverage the biblical story into our life. There could also be joint study of Modern Hebrew poetry, guided imagery, or connection to nature. “The spiritual care provider brings with him an entire content world that a social worker or other therapist does not. He touches a basic place of the spiritual world, and when a person is going through a crisis, he has the ability to reach such places, because even when the body is ill, we sometimes discover the spirit is strong.”

Seeing the scenery outside

Rabbi Schultz, a Jewish spiritual care provider, tells us, “The first thing is listening to them with an open heart, accepting everything they say. Only after you make a connection with the patient, you start to try to understand what is happening inside, what is going on in their spiritual world. In training, you learn how to reach the major points, and it is done through a lot of listening.”

“The attentiveness of the spiritual care provider demands that he does not escape the difficult things he hears. People don’t always immediately express the difficulty, they rather imply it. Some 70% of my help, I believe, is that the person in front of you accepts your difficulty. “If someone feels fear, then your job is to enter that place of fear and uncertainty so he is not alone with his fears and then help him connect with his strengths.” The spiritual care provider meets with patients in unpleasant places, and their purpose – as tour guides in the paths of life is to show them the scenery on the way. “I received a telephone call from a social worker that one of her patients was diagnosed as a cancer patient, and refused to receive treatment,” says Rabbi Schultz. “The team had a hard time accepting her decision because she had good chances of recovery. This is a woman that has already been sick in the past, and underwent very difficult treatments, and she told me she does not want to go through them again. “She said she feels like a prisoner that cannot get herself out of the prison, asking me to get her out. Of course I wanted her to do the treatments, but you cannot force her. When we talked about her ability to choose, she felt that her entire body is releasing, and decided to do the treatments. Today, she is in a good state.”

Light shining through great darkness

Corn tells us about a 47-year-old woman, suffering of terminal cancer, who wanted to know how she could end her life without destroying her family.

“Except for cancerous cells, her body was packed with guilt that instead of being a mother to her children and take care of them, they are taking care of her. She felt that she is a burden on her family, the spiritual care process was to return her to maternal function. “During the process we showed her that she has power because of what she went through. We cannot say she passed away happy, because she wanted to live. However, at the end of her life, she taught her children that you couldn’t do everything alone.

“To her eldest daughter, who got engaged during her illness, she wrote: ‘I will not be at your wedding, but when you enter the relationship you will understand that from now on you depend on someone else as well, and it is a good dependency. You will get everything from this dependency. Do not see it as a negative thing.’ “She could write that from the illness of all places. The spiritual care provider taught her and her entire family that dependency can be seen as a system of give and take, and at the end of her life, she taught her children what should be important in life.”

Dignity Therapy: For The Dying, A Chance To Rewrite Life : NPR

Dignity Therapy: For The Dying, A Chance To Rewrite Life : NPR.

One of the important pieces of working with the dying is to give them or their families an opportunity to rethink and relay their lives to others.  We are afraid that we will not have a legacy, and as such, some of our fear of death could potentially be alleviated through reflection and story telling.  There is a formal methodology for this, which is called dignity therapy.  Unfortunately, for many, reflection comes too late because of other concerns getting in the way, such as the fear of telling the person the truth because if someone knows he is dying, the person will get very depressed.  Instead, dignity therapy is a means of working through the depression to find a place of meaning that will outlast one’s life. 

For several decades, psychiatrists who work with the dying have been trying to come up with new psychotherapies that can help people cope with the reality of their death. One of these therapies asks the dying to tell the story of their life.

This end-of-life treatment, called dignity therapy, was created by a man named Harvey Chochinov. When Chochinov was a young psychiatrist working with the dying, he had a powerful experience with one of the patients he was trying to counsel — a man with an inoperable brain tumor.

“One of the last times that I went into his room to meet with him, on his bedside table was a photograph of him when he had indeed been young and healthy and a bodybuilder, and it was this incredible juxtaposition of these two images,” says Chochinov.

So in the bed there’s his patient — this skeleton of a man — very pale and weak. On the bedside table, there’s this portrait of a glistening, muscled giant. And Chochinov says that sitting there, it was very clear to him that by placing this photograph in such a prominent position, the man was sending a message: This was how he needed to be seen.

As Chochinov continued his work with the dying, he confronted this again and again — this need people have to assert themselves in the face of death. And he started to wonder about it…

“When you face death, it’s like facing a wall, and it forces you to turn around and look at the life that you’ve lived,” says William Breitbart, a psychiatrist at Sloan-Kettering Cancer Center in New York. He’s been trying to develop new psychotherapies for the dying. He says that many people have the wrong idea about the dying process.

“The prevailing mythology is that you die the way you live, and you can’t change yourself in any way,” says Breitbart. “The fact is that the last few months of life — because of the awareness of death — create an urgency that facilitates growth and change.”

This, he says, is why something like dignity therapy can be good. Though there’s no evidence that it relieves depression or anxiety, he thinks it can help us change in the very last moment of our lives. After all, he says, we’ve all lived imperfect lives.

“All of us fail, and the process, the task of dying, is to relieve ourselves of this guilt, whether it’s forgiving yourself or asking others to forgive you,” says Breitbart. “Or to remember your life slightly differently. But that’s the task of dying.”

As for Frego, she says she’s developed a strange relationship to the document her mother put together. Since her mother’s death, Frego says she’s actually carried the document around with her. She has the story of her mother’s life, always at her side, knocking around in the bottom of her bag.

My Worst Enemy’s Shiva

I found this today and felt it was quite important to share as a whole.  People have enough trouble paying a shiva visit in general.  How much more so when we think we need to visit someone we are in conflict with.  I am somewhat concerned by the Q and A here.  While I agree with the author’s response and strategies for visiting and how to visit, I would have started with a simpler question;  why do you feel the need to visit in the first place?  Is it out a sense of reconciliation, or a sense that the fighting was a mistake to begin with?  Or do you merely feel the need to fulfill the commandment of comforting the bereaved?  Nevertheless, consider the answer Hammerman offers for it does provide us a real sense of the appropriate timing and means of visiting while limiting the potential for fighting. 

Q. The mother of my worst enemy just died and I’m not sure whether to visit during Shiva. In truth, I sincerely see this as a chance to reconcile (we haven’t spoken in about five years but have a lot of friends in common). My only concern is that he would misinterpret the reason for the visit and kick me out of the house. I really don’t want to cause him any discomfort. What should I do?

A. Do you think this would be the first time that two people at a shiva had unresolved issues?  It happens all the time, usually involving people from the deceased’s family who are barely on speaking terms. I’ve seen amazing moments of reconciliation happen during the period of grieving. When someone says “over my dead body,” sometimes that’s precisely the most likely location for enemies to reunite, as happened to  Isaac and Ishmael when they buried Abraham.

So go.

But I add this disclaimer: If you poisoned his Akita or stole his birthright, I might hold off until the time is right. Jacob’s journey back to Esau was paved with gifts and trepidation. It took decades before each party was ready. In any event, if you do go to the Shiva, I’d avoid visiting during peak periods, when the mourner might feel you are simply making an appearance for show. If the guy shows signs of being uncomfortable with your presence, or worse, begins to make a scene, I’d make a hasty exit and not take it personally.  The rabbis explained that the second Temple was destroyed because of the resentment of a person humiliated in public by his worst enemy. Don’t let that happen to you. It’s also OK to wait until after shiva, when you might call and meet for coffee in a quite spot. Or maybe the best strategy would be to write a heartfelt letter.

I believe that all conflicts have an expiration date. Even the Hatfields and McCoys signed a truce just a few years ago. If you could reconcile with your worst enemy and become a true pursuer of peace, echoing the words of Psalm 34:15, you will make the world a better place. And an enormous weight will be taken off your shoulders.

Are we fooling ourselves?

I came across another of Rev. Jacob’s posts on Huffington Post revolving around end-of-life issues.  She focuses on an article written a month ago which I already wrote about here.  She uses the story to elicit from her readers the question of how we would want our own death to look like, assuming we don’t suddenly drop dead.  She poses the following questions for us to contemplate:

What would you do were you in Dudley Clendinen’s situation? I am not asking you to judge what he has decided is right for him. I am asking you to consider what you would want were you to find yourself in Dudley’s situation. Would you want to die the way he describes his mother, cousin and his aunts did, “… all of whom would have died of natural causes years earlier if not for medical technology, well-meaning systems and loving, caring hands”? Or would you prefer what Dudley has decided? Or something else?

Also, thinking about the prospect of only having several months to live (although death could occur for any of us at any time — whether it be while walking down the street, eating a meal or sleeping), I wonder how many of us could do what Dudley is doing while he is dying — living one day at a time? For those of us who have not done a 12-step program, are we able to live today and focus only on this day? Can we appreciate what we have before us right now? “Consider the birds in the fields” (Matt 6:26) “Behold the lilies of the field” (Matt 6:28) — Can we just “be still, and know” (Ps 46:10) — Can we see the “goodness of the Lord in the land of the living?” (Ps 27:13)

What do you think that God expects of us as we live this life — and await our time to die? And, then, as Ecclesiastes reminds us, there is a time for everything … “A time to be born and a time to die …” (Eccl 3:1-2) We know that we will one day die. And, what do you think that God expects of us as we are dying?

From the standpoint of the questions she poses, I am left with one thought.  There are times we, the healthy, look on the ill or the elderly and say, “I don’t want to end up this way.  I would rather no aggressive interventions to prolong my life.”  Yet, I would venture that for many of us, as we age, we will think somewhat differently when faced with the closeness of our own mortality.  This is not to suggest a lack of belief in G-d or an afterlife, a subject unto themselves.  It is rather to say that a part of what makes us who we are will never want to disappear.  Our self is afraid of not existing.  That is why contemplating death is a difficult spiritual practice.  I think many are too quick to say I would rather not live if… On the flip side, for those who are suffering, realize that my critique is not about any of the trauma and challenge of chronic or life limiting illnesses.  I am merely saying that it is easy for the young and healthy to prefer death over a partial life when it is a hypothetical decision as opposed to something that is current in his/her life. 

 

More Medical Schools Are Screening Applicants Closely for People Skills

Bedside manner is a very important element in patien care.  So much so that medical students are being given a basic training in how to have better people skills.  The NY Times had an article, “More Medical Schools Are Screening Applicants Closely for People Skills” which describes new means of teaching and testing how these future doctors will act in practice.  When i was first learning about chaplaincy work, one of the most valuable lessons I learned was something quite simple.  If a person enters a room and completely faces the patient, that patient will perceive the person having been in the room longer than they really were.  As such, body language and posture will often be the first step of refining people skills. 

The article goes further, as it indicates a need to teach the students how to be effecient and quick thinking while also being “in the room” with the person, even for a short interval.  Additionally, part of the article’s description of the increased need to find people friendly doctors is to also teach the need to work in a team.  Healthcare is no longer provided as a medical model in its own right as most people are looking for holistic care, requiring multiple disciplines to be available.  This is something hospice does well but other areas of medicine are not up to speed with yet. 

Doctors save lives, but they can sometimes be insufferable know-it-alls who bully nurses and do not listen to patients. Medical schools have traditionally done little to screen out such flawed applicants or to train them to behave better, but that is changing…

At Virginia Tech Carilion, 26 candidates showed up on a Saturday in March and stood with their backs to the doors of 26 small rooms. When a bell sounded, the applicants spun around and read a sheet of paper taped to the door that described an ethical conundrum. Two minutes later, the bell sounded again and the applicants charged into the small rooms and found an interviewer waiting. A chorus of cheerful greetings rang out, and the doors shut. The candidates had eight minutes to discuss that room’s situation. Then they moved to the next room, the next surprise conundrum and the next interviewer, who scored each applicant with a number and sometimes a brief note.

The school asked that the actual questions be kept secret, but some sample questions include whether giving patients unproven alternative remedies is ethical, whether pediatricians should support parents who want to circumcise their baby boys and whether insurance co-pays for medical visits are appropriate.

Virginia Tech Carilion administrators said they created questions that assessed how well candidates think on their feet and how willing they are to work in teams. The most important part of the interviews are often not candidates’ initial responses — there are no right or wrong answers — but how well they respond when someone disagrees with them, something that happens when working in teams.

Candidates who jump to improper conclusions, fail to listen or are overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.

“We are trying to weed out the students who look great on paper but haven’t developed the people or communication skills we think are important,” said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carilion…

A pleasant bedside manner and an attentive ear have always been desirable traits in doctors, of course, but two trends have led school administrators to make the hunt for these qualities a priority. The first is a growing catalog of studies that pin the blame for an appalling share of preventable deaths on poor communication among doctors, patients and nurses that often results because some doctors, while technically competent, are socially inept.

The second and related trend is that medicine is evolving from an individual to a team sport. Solo medical practices are disappearing. In their place, large health systems — encouraged by new government policies — are creating teams to provide care coordinated across disciplines. The strength of such teams often has more to do with communication than the technical competence of any one member.

“When I entered medical school, it was all about being an individual expert,” said Dr. Darrell G. Kirch, the president and chief executive of the Association of American Medical Colleges. “Now it’s all about applying that expertise to team-based patient care.”

The Good Short Life With A.L.S.

The Good Short Life With A.L.S. – NYTimes.com.

This piece is the kind of first hand account of dying that causes me to pause and reflect on the conflict we all face between wanting to keep living and yet not wanting to become a burden to others.  The author seems to say that he would rather allow nature to takes its course than to begin the various artificial means of prolonging life. 

As a Jewish chaplain who has tremendous problems with the idea of euthanasia/assisted suicide, I am challenged with a story like this.  If he were Jewish, would he be forced to have a tracheotomy because of the idea that every second matters?  Or would we accept that he does have a choice if that choice is coming from a desire to avoid further suffering?  I certainly empathize with the author, but am left with one additional question:  In the discussion of assisted suicide, one of the pieces often overlooked is post-death grief.  While the author is not saying he will avail himself of such a way out, it is still important to wonder about how the survivors will process the death when no means are taken to extend his life.  To me, I tend to believe that assisted suicide often leaves families scarred in ways that we tend to ignore in the face of the ill person’s suffering.  If we are intertwined, then both elements should be taken into account when decisions are made. 

I HAVE wonderful friends. In this last year, one took me to Istanbul. One gave me a box of hand-crafted chocolates. Fifteen of them held two rousing, pre-posthumous wakes for me. Several wrote large checks. Two sent me a boxed set of all the Bach sacred cantatas. And one, from Texas, put a hand on my thinning shoulder, and appeared to study the ground where we were standing. He had flown in to see me.

“We need to go buy you a pistol, don’t we?” he asked quietly. He meant to shoot myself with.

“Yes, Sweet Thing,” I said, with a smile. “We do.”

I loved him for that.

I love them all. I am acutely lucky in my family and friends, and in my daughter, my work and my life. But I have amyotrophic lateral sclerosis, or A.L.S., more kindly known as Lou Gehrig’s disease, for the great Yankee hitter and first baseman who was told he had it in 1939, accepted the verdict with such famous grace, and died less than two years later. He was almost 38.

I sometimes call it Lou, in his honor, and because the familiar feels less threatening. But it is not a kind disease. The nerves and muscles pulse and twitch, and progressively, they die. From the outside, it looks like the ripple of piano keys in the muscles under my skin. From the inside, it feels like anxious butterflies, trying to get out. It starts in the hands and feet and works its way up and in, or it begins in the muscles of the mouth and throat and chest and abdomen, and works its way down and out. The second way is called bulbar, and that’s the way it is with me. We don’t live as long, because it affects our ability to breathe early on, and it just gets worse.

At the moment, for 66, I look pretty good. I’ve lost 20 pounds. My face is thinner. I even get some “Hey, there, Big Boy,” looks, which I like. I think of it as my cosmetic phase. But it’s hard to smile, and chew. I’m short of breath. I choke a lot. I sound like a wheezy, lisping drunk. For a recovering alcoholic, it’s really annoying.

There is no meaningful treatment. No cure. There is one medication, Rilutek, which might make a few months’ difference. It retails for about $14,000 a year. That doesn’t seem worthwhile to me. If I let this run the whole course, with all the human, medical, technological and loving support I will start to need just months from now, it will leave me, in 5 or 8 or 12 or more years, a conscious but motionless, mute, withered, incontinent mummy of my former self. Maintained by feeding and waste tubes, breathing and suctioning machines.

No, thank you. I hate being a drag. I don’t think I’ll stick around for the back half of Lou.

I think it’s important to say that. We obsess in this country about how to eat and dress and drink, about finding a job and a mate. About having sex and children. About how to live. But we don’t talk about how to die. We act as if facing death weren’t one of life’s greatest, most absorbing thrills and challenges. Believe me, it is. This is not dull. But we have to be able to see doctors and machines, medical and insurance systems, family and friends and religions as informative — not governing — in order to be free.

And that’s the point. This is not about one particular disease or even about Death. It’s about Life, when you know there’s not much left. That is the weird blessing of Lou. There is no escape, and nothing much to do. It’s liberating.

I began to slur and mumble in May 2010. When the neurologist gave me the diagnosis that November, he shook my hand with a cracked smile and released me to the chill, empty gray parking lot below.

It was twilight. He had confirmed what I had suspected through six months of tests by other specialists looking for other explanations. But suspicion and certainty are two different things. Standing there, it suddenly hit me that I was going to die. “I’m not prepared for this,” I thought. “I don’t know whether to stand here, get in the car, sit in it, or drive. To where? Why?” The pall lasted about five minutes, and then I remembered that I did have a plan. I had a dinner scheduled in Washington that night with an old friend, a scholar and author who was feeling depressed. We’d been talking about him a lot. Fair enough. Tonight, I’d up the ante. We’d talk about Lou.

The next morning, I realized I did have a way of life. For 22 years, I have been going to therapists and 12-step meetings. They helped me deal with being alcoholic and gay. They taught me how to be sober and sane. They taught me that I could be myself, but that life wasn’t just about me. They taught me how to be a father. And perhaps most important, they taught me that I can do anything, one day at a time.

Including this.

I am, in fact, prepared. This is not as hard for me as it is for others. Not nearly as hard as it is for Whitney, my 30-year-old daughter, and for my family and friends. I know. I have experience.

I was close to my old cousin, Florence, who was terminally ill. She wanted to die, not wait. I was legally responsible for two aunts, Bessie and Carolyn, and for Mother, all of whom would have died of natural causes years earlier if not for medical technology, well-meaning systems and loving, caring hands.

I spent hundreds of days at Mother’s side, holding her hand, trying to tell her funny stories. She was being bathed and diapered and dressed and fed, and for the last several years, she looked at me, her only son, as she might have at a passing cloud.

I don’t want that experience for Whitney — nor for anyone who loves me. Lingering would be a colossal waste of love and money.

If I choose to have the tracheotomy that I will need in the next several months to avoid choking and perhaps dying of aspiration pneumonia, the respirator and the staff and support system necessary to maintain me will easily cost half a million dollars a year. Whose half a million, I don’t know.

I’d rather die. I respect the wishes of people who want to live as long as they can. But I would like the same respect for those of us who decide — rationally — not to. I’ve done my homework. I have a plan. If I get pneumonia, I’ll let it snuff me out. If not, there are those other ways. I just have to act while my hands still work: the gun, narcotics, sharp blades, a plastic bag, a fast car, over-the-counter drugs, oleander tea (the polite Southern way), carbon monoxide, even helium. That would give me a really funny voice at the end.

I have found the way. Not a gun. A way that’s quiet and calm.

Knowing that comforts me. I don’t worry about fatty foods anymore. I don’t worry about having enough money to grow old. I’m not going to grow old.

I’m having a wonderful time.

I have a bright, beautiful, talented daughter who lives close by, the gift of my life. I don’t know if she approves. But she understands. Leaving her is the one thing I hate. But all I can do is to give her a daddy who was vital to the end, and knew when to leave. What else is there? I spend a lot of time writing letters and notes, and taping conversations about this time, which I think of as the Good Short Life (and Loving Exit), for WYPR-FM, the main NPR station in Baltimore. I want to take the sting out of it, to make it easier to talk about death. I am terribly behind in my notes, but people are incredibly patient and nice. And inviting. I have invitations galore.

Last month, an old friend brought me a recording of the greatest concert he’d ever heard, Leonard Cohen, live, in London, three years ago. It’s powerful, haunting music, by a poet, composer and singer whose life has been as tough and sinewy and loving as an old tree.

The song that transfixed me, words and music, was “Dance Me to the End of Love.” That’s the way I feel about this time. I’m dancing, spinning around, happy in the last rhythms of the life I love. When the music stops — when I can’t tie my bow tie, tell a funny story, walk my dog, talk with Whitney, kiss someone special, or tap out lines like this — I’ll know that Life is over.

It’s time to be gone.

Dudley Clendinen is a former national correspondent and editorial writer for The Times, and author of “A Place Called Canterbury.”